Suicide Prevention

* In “What Drives So Many to Take Their Lives?” (Commentary, Aug. 9) Robert Gerner suggests that the White House attorney, Vincent W. Foster Jr., committed suicide because he was suffering from a clinical depression. This may well be true, although it is also true that many people (especially adolescents) who attempt or commit suicide are not clinically depressed.

Although Gerner provides considerable valuable information about depression, there is some vital information that was overlooked. First, it is important to note that many depressed patients do not respond to antidepressant medication, and many depressed patients, for various reasons, refuse to take medication. Second, research on the treatment of depression indicates that some psychotherapies, especially when administered by trained, experienced therapists, can be very effective in the treatment of clinical depression. In many cases, psychotherapy can be as effective as medication, although a combination of psychotherapy and medication is usually more effective than either medication alone or psychotherapy alone.

Gerner has erroneously suggested that only MDs can effectively treat depression. That, of course, is true for the administration of antidepressive medication. But effective treatment for clinical depression is not just medication and in many cases involves no medication.

MICHAEL L. PECK Ph.D.

President, Los Angeles Society

of Clinical Psychologists

Executive Director

Institute for Suicide Prevention

* I regret that Gerner has taken the tragic event of Vincent Foster’s suicide to peddle the notion that suicide is a medical disease. Depression--a condition of unquestioned seriousness in its own right--is not a cause of death. One can lead a long and unhappy life with depression. Further, depression is not a legitimate entry on a death certificate. What kills--what causes suicide--is psychological pain: psychache. Depression should, of course, be treated (and physicians are best qualified to treat it), but suicide has other clues. These clues include indications of hopelessness, of worthlessness, of psychological pain, of frustration of vital psychological needs. It serves no useful public function to medicalize the human condition of suicide in order to reserve the treatment of suicide solely for physicians. Suicide can be treated by a variety of skilled mental health specialists. If we learned anything in the past 50 years it is that suicide is not a disease of the brain, but is primarily a psychological storm in the mind.

EDWIN S. SHNEIDMAN Ph.D.

Professor of Thanatology Emeritus, UCLA

Founder, American Assn. of Suicidology