Attempted Suicide as Language: An Empirical Study

¹ Assistant Director, Medical Research Council Unit for Epidemiological Studies in Psychiatry, University Department of Psychiatry, Morningside Park, Edinburgh, 10
² Medical Research Council Clinical and Population Cytogenetics Research Unit, Western General Hospital, Crewe Road, Edinburgh, 4
³ Professor, Department of Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia.

1. It is proposed that the concept of 'attempted suicide' as a form of communication leads to the hypothesis that suicidal attempts should occur in socially-linked groups of individuals with a frequency greater than would be expected from a sample of the general population matched for those demographic factors known to influence rates of attempted suicide.

2. Between 1 January and 31 March 1967, 181 persons diagnosed as attempted suicides were admitted to the Regional Poisons Treatment Centre, Royal Infirmary, Edinburgh, of whom 135 were interviewed to ascertain, inter alia, details of their close associates ('contacts') including name, age, sex and residence between January 1962 and December 1966. The data were checked from another family member in 10 per cent of the patients, and were found to be of acceptable reliability. Contacts who for at least part of the survey period were alive, aged over 15 and resident in Edinburgh, totalled 578: those constituted the `population at risk'.

3. For each individual contact the expectation of being admitted to the R.P.T.C. at least once during the survey period was calculated, using previously determined rates for age, sex and duration of residence in each of the city wards; for the latter `area factors', calculated as standardized morbidity ratios were used.

4. The actual number of attempted suicides was ascertained by checking each contact's name in the Centre's registers.

5. For the whole group of patients, 17 positive contacts were identified, which was significantly greater than the expected number of 4.23 (p<.001). There was evidence that an excess of positive contacts was characteristic of those below 35 years of age (p<.02), especially for females and of those using drugs in their suicidal attempt (p<.05); other variables were without significant effect.

6. Among the population at risk no significant excess was demonstrable among those biologically related to the patients as compared with other family members and friends.

7. There was tentative evidence that the positive contacts tended to have made their suicidal attempt towards the end of the survey period rather than uniformly over the 4 years at risk.

8. The results were reviewed, and with certain reservations it was concluded that the findings were compatible with the hypothesis advanced. Alternative tests of the `language' theory may be useful for an understanding not only of attempted suicide but also of other forms of pathological communication.

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