Suicide and attempted suicide among the aged To the editor: With regard to the recent editorial by Dr. J.M. Sendbuehler (Can Med Assoc J 117: 418, 1977) I have a comment to make concerning his use of the words successful and unsuccessful in connection with suicide attempts. I wrote an editorial on this subject for the Journal 15 years ago (87: 676, 1962); the last paragraph read as follows: In regarding a suicidal act as a desperate "cry for help", it is more logical to consider a suicidal attempt "successful" when this event becomes the starting point for the surviving individual to be helped to solve successfully his underlying life problems. A fatal suicidal act should not be called "successful"; on the contrary, it is a tragic failure on the part of the significant people in the individual's environment to recognize the suicidal person's needs and to respond promptly with lifesaving action. The use of the word successful as applied to suicidal attempts appears to be so firmly entrenched that such experts as Dr. Sendbuehler still use this adjective as if the accomplishment of the purpose is to be considered as success and the opposite as failure. As a physician I can never accept such confusion between two different meanings of the same word because for me a "successful" suicide (in Dr. Sendbuehler's sense) is always a failure usually a tragic failure in preventive medicine. I suggest that instead of saying that a suicidal attempt was "successful" we should say that it was "fatal"; likewise the word unsuccessful should be replaced by "nonfatal". C.H. CAHN, MD Douglas Hospital Montreal, PQ
To the editor: Suicide and attempted suicide are subjects that have many contentious issues. For example, many of our medical colleagues believe that suicidal patients should be given every opportunity to do away with themselves. I believe that Dr. Cahn and I basically are in agreement and that our different opinion regarding the use of the word successful is really only a problem in semantics. I agree that suicide is a failure and a tragic failure. However, I have observed repeatedly that patients emerging from a coma that was self-induced are preoccupied with the fact that they "haven't been successful". The word success for patients who are contemplating suicide has to be interpreted in a distorted way. That is, they feel better after they have attempted suicide. Moreover, some pa-
tients discover that they "feel better" after they threaten suicide. Social class influences the use of the word successful. Patients from the lower classes may grumble that they have not been successful in life or in attempting suicide. On the other hand, patients from the upper classes, especially professionals who are successful in their everyday lives, are usually so inclined towards suicide. This may explain why there are proportionately more serious suicide attempts among the upper classes and why there is a higher suicide rate among gifted professionals. J.M. SENDBUEHLER, MD Royal Ottawa Hospital Ottawa, Ont.
What do family physicians see in practice? To the editor: The survey by Dr. A.M. Warrington and colleagues of the content of family practice (Can Med Assoc J 117: 354, 1977) fails to confirm the current article of faith that sickness can be significantly reduced by changes in lifestyle or improved physical fitness. I am curious as to why hypertension and disorders of stomach function should be classified as diseases of choice or lifestyle. Such classification seems to make assumptions about the etiology of these conditions that our current state of knowledge scarcely confirms. Should not pregnancy be classified as a condition (not a disease) of choice? R.T. FRANKFORD, MD 2615 Danforth Ave. Toronto, Ont.
Evaluation of the Canadian Home Fitness Test in middle-aged men To the editor: Dr. G.R. Gumming and Judith Glenn continue their spirited attack on their conception of the Canadian Home Fitness Test (CHFT) (Can Med Assoc J 117: 346, 1977). It is a great shame that the effort is being made based largely on their personal misunderstandings of the procedure. I
Table
n. sp.
1. tN. Ce
have outlined a few of their more obvious errors below. Gumming and Glenn claim that the speed of stepping is incorrect. With most types of musical performance large errors would be conceivable, but with the electronic synthesizer used for the CHFT the speed is electronically preset. The intended speed, the actual speed and the speed reported by Gumming and Glenn are given in Table I. Instead of using the required double 20.3-cm-high step Gumming and Glenn used one 22.9 cm high. It is not clear whether this was a double step or whether the "corrections" were appropriate; in any event, the subjects must have been worked at nine eighths the intended rate. The next stage in the calumny of misfortunes is to proceed from a wrong stepping rate and a wrong step height and then complain that the oxygen consumption is wrong. Having obtained an incorrect oxygen consumption Gumming and Glenn then complain that the predicted maximal oxygen intake (Vo2 max) from these data does not agree with an alternative value "estimated" (not measured) from treadmill endurance time. There is the associated supposition that in home use of the GHFT it is intended that the Vo2 max should be predicted. As already explained in the correspondence columns of the Journal, fitness assessment in the home is not based on a predicted Vo2 max but is an arbitrary criterion based on test endurance, work accomplished and heart rate. I and my colleagues1 have clearly indicated the problems that can occur until a subject has mastered the simple art of pulse counting; however, it is also well known from the experience of extensive postcoronary programs that middle-aged men can learn quickly to record accurate recovery pulse rates. It may seem a matter of serious scientific concern that the reported speed of sound is up to 6% higher in Winnipeg than elsewhere in the world. However, before writing erudite articles
Fttn. Teat (CNFT)
Women 1 2 3 4 5 6
66 84 2102 114 129 132 -.
1136 CMA JOURNAL/NOVEMBER 19, 1977/VOL. 117
84.0 102.5 114.5 121.5 134.0
Men Re.rte.. Iu.e#ud Qiopo .72 JAIl 120 126 1%. -
66 14 102 114 132 .244 156
66.0 *4.5 102.5 114.0 1.#.5 14L7 1510
Reported by Cumnilng and Glenn 66 84 102 120 1R..
To the editor: Suicide and attempted suicide are subjects that have many contentious issues. For example, many of our medical colleagues believe that suicidal patients should be given every opportunity to do away with themselves. I believe that Dr. Cahn and I basically are in agreement and that our different opinion regarding the use of the word successful is really only a problem in semantics. I agree that suicide is a failure and a tragic failure. However, I have observed repeatedly that patients emerging from a coma that was self-induced are preoccupied with the fact that they "haven't been successful". The word success for patients who are contemplating suicide has to be interpreted in a distorted way. That is, they feel better after they have attempted suicide. Moreover, some pa-
tients discover that they "feel better" after they threaten suicide. Social class influences the use of the word successful. Patients from the lower classes may grumble that they have not been successful in life or in attempting suicide. On the other hand, patients from the upper classes, especially professionals who are successful in their everyday lives, are usually so inclined towards suicide. This may explain why there are proportionately more serious suicide attempts among the upper classes and why there is a higher suicide rate among gifted professionals. J.M. SENDBUEHLER, MD Royal Ottawa Hospital Ottawa, Ont.
What do family physicians see in practice? To the editor: The survey by Dr. A.M. Warrington and colleagues of the content of family practice (Can Med Assoc J 117: 354, 1977) fails to confirm the current article of faith that sickness can be significantly reduced by changes in lifestyle or improved physical fitness. I am curious as to why hypertension and disorders of stomach function should be classified as diseases of choice or lifestyle. Such classification seems to make assumptions about the etiology of these conditions that our current state of knowledge scarcely confirms. Should not pregnancy be classified as a condition (not a disease) of choice? R.T. FRANKFORD, MD 2615 Danforth Ave. Toronto, Ont.
Evaluation of the Canadian Home Fitness Test in middle-aged men To the editor: Dr. G.R. Gumming and Judith Glenn continue their spirited attack on their conception of the Canadian Home Fitness Test (CHFT) (Can Med Assoc J 117: 346, 1977). It is a great shame that the effort is being made based largely on their personal misunderstandings of the procedure. I
Table
n. sp.
1. tN. Ce
have outlined a few of their more obvious errors below. Gumming and Glenn claim that the speed of stepping is incorrect. With most types of musical performance large errors would be conceivable, but with the electronic synthesizer used for the CHFT the speed is electronically preset. The intended speed, the actual speed and the speed reported by Gumming and Glenn are given in Table I. Instead of using the required double 20.3-cm-high step Gumming and Glenn used one 22.9 cm high. It is not clear whether this was a double step or whether the "corrections" were appropriate; in any event, the subjects must have been worked at nine eighths the intended rate. The next stage in the calumny of misfortunes is to proceed from a wrong stepping rate and a wrong step height and then complain that the oxygen consumption is wrong. Having obtained an incorrect oxygen consumption Gumming and Glenn then complain that the predicted maximal oxygen intake (Vo2 max) from these data does not agree with an alternative value "estimated" (not measured) from treadmill endurance time. There is the associated supposition that in home use of the GHFT it is intended that the Vo2 max should be predicted. As already explained in the correspondence columns of the Journal, fitness assessment in the home is not based on a predicted Vo2 max but is an arbitrary criterion based on test endurance, work accomplished and heart rate. I and my colleagues1 have clearly indicated the problems that can occur until a subject has mastered the simple art of pulse counting; however, it is also well known from the experience of extensive postcoronary programs that middle-aged men can learn quickly to record accurate recovery pulse rates. It may seem a matter of serious scientific concern that the reported speed of sound is up to 6% higher in Winnipeg than elsewhere in the world. However, before writing erudite articles
Fttn. Teat (CNFT)
Women 1 2 3 4 5 6
66 84 2102 114 129 132 -.
1136 CMA JOURNAL/NOVEMBER 19, 1977/VOL. 117
84.0 102.5 114.5 121.5 134.0
Men Re.rte.. Iu.e#ud Qiopo .72 JAIl 120 126 1%. -
66 14 102 114 132 .244 156
66.0 *4.5 102.5 114.0 1.#.5 14L7 1510
Reported by Cumnilng and Glenn 66 84 102 120 1R..
