Robin Williams’ recent suicide prompted an enormous reaction from the general public, evoking a variety of opinions and perspectives. Locally, Carly Weeks, (Globe and Mail, August 15th, 2014) rightfully asserts that there are no easy answers to understanding suicide and that we are often left at a loss as to try and understand why someone would take their own life. She cites Dr Martin Heisel, a researcher at the University of Western Ontario who emphasizes the fact that, “…there are variety of factors” that go into a individual’s death by suicide, and rarely just one consideration.

Weeks states that the vast majority of those who die by suicide have some form of mental health difficulty, with depression being the most frequently occurring syndrome. As David Gratzer (also The Globe and Mail,  August 15) points out, many people carry with them on a daily basis, the burden of depression, anxiety, addiction or other some the debilitating affliction. Michael Redhill’s poignant commentary on depression particularly caught my eye (The Globe and Mail, August 16) and is a particularly personal account from the perspective of an “artistic mind”.

Instead of avoiding talking about depression and suicide, Heisel, (from Week’s article), rightly stresses the importance of speaking about depression openly, that  helping a person express how she or he feels is critical. As a psychoanalyst listening to people talk about suicide I feel that it is vital to listen with an attitude of equanimity, non-judgement, seriousness and patience. I think that the capacity to listen to a patient verbalize suicidal feelings or ideas can actually strengthen the boundary between thought and action. In my mind it is important to give the individual (implicit) permission to express the powerful emotions that are threatening from within. In particular, I have found that this can help improve a person’s capacity to understand his or her inner and outer realities.

In circumstances where matters are thought to be getting more out of hand, often as a result of the patient becoming too depressed to communicate or indeed making practical plans for committing suicide, it is important that the individual be actively protected. However,  I always feel that such behavioural limit setting should be combined, as much as possible, with a continual emphasis on understanding and on attempting to uncover the potential meanings of impulses and actions. Otherwise, I feel that a patient can get  the impression that I’m only interested in his/her behaviour and not the subjective distress that underlies it. At times we, as psychoanalysts dealing with suicidal patients,  should realize that there are situations when one to one psychotherapy is simply not enough to contain the psychosocial distress involved. Hence, I might deploy adjunct measures including, amongst other things, the enlistment of family members’ help.