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Fifty dangerously suicidal hospital patients of various diagnostic types, treated at the Westchester Division of New York Hospital between 1934 and 1953, were analyzed to determine the factors responsible for successful therapy. All diagnostic categories of mental illness were included and two control groups were studied.
No specific conflicts consistently precipitated suicidal tendencies. The patients seemed to be struggling with conflicts common to others of similar age and circumstances. Psychodynamics and symbolic significance were peculiar to each case. However, three coexisting unconscious or partially conscious factors appeared to determine each suicidal act: 1, hope of future greater satisfaction (reunion in death with a lost loved one, a wish to force attention or satisfaction from the present environment, or the pleasure of spite or revenge); 2, hostility or rage directed toward another, now directed at the self; 3, expression of hopelessness and frustration, relinquishing any prospect of gaining satisfactions from the present environment.
In ninety-five percent of the cases there had occurred death or loss, often under tragic circumstances, of someone closely related to the patient. In seventy-five percent of these cases the deaths had occurred before the patient had completed adolescence. In over sixty percent the death of someone close to the patient was an important precipitating factor in the present illness.
The course of therapy was divisible into three phases. In the acute phase therapy was directed toward adequate protection, relief of anxiety and hopelessness, and restoration of satisfactory relationships with others. The nursing staff must function as companions, not just as guards. Since a suicidal attempt is a miscarried aggressive act, the physician must explain to the patient that it was an effort to solve an overwhelming problem. This helps bind patient to physician, to reduce guilt and fear of retaliation and rejection, and to dire