Table Of ContentLadislav Valach
Annette Reissfelder
Casebook
Suicide and
Suicide
Prevention
Twelve Suicide Attempts Analyzed
by Action Theory
Casebook Suicide and Suicide Prevention
Ladislav Valach • Annette Reissfelder
Casebook Suicide and
Suicide Prevention
Twelve Suicide Attempts Analyzed by
Action Theory
With Contrib. by Kornelia Helfmann and Jaromira Kirstein
Ladislav Valach Annette Reissfelder
Bremgarten b. Bern, Bern, Switzerland Hamburg, Germany
With Contrib. by
Kornelia Helfmann
Bern, Switzerland
Jaromira Kirstein
Kreuzlingen, Switzerland
ISBN 978-3-662-66304-2 ISBN 978-3-662-66305-9 (eBook)
https://doi.org/10.1007/978-3-662-66305-9
© The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer-Verlag GmbH, DE, part
of Springer Nature 2022
This book is a translation of the original German edition „Fallbuch Suizid und Suizidprävention“ by Valach,
Ladislav, published by Springer-Verlag GmbH, DE in 2021. The translation was done with the help of artificial
intelligence (machine translation by the service DeepL.com). A subsequent human revision was done primarily
in terms of content, so that the book will read stylistically differently from a conventional translation. Springer
Nature works continuously to further the development of tools for the production of books and on the related
technologies to support the authors.
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the
whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now
known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does
not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective
laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are
believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give
a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that
may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and
institutional affiliations.
This Springer imprint is published by the registered company Springer-Verlag GmbH, DE, part of Springer Nature.
The registered company address is: Heidelberger Platz 3, 14197 Berlin, Germany
Abstract
The aim of this book is to give the reader an insight into the suicide process from several
perspectives through the narratives of the suicidal people. A writer and systems therapist
and two psychologists with journalistic, counseling, and therapeutic experience freely tell
the story of suicidal people through these people’s conversations with a medical profes-
sional. A psychotherapist who is also a researcher provides an understanding of these
conversations and the suicide attempt as a process of action. What do the patients tell, what
did they experience in their suicide attempts, and what happens in the conversations with
doctors and psychiatrists? How can we understand these suicide attempts and develop an
effective suicide prevention procedure from this understanding?
V
Acknowledgment
Thanks to Dr. Cassandra Valachova for language review and correction.
Vii
Contents
Part I Suicide: Conceptual Considerations � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1
1 Suicide and Suicide Attempt � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3
1.1 What Is Suicide or Suicide Attempt? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.2 Suicide as an Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3 Suicide Is an Action in a Project and a Long Term Career . . . . . . . . . . . . 6
1.4 Suicide Is Socially Embedded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.5 Suicide Can Be Consciously Prepared or Spontaneous . . . . . . . . . . . . . . 7
1.6 Suicide Is a “Damaged”, Defective Action . . . . . . . . . . . . . . . . . . . . . . . . 8
1.7 What Is the Purpose of Seeing Suicide as an Action? . . . . . . . . . . . . . . . 8
1.8 Talking to a Patient After a Suicide Attempt . . . . . . . . . . . . . . . . . . . . . . 9
1.9 The Inner Experience in an Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.10 Suicide Prevention as a Joint Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Part II S uicide Cases � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13
2 Introduction to the Suicide Cases � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15
3 Case 1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 17
3.1 Suicide Story: Ms. Huber, Who Wants to Please Everyone . . . . . . . . . . . 17
3.2 Suicide Analysis: Britta Huber “I Can’t Take It Anymore…” . . . . . . . . . 20
3.2.1 Long-Term and Medium-Term Concerns and Short-Term
Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.2.1.1 Long-Term Concerns and Medium-Term
(‘Projects’) Concerns . . . . . . . . . . . . . . . . . . . . . . . . 20
3.2.1.2 Short-Term Actions in Medium-Term Concerns . . . 21
3.2.2 Problems of Action Organization . . . . . . . . . . . . . . . . . . . . . . . . 24
3.2.3 Consciously Prepared or Spontaneously Undertaken? . . . . . . . . 25
3.2.4 Problems of the Action Monitoring Processes . . . . . . . . . . . . . . 26
3.2.5 Problems of Action Energization . . . . . . . . . . . . . . . . . . . . . . . . 27
3.2.6 Suicide and Interactive and Joint Action . . . . . . . . . . . . . . . . . . . 28
ix
x Contents
3.2.7 The Young Woman’s Conversation with a Psychiatrist . . . . . . . . 29
3.2.8 The Self-Confrontation Interview . . . . . . . . . . . . . . . . . . . . . . . . 30
4 Case 2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 33
4.1 Suicide Story: Mrs. Meier in a Vicious Circle . . . . . . . . . . . . . . . . . . . . . 33
4.2 Suicide Analysis: Mrs. Meier “I Can’t Imagine Life Without Him…” . . 36
4.2.1 Long-Term and Medium-Term Concerns and Short-Term
Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.2.1.1 Medium-Term (‘Projects’) and Long-Term
Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.2.1.2 Actions in the Suicide Project . . . . . . . . . . . . . . . . . 39
4.2.2 Problems of Action Organization . . . . . . . . . . . . . . . . . . . . . . . . 45
4.2.3 Consciously Prepared or Spontaneously Undertaken? . . . . . . . . 46
4.2.4 Problems of the Action Monitoring Processes . . . . . . . . . . . . . . 47
4.2.5 Problems of Action Energization . . . . . . . . . . . . . . . . . . . . . . . . 48
4.2.6 Suicide and Interactive and Joint Action . . . . . . . . . . . . . . . . . . . 48
4.2.7 Mrs. Meier’s Conversation with a Psychiatrist . . . . . . . . . . . . . . 49
4.2.8 The Self-Confrontation Interview . . . . . . . . . . . . . . . . . . . . . . . . 51
5 Case 3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 55
5.1 Suicide Story: Ms. Widmer, Who Nobody Listens to . . . . . . . . . . . . . . . 55
5.2 Suicide Analysis: Ms. Widmer: I Simply Asked Myself About the
Meaning of My Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
5.2.1 Long-Term and Medium-Term Concerns and Short-Term
Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
5.2.1.1 Medium-Term (‘Projects’) and Long-Term
Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
5.2.1.2 Long-Term Concerns . . . . . . . . . . . . . . . . . . . . . . . . 59
5.2.1.3 Short-Term Actions in the Conflict Project . . . . . . . 60
5.2.2 Problems of Action Organization . . . . . . . . . . . . . . . . . . . . . . . . 68
5.2.3 Consciously Prepared or Spontaneously Undertaken? . . . . . . . . 69
5.2.4 Problems of the Action Monitoring Processes . . . . . . . . . . . . . . 70
5.2.5 Problems of Action Energization . . . . . . . . . . . . . . . . . . . . . . . . 71
5.2.6 Suicide and Interactive and Joint Action . . . . . . . . . . . . . . . . . . . 71
5.2.7 Ms. Widmer’s Conversation with a Psychiatrist . . . . . . . . . . . . . 72
5.2.8 The Self-Confrontation Interview . . . . . . . . . . . . . . . . . . . . . . . . 73
6 Case 4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 77
6.1 Suicide Story: Anna, Who Is Disgusted with Herself . . . . . . . . . . . . . . . 77
6.2 Suicide Analysis: It Was Mainly Disgust with Myself . . . . . . . . . . . . . . . 80
6.2.1 Long-Term and Medium-Term Concerns and Short-Term
Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Contents xi
6.2.1.1 Medium-Term (‘Projects’) and Long-Term
Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
6.2.1.2 Short-Term Actions in the Suicide Project . . . . . . . . 81
6.2.2 Problems of Action Organization . . . . . . . . . . . . . . . . . . . . . . . . 87
6.2.3 Consciously Prepared or Spontaneously Undertaken? . . . . . . . . 88
6.2.4 Problems of the Action Monitoring Processes . . . . . . . . . . . . . . 88
6.2.5 Problems of Action Energization . . . . . . . . . . . . . . . . . . . . . . . . 89
6.2.6 Suicide and Interactive and Joint Action . . . . . . . . . . . . . . . . . . . 90
6.2.7 The Young Woman’s Conversation with a Psychiatrist . . . . . . . . 90
6.2.8 The Self-Confrontation Interview . . . . . . . . . . . . . . . . . . . . . . . . 91
7 Case 5 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 95
7.1 Suicide Story: Margrit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
7.2 Suicide Analysis: I Can’t Imagine Living Without Him . . . . . . . . . . . . . 97
7.2.1 Long-Term and Medium-Term Concerns and Short-Term
Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
7.2.1.1 Medium-Term and Long-Term Concerns of the
Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
7.2.1.2 Short-Term Actions in Medium-Term Projects:
Work; Life Together . . . . . . . . . . . . . . . . . . . . . . . . . 100
7.2.2 Problems of Action Organization . . . . . . . . . . . . . . . . . . . . . . . . 106
7.2.3 Consciously Prepared or Spontaneously Undertaken? . . . . . . . . 107
7.2.4 Problems of the Action Monitoring Processes . . . . . . . . . . . . . . 107
7.2.5 Problems of Action Energization . . . . . . . . . . . . . . . . . . . . . . . . 108
7.2.6 Suicide and Interactive and Joint Action . . . . . . . . . . . . . . . . . . . 108
7.2.7 The Woman’s Interview with a Psychologist . . . . . . . . . . . . . . . 109
7.2.8 The Self-Confrontation Interview . . . . . . . . . . . . . . . . . . . . . . . . 110
8 Case 6 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 113
8.1 Suicide Story: A Young Man . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
8.2 Suicide Analysis: That’s When Everything Fell Apart for Me… . . . . . . . 115
8.2.1 Long-Term and Medium-Term Concerns and Short-Term
Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
8.2.1.1 Medium-Term and Long-Term Concerns of the
Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
8.2.1.2 Short-Term Actions in Projects. . . . . . . . . . . . . . . . . 117
8.2.2 Problems of Action Organization . . . . . . . . . . . . . . . . . . . . . . . . 133
8.2.3 Consciously Prepared or Spontaneously Undertaken? . . . . . . . . 136
8.2.4 Problems of the Action Monitoring Processes . . . . . . . . . . . . . . 137
8.2.5 Problems of Action Energization . . . . . . . . . . . . . . . . . . . . . . . . 138
8.2.6 Suicide and Interactive and Joint Action . . . . . . . . . . . . . . . . . . . 139
8.2.7 The Young Man’s Conversation with the Psychiatrist . . . . . . . . . 140
8.2.8 Self-Confrontation Interview . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
xii Contents
9 Case 7 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 145
9.1 Suicide Story: Nicole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
9.2 Suicide Analysis: I Just Didn’t See A Reason Behind It All Anymore . . 148
9.2.1 Long-Term and Medium-Term Concerns and Short-Term
Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
9.2.1.1 Medium-Term (‘Projects’) and Long-Term
Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
9.2.1.2 Actions of Suicide in Suicide and Other Projects . . 152
9.2.2 Problems of Action Organization . . . . . . . . . . . . . . . . . . . . . . . . 165
9.2.3 Suicidal Action: Consciously Prepared or Spontaneous? . . . . . . 167
9.2.4 Problems of the Action Monitoring Processes . . . . . . . . . . . . . . 168
9.2.5 Problems of Action Energization . . . . . . . . . . . . . . . . . . . . . . . . 169
9.2.6 Suicide and the Interactive and Joint Action . . . . . . . . . . . . . . . . 170
9.2.7 The Woman’s Conversation with A Psychiatrist . . . . . . . . . . . . . 171
9.2.8 Self-Confrontation Interview . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
10 Case 8 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 177
10.1 Suicide Story: René – I Am Not Needed in This World Anymore . . . . . . 177
10.2 Suicide Analysis: It Does Not Need Me in This World Anymore . . . . . . . 179
10.2.1 Long-Term and Medium-Term Concerns and Short-Term
Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
10.2.1.1 Medium-Term (“Projects”) and Long-Term
Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
10.2.1.2 Long-Term Concerns . . . . . . . . . . . . . . . . . . . . . . . . 180
10.2.1.3 Medium-Term Concerns – “Projects” . . . . . . . . . . . 181
10.2.2 Short-Term Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
10.2.3 Problems of Action Organization . . . . . . . . . . . . . . . . . . . . . . . . 189
10.2.4 Consciously Prepared or Spontaneously Undertaken? . . . . . . . . 191
10.2.5 Problems of the Action Monitoring Processes . . . . . . . . . . . . . . 191
10.2.6 Problems of Action Energization . . . . . . . . . . . . . . . . . . . . . . . . 193
10.2.7 Suicide and Interactive and Joint Action . . . . . . . . . . . . . . . . . . . 194
10.2.8 The Young Man’s Conversation with a Psychiatrist . . . . . . . . . . 196
10.2.9 The Self-Confrontation Interview . . . . . . . . . . . . . . . . . . . . . . . . 197
11 Case 9 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 199
11.1 Suicide Story: Marie, Who Actually Did This on Purpose . . . . . . . . . . . . 199
11.1.1 The Mother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
11.1.2 Regula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
11.1.3 Vreni . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
11.1.4 Ilonka . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
11.1.5 Petra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
11.1.6 The Father . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
11.1.7 The Boss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
11.1.8 The Boyfriend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
