The epidemiology of suicide and attempted suicide

Since more than one century suicides have been registered in national statistics of death causes. They thus furnish one of the few parameters of psychiatrically relevant behaviour by means of which trends, cohort, age-group and period effects can be studied over longer periods. Since the second half of last century, the suicide rates for Swiss males--similar to those found in England and Wales--show a decrease in consecutive birth cohorts up to males born in the decade 1930-1940, and a continued decline in the total trend until about World War II. From then on the suicide rates of males in consecutive birth cohorts have been slowly increasing in the majority of European and North American countries--but not so in Sweden. Opposite to this, the predominantly low rates for females display little change. Further to the considerable differences between nations and the predominance of suicides committed by females in some Asian countries and Cuba, the changes indicate the significance of cultural and economic environmental factors. Typical period effects are mainly the result of changes in conception and conditions of life. In attempted suicide they proceed in a more sensitive and more rapid way and are about ten times higher. Such a period effect showing increases by about 300% in younger age-groups followed by a decline, attaining its peak about 1976, was ascertained in large cities of the Federal Republic of Germany. By the example of the effects of a television serial, the study of causal processes turning collective environmental factors into individual suicidal behaviour, proved that regularities are effective in learning by a process of modelling. Besides, the epidemiological data give essential hints how to treat suicidal behaviour.     

HIV infection: trauma and coping with trauma

The initial results of a German-Swedish research project demonstrate the at times active-resistant and at times passive-resigned approaches of AIDS patients toward their illness.     

Threshold tracking for assessment of long-term adaptation and sensitization in pain perception

To assess temporal variations in the perception of "phasic" heat pain stimuli a psychophysical tracking procedure was developed that enables repeated assessment of the pain threshold at short intervals. This "double-tracking" procedure produces two tracking curves simultaneously, one that approaches the pain threshold gradually from above, the other from below. The threshold for phasic heat pain was measured in 80 tracking trials with stimuli at temperatures near the pain threshold. Concurrently, the threshold for "tonic" heat pain was determined after every 20 tracking trials with a stimulus adjustment procedure. Eleven healthy subjects (age: 26.4 yr. +/- 6.0) participated in 2 sessions each. Phasic stimulation near the pain threshold did not produce any trends in either of the two threshold measures. Hence there was no long-term adaptation or sensitization. However, there were random variations (random walks) in the tracking curves, which we interpret as resulting from a stochastic relationship between stimulus and sensation. In agreement with other reports, discrimination seemed to be better at painful than at nonpainful temperatures.     

Decision time and movement time in depression: differential effects of practice before and after clinical improvement

Choice reaction time involves, at least two components of response latency, decision time and movement time. Studies of choice reaction time usually provide values of these two components averaged over a given number of trials. The aim of the present study of depressed subjects was to investigate changes across practice on Decision Time (DT) and Movement Time (MT) before and after clinical improvement. 19 depressed subjects were given two sessions of 50 trials each, one before treatment (Di) and one after recovery (Df). Decision time and movement time exhibited quite different patterns. Decision time significantly decreased with clinical improvement. No significant variation across trials was found, in either session. Movement time values varied across trials but the variations observed on Di and Df were significantly different, whereas before treatment latencies recorded at the end of the session were greater than those scored at the start, the contrary was observed after clinical recovery. No significant difference was found between values of movement time scored at the start of the two sessions.     

On the logic of causally necessary and sufficient conditions: Towards a theory of motive-explanations of human actions

Research carried out under the auspices of the Bank of Sweden. Tercentenary Foundation project RJ 86/183: Basic Concepts of Procedural Law in the Light of Present-Day Philosophy of Language and Linguistics.     

Reading long words embedded in sentences: informativeness of word halves affects eye movements

The possibility was explored that the informativeness of a specific region within a word can influence eye movements during reading. In Experiment 1, words containing identifying information either toward the beginning or toward the end were displayed asymmetrically around the point of fixation so that the reader was initially presented with either the informative or noninformative zone. Words were read with shorter summed initial fixation time when the reading was started from the informative zone. In Experiments 2 and 3, the target words were presented in sentences that were to be comprehended. More attention was given to the informative endings of words than to redundant endings. The latter were also skipped more often. The duration of the first fixation was not affected by information distribution within the word, whereas the second fixation duration was. The results of these experiments lend good support to the hypothesis of immediate lexical control over fixation behavior and to the notion of a convenient viewing position.     

Social anxiety and fear of bodily sensations in panic disorder and agoraphobia: A matched comparison

This study tests the hypothesis that social anxiety and fear of bodily sensations are associated with the development of agoraphobic avoidance behavior in panic disorder patients. Twenty patients with panic disorder were compared to 20 patients with panic disorder with agoraphobia, matched by sex and duration of disorder. The two groups did not differ on measures of fear and frequency of assertive social responses. However, the agoraphobics scored higher on measures of interpersonal sensitivity, depression, feelings of inadequacy, and hostility. They also reported higher fear of bodily sensations. Although definitive conclusions need to be postponed until prospective studies have been conducted, there is evidence suggesting that the development of agoraphobia in panic patients is associated with hypersensitivity to bodily sensations and interpersonal situations.This research was supported by Grant 560-268-009 of the Dutch Organization for Scientific Research.     

Resistance revisited

It was a coincidence that I was asked to talk about resistance at Ground Rounds at the University of Texas, Department of Psychiatry, on the tenth anniversary of mailing the first version of Death of Resistance to a journal in 1979. Although the paper was subsequently rejected 17 times and revised six times, it was eventually published inFamily Process (de Shazer, 1984). I still insist that the concept of resistance was a bad idea for therapists to have in their heads.This paper was presented April 14, 1989, at Ground Rounds, University of Texas, Southwest Medical Center, Department of Psychiatry, Dallas, Texas.