by Raffaele De Luca Picione, Elvira Martini, Chiara Fioretti, Vittorio Lenzo, Alessandro Musetti, Alessandro Germani

Abstract

Suicide represents a complex clinical phenomenon that cannot be adequately understood through categorical diagnoses or risk-factor models alone. This narrative, historical, and critical review examines suicide through a psychoanalytic lens, integrating intrapsychic, intersubjective, and sociocultural dimensions. Drawing on major Freudian and post-Freudian traditions, this paper explores how unconscious dynamics, such as mental pain (psychache), guilt, shame, narcissistic injury, aggression, and fantasies of annihilation or rebirth, organize suicidal ideation and behavior in clinically meaningful ways. Rather than proposing a unitary explanatory model, this review advances an integrative clinical framework that conceptualizes suicide as the outcome of heterogeneous and dynamic psychic configurations, shaped by developmental trajectories, relational contexts, and failures in affect regulation and symbolization. By examining the profound connection between theory and clinical practice, this work advocates for a dimensional and idiographic approach capable of capturing the subjective meaning and the transformative or destructive function inherent in suicidal fantasies and behaviors. By mapping different psychoanalytic models onto specific clinical constellations, the paper highlights how suicidal behavior may serve distinct unconscious functions (e.g., self-punishment, revenge, spite, preservation of internal objects, escape from fragmentation). The implications for clinical assessment and intervention are discussed, emphasizing the importance of idiographic formulation, attention to unconscious meaning, and careful management of countertransference in suicidal crises. This perspective aims to complement contemporary suicidology by offering clinicians conceptual tools for understanding the subjective logic of suicidal behavior beyond risk prediction alone.

Key words: suicide, psychache, unconscious dynamics, intersubjective processes, psychoanalysis, idiographic approach