[Endogenous control and personal self-determination in suicide during manic-depressive psychoses]

According to the "Chronopathological theory of manicdepressive disorder" (Supprian: "Ordnung und Psychose" pubd. by R. Krämer Hamburg 1988, ISBN: 3 926952 07 5), the syndromatic day-to-day shifting of the psychopathological features with manic, depressive and several mixed states has a well-defined time structure, as in 25 patients studied and reported on in this paper. This time structure is given with a chronobiological cycle of an (individual) length and an inherent sequence of psychopathological phenomena (the theory stipulates a series of several cycles--from rapid to long-term-periodicity--and related sequences). Within this order the psychopathological surface of each day is strictly determined by its numeric position in the cycle. The several states and the individual comments on suicide (from announcement to dissimulation or distancing and to trying out and execution, etc.) can be described by means of affective disorders, a special casted typology of 12 types. The material for this study consisted of 25 cases with a well-known time-structure (obtained via previous analyses by computer-aided sequence spectra) and 178 text extracts from patients histories, compiled in a booklet, one for each expert. 10 independent experts (psychiatrists and psychologists) rated the typology of each text. Statistical studies of frequency tables (Chi2-technique) show a close matching between psychopathologic and suicidological states. Final action, for example, is correlated with an overall dysregulation of the mood system (with no dependence on the drive system--contrary to a widespread doctrine). Any lack of drive can be instrumentally compensated. Timing of suicide (and all other types of translation into reality) during the course of an affective disorder could be shown as being strictly determined by the endogenous process and its time structure. The results confirm the chronopathological theory.