Phenomenology and predictability of suicide on Rorschach Test

 4
taxonomic cage and to causalistic reduction of his act; he represents a checkmate not only for rules 
of scientific reason, but especially for family, friends, closers, caregivers who tried to help him.  
As well as historical and philosophical considerations, our interst for suicide get us to reflect about 
its psychological ambiguity and paradox too: on the one hand it appears as one of the most personal 
action that someone can do, on the other it’s always happened during all human history, in all 
cultures and societies, although with different frequencies in time. Although we know a lot, both in 
epidemiological area and in clinical or psychological research one, on the “what” and “how” of 
suicide, we know still a little about “why”. The core of unpredictability and  ineluctability, often  
painful and tragic, of suicide that perhaps contributes not a little to cover it as a taboo, represents a 
stimulus for the point of view of prevention and psychodiagnostic prevision too.  
Because it represents a real medical emergency in all the world (in the opinion of WHO, about one 
million people in the world kill themselves during the year 2000, mortality by suicide in the last 45 
years increased on 60%, suicidal rates continue to increase with the age, but yet in a lot of States 
youth segments, 15-25 years old, increase more of the old ones), it persuaded us to reflect about 
problem of possibility of so important and at the same time delicate psychodiagnosis. Its prediction 
represents still today one of the most difficult aspects both of the clinic and the research, because a 
definite and deducible “suicidal behaviour” isn’t identify yet. Suicide can represent  inauspicious 
outcome of some serious psychopathologies (first of all depression), but can also appear in neurotic 
diseases or be a risk factor in some crucial moments of life or in some ages, as adolescence and old 
age. The disquieting aspect of suicide consists in its particular transversality both social-
geographical (it can happen in every place and socila class), and nosographical one, as well as its 
relative unpredictability. Usually we are surprised reading that someone known killed himself or 
tried to do it, and the common reaction of family and friends is perplexity and astonishment (“I 
shouldn’t say it”).  
So in which degree is suicide a predictable event by psychodiagnostic point of view? In particular, 
which phenomena and specific responses on Rorschach test represent specific alarm signals of 
suicide potential for the clinician? Besides historical studies of Sixties and Seventies, are some 
recent important studies about Rorschach test and assessment of suicide potential?  
This text is divided in two parts. The first one serves as theoretic frame on general theme of suicide. 
First chapter is dedicated to problem of definitions of suicidal range; the second to the most 
common social-demographical factors; the third to discussed relationship between suicidal 
phenomena and psychopatologies; the fourth treats the theme by psychoanalitic point of view and in 
the Shneidman’s works.  
In the second part attention is balanced on identification and predictability of suicide on Rorschach 
test, beginning from methodological clinical and research problems (chapter 5). In particular, 
historical studies on single sign Rorschach (chapter 6), multiple signs (chapter 7) and most frequent 
contents in protocols (chapter 8) are analysed. In appendix there are the most popular psychometric 
scales for assessment of suicidal risk, finally Conclusions, bibliography and visited websites. 
I wish to thank the staff of the library “Federico Kiesow” of Faculty of Psychology (University of 
Turin) that has been present me in the search of the articles in English on the Rorschach test; the 
Center of research and documentation on the death and the die of the Ariodante Fabretti foundation 
for the precious collaboration to the contents of the first part; my friends Armando Molari and 
Flavia Melidoni that have given they critical contributions during the elaboration of the thesis; 
finally, my family which devote ideally this work, that has sustained me during all the university 
course and to which I have to big part of my personal and professional growth. 
 5
 
First Part. General aspects of suicide 
“Neither the sun nor the death can be looked hard at”. (F. La Rochefoucauld, 1664) 
“One doesn’t kill himself because of one woman’s love, but because a love, any love, reveals our 
nakedness, meanness, defencelessness, insignificance”. (C. Pavese, dead suicide in 1950 at the age 
of 42 years old, from the diary “Il mestiere di vivere”) 
 
 
 
Chapter 1. Definition of suicidal phenomena 
Nobody expects that defining or classifying suicide is simple, because there are too many unknown 
motivations, complex psychologic factors and uncertain circumstances so that its definition can go 
in precise categories. So definitions and sistems of classification of suicide remain very different, 
controversial and subject to continous revision. All sistems of classification and nomenclature of 
suicide are roughly defective; a lot of them have specific points of view and original aspects. 
Problems with which one meets analyzing  scientifically the phenomenon of suicide are several, 
first of all about exactly definition. The term “suicide” is the italian version of french word, coined 
in 1700 on the model of “homicide”, from latin “sui”
1
 self and “caedes” killing. So there are no 
doubts that “suicide” means literally “killing of self”.  
While etymology of the word is univocal, it isn’t so simple to examinate scientific definitions of 
suicide, that is attemps, sound on theoretic principles and logical criteria to tell exactly what one can 
mean with suicide, so bounding the area of investigation: actually among definitions that we have, 
homogeneity doesn’t exist, especially because single experts’ different theories and disciplines. 
 
                                                 
1
 It’s important point out that “there was imaginative etymology for which “sui” means not really self, but from “sus” as 
pig, indicating  animality of the act” (Tondo, 2000, p. 18). 
 6
 
1. Definitions of suicide 
Current definitions of suicide can be divided in two wide categories. To the first one belong those 
that limit use of the term to voluntary “killing of self”, acts which whom a subject kills himself 
consciously and intentionally; whereas to the second one those that include also deaths witn the 
presence of unconscious impulse to kill himself.  
The first category comprehends most of all current definitions of suicide. We examine the most 
classic and quoted definitions, formulated by Emile Durkheim, one of the forefathers of modern 
sociology: “Suicide is every case of death that results directly or not by a positive or negative act, 
completed by own victim conscious to product this outcome” (1897, p. 168).  
This definition puts us in front of some problems. On the one hand it crosses every types of  
judgment of the act, but on the other hand puts a lot of rigid limitations: first of all it reduces the 
term suicide in all those cases in wich final outcome is effective death, that is it defines suicide from 
result; but it gaines a distorted imagine because “the death is one of the possible results of a suicide 
thought or will. So the important problem is if the subject that wanted to die is different from one 
that wanted to die and at the same time to reach death” (Farmer, 1988, p. 18).  
Really if, even though there are will to die, one doesn’t reach death, there is a situation that can’t be 
considerated in univocal way, because it could be result of a casual, accidental event, such for the 
presence of other factors, consequent to a not really determinated or ambivalent will. This problem, 
much discussed and unresolved, constitutes the reason why other terms as “attempted suicide”, 
“missed suicide”, “parasuicide” came up alongside term suicide.  
But this isn’t the only criticism to the Durkheim’s definition. The expression “conscious to product 
this outcome” reveals a totally rationalist idea where every man’s behaviour is clear to himself, with 
a lucid awareness and precise determination, it involves deep knowledges and certainty of effects of 
used method, while not always clearness of mind is a constituent element of suicide.  
Recently Edwin Shneidman, that since at least 30 years works with suicide, pays attention also to 
socio-cultural anh historical variables that intervene in definition of suicide and point out “currently 
in western society suicide is a conscious act of self-induced annihilation, better understood as a 
multidimensional uneasiness inside a individual need that definies a problem for which suicide is 
seen as better solution” (Shneidman, 1989, pp. 17-18).  
Anyway, every definitions raise specific issues (for example, the fact is suicide as a victim in 
Durkheim’s definition, or suicide results from a type of uneasiness rather then a disease in 
Shneidman’s definition), but all of them rotate around idea of conscious intent. 
Instead, definitions of the second category, elaborated by experts of psychoanalitical school, 
support the important role of unconscious motivations for determinate suicidal act. So, suicide’s 
consciousness represent a try to defend towards progress of unconscious intrapsychic process for 
selfkilling rather than a necessary condition for talk about suicide. For example, Deshaies definies 
suicide as “act to kill self in usually (so not exclusively) conscious way, having death as way or 
purpose” (1947, p. 14), whereas Haim points out that “suicide excludes criterion of consciousness 
and intent, but includes idea of act [...] so unconsciuos suicide ia a real suicide as conscious one” 
(1973, p. 159-256).  
“Suicidal equivalents” are seemingly accidental and unintentional deaths (self-mutilations, 
continuous research of surgey, anorexia, drug addiction, alcoholism, car accidens and other risky 
behaviours) could be result of unconsciuos impulse to kill self with a real and conscious intent of 
death.  
Compared, definitions of both categories are evidently contrasting. Definitions found on criterion of 
suicidal intent have problem of indentifying will of act, because, except for cases in which subject 
leaves a message that explains the reason of his act (it happens only in 15% of cases), it’s not 
simple to go up conscoius motivation of suicide neither in direct way (failed attempted suicides), 
nor indirect (family and caregivers).  
 7
So if definitions of first category can result restrictive (because they don’t consider that sometimes 
suicide has ambivalence between wish to live and wish to die, often both indefinite), those of 
second one can present the opposite problem: if also incidents and selfmutilations are considerated 
suicides, there is risk to include also the not intentional death, even unconsciously.  
So, paradoxically definitions of both categories, both separately and compared, instead of 
specifying nature and traits of suicide, return to us phenomenon with its elusiveness and 
complexity. Experts’ different positions about definition of suicide undurline that “there is 
gradualness in behaviour generally defined self-detrimental, that extends from absence of roles for 
psychophysical integrity until radicality of suicide” (Cazzullo et al., 1987, p. 7).  
Kreitman comes to say that an ideal definition of suicide isn’t possible because “whereas motivation 
is certainly central in suicide, we don’t have a definite theory of motivation. There isn’t a generally 
accepted vision about which types of motivation people has, how treat unconscxious detrminants of 
actions, how distinguish clearly immediate and final aims, how think about hierarchies of 
motivations, or how make our definitions operative. It’a a general problem, not specific of suicide” 
(1988, p. 843).  
It’s problematic to have a definition that shares in one category both completed suicides, failed 
suicide, and behaviours that get death durectly or not. Howevere when we talk about intent an 
motivation, we go in “that wide range that includes from intellectual vision to obscure and 
immanent impulses” (Holderegger, 1977, p. 42).  
Definition of suicide as expression “killing of self” defines wel suicidal events, eliminating every 
ambiguous reference about both homicide and possible accidental death.  
Whereas about conscious or unconscious ideal motives of suicide, there difficulties beacuse every 
line of studies has its definition of suicide, underscoring specific aspects of suicidal act. So, suicide 
shuold be considered when there is an intentional action that has death as inexorable purpose, 
excluding, if possible, what seems suspicious, not clear and ambiguous. 
 8
 
2. Suicide and attempted suicide  
An other important issue about delimitation of investigation area is relationship suicide and 
attempted suicide. First of all, one must dispell prejudices about attempted suicide as french 
sociologist Patrick Baudry “every attempted suicide is serious, one in three attempted suicides is 
injured seriously. In 40% of cases there is  relapse. So, one can’t talk about false suicides” (1985, 
pp. 21-22). Also the most banal try to suicide has to be considerated seriously and not 
underestimated, because there is an essential overlap between attempted suicides and completed 
suicides (long-term 10-15% of attempted suicides finally will die).  
Stengel most of all investigated relationship between suicides and attempted suicides, opposing idea 
for which all real suicidal acts aim exclusively to death, whereas “a lot of suicides and attempted 
suicides are made in state of mind “i don’t care if i live or die” rather than with a definite and 
unequivocal determination to finish own life. Most of people, in the moment of suicidal act, are in 
state of confusion” (1964, p. 80).  
So Stengel underlines how attempted suicide isn’t a univocal and clear phenomenon. Also 
Shneidman classifies suicidal non fatal acts, with own subject’s expressions, in intentioned and 
conscious, subintentioned unconscious, unintentioned, contraintentioned.  
So, attempted suicide is a complex action with several functions: wish to provoke a change in a 
situation, escape, rilieve and rest, so a loto of people, before and during suicidal act, don’t think at 
all about problem of death. Other functions shuold be unconscious appeal to arouse others’ attention 
and intervention (demonstrative attempted suicide). Stengel concludes that “most of the people 
attempted suicide don’t want to die or live, but to do both at the same time” (1964, p. 85).  
Anyway, attempted suicides have a different mean from completed or failed suicide: if suicide is 
definitive act against self found by conscious motivation to die, attempted suicide should be an act 
againt others, a cry for help and death as not wanted result.  
About attemptes suicides, more than completed suicides, there are problems tied to 
intent/motivation to die and letality as probability of provoke death.  
Letaly and intent are distinct but interdependent factors (method indicates often soundness and deep 
of intent in explicit way), so they can be correlated in different ways: 
a) attempt with low letality and low intent, subject doesn’t want to die really and uses not 
lethal methods; 
b) attempt with low intent but high letality, because weak  knowledge of method, little 
intention to die, but used method is lethal; 
c) high intent and high letality, there is will to die with a effective method (precipitation, 
hanging, guns), suicide can succedd or not; 
d) high intent and low letality, one wants to die, but chooses with low lethal method 
(insufficient amount of medicine). 
In parasuicide proportionality between intent and letality is very small, because suicidal behaviour 
is only instrumental, often to attract attention with clear manipulative aims.  
Furthermore, distinction between suicide and attempted suicide emphasized some interesting 
differences in the epidemiology of  both phenomena. Attempted suicides have greater frequency 
than effected suicides and 
- greater frequency in women compared men; 
- greater frequency in young people (until 25 years old) compared old; 
- grater use of weak methods (first of all drugs); 
- greater frequency for interpersonal causes; 
- less frequency in important psychic diseases; 
- most of all are ruslt of a spontaneous and not meditated decision. 
Because inadequacy of current terms, there are others to defining better carateristics of attempted 
suicides. European suicidology unifies in idea of “parasuicide” (Kreitman et al., 1969) all 
 9
behaviours with intent of death, also uncertain ones, apart from letality, reserving term of “failed 
suicide” to more rare cases (1 one 10 attempts) of casual survival. “failed suicide” indicates “missed 
letal conclusion of an selfdetrimental act with strong suicidal intent and choice of letal methods and 
appropriate time and place” (Corfiati et al., 1994, p. 76). Instead “attempeted suicide” is “an 
selfdetrimental but not letal act, with conscious suicdal intent, also with little risky ways for life or 
with weak suicidal intent” (Crepet, 1994, p. 80).  
In conclusion, distinction between suicide and attempetd suicide is very shaded “because particular 
conditions of mental and motivational functioning and strongly conflicting impulses, but present at 
the same time in suicide persone and environment” (Pandolfi, 2000, pp. 66-67). Furthermore, 
because different opinions about what attempted suicide has to be considered, it isn’t surprising that 
incidence of phenomenon in different studies are very variable.  
Although most of tha Authors emphasize utility of distinctions, agree that they don’t have to be 
overestimated and, in therapy end prevention, are very insignificant, whereas it’s more important 
save a life and prevent the death. 
 10
 
3. Suicidal range 
whereas distinction between suicide nad parasuicde is used mainly in Europe, american authors 
prefer to distinuish a gradual continuum between suicide, attempted suicide, suicidal gestures (less 
determinated from reserach of death, with a great manipulative theatricality), suicidal equivalents 
without a sure suicidal ideation until simple ideation.  
Among suicidal gestures, suicidal pretension reveals in not very important, selfdetrimental acts, as 
cut wrists or drug not lethal overdose. Often motivation of these cases is just not to die, but sleep, 
go away, doing a kind of “dress rehearsal” for self and environment.  
Instead, own selfdetrimental behaviours are attcks to integrity of body, but without conscious aim of 
suicide, as cuts or burns of skin, limitated, often violent, with a real aim “isn’t to look for detah, but 
to attack body with a not exclusive sadistic and negative quality” (Pandolfi, 2000, p. 68). Also 
selfdetrimental behviours, as all symptoms, have different motivations and senses, often at the same 
time, as method to attack in punitive way a part of body in which perhaps is collocated 
fantasmaticly a bad or repulsive object, or to ascertain that one is live ans sensitive to stimuli, to 
verify own insensitiveness or tolerance to pain, or to damage a part of self that so can be cured and 
redressed carefully.  
Instead, other ones carry out selfdetrimental acts called suicidal equivalents or partial suicides, not 
immediately lethal: they are drug addicts, alcoholics, people who don’t care own health, smokers, 
don’t control diet, have antisocila acts, risking often life. These behaviours are abiguously between 
voluntary and not, in which aim is probable but non certain death. Although by descriptive point of 
view we can’t talk about suicide without clear will to die,unconscious underlying mechanisms are 
identical to suicide. Menninger talked about “chronic suicide” as asceticism, martyrdom, 
alcoholism, antisocial behaviour, psychosis; “focal suicide” limitated to parts of body, as 
selfmutilations, continous research of surgery, voluntary accident, impotence or frigidity; “organic 
suicide” in psychosomatic diseases (1939, cit. In Tondo, 2000, pp. 89-90).  
Suicide doesn’t work according to “all-or-nothing” law: if at the opposite we have effected suicides 
of people consciously intentioned to die and with a sure lethal method, and attempted suicides of 
people consciounsly not oriented to die with a sure not lethal method, in the middle we have a range 
of suicides and attempted sucides with often not univocal mean, ambiguous, where there are 
different aspects such as conscious/unconscious motivations, knowledge of used methods, 
impredictable circumstances, external intervention and others factors tha make impossible a clera 
cut distinction of both phenomena.  
In conclusion, difficulties trying to define suicide are inevitable consequence of own complexity, 
that seems to avoid any definitive try.  
Karl Jaspers wrote that “any single suicide, as unconditional fact, can’t be undurstood and explained 
in sufficient way according to causal law of general validity, we can only try to reconstruct and get 
together some circumstances that make possible suicide (1948, cit. in Festini Cucco, Cipollone, 
1992, p. 17).  
So reason for it’s so difficult to define suicide is because , in real experience, “the” suicide doesn’t 
exist, but a wide range of situations around suicide, linked with a complex factors, not always 
inquirable clearly. Moreover own term “suicide” indicates txo different things tied in not univocal 
way: on the one hand it’s an event, a fact, death phenomenologically inquirable; on the other it’ a 
behaviour interacting with several internal and external factors. 
 11
 
 
Chapter 2. Risk factors in suicidal behaviour 
A report of World Health Organization (WHO/OMS) shows that, in 2000, about one millon of 
people is death for suicide in the world, the ninth cause of death in men and the second in women 
from 15 to 44 years; and that, in the only Europe, suicides have been 120.000. The suicide 
represents, everywhere in the world, one of the ten most frequent causes of death. Both in UK and 
in Italy, for example, the suicide represents about 1% of all causes with death (fifth or sixth in 
classification of the most frequent). Between European youthes from 15 to 24 years, it’s to the 
third place, exceeded only by car accidents, homicides or by cancer, in accordance with different 
countries, and in United States it reaches the first place among youthes. If we consider, then, that 
every suicide concerns on psychological and emotional plan on average six people between family 
and friends (so called “survivors”) and that numerous statistics denounce an increasing trend, the 
phenomenon reveals in all its dramatic actuality. 
The first problem in face of the statistics concerning suicide, is how much they can be considered 
reliable. It’s common conviction that official statistics introduce an undervalues of phenomenon that 
varies, in accordance with studies, from 10 to 30% more, considering the disparity between official 
and real data brought by single countries. Besides, it’s always necessary distinguish between number 
of suicides (in a selected sample, instance, of in-patients) and rate of suicides (annual average of 
suicides every 100.000 inhabitants). 
The reasons of incompleteness of data can be a lot of. It’s likely that in a lot of cases there could be 
an attempt of hiding from family and physicians, dictated by religious heritages and by social stigma, 
with shame, by the fact that suicide is still considered an insane event, by fright of possible penal or 
insurance consequences. A difficulty that is added is that only in a minority of cases (15-20 %) are 
present writings communications of suicide. 
Besides, they exist sensitive differences between a country and other in methods uses for 
identification of the cases of suicide, in the modalities of compilation of death certificate and in the 
coding of causes with death. The same cultural attitude toward suicide has a profound influence in 
determining how the problem is definite, how intention to die is interpreted and on how, finally, 
they are conceived the informative procedures for data collection on suicide, above all in all those 
cases when circumstances of decease are not very clear, because cases of declared and evident 
suicide are a limited percentage. 
Among the factors that contribute to undervalues of suicides even reenter cases of disguised suicide 
(for example, dissimulation in form of car incidental), suicidal erosions of the elderly (for example, 
refusal to cares and to feeding) and a percentage of lethal addicts overdose.  
In any case, some undervaluation of number of suicides, although minim (about 20%), exists, but it’s a 
relative and constant undervalues, for which  “the ambiguity same underlying to a lot of cases of suicide 
would reflect itself necessarily in a smaller reliability of the statistics data (Festini Cucco, Cipollone, 
1992, p. 22).  
Still more difficult is the recording of attempted suicides, of which only a minority arrives 
to be considered in official statistics. The statistics for parasuicides are much more volatile than 
for suicides, because lack of national records everywhere in the world and for scarce homogeneity 
of classifications. The importance of data on parasuicide has an enormous preventive value, 
because parasuicides/suicides ratio fluctuates between 8 to 1 and 20 to 1 and that 10-14% of 
attempted suicides commit suicide subsequently. The comparison between subject suicides and 
parasuicides announces that the first ones are old, not married, more probably jobless or retired and 
they live alone; they have even a more elevated prevalence of psychiatric disorders (mood diseases 
and schizophrenia ), they take more easily medicines and misuse alcohol and drugs. 
Because the incidence of suicide suffers notable fluctuations in time and differences among different 
countries are attributable both to different criteria of classification and to the real lack of 
homogeneity in distribution of phenomenon, the official statistics can be used, with caution, as good 
 12
indicators of general trends of suicidal phenomenon. The European countries have an incidence of 
the suicide anything but homogeneous, in which Mediterranean ones have traditionally a very low 
incidence of suicide in comparison with the northern and eastern countries. We remember, however, 
that in a lot of Mediterranean countries, the tendency is still that to hide suicide on behalf of the 
family, while in the Scandinavian countries, more inclined to the recording of data, the rate of suicides 
reaches values higher. 
Italy shapes as a country with middle-low mortality, with a tendency to increase in late years; even the 
most recent ISTAT data confirm that frequency of suicides is higher in the northern regions and lower 
in the south. It isn’t, as Crepet and Florenzano say, a recent phenomenon, because, on the basis of their 
analysis on statistics on suicide in Italy from 1800 to today, the differences between center-north and 
south in rate of suicides has been constant in the time. 
In an epidemiological optics, decomposing the numerical general datum in its more meaningful 
particular aspects, it’s possible to delineate existence of some groups that have a suicidal risk higher 
than general population: it’s task of clinician and researcher the evaluation of risk factors with the 
object of get the better prediction possible of a following lethal behaviour. With predisposing factors 
we intend a wide range of situations, clinical and not, that can predispose a person to think and 
effect suicidal intentions. Seems evident, because the complex and polymorphous nature of 
suicide, utility to consider simultaneously different factors and their mutual influences in an 
interactive-integrative optics.