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LETTER TO EDITOR
Year : 2014  |  Volume : 23  |  Issue : 1  |  Page : 73-74  Table of Contents     

Silverman revisited: A relook at some of the pitfalls and challenges in suicide nomenclature and few suggestions


Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

Date of Web Publication18-Nov-2014

Correspondence Address:
Vikas Menon
Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6748.144979

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How to cite this article:
Menon V. Silverman revisited: A relook at some of the pitfalls and challenges in suicide nomenclature and few suggestions. Ind Psychiatry J 2014;23:73-4

How to cite this URL:
Menon V. Silverman revisited: A relook at some of the pitfalls and challenges in suicide nomenclature and few suggestions. Ind Psychiatry J [serial online] 2014 [cited 2019 Sep 22];23:73-4. Available from: http://www.industrialpsychiatry.org/text.asp?2014/23/1/73/144979

Sir,

Suicide is a multi-dimensional human behaviour that may have many determinants. Due to this complexity, perhaps, one can find at least 15 commonly referenced definitions of suicide in literature. With regard to the issue of definitions for attempted suicide, the waters are even muddier with a plethora of terms such as 'parasuicide', 'non-fatal suicidal behaviour' and 'deliberate self-harm' being used synonymously by researchers. In an attempt to clarify this aspect, Silverman et al. [1] state that unless the intent to end one's life is established in an episode of self-injurious behaviour, clinicians should desist from calling it a suicide attempt. It is questionable, though, to what extent these recommendations have penetrated among clinicians as well as the non-medical community, many of whom interact with suicidal clients. Often, we encounter scenarios where definitions related to suicide are used without rigour or differently interpreted according to the author of the paper under consideration. One possible reason for this confusion is the difficulty one faces in assessing the individual elements of contemporary suicide definitions, especially the intent. These may include the ambivalence of the individual in talking about the act and the need to magnify or minimize intent so as to meet some objective. [2] Additionally, as most suicide attempts are assessed retrospectively, reliance on patient self-report and the judgement of the clinician in establishing suicide intent is much greater. As a result of these practical difficulties, it is often observed that episodes of self-harm end up getting mislabelled as suicide attempts without due diligence in establishing the intent and lethality involved in the act.

There are few suggestions that can be considered, to modify this existing scenario. For example, we could do away with terms like 'suicidal inclination' or 'morbid ruminations' for suicide intent and ideation, respectively. [3] Having these terms used or read widely in contemporary research encourages clinicians and trainees to use them interchangeably with little understanding. Alternatively, in my opinion, it may be beneficial to prepare a list of minimum essential elements for each suicidal construct. This is because suicide as a behaviour is studied and reported by many disciplines and each field may assign differential weightage to different components of suicidal behaviour. Hence, it may be more meaningful to have a list of common minimum elements that would serve as building bricks for definitions in suicidology. To give an example, any definition of intent would have to include intended outcome (death), agency (self) and subjective expectations about a chosen method resulting in intended outcome. Contemporary assessment guidelines for suicidal behaviour do not provide much clarity on how to assess these individual constructs, many of which play a role in determining future suicide risk. [4] A standardized evaluation scheme could be developed for suicide attempters with adequate provisions for individual variations along the lines of what has been developed for catatonia. [5] A strong nomenclature would improve the quality of clinical documentations and data collection leading to meaningful suicide research, improved clinician communication, and better extrapolation of findings due to increased validity.

 
   References Top

1.Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE. Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviour Part 2: Suicide-related ideations, communications and Behaviours. Suicide Life Threat Behav 2007;37:264-77.  Back to cited text no. 1
    
2.Wagner BM, Wong SA, Jobes DA. Mental health professionals' determinations of adolescent suicide attempts. Suicide Life Threat Behav 2002;32:284-300.  Back to cited text no. 2
    
3.Silverman MM. The language of suicidology. Suicide Life Threat Behav 2006;36:519-32.  Back to cited text no. 3
    
4.Menon V. Suicide risk assessment and formulation: An update. Asian J Psychiatr 2013;6:430-5.  Back to cited text no. 4
    
5.Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1996;93:129-36.  Back to cited text no. 5
    




 

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