Tel Aviv University School of Medicine, Tel Aviv, Israel
For a long period, the wish to die and the wish to commit suicide seemed to stem from one root. Many psychoanalytic theories connected the relationship between suicide, death and depression as parts of the same complex. This association has become so obvious that the first question asked by the clinician when an attempted suicide victim arrives is “Why did you want to die?” Doubt is cast on this clear-cut association by studies that show that many suicide victims had not suffered from any severe psychopathology before the suicidal event. The problem concerns not only suicidal adolescents, but adolescents in general, as suicidal ideation is common in many adolescents.
We shall try to demonstrate the difference between the two wishes – to die and to commit suicide – as they express themselves during adolescence. First, death is seen as irreversible, while the suicidal act, at least during adolescence, is seen as reversible. While thoughts of suicide may be a part of normal adolescence, and the suicidal act a manifestation of the part of pathological development specific to this stage in life, the wish to die has no age restrictions and may accompany life as a shadow, devoid of any suicidal act, for many years. It should be noted that both these wishes may be normal, related to the developmental stage and the balance with the wish to live , i.e., the libido. The pathology appears when there is an imbalance of wishes and abnormal developmental processes. This imbalance can result in suicidal acts and “death behaviors,” – the latter being distinctly different from the former. We suggest that suicidal acts stem from different mechanisms and personality pathologies than the acts and behaviors connected to the death wish. Therefore, they should be evaluated and understood separately in order to better understand suicidal, as well as other, aggressive acts and the manifestations of death wishes connected to the adolescent period.