I welcome the opportunity to respond to the letters from Mark Latowsky and Jeffrey Schaler concerning my book review.1 The debate about suicide and the role of psychiatry needs to be encouraged, and both subjects need to be better understood.
Suicide is a multidetermined act; it is not solely an ethical or medical issue. Although “a person who commits suicide might be sane,” as Latowsky argues, let us not lose sight of the fact that 9 out of 10 suicide victims have a diagnosable psychiatric illness. Psychiatry is equally misperceived. With major thrusts into community care, psychiatry has evolved far beyond its institutional beginnings. However, psychiatric practices have created the perception of “totalitarianism.” In a 1999 report, the US Surgeon General suggested that improving the effectiveness of treatment strategies and accessibility to care could significantly reduce the coercion of psychiatric practices.2 Rather than retreating to the dark of night, let's push forward to the light of better understanding.