Old Lessons Hold True

Recent letters and articles about suicide and depression in Psychiatric News contain enough mystification to make me wonder about the kind of instruction that is available for psychiatry residents these days.

In more than 30 years as a teacher, at the Washington School of Psychiatry, Johns Hopkins, and Walter Reed Residency programs, I reminded my students that self-destructive behavior gives evidence of a split in that self. The split consists of criticizing versus criticized parts.

In a successful suicide, the harsh criticizing part decides that the criticized one is so worthless that it deserves to be killed and carries out the action.

In depression, punishment is the action.

In terminal illness, untreated pain may be so severe that it abets the criticizing part so that a Dr. Kevorkian substitute may be sought out to provide the action.