Theodore L. Dorpat

The relationship between attempted suicide and committed suicide

Summary The statistical relationship between attempted suicide and completed suicide was studied by (1) a review of 15 published follow-up studies of attempters that provided information on the incidence of completed suicide, and (2) a review of 9 published studies of committed suicide that provided data on the frequency of prior suicide attempts. The results of these studies were compared and tabulated. The limitations and methodologie deficiencies of the studies were discussed and suggestions were made for more reliable and comprehensive future research. The incidence of completed suicide in the follow-up studies of attempted suicides ranged from 0.03 per cent in one short-term study to 22.0 per cent in the longest follow-up study. The incidence of completed suicide among attempters was many times that occurring in the general population. Studies of groups who have committed suicide have found the incidence of prior suicidal attempts to vary from 8.6 per cent to 62.0 per cent. The incidence of prior suicide attempts among those who completed suicide was many times that of the general population. The clinical prognostic value of a history of attempted suicide and of the presence of those social and psychological factors associated with a high suicide risk was discussed. These data support the concept that attempted suicide and committed suicide involve two different, though overlapping, populations. The aim of this paper was to clarify the nature and extent of the overlapping.

An evaluation of suicidal intent in suicide attempts

Summary Many significant differences exist between populations who attempt suicide and who succeed in killing themselves. Variations in intent account for these differences. This study describes a method of measuring intent to die in suicide attempts in which the intent is inferred from the degree of risk taken by the subject. Using a five-point ordinal scale of suicidal intent, a group of judges made independent judgments of suicidal intent in a series of 121 unselected, consecutive attempted suicides. The judgments showed a high degree of agreement. Comparisons were made between this group and a group of 114 completed suicides. Severity of intent increased with age. Women tended to make less serious attempts. Over one-third of those who completed suicide were psychotic whereas the most frequent diagnoses in those who attempted suicide were personality disturbances. Three subgroups are distinguished. Those who make suicide gestures are individuals who have no intent to die, who tend to manipulate others in their act and to enforce a close bond with the object of their action. The ambivalent group are vacillating and confused in intent, but in taking a risk of death they too may test the affection and care of others. The serious attempt group are similar to the completed suicide group in their depression, hopelessness, and lack of social interaction. The gesture group seek to compel help from others. The ambivalent group act out fantasies of a dangerous ordeal followed by rescue. The serious group leave little room for help, but a disguised plea for help can be heard in their frequent communications of their intent to die.

Phantom sensations of internal organs

Abstract This paper reports a clinical study of two women who described having recurrent pelvic pains during the immediate postoperative period following a total hysterectomy. The cramping pains were subjectively indistinguishable in quality, intensity, duration and location from previously experienced menstrual cramps and labor pains. These postoperative cramping pains are here termed “phantom uterine contraction pains”. Reports of phantom sensations of other internal organs (bladder, rectum, stomach, genitalia) occurring after removal or denervation of the organ are reviewed. These data support the conclusion that phantom phenomena occur after interruption of sensory input from any internal organ with a mental representation. The interruption of afferent input to the brain from external organs leads to phantom organs, whereas the interruption of afferent input from internal organs does not lead to the subjects experiencing a phantom of the organ but rather leads to the experience of phantom sensations. Both clinical and experimental data support hypothesis that a necessary condition for the development of phantom phenonmena is the interruption of sensory input. The clinical data on phantom phenomena are not explained by the Freudian wish-fulfillment theory of hallucinations. Rather, these data are compatible with theories arising out of research on dreaming and sensory deprivation which say that the organism has built-in needs for sensory stimuli. It is hypothesized that the interruption of sensory input causes the central nervous system to create its own discharge of sensory centers, experienced as an hallucination.

Psychophysiologic Aspects of Backache

A study of 65 patients revealed that the backache syndrome most often appeared in situations evolving from difficulties in personal and social adjustment. In addition to emotional factors, a variety of illnesses and injuries also may precipitate backache, or psychiatric and orthopedic disease may combine to produce the clinical picture. The authors suggest that management should include psychotherapy, physical therapy and measures to reduce pain, induce muscular relaxation. and improve blood flow.

Interactional Perspectives on Denial and Defense

In this chapter, my aim is to provide an overview and discussion of the literature on the interactional aspects of denial and defense. Psychiatrists and psychoanalysts often speak or write about defense mechanisms as independent mental operations dissociated from the ebb and flow of interpersonal events. This review will show defense as an important aspect of communication between individuals and how they relate to each other. Until recently, classical psychoanalytic literature contained few studies of the influence of interpersonal relations on the formation or maintenance of defensive operations. The investigations summarized later reveal how both the form and the content of a person’s denials and defensive functioning throughout life are influenced and even partly shaped by interactions with other individuals operating out of their awareness.