ABSTRACT
This chapter presents what I consider to be some of the basic dynamics of suicide. Much of it is taken from a paper written with Donald Campbell in 1991 (Campbell and Hale 1991), but it also borrows from authors in Essential Papers on Suicide by Maltsberger and Goldblatt (1996). It is, then, a mixture of my own and other people's ideas. The work on which it is based took place over twenty-®ve years ago when I was working at St Mary's Hospital. For ®ve years I saw only people who had attempted suicide. I had an of®ce on the Acute Medical Admissions ward and saw well over 500 people who had been admitted following a suicide attempt. Some of these people went on to psychotherapy with me or a colleague, and a very small number entered psychoanalysis. Some twenty-two years later, two colleagues (Jenkins et al. 2002) followed up a cohort of 240 consecutive admissions following a suicide attempt. Not surprisingly, given previous studies, a much higher proportion of them ended up killing themselves than would be expected by chance, but surprisingly the rate of death by suicide did not fall signi®cantly over the years. The conclusion, then, is that suicide remains a lifelong option which can be employed at times of crisis.
