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Section 17
Figure Drawings for Screening of Suicidal Potential

Question 17 | Answer Booklet | Table of Contents

Figures 7.6 and 7.7: Nathan and Dora R.
Nathan is a 63-year-old man who applied originally for psychotherapy because he had reached the same age as an uncle who had murdered his wife and then committed suicide. Nathan feared he would do the same as his uncle. While he had not made an overt suicide attempt, he was filled with suicidal ideation and was covertly very self-destructive. He was tremendously fat, for example, weighing well over 300 pounds, despite a heart condition and severe diabetes. He was also crude and insensitive and seemed to have a gift for insulting people. Both he and his wife agreed that he was completely evil and the cause of any troubles they were undergoing, while she was all good. He said this with a sneer, but meant it.

Nathan's drawing, figure 7.6, is filled with indications of severe personality difficulties. It is empty, emasculated, expressive of unfulfilled needs and a reactive rage because these needs are not filled. The shaded and squiggly lines he uses to represent an ear are typical of overly sensitive or paranoid people who may be subject, for example, to ideas of reference. Actually, when he passed an office where some secretaries were chatting, he was convinced they were talking about him. His enormous weight and almost grotesque appearance suggest that people often do talk about him. The empty circle that serves for an eye is an expression of the use of great denial: he is not looking at what is there. He also draws a profile, often indicative of someone who is evasive and guarded. The open crotch expresses feelings of castration and sexual impotence. On the other hand, the elongated nose suggests an overcompensation through the assumption of a pseudomasculine, phallic-aggressive stance. Essentially, there is no mouth in his drawing, a feature found in pessimistic people who are convinced their fundamental needs cannot be met. The heavy lines at the neck, through the arm, and on the legs are all examples of slash lines, which communicate the presence of the suicidal impulse.

Dora R., Nathan's wife, is aged 70. Both clinically and in her drawing she appears as better controlled, better organized, and with an all-around higher intelligence and stronger ego than her husband. However, the conflicted lines around the mouth suggest that she, too, possesses deep oral conflicts that are still active. She also exhibits slashlike lines at the neck, waist, and wrist, attesting to a suicidal or self-destructive potential in herself that may be acted out by others through a process of projective identification.

In actuality, the suicidal behavior in the family is enacted through the husband, Nathan, and their daughter, Rebecca, now in her mid-thirties, who is a chronic psychiatric patient with a suicidal history.

The challenge of turning this trio, including the daughter, into a better functioning self-help group (in contrast to the self-sacrifice of the daughter through psychosis), with greater individual fulfillment, was challenging. The intelligence and emotional accessibility of the couple, perverted though it was,clearly indicated that there was something in this family to work with. Unfortunately, Nathan suffered a severe heart attack shortly after our one interview. The entire family then joined a fanatical religious sect and declined any further counseling.

Figure 7.8: Juan

Juan was a highly intelligent 27-year-old man, but a college dropout, working as a laborer. He had been admitted to a psychiatric hospital for a paranoid psychosis, with no overt suicidal symptoms or thoughts. However, a set of three figure drawings (figure 7.8 is one of the set) obtained upon admission all contained suicidal features. Juan did kill himself the week before he was to be discharged home.

This drawing also presents many indications of a wide range of emotional and psychiatric disturbances and problems. The one point to be emphasized is the suicidal slash lines at the neck, indicating the presence of suicidal urges, even though they had not been verbalized or expressed.

It is true that about 40 percent of the figure drawings of patients being admitted then to that particular psychiatric hospital did contain suicidal features, even though Juan was the only patient (at the time) who committed suicide. That is no reason to ignore the signs. When there are suicidal features in the drawings or other materials but no suicide takes place, that may mean there are life-saving forces operating. It does not necessarily mean that the message is false. One of these life-saving forces is the hospital itself. That may be a tribute to the efficacy of the treatment. It does not mean the message of the drawings and other indicators is to be discounted. The possibility of suicide should at least be investigated further. Since such drawings are so easy to obtain, I recommend that all psychiatric patients be routinely evaluated for suicide potential upon admission and prior to discharge, with drawings included in the evaluation.

To conclude, it might be illuminating for the reader to administer the drawing test to himself or herself. If so, the attitude might best be one of humorous interest. A word of reassurance is in order: not to take the interpretations presented here too literally where your own productions are concerned. The reaction is often similar to that of a medical student who is first learning about medical pathology and believes he or she is suffering from all the ills described in the text. That is most true of the sensitive student with the greatest potential for becoming a skilled and empathic physician. The reactions may be similar with the figure drawings and other psychological tests, where the sensitive reader will find evidence that all the mental and emotional disorders reside within his or her own psyche. In such a person lies the capacity for the greatest empathy and compassion.

Four principles may help the findings be more palatable, as applied to yourself. One, that it is impossible not to express yourself when drawing. Your characteristic personal style will emerge, be it impulsive and emotionally labile, cautious and indecisive, or whatever. Two, that the task touches upon deep, delicate, and sometimes distressing attitudes and feelings regarding the self and body image. Three, that we are all human, the serene and the troubled alike, and there is no sharp line dividing the "normal" and the emotionally disturbed. Our drawings may sometimes alert us to life tasks or conflicts we need to work out or obtain help for. Four, that the meanings of the drawings may differ according to the situation and the task. Drawings made in the privacy of the home or at a social gathering may have very different meanings from those obtained during a psychiatric or therapeutic examination. Whatever one's personal reactions, the Figure Drawing Test is a potentially valuable resource for the understanding of the suicidal person and family.
- Richman, Joseph, Family Therapy for Suicidal People, Springer Publishing Company: New York, 1986.

Personal Reflection Exercise #3
The preceding section contained information about figure drawings for screening of suicidal people. Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 17
What four principles may help the findings by analyzing drawings be more palpable as applied to yourself? To select and enter your answer go to Answer Booklet.