Battling With the Life Instinct: The Paradox of the Self and Suicidal Behavior in Psychosis

Suicidal behavior in psychotic disorders, such as schizophrenia, is not uncommon: About 10% of patients diagnosed with schizophrenia are estimated to eventually commit suicide and even more will attempt it.1 Even Eugen Bleuler, who first coined the term schizophrenia at the beginning of the 20th century, had suggested that “the most serious of all schizophrenic symptoms is the suicidal drive.”2 However, despite its prevalence and seriousness, suicidal behavior in psychosis does not seem to be a major research focus and, while biological psychiatry has greatly advanced our understanding of the neurophysiological basis of suicidal behavior in a variety of disorders, there is little research into the actual experience or phenomenology of suicidal ideation and subsequent behavior in psychosis. Since I wrote my first article, my symptoms have remitted to such an extent that a firm diagnosis of schizophrenia can no longer be held in place, which has brought even more uncertainty to my condition. Nevertheless, certain symptoms—albeit far less florid than many of the positive symptoms I have had before—still linger in my mind. These include a never-ending sense of disintegration and fragmentation of the self and intrusive thoughts—which I think are an attenuated form of the voices I used to hear—urging me to throw my life away because a life without an active self is not worth living. At the same time, I am aware the very fact that I have a living body means I have a self, active or not, so if I killed myself the container for my real self would be lost forever. Still, the thoughts are correct in their own right, too. During this period of remission, I have realized that my whole life is full of contradiction, full of irreconcilable and irresolvable paradoxes which originate from my shattered self, beyond the realm of logic and reason. In this article, I would like to use my own experiences of psychosis in order to propose and analyze some of these paradoxes from a first-person perspective.