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Book Forum: Suicide   |    
The Suicidal Mind
MICHAEL GARVEY, M.D.
Am J Psychiatry 1998;155:1622-1623.
View Author and Article Information
Iowa City, Iowa

by Edwin S. Shneidman, Ph.D. New York, Oxford University Press, 1996, 181 pp., $35.00; $12.95 (paperback published in 1998)

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Dr. Shneidman has spent decades studying suicidal behavior. This book offers the reader an account of his thoughts and observations about the psychology of suicide. The major theme of this book is that suicide is the result of "psychache," or psychological pain. He suggests that the most important issue to assess in a suicidal person is, "Where do you hurt?" He states that this is more important than asking about family history or examining blood or spinal fluid chemistry.

Much of this text is devoted to personal histories or written materials from suicidal patients. These are used to illustrate features of suicidal behavior that Dr. Shneidman believes are important for clinicians to learn. For example, he suggests that most suicides fall into five categories of psychological needs: thwarted love, fractured control, shame, ruptured relationships, and excessive anger. Dr. Shneidman lists and discusses what he believes are the 10 commonalities of suicide: search for a solution, cessation of consciousness, unbearable psychological pain, frustrated needs, hopelessness, ambivalence, constricted thinking, escape, communication of intention, and extension of lifelong personality styles.

One section of the book offers the reader recommendations of psychotherapeutic interventions that can be used in working with suicidal patients. Dr. Shneidman suggests several examples of techniques he has found useful in therapy sessions.

Throughout the book, Dr. Shneidman reminisces about past studies he has done and the geographical location of the studies. (Caution: the reader must resist prolonged daydreaming about the beautiful places in California that are mentioned.) From time to time, he also reflects on scholars who have impressed him or influenced his thinking.

This book is recommended to the reader who would like an introduction to the thoughts of a respected pioneer of the study of suicide. Those of you wishing to explore some of the early research of Dr. Shneidman, pull out your Internet address for MEDLINE. If you want a comprehensive review of suicide, including biological and psychiatric research with references, put on your walking shoes and head for the library to find other books.

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