Suicide is not a disease. It is an event—a tragedy. It is regularly precipitated by any number of events: loss of a job, stock-market crash, divorce, accident, fire, physical illness, and other happenings that are far beyond the control of any psychiatrist.

Suicide prevention is a popular term but very imprecise. Much of what is called suicide prevention is really crisis intervention. While we do prevent some suicides, other are just postponed. Since most suicide threats are not carried to completion, psychiatrists may be given credit for preventing something that never happened. Unfortunately, they are also blamed when they did everything right.

Conventional wisdom has it that when a suicide does occur, the psychiatrist was negligent or incompetent. This is most unfortunate and a source of endless grief. Many suicides cannot be prevented; some even occur in hospitalized patients under 24-hour observation.

What are the responsibilities of the psychiatrist to the patient at risk? He or she can carefully examine the patient, diagnose the patient, and supervise appropriate treatment. That is all that is possible. Unfortunately, it may not be enough for trial lawyers and juries.

SAMUEL GREENBERG, M.D.
Gainesville, Fla.