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Book Forum: Suicide   |    
AJP nov97 Book Forum ? Essential Papers on Suicide
Howard S. Sudak, M.D.
Am J Psychiatry 1997;154:1622-a-1623.
View Author and Article Information
Philadelphia, Pa.

edited by John T. Maltsberger, M.D., Mark J. Goldblatt, M.D. New York, New York University Press, 1996, 638 pp., $75.00; $27.50 (paper).

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This anthology of "essential" journal articles and book chapters is part of the series Essential Papers in Psychoanalysis, under the general editorship of Leo Goldberger. Fifteen volumes have been published on a wide range of topics—all apparently with a psychoanalytic or psychodynamic slant. If all are of the same quality as Essential Papers on Suicide, then Leo Goldberger and New York University Press are certainly to be congratulated.

In their introduction to the work, Maltsberger and Goldblatt explain why they selected these specific papers for inclusion. They purposely gave short shrift to biochemical and pharmacological contributions to the literature, but without any intent "to minimize the value of psychopharmacological and biological contributions" (p. 3). They acknowledge that "the development of anti-depressant drugs represents the major therapeutic advance in helping suicidal patients in recent years. However, most psychopharmacological papers pertain to the treatment of depression and other psychiatric illnesses in general, and not to suicide specifically" (pp. 3–4). The authors' purpose in this collection is "to offer an array of papers that are psychologically close to the suicide experience, or else throw light on that experience, whether the papers are biological, chemical, or sociological. Our bias is, in short, psychoanalytic. We believe that a good grasp of the psychology of suicide, and of the special emotional challenges that confront those who treat suicidal patients, is the sine qua non for effective clinical work, whatever psychotherapeutic or psychopharmacological tactics one may embrace. If these papers are essential, it is because they deepen our grasp of the texture and color of the inner lives and struggles of suicidal patients and the corollary challenges they pose for those who treat them" (p. 4). The editors clearly achieved this goal.

The papers are arranged chronologically, beginning with classical papers by Ernest Jones and Karl Menninger, followed by Gregory Zilboorg, Kate Friedlander, and Ives Hendrick. Emil Gutheil's "Dream and Suicide" and Viggo Jensen and Thomas Petty's "The Fantasy of Being Rescued" follow. Some epidemiologic points of view are represented in the paper by Eli Robins et al. on 134 successful suicides, Pokorny's prediction study, the work on child psychiatry inpatients by Cynthia Pfeffer et al., and the view of suicide and panic disorder of Myrna Weissman et al. Transference and countertransference issues are addressed by Leston Havens, Gerald Adler and Dan Buie, and Maltsberger and Buie. Additional aspects of the psychotherapeutic endeavor include works by Donald Schwartz, Don Flinn, Paul Slawson, Edwin Shneidman, and John Birtchnell. Suicide prediction is represented by the paper on hopelessness by Aaron Beck, Maria Kovacs, and Arlene Weissman, the classic paper on 5-HIAA in the CSF by Marie Åsberg, Lil TrÄskman, and Peter Thorén, Maltsberger's paper on clinical estimates of suicide danger, and others. David Phillips' paper on the influence of suggestion, Robert Litman and Charles Swearingen's paper on bondage and suicide, and Alec Roy's paper on chronic schizophrenia and suicide are also included. The paper by Jan Fawcett et al. showing that hopelessness was a more accurate predictor of later suicide than suicide in the first year following discharge, and Shneidman's paper on suicide as "psychache" are among the later chapters.

How does one determine which papers constitute the 40 essential papers in suicide? If one agrees with the editors' perspective, one is still apt to have a different short list from theirs. If one has a different bias, then an entirely different list would be produced. For instance, because the rate of change—the slope of the science—is less steep in psychology than it is in biology, a "classic paper" remains classic for perhaps longer in our psychological domain than in our molecular biological one. There is a large, ever-changing body of literature on biological aspects of psychiatry, so that an "essential" paper on psychopharmacology grows more quickly out of date than the assemblage produced here. These are, in my view, essential papers—they include many of the ones I suggest to residents and medical students, so I applaud the editors' efforts. Too little is currently written about the psychology of suicide—the internal psychodynamics and the understanding of these—which can be so critical in helping the suicidal patient. I also appreciated the editors' brief comments and biographical notes that precede each of the entries because of the helpful perspectives these provide.

One can always find something about which to quibble—for instance, including Phillips' paper on suggestion but omitting any of the work of David Shaffer and his group on imitation—but I can't imagine that any two experts would independently come up with same "top 40" list. There is an acknowledged bias toward the Massachusetts Mental Health Center semiradicals group here, but there has also been an enormous and significant contribution in the literature from that group. My own wounded narcissism (for the lack of inclusion of any of my papers) was greatly assuaged when I realized that two of the chapters (Erna Furman's and Jack Novick's) were reprinted from a book that my colleagues and I edited. I, perhaps, might have included a few more classic psychopharmacological papers, and the reader will undoubtedly find other nits to pick. Nonetheless, the book is true to the editors' stated biases. Maltsberger, certainly, is first and foremost a clinician, an analyst, and a sensitive microscopist of human behavior, and he and Goldblatt have put together an anthology that should be treasured by all of us in the mental health field who psychologically must confront the dilemma of suicide almost daily.

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