I want to die! The suicidal patient.

“How do I overcome my patient’s urge to die?”

We don’t overcome her urge to die. We accept it. We make room for it. We explore it.

As therapists, we can make the mistake of trying to “fix” the patient. We try to drug away her suicidal thoughts. We argue with her, try to convince her not to kill herself, offer all the reasons she should live. Then the conflict is between you and her: you want her to live and she wants to die. Meanwhile, no one listens to her.

The urge to die is double-sided. On the one hand, wanting to die is almost always how we turn rage toward others upon ourselves. In fact, the suicidal urge can be an opportunity to help the patient feel her rage where it really belongs.

At the same time, the urge to die affirms her life: “I don’t want to live this way. I don’t want to pretend I feel something I don’t feel. I don’t want to keep putting up this façade. This life of the false self is not worth living.”

We can agree. A life of lying to oneself, of being a false self, is not worth living.

Underneath her wish to kill the false self that traps her, is the urge to come out of prison. Underneath her wish to die is a wish to be reborn. Suicidal thoughts keep saying to her, “This is not enough! You shouldn’t have to live this way.” Her despair is not wrong. She should despair. Living with a façade is hopeless. Lying to herself is hopeless. She does not need to give up hope on herself, but she does need to give up hope on hopeless strategies: defenses.

She is right. Something does need to die. Not her. But her way of dying, the defenses that are killing her.