49 Perhaps 20 percent: J. A. Urquhart, “A Call for a New Discipline,” Pharmacology Technology, 11 (1987): 16–17.
50 in medical conditions such as epilepsy: D. L. Sacket, “The Magnitude of Compliance and Noncompliance,” in D. L. Sacket and R. B. Haynes, eds., Compliance with Therapeutic Regimens (Baltimore: Johns Hopkins University Press, 1976), pp. 9–25; J. A. Cramer and R. Rosenbeck, “Compliance with Medication Regimens for Mental and Physical Disorders,” Psychiatric Services, 49 (1988): 196–201.
51 For patients taking antidepressants: J. L. Young, H. V. Zonana, and L. Shepler, “Medication Noncompliance in Schizophrenia: Codification and Update,” Bulletin of the American Academy of Psychiatry and the Law, 14 (1986): 105–122; F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990); W. S. Fenton and T. H. McGlashan, “Schizophrenia: Individual Psychotherapy,” in H. I. Kaplan and B. J. Sadock, eds., Comprehensive Textbook of Psychiatry, 6th ed., vol. 1, (Baltimore: William & Wilkins, 1995), pp. 1007–1018; S. A. Montgomery and S. Kasper, “Comparison of Compliance Between Serotonin Reuptake Inhibitors and Tricyclic Antidepressants: A Meta-Analysis,” International Clinical Psychopharmaology, 9 (Suppl. 4) (1995): 33–40; W. S. Fenton, C. R. Blyler, and R. K. Heinssen, “Determinants of Medication Compliance in Schizophrenia: Empirical and Clinical Findings,” Schizophrenia Bulletin, 23 (1997): 637–651; J. Garavan, S. Browne, M. Gervin, A. Lane, C. Larkin, and E. O’Callaghan, “Compliance with Neuroleptic Medication in Outpatients with Schizophrenia,” Comprehensive Psychiatry, 39 (1998): 215–219; E. Frank, R. F. Prien, D. J. Kupfer, and L. Alberts, “Implications of Noncompliance on Research in Affective Disorders,” Psychopharmacology Bulletin, 21 (1985): 37–42.
52 The one study that directly compared: P. E. Keck, S. L. McElroy, S. M. Strakowski, M. L. Bourne, and S. A. West, “Compliance with Maintenance Treatment in Bipolar Disorder,” Psychopharmacology Bulletin, 33 (1997): 87–91. An earlier short-term study found essentially no differences in compliance between lithium and valproate; see C. L. Bowden, A. M. Brugger, A. C. Swann, J. R. Calabrese, P. G. Janicak, F. Petty, S. C. Dilsaver, J. M. Davis, A. J. Rush, J. G. Small, E. S. Garza-Treviño, S. C. Risch, P. J. Goodnick, and D. D. Morris, “Efficacy of Divalproex vs. Lithium and Placebo in the Treatment of Mania,” Journal of the American Medical Association, 271 (1994): 918–924.
53 Compliance rates are even lower: H. M. Bogard, “Follow-up Study of Suicidal Patients Seen in Emergency Room Consultation,” American Journal of Psychiatry, 126 (1970): 141–144; N. Kreitman, “Reflections on the Management of Parasuicide,” British Journal of Psychiatry, 125 (1979): 275; H. G. Morgan, C. J. Burns-Cox, H. Pocock, and S. Pottle, “Deliberate Self-Harm: Clinical and Socio-Economic Characteristics of 368 Patients,” British Journal of Psychiatry, 134 (1979): 335–342; I. F. Litt, W. R. Cuskey, and S. Rudd, “Emergency Room Evaluation of the Adolescent Who Attempts Suicide: Compliance with Follow-up,” Journal of Adolescent Health Care, 4 (1983): 106–108; E. Taylor and A. Stansfeld, “Children Who Poison Themselves: I. A Clinical Comparison with Psychiatric Controls. II. Prediction of Attendance for Treatment,” British Journal of Psychiatry, 122 (1984): 1248–1257; G. O’Brien, A. R. Holton, K. Hurren, L. Watt, and F. Hassanyeh, “Deliberate Self-Harm and Predictors of Outpatient Attendance,” British Journal of Psychiatry, 150 (1987): 246–247; R. B. Vukmir, R. Kremen, D. A. Dehart, and J. Menegazzi, “Compliance with Emergency Department Patient Referral,” American Journal of Emergency Medicine, 10 (1992): 413–417; P. D. Trautman, N. Stewart, and A. Morishima, “Are Adolescent Suicide Attempters Noncompliant with Outpatient Care?” Journal of the American Academy of Child and Adolescent Psychiatry, 32 (1993): 89–94.
54 Psychotherapy increases medication compliance: S. D. Cochran, “Preventing Medical Noncompliance in the Outpatient Treatment of Bipolar Affective Disorders,” Journal of Consulting and Clinical Psychology, 52 (1984): 873–878; F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990); D. J. Miklowitz and M. J. Goldstein, “Behavioral Family Treatment for Patients with Bipolar Affective Disorder,” Behavior Modification, 14 (1990): 457–489; D. J. Miklowitz and M. J. Goldstein, Bipolar Disorder: A Family-Focused Treatment Approach (New York: Guilford, 1997).
55 some, but not all, of the programs: R. Allard, M. Marshall, and M. C. Plante, “Intensive Follow-up Does Not Decrease the Risk of Repeat Suicide Attempts,” Suicide and Life-Threatening Behavior, 22 (1992): 303–314; C. Van Heeringen, S. Jannes, W. Buylaert, H. Henderick, D. De Bacquer, and J. Van Remoortel, “The Management of Non-Compliance with Referral to Outpatient Aftercare Among Attempted Suicide Patients: A Controlled Intervention Study,” Psychological Medicine, 25 (1995): 963–970; M. J. Rotheram-Borus, J. Piacentini, R. Roosem Can, F. Grace, C. Cantwell, D. Castro-Blanco, S. Miller, and J. Feldman, “Enhancing Treatment Adherence with a Specialized Emergency Room Program for Adolescent Suicide Attempters,” Journal of the American Academy of Child and Adolescent Psychiatry, 35 (1996): 654–663; A. Spirito, “Improving Treatment Compliance Among Adolescent Suicide Attempters,” Crisis, 17 (1996): 152–154; R. van der Sande, L. Van Rooijen, E. Buskens, E. Allart, K. Hawton, Y. van der Graaf, and H. van Engeland, “Intensive Inpatient and Community Intervention Versus Routine Care After Attempted Suicide: A Randomised Controlled Intervention Study,” British Journal of Psychiatry, 171 (1997): 35–41; D. C. Daley, I. M. Salloum, A. Zuckoff, L. Kirisci, and M. E. Thase, “Increasing Treatment Adherence Among Outpatients with Depression and Cocaine Dependence: Results of a Pilot Study,” American Journal of Psychiatry, 155 (1998): 1611–1613; R. Kemp, G. Kirov, B. Everitt, P. Hayward, and A. David, “Randomised Controlled Trial of Compliance Therapy: 18-Month Follow-up,” British Journal of Psychiatry, 172 (1998): 413–419; D. Spooren, C. Van Heeringen, and C. Jannes, “Strategies to Increase Compliance with Outpatient Aftercare Among Patients Referred to a Psychiatric Emergency Department: A Multi-Centre Controlled Intervention Study,” Psychological Medicine, 28 (1998): 949–956.
56 Being well informed: These issues are further discussed in K. R. Jamison, “Psychotherapeutic Issues and Suicide Prevention in the Treatment of Bipolar Disorders,” in R. E. Hales and A. J. Frances, eds., American Psychiatric Association Annual Review, vol. 6 (Washington, D.C.: American Psychiatric Press, 1987), pp. 108–124; K. R. Jamison, “Suicide Prevention in Depressed Women,” Journal of Clinical Psychiatry, 49 (1988): 42–45; F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990).
57 Several recent clinical studies: D. Miklowitz and M. Goldstein, “Behavioral Family Therapy Treatment for Patients with Bipolar Affective Disorder,” Behavioral Modification, 14 (1990): 457–489; E. Van Gent and F. Zwart, “Psychoeducation of Partners of Bipolar Manic Patients,” Journal of Affective Disorders, 21 (1991): 15–18; H. J. Moller, “Attempted Suicide: Efficacy of Different Aftercare Strategies,” International Clinical Psychopharmacology, 6 (Suppl. 6) (1992): 58–59; C. A. King, J. D. Hovey, E. Brand, R. Wilson, and N. Ghaziuddin, “Suicidal Adolescents After Hospitalization: Parent and Family Impacts on Treatment Follow-through,” Journal of the American Academy of Child and Adolescent Psychiatry, 36 (1997): 85–93; A. Perry, N. Tarrier, R. Morriss, E. McCarthy, and K. Limb, “Randomised Controlled Trial of Efficacy of Teaching Patients with Bipolar Disorder to Identify Early Symptoms of Relapse and Obtain Treatment,” British Medical Journal, 318 (1999): 149–153.
58 “And, when our lives crack”: Sylvia Plath, March 6, 1956, in T. Hughes and F. McCullough, eds., The Journals of Sylvia Plath (New York: Ballantine Books, 1983), p. 125.
59 Take your friend or family member seriously: National Depressive and Manic-Depressive Association, Suicide and Depressive Illness (Chicago: NDMDA, 1996). Detailed information about mental illness, medication, and suicide for doctors, patients, and family members can be found in R. J. Wyatt, Practical Psychiatric Practice, 2d ed. (Washington, D.C.: American Psychiatric Association Press, 1998).
60 “I have
a mental disorder”: A. Kent, “Perspectives,” Diversity & Distinction, 2 (1996): 23.
61 “Take a look around”: A. Kent, “Balancing Act: A Battle with Manic Depression Inspires One Student to Lead a Crusade for Mental Health Awareness,” Harvard Independent, March 25, 1999.
9 • AS A SOCIETY
1 “As a society”: D. Satcher, “Bringing the Public Health Approach to the Problem of Suicide,” Suicide and Life-Threatening Behavior, 28 (1998): 325–327, p. 326. David Satcher was appointed by President Clinton in 1998 to the position of Assistant Secretary for Health and Surgeon General of the United States. A physician and scientist, Dr. Satcher previously served as Director of the Centers for Disease Control and Prevention in Atlanta.
2 “What was constant”: P. Perl, “A Bridge He Could Not Cross,” Washington Post Magazine, November 14, 1993.
3 twice as likely to kill themselves: K. D. Rose and I. Rosow, “Physicians Who Kill Themselves,” Archives of General Psychiatry, 29 (1973): 800–805; C. L. Rich and F. N. Pitts, “Suicide by Male Physicians During a Five-Year Period,” American Journal of Psychiatry, 136 (1979): 1089–1090; A. H. Rimpelä, M. M. Nurminen, P. O. Pulkkinen, M. K. Rimpelä, and T. Valkonen, “Mortality of Doctors: Do Doctors Benefit from their Medical Knowledge?” Lancet, 1 (1987): 84–86; S. Lindeman, E. Läärä, H. Hakko, and J. Lönnqvist, “A Systematic Review on Gender-Specific Suicide Mortality in Medical Doctors,” British Journal of Psychiatry, 168 (1996): 274–279; K. Juel, J. Mosbech, and E. S. Hansen, “Mortality and Cause of Death Among Danish Physicians, 1973–1992.” Ugeskrift for Læger, 159 (1997): 6512–6518.
4 Psychiatrists and anesthesiologists: D. L. Bruce, “Causes of Death Among Anesthesiologists: A 20-Year Survey,” Anesthesiology, 29 (1968): 565–569; A. G. Craig and F. N. Pitts, “Suicide by Physicians,” Diseases of the Nervous System, 29 (1968): 763–772; D. E. DeSole, P. Singer, and S. Aronson, “Suicide and Role Strain Among Physicians,” International Journal of Social Psychiatry, 15 (1969): 294–301; C. L. Rich and F. N. Pitts, “Suicide by Psychiatrists: A Study of Medical Specialists Among 18,730 Consecutive Physician Deaths During a Five-Year Period, 1967–1972,” Journal of Clinical Psychiatry, 41 (1980): 261–263; B. B. Arnetz, L. G. Hörte, A. Hedberg, T. Theorell, E. Allander, and H. Malker, “Suicide Patterns Among Physicians Related to Other Academics as Well as to the General Population,” Acta Psychiatrica Scandinavica, 75 (1987): 139–143; L. M. Carpenter and A. J. Swerdlow, “Mortality of Doctors in Different Specialties: Findings from a Cohort of 20,000 NHS Hospital Consultants,” Occupational and Environmental Medicine, 54 (1997): 388–395; S. Lindeman, E. Läärä, J. Hirvonen, and J. Lönnqvist, “Suicide Mortality Among Medical Doctors in Finland: Are Females More Prone to Suicide Than Their Male Colleagues?” Psychological Medicine, 27 (1997): 1219–1222.
5 women doctors are three to five: R. C. Steppacher and J. S. Mausner, “Suicide in Male and Female Physicians,” Journal of the American Medical Association, 228 (1974): 323–328; F. N. Pitts, A. B. Schuller, C. L. Rich, and A. F. Pitts, “Suicide Among U.S. Women Physicians, 1967–1972,” American Journal of Psychiatry, 136 (1979): 694–696; F. Pepitone-Arreola-Rockwell, D. Rockwell, and N. Core, “Fifty-Two Medical Student Suicides,” American Journal of Psychiatry, 138 (1981): 198–201; W. Simon, “Suicide Among Physicians: Prevention and Postvention,” Crisis, 7 (1986): 1–13; S. M. Schlicht, I. R. Gordon, J. R. B. Ball, and D. G. S. Christie, “Suicide and Related Deaths in Victorian Doctors,” Medical Journal of Australia, 153 (1990): 518–521; C.-G. Stefansson and S. Wicks, “Health Care Occupations and Suicide in Sweden 1961–1985,” Social Psychiatry and Psychiatric Epidemiology, 26 (1991): 259–264; S. Lindeman, E. Läärä, H. Hakko, and J. Lönnqvist, “A Systematic Review on Gender-Specific Suicide Mortality in Medical Doctors,” British Journal of Psychiatry, 168 (1996): 274–279; L. M. Carpenter and A. J. Swerdlow, “Mortality of Doctors in Different Specialities: Findings from a Cohort of 20,000 NHS Hospital Consultants,” Occupational and Environmental Medicine, 54 (1997): 388–395; S. Lindeman, E. Läärä, J. Hirvonen, and J. Lönnqvist, “Suicide Mortality Among Medical Doctors in Finland: Are Females More Prone to Suicide Than Their Male Colleagues?” Psychological Medicine, 27 (1997): 1219–1222.
6 Women psychologists and chemists: P. H. Blachly, H. T. Osterud, and R. Josslin, “Suicide in Professional Groups,” New England Journal of Medicine, 268 (1963): 1278–1282; F. P. Li, “Suicide Among Chemists,” Archives of Environmental Health, 19 (1969): 518–520; H. King, “Health in the Medical and Other Learned Professions,” Journal of Chronic Disease, 23 (1970): 257–281; J. S. Mausner and R. C. Steppacher, “Suicide in Professionals: A Study of Male and Female Psychologists,” American Journal of Epidemiology, 98 (1973): 436–445; J. Walrath, F. P. Li, S. K. Hoar, M. W. Mead, and J. F. Fraumeni, “Causes of Death Among Female Chemists,” American Journal of Public Health, 75 (1985): 883–885.
7 Women also probably experience: J. Firth-Cozens, “Sources of Stress in Women Junior House Officers,” British Medical Journal, 301 (1990): 89–91.
8 stress and depression are common: K. Hsu and V. Marshall, “Prevalence of Depression and Distress in a Large Sample of Canadian Residents, Interns, and Fellows,” American Journal of Psychiatry, 144 (1987): 1561–1566.
9 and sleep deprivation: T. A. Wehr, D. A. Sack, and N. E. Rosenthal, “Sleep Reduction as a Final Common Pathway in the Genesis of Mania,” American Journal of Psychiatry, 144 (1987): 201–204; D. E. Duncan, Residents: The Perils and Promise of Educating Young Doctors (New York: Scribner, 1996).
10 “things seem inexplicable”: S. B. Nuland, How We Die: Reflections on Life’s Final Chapter (New York: Alfred A. Knopf, 1994), p. 151.
11 Yet nearly a third: B. Barraclough, J. Bunch, B. Nelson, and P. Sainsbury, “A Hundred Cases of Suicide: Clinical Aspects,” British Journal of Psychiatry, 125 (1974): 355–373; K. Hawton and E. Blackstock, “General Practice Aspects of Self-Poisoning and Self-Injury,” Psychological Medicine, 6 (1976): 571–575; J. Bancroft, A. Skrimshire, J. Casson, O. Harvard-Watts, and F. Reynolds, “People Who Deliberately Poison or Injure Themselves: Their Problems and Their Contacts With Helping Agencies,” Psychological Medicine, 7 (1977): 289–303; D. H. Myers and C. D. Neal, “Suicide in Psychiatric Patients,” British Journal of Psychiatry, 133 (1978): 38–44; J. Beskow, “Suicide and Mental Disorder in Swedish Men,” Acta Psychiatrica Scandinavica, 277 (Suppl.) (1979); S. E. Borg and M. Stahl, “Prediction of Suicide: A Prospective Study of Suicides and Control Among Psychiatric Patients,” Acta Psychiatrica Scandinavica, 65 (1982): 221–232; R. M. Turner, “Parasuicide in an Urban General Practice, 1970–1979,” Journal of the Royal College of General Practice, 32 (1982): 273–281; K. Petrie, “Recent General Practice Contacts of Hospitalized Suicide Attempters,” New Zealand Medical Journal, 102 (1989): 130–131; E. T. Isometsä, M. E. Heikkinen, M. J. Marttunen, M. M. Henriksson, H. M. Aro, and J. K. Lönnqvist, “The Last Appointment Before Suicide: Is Suicide Intent Communicated?” American Journal of Psychiatry, 152 (1995): 919–922; L. Appleby, T. Amos, U. Doyle, B. Tomenson, and M. Woodman, “General Practitioners and Young Suicides: A Preventive Role for Primary Care,” British Journal of Psychiatry, 168 (1996): 330–333; A. L. Beautrais, P. R. Joyce, and R. T. Mulder, “Psychiatric Contacts Among Youths Aged 13 Through 24 Years Who Have Made Serious Suicide Attempts,” Journal of the American Academy of Child and Adolescent Psychiatry, 37 (1998): 504–511; J. Pirkis and P. Burgess, “Suicide and Recency of Health Care Contacts: A Systematic Review,” British Journal of Psychiatry, 173 (1998): 462–474.
12 Some doctors remain skeptical: R. F. W. Diekstra and M. van Egmond, “Suicide and Attempted Suicide in General Practice, 1979–1986,” Acta Psychiatrica Scandinavica, 79 (1989): 268–275; A. Macdonald, “The Myth of Suicide Prevention by General Practitioners,” British Journal of Psychiatry, 163 (1993): 260; H. G. Morgan and M. O. Evans, “How Negative Are We to the Idea of Suicide Prevention?” Journal of the Royal Society of Medicine, 87 (1994): 622–625; K. Power, C. Davies,
V. Swanson, D. Gordon, and H. Carter, “Case-Control Study of GP Attendance Rates by Suicide Cases with or Without a Psychiatric History,” British Journal of General Practice, 47 (1997): 211–215.
13 the Swedish Committee for the Prevention and Treatment: W. Rutz, L. von Knorring, and J. Wålinder, “Frequency of Suicide on Gotland After Systematic Postgraduate Education of General Practitioners,” Acta Psychiatrica Scandinavica, 80 (1989): 151–154; W. Rutz, J. Wålinder, G. Eberhard, G. Holmberg, A.-L. von Knorring, L. von Knorring, B. Wistedt, and A. Åberg-Wistedt, “An Educational Program on Depressive Disorders for General Practitioners on Gotland: Background and Evaluation,” Acta Psychiatrica Scandinavica, 79 (1989): 19–26; A. Macdonald, “The Myth of Suicide Prevention by General Practitioners,” British Journal of Psychiatry, 163 (1993): 260; H. G. Morgan and K. Hawton, “Suicide Prevention,” British Journal of Psychiatry, 164 (1994): 126–127; J. M. G. Williams and R. D. Goldney, “Suicide Prevention in Gotland,” British Journal of Psychiatry, 165 (1994): 692–698; Z. Rihmer, W. Rutz, and H. Pihlgren, “Depression and Suicide on Gotland: An Intensive Study of All Suicides Before and After a Depression-Training Program for General Practitioners,” Journal of Affective Disorders, 35 (1995): 147–152.
14 Widespread screening: Canadian Task Force on the Periodic Health Examination, Canadian Guide to Clinical Preventive Health Care (Ottawa: Canada Communication Group, 1994), pp. 450–455; United States Preventive Services Task Force, “Screening for Depression,” Guide to Clinical Preventive Services, 1996; C. P. Schade, E. R. Jones, and B. J. Wittlin, “A Ten-Year Review of the Validity and Clinical Utility of Depression Screening,” Psychiatric Services, 49 (1998): 55–61.
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