Beyond the Symptoms: What is Suicidability?

Part I: Deadness, Desire, and the Vocabulary of Inner Life

We often talk about suicide as a crisis, an emergency, or a risk. It appears in clinical notes as an event to be prevented, managed, or explained, often through terms like “impulsivity,” “hopelessness,” or “a cry for help.” But these descriptions often silence the psychic truth that underlies suicidality. To think about suicide is to listen not just to what a person says about wanting to die, but to what part of them express the wish and wants to die, but to be reborn? And why. What psychic life becomes unbearable? What desires are exiled or unspeakable?

Life and Death Instinct, the in-between space is where we live

Adam Phillips, in Making the Case, suggests that symptoms are not errors to be corrected but communications to be heard. They are private solutions to internal problems, “makeshift theories” of the self. Suicidality, too, can be seen as a kind of symptom, not a threat alone, but a form of language, rich with imaginative content, symbolic memory, and disavowed longing. This reframes suicide not as a mere act, but as a psychic state: suicidability. A terrain that exists long before the final act, and sometimes never culminates in it.

In a recent workshop with practitioners and students, I invited participants to reflect on what makes us feel alive. The responses were subtle and intimate: feeling seen, creating something new, sharing silence with someone, reading something that stirs the inner world, close relationships, or simply having a reason to move. These are not trivial things.

One student shared, “I feel alive when I’m with my close ones and not on my phone”, a longing for presence and connection. Another said it’s during travel, while someone else found that aliveness in writing, reading, or learning creating something new. One participant mentioned she feels alive when her life has a sense of purpose.

Each of these reflections reveals a different but overlapping thread — a movement toward closeness, growth, creativity, or meaning. These are forms of aliveness that Winnicott might call the “spontaneous gesture”, natural, unforced expressions of the true self. They are not loud or dramatic, but they quietly affirm the self’s continuity, vitality, and capacity to be in relationship with the world.

So what then makes us feel dead inside? What are the quiet, chronic ways in which psychic deadness enters? It’s not always a dramatic event. It can be a slow erosion of connection when no one sees you, when there is no one to be real with, loss of a close one, or when presence or absence feels inconsequential. When we live in a split between the self we show and the self we are (True and False self, Winnicott). Or when a loss is not only personal but symbolic: the loss of future, of recognition, of the sense that our inner world matters to anyone.

Analytically speaking, we all carry deadness within us. The death instinct, as Freud proposed, is not external to the psyche but an intimate part of it. We are made of conflicting forces, those that seek aliveness and connection, and those that retreat, destruct, or withdraw. Winnicott, in his paper The Value of Depression, argues that depression, when not overwhelming, can be a sign of psychic life, it signals that there’s still a relationship with loss, a reaching for meaning. It is when that relationship collapses, when there is no longer a self to feel with, that suicidality emerges. Not as a choice, but as a condition.

Part II: The Symbolic Life of Suicidality

When someone speaks about wanting to die, it is tempting, clinically and socially, to respond with urgency or reassurance. But if we listen, we find that what is being expressed is often not about death at all. It is about a failure of imagination: not being able to imagine a future, not being able to imagine being received by another, or not being able to imagine one’s internal states as tolerable or survivable (Psychic despair).

One person I knew would often talk about dying by throwing herself in front of a train. Over the years, she would sit at railway stations as a spot after her runaways from family, watch trains pass by, sometimes talk about it, sometimes not. It was viewed as a runaway spot only, until, many years later, the symbol began to speak. Her father used to travel via train for his job, she saw him leave. What she longed to destroy was not life itself, but the object that had signified her being left behind. The train became a carrier of her recurrent ungrieved loss, her unmet rage, and her need to be witnessed exactly where she was not. She didn’t express the wish to die, but expressed her curiosity to explore what it would mean to die under a train because it had already killed a part of her, perhaps? 

In this sense, suicidality is rarely about a singular drive toward death. It is often the psyche’s way of marking something that could not be symbolised otherwise. Adam Phillips reminds us that symptoms are ways of living with what we cannot live without. They preserve something vital, however painful. Suicidality can hold multiple, conflicting meanings: a protest, a withdrawal, a call for recognition, or a way of containing unbearable states. And like all symptoms, it has its own logic. It must be interpreted, not eliminated.

But interpretation alone is not enough. It is not only what suicidality means that matters, but how it is held. This is where therapy becomes essential, not as a place to correct, but as a space where a person's internal vocabulary can emerge, without being rushed or judged. Suicidal thoughts often carry shame, and shame silences. To speak to them is to risk being misunderstood, pathologised, or dismissed. But not speaking to them is to deepen the psychic isolation that makes them grow.

Therapy at its best makes the intrapsychic interpersonal. It allows for the patient’s psychic world to be seen, joined, and spoken in. Winnicott believed that the therapist’s task is to survive the patient, not to fix, but to stay. To be a presence that doesn’t collapse in the face of intensity. When we think of suicidality from this lens, the question is not “how do we stop it?” but “what part of the person is being lost, and how might it be found again?”

It’s not only the suicidal person who must re-find themselves. The therapist, too, must be willing to enter a space of uncertainty, where nothing is fully known, where answers do not arrive quickly, and where meaning might not yet exist. To sit with another in that raw, unmapped terrain is not easy. But often, what helps someone survive is not a clever interpretation or a clear path forward. It is the presence of another person who doesn’t flinch in the dark.

Thomas Ogden speaks of this space as “the analytic third”—a shared field that is created in the analytic encounter, where both therapist and patient are affected, and both are discovering something new. In The Primitive Edge of Experience, he writes about the necessity of “surrendering to the process” and staying with the patient’s experience without rushing to understand or explain it. As Ogden puts it:

“The analyst must risk being disorganized by the patient’s experience in order to help the patient bear it.” (Ogden, 1989, p. 145)

This risk is essential. It means the therapist, too, is vulnerable, not omniscient, not separate, but present and affected. Therapy, then, becomes a space where meaning is not handed down, but slowly co-created.

For the suicidal person, this kind of companionship can be life-sustaining. Not because it fixes the problem, but because it says: you don’t have to be alone here. The terror, the numbness, the unbearable feeling that no one sees or feels you, these are not interpreted away. They are shared. And in that shared space, something changes. Maybe not quickly, maybe not in words, but the deadness begins to be held.

Part III: When the Balance Breaks: Suicidality and the Place of Therapy

We all live with an inner balance between what makes us feel alive and what reminds us of deadness. There are days when one leans more heavily than the other, but health, if it can be called that, lies not in the absence of deadness, but in our capacity to hold both. Aliveness isn’t an uninterrupted stream of joy or productivity, it is often quiet, hesitant, found in moments of connection, in a sentence that lands, in a memory made tolerable through another’s listening.

But when deadness begins to dominate, when there is no one to speak to, when one’s gestures find no response, when the inner world becomes sealed off from the external, something begins to break. This is when suicidality enters not only as a fantasy, but as a lived possibility. Not necessarily because someone wants to die, but because they can no longer imagine a self that can survive being alive.

Winnicott’s thinking offers an important view here. He writes that “it is a joy to be hidden, but a disaster not to be found.” Suicidality often emerges when someone has been hidden for too long, when their inner world has not been found, mirrored, or made sense of. When the part of the self that feels hopeless, humiliated, or worthless has had no relational home. The self splits. A false self takes over, the one that functions, that performs, that appears “fine.” But the deadness behind it grows. The split becomes unbearable. This is when suicidality becomes more than a thought, it becomes a structure of feeling, often chronic, often unnamed.

Here, the role of therapy is not only interpretive but reparative. It’s not simply about uncovering the symbolic roots of one’s suicidal thoughts, though that matters, it is also about co-creating a space where these thoughts can be held without terror—a space where what feels monstrous or shameful inside the person can be met with curiosity and care. As Adam Phillips writes, the symptom is not something to be conquered, but to be lived with more freely. It may not disappear, but it can lose its grip.

To make suicidality speakable is to make it less total. A new possibility opens when a person can say, “I don’t want to live like this,” and be met not with panic or silence, but with reflection and containment. Not a cure, but a relationship. Not a quick answer, but a living question: what part of me wants to die, and what part of me might still want to live, if it could be found?

In the end, suicidality is not only about despair. It is also about longing. A longing for a different experience of the self, a different future, a different place in the world. If we listen closely, without trying to fix or erase, we may find in it not just death, but an unlived life, waiting, however faintly, to be imagined again.

References

• Freud, S. (1920). Beyond the Pleasure Principle. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XVIII (1920–1922): Beyond the Pleasure Principle, Group Psychology and Other Works, 1–64.

• Laplanche, J., & Pontalis, J.-B. (1973). The Language of Psychoanalysis. London: Hogarth Press. 

• Phillips, A. (1993). On Kissing, Tickling and Being Bored: Psychoanalytic Essays on the Unexamined Life. Harvard University Press.

• Phillips, A. (2006). Side Effects: Essays on Psychoanalysis and Literature. Basic Books.

• Phillips, A. (2000). Promises, Promises: Essays on Psychoanalysis and Literature. Basic Books.

• Ogden, T. H. (1989). The Primitive Edge of Experience. Jason Aronson.

• Winnicott, D. W. (1958). The Capacity to Be Alone. In The Maturational Processes and the Facilitating Environment (pp. 29–36). London: Hogarth Press.

• Winnicott, D. W. (1963). The Value of Depression. In The Maturational Processes and the Facilitating Environment (pp. 221–225). London: Hogarth Press.

  Blog:https://chicagoanalysis.org/blog/psychoanalysis/death-instinct-therapy/