Suicide is a common and difficult problem in all societies. Many studies have shown that pain and depression are potential risk factors for suicidal risk in medical patients. Acute changes in medical condition and loss of physical function have also been identified as risk factors, as have agitation and readily available lethal means in this population.
The interface of suicide and euthanasia in medical patients is an area where the attitudes of physicians, and especially psychiatrists are of great importance. One study compared the attitudes of psychiatrists in Japan and the United States in order to investigate their ideas on whether patients in general medical hospitals who have a desire to die should be allowed to, or assisted in this regard, and whether they require psychiatric evaluation and intervention, and the cultural influences on these attitudes.
Japanese and American general hospital psychiatrists' attitudes towards the reasonability of suicide, physician assisted suicide, and removal of life supports under various medical and psychosocial situations were compared. Seventy-two American and sixty-two Japanese psychiatrist's data was collected using the Suicidal Attitudes Inventory (SAI).
The majority of both American and Japanese psychiatrists agreed that there may be times when suicidal ideation, or completed suicide in medical-surgical patients could be reasonable. Significantly more Japanese psychiatrists responded with some agreement to the reasonability of suicide when one is unable to fulfill social role expectations, and had more concern about causing suicidal ideation by informing terminal patients of their diagnosis.
Proper use of antidepressants in appropriate suicidal patients is also necessary to consider. The status of antidepressants in Japan that are approved by the Japanese Authorities is an issue that needs to be followed as it has traditionally lagged far behind the West.
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“However great a man’s fear of life, suicide remains the courageous act, the clear-headed act of a mathematician. The suicide has judged by the laws of chance—so many odds against one that to live will be more miserable than to die. His sense of mathematics is greater than his sense of survival. But think how a sense of survival must clamour to be heard at the last moment, what excuses it must present of a totally unscientific nature.”
—Graham Greene (1904–1991)
“Mark Twain didn’t psychoanalyze Huck Finn or Tom Sawyer. Dickens didn’t put Oliver Twist on the couch because he was hungry! Good copy comes out of people, Johnny, not out of a lot of explanatory medical terms.”
—Samuel Fuller (b. 1911)
“I am a lantern—
My head a moon
Of Japanese paper, my gold beaten skin
Infinitely delicate and infinitely expensive.”
—Sylvia Plath (1932–1963)
“You are, I am sure, aware that genuine popular support in the United States is required to carry out any Government policy, foreign or domestic. The American people make up their own minds and no governmental action can change it.”
—Franklin D. Roosevelt (1882–1945)
“A psychiatrist is a man who goes to the Folies-Bergère and looks at the audience.”
—Mervyn, Bishop Stockwood (b. 1913)
“Rarely do American parents deliberately teach their children to hate members of another racial, religious, or nationality group. Many parents, however, communicate the prevailing racial attitudes to their children in subtle and sometimes unconscious ways.”
—Kenneth MacKenzie Clark (20th century)