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Book Review   |    
Suicide: Individual, Cultural, International Perspectives
Michael F. Heiman, M.D.
Psychiatric Services 1998; doi:
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edited by Antoon A. Leenaars, Ph.D., Ronald W. Maris, Ph.D., and Yoshitomo Takahashi, M.D.; New York City, Guilford Publications, 1997, 151 pages, $25

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In his soliloquy, Hamlet pondered his self-deliverance with a bare bodkin. A similar dramatic energy, but directed toward enhancing the prevention of self-slaughter, has propelled both the interest and the research foci of the American Association of Suicidology for nearly 30 years.

Suicide: Individual, Cultural, International Perspectives is the published compilation of the core keynote papers delivered at the association's 29th annual conference. At least 19 international contributors provide their clinical and research expertise to this three-part, 14-chapter, interdisciplinary volume (also published simultaneously as a special issue of the journal Suicide and Life-Threatening Behavior in spring 1997). The papers range from the idiographic perspective of intensive single-case study to the more classical nomothetic approach with its statistical and demographic focus.

Part 1, consisting of four case studies and an essay, explores the individual suicidal mind. Each case study underscores the uniqueness of someone embedded in a social and cultural world that is hallmarked by heartaches, natural shocks, and, ultimately, fatal consequences. The bonus essay, by coeditor Maris, called "Social Suicide," moves suicide's unique personal quality into the social realm.

Dr. Maris explores the problematic and social pathologies that produce "any roughly cotemporaneous intentional self-murder of two or more persons." Subsuming this definition are phenomena such as mass suicides, organizational self-destruction, suicide clusters, social analogs to individual suicide, military suicides and war, murder-suicide, suicide pacts, and witnessed suicides. Dr. Maris concludes that if we are to lower the suicide rates, "then we need to see suicide as a social act."

Part 2, with its five chapters, emphasizes the cultural connotations of the naming of the suicide act. The diversity of meanings is highlighted by focusing on suicide among Native, African, and Mexican Americans and on Asian groups compared with Caucasian groups in San Francisco. Dr. David Lester's introductory essay, "Suicide in America: A Nation of Immigrants," both provides a historical overview and sets the pattern of the subsequent chapters as culture and acculturation play out their sometimes lethal role in the ethnic meaning of suicidal behavior.

Part 3, with its four chapters, extends the concept of sociocultural influences on suicidal behavior to a global perspective. Dr. Lester provides a thoughtful discussion of limitations of data for discerning worldwide trends. Western sociocultural suicide patterns are represented by epidemiological research from Canada and Europe. Finally, Dr. Takahashi's essay, "Culture and Suicide: From a Japanese Psychiatrist's Perspective," gives the reader a refreshing and illuminating insight into the clinical mind of a caring practitioner as he confronts suicidal patients against the backdrop of Japanese culture.

In sum, this volume has something for every clinician who deals with suicidal behavior as part of a professional practice. Its major virtue is in whetting the reader's appetite to seek out more information on sociocultural issues and suicidal behavior. One area I hope future papers may address is suicidal behavior in correctional settings. Jails and prisons, with their interplay of sociocultural and economic factors with psychopathology, have been easily ignored by researchers and suicidologists. Perhaps one of the essays will inspire some readers to address this issue.

Dr. Heiman is affiliated with the department of psychiatry at the University of California, Davis.




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