In this article the author reports on his clinical work with a young man who is severely automutilating. Still very young, the patient is not only confronted with the death of his mother but moreover with a dead and unbearable silence about it. If, during adoles¬cence, the original trauma in a retroactive movement is reactivated, this results in whole¬sale autodestruction. Based in clinical conversation material, a number of dynamics that could ground automutilation are explored. It is argued that when the subject cannot contemplate his place in the desire of the first Other, that a break-through of the real takes place which produces an unlimited jouissance. The author also defends the assertion that working with these patients demands that the therapist takes up an active position. Signi¬fiers must be offered in order to protect the subject against a destructive confrontation with the real. This is only possible within a therapeutic alliance where trust and safety are sufficiently guaranteed.