A Welshman who was 40 hanged himself after searching unsuccessfully for work for 10 months. The next day a letter arrived offering him a job. The letter the dead man left said: "I can't go on like this, reading and watching television all day. I Unemployment has been associated not only with suicide but also with the inelegantly named parasuicide, which the Oxford Textbook of Medicine prefers to call "non-fatal deliberate self harm" and defines as: "a deliberate non-fatal act, whether physical, drug overdosage, or poisoning, done in the knowledge that it was potentially harmful, and in the case of drug overdosage, that the amount taken was excessive. "I Despite the preference of the Oxford textbook, I will use the word parasuicide-as do most people writing on the subject. But it is important not to be deceived by the similarity of the words suicide and parasuicide into thinking that parasuicide is simply failed suicide: it is not. Suicide is usually associated with severe and often longstanding psychiatric or physical illness and is commoner in older people and in men; parasuicide, in contrast, is commoner in younger people and women and is usually not associated with longstanding psychiatric illness, although the patients have often experienced intense but shortlasting anxiety or depression. Parasuicide, too, is commoner in social classes IV and V and in deprived urban areas: some association with unemployment would thus be expected.Studies looking for an association between suicide and unemployment are much commoner than those looking for an association with parasuicide, and the main reason for this is simply that parasuicide British Medical Journal, London WC1H 9JR RICHARD SMITH, MB, BSC, assistant editor is a modern phenomenon: it has increased rapidly in the past 20 years and now accounts for about a fifth of all medical emergency admissions. (Interestingly the most recent data suggest that the parasuicide rate has begun to fall, while the unemployment rate has continued to rise.) Although the older studies have thus been of suicide and unemployment, many recent studies are of parasuicide. These have the potential to be more rewarding; because there are many more cases of parasuicide than suicide prospective studies of individuals become a possibility and also the individuals are left alive to investigate. Nevertheless, these potential advantages have not led to much. And one disadvantage is that parasuicide is more difficult both to define and to measure than suicide.Studies of suicide and parasuicide in the employed and unemployed More than 150 years ago Falret suggested that suicide rates rise during economic depressions,4 and Durkheim (the father of the modern word "anomie") in his classic book on suicide confidently wrote: "It is a well known fact that economic crises have an aggravating effect on the suicidal tendency."5 Many contemporary researchers are less confident.In his review Platt follows Dooley and Catalano' in classifying studies of unemployment and both suicide and parasuicide into cross se...

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Journalists reflect tendencies that we all have when they polarise issues and try to force opposite sides into acrimonious and fruitless argument. In this way prevention enthusiasts are sometimes pitted against those who work treating established disorders, but often-and particularly with alcohol problemsthe division is false. Prevention and treatment overlap: for instance, is encouraging those who are just beginning to develop problems from drinking to come forward for treatment tertiary prevention or early treatment ? This policy has been called both, and it is both. Only a few people in Britain specialise in alcohol problems, and these specialists are adept at moving from prevention to treatment issues. Increasingly, those concerned with treatment use educational techniques associated with prevention, and prevention enthusiasts borrow techniques-for instance, self-monitoring-developed in treatment programmes.' Eclecticism is not just the best policy for responding to alcohol problems, it is the only policy. Alcohol cannot be banished from Britain: though to some people alcohol is the "devil in solution," to most of us life without alcohol is unimaginable. Prohibition does not work, as has been shown not only in the United States but also in Finland and other countries, and while there is alcohol there will be associated damage, and treatment facilities will always be needed. Similarly, health education about alcohol cannot be abandoned on the grounds that it has produced no change in drinking behaviour: any political action to limit alcohol consumption will be unacceptable to the electorate unless an educational campaign has explained why such action is necessary. If alcohol damage in Britain is to be reduced then treatment, education, and political measures will all be necessary. Nevertheless, when resources are limited-and they always are and always will be limited-then decisions must be made on priorities. This is why a careful consideration of the options is important. Various preventive strategies will be considered in this article, while the next article will examine treatment. Education on alcohol Preventive measures may be directed at individuals or they may work by manipulating the environment in which those individuals live. Health education aims at the individual, and in principle few people object to educating people about alcohol problems, whereas many object strongly to political intervention in price, advertising, or licensing. Some, however, worry about the morality of trying to change people's behaviour (they see a distinction between education and propaganda), while others are concerned about the effectiveness of health education.

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and recorded two eye injuries. Both patients had a hyphaema and one also had a choroidal rupture. Given that these injuries were caused by the ball, the rate of 9-4 eye injuries per 100 000 competitive playing sessions is no different from our observed rate at the 5%" level of significance. We thank M J Absolon, I H Chisholm, J I McGill, and C B Walker for allowing us to study the notes of patients under their care. We are indebted to Professor W E Waters for his helpful criticism, and we are grateful to the Southampton University Department of Teaching Media for the illustration. References Veal AJ. Sport and recreation in England and Wales: an analysis of adult participation patterns in 1977. Birmingham: Leisure and Tourism Unit, Centre for Urban and Regional Studies, University of Birmingham, 1979. (Research memorandum 74.) 2Ingram DV, Lewkonia I. Ocular hazards of playing squash rackets.