Suicide: An Unnecessary Death. Ed Danuta Wasserman. Martin Dunitz, £29.95, pp 286. ISBN 1 85317 822 5. Rating: ★★★
Around the world, approximately one million people a year take their own lives, but of greatest concern is the recent rise in suicide rates among young people. The largest proportion of suicides now committed relates to those below the age of 45. This “ungreying” of suicide, traditionally associated with later life, acquires a dramatic aspect when one considers that the proportion of elderly people in the total population is increasing at a greater rate than that of younger people.
As a result of the sensational rise in the global suicide rate since the 1950s, the World Health Organization predicts that by the year 2020 the rate will increase by approximately 50% and that 10 to 20 times more people than this will attempt to kill themselves.
The lowest suicide rates around the world are found in the eastern Mediterranean, comprising mostly countries that follow Islamic traditions. The highest international rates are found in Europe—particularly eastern Europe in a group of countries that share similar genetic, historical, and sociocultural characteristics, such as Estonia, Latvia, and Lithuania. Outside Europe, curiously high rates tend to be found in island countries such as Cuba, Sri Lanka, and Mauritius. Also, why does Canada, which consistently gets into the top three countries for quality of life in international league tables, still have twice the suicide rate of India?
Although unable to provide satisfactory answers to these and many other oddities, this is a comprehensive, if somewhat dry, account of the state of suicide research today. It is perhaps the most authoritative account of its subject currently available, produced as it is by a collaboration between the network of WHO experts on suicide, and edited by a professor of suicidology whose clinical experience derives from Sweden—a country with traditionally a high rate of suicide.
Beyond the epidemiology, there is also much of use here to the clinician trying to detect genuine suicidal tendencies. For example, the book confronts the dangerous interaction between suicidal patients' ambivalence—swinging from wanting to die to wanting to live—with the ambivalence of the doctor performing the assessment. After all, psychoanalysts argue that many employees in the healthcare services choose their occupation out of fear of death, dependence, and helplessness—suicidal patients' self destructive behaviour runs counter to the instinct for self preservation and the desire to cure and to alleviate that are so strongly developed in healthcare staff.