The Prevention of Suicide in Adults
Were it not for the fact that the great majority of those who set out to commit suicide are ambivalent about it, writing (or reading) a chapter about suicide prevention would be a waste of time. The subject invites attention, however, because most would-be suicides are not at all sure they wish to go all the way over the edge. For every person who successfully commits suicide, a hundred will attempt it. Most patients who become seriously suicidal do not remain so for very long periods—self-destructive fever ameliorates. Only a small fraction remain continuously and seriously suicidal over many months or years. Because most patients are not at all sure they wish to do away with themselves, they are likely to involve others in their self-destructive enterprises, and to make us a part of their struggle in the choice between living and dying. The majority of would-be suicides are prepared to accept our preventative interventions, with whatever mixture of feelings. A discussion of suicide-prevention makes sense because for the very great majority of patients suicide is a permanent solution to a temporary problem (as Ed Shneidman is fond of reminding us); these patients commonly thank us for interfering with their lethal designs and activities once their psychological distress has been ameliorated. For a small and resolute minority, therapeutic efforts at suicide prevention will fail; some of these will have been more or less intent on dying from the beginning. Some others incline more and more toward death with the passing of time despite all outside efforts to reverse the lethal trend.
KeywordsFatigue Depression Europe Lithium Dementia
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