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September 1965

Suicidal Precautions: A Dilemma in the Therapeutic Community

Author Affiliations

From the University of Chicago Hospitals and Clinics. Associate Professor, Department of Psychiatry and Director, Psychiatric Inpatient Service (Dr. Margolis); Assistant Professor, Department of Psychiatry and Associate Director, Psychiatric Inpatient Service (Dr. Meyer); and Instructor, Department of Psychiatry and Assistant Director, Psychiatric Inpatient Service (Dr. Louw).

Arch Gen Psychiatry. 1965;13(3):224-231. doi:10.1001/archpsyc.1965.01730030030005

IN THE United States there are approximately 24,000 suicides per year; in Illinois there are about 1,200 per year (50%). These are the recorded suicides. Thousands more attempt it along a continuum that ranges from an earnest, serious try to an "accident."

One attempt to prevent suicides is hospitalization, or even more specifically, psychiatric hospitalization. To the question, does hospitalization prevent suicides? the answer is "yes" in most cases, "no" in an occasional instance. The occasional "no" was confirmed in the spring of 1964 by a suicide on W-3, the 25-bed psychiatric unit of the University of Chicago Hospitals. The tragedy stimulated the ward staff to reevaluate the ward philosophy and to reexamine its implementation, with special reference to the management of the suicidal risk. This examination brought into focus a fundamental dilemma, namely, the paradox of a ward philosophy which stresses interpersonal relationships, and