Letter: Patient's suicide offers sad lessons

Sir: Tony Sheldon's article ('The doctor who prescribed suicide', 30 June) concerning the Dutch psychiatrist helping a woman to kill herself was most alarming reading, principally because of the psychiatrist's naivety and failure to understand unconscious psychological processes. What he failed to consider was the unconscious significance of what he was doing by literally killing the woman.

She was undoubtedly depressed, and probably intensely guilty, about the suicide of her first son, compounded by the death of her second son. The guilt she felt she believed could only be atoned for by executing herself, which is principally what suicide is about. This, of course, is something that often we cannot prevent and is a terrible tragedy when it happens, but to carry out the execution for the patient is a complete misunderstanding of the patient's mental state.

The doctor has simply colluded with the deluded side of her that demands the death penalty for her perceived wrongdoing (allowing her sons to die). What he should have done was to understand this unconscious belief, which is a delusion, and help her with it. Helping her to come to bear the awful reality that she has lost her sons, but that she is not responsible for their deaths, as she unconsciously deeply believes herself to be.

This is called grief and mourning, and it is the psychiatrist's job to treat such grief, not to enact the unconscious fantasy, which sadly, erroneously and in a disturbingly misguided way, he has done.

Yours faithfully,

IAIN OSWALD

Department of Psychiatry

Watford General Hospital

Watford, Hertfordshire

30 June