A Narrative Review of Suicide: Aiming at a More Encompassing Understanding
Round 1
Reviewer 1 Report
The problem of suicidal process worth considering from different perspectives. Discussion on it is lasting in suicidology for decades.
I find your topic quite interesting, but I also see the main problem with your manuscript - namely the lack of the clear purpose of the article and lack of more analytic approach.
The main problem with this manuscript is, the aim of the article is unclear. What purpose? What main problem/question? There is no "rethinking suicide", no analysis, it lacks deeper either suicidological or philosophical perspective. The main part of the article is named "Different philosophical perspectives..." but you find only description of different emotions common to different suicidal subjects and also to health professionals. And also in "Conclusions" part you find not analytical conclusion, but rather practical description of emotional states of survivors and of need of help, psychoterapeutic, pharmacotherapeutic etc.
Some remarks:
- in the Introduction part you mention different authors, but refer to only one position - the article of M. Pompili (1)
- in p. 2 the statement about "Werther Effect" according to psychoanalysis", is not correct. The term was introduced from sociological perspective by D.P. Phillips (1974)
Author Response
- “The problem of suicidal process worth considering from different perspectives. Discussion on it is lasting in suicidology for decades.”
Answer: We thank the review for supporting the publication of our paper.
- “I find your topic quite interesting, but I also see the main problem with your manuscript - namely the lack of the clear purpose of the article and lack of more analytic approach.”
Answer: We thank the reviewer for constructively clarifying this negative feature of our paper. It is indeed a non-systematic approach to the topic as we aimed to gather what became too different perspectives of groups affected by suicide, trying to find the similarities between them, namely we aimed to consider several emotions of each group. Our narrative review aims to provide phenomenological input (mainly continental philosophy elements) and as we are both from the medical field AND Portuguese we believe that there are several language limitations and issues with philosophical structure. Despite this being our first effort we aim to explore it in further detail as we recognize the interest of a more analytical approach to explore the theme.
- “The main problem with this manuscript is, the aim of the article is unclear. What purpose? What main problem/question? There is no "rethinking suicide", no analysis, it lacks deeper either suicidological or philosophical perspective. The main part of the article is named "Different philosophical perspectives..." but you find only description of different emotions common to different suicidal subjects and also to health professionals. And also in "Conclusions" part you find not analytical conclusion, but rather practical description of emotional states of survivors and of need of help, psychoterapeutic, pharmacotherapeutic etc.”
Answer: We thank the reviewer for identifying these flaws of our abstract. We have now changed our paper to highlight the purpose of the article - identify emotions that are common to different groups affected by suicide, regardless of the context, experiences, and means used to commit suicide. We also changed the title so that it reads “A Narrative Review of Suicide: aiming at a more encompassing understanding”. Indeed, with our approach, we aimed to understand the core features of suicide that could be transversal to all practices and therefore allow a way to therapeutic and preventive attitudes to each of these emotions, not only in individual consultations, but also in support groups and pharmacological therapies. Also the title “Different philosophical perspectives” now reads “Seminal inputs”. Also we changed our conclusion to include suggestions from both reviewers:
“Shneidman's phenomenology understands the suicidal mind in terms of psychological pain interpreting suicide as a last attempt to escape intolerable emotions.
Among each of the groups affected by the suicide, there are similar emotions during the process such as the stigma and regret of the family, the guilt of the health professional, and the sadness and despair of the suicidal individual.
The management of post-suicide consequences benefits from the specialized support of health professionals, either through psychotherapy and pharmacotherapy or support groups.
Our review suggests that in clinical practice a phenomenological approach might serve not only an epistemic necessity to identify and explore emotions underlying the experience of suicide (the before and after) but also help in the clinical relation to clarify several complex emotional states. Together clinical and patient insights might ultimately help in primary and secondary prevention of suicide - a new paradigm.”
- “In the Introduction part you mention different authors, but refer to only one position - the article of M. Pompili (1).”
Answer: We thank the reviewer for identifying the fact that we considered different authors. In our review we realized M. Pompili himself provided an extensive review of most of the authors we found. It seemed fair to consider authorship of many of the ideas came from his book "Phenomenology of Suicide: Unlocking the Suicidal Mind" as we relied in it when gathering information for our article. The book did not have the authors broken down by information, so we chose to quote M. Pompili.
- “In p. 2 the statement about "Werther Effect" according to psychoanalysis", is not correct. The term was introduced from sociological perspective by D.P. Phillips (1974)”
Answer: We thank the reviewer for highlighting this incorrection – indeed, the origin of the term is by D.P.Philips. We now edited our paper considering the reviewer correction.
“(…) a protagonist who gives in to his own existential annihilation by an unrequited passion, provoking in young people of the time the same outcome - 'Werther Effect', according to D.P. Phillips (1974).”
Reviewer 2 Report
The present paper is a narrative, theoretical review of the phenomenology of suicide in different prospectives; the patients, the family, and healthcare professionals. The paper is well written and readable, the literature cited is proper. I believe there is a need for studies on the subjective experience of suicide, and this paper is a good contribution. However, I would recommend some areas of improvement:
- I would put more emphasis on the studies on the subjective experience, of suicide, and also try to find more references on this (e.g. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31498-3/fulltext#articleInformation). I would highlight that there is a need for a paradigm shift in suicide prevention. Even if this is a theoretical paper, I believe this would a great opportunity to highlight this.
- I would suggest better clarifying the objectives of the study, and also try a narrower search strategy, it seems to me that the objective is over-ambitious and I am not sure the literature was covered extensively.
- In the conclusion, I would talk about survivors and what is missing to help them. What could a philosophical approach add to the medical approach? I think this is the main strength of this paper and this needs to be highlighted from the introduction and in the conclusions, stating what is missing both in the literature both in the healthcare of suicide survivors and suicidal people.
Author Response
- The present paper is a narrative, theoretical review of the phenomenology of suicide in different prospectives; the patients, the family, and healthcare professionals. The paper is well written and readable, the literature cited is proper. I believe there is a need for studies on the subjective experience of suicide, and this paper is a good contribution. However, I would recommend some areas of improvement: I would put more emphasis on the studies on the subjective experience, of suicide, and also try to find more references on this (e.g. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31498-3/fulltext#articleInformation). I would highlight that there is a need for a paradigm shift in suicide prevention. Even if this is a theoretical paper, I believe this would a great opportunity to highlight this.
Answer: We thank the reviewer for supporting the publication of our paper and for highlighting the importance of our article for the relevance of the topic, the language, the literature cited, and the contribution to the field of Suicide. Furthermore, we thank for the suggested article, which have incorporated in our references and article “There is a need for a paradigm shift that should emphasize the mental pain in individuals as the focus of the suicide risk”.
We also emphasize the importance of the paradigm shift in suicide prevention in our conclusion which now reads “Together clinical and patient insights might ultimately help in primary and secondary prevention of suicide - a new paradigm.”
- I would suggest better clarifying the objectives of the study, and also try a narrower search strategy, it seems to me that the objective is over-ambitious and I am not sure the literature was covered extensively.
Answer: We thank the reviewer for constructively clarifying the negative parts of our paper. We tried to restrict our search to the key words mentioned in the methodology and the time frame between 2017-2021. We reviewed the methodology and added the objective of our study.
- In the conclusion, I would talk about survivors and what is missing to help them. What could a philosophical approach add to the medical approach? I think this is the main strength of this paper and this needs to be highlighted from the introduction and in the conclusions, stating what is missing both in the literature both in the healthcare of suicide survivors and suicidal people.
Answer: We appreciate the suggestion of the reviewer, which we will take into account and have added to our article. Also we changed our conclusion to include suggestions from both reviewers in hope that it now reads better:
“Our review suggests that in clinical practice a phenomenological approach might serve not only an epistemic necessity to identify and explore emotions underlying the experience of suicide (the before and after) but also help in the clinical relation to clarify several complex emotional states. Together clinical and patient insights might ultimately help in primary and secondary prevention of suicide – a new paradigm”.
Round 2
Reviewer 1 Report
I accept your corrections of the manuscript and will recommend to publish it.
