Letter From Ronal Rosso
Dear Tony,

I read with interest the “note” document you sent to me. As I promised I would spin back to you a quick and dirty impression of a general psychiatrist who is frequently responsible for determining lethal risk and suicidality among psychiatric impatient admissions and threatening outpatient in the community. I need not repeat the caveats and disclaimers I stated in our phone conversation. It is enough to say that suicide notes are only part of the indirect, complementary information we garner and use to assess the suicidal patient. Our greater emphasis is the determination of the direct clinical assessment and its correlation with other available data.

If the note is a suicide letter it is a very weak form of one. There is surely no explicit threat of self destructive behavior. There is no definite expression of hopelessness or helplessness. Amateur, as well as professional, psychologists can usually infer and find latent content of despair in most any lament, apology, admission of error or rhetorical expression of rectification. But such inference seems excessive here. A competent patient who argued that it was other than a suicidal would deserve little challenge in regarding its dangerous message.

I might mention a couple of my intuitive responses to the letter when considering a suicide note. Who was the intended audience? Could it be compared to the public statement Dick Nixon’s “you won’t have me to kick around any more”. It surely is no more suicidal in content. Where is the personal pain in this systematically comprehensive and exculpatory statement for his bosses? Finally I wonder how similar its style is to that of the author’s journal writing ?

I do encourage and find interesting your efforts at finding in the professional literature some rigorous and systematic criteria for characterizing “suicide notes”. Investigators in suicidology and the forensic sub-specialists may afford a more refined analysis. So let me know if you need a referral.

Ronal George Rosso M.D.