Enquiries into Attempted Suicide [Abridged]

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Abstract
Retrospective analysis of people who had committed suicide is of only limited value for clinical psychiatry; a great deal may be learned through an intensive study of those who have survived suicidal attempts. No data are now available concerning the real incidence of attempted suicide; it is estimated that this number is ca. 6-7 times as high as that of suicides. In Greater London, more men than women committed suicide, while attempts were more frequent among women. The peak incidence occurs in men in the age group 65 to 74 and in women of 35 to 44. In recent years drugs are being used more frequently; this is related to the increased availability of sedatives. Drugs being the least effective method, for the first time registered attempts outnumbered successful suicides. 138 attempted suicides, 74 men and 64 women, were traced and reexamined to ascertain their state of health and the immediate and long-term effects of the suicidal attempts on their relationship to their environment. 72 were initially diagnosed as psychotic; 21, as psychopathic reaction and 45 as neurotic depression. Death by suicide subsequently occurred in only one patient. Social isolation was an important motivating factor, 22.6% of the patients were living alone as compared with 5 to 6% in the general population. Attempted suicide is regarded as a behavior pattern. Self destruction cannot be the main and only purpose of the suicidal attempt. The majority of those who kill themselves do so at the first attempt. There appears to be social element in the pattern of most suicidal attempts[long dash]an element of "appeal" to other human beings. Attempted suicide is regarded as a catastrophic reaction to an intolerable social and emotional situation. The suicidal attempt usually results in some modification of the individual''s attitude to himself, and of the social situation. The response of the human environment is of decisive importance. There was a group in which crumbling relationships were cemented and others in which it resulted in a rupture of precarious human relations. In the latter instance, there was usually a regression to a state of greater dependency. The frequency of suicidal attempts lies partly in the attitude of our society[long dash]we can tolerate the threat of suicide less than any other threat, including that of murder. This gives the appeal character of the suicidal attempt such a tremendous force. During periods of war, the rate for attempted suicide declines; this is thought to be due to decline in the value of life and, hence, in the loss in the force of appeal. However, "attempted suicide" is thought to be a behavior pattern which is at the disposal of only a limited group of personalities.
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