from MENTAL MALADIES: A TREATISE ON INSANITY
It does not belong to my subject to treat of suicide in its legal relations, nor, consequently, of its criminality. I must limit myself to showing it to be one of the most important subjects of clinical medicine. Self-murder takes place under circumstances so opposite, and is determined by motives so diverse, that it cannot be limited to any single denomination. However varied may be the motives and circumstances, which cause men to expose their lives, and to brave death, they almost always exalt the imagination, either on account of a good, more precious than life, or an evil more formidable than death.
Before tracing the history of suicide, it may be well perhaps, to point out the principal circumstances which lead man to terminate his own existence. From these preliminary considerations, we will pass to an exposition of the symptoms, to an enquiry into the causes, and to the post-mortem examination of bodies. We will finally close, with some general views respecting the means proper to prevent suicide, and to combat the fatal impulse which urges man to the commission of self-murder. Man destroys himself, or exposes his life to certain destruction, under the impulse of the loftiest sentiments. The act is then worthy of admiration, and excludes all blame. The victims of false, but popular views; of barbarous, but national usages; not only are individuals, but whole sects, doomed to a voluntary death. All the passions have their seasons of fury. In their excesses, there is nothing that they do not sacrifice; and man, while a prey to a passion, spares not his own life. In febrile delirium and mania, more lives are taken than is usually supposed. Hypochondria and lypemania are most frequently the true cause of that abhorrence and utter weariness of life, which so often give birth to that form of suicide, which we call voluntary. He who wishes to terminate his existence, moved by diverse motives, does not always lay violent hands upon himself, but becomes a homicide. It is not unusual for two individuals, led away, either by blind passion, or by wretchedness, to resolve to die, and reciprocally to take each other’s life.
Finally, suicide is sometimes feigned. From what precedes, we already perceive, that suicide is, with respect to our knowledge; only a phenomenon, consecutive to a great number of diverse causes; that it presents itself under very different characters; and that this phenomenon is not exclusively confined to any one malady. It is in consequence of having made suicide a malady sui generis, that they have established general propositions, which experience disproves. He is not the homicide of himself, who, listening to the dictates of noble and generous sentiments, places himself in certain peril, exposes himself to inevitable death, and makes a voluntary sacrifice of life in obedience to the laws, and to guard the faith, plighted for the salvation of his country. Such were the Decii, who sought death in the camp of the enemy, to fulfil an oracle, which, at this price, had furnished victory to the Athenians. Such also, was Curtius, who precipitated himself armed, into an abyss, to assure victory to the Romans. Assas was another, who hesitated no to sacrifice his life to save the regiment of Auvergue, which would have been surprised, had it not been for the heroic devotion of this officer. The generous inhabitants of Calais and Rouen, were of this number; who made an offering of their lives, to save their fellow citizens who were ready to perish by the sword of the enemy, or by famine. Were Socrates and Regulus self-murderers; the one, for having refused to avoid the execution of the laws which condemned him to death; the other, for being unwilling to forfeit his word? Shall we denominate suicides, those wretched beings who, victims to religious beliefs, and the usages of their country, think, that by devoting themselves to death, they perform a duty, and an act at once memorable, and worthy of recompense? This hope, embraces with ardor, has resulted in the sacrifice of life, not only on the part of a few individuals, but of colonies, and entire nations. Such were the Thracians, Germans and Arabians; and such, at this day, are the Indians…
Suicide Provoked by the Passions
A few words will satisfy the most incredulous, that the passions, when strongly excided, ever produce disturbance, either in the organism or understanding of man. When the soul is strongly moved, by a violent and unexpected affection, organic functions are perverted, the reason is disturbed, the individual loses his self-consciousness, is in a true delirium, and commits acts the most thoughtless; those most opposed to his instinct, to his affections and interests. Thus, terror often takes away the thought of flight, and urges its victim into perils, greater than the danger he would shun. Love deprives him who is powerfully impressed by it, of all those qualities proper for the accomplishment of his desires; while anger and jealousy, lead the man who is endowed with the mildest disposition, to imbrue his hands in the blood of his best friend. A sudden and unexpected trial, love betrayed, ambition disappointed, honor compromised, the loss of fortune, by overthrowing the reason, deprive man of the power of reflection. Does the delirium of the passions permit man to reflect? Do not all laws acquit him who has committed, during the first transports of a violent passion, an act, which would have been criminal had it not been for this circumstance? The actions of a man, transported by a sudden passion, are regarded as performed without free agency; and are judged of, as the effect of a temporary delirium. Strong men, of a sanguine temperament, of great susceptibility, and of an irascible disposition, are impelled to suicide by an impulse so much the more strong, as the impression has been unexpected; and the passion a social one, suddenly called into exercise. But the acute delirium provoked by the passions, is temporary, and the suicide which it provokes is promptly executed. If not consummated, the impulse is not, ordinarily, renewed. The fruitless attempt seems to have been the crisis of the moral affection. The involuntary and acute form of suicide is very different from that which is chronic, and the result of premeditation. Examples of acute suicide produced by disorder of the passions are so frequent, that it will be sufficient for me to point out a small number of them. The trustee of the fortunes of his fellow-citizens, loses at play the money that has been committed to his care. His honor is lost, and he blows out his brains…
But the most violent passions do not always impel the passionate man suddenly to the commission of acts of fury. When the passion is primitive, or the moral impression has been foreseen, its action is less rapid, especially when it operates upon enfeebled subjects, or those of a lymphatic temperament. The secret prey of hatred and jealousy and of miscalculations with respect to schemes of ambition and fortune, man arrives slowly, and by successive paroxysms, to the most fatal resolutions. Although acting slowly, the passions do not less enfeeble the organs, nor less disturb the reason. They are not less likely to destroy life, and when time is still afforded to relieve these wretched beings from their peculiar fury, they present all the features of despair, as well as the characteristics of lypemania. Many have made attempts upon their lives, without knowing what they were doing; and many have assured me, that they recollected nothing that they had done. Many also, had singular hallucincinations. This, though voluntary suicide, is chronic. It is to this variety, that we are to refer that form of suicide which is resolved upon through hatred or weariness of life; which last, appears to me to offer important considerations. Chronic suicide has, more particularly, given rise to discussions respecting the criminality of self-murder, because it presents the characteristics of a premeditated act. It is not, perhaps, so much with respect to the act, in itself considered, that this dissidence exist; for it is certain, that up to the moment of its execution, he who attempts his own life, almost always resembles a man in a state of despair, connected with delirium. Physical suffering, which often leads to lypemania and hypochondria, also causes suicide. It changes the sensations, concentrates the attention, impairs the courage, and destroys the reason, by modifying the sensibility so as to accord with the prevailing passions. Its action however, is slower than that of moral suffering, and rarely provokes self-murder. The man to whom physical suffering leaves no moment of relief, who perceives not the limit of a long and cruel malady, after having at first supported his ills with resignation, at length becomes impatient. Overcome by sufferings which have for a long time enfeebled him, He takes his life, to put an end to these intolerable evils. He considers that the pain of dying is but temporary, and yields to premeditated despair. It is the same moral condition, that determines the suicide of hypochondriacs; all of whom are persuaded that their sufferings are greater than one can conceive, and are never to terminate; partly, on account of their extraordinary nature, and in part, in consequence of the impotence of art, or the ignorance of physicians…
When maniacs commit self-murder, they do it without reflection. They usually throw themselves from a height; a circumstance which proves that they obey a blind impulse, by the employment of a means the most easy and accessible. Maniacs are affected by illusions; perceive imperfectly the relations of things, and are often pursued by panic terrors. They are the sport of their sensations, or of the hallucinations which constantly deceive them. One, wishing to descend the stairs, and believing that he is opening the door of his apartment, opens the window, and precipitates himself to the ground. Another, estimating distances imperfectly, and believing that he is on the ground floor, throws himself out of the window. This latter person, wishes to do violence to a woman who waits upon him, and throws himself from the stair-way of the third story, hoping to arrive at the bottom before she escapes his pursuit. A maniac, impelled by hunger, was accustomed to eat whatever came in his way. He dies suddenly, and on examining his body, they find a spunge that he devoured, and which rested in the esophagus. Some maniacs destroy themselves while endeavoring to perform feats of strength and address. There are maniacs who suffer from a violent cephalalgia, and who, by striking their heads against the walls, experience relief. Others believe that they have some foreign body in the cranium, and hope to remove it by opening the head. We have seen them destroy life by smiting themselves for this purpose. Maniacs also destroy themselves at the commencement of the disease, driven to despair by the moral affection which has caused the delirium, or coincided with its explosion; the recollection of this affection, not being destroyed by the delirium, which has not yet invaded the entire understanding. This class of patients also take their lives, because they have a knowledge of the disease which is commencing, and which plunges them into despair. There are those who destroy themselves during convalescence from mania, rendered desperate by the excess they have committed, or ashamed of having been insane. Finally, (we must confess it), there are those who destroy life while making efforts to disengage themselves from means of restraint, unskilfully applied, or to escape from places in which they had been confined. Those who are suffering from a fever, in their delirium destroy themselves, like maniacs.
Every case of monomania may lead to self-murder; whether the monomaniac obey his illusions or hallucinations, or fall a victim to a delirious passion. A monomaniac hears an internal voice, which is constantly repeating; slay thyself, slay thyself; and he takes his life, in obedience to a superior power, whose mandate he cannot disobey. A man, whose brain was deranged by some obscure and mystical notions, believed that he was in communication with God. He hears a celestial voice which says to him: my son, come and sit down at my side. He springs from the window, and fractures a leg. Whilst they are raising him up, he expresses much astonishment at his fall, and particularly on finding himself wounded. A soldier hears an organized hurdy-gurdy. He thinks he is listening to celestial music, and at the same time sees a luminous chariot, which is coming to bear him away to heaven. He very seriously opens the window, extends a leg to enter the car, and falls to the ground…
Nostalgia leads to suicide. The ranz des vaches, and the notes of the bagpipe, through the influence which actual sensations have over the ideas and recollections, produce regret at being no longer in the country of their birth; and grief, at being removed from the objects of their earliest attachments. Hence, springs up a violent desire to revisit the places where they were born. The emotions thus awakened, together with their despair at being separated from those objects which call them into exercise, rise superior to all other feelings, and both Swiss and Scotch soldiers destroy themselves, if they cannot desert. How many lypemaniacs, who believe themselves pursued by robbers, or agents of government, destroy themselves, in order to avoid falling into their hands! Some make no estimate of the danger they run, in order to effect their escape; while others prefer certain death, to the torture and disgrace which are preparing for them. How many, who believe that they are betrayed by fortune and their friends, destroy themselves, after a struggle of longer or shorter duration! They take their lives as do men, whom a passion urges slowly, to the commission of self-murder…
Weariness of life, has not been sufficiently distinguished from hatred of it, when writers have enquired into the determining motives to self-murder. Not-withstanding, these two conditions of the mind are very different. Hatred of life is an active state, and supposes a sort of irritation and exaltation of the sensibility. Weariness of life is a passive state, the effect of atony of the sensibility. Hatred of life is frequent, because a thousand circumstances provoke it. It spares no class of society, and most frequently attacks men abounding in wealth and dignity, because they possess more passions, which are called into active exercise. A prey to vexations, either real or imaginary, or to a chronic passion, man, at first disgusted with life, ends by hating it, and destroying himself. I ought finally to state, that words here but imperfectly express the ideas which they are designed to convey, and that from this circumstance, discussions have sprung up respecting hatred of life and desire of death. In fact, they have no aversion to life, but hate the sufferings which traverse it, and have a horror of their uneasiness. They do not desire death; but wish to be delivered from pains, oppositions and vexations, and have recourse to death as the most certain means. Suicide, determined by hatred of life, forms one of the distinctions which we have already established. It appertains to lypemaniacal suicide, or to suicide produced by a chronic passion; according as the causes which occasion hatred of life, are real or imaginary.
Weariness of life, the tœdium vitœ, leads to self-murder. Although weariness may be a passive condition, it is, in some instances, not the less a motive of action. Such has been the opinion of many philosophers, and I have observed, that weariness determined certain monomaniacs to do what had appeared most repugnant to them, and that they were cured by efforts made upon themselves, from excessive ennui. Ennui, at the epoch of puberty, originates in a vague desire, the object of which is unknown to him who experiences it; and this want gives rise to an inquietude, which occasions sadness, terminating in weariness. The most common effects of this tediousness are, decay, feebleness, and sometimes suicide: a phenomenon noticed by Hippocrates among young girls, who either have not, or but imperfectly, menstruated. Ennui recognizes moreover as a cause, the cessation of engrossing occupations; the transition from a very active life to one of repose and idleness, when no occupation for the mind or affections of the heart have been previously formed. Weariness is also the effect of the abandonment, either forced or voluntary, of the fashionable world, and frivolous pleasures; when the individual remains isolated, and without any interest whatever. It is so much the more fatal, when, having no aptitude for the arts and sciences, one is deprived of the resources of pleasures, in consequence of having abused them.
Man must have desires, or he falls into a state of painful weariness. But if he has exhausted his sensibility by the excessive exercise of the emotions and the abuse of pleasures; if, having exhausted all the sources of happiness, there is nothing more that can cause him to feel that he still lives, and all external objects are indifferent to him; if, the more means of self-satisfaction he has enjoyed, the less numerous are the new objects which he meets with that are calculated to awaken his interest; man then occupies a frightful void. He sinks into a state of satiety; a terrible weariness, which conducts to suicide. To quit life, is to him an act as indifferent as that of leaving a splendidly furnished table, when he no longer desires food, or to abandon a woman whom he formerly adored, but whom he no longer loves. That form of suicide which is called splenic, is chronic. It is executed with coolness and composure. Nothing announces either violence or effort, like other forms of suicide. Finally, those who suffer from spleen, present all the characteristics of melancholy. The most frequent causes of spleen are debilitating, and act upon the nervous system. Such are the abuse of pleasures, onanism, and the immoderate use of alcoholic drinks. There is the same changes of disposition and habits; the same indifference towards the dearest objects; the same physical symptoms; loss of appetite, insomnia, constipation, emaciation or œdema; the same concentration of the attention upon a single idea: the same integrity of the understanding upon every other subject; the same perverseness: and the same dissimulation in the execution of the determinations in the former as in the latter.
I have strong reasons for believing that the spleen is a very rare disease, even in England. We too often attribute the suicides of the English to weariness of life, because England is the country in which most frequently the people have recourse to it. The English without doubt, suffer most from this distressing weariness; still many other motives than this give rise to suicide among them. I have had charge, as well in establishments for the insane as in my private practice, of a great many individuals, who have either attempted, or taken their lives. I have seen no one who was driven to suicide in consequence merely of weariness of life. All had determinate motives, real or imaginary vexations, which led them to loathe existence…
There are persons who, amidst fortune, grandeur and pleasures, and enjoying the perfect use of their reason; after having embraced their relations and friends, set their affairs in order, and written excellent letters, clip the thread of life. Do they yield to a delirious resolution? Yes, unquestionably. Is it not true that monomaniacs appear rational, until an external or internal impression comes in suddenly to awaken their delirium? Do they not know how to repress the expression of their delirium, and to dissemble the disorder of their understanding, so as to deceive the most skilful, as well as persons who live with them on terms of intimacy? The same is true of some individuals, over whom the purpose to commit suicide holds complete sway. A physical pain, an unexpected impression, a moral affection, a recollection, an indiscreet proposal, the perusal of a book, kindle up anew the dominant thought, and instantaneously provoke determinations the most fatal, in the breast of an unfortunate being who, an instant previous, was perfectly composed. That then happens, which took place in the case of the maniac detained at the Bicêtre, of whom Pinel says, that the revolutionists set him at liberty, because he appeared to them perfectly sane. They led him forth in triumph, as a victim of tyranny, when being excited by the vociferations and the sight of the arms of his liberators, he suddenly fell upon them, sabre in hand.
Does not the fury of the homicidal monomaniac burst forth instantaneously, so that no antecedent circumstance may have forewarned the victim? We cannot deny that there are individuals whom a fatal inclination leads to suicide, by a sort of resistless charm. I have never seen such persons; and I dare say that if those cases had been more carefully studied, in which they pretend that the patients obeyed an insurmountable impulse; it would have unfolded the motives which led to their determination. There are suicides as well as other insane persons, of whom we speak, as of unfortunate beings, who are obeying a blind destiny. I believe that many persons have learned to read the thoughts of these patients, and proved that their determinations are, almost always, the result of motives and the logical consequence of a principle, though it may be, in truth, a false one. There are persons, however, who, in the midst of good fortune, destroy themselves. Voltaire, sustained by certain striking examples, pretends that it is those who are distinguished for their good fortune who voluntarily terminate their existence, and not the man who is the victim of want, and compelled to labor for his subsistence. This proposition is false. Misery leads to suicide, and self-murder is most frequent during years signalized by calamities. Amidst ruin and famine, suicides are frequent. During the horrors of a siege, the besieged destroy themselves. Amidst defeats, soldiers take their own lives. Self-murder takes place during great political convulsions. The fortunate of the age destroy themselves; but good fortune, says Jean Jacques, has no external sign. To judge of it, we must read the heart of the man who appears to be happy…
Thus, among those wretched beings who destroy others, before taking their own lives, some obey those vehement passions which lead them quickly to this double homicide. Others are aroused by passions whose effects are slow in manifesting themselves. There are those who are unwilling to destroy themselves, through fear of eternal condemnation; knowing that suicide is a great crime, for which they could not obtain pardon. They are however, certain of being condemned to death after taking the life of a fellow-being, and hope to have time, before their punishment, to reconcile themselves to God, and to prepare for a happy death. There are those who slay the dearest objects of their affection, in order to preserve them from the trials of life and the dangers of condemnation. Finally, we have seen those who slew the objects of their tenderest attachment, being unwilling to be separated from them, and believing that they should be reunited after death. Is it possible to believe that such a violation of the fundamental laws of nature; such exaltation of the imagination; such perversion of the sensibility; can be compatible with the enjoyment of sound health and the integrity of reason? Must he not, on the contrary, have reached the extreme limit of delirium, who resolves to take the life of the wife whom he tenderly loves, and the children whom he adores? Does he not abandon himself at once, to acts most opposed to natural laws, and the instinct of self-preservation? Notwithstanding, many facts prove that these unfortunate beings, aside from this act, both before and after its accomplishment, are composed and rational. Do we not observe this composure and reason among those maniacs who, from the slightest motives, from the most trifling opposition, give themselves up to the commission of acts indicative of the blindest fury? It is not the signs of delirium on the part of those who commit suicide, that are wanting; but observers who are at hand to see all, and to see correctly.
Reciprocal suicide is that act by which two individuals slay, one the other. It is generally the delirium of some passion, and sometimes extreme wretchedness, which lead those who are their victims, to devote themselves to death. The same passion, leading to the same determination, finds a certain charm in dying by the hand it adores. Examples of this form of fury are not rare, and we can trace them back to the remotest antiquity…
What precedes, will justify the remark which was made at the commencement of this article, to wit: that self-murder is only a phenomenon, consecutive to very different causes; that it cannot be regarded as a malady sui generis; and that it is, almost invariably, a symptom of mental alienation. The greater part of those unfortunate beings who have made attempts upon their own lives, or who have committed suicide, belong to families, some of whose members have been affected with mental alienation. Most of those who have failed in accomplishing their designs, remain insane for a longer or shorter period of time, or become so afterwards. A large proportion of them have manifested, before committing the fatal deed, all the symptoms of lypemania. Some have destroyed themselves, after having had an attack of mania, subsequently to which they have remained sad and morose…
Cabanis observed, that after a very dry summer, succeeded by a rainy autumn, that suicides were most frequent during the latter season. I made the same observation in 1818. We received during that year into our hospital, a much greater number of suicides than we had received in previous years, or have since admitted. In my private practice also, I had at the same period a greater number of suicides to treat. Is not the transition from a dry summer to a humid autumn, especially favorable to the development of abdominal affections, upon which suicide so often depends? We do not charge external causes alone with producing suicide. There are certainly individual predispositions, a certain physical state, which modifies, exalts or enfeebles the sensibility.
The difference in the mood of mind, causes one man to laugh at the most afflictive events, while another is excessively agitated, or filled with despair. The latter destroys himself; while the former becomes insane. Is not this predisposition rendered evident by the hereditary nature of suicide? We have known entire families destroy themselves, just as we have known whole families become insane…
But these conclusions are subject to accidental exceptions. In fact, authors speak of epidemics of suicide, which have been confined to women. The character of these epidemics confirms what we have said; that suicide is only a consecutive symptom. The appearance of an epidemic form of suicide is most singular. Does it depend upon a latent condition of the atmosphere; upon imitation, so powerful in its influence over the determinations of men; upon those circumstances which produce a revolution, in a country; in fine, upon any governing sentiment? It is certain, that these sudden and temporary epidemics are the effect of different causes, and confirms what we have already said;—that suicide is not a malady sui generis…
Education, the reading of works that extol suicide, the power of imitation, contempt for religious opinions, the excesses of civilization, a military spirit, political revolutions, the depravation of morals, gaming, onanism, the abuse of fermented liquors, physical pain, pelagra, are also causes that lead man to commit suicide. If by education, the mind of man is not fortified by a religious belief, by moral precepts, by habits of order, and a regular course of life; if he is not taught to respect the laws, to fulfil his duties towards society, and to support the vicissitudes of life; if he has learned to despise his equals, to treat with disdain the authors of his being, and to be imperious and capricious in his desires; then unquestionably, cæteris paribus, he will be most disposed to terminate his existence by a voluntary act, so soon as he shall experience any serious vexations or reverses. Man needs a controlling authority, which shall direct his passions and govern his acts. Given over to the guidance of his own native weakness, he falls into indifference, and from that into acepticism. Nothing now sustains his courage. He meets unarmed, the conflicts of life, the anguish of the heart, the vicissitudes of fortune, and the wayward impulses of the passions. A student, educated in religious principles, becomes melancholic, and finally speaks of death. He often enquires of one of his companions if man has a soul. The latter replies that he has not. After a painful struggle between the principles of his childhood and the errors of youth, this unfortunate young man terminates his career by suicide. A young man, before destroying himself, in a writing which he leaves, censures his parents for the education they have given him. Another utters blasphemies against God and imprecations upon society. A third, destroys himself because he has not air enough to breath at his ease. Two students, at the age of twenty-one, asphyxiate themselves, because a play which they had prepared together, did not succeed. A child, thirteen years old, hangs himself, and leaves a note which begins thus: I bequeath my soul to Rousscau, my body to the earth!! When a great intellectual and moral change is brought about in society, it influences the progress of thought, and the conditions of existence.
Recklessness of mind reveals itself not only in useless writings and romances, but also in productions of a more elevated character. When the theatre presents only the triumphs of crime, and the misfortunes of virtue; when books, placed by their cheapness within the reach of all, contain only declarations in opposition to creeds, family ties, and the duties which all owe to society; they inspire a contempt for life, and suicides multiply. Death is regarded as a safe asylum against physical pains and moral sufferings. The reading of books which extol suicide is so fatal, that Madame de Staël assures us, that the reading of the Werther of Goëthe has produced more suicides in Germany, than all the women of that country. Suicide has become more frequent in England, since the apology that has been made for it by the Downes, Blounts, Gildons, etc. The same is true of it in France, since they began to write in favor of self-murder, and have held it up before the public as an act of our free will and courage. The suicide of Richard Smith and his wife: that of Philip Mordant, who destroyed himself, saying that when one is dissatisfied with his house, he should leave it; were the signal for a great number of suicides in England.
What precedes, establishes the fact there are epochs in society, more favorable than others to suicide, in consequence of the general exaltation of mind. The more excited the brain is, and more active the susceptibility, the more do the wants augment; the more imperious become the desires; the more do the causes of chagrin multiply; and the more frequent become mental alienation and suicide. Any person may satisfy himself of this, by comparing the number of suicides in cities, particularly capital cities, with those that take place in the country. The same fact will appear by comparing the number of suicides in Russia with those that occur in France, and particularly England. If one now compares the actual state of Europe with that of Italy, during the time of the emperors, will he be astonished that epochs so similar, as it respects morals and the splendor of civilization, are equally fruitful in suicides? During the ninth and tenth centuries, the epoch of confusion in opinions and doctrines, the donatists, seized with a suicidal frenzy, devoted themselves to death, or gave themselves up to it for money. Men, women and children hung themselves, or threw themselves from precipices, or upon funeral piles. The gnostics permitted themselves to die of hunger, through fear of wounding a creature which was a part of the Deity.
A military spirit, which inspires indifference to life, which attaches little importance to a good which one is ready to sacrifice to the ambition of a master, is favorable to suicide. At Rome, during their civil wars, the conquered generals destroyed themselves, that they might not fall beneath the yoke of the victor. The vessel which carried Vitellius and his cohort, was taken by the fleet of Pompey, among the sands of the Illyrian sea. After having fought valiantly, fatigued with the carnage, Vitellius exhorted his surviving soldiers to prevent, by a death of their own choosing, the disgrace of falling into the hands of the victors. Animated by his discourse, his soldiers slew each other upon the deck.
Great calamities also lead to suicide. It prevailed extensively during the existence of the black plague that ravaged Europe, towards the middle of the fourteenth century. Historians assure us that the Peruvians and Mexicans, in despair at the destruction of their worship, usages and laws, destroyed themselves in great numbers; and that more fell by their own hands than by the fire and sword of their barbarous conquerors. Ross Cox, in his account of a voyage in the waters of Columbia, published in London in the year 1831, relates, that at the close of the last century the small pox committed horrible ravages in India, and that thousands of Indians hung themselves to trees, believing that the Great Spirit had delivered them over, to be punished by evil ones. Montaigne states, that during the wars of the Milanese, this people, impatient of so many changes of fortune, so fully determined to die, that I have heard it stated to my father that they had taken an account of at least twenty-five heads of families, who destroyed themselves in a single week.
In 1320, five hundred Jews, pursued by the peasantry of the country, took refuge in the château of Verdun, upon the Garonne. Besieged by their implacable enemies, and driven to despair, after having thrown their infants over the walls to their besiegers, they cut their own throats. The Jews, at the time of the siege and taking of Jerusalem by Titus, in order to put an end to their sufferings, threw themselves from the top of the ramparts, or set fire to their houses, in order to become a prey to the flames.
Onanism is referred to by Tissot, as one of the causes of suicide. I have very often seen suicide preceded by the practice of masturbation. The same is true with respect to the abuse of alcoholic drinks. These two causes exhaust the sensibility, producing languor or despair. They produce also much insanity. Individuals thus enfeebled sink into lypemania, and form no other purpose than that of ridding themselves of life, which they have no longer the capacity to endure…
I will not enlarge more upon the causes of suicide, but will confine myself to the indication of those, which seem to produce it most frequently. If I have not spoken of the passions which often occasion suicide, either acute or chronic, it is because I have noticed them sufficiently, while analyzing the circumstances which almost invariably precede it. The phenomena which accompany or succeed the disposition to suicide, offer the most striking analogy to those of mental maladies. We say in general, that persons of a melancholic temperament and a bilious constitution, are very prone to suicide. They have a sallow complexion, and the features of the countenance are shrunken. They suffer also from abdominal constrictions and embarrassments. We see individuals however, endowed with a sanguine temperament, and offering all the signs of plethora, who terminate their own existence. This plethora is particularly manifest among women, who usually destroy themselves, or attempt to do so, during the menstrual period. Those who are known to suffer from suicidal impulses, should be carefully watched at these seasons. A scrofulous habit is also very often met with in persons who have been driven to commit suicide. It disposes to discouragement, apathy, indifference, and consequently, to ennui. As it respects the moral character of the suicidal, from which an effort has been made, to deduce something ennobling in the act of self-murder, there is nothing constant. Courage is manifested, it is said, in committing suicide. But poltroons and warriors, women and men, master and slave, rich and poor, the criminal and honest man, all destroy themselves; offering no other differences, than those which spring from causes foreign to the character of each…
There is not an individual belonging to this class, who has not ideas of suicide and a desire even, to precipitate himself therefrom, whenever he finds himself upon an elevation, or near a window; or of drowning himself when passing over a bridge. These, like all possible ideas, which are constantly renewed, and succeed each other by crowds in the mind, are represented in turn. They usually leave no traces in the mind, more than other thoughts. But if a man actually experiences a violent vexation; if the idea of self-destruction presents itself, in connection with a thousand other thoughts, to his mind; this one thought of suicide associates itself strongly to the moral state which is present together with the vexation, and the desire of freeing himself from it. Hence arises the determination to self-murder, as an infallible means of terminating his misfortunes. The impulse to suicide is more or less violent and sudden, and depends upon numerous causes; upon the age, sex, temperament, habits, profession and irritability of the individual, and a thousand other circumstances that escape our observation. Does not this obstinate association of ideas occur fortuitously in a state of health, while we are engrossed with a given subject? It is durable, in proportion as the false ideas are associated together, in a manner calculated to absorb the understanding, and to concentrate the attention and sensibility. These ideas, closely connected, and varying with individual cases, lead men to form erroneous judgments; and to determinations, sometimes sudden, and sometimes long reflected, in connection with the prejudices and exclusive reasonings which characterize monomania…
What misgivings characterize the conduct of those who meditate suicide! What conflicts before determining upon it! What efforts to reconcile themselves to it, hidden and concealed from the public, to secure to this senseless act, the external aspect of courage and fortitude! It is self-love still, that invests suicide with its mantle. How many self-murders would yet live, were some friend able to unite again the thread of life which they have severed! How many are there, who regret, in quitting life, the destiny which they found too unhappy! With what avidity do they seize again upon life, by every means that are offered them! A man throws himself into a well. He makes every effort to get out of it, and points out the means of effecting this purpose. Pauline, the wife of Seneca, both young and beautiful, wished to die with her husband. She opens certain blood vessels. Nero, on being informed of this act, orders the bleeding wounds to be stanched. Snatched from the portals of the tomb, she thinks no more of death. The struggles of suicides, against the desire which leads them to the commission of self-murder, are either exceedingly painful, or they contemplate their destruction with a kind of joy. They have paroxysms, now regular, and now irregular; deferring the execution of their design, now, from one motive, and now from another. Often do they wear upon their persons, or conceal in a safe place, the instruments or means of destruction; uncertain with respect to the time, place or occasion, most favorable for the accomplishment of their purpose. We can also, with some experience, prevent the effects of these exasperations, which impress upon the physiognomy a sinister expression, in consequence of the return of the physical and moral symptoms, previously indicated. The physical symptoms are then most grave, the moral sufferings most intense, and life most insupportable.
Finally, after having engaged for months and years, in an internal struggle, with alternate remissions, a prey to the most frightful passions, or else indifferent and insensible to every thing; experiencing neither the blessings nor pain of living; led on slowly, to the last degree of physical and moral insensibility, which deprives man of the conservative instinct of his own proper existence; they quit life, to avoid intolerable sufferings, or a most trying weariness of it. Their eyes are haggard, the countenance is flushed, or very pale, the respiration is hurried, and the mind perplexed. They are no longer masters of their actions. The sentiments which some of them leave behind; do not these prove the exaltation and derangement of their reason? If some write to their relatives and friends, letters which express the composure of reason, do they not dissemble their moral condition, as so often happens in the case of monomaniacs?
This destruction of all physical sensibility is not rare among monomaniacs, as we have known them to mutilate and burn themselves, and amputate the limbs, without appearing to suffer any pain in consequence of it; so completely had the exaltation and fixedness of their emotions blunted their sensibility, and driven it from its true seat.
Many suicides, after having most seriously wounded themselves, do not complain of the pain of their wounds. This state of organic insensibility indicates that the delirium has not ceased, and that the patients ought to be watched with care. Porcia, filled with despair on account of the death of her husband, swallows burning coals. Haslam speaks of a woman who, having champed some glass in her mouth for a half-hour, assured him that it did not occasion the least suffering. I have applied blisters, setons, moxas and the actual cautery, to persons strongly inclined to suicide, and lypemaniacs, in order to interrogate their sensibility, without producing pain. Some, after their restoration to health, have assured me that they did not suffer in the least from these applications. A young man, twenty-seven years of age, in a fit of financial despair, throws himself from the fourth story; protests that it has done him no harm, and ascends immediately to his apartment. The fibula was fractured. A soldier fractured one of his thighs, by throwing himself from the second story. He constantly repeated, it is nothing, I am not in pain. I do not insist upon this point of analogy between suicides and the insane. We shall see other examples of it, in the course of this article…
The obstinacy manifested in the resolution to commit suicide, and perseverance in the execution of this design, surpass all belief; especially among lypemaniacs. When this class of persons, controlled by a fixed idea, have resolved to terminate their existence, they resist, not merely the councils of reason, of friendship and tenderness, and those material obstacles that oppose their designs; but support unheard of sufferings, whilst preserving a composure and resignation which contrast singularly with the convulsive and painful expression of their countenance. In vain do they tell us that they do not suffer, whilst every thing betrays the keenest mental agony…
All that I have said hitherto, together with the facts which I have related, prove that suicide offers all the characteristics of mental alienation, of which it is, in reality, a symptom: that we must not look for a single and peculiar sign of suicide, since we observe it under circumstances the most opposite, and since it is symptomatic or secondary, either in acute or febrile delirium, or in chronic delirium…
Treatment of Suicide: Means of Preventing It
Suicide being an act consecutive to the delirium of the passions or insanity, I ought to have little to say respecting the treatment of a symptom; a treatment which belongs to the therapeutics of mental diseases, and reposes essentially upon the appreciation of the causes and determining motives of suicide. Therefore, it is to the treatment adapted to each variety of insanity that we must have recourse, in treating an individual urged on to his own destruction; just as it is necessary to go back to the councils of religion and public morals, when we would prevent the numerous suicides that are provoked by general error of opinion, and the exaltation of the passions. I would have limited myself to these general remarks, were not suicide so grave a symptom as to render it important that we should avail ourselves of all possible means of combating and preventing it. Suicide is sometimes cured spontaneously, like mental diseases; through the influence of hygienic agents, by some physical or moral crisis; or by the aid of medicines. Pinel speaks of a certain scholar who, being in London for the purpose of dissipating a melancholic affection, was going to drown himself in the Thames, when he was attacked by robbers. He defended himself against these ruffians, and forgot the purpose which had led him from home. This gentleman died at the age of eighty-four years; and although often reduced to the necessity of receiving aid from his friends, he did not again experience a desire to destroy himself.
A young man wishes to take his life, and goes out to purchase a pair of pistols. The gun-smith demands an exorbitant price; he becomes irritated, disputes with the dealer, and forgets that he wanted to purchase arms wherewith to destroy himself. How many people are there who, after an ineffectual attempt to take their own lives, no longer entertain a thought of it; because they have been frightened by the risk that they run, or saw death so near at hand, as to desire no more immediate intercourse. A lady desires to die of hunger, because she has openly betrayed the secrets of her heart. Attentions and consolations, the assurance that no one credits what she has said, and the hope of seeing her lover whom she supposed dead; cause her to entertain once more a desire for life, and she decides, not only to take nourishment, but to do whatever is recommended, with a view to her entire cure…
Some physicians have proposed a specific treatment for suicide. Persuaded that the liver is the seat of the evil, and that the bile is the prime cause of it; some recommended what are called hepatic purgatives. Others believe that we should bleed, so as to unload the great vessels of the brain. The latter holding that the tendency to suicide, is the effect of the weakness or oppression of the vital principle, have recommended tonics in large doses. I can say that bark, in combination with opium, hyoscyamus and musk, has sometimes succeeded in modifying the sensibility of this class of patients, and in procuring sleep. These means however, would not be applicable to all cases. Subjects enfeebled by onanism, are much benefited by the cold bath, and even aspersions of cold water. Avenbrugger proposed an exutory over the region of the liver, and copious draughts of water. The celebrated Theden, and more recently, Dr. Leroy, physician at Anvers, have insisted upon the very abundant use of cold water as a specific, Theden states that he made a most successful trial of it upon himself, and relates some cases in support of the efficacy of this method. Dr. Chevrey, cites several cases establishing the fact, that the cure of the disposition to suicide, has been effected by the method of Avenbrugger. I have submitted to this treatment several patients who had made divers attempts to commit suicide, but with little success. In three cases, treated at the Salpêtrière, I ordered, for two of them, a seton over the right hypochondrium, and a blister for the third. I also prescribed a great quantity of water. I related above the case of a lady, in which I had caused a large seton to be inserted over the region of the liver. At Charenton, I caused blisters to be placed over the same region. Setons and blisters continued for several months, effected no amelioration.
Suicides, like all lypemaniacs, think too much. We must either prevent them from thinking, or oblige them to think differently from what they are in the habit of doing. Reasoning effects little; moral commotions are of more service. Celsus advises that individuals who entertain a desire for suicide, should go abroad; and physicians, in all times, have recommended corporeal exercises, gymnastics, riding on horseback, the cultivation of the soil, journeying, etc…
I have nothing to remark respecting the treatment which the symptoms, following attempts at suicide, may demand. Cerebral congestions, asphyxia, whether produced by immersion or strangulations, wounds, bruises, the symptoms of poisoning and the effects of abstinence, present various indications of which we cannot here speak. Persons who have a propensity to suicide, should occupy apartments on the ground floor of a building, cheerful, and pleasantly located. They should be guarded night and day by attendants, vigilant, and having experience to meet the wiles of suicides, usually exceedingly skillful in baffling the watchfulness of the most active. If it be necessary at any time, to have recourse to the camisole, this should not operate as a motive to security, for patients have made use of it to strangle themselves. A woman at the Salpêtrière had been fastened upon her bed, by means of this garment. During the night she threw herself from it, and her body, resting with all its weight upon the waistcoat, compressed the trachea, and the patient was asphyxiated. A patient, confined to his bed, succeeds in throwing from his couch every portion of his bedding, and is suspended and strangulated by the camisole. In public establishments, individuals who are disposed to suicide, demand the utmost attention. These patients should not be placed in isolated cells, but in public halls, where they may be better watched, by both their fellow patients, and the attendants. They should never be out of sight. It is to this attention, and the advantage of having all the apartments of this class of patients upon the ground floor, that we are indebted, at the Salpêtrière, for having scarcely any suicides; since, among eleven or twelve hundred insane persons, of whom one hundred at least have made attempts upon their lives in the course of ten years, only four suicides have been committed; whilst, every where else, the number is far more considerable. I congratulate myself, on having first laid down a general rule for the government of suicides, even with respect to their sleeping arrangements; a precept that has not been lost in other establishments, where they have made use of it, and in which many individuals are disposed to suicide…
I might here close what I have to say upon the subject of suicide. It is, however, a malady so deplorable and frequent, it propagates itself in a manner so frightful to families and society, and suggests questions of so much importance, that I cannot refrain from saying a word upon these points. And in the first place, is suicide a criminal act which may be punished by the laws? Has the legislator the means of preventing it? Since suicide is almost always the effect of disease, it cannot be punished; the law inflicting penalties, only upon acts voluntarily committed, in the full enjoyment of reason. Now I believe that I have shown, that man only makes attempts upon his life, when in a state of delirium, and that suicides are insane persons. Fodéré is of the same opinion. In 1777, the parliament of Paris examined this question, but without deciding it. But, in view of the interest of humanity and society, can the legislator have recourse to means adapted to prevent an act, which outrages equally, natural laws, the laws of religion and of society, and which is so frequent also, that in France for example, there are annually committed, three times as many suicides as assassinations? Experience shows, that comminatory enactments have sufficed to prevent suicide. When the declamations of Agesias rendered suicide frequent in Egypt, a law of Ptolemy, which forbad any one, on pain of death, from teaching the philosophy of Zeno, put an end to this dreadful practice. When the daughters of Miletus hung themselves in emulation one of another, the senate passed a decree, that the bodies of suicides should be exposed in some public place, and the contagion ceased. The negroes who were transported to America, were accustomed to destroy themselves, in the hope of returning to Africa after death. An Englishman caused this impulse to cease, by ordering the hands of those negroes who committed suicide to be cut off, and exposed to the observation of their companions. Penal enactments were passed by certain ancient nations with a view to prevent suicide. The laws of Athens prosecuted this crime even beyond the limits of life; requiring that the hand of the offender should be burned separately from the body. A law of the elder Tarquin, deprived of the right of sepulture, the body of any citizen, who voluntarily destroyed himself. The senate of the republic of Marseilles, which tolerated suicide, condemned him who took his own life without a legitimate cause. At an earlier period, the Roman laws favorable to suicide, annulled the testament of him, who destroyed himself, in order to escape an ignominious punishment, and forbade mourning for it. Soldiers were disgraced, if they made an attempt upon their own lives. At Thebes, the dead body of a suicide, was burnt in disgrace.
The laws of Christian countries, which condemn all murder, have pronounced self-murder to be the greatest crime, because it leaves no room for repentance. They refuse to the dead bodies of suicides, a Christian burial. All modern legislation, to which the laws of the church have served as a basis, have branded suicide with infamy. In England, the corpses of suicides were formerly thrown out into the highway. More recently, they have been interred in the country, where three roads meet. In France, during the time of St. Louis, the household goods of the suicide were confiscated for the benefit of the proprietor of the soil on which the crime was committed. At a later period, the dead bodies of suicides were drawn through the streets upon a hurdle. All these laws have fallen into desuetude, particularly in France. In England, they evade their application, by obtaining the certificate of a physician, who testifies that the person who has committed the act of self-murder was insane. At this day in France, and in the greater portion of Europe, they would look upon the punishment of suicide, as an act of barbarism. Beccaria opposes the penalties enacted against suicide, on the grounds that they are inflicted only upon a dead body, and produce no impression upon the living; whilst, at the same time, by causing the relatives to suffer, the innocent are punished, which is unjust. If it be affirmed in opposition, says this writer, that the disgrace and penalties attending this act, and the fear of infamy, will prevent the most resolute man from the commission of it; I reply that he whom the horror of death, and the threats of eternal punishment do not restrain, will not be deterred, by considerations far less weighty.
Are not the fundamental laws of our being, and the warnings of religion, daily sacrificed to the force of prejudice, to passions and social interests? Did we not say, that the punishments inflicted upon sorcerers and the possessed, far from diminishing their number, augmented it? Will it not be the same, with respect to the penalties enacted against suicide? With reference to the former, the penalties inflicted upon sorcerers and the possessed, were enacted in accordance with a popular error. The more severe the enactments, the more thoroughly persuaded were the public of the existence of sorcerers and the possessed, of which, the laws sanctioned the belief. The number of these deluded people began to lessen, so soon as they ceased to believe in the existence of sorcerers, and to fortify the public mind in this belief, by the zeal which was manifested, not in destroying error, but in punishing it.
Popular opinion is not favorable to suicide, nor is it exercised with a view to combat an error, but to prevent an act, whatever, aside from this, its moral or legal character may be. Argument merely, should not prevail against the authority of experience. Comminatory laws caused suicides, to cease in Egypt, Miletus and America. Suicide is more frequent, since the laws which condemn it, have lost their force. Hence, for the welfare of society, the legislature should establish laws, not attaching penalties to the dead body of the suicide, and still less against his relatives; but with a view to prevent the commission of suicide. It does not belong to me to say what these laws shall be, but, in my opinion, they should vary to suit the dispositions, morals, and even the prejudices of the people inhabiting different countries; and should be designed to meet the social causes, which are calculated to develop a tendency to suicide. For example, in our day, the king of Saxony has enacted a law, that the bodies of suicides, should be placed in public amphitheatres for dissection. Until wise legislation apply some remedy to this social evil, the friends of humanity should desire that education may repose upon the solid basis of moral and religious principles. They should protest against the publication of works which inspire a contempt for life, and laud the advantages connected with a voluntary death. They should point out to the government, the dangers which result from making public the infirmities to which man is exposed. They should loudly demand, that the journals be forbidden to publish suicides, and from relating the motives and trifling circumstances connected with the commission of the act. These frequent accounts familiarize the mind to the idea of death, and cause it to be regarded with indifference. The examples daily presented for imitation, are contagious and fatal; and that person, who is now harassed by reverses or vexations, would not have destroyed himself had he not read in a journal, the history of the suicide of a friend or an acquaintance. The freedom of the press should not prevail over the true interest of humanity.
When speaking of the particular causes of suicide, I demonstrated that the present age was fruitful in causes adapted to produce it. As when in times of ignorance, and at periods when religious discussions prevail, and religious monomania abounds, we meet with magicians, sorcerers and the possessed; so suicides prevail, when the excesses of civilization threaten the destruction of empires. During the prosperous periods of the Roman Republic, suicide was rare. But it became frequent, when the philosophy of the stoics found partisans in the patrician order; when two soothsayers could no longer regard each other without a smile; when luxury and wealth had corrupted the morals of the people; and political agitations had shaken the Republic to its centre.
The same has been true in England, since Richard Smith, and particularly Mordan, set an example which became contagious. Moreover, since the writings of Donne, Blount and Gildon have found readers; since certain philosophers in France have revived and given credit to the doctrine of Zeno; since certain others have taken up the defence of self-murder; and revolutions have given a new impulse to all the passions, suicide has become more frequent. Under all these circumstances, the natural motives which inspire a horror of death, and especially of self-murder, are not strengthened by considerations drawn from morals, religion and the laws. If suicide is constantly represented in books and upon the stage, not merely as an indifferent act, but as one indicative of courage, from which men the most grave, and often the most eminent in society do not recoil; the public mind will doubtless be more disposed to suicide; and this disposition will be fortified by the force of imitation, if examples are daily presented in the public prints.
