Psychiatry and suicide: The management of a mistake.
Light, Donald W. Jr. (1972). Psychiatry and suicide: The management of a mistake.
American Journal of Sociology, Vol. 77, No. 5, pp. 821-838.
This paper works to collect and present a body of psychiatric literature on the professional response to the suicide of a patient, which, at the time of publication, had not been done previously. The authors outline why and how identified psychiatric ‘mistakes’ throughout the psychotherapy of a patient can be used to analyze the organization and performance of social interactions. To identify and describe the basic beliefs, values and features of the psychiatric and psychotherapeutic professions, the authors investigate what is perhaps considered the most major error in modern psychiatry—the act of suicide committed by the patient or subject. A patient’s suicide is framed as an ‘error’ among the presented psychiatric discourse. This is done to place distance between psychiatrist and patient, and to permit psychiatrists to discuss the sometimes tragic or horrifying results of their therapy without guilt, or in a way which will prevent the patient’s death from being blamed on their therapist.
The authors draw their conclusions from a variety of psychiatric literature on the topic of patient suicide and suicide prevention. The analysis found within the article is entirely observational and based on preexisting articles, dissertations and written discussions within the psychiatric and psychotherapeutic communities. The article attests that its central finding is that the fundamental conflict of psychotherapy is that psychiatrists are constantly torn between acting as both physicians and therapists. The threat of a patient’s suicide is at the crux of this conflict, as it not only affects the physical body and leads to expiration—the concern of a physician—but that the injury is—by definition—self-inflicted, the concern of the therapist. Perhaps the strongest statement in the piece is, “Putting nude suicidal persons in padded isolation cells symbolizes perfectly the end point of professional ambivalence between the responsible physician who cannot help and the helping therapist who does not wish to be responsible” (836). When a patient is deemed suicidal, the therapist side of the psychiatrist devises a plan to cure their patient’s psychosis. However, the data show that as suicidal tendencies flare up or worsen, or when the patient appears increasingly unstable or incurable, the physician side of the psychiatrist increasingly asserts that the life of the patient as well as the success of the therapy is entirely the responsibility of the patient. The conflicting beliefs and actions of psychiatrists are apparent.
In identifying a pattern of major mistakes made in psychiatric philosophy and practice, the authors highlight and undermine the flawed beliefs and foundations of the profession. The meanings which psychiatrists construct and ascribe to an act of suicide become the clinical reality of the practice. The authors attest that their analysis works to shed light on the true inner workings and realities of the psychiatric profession. The authors also likewise ascribe tremendous power to the psychiatrist insomuch as psychiatrists’ behavior and treatment protocols are constructed as having a direct relationship with clients’ behavior and outcomes. This article directly relates to the treatment of patients or subjects by psychiatrists and emphasizes the risks and flaws found in the discipline’s philosophy and methodology, which–according to the authors– can lead to clinical failure (i.e., client suicide).