Suicide: American Handbook of Psychiatry

The suicide of a patient, because of its finality, is perhaps the most devastating experience in the practice of psychiatry. And suicide, considered as a sign of mental disorder, is a prime cause of death among psychiatric patients. Inextricably involved with the attitudes, folkways, mores, taboos, and laws of culture and subculture, with tragedy for the person and the group, with emotions and values, suicide is a sociopsychiatric phenomenon about which much confusion exists. The nature of this phenomenon is complex, and its scientific study is difficult, in part for the obvious reason that persons who have committed suicide successfully are no longer available for psychological or psychiatric study. The universal fascination of the study of suicide, however, is reflected in the great bulk of literature concerning this subject. There are now more than 7000 books and articles about suicide (exemplified by Farberow's extensive bibliography and an American journal -the Bulletin of Suicidology- devoted solely to this topic). But much prior research into suicide and attempted suicide has tended to be either actuarial and at times somewhat superficial, or clinical and often anecdotal, or oriented to depth psychology and rather speculative. It does seem evident that there are three chief etiological factors in suicide: the group attitudes in each particular society, the adverse extraneous situations that each person must meet, and the interaction of these with his character and personality. This last single variable appears to be the most important one. Obviously, different persons meet adversity differently. One whose personality is poorly integrated may respond to stress by taking or attempting to take his own life. Yet anthropologists and epidemiologists have demonstrated that suicide may be completely unknown among certain primitive tribes, that suicide rates are extremely low in certain countries, and, alternatively, that suicide is not only acceptable but obligatory as a consequence of certain specified activities or happenings in certain other cultures. The ancient warrior people of Germany and Scandinavia, as well as the Greek Stoics, approved of suicide, Oriental and Hindu cultures sanctioned it under specified conditions, and in some South Sea Islands it is looked upon even today as an honorable act. However, as cultural patterns affect large numbers of people who do not always act similarly, and as every person must meet difficult and dangerous situations in an environment that can never be "sterilized" psychologically, it appears likely that some degree of personality disintegration is the most important single variable in the etiology of suicide. The psychiatric concept applies, that external tensions are reacted to in proportion to the amount of internal tension already existing.