The Practical Recognition of Depressive and Suicidal States

Abstract

Every physician can do a great deal more than he is already doing to reduce the shocking rate of suicide. Troubled persons who suffer from emotional ills turn first and most often to their physicians, next to their clergymen and then to psychologists and psychiatrists for help. Contrary to earlier erroneous concepts, few persons commit suicide without giving prior warning. Very significant numbers of those who successfully complete suicide have recently been under medical care, indicating that physicians need to be alert to such warnings in their diagnostic evaluations and subsequent management. A frequent precursor to suicide is the depressive state which all too frequently presents itself wearing a somatic mask. Somatic equivalents of depression are readily ascertained in the course of the physician''s ordinary diagnostic process. The major aspect is an alteration of the basic biological functions, especially a loss of the feeling of well-being, a sense of fatigue, altered sleep patterns especially early morning awakening, a loss of the refreshing quality of sleep, appetite and weight loss, gastrointestinal complaints (typically constipation), and diminished sexual interest. There are also those who express their underlying emotional state in the social behavioral sphere, where they commit social suicide. Alcoholism, the inexorable drinking one''s self to ruin and death, drink by drink, is often truly suicidal in nature. Sexual promiscuity and escapades constitute another avenue of social suicide. Smoking is still another. Management includes ample emotional support, anti-depressant drugs, and Intensive and extensive psychodynamic psychotherapy. Electrotherapy in the case of the agitated and involutional depression may be life-saving.