Preventing Suicide

An article in the July 4 issue discussed how psychiatrists are often overwhelmed by a patient’s suicde. Psychiatrists are expected to prevent suicide, but all too often this is an impossible task. The psychiatrist can make a careful diagnosis and initiate the best treatment available. That is all. Suicide prevention is a monumental task. Suicides occur even among hospitalized patients on 24-hour suicide watch. More often, suicides are postponed rather than prevented.

While most individuals who kill themselves give warning of their intent, the threats are difficult to interpret. We can recognize that certain individuals are at high risk, but studies have shown that identifying individuals who are likely to commit suicide is not always possible. Unfortunately, the general public, judges, juries, etc., believe that suicide is always preventable. Whenever a suicide occurs there is an immediate search for “what went wrong.” Guilt-ridden relatives want to blame somebody. Insurance companies would rather settle claims than incur the expense of a trial and trust the verdict of a jury.

What can the psychiatrist do? He or she needs to recognize the limitations and do his or her clinical best and keep careful notes (never erase). Suicidal patients are a source of endless disquiet. No other mode of death causes so much distress to relatives, friends, and caregivers. It is a shock to the psychiatrist, a blow to his or her narcisisim, and the occasion for an agonizing reappraisal of competence as a clinician.

The ultimate in suicide prevention is to help people live meaningful, productive lives. It is not a task for the psychiatrist alone.