The power of the life force is striking—in even among the most abominable conditions, like concentration camps, suicide remains relatively uncommon. Yet some human beings appear to harbor a powerful destructive force, which can under certain conditions manifest itself in violence, homicide, or suicide. Suicide has been with us since the beginning of history; it has often been romanticized, or viewed as an understandable escape from an intolerable situation. Philosophers and writers from William James to Albert Camus to Goethe have tended to view suicide as a window into the human condition, perhaps extreme but nevertheless a reflection of our shared humanity. However, highly reliable research has shown that suicide is, by and large, not a window into the human condition, but rather a manifestation of a disturbance—an abnormality of the human condition—a mental disorder.

Physicians know that the primary goal of medical treatment (after first doing no harm) is to prevent death. Death is the ultimate enemy in medical illness. In psychiatric illness, this enemy usually appears in the guise of suicide; the illness uses the hands of patients to wreak its havoc. To reduce mortality in psychiatric conditions, then, means to reduce suicide. It is indeed striking how little this matter has been analyzed. Little data are available on mortality with medications that are researched and approved for psychiatric illness. This would not be acceptable for medical illnesses outside of psychiatry today; it should not be the case in psychiatric illnesses either.