The suicidal person
The suicide attempter
They have different motives. The suicidal person wants to die and the ‘suicide attempter’ does not want to die. However the suicide attempter can die by accident in that they did not mean for the suicide attempt to be completed.
I had an example of that happen recently. A woman in her early 20s had sent an email to her boyfriend that she had taken an overdose. She knew he was very likely to get the email and save her as he had done so a number of times before. He never got the email and she died. As she had a history of doing this one can conclude that her motive was not to kill self. Her goal was to manipulate him to act a certain way which had worked on many occasions before. She wanted him to come and save her thus demonstrating his love for her in her mind.
Would this grab your attention if you saw it? I think so.
However one needs to look at this situation more closely. If in her attempts at suicide she engages in acts that are highly dangerous then she is repeatedly engaging in high risk behaviour. On suicide risk assessment scales she would score on this point thus indicating that she is possibly suicidal to some degree.
It seems that the type of suicide attempt is significant for understanding the suicide attempter. If the attempts are clearly non-lethal then one can more safely conclude that the person is not motivated to kill self. They are making suicidal gestures for other reasons such as a cry for help or to manipulate others.
If the attempts are potentially quite lethal then the situation is less clear. Whilst the person may be acting in a suicidal way to gain attention there may also be some genuine desire to kill self. The individual may have made the suicide decision in childhood and thus in the psychological sense be ‘truly’ suicidal. However they may also have other motives as well such as manipulation and so forth. If they die in one of these suicide attempts then it may be partially a suicide and partially an accident. They are both a suicidal person and a suicide attempter at the one time.
Indeed one could argue that all suicidal people are suicide attempters to some degree because of the idea of suicidal ambivalence. I have postulated this before.
All suicidal individuals are ambivalent to some degree. They all have an internal dialogue which states: “I do want to die vs I do not want to die”.
All suicidal people have this contradictory set of thoughts and urges inside self. If a person is 100%, “I do want to die” then it wont be too long before they are. If a person is 100%, “I do not want to die” then there would be no suicidal thoughts or urges in the first place. The suicidal individual has percentages of both with the levels waxing and waning over time. Sometimes it will be 50/50 and then on other days it might be 60/40 or 30/70.
The individual shown in the diagram above would be classed as a suicidal person not a suicide attempter because they have made the suicide decision which is known in Transactional Analysis terms as the “Don’t exist” injunction. However they also have a Free Child aspect of their personality and thus they don’t fully want to die. So their suicidal actions are therefore at least at times going to be half hearted, quarter hearted or third hearted depending on how much energy is in the FC and how much in the AC at the time of the attempt.
For instance a man reported to me a suicide attempt of a few years ago. He plunged a large fishing knife into his abdomen, then rang his mother on the phone. He could have very easily died and almost did. He definitely had made a suicide decision in early life and his AC energy was high at the time of the attempt. However he also rang his mother which in my view was an expression of his Free Child desire to live. So in this way one could say he was a suicide attempter and he was trying to manipulate his mother.