Half in Love With Death

by Joel Paris

Half in Love With Death presents a new way for therapists to manage chronically suicidal patients, an incredibly challenging task for clinicians and one where an insufficient amount of literature exists to guide professionals. Author Joel Paris suggests an approach that defies conventional wisdoms about whether suicide can be predicted or prevented. He asserts that managing chronically suicidal patients begins with tolerating suicidality, understanding the inner world of patients, avoiding repeated hospitalizations, and focusing on life situations that maintain suicidal ideas and behaviors.

Each chapter in the book develops a theoretical perspective based on empirical data, and many are illustrated by clinical examples. Topics addressed throughout the text
*distinctions among various types of suicidality;
*the inner world of the chronically suicidal patient, with a particular focus on pain, emptiness, and hopelessness;
*the relationship between chronic suicidality and personality disorders, especially the category of borderline personality;
*the effectiveness of psychotherapy and pharmacotherapy for chronically suicidal patients; and
*the risks of litigation in managing this patient population.

This volume is a crucially important resource for clinicians who treat chronically suicidal patients, as it fills a gap in existing literature and provides enlightened guidelines that stem from a large body of research in the field.

Genres: Psychology, Nonfiction

246 pages, Paperback

First published June 21, 2006

About the author

Dr Paris is Professor, Department of Psychiatry, McGill University, and Research Associate, Department of Psychiatry, Jewish General Hospital. He obtained his psychiatric training at McGill. His research interests include: developmental factors in personality disorders (especially borderline personality), culture and personality.
Current projects: risk factors for borderline personality disorder in children the biological correlates of borderline personality disorder.

Reviews

[Eliza · Rating 2 out of 5]

I can understand the author's suggestion to try to get at WHY a person is suicidal rather than intervening at every mention of suicidal ideation. However, I think suicidal thoughts and intentions need to be assessed and taken seriously. Otherwise the person may feel invalidated and abandoned with his or her feelings and an opportunity to prevent disaster may be missed. I think this is ESPECIALLY true of people wiht bpd who have an extremely strong need to be heard and understood. Usually suicidal feelings are very real and frightening and are not just some "plea for attention." They are the result of horrible despair, mood dysregulation, rejection and hopelessness. 10% of people with bpd do complete suicide. That is a very high percentage. Clinicians need to listen carefully to their patients' words at the same time that they try to problem solve around the causes of the desire to die and gently push patients towards things that can help them live better.

[Matt · Rating 4 out of 5]

I treat a lot of chronically suicidal people in my practice and appreciate this book's refreshing support. Most people who struggle with chronic suicidality do not die by suicide, so the emphasis of treatment should be on validation and building support and encouraging engagement in a healthy life instead of disruptive hospital stays or minimally-effective polypharmacy.

[Joanna · Rating 5 out of 5]

Veldig tilgjengelig skrevet forskningsbasert bok om terapi med pasienter som er kronisk suicidale. Paris anbefaler solide doser empati og forståelse, å unngå sykehusinnleggelser og å støtte pasienten i å bygge opp et meningsfullt liv.

[Anna · Rating 1 out of 5]

The book was informative but I feel bad for people who end up with the author as their doctor.

[Danielle · Rating 2 out of 5]

This book was oh-kay. On one hand, I loved how it so accurately described the inner world of the chronically suicidal patient, and encouraged the reader to understand and empathise with how unbearable this state can be.

However, on the other hand, I feel like this book walks a very dangerous line in regard to its treatment recommendations for such patients - much like Marsha Linehan, this author seems to encourage the "suck it up" approach to suicidal behaviour; he generally discourages practitioners from making any kind of undue fuss or showing any real compassion toward the chronically suicidal, so as not to encourage or reinforce their behaviour (he justifies this stance by stating that most chronically suicidal people never complete an attempt). While this may be a great idea when dealing with the sickest of Borderlines, for CS patients with other, similar disorders (eg, eating disorders, CPTSD, etc), this lack of validation or nuturance has the potential to exacerbate a patient's despair to the point where they may - at worst - succeed in killing themselves; or at the very least, lose trust in the therapist/engage in self-damaging behaviours in order to cope. I'm much more a fan of an approach to therapy that recognises chronic suicidality as a crisis state, and encourages extra support during these periods, within safe boundaries.

[Robert Bogue]

Most books about suicide draw little – or no – distinction between those who live with chronic suicidality and those who are acutely suicidal. Joel Paris in Half in Love with Death: Managing the Chronically Suicidal Patient draws a bright line between what works for the acutely suicidal person and what works for the chronically suicidal person. The line helps to delineate what activities might be appropriate or a bad idea for a chronically suicidal person and the acutely suicidal. That’s an important distinction, because half of people who die by suicide had no meaningful contact with the mental health system.

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