ABSTRACT
This chapter shows that empirical evidence on the prediction and prevention of suicide suggests that clinical impressions about prevention do not reflect reality. A point of controversy in suicide prevention concerns the usefulness of psychopharmacology. Reductions of completion rates that result from restricting access to fatal means stand in contrast to the relative ineffectiveness of volunteer organizations that were specifically designed for suicide prevention. Yet some experts continue to advocate hospitalization for patients with personality disorders who threaten suicide. When therapy spirals out of control and the clinician needs the help of a specialized team, partial hospitalization is useful. Full hospitalization carries even more risks, making patients more suicidal, not less, and cutting them off from their social and occupational networks. O. F. Kernberg agreed that chronic suicidality requires patience and tolerance and also suggested that therapists need to maintain the frame of therapy and avoid going out of their way to “prevent” suicide at all costs.
