Living with attempted suicide.

Self-destructive behaviour is an increasing problem to workers in all fields of medicine. When attempted suicide occurs this will be an indication of distress and this will be manifest in the patient, persons in his social environment and to medical workers involved in rescue from the attempt itself and treatment of the condition which led to this behaviour. One of the major issues confronting those who have a theoretical interest in suicidal behaviour and those who are confronted with the management problem of such patients, is the definition of the problem. The suicidal patient may harbour ideas of self destruction which may in themselves be incapacitating or, instead, only appear during periods of despair. He may actually carry out a wilful act, clearly indicating to others that he wishes to die, even though up to a third may subsequently deny any such intention. The attempt may be less clear-cut because of an unconscious factor which at the time had been brought about by alcohol or had been induced by psychological stress leading to hysterical behaviour. For some there will be an attraction to dangerous and lethal activities mainly because of low self-esteem, a life-long feeling of despair and the belief that death by chance is a worthwhile alternative (Menninger, 1938). There is a group of individuals that present major problems to medical services only because of their persistant suicidal behaviour. These comprise a significant proportion of admissions to casualty departments and medical units and might even reach surgical wards following purposeful falls from heights or in the path of moving objects. It will be found that the patient who makes repeated attempts at suicide will do so because of overpowering feelings of despair, frustration and failure. It is unfortunate that the gamble with death, which is implicit in multiple attempted suicide, will not be followed by appropriate management in the great majority of cases. The difficulty which medical and psychiatric workers experience will, in itself, be distressing. In the present paper it is my intention to give an account of the problems which will be found in the suicidal patient, his social network and finally in the medical community which has been regarded as an alternative support system. In order to complete this account it will be necessary to describe patterns of coping in the patients mentioned as well as in the groups remaining when suicide occurs.