This paper presents an emerging understanding of the psychodynamics of suicide loss, derived from over 1500 accounts of suicide bereavement shared by families, friends and clinicians. It identifies clear patterns in the responses of the bereaved, particularly the formation of delusional narratives that often place them at the centre of blame for the death. These narratives have a profound impact on well-being, increase the risk of mental illness and elevate the likelihood of death by suicide. They not only cause harm to the bereaved but also permeate and distort our systemic and societal responses. Understanding why suicide unleashes such painful and dangerous forces helps mitigate the widespread harm and distress that often follows such a death. This knowledge also enables us to effectively and compassionately support those bereaved.

This paper summarises themes that have emerged from 14 years of study of suicide and work with those bereaved. It is based on a talk given in many clinical settings over the past 10 years. I describe my own emotional journey following impactful deaths and summarise personal ‘truths’ about suicide that have emerged over time. Case studies used for illustration are composites taken from clinical practice; accounts of relatives and other survivors of suicide; and data taken from many sources including suicide audits in mental health organisations, the police and transport services, and from the examination of coroners’ records. The intention is to assist open dialogue about the nature of suicide, to contribute to the understanding of the impact on those bereaved and to encourage open-hearted clinical engagement with those who are suicidal.

The aim of this essay is to bring the philosophical theology of St Augustine, and in particular his anthropology, into fuller dialogue with contemporary psychology, and to examine how psychology and theology might benefit from such an engagement. A further aim is to show that intra-psychic accounts of Augustine's Confessions are insufficient on cultural-psychological, philosophical and theological grounds. To the extent that the modern concept of ‘pure nature’ is incompatible with Augustine's philosophical theology, attempts to develop naturalistic intra-individual, psychological accounts of spiritual change will necessarily be limited once the full ‘ecstatic’ orientation of human existence is factored out. The picture of the person that emerges from naturalistic accounts of any mystical theologian may be plausible within the framework of a classical modern, post Cartesian concept of scientific rationality, and potentially useful for some purposes, but it will be over simplified and never wholly sufficient to account for the potentialities of human existence.

Psychodynanzic counselling is based upon, and informed by, psychoanalytic insights. The origins include the work of Freud, the Post Freudians, and the Object Relations school. These schools of thought embrace concepts of primitive infantile emotions and states of mind that produce overwhelming feelings of anxiety and fear and against which defences are formed to maintain a psychic equilibrium. Although these defences may have roots in the past, changes can only be effected by thinking about their significance in the present. The psychodynamic counsellor attempts to help clients make sense of their current situation by focussing on the actual dynamics of what is happening outside the counselling room with others and inside the counselling room with the counsellor: Thus, repeated and “stuck” ways of being with others are brought to light in tertms of transference and countertransference. In addition, painful and unbearable feelings are shared and contained in the relationship so that clients are more able to reflect upon and understand their own contribution to their present situation and to respond more constructively to that situation.