Lifelines

Suicide is a source of endless disquiet. One of the few fatal consequences of psychiatric illness, it is a threat to patients, and a vexation to therapists that puts clinical judgment to the ultimate test. It arouses countertransference reactions of unusual intensity-helplessness and guilt when the suicide is successful; anxiety and anger when it is used as a manipulative tool. For as Samuel Johnson was aware when he com­ mented that many "commit suicide, as a passionate man will stab an­ other," it is not only an escape from hopeless despair but an expression of the most violent rage. To all those who care for suicidal patients, this book will come as a welcome guide. Each of the authors represented here brings a wealth of clinical expe­ rience to bear on the subject under discussion. The psychological and bi­ ological determinants of depression are simply and clearly delineated to provide a basis for understanding the processes underlying suicide, for judging its likelihood, and for preventing its occurrence. Detailed de­ scriptions of the variety of psychological and pharmacological treatments of the suicidal patient are complemented by extensive discussions of the several settings in which such patients will be encountered, whether these be an in-patient unit, an out-patient clinic, a medical ward, an emergency room, or a private office.

The Extent of the Problem.- I. Assessment Issues.- 1. Vulnerability to Suicide.- 2. General Principles of Assessment.- II. Therapeutic Approaches 1: Methods for Immediate Containment.- 3. Crisis Therapies.- 4. Pharmacotherapy of the Suicidal Patient.- III. Therapeutic Approaches 2: Issues in Psychotherapy.- 5. Outpatient Therapies for Suicidal Patients.- 6. The Moment of Truth: Psychotherapy with the Suicidal Patient.- 7. The Stress of Therapy.- IV. Setting and Staffing Issues.- 8. Care of the Suicidal Patient in the Emergency Setting.- 9. Care, Containment, and Countertransference: Managing the Suicidal Patient in Medical Settings.- 10. Intensive Care for Suicidal Patients.- 11. Nursing Issues.- 12. The Role of the Social Worker.- 13. Suicidal Patients and the Therapist-in-Training.- V. Childhood and Adolescent Suicide.- 14. Suicidal Behavior in Children and Adolescents.- VI. Legal Issues.- 15. Suicide: A Legal Perspective.- 16. Clinical Comment.