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Book Review   |    
Comprehensive Textbook of Suicidology
Andrew Edmund Slaby, M.D., Ph.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.4.540-a
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Ronald W. Maris, Alan L. Berman, and Morton M. Silverman, with contributions by others; New York, Guilford Press, 2000, 650 pages, $70

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It is a tribute to the coming of age of suicidology that a volume of this quality can be written. What is lamentable, however, is that a volume of this nature is dearly needed. On average, some 30,000 Americans die of suicide each year. Another 775,000 make suicide attempts. In a conservative estimate, six family members or friends are affected by each suicide, creating large numbers of survivors each year.

Our understanding of the complex interplay of biogenetic, psychological, social, and neurochemical variables has come a long way since Emile Durkheim's 1897 study of suicide in France and the French-speaking cantons of Switzerland. Maris and colleagues' Comprehensive Textbook of Suicidology synthesizes state-of-the-art findings across behavioral and social sciences.

Coauthorship by three internationally recognized scholars of different disciplines with contributions by other authors seems to have kept to a minimum the redundancy often found in multiauthor texts. Data sources are evaluated and conflicting information explicated. Earlier reference books tended to confuse readers with inconsistent and sometimes contradictory data. By contrast, Maris and associates explain inconclusive data in summary statements and by presenting key areas of controversy in boxes describing opposing viewpoints. Examples include boxes exploring questions such as: Can suicide ever be rational? Do selective serotonin reuptake inhibitors such as Prozac cause or protect against suicide?

The book is divided into five parts. The first, with four chapters, includes an introduction to suicidology and discussions of theory, methods of study, and history. Part 2 addresses issues of age, sex, gender, race, work, marital status, family, social relations, suicide attempts, and methods of suicide. The third part includes chapters on mental disorders, physical illness, alcoholism, substance abuse, biological factors, and aggression and violence. The chapters in part 4 examine indirect self-destructive behavior and ethical, religious, philosophical, and legal aspects of suicide. The book concludes with discussions of treatment, prevention, "postvention"—that is, prevention of additional suicides in a vulnerable population—and survivor issues.

The book is enriched by suggestions for further reading at the end of each chapter, considered summaries, and illustrated case examples, including some of well-known suicides—for example, Ernest Hemingway, Sylvia Plath, Arthur Koestler, and Vince Foster.

A discussion of the complex relationship between suicide and physical illness in the chapter on that topic exemplifies the unique perspective this volume offers. While most people with acute or chronic illness do not commit suicide, some medical conditions are associated with increased suicide risk. Suicide rates among patients undergoing kidney dialysis are 14.5 times as high as those among the general population; rates are 11.4 times as high among those with malignant neoplasms of the head and neck, and 6.6 times as high among AIDS patients. Various factors figure into the calculation of suicidal risk—preexisting psychopathology; ability to manage stress, both physical and emotional; ability to seek and use social supports; mental states secondary to depression, anxiety, and psychosis; altered states of consciousness; mental deterioration; pain management; social isolation; and external pressures, such as economic woes. Sadly, most clinicians working with the chronically ill are not trained in suicide assessment, treatment, and prevention.

This Comprehensive Textbook of Suicidology should be read by all those who provide care, regardless of professional identity or specialty training.

Dr. Slaby is clinical professor of psychiatry at New York University and New York Medical College and past president of the American Association of Suicidology.

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