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This book deals with suicide and its prevention. Its authors label their orientation as “psychosocial, field-theoretical or transactional.” They maintain that social interaction, rather than specific psychological derangement, is largely the responsible factor in suicide. They support their theory with conclusions drawn from research literature, and illustrate it with the case histories of five patients, one an attempted suicide, the other four “successful” suicides.
The setting is a small psychiatric hospital. In its nine and one-half years of existence prior to the suicide “epidemic” of which the authors treat, the hospital had specialized in individual psychotherapy and milieu therapy, defined as “concern for the potentially therapeutic value of all twenty-four hours of the patient's day in the hospital.” The importance given to attitude therapy entailed full involvement of the ward staff and close communication between staff and doctors. “Psychological treatment for the psychologically ill” was emphasized to the almost complete exclusion of other treatment means. However, changes of directorship, altered policies, problems with persons in the outside professional community, internal dissension and financial difficulties gradually undermined the confidence of the reduced professional staff in itself and its leadership, and inhibited communication.
The hospital's history is given to substantiate the authors’ premise that the demoralization of the hospital staff gave rise to an atmosphere which affected the potentially suicidal patients, so that the staff's expectation that the worst would happen caused these expectations to be fulfilled. The authors regard the patients’ communication of their suicidal