Barry Blackwell: The Baby and the Bathwater

Barry Blackwell’s reply to Leonardo Tondo’s comment 


       With due respect to Leonardo Tondo’s comment I must point out he has misconstrued my metaphor. We appear to be looking at three different bathtubs.

       Tondo emphatically informs us that his impressive cohort of 6,000 patients treated with anti-depressants had only 1% who committed suicide. This is both a tribute to clinical practice and refutation that antidepressants increase suicidal risk.

       However, my recent biography of Martin Kassell suggests otherwise (Blackwell, 2018). Based on clinical practice, not research, he described a sample of more than 200 attempted suicides in a population of undefined size, the majority of which were impulsive and not preventable, although therapy directed at the dynamics could stifle recurrence.

       A more recent and scrupulous research study found 24% of 153 subjects who attempted suicide were impulsive (Simon et al. 2001).

       These three samples differ markedly. Kassell’s subjects were from the consultation-liaison service of a County general hospital and a County forensic unit. Simon et al.’s were from a population-based  sample of young people ages 13-34 and while Tondo does not describe the source of his population it was presumably based on private practice of a diverse nature over an extended period.

       Unfortunately, the other two samples do not report the extent of anti-depressant use or the relationship between the suicide attempt to any treatment or its duration.

       While Tondo focusses on the relationship between suicide and depressive ideation and denies the presence of impulsivity the other two studies emphasize anger and impulsivity.

      Taken together the incompatible findings of the three different studies suggest that before arriving at any conclusion about the baby and the bathwater the observer needs to define the baby, the bathwater and the bathtub in which they have been immersed.



Blackwell B, Martin Kassell; One of a kind psychiatrist. biographies October 23, 2018.

Simon TR, Swann AC, Powell KE, Potter LB. Kresnow M. O’Carroll PW. Characteristics of impulsive suicide attempts and attempters. Suicide Life Threat Behav.2001: 32 (Supp 1):49-59.


April 4, 2019