Not surprisingly, health professionals have been found to have difficulties in accepting and understanding suicide attempters, especially in the absence of psychiatric illness (Patel 1975; Reimer and Arantewicz 1986). Physicians had a more favourable attitude towards patients whose motives were interpreted as "wanting to die" than those whose behaviour was seen as manipulative (Ramon et al, 1975; Hawton et al, 1981). Suicidal patients may not consider contacting their general practitioner or psychiatrist when in a suicidal crisis because they often perceive doctors as unhelpful (Hawton and Blackstock 1976; Wolk-Wasserman 1987). Suicidal adolescents are particularly reluctant to seek help (Choquet and Menke 1989). When suicidal persons expect that the physician will label an act of deliberate self-harm as pathological or irrational, they are likely to keep suicidal thoughts and their inner turmoil to themselves.

There is a tendency for physicians and psychiatrists to interpret suicidal behaviour as manipulative, as opposed to the patients themselves, who less often mention interpersonal reasons for attempting suicide. For instance, Bancroft and colleagues (1979) found a striking discrepancy between patients' explanations of suicide attempts and those of examining psychiatrists. Clinicians most frequently chose reasons for attempting suicide such as "communicating hostility", "to frighten/to make someone feel sorry," "to show desperation," or "aiming to influence other people." The patients, however, were much more likely to explain themselves as wanting "to get relief from a terrible state of mind," or "to escape for a while from an impossible situation." Assuming manipulative reasons is not only a typical interpretation by an outside observer, but also an expression of the medical 'the professional-is-the-expert' attitude.

References

Bancroft, J., Hawton, K., Simkin, S., Kingston, B., Cumming, C., Whitwell, D. (1979) The reasons people give for taking overdoses: a further enquiry. British Journal of Medical Psychology, 52: 353-65.

Choquet, M., Menke, H. (1989) Suicidal thoughts during early adolescence: prevalence, associated troubles and help-seeking behaviour. Acta Psychiatrica Scandinavica, 81:170-177.

Hawton, K., Blackstock, E. (1976) General practice aspects of self-poisoning and self-injury. Psychological Medicine, 6: 571-575.

Hawton, K., Marsack, B., Fagg, J. (1981) The attitudes of psychiatrists to deliberate self-poisoning: comparison with physicians and nurses. British Journal of Medical Psychology, 54: 341-7.

Patel, A. (1975) Attitudes towards self-poisoning. British Medical Journal, ii: 426-30.

Ramon, S., Bancroft, J., Skrimshire, A. (1975) Attitudes towards self-poisoning among physicians and nurses in a general hospital. British Journal of Psychiatry, 127: 257-64.

Reimer, Ch,, Arantewicz, G. (1986) Physician's attitudes toward suicide and their influence on suicide prevention. Crisis, 7: 80-83.

Wolk-Wasserman, D. (1987) Contacts of suicidal neurotic and prepsychotic/psychotic patients and their significant others with public care institutions before the suicide attempt. Acta Psychiatrica Scandinavica, 75: 358-372.

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