Foreword

Every year a million people kill themselves and at least ten times as many attempt to do so, frequently ending up disabled by the psychological, physical and social consequences of their attempts. A large proportion of this loss of human life could be prevented, but this does not happen. One of the reasons for this is that the information about the magnitude of the problem and about ways to reduce it, as well as the results of research done to explore the causes and consequences of suicidal behaviour, are not sufficiently well known.

It is easy to understand this. The prevention of suicide requires access and use of many sources of information. The media, schools, health services, social services, authorities dealing with labour and many others who should be involved in the prevention of suicide, and in the evaluation of methods used to do this, are distant from one another and belong to different worlds. There is little or no sharing of information among them. Data remain in the parts of the society in which they were produced. Highly interesting positive and negative experiences obtained in programmes of suicide prevention by one social agency or one country are often not published in widely read journals, neither in the country in which they were obtained nor in other countries.

What is true for the difficulties in obtaining information is even more disturbing when it comes to collaboration between agencies and countries in programmes of suicide prevention. Declarations of intent to work together are numerous and recommendations to do so even more frequent: yet in most countries there is no serious and lasting intersectoral collaboration on any topic—including the prevention of suicide. The same problem is a major hurdle to any programme aiming to help those who have attempted suicide but did not complete it.

The magnum opus that Danuta and Camilla Wasserman and their colleagues prepared attempts to deal with the first of these two problems. It brings together information about suicide in different cultures and at different stages of life; about the relevance and role of religion in the prevention of suicide; about political and socio-economic determinants of suicide; about the psychiatric and somatic diseases and their relationship with suicidal behaviour. The volume explores the theories of suicidal behaviour and provides a cogent review of methods that help in the recognition of suicidal risks and in the prevention of suicide. The strategies of the health care system, and the ways in which health services can make a contribution to the prevention of suicide and to the alleviation of the consequences of suicidal behaviour, are examined critically. The impact of suicide on those who are left behind, and an estimation of the economic cost of suicide to society, are discussed along with the arguments for action that can be successful, as examples from many countries clearly demonstrate.

The large number of contributors to the volume is a witness to the size and excellence of the network that Professor Wasserman and her colleagues working in the field of suicide have established: more importantly, however, it demonstrates that suicide and its consequences are a global problem that is likely to become even more important in the future for a variety of reasons, ranging from changes of the demographic structure and the growing prevalence of chronic mental and physical disorders (often occurring together, thus worsening the prognosis of both types of disorders), to the increase of alcohol consumption and of other risk factors for suicide, and the many forms of social disruption leading to the reduction of sources of support in times of stress and destructive anomie.

I wish to be the first among the many who will wish to express thanks to the editors of this work. They give us a volume that is unique in its coverage of the field—both in geographical and in epistemological terms—and remarkable because of the excellence of its many contributors who give us hope that the major public health problems created by suicidal behaviour can be reduced by concerted action. They show us that this can be done by describing successful programmes, which give us information that is often difficult to access, yet can be of great importance for the understanding of suicidal behaviour and for the development of programmes to prevent suicide and its consequences. It is to be hoped that the book will be read by many and that the information that has been so skilfully presented will be used in developing programmes against suicide: in that lies the usefulness of this effort and, in that, would be the greatest reward for the editors and the contributors to this extraordinarily valuable book.

Professor N. Sartorius, M.D., Ph.D.