Around the world there are about 1 million deaths from suicide each year. This is more than in all the various wars and conflicts currently ongoing, a fact that would doubtless surprise many, including some policy makers. Suicide is clearly a major public health problem and this new textbook addressing suicide and its prevention is to be welcomed. The editors are a psychiatrist and an anthropologist, widely published in a range of issues related to suicide, who have brought together a distinguished international group of contributors with a breadth of academic and clinical experience in this field.
The strengths of the book are in the breadth of its coverage embracing both public health and healthcare issues as well as giving the reader a truly international perspective on suicide and strategies for its prevention. There is much to be learnt from the shared experiences of authors from every corner of the globe. I was particularly engaged by the chapter on suicide during a time of transition in the former Soviet republics. The ethnic and religious diversity in the post-Soviet countries, as well as the role of alcohol and the anti-alcohol policy in the perestroika period, mean the lessons of this chapter have significance well beyond these countries themselves.
It will surprise many readers that the book opens with chapters on suicide in a religious and cross-cultural perspective. The editors defend this decision in the preface, highlighting the fact that suicide is deeply tied up with the individual's existential and social condition; this is also ably argued further throughout the book. Psychiatrists as a group are less religious than their patients, yet strategies to prevent suicide need to ‘incorporate the traditional world views of individuals and communities’ and their constructions of the meaning of life and death. Thus, psychiatrists should heed the message of these chapters irrespective of their own beliefs.
From the perspective of a practising clinician, I found the chapter on the clinical interview as an assessment tool of particular value, as it emphasises being able to understand the patient's ‘experiential world’ as a crucial part of clinical assessment, complementing standard assessment of risk factors. However, like many other chapters in this book, it will leave the reader thirsting for more.
The book has other weaknesses. Given that the population attributable risk for suicide in people who have a mental illness is 40%, and as one of the authors notes, mental illness is ‘an almost necessary but insufficient risk factor for suicide’, psychiatrists will be surprised that there is only one 12-page chapter on major psychiatric disorders and suicide (though this is covered to some degree in other chapters). Other omissions include discussion of mentalisation-based treatments for border-line personality disorder; similarly, discussion of the role of primary care in suicide prevention is weak. Surprisingly in the current political climate, there is little or no mention of suicide as a political act (including suicide bombing). Finally, UK readers will be surprised that this Oxford textbook contains no contributions from the Oxford University Centre for Suicide Research. These comments notwithstanding, this book is a notable addition to the literature on suicide and its prevention and it is highly recommended.
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