Physicians View Death and Suicide*

ABSTRACT: Comparisons were made between physicians' attitudes toward death and suicide and those of a nonphysician control group. Results of the analysis revealed significant differences that may offer some insights as to why physicians have an elevated suicide rate.     

Suicide and the Generation Gap*

ABSTRACT: To explore psychological parameters of suicide as perceived by young adults, the middle-aged, and old people, an area sample of 317 Detroit subjects, whose ages placed them in one of these three generations, was administered a questionnaire concerning their beliefs about the generations and suicide and their self-reported relationship to suicide. A 3-way fixed-effects analysis of variance (generation × sex × socioeconomic status) indicated that all generations believed that the old (a) have the greatest desire to die, (b) know the least about suicide, (c) make the fewest attempts, (d) are the least frequently successful, and (e) are the least socially condemned for committing suicide. Self-appraisals indicated that (a) lower socioeconomic status is associated with a greater “death wish,” (b) young adults and males claim a greater knowledge about suicide, and (c) the generations do not differ in desire to die, considerations of suicide, and suicide attempts.     

Transcultural Attitudes toward Homicide and Suicide*

ABSTRACT: Using the concept that homicide and suicide are complex sociopsychiatric phenomena clearly influenced by cultural norms and values that define which behaviors are viewed as deviant, the investigators constructed a small-sample model to determine relevant qualitative attributes of public opinion. A stratified factorial sample of 258 subjects distributed among eight large cities throughout the world was selected for interviewing. The 2,603 resulting statements were then subjected to content analysis and categorization. Results indicated that people in cities, regardless of location, are most concerned about crimes of violence, especially homicide, and those against property. Other kinds of life-threatening offenses such as arson, war, and suicide are seldom seen as important “crimes.” Many people endorse a problem-solving approach to dealing with crime and criminals, but a reservoir of traditional, punitive attitudes clearly remains among the less educated, lower socioeconomic classes. A commonality of many attitudes in these various urban centers does suggest that modern communication techniques may well have a modulating effect on culture-bound orientations toward crime.     

Firearms and Their Role in Homicide and Suicide*

ABSTRACT: Various arguments against firearms from the standpoint of their role in homicide and suicide are discussed. It is contended by some that murderers are law-abiding citizens who get into trouble because of the availability of firearms. A study in Detroit indicated that both murderers and suicidal persons are prone to misuse the firearm as they would misuse any potential instrument of destruction, independent of gun control measures. If the Second Amendment to the Constitution is to be used by those favoring the right to bear arms, the argument must involve an incorporation of an inherent responsibility toward the use of the firearm; that people wanting to use them should be able to accept reasonable rules and personality qualification as a factor in having the right to obtain them. More effective education and screening of the overly aggressive person or the self-destructive individual are suggested, in terms of school mental health programs, screening at the police precinct level, gun permit application level, and through effective suicide prevention and crisis centers.     

New Directions for Suicide Prevention Centers*

ABSTRACT: This paper considers a number of questions regarding the epidemiology of suicidal phenomena and discusses some of the efforts of the Cornell Program in Social Psychiatry to study these questions and to explore new directions for suicide prevention work. Particular attention is paid to high suicide risk groups that are outside the network of existing medical services. Strategies for extending the clinical picture differentiating between syndromes assessing individual risk, clarifying etiological factors, and improving the working of the health services are considered.     

Suicide Risk Prediction: A New Approach*

A computer program that collects suicide risk factors by computer interview from persons with thoughts of suicide and processes the data to provide risk predictions has been written and pilot tested. Patient acceptance of the interviewing technique was good; more than half of the patients interviewed preferred the computer to a doctor as an interviewer. Bayes Theorem is used to process the data collected against a subjective data base. In a retrospective study comparing risk predictions made by the computer with predictions by experienced clinicians, the computer was more accurate in predicting suicide attempters (p .01) and slightly less accurate in predicting nonattempters. The program is economical, can be used wherever a telephone and a computer terminal are available, and is readily and uniformly modified to include new data.     

Suicide in the Subway: Psychodynamic Aspects*

ABSTRACT: Fifty-one cases of suicide attempts in the subway have been investigated to examine the question of whether the method used has psychodynamic significance or is merely adventitious. We found that no single characteristic distinguished subway suicide from all other suicide modalities, although as a group the subway cases had a higher proportion of psychotic and previously suicidal patients than other series quoted in the literature. However, there were important differences between subway suicide cases seeking a “traumatic” death (jumping in front of a train; lying across the track awaiting destruction) and those seeking a “nontraumatic” death (electrocution on the live “third rail”). The traumatic group had histories of exposure to violence, other traumatic suicide attempts, hostile or destructive delusions, and many “destroy” words on psychological test protocols. The smaller nontraumatic group had no such history of exposure to violence; their previous suicide attempts were nontraumatic; delusions, when present, were not menacing; and the psychological tests showed more “escape” words than “destroy” words.     

Five Components of a Basic Suicide Syndrome*

ABSTRACT: To the question “Why suicide?” a tentative framework is proposed, taking the form of a syndrome of five components: (a) commitment; (b) rigidity; (c) failure; (d) shame; and (e) isolation. These are quite similar to the conclusions of a study by Dorothy Miller. The syndrome is psychological as well as sociological, deals with the response of the suicider to crisis, and suggests mechanisms lacking in other theoretical frameworks. Quantitative and qualitative data taken from interviews with survivors of well over 100 suiciders support the framework. Also discussed are possible further refinements of the syndrome, its adequacy, and its applications to intervention with suicidal persons.     

Suicide Attempt and Social Isolation on the MAPS Test*

ABSTRACT: Make-A-Picture Story Test protocols of 14 suicidal, 47 schizophrenic, and 49 normal male Caucasian subjects were evaluated for the presence and extent of social isolation. Social isolation was defined by the number of figures used and their social withdrawal implications. It was found that the suicide attempters used more figures than the other subjects and that there was no difference in the social withdrawal implications of the figures used by the suicidal and normal subjects. It was concluded that the social isolation of suicidal individuals manifests itself on the MAPS by increased compensatory fantasied interpersonal contacts.     

Suicide prevention in the Pacific War (WW II).

During the war against Japan, there were two facets of an American program to prevent suicide among the Japanese. One was a research component in the Foreign Morale Analysis Division (FMAD), a subunit of the Office of War Information. The principal FMAD figure who did most of the research on Japanese suicide and ways to prevent suicide among the Japanese military was the anthropologist Ruth Benedict, assisted by her Japanese-American aide Robert Hashima. The second facet was the suicide prevention program itself, which was put into effect toward the end of the war in the battles of Saipan and Okinawa. This program of action was undertaken by American GIs. These unheralded activities in suicide prevention merit a place in the annals of suicide prevention programs.     

An Assessment of the Utility of Suicide Prediction*

ABSTRACT: Efforts to predict a future event assume varying levels of confidence depending on its base rate and the error rate of the prediction instrument. Most researchers working with suicide prediction instruments seem tacitly to assume they will be able to predict a future suicide most of the time. Applying basic decision theory on a neuropsychiatric hospital population indicates that researchers using a prediction schedule will be unlikely to predict a future suicide beyond a 20% level of efficiency. Contrary to the general clinical view, eliminating false negatives was shown to be more practical than eliminating false positives in increasing the efficiency of a predictive schedule.     

Content Analysis of Multiple Messages in Suicide Notes*

ABSTRACT: Two hundred twenty individuals who committed suicide and who left notes, when compared with 813 non-note writers, were significantly more likely to be white, female, and, if female, to have any other marital status than “widowed.” With respect to method, the results indicated that note writers were more apt to have committed suiced with “Drugs” and less apt to have used “Other” methods. The question is raised as to whether or not note writers can be accepted as representative of the whole group of those who commit suicide. In 195 suicide notes for which content was available for analysis, the relative percentages of statements containing advice, instructions, and requests (31), other-directed positive affect (19), acknowledgment of wrongdoing (7), and hostile affect (5) were the same in the entire sample as in subsamples of age, sex, and marital status. Only for a few specific content categories did the relative frequency of content vary significantly with age, sex, or marital status. Advantages of the present method of content analysis are discussed, and suggestions for further research in this area are offered.     

A Two-Year Follow-up of Suicide Prevention Center Patients*

ABSTRACT: A random sample of Los Angeles Suicide Prevention Center patients was selected for follow-up about two years after their prior contact with the Center. Of 417 patients sought, 184 were located and interviewed at follow-up. Sixteen had died and nine had committed suicide. The deaths were studied in depth by interviewing survivors (by means of a psychological autopsy). Results of the psychological autopsies uncovered two apparent suicides who had been certified as natural deaths (included in the total of nine). Interviews with the 184 follow-ups yielded longitudinal information about the onset, duration, and recurrence of suicidal states.