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1. Introduction
“It should be axiomatic that suicide cannot be prevented until it is properly conceptualized”.
[1]
Suicide is a multifactorial phenomenon, and there are numerous models of suicide and suicidal behaviour, ranging from Durkheim’s anomic suicide to suicide as an outcome of serotonin dysfunction [2,3]. Ultimately, models of suicidal behaviour must translate into projects that are effective in reducing suicidal behaviour. The clinically most prevalent model is the biomedical model, based on the close association of suicide with psychiatric pathology [4]. However, although psychiatric diagnoses are major risk factors for suicide [5], prevention projects aimed at improving the detection and treatment of psychiatric disorders have limited potential to reduce suicidal behaviour on a population level [6,7]. The evidence for pharmacotherapy, and antidepressant treatment in particular, is mixed [8,9,10], with the exception of long-term lithium treatment [11].
We need to look beyond the medical model in order to improve the effect of clinical suicide prevention [12,13,14,15]. A number of psychotherapeutic treatments, including Cognitive Behaviour Therapy (CBT), Dialectical Behavior Therapy (DBT), and Collaborative Assessment and Management of Suicidality (CAMS), have shown a reduction in repeated suicidal behaviour [16,17,18,19], but due to small numbers and the lack of replication studies, the evidence so far is limited [20,21].
2. A Tower of Babel Syndrome
“I got very angry when they kept asking me if I would do it again. They were not interested in my feelings. Life is not such a matter-of-fact thing and, if I was honest, I couldn’t say if I would do it again or not. What was clear to me was that I could not have enough trust in any of these doctors to really talk openly about myself”.
[22]
A major obstacle in clinical suicide prevention is the fact that many individuals at risk of suicide, males in particular, do not seek help [23]. We asked patients one year after a suicide attempt, who, in retrospect, could have helped to stop them from harming themselves. Twenty percent mentioned relatives or friends, while 52% said nobody, and only 10% mentioned a health professional [24]. Suicidal patients, above all men and the young [25], do not feel that consulting a health professional might be helpful. Most people experience suicide ideation as ego-syntonic, i.e., as something...