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Book Review   |    
Andrew E. Slaby
Psychiatric Services 2007; doi:
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by Edwin S. Shneidman; New York, Oxford University Press, 2004, 206 pages, $19.95

Dr. Slaby is clinical professor of psychiatry at New York University School of Medicine, New York City.

People who die by suicide do not want to die. They want to end their pain. If there were another solution, they would seek it. Although most people who die by suicide are depressed at the time, it is despair more than depression that predicts who attempts suicide. Pessimism coupled with impulsivity limits envisioning alternatives to death.

Edwin Shneidman, considered by many to be the dean of suicidology and cofounder of the American Association of Suicidology, calls the pain felt by those who die by their own hand "psychache." In this book, he craftily guides the reader through an extraordinary psychological autopsy of a sensitive, brilliant young man named Arthur, who is schooled in law and medicine and could find no enduring happiness in his work or personal relationships. Readers are provided with the suicide note Arthur left together with transcriptions of interviews with Arthur's parents, siblings, best friend, former wife, girlfriend, therapist, and psychiatrist.

Penetrating insights are provided by Shneidman and eight other eminent suicidologists in psychiatry, psychology, and sociology who served as consultants. The reader learns the many ways psychological autopsy data provide insights into the complex web of genetic, psychological, neurophysiological, and existential forces that interact to create a person who wishes to die despite obvious support from many who love him or her. Shneidman and his consultants exhibit exquisite sensitivity toward Arthur and the pained survivors who loved and cared for him as they critique what was done and what more may or may not have occurred.

All suicides are tragic even when one feels as bad as Arthur. He begins his suicide note, "All I do is suffer … every moment is pain or numbness." Self-inflicted death provides reprieve from pain that, mercifully, few of us will ever know or have the capacity to feel in such depth. Suicide, however, also deprives forever those who survive of the unique creativity and talent that ironically seems coupled with such pain. It also raises the question of whether death was inevitable and what may have been done or not done to prevent it. Shneidman and his consultants provide some answers and, equally important, raise some questions for further scientific exploration.

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