Treatment of Suicidal Patients

To the Editor: Hirschfeld and Russell's algorithm for treating suicidal patients (Sept. 25 issue) 1 does not emphasize the fundamental importance of psychodynamic formulation and brief psychotherapy in clarifying and managing a suicidal crisis. Although major depression, alcohol abuse, and other psychiatric conditions have been shown to figure prominently in suicidal states, recent blows to self-esteem or disruptions of key relationships may explain why a particular patient presents in crisis at a specific time. 2 Moreover, some patients, particularly those with certain personality disorders, may be so sensitive to losses that the resulting reactive depressive states may prove no less deadly than . . .