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The specter of patient suicide is a horrifying potential nemesis to clinicians; therefore the promise of aid in evaluating suicide risk is welcome. Suicide Risk is intended to guide the judgment of a variety of mental health professionals, with an emphasized concern for colleagues in training. This slim volume is an expansion of a 1983 pamphlet which Maltsberger wrote in collaboration with Dan H. Buie, Jr. It is divided into five chapters and two appendices. Appendix "A" outlines, in twenty pages, the procedure for obtaining a comprehensive anamnesis and mental status examination, stressing "items that are especially important where suicide is in question" (p. 137). It is routinely distributed to psychiatric residents at Massachusetts General Hospital. Appendix "B" is a risk estimator scale, meant to be combined with clinical judgment. The main text is a guide to the psychodynamic formulation of such judgment.
Chapter 1, entitled "Vulnerability to Suicide," describes the psychology of despair and "giving up on oneself." Three intolerable affect states are discussed: aloneness, self-contempt, and murderous rage. Psychoanalysts will find an excellent sketch of the psychodynamic principles involved in separation-individuation. There are also good descriptions of identifications and introjections. Introduced here and then referred to throughout the book is the