David Titelman

Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. Suicidal crisis: Acute intervention should start immediately in order to keep the patient alive. An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. in order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Long-term treatment with lithium has shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment team: Multidisciplinary treatment team including psychiatrist and other health professionals are always preferable. Family: The suicidal person independently of age should always be motivated to involve family in the treatment. Social support: Psychosocial treatment is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack social networks. Training of Personnel: Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other health professionals.

Observers of life are often so intrigued by its organic design and beauty, as to think of it (at least metaphorically) as divine. This is also true of the psychoanalytic inquirer of the mind, although many of us are or, as the Finnish psychoanalyst and essayist Mikael Enckell would probably put it, consider ourselves godless. In his earlier work, Enckell consistently equated a Jewish understanding of God whose presence as the primary mover is felt or sought by humans, but who nonetheless is unknowable in any direct way with the psychoanalytic understanding of the unconscious. The nine essays that comprise Enckell's most recent book, The Soul that wouldn't Shrink: Essays on Jewish Topics (Helsinki: Soderstroms, 2001), focus on the history and psychological underpinnings of 20th century anti-Semitism in Soviet Russia and the Western world, in particular Finland and Sweden. In the first essay, "Caliban's face in the mirror", Enckell discusses an incident in which an invited lecturer, a philosopher, dumbfounded the audience of the Swedish Psychoanalytical Society when he blamed the Jews for the Holocaust and expressed uncannily archaic, anti-Semitic cliches, wrapped in philosophical phraseology and literary jargon. Another manifestation of anti-Semitism in Sweden during the same period, the late 1980s, was the so-called Rami-Bergman affair. A professor of theology, Jan Bergman of Uppsala University, testified in court in defence of the revision of the history of the Holocaust and defamation of Judaism in radio broadcasts (and subsequently on the Internet) by Ahmed Rami, a former Moroccan officer and political refugee in Sweden. Rami and Bergman claimed that Jewish law obliges Jews to kill non-Jews. Scandalously, in the name of academic freedom, the president of Uppsala University supported Bergman. Another theme of the book is what Enckell considers the specifically Jewish characteristics of the works of Freud, Kafka, Proust, the Soviet filmmaker Eisenstein, the French author Perec, and others qualities that are generally ignored by historians but acknowledged, if in a distorted way, by commentators with anti-Semitic proclivities. The book also addresses what could be termed the call of Judaism, the "original explosion at Sinai" (p. 157), which according to Enckell contains two fundamental but contradictory demands: that of submitting to an abstract but all-powerful God; and that of respecting the Other ("Behind the stranger's face, your own features" is a key citation from the Talmud which he quotes in one of his two essays on psychoanalysis). The Sinaitic call is embraced by the philo-Semite, as Enckell considers himself, fiercely hated by the anti-Semite, and resisted by the many people who demand simple, either/or answers in practical life and in philosophy. Enckell finds it a bitter irony that the two descendants of Judaism, Christianity and Marxism, have frequently evolved into anti-Jewish systems of thought, promising simple, one-dimensional solutions that they are notoriously unable to fulfill. In a concluding autobiographical essay and in formulations throughout the volume to which this essay makes the reader sensitive, Enckell presents a powerful rendering of the personal background of his identification with Jewish perspectives.

The authors investigated suicide-bereaved siblings' reported reasons for seeking or not seeking professional support, their reported satisfaction when receiving it, and their recommendations to health services when meeting suicide-bereaved siblings. Using qualitative content analysis of 18 interviews with suicide-bereaved siblings, the authors found that the perception of health services as being helpful was influenced by both the participants' and by the deceased siblings' experiences with health services. They conclude that the bereaved sibling's and the deceased sibling's unmet needs may generate negative attitudes toward health services, which reduces the likelihood of seeking professional help as well as medication acceptance in some cases.

1. Lakartidningen. 2011 Dec 7-13;108(49):2548-9. [Neuropsychiatric diseases: the biggest challenge of this century for health care authorities]. [Article in Swedish]. Stain R, Hadlaczky G, Carli V, Titelman D, Wasserman D. Centrum för suicidforskning och prevention av psykisk ohälsa (NASP) och institutionen för lärande, informatik, management och etik (LIME), Karolinska institutet, Stockholm. rigmor.stain@tele2.se. PMID: 22468389 [PubMed - indexed for MEDLINE]. MeSH Terms. ...

This public mental health study highlights the interactions among social determinants and resilience on mental health, PTSD and acculturation among Iraqi refugees in Sweden 2012-2013. Objectives: The study aims to understand participants' health, resilience and acculturation, paying specific attention to gender differences. Design: The study, using a convenience sampling survey design (N = 4010, 53.2% men), included measures on social determinants, general health, coping, CD-RISC, selected questions from the EMIC, PC-PTSD, and acculturation. Results: Gender differences and reported differences between life experiences in Iraq and Sweden were strong. In Sweden, religious activity was more widespread among women, whereas activity reflecting religion and spirituality as a coping mechanism decreased significantly among men. A sense of belonging both to a Swedish and an Iraqi ethnic identity was frequent. Positive self-evaluation in personal and social areas and goals in life was str...

The aim of this study was to explore the unconscious dimensions of suicide as conveyed by the Swedish writer Harry Martinson, who took his life in 1978, four years after having received the Nobel Prize in Literature. A psychoanalytically informed “listening” to Martinson comprised a close reading of his writings, reflection on my total response to the material, the application of psychoanalytic hypotheses on severe depression and suicide-nearness, and the study of biographical sources. The dramatic fluctuations of Martinson’s self-regard were noted, as was the juxtaposition of opposites in his poetry: darkness that seeps through observations of the beauty of nature and man or the reverse, a gleam of love that defuses the cruelty of the world. Martinson’s drive to communicate with himself and others by talking and writing, to find auxiliary objects compensating for the traumatic losses of his childhood, and to realize mature love in adulthood was understood as a counterforce to self-destructiveness and threatening narcissistic disintegration. Pressured by negative reactions to the Nobel, which overlay decades of envy and political critique from colleagues, whose support he coveted, Martinson’s aggressivity—reflecting the near soul-murder of his early life—exploded in his suicide.

Asylum seekers have increased risk of suicide and suicidal behavior, with differences related to origin, gender, and age. There are barriers to communication in clinical encounters between asylum seekers and clinicians. There is insufficient knowledge about how communication in the clinical encounter affects the suicide risk in female asylum seekers. To explore the documented communication between female asylum-seeking suicide attempters and clinicians and how it affects treatment. The medical records of 18 asylum-seeking women who had attempted suicide were analyzed with content analysis. Communication between patients and clinicians was affected by: the unbearable realities of the women; difficulties for clinicians in decoding languages of distress, and understanding trauma and subjective meanings of suicide; challenges of combining patients' and clinicians' perspectives; and a sense of shared powerlessness. The medical records did not give direct access to the patient&#39...

Encountering the body of a child who died by suicide at the site of death is believed to be especially harmful for bereaved parents. We investigated the association between encountering the body at the site of the suicide and psychological distress in 666 suicide-bereaved parents. Parents who had encountered their child's body at the site of the suicide (n = 147) did not have a higher risk of nightmares (relative risk [RR] 0.95, 95% confidence interval [CI] 0.67-1.35), intrusive memories (RR 0.97, 95% CI 0.84-1.13), avoidance of thoughts (RR 0.97, 95% CI 0.74-1.27), avoidance of places or things (RR 0.91, 95% CI 0.66-1.25), anxiety (RR 0.93, 95% CI 0.64-1.33), or depression (RR 0.94, 95% CI 0.63-1.42) compared with parents who had not encountered the body (n = 512). Our results suggest that losing a child by suicide is sufficiently disastrous by itself to elicit posttraumatic responses or psychiatric morbidity whether or not the parent has encountered the deceased child at the s...

To determine the reliability and validity of a previously identified "suicide cluster" in the Percept-genetic Object-Relation Test (PORT), which test documents subliminal perception of object-relation pictures, 20 suicide attempters and 70 controls were investigated. The correspondence between scores assigned by two judges was 95%-100%. The suicide-cluster signs in PORT, notably "lack of attachment relationships" and "Motor activity," were significant. Differences between the results of this and the previous study are discussed as is the role of psychiatric disorder in suicide.

Depressive affect, anxiety, and psychological defenses were studied in the presented research with PORT, a projective test that exploits subliminal perception of object-relation images. Protocols of 20 hospitalized suicide attempters were compared to those of 20 matched controls, 34 previously studied nonsuicidal depressed patients, 18 patients with panic attack, and 32 patients with borderline and psychotic disorders. The suicide attempters were anxious; their defenses resembled those seen in borderline pathology; depressive reactions were limited in symbolic content; reality testing was poor. The closeness between depression and anxiety in suicidality is further discussed throughout this article. A constellation of signs using the PORT test was hypothesized to be a marker for suicidality. The test is deemed useful for future research on suicide.

1. Lakartidningen. 2011 Dec 7-13;108(49):2548-9. [Neuropsychiatric diseases: the biggest challenge of this century for health care authorities]. [Article in Swedish]. Stain R, Hadlaczky G, Carli V, Titelman D, Wasserman D. Centrum för suicidforskning och prevention av psykisk ohälsa (NASP) och institutionen för lärande, informatik, management och etik (LIME), Karolinska institutet, Stockholm. rigmor.stain@tele2.se. PMID: 22468389 [PubMed - indexed for MEDLINE]. MeSH Terms. ...

In the literature on siblings of schizophrenic individuals, recurrent experiential themes include guilt feelings, a fear of madness in oneself, and a wish to escape the turbulence that surrounds the schizophrenic person. In psychotherapy conducted by the author with three siblings of schizophrenic individuals, the siblings manifested sadness, guilt, identification with the schizophrenic brother or sister, and manic-defensive externalization as aspects of their survivor predicament. The suitability of the schizophrenic individual as a target of externalization and the significance of defeated parents to the survivor sibling are discussed.

1. Lakartidningen. 2011 Dec 7-13;108(49):2548-9. [Neuropsychiatric diseases: the biggest challenge of this century for health care authorities]. [Article in Swedish]. Stain R, Hadlaczky G, Carli V, Titelman D, Wasserman D. Centrum för suicidforskning och prevention av psykisk ohälsa (NASP) och institutionen för lärande, informatik, management och etik (LIME), Karolinska institutet, Stockholm. rigmor.stain@tele2.se. PMID: 22468389 [PubMed - indexed for MEDLINE]. MeSH Terms. ...

ABSTRACT Political developments in Sweden during the last decade, including a period of increased activities of the extreme right, coincide with a resurgence of previously suppressed antisemitic sentiments in the media and among politicians of different affiliations. Classical, often traditional Christian, antisemitic formulations are published in both Sweden and Finland in connection with media reports of the conflict between Israel and its neighbors. An increase of signs of anti-Jewish hatred among young Muslim immigrants in Sweden is described, as is the Rami-Bergman affair in the 1980s at Uppsala University in which a Professor of Theology testified under oath that there is a compelling Biblical commandment for Jews to kill strangers. Recent antisemitic statements made by high-ranking Finnish dignitaries of government, parliament and church against the background of 20'h century Finnish history are discussed and a government decision to deprive Israel of Finnish-made gasmasks during the American war against Saddam Hussein's Iraq is noted. We contend that traditional antisemitic thought patterns are visible in the Nordic countries and that they can be understood in terms of envy, the narcissism of small differences, the return of the repressed, and as representing an unconscious resentment against truthfulness.