Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...

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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 6/2012Title: Suicide in the absence of mental disorderAuthors: Saxby Pridmore 1 *; Jamshid Ahmadi 2 and Anil Reddy 3 ;Type: Original ArticleKeywords: Suicide; Mental Disorder;AbstractThis paper is the result of two decades of studies by a small group of clinician/academics,with an interest in the aetiology of suicide. We find the notion that all or almost all those whocomplete suicide are suffering a mental disorder to be too restricting. We developed theconcept of Predicament Suicide, in which suicide is conceptualized as an escape fromunacceptable predicaments. One of these is painful, unresponsive mental disorder. Another isdistressing social circumstances. We have used the public record (historical texts through tonewspapers and electronic resources) to demonstrate that people with no evidence of mentaldisorder may suicide in unacceptable predicaments. We have developed the OperationalizedSuicide Predicaments (OPS) framework, a means of classifying suicide. The OPS allows forsuicide to be classified (as appropriate) as triggered by social factors. It has been found tohave face validity and acceptable correlation. It is hoped the OPS may encourage scholars andclinicians to think beyond the medical model.1 Professor of Psychiatry, University of Tasmania, Australia. S.Pridmore@utas.edu.au;* Corresponding author;2 Professor of Psychiatry, Shiraz University of Medical Sciences, Iran. jamshid_ahmadi@yahoo.com;3 Psychiatrist, Royal Hobart Hospital, Australia. Anil.Reddy@dhhs.gov.tas.au;1
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 6/20121. IntroductionSuicide is the tenth leading cause of death from a global perspective (Levi et al, 2003), butremains to be incompletely understood.For half a century, the academic view has been that all, or almost all those who completesuicide are suffering from a mental disorder. This has led to two unfortunate outcomes. First,this view has logically led to all suicide prevention efforts to be focused on the early detectionand treatment of mental disorder. Second, in some jurisdictions, when suicides occur they arebeen frequently followed by attacks by authorities who have accepted that all suicide is theresult of mental disorder, and thus the occurrence of a suicide indicates health workers arefailing to do their duty.Most lay people easily accept that people may suicide without having a mental disorder – theypoint to the occasional deaths of a jilted lover and the suicide of the person with painfulincurable disease.2. The ProblemThe social science academic community has refused to accept common sense and hassteadfastly maintained that suicide is always or almost always the result of mental disorder. Itis necessary to present some of the usually cited ‘evidence’, to confirm that a problem exists.This evidence comes from psychological autopsies, in which evidence is taken from allsurviving contacts of the deceased (family, friends and medical personnel) and the attempt isthen made to determine whether mental disorder was present or absent. In 1960, Dorpat &Ripley examined a series of suicides and concluded that 100% had been the result of mentaldisorder. In 1984 Robins examined 134 cases and concluded that 94% were the result ofmental disorder. In 1997 Mosicki stated that “a psychiatric disorder is a necessary conditionfor suicide to occur”. In 1999 Jamison stated that there is ‘unequivocal presence of severepsychopathology by those who die by their own hand”. In 2004 Bertolette et al reviewed thepsychological autopsy studies and concluded 98% of those who suicided suffered a mentaldisorder. Also in 2004 Ernst et al examined 10% of cases for whom there was no evidence ofpsychiatric disorder and concluded that there was “probably have an underlying psychiatricprocess”, which the investigators “failed to detect”.In the face of such evidence, those in authority accepted that suicide was almost exclusivelythe result of mental disorder. Our group contested this evidence.2
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