(p. 431) Epilogue
Two factors are emphasized in this study of suicide: the circumstances surrounding each of 134 cases of suicide and the psychiatric diagnosis of each of the 134 suicidal individuals. The introduction to this report calls for further such studies for there is clearly more to learn about the general clinical phenomena of suicide. The broader our knowledge of suicide, in terms of numbers, the less likely we are to overlook clues to a biological cause. But ultimately, prevention of suicide cannot be accomplished simply by repeating clinical studies and thereby broadening the fund of clinical information indefinitely. We must be prepared to use the accumulated clinical knowledge in an effort to uncover the biological nature of those psychiatric illnesses most commonly associated with suicide. Suicide is not an isolated event, but rather the last link in a chain of increasingly mortal symptoms.
The first chapter of this book lists seven questions that the St. Louis study was designed to answer. Six of these were answered with numerical results and the sample on which these were based is representative of the U. S. population in terms of race and sex ratios:
1. What proportion of persons who commit suicide are clinically ill psychiatrically? In the St. Louis sample, 94% were diagnosed as having had mental illness.
2. What is the nature and frequency of the illnesses from which these people suffer? Findings of the St. Louis study: affective disorder, depressed phase—47%; alcoholism—25%; organic brain syndrome—4%; schizophrenia—2%; drug dependence—1%; undiagnosed psychiatric illness—15%.
(p. 432) 3. Are there mental illnesses which, while common in the population, are rarely or never associated with a completed suicide? In the St. Louis sample, there were no cases of anxiety neurosis, obsessional neurosis, phobic neurosis, or uncomplicated hysteria.
4. What are some of the factors other than diagnosis that may be helpful in assessing the probability of suicide, or indicative of the possibility of suicide (predictors of suicide)? Increasing age, being male, being white. Each of these “predictors” increases in accuracy, positively or negatively, in combination with psychiatric diagnosis.
5. In urban western society, to what degree is suicide a medical problem as measured by the proportion of suicides who have been seen by physicians or psychiatrists or have been hospitalized during or shortly before the last episode of illness? St. Louis study results: 73% of the sample had sought professional clinical help in the last year of life.
6. What proportion of subjects are not psychiatrically ill at the time of suicide? St. Louis study finding: 6%.
7. Does the presence of medical or surgical illness seem to play a role in suicide? This is the single question that the results of the St. Louis study did not answer unequivocally. Some of the informants felt that physical illnesses had played important roles; others felt they had played only minimal roles; still others were uncertain about their significance.
It is my belief that individuals suffering from affective disorder and alcoholism account for 70% to 80% of completed suicides. To answer the larger questions concerning the causes and prevention of suicide will require further investigation of these two illnesses, especially their biological aspects.