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Suicide prevention: An ethically and scientifically informed approach.

Those who belong to a community in which they feel loved and valued are much less likely to die from suicide. Unfortunately, many people lack that sense of connection. Often, they end up in the offices of psychotherapists who must help them build or reestablish the social connections and resources needed to make life worth living. I wrote this book to help psychotherapists become better at assessing, managing, and treating patients who are suicidal. This topic is important to me. During the 1970s and 1980s, I delivered emergency services in two community mental health centers in rural Pennsylvania. I remember the faces and the stories of many of my patients. I remember the young man who shot himself in the head with a pistol (and lived); the young woman who took an overdose of drugs, came into my office the next day, and refused to talk; and the middle-aged mother who hated herself because she had neglected her children years ago during a depressive episode. These memories evoke strong emotions even 40 years later. The emotional quality to these stories is hard to capture fully in written text. I also worked with the survivors of suicide. They often stated that their lives were shattered by guilt and loneliness. Suddenly they questioned basic assumptions about themselves as good parents or good spouses. Their expectations for the future changed for the worse. During those years, my colleagues and I tried to deliver effective and respectful services (see Knapp, Dirks, & Magee, 1982). Most patients were cooperative and received outpatient treatment. But some seriously suicidal Introduction