Spiritual Aspects of Suicide Prevention Efforts: Response to Parry

To the Editor: The very fact that suicidal patients are still alive prevents psychiatrists from proving that their efforts have prevented deaths. Yet it makes intuitive good sense that interventions designed to lessen despair underpinning suicidal states and to increase reasons for living would, in fact, save lives. Based on a chain of circumstantial evidence from prominent researchers and theologians, Parry speculates that patients with spiritual beliefs and practices woven into the warp and weft of their lives are less likely to die by their own hands.

In our article (1), we reported that nearly 60% of suicide deaths (48 of 81 subjects) occurred in individuals making a first suicide attempt coming to medical attention. The first stop for these attempters was not the emergency department but, rather, the coroner’s slab. We believe that our findings provide compelling evidence for increasing primary prevention efforts that dissuade individuals from ever making a first attack on their lives. Psychiatrists probing for patients’ religious beliefs and encouraging them to affirm and deepen spiritual connectivity when it is there could be as helpful for some as antidepressant medication or secular supportive psychotherapy.

Anecdotes can serve as powerful invocations of salvation. I offer one here of my own about a patient whose life I believe I saved through spiritual action. I met this 35-year-old father of two, a wavering Catholic, for the first time a day after he had found himself behind his house with the muzzle of a hunting rifle in his mouth. Had he pulled the trigger, he likely would have died. He was terrified enough at how close he had come to ending his life that he sought psychiatric help. I took a risk in not reflexively hospitalizing him, a disposition he opposed. I judged him no longer acutely suicidal, prescribed an antidepressant and an anxiolytic, and arranged to see him in follow-up within a couple of days. He did not want to part with his rifle, but in exchange for my not admitting him, he agreed to lock up his rifle and give the gun cabinet keys to his priest. Not until 5 years had passed, during which he recovered from a major depressive episode, gave up excessive alcohol use, left a bad marriage, renewed his faith, and contracted a new and supportive loving relationship, did he ask the priest for the return of the keys.

I believe Dr. Parry would agree that what I accomplished with this patient was a “bio-psycho-social-spiritual” maneuver.