Conference Agenda

Dorit Braun brings the voice of lived experience to this symposium. Her beloved daughter-in-law, Mariana Pinto, died by suicide during a psychotic episode on 16 October 2016, aged 32. Dorit will recount the sequence of events leading to Mariana’s death, including the intense night preceding it—described by the Coroner as a “particularly florid episode”—which involved police, ambulance, and a Mental Health Act assessment. She will then speak about the immediate aftermath and her long process of mourning, reflection, and meaning-making in the years that followed.

Dorit is CEO of Making Families Count, a UK non-profit organisation that provides training, consultancy, and advocacy to improve how public services respond to families after serious harm or death. The organisation promotes compassionate, transparent, and learning-oriented approaches within health and social care systems. Drawing on her personal and professional experience, Dorit will reflect on how families, communities, and services can better hold those affected by suicide—transforming silence and blame into empathy, dialogue, and change.

This oral presentation explores the phenomenon of splitting in suicide, the psychic and neurobiological division between parts of the self that can no longer coexist. Drawing on psychoanalytic and neuroscientific perspectives, it argues that suicidal states emerge when the mind’s internal split, between a punitive, moralistic superego and a wounded, despairing ego, reaches a point of collapse.

At the neurobiological level, imaging studies demonstrate alternating dominance between prefrontal–cingulate “control” networks (associated with self-criticism, guilt and hopelessness) and limbic–insular “affective” circuits (linked with shame, panic and unbearable emotional pain). When trauma or loss destabilises their integration, the person experiences the self as divided: one part attacking, the other under siege.

Through two clinical case studies, the presentation illustrates how this split can manifest in suicidal crises. In one, a high-functioning professional maintains a punishing internal regime that turns lethal when external containment fails. In another, a traumatised young adult oscillates between omnipotent self-control and annihilating despair, culminating in an act of self-destruction experienced as a kind of internal murder.

Integrating classical psychoanalytic theory (Freud, Klein, Fairbairn, Winnicott, Kernberg) with contemporary neuroimaging findings, the talk proposes that suicide represents the collapse of dialogue between divided self-states. Where self-harm may communicate a wish to live, suicide reflects the failure of communication altogether.

The paper concludes that therapeutic work must aim to restore internal communication and compassion between warring self-parts — transforming persecutory dynamics into reflective ones. Understanding suicide through the lens of splitting reveals it not as a single impulse to die, but as the catastrophic breakdown of the mind’s fragile internal relationship with itself.

Individuals admitted to emergency medical facilities following suicide attempts rarely possess the ability to verbally articulate their psychological distress or the difficulties they have previously endured. Acquiring the language necessary to explain their suicidal actions requires a profound epistemological shift.
Although uncommon, some individuals who have attempted serious suicide are eventually able, through their narratives, to convey their psychological reality and communicate it to the therapist.
A preceding step toward such transformation can sometimes occur when therapists or support staff engage with the individual in a manner that respects their entire existence, including their physical being.

Bion (1962, Learning from Experience; 1963, Elements of Psychoanalysis) described, in meta-psychological terms, how unconscious experiences and bodily sensations can become consciously recognised and symbolically communicated. Within Bion’s Grid—which schematises the stages of human thought processes—suicide, self-harm, and addictive behaviours are located within the category of Action. When understood as the individual’s Action, these behaviours can be interpreted as evacuations of disturbing mental or somatic content.

If the therapist can regard such acts as part of a psychological process—treating them as psychological events rather than merely physical acts—the individual may gradually become capable of integrating the experience. However, this process may take several years.

This paper presents a psychoanalytic approach to the treatment of individuals who have attempted suicide, focusing on childhood traumatic experiences, the pathology of personality disorder, and disturbances of mourning. The author seeks to discuss how a psychoanalytic understanding of suicidal behaviour can inform and deepen clinical treatment.

In most writings on suicide, across disciplines, we can find the claim that suicide is a uniquely human act. This is often glanced over, taken as a truism. The current mainstream suicide prevention paradigms, however, appear to leave little room for the human, who is instead reduced to a statistic, a bundle of risk factors, and a diagnosis. The focus on prediction in such frameworks renders clinical work a mechanistic and reductionist process, failing both clinician and patient. Suicide becomes something solely to be managed rather than understood.

The presentation is a plea for a deeper theoretical engagement with suicide, an act that, in its essence, resists comprehension. Psychoanalysis, with its embracing of uncertainty, is in a privileged position to speak to the inherent complexity of suicidal acts. By prioritising the singularity of the individual and her suffering, it has much to contribute to our attempts to make sense of and work with suicide, leaving plentiful space for the human. The presentation is centred on this question: what is it about the human condition that makes suicide possible? I turn to the work of Lacan to investigate.

Lacan describes psychoanalysis as the ‘science of language inhabited by the Subject’ (1955-56). What do we mean by Subject? Why use this term instead of ‘self’? Psychoanalysis recognises that a person is not a whole, united entity; rather, as Lacan suggests, split. Using Lacan’s mirror stage paper, I examine the Subject’s entry into the symbolic order, somewhere the human finds shelter, constructing a sense of self. Far from a seamless process, Lacan continues, we are ‘captured and tortured by language’ (1955-56). I argue that suicide should be understood through a clash between body and language as the suicidal Subject, both agent and victim of her act, seeks an exit from an uninhabitable home.

Dr O'Reilly is Chair of the Psychotherapy Faculty at the Royal College of Psychiatry. Drawing on over twenty years’ experience as a psychoanalyst within an NHS Mental Health Trust, Dr O'Reilly has led the development of a Risk Panel within her organisation.

This presentation explores the profound emotional impact of working with suicidal states of mind and the organisational defences that arise in response. A clinician’s capacity to contain anxiety and fully engage with distress is dependent on the containment offered by the organisation within which they work.

Overwhelming anxiety and fear of blame can paralyse thought, impair reflective functioning when working with patient in a suicidal state of mind. The paper introduces an innovative, Risk Panel, developed to provide a structured reflective space within NHS services. This model functions as a containing intervention for staff, strengthening clinical understanding and enhancing the organisation’s capacity to think about risk rather than react to it.

When clinicians are supported in this way, care becomes grounded in compassion and understanding rather than fear and defensiveness. Drawing on the work of Bion, Winnicott, and Klein, the presentation highlights how psychoanalytic thinking can transform organisational culture—allowing anxiety to be held, meaning to be made, and suicidal states of mind to be met with thought rather than retreat.