[Suicide].

UNLABELLED

BRIEF HISTORY: The definition of suicide differs depending on the era, author or theory. Society's attitude has varied throughout history. When psychiatry appeared in the nineteenth century it medicalized the problem. First with Esquirol in 1838, followed by Delmas in 1932. Whereas Durkheim, with his theory of anomia in 1897, defended the sociological position presented in the form of a law: the percentage of suicides increases in inverse proportion to the social integration of the individual and one should not forget Halbwachs (1930) in this debate. Re-medicalization was mainly due to Deshaies in 1947, who dismissed the excessiveness of these two trends, while remaining open to them. According to his theory, "suicidal equivalences" should also be taken into account, even if the individual's death wish is subconscious. CONTRIBUTION OF THE PSYCHOANALYTICAL THEORY: This contribution is considerable and has gone through several stages. Currently, psychoanalysts accept the influence of extrinsic factors in suicidal behavior. This is the case, for example, for the pre-morbid states or the initiating factors, the importance of which are no longer denied and which favor regression and destruction of the personality and resulting in suicidal behavior. DOES A CLINICAL PROFILE EXIST?: Fifteen percent of depressive patients commit suicide. With regard to the act itself, it is far more dangerous and violent in the elderly than in young adults. The suicide rate of elderly people is 2-fold greater than that of the general population. Suicidal equivalents consist in letting oneself die, because of the loss in will to fight that characterizes the classical syndrome of this attitude.

EPIDEMIOLOGICAL DATA

In France there are around 12,000 suicidal deaths per year among 150,000 suicide attempts, i.e., 1 attempt every 4 minutes and 1 suicide every 40 minutes. This corresponds to a raw mortality rate of 20 out of 100,000 inhabitants. However, epidemiologists consider that these figures are underestimated by around 20%. Since 1983, they exceed the mortality rate caused by road accidents (8,000/year in France). MISINTERPRETED DEPRESSION: Most suicides result from depression that was not recognized and treated as such. Clinical intuition is essential. It is the risk of suicide that renders the diagnosis of depression urgent. Retrospective surveys show that 50% of individuals having attempted suicide had consulted a doctor the month preceding their act. It is therefore important to organize the prevention of such risks. When depressive patients do not express any suicidal tendency, it is essential to raise the subject. In most cases, verbalization relieves the patients. However the eventual hospitalization of such patients should always be boum in mind.