Toward a Psychoanalytic Approach to Suicidality

In recent years, suicide has risen at an alarming rate. In 2022, it was the second leading cause of death in the United States for people aged 20-34, and among the top nine causes for people aged 10-64. Provisional data from the Centers for Disease Control and Prevention show that the number of suicide deaths in 2023 was the highest ever recorded. These deeply distressing statistics highlight an urgent need for continued examination into how best to support patients with suicidal ideation and behavior. This article explores the use of psychoanalytic theory, particularly that of D. W. Winnicott, in treating such patients, with a strong focus on countertransference as a guiding principle for risk assessment, intervention, and treatment. Winnicott's concept of True/False Self is drawn upon as a foundation from which to understand symptom formation. The implementation and efficacy of safety measures is discussed from a psychoanalytic perspective.