Working in the Dark: Understanding the pre-suicide state of mind

135 Pages·2017·16.234 MB·English

by  Donald Campbell, Rob Hale

‘It’s subject notwithstanding – what a brilliant, much-needed and
ultimately hopeful-helpful book this is! The experience, if not the facts,
of suicide remain taboo. The authors, based on nearly a century of
combined clinical experience, expound its psychic meaning,
developmental origins and therapeutic implications in ways relevant and
accessible to all mental health practitioners. Robustly yet flexibly
psychoanalytic, they demonstrate the paradox of suicide as ‘an attempt
to live at the cost of life itself’, outline the ‘10 danger signals’ of suicide
for professionals, and illuminate the underlying phantasies inherent in
the suicidal act. Heeded, this book will be a life-saver!’
Professor Jeremy Holmes, MD, FRCPsych, University of Exeter, UK
‘The authors’ unrivalled knowledge and experience garnered over many
years is distilled to present a rich and compelling approach to suicide
and therapeutic practice with suicidal people. The exploration of the
influential concept of the pre-suicide state makes sense of suicidal
motivations, explains the strong and often seemingly strange counter-
transference responses encountered in this work and why working with
suicidal people can draw negative reactions from professionals.
Challenging conventional wisdom, Working in the Dark demonstrates
that understanding unconscious suicide fantasies underpinning suicidal
behaviour is essential to prevent the dangers of repeated suicide
attempts.’
Professor Stephen Briggs, University of East London, UK
‘Given the exceptional combination of clinical experience in dealing
with suicide and self-harm, and the theoretical sophistication that Don
Campbell and Rob Hale bring to the understanding of deeply disturbed
people, I was prepared for a very significant contribution and I was not
disappointed. The reason that you really do need to read this book from
beginning to end is because of the help it brings to all of us who in our
daily professional lives need to survive the trauma of working with
people in the extremes of crises of mind and relationships. This is not
just a book for the young, inexperienced staff who are usually, and often
inappropriately, left to deal with the emotional complexities of those
who have tried to harm themselves. No matter how long you have been
in the field you will time and again find help, insight and support in this
very valuable book.’
John, Lord Alderdice, FRCPsych, University of Maryland,
Baltimore, USA

Working in the Dark
Working in the Dark focuses on the authors’ understanding of an
individual’s pre-suicide state of mind, based on their work with many
suicidal individuals, with special attention to those who attempted
suicide while in treatment. The book explores how to listen to a suicidal
individual’s history, the nature of their primary relationships and their
conscious and unconscious communications.
Campbell and Hale address the searing emotional impact on relatives,
friends and those involved with a person who tries to kill themself, by
offering advice on the management of a suicide attempt and how to
follow up in the aftermath. Establishing key concepts such as suicide
fantasy and pre-suicidal states in adolescents, the book illustrates the
pre-suicide state of mind through clinical vignettes, case studies,
reflections from those in recovery and discussions with professionals.
Working in the Dark will be of interest to social workers, probation
officers, nurses, psychologists, counsellors, psychotherapists, psycho-
analysts and doctors who work with those who have attempted suicide
or are about to do so.
Donald Campbell is a qualified child, adolescent and adult psychoanalyst
and a Training Analyst and Supervisor at the British Psychoanalytical
Society. He has worked for thirty years as Principal Child and Adult
Psychotherapist at the Portman Clinic. Campbell has lectured, taught
widely and published papers and chapters on the subjects of suicide,
violence, child sexual abuse, adolescence, shame and horror films.
Rob Hale trained originally in psychiatry and psychoanalysis and held a
research post at St Mary’s Hospital in London where, for five years, he
worked closely with people who had attempted suicide. Hale has treated
suicidal patients in long-term psychotherapy, and for thirty-five years
worked at the Portman Clinic with those who act out in a violent or
sexually deviant way.

Working in the Dark
Understanding the pre-suicide
state of mind
Donald Campbell and Rob Hale
First published 2017
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2017 Donald Campbell and Rob Hale
The right of Donald Campbell and Rob Hale to be identified as authors
of this work has been asserted by them in accordance with sections 77
and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical, or
other means, now known or hereafter invented, including photocopying
and recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging in Publication Data
Names: Campbell, Donald, author. | Hale, Rob (Robert), author.
Title: Working in the dark : understanding the pre-suicide state of mind /
Donald Campbell and Rob Hale.
Description: London ; New York : Routledge, 2017.
Identifiers: LCCN 2016012311| ISBN 9780415645423 (hardback) | ISBN
9780415645430 (pbk.) | ISBN 9781315731490 (ebook)
Subjects: LCSH: Suicidal behavior. | Suicide.
Classification: LCC RC569 .C36 2017 | DDC 616.85/8445--dc23
LC record available at https://lccn.loc.gov/2016012311
ISBN: 978-0-415-64542-3 (hbk)
ISBN: 978-0-415-64543-0 (pbk)
ISBN: 978-1-315-73149-0 (ebk)
Typeset in Times
by Saxon Graphics Ltd, Derby
To Lizzie Campbell and Lizzie Hale

Contents
Acknowledgements xiii
Introduction 1
1 Attitudes about suicide over the ages 7
2 Suicide and mental illness 11
Personality constellations in suicidal behaviour 14
3 Psychoanalytic understanding of suicide 18
Historically 18
Contemporary perspectives 21
Acting out 24
Suicide fantasies 26
4 The Core Complex 30
Ruthless and sadistic violence 31
The suicidal process 33
The pre-suicide state 35
5 Suicide fantasies and the pre-suicide state of
mind 43
6 How learning from the patient generates theory 51
Countertransference during a pre-suicide state 54