Category Archives: Psychiatry


from Letters
  • July 10, 1946
  • July 25, 1946
  • Oct. 13, 1951
  • Nov. 10, 1955


Carl Gustav Jung, born Karl Gustav II Jung, is regarded as the founder of analytical psychology. He was born in Kesswil, Switzerland, the son of a poor Protestant clergyman and philologist who taught him Latin at an early age. Although at first pressured to become a minister like many in his family, Jung eventually decided to become a psychiatrist, receiving his M.D. degree from the University of Zurich in 1902. Despite his focus on scientific topics, Jung integrated many religious, philosophical, and archeological works into his studies. Working with asylum patients under Eugen Bleuler, a pioneer in mental illness research, Jung studied patients’ responses to stimulus words, and termed the group of associations they avoided a “complex.” Between 1907 and 1912, Jung collaborated closely with Sigmund Freud, whose theories were supported by Jung’s results and who for a while regarded Jung as his outstanding disciple; however, the pair split in disagreement over the role of sexuality in neurosis and the development of children. Jung’s subsequent publications, Psychology of the Unconscious (1912) and Psychological Types (1921), ran counter to Freud’s arguments and established Jung’s unique views in psychology. In the 1930s and early 1940s, Jung served as professor of psychology at the Federal Polytechnic University in Zurich. He was appointed professor of medical psychology at the University of Basel in 1943, but was forced to resign almost immediately because of his poor health. He continued to write prolifically until well into his 80s.

Among the many concepts that Jung originated were those of “extroverted” and “introverted” personalities (into which two classes he divided most men), the “collective unconscious,” and the theory of “archetypes.” Jung’s ideas have influenced not only psychiatry, but also the fields of religion, literature, and parapsychology. Jung interpreted Christianity as an essential step in the historical development of consciousness and argued that heretical movements were archetypal constituents of religion not fully contained in Christianity. Jung pioneered therapy for older patients who had lost their faith in life. Individuation, or the ingrained capacity to reconcile complementary oppositions in one’s personality, including one’s basic bisexuality, and thus undergo the process of full human development, is at the core of Jung’s teachings. Neuroses are merely impulses to broaden one’s consciousness toward self-realization and totality. Jung conceived of therapy as an active and analytic process, steering away from Freud’s free associations into a form of directed associations. Various societies around the world serve as centers for the development of Jung’s teachings and provide training for new Jungian analysts.

In these selections from Jung’s collected Letters—some originally in English, some in German—Jung communicates with acquaintances who are dealing with suicide. Jung frequently used letters as a way of communicating his views to the outside world (he sent copies to people whose judgment he trusted) and correcting misinterpretations of and expanding on his views. In the three letters addressed to people who have evidently written to him because of his fame, he appears to argue that suicide is a denial of full self-realization, as is clearly evident in the letter of July 10, 1946, addressed to an elderly resident of Germany and the letters of October 13, 1951, and November 10, 1955, to two different “Mrs. N”s. In the more reflective letter of July 25, 1946, addressed to his acquaintance Dr. Eleanor Bertine, however, he appears to adopt an almost fatalistic attitude toward suicide—“I’m convinced that if anybody has it in himself to commit suicide, then practically the whole of his being is going that way”—and arguing against interference or prevention.

Carl Gustav Jung, Letterseds. Gerhard Adler with Aniela Jaffé, tr. R. F. C. Hull. (Princeton, N.J.: Princeton University Press, 1953, 1975), Vol. 1, pp. 434-37, Vol. 2, pp. 25-26, 278-279.




Dear Sir,                                                                                        10 July 1946

By parental power is usually understood the influence exerted by any person in authority.  If this influence occurs in childhood and in an unjustified way, as happened in your case, it is apt to take root in the unconscious.  Even if the influence is discontinued outwardly, it still goes on working in the unconscious and then one treats oneself as badly as one was treated earlier.  If your work now gives you some joy and satisfaction you must cultivate it, just as you should cultivate everything that gives you some joy in being alive.  The idea of suicide, understandable as it is, does not seem commendable to me.  We live in order to attain the greatest possible amount of spiritual development and self-awareness.  As long as life is possible, even if only in a minimal degree, you should hang on to it, in order to scoop it up for the purpose of conscious development.  To interrupt life before its time is to bring to a standstill an experiment which we have not set up.  We have found ourselves in the midst of it and must carry it through to the end.  That it is extraordinarily difficult for you, with your blood pressure at 80, is quite understandable, but I believe you will not regret it if you cling on even to such a life to the very last.  If, aside from your work, you read a good book, as one reads the Bible, it can become a bridge for you leading inwards, along which good things may flow to you such as you perhaps cannot now imagine.

You have no need to worry about the question of a fee.  With best wishes,

Yours sincerely, C. G. JUNG



Dear Dr. Eleanor Bertine,                                                          25 July 1946

I’m just spending a most agreeable time of rest in my tower and enjoy sailing as the only sport which is still available to me.  I have just finished two lectures for the Eranos meeting of this summer.  It is about the general problem of the psychology of the unconscious and its philosophical implications.

And now I have finally rest and peace enough to be able to read your former letters and to answer them.  I should have thanked you for your careful reports about Kristine Mann’s illness and death long ago,[i] but I never found time enough to do so.  There have been so many urgent things to be done that all my time was eaten up and I cannot work so quickly any longer as I used to do.

It is really a question whether a person affected by such a terrible illness should or may end her life.  It is my attitude in such cases not to interfere.  I would let things happen if they were so, because I’m convinced that if anybody has it in himself to commit suicide, then practically the whole of his being is going that way.  I have seen cases where it would have been something short of criminal to hinder the people because according to all rules it was in accordance with the tendency of their unconscious and thus the basic thing.  So I think nothing is really gained by interfering with such an issue.  It is presumably to be left to the free choice of the individual.  Anything that seems to be wrong to us can be right under certain circumstances over which we have no control and the end of which we do not understand.  If Kristine Mann had committed suicide under the stress of unbearable pain, I should have thought that this was the right thing.  As it was not the case, I think it was in her stars to undergo such a cruel agony for reasons that escape our understanding.  Our life is not made entirely by ourselves.  The main bulk of it is brought into existence out of sources that are hidden to us.  Even complexes can start a century or more before a man is born.  There is something like karma.

Kristine’s experience you mention is truly of a transcendent nature.  If it were the effect of morphine it would occur regularly, but it doesn’t.  On the other hand it bears all the characteristics of an ekstasis.  Such a thing is possible only when there is a detachment of the soul from the body.  When that takes place and the patient lives on, one can almost with certainty expect a certain deterioration of the character inasmuch as the superior and most essential part of the soul has already left.  Such an experience denotes a partial death.  It is of course a most aggravating experience for the environment, as a person whose personality is so well known seems to lose it so completely and shows nothing more than demoralization or the disagreeable symptoms of a drug addict.  But it is the lower man that keeps on living with the body and who is nothing else but the life of the body.  With old people or persons seriously ill, it often happens that they have peculiar states of withdrawal or absent-mindedness, which they themselves cannot explain, but which are presumably conditions in which the detachment takes place.  It is sometimes a process that lasts very long.  What is happening in such conditions one rarely has a chance to explore, but it seems to me that it is as if such conditions had an inner consciousness which is so remote from our matter-of-fact consciousness that it is almost impossible to retranslate its contents into the terms of our actual consciousness.  I must say that I have had some experiences along that line.  They have given me a very different idea about what death means.

I hope you will forgive me that I’m so late in answering your previous letters.  As I said, there has been so much in between that I needed a peaceful time when I could risk entering into the contents of your letter.

My best wishes!

Yours sincerely, C. G. JUNG



Dear Mrs. N.,                                                                                    13 October 1951

It isn’t easy or simple to answer your question, because much depends upon your faculty of understanding.  Your understanding on the other hand depends upon the development and maturity of your personal character.

It isn’t possible to kill part of your “self” unless you kill yourself first.  If you ruin your conscious personality, the so-called ego-personality, you deprive the self of its real goal, namely to become real itself.  The goal of life is the realization of the self.  If you kill yourself you abolish that will of the self that guides you through life to that eventual goal.  An attempt at suicide doesn’t affect the intention of the self to become real, but it may arrest your personal development inasmuch as it is not explained.  You ought to realize that suicide is murder, since after suicide there remains a corpse exactly as with any ordinary murder.  Only it is yourself that has been killed.  That is the reason why the Common Law punishes a man that tries to commit suicide, and it is psychologically true too.  Therefore suicide certainly is not the proper answer.

As long as you don’t realize the nature of this very dangerous impulse you block the way to further development, just as a man who intends to commit a theft, without knowing what he is intending and without realizing the ethical implication of such a deed, cannot develop any further unless he takes into account that he has a criminal tendency.  Such tendencies are very frequent, only they don’t always succeed and there is hardly anybody who must not realize in this or any other way that he has a dark shadow following him.  That is the human lot.  If it were not so, we might get perfect one day which might be pretty awful too.  We shouldn’t be naïve about ourselves and in order not to be we have to climb down to a more modest level of self-appreciation.

Hoping I have answered your question, I remain,

Yours sincerely, C. G. JUNG

Thank you for the fee.
Nothing more is needed.



Dear Mrs. N.,                                                                                19 November 1955

I am glad that you do understand the difficulty of your request.  How can anybody be expected to be competent enough to give such advice?  I feel utterly incompetent—yet I cannot deny the justification of your wish and I have no heart to refuse it.  If your case were my own, I don’t know what could happen to me, but I am rather certain that I would not plan a suicide ahead.  I should rather hang on as long as I can stand my fate or until sheer despair forces my hand.  The reason for such an “unreasonable” attitude with me is that I am not at all sure what will happen to me after death.  I have good reasons to assume that things are not finished with death.  Life seems to be an interlude in a long story.  It has been long before I was, and it will most probably continue after the conscious interval in a three-dimensional existence.  I shall therefore hang on as long as it is humanly possible and I try to avoid all forgone conclusions, considering seriously the hints I got as to the post mortem events.

Therefore I cannot advise you to commit suicide for so-called reasonable considerations.  It is murder and a corpse is left behind, no matter who has killed whom.  Rightly the English Common Law punishes the perpetrator of the deed.  Be sure first, whether it is really the will of God to kill yourself or merely your reason.  The latter is positively not good enough.  If it should be the act of sheer despair, it will not count against you, but a willfully planned act might weigh heavily against you.

This is my incompetent opinion.  I have learned caution with the “perverse.”  I do not underestimate your truly terrible ordeal.  In deepest sympathy,

 Yours cordially, C. G. JUNG


[i]  Kristine Mann had died on 12 Nov. 45.  About 3 or 4 months before her death, while in hospital with a good deal of pain, depressed and unhappy, Dr. Mann saw one morning an ineffable light glowing in her room. It lasted for about an hour and a half and left her with a deep sense of peace and joy. The recollection of it remained indelible, although after that experience her state of health worsened steadily and her mind deteriorated. Jung felt that at the time of the experience her spirit had left her body.


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from Suicide


Born near Vienna to a grain merchant, Adler’s experiences with rickets and a near fatal case of pneumonia as a child made him interested in a medical career. He received his M.D. from the University of Vienna in 1895 and practiced general medicine until about 1900, when he turned to psychiatry and neurology. As a physician, Adler demonstrated a holistic approach to the patient, taking seriously into account the contexts of social and human factors. In 1902, he began a close association with Sigmund Freud, which eventually disintegrated because of irreconcilable differences between their theories. Adler rejected Freud’s idea that neurosis stemmed from childhood sexual conflicts; instead, for Adler, sexuality filled a figurative position in the attempt to overcome feelings of inadequacy, that universal infantile “inferiority feeling” (or “inferiority complex,” as it came to be known), responses to which form the basis of character.

In a Study of Organ Inferiority and Its Psychical Compensation (1907) and The Neurotic Constitution (1912), Adler repudiated drive psychology and developed a system that came to be known as “Individual Psychology.” This theory posits that man’s opinion of himself and his surroundings affects all of his psychological operations; man’s principal motive is an inherent effort for perfection while his liability is the inferiority complex. For Adler, psychotherapy was a tool to help the patient become more self-determined, socially useful, reasonable, mature, and self-transcendent; this is accomplished by bringing the patient’s attention to the failures of his attempts to cope with feelings of inferiority. In 1921, Adler was the first to establish child-guidance clinics in Vienna where he could implement his belief that social values were transmitted in the early education of children, though these clinics were closed by the Austrian government in 1934 because of Adler’s Jewish heritage. He lectured and taught widely on social and scientific issues: from 1927 to 1937, he taught in the United States at Columbia University and the Long Island College School of Medicine. He died while on a lecture tour in Scotland.

Adler’s essay “Suicide” (1937) is an example of the increasingly scientific, non-moralizing treatment of suicide that arose with the development of psychiatry and psychology around and after the turn of the century. Adler recognized the situational factors that contribute to suicide, such as cultural beliefs and financial distress; in addition, certain predisposing factors are apparent in certain characteristics of children, such as oversensitivity. Adler also argued that the typical suicide suffers from a limited “social interest”—the importance of social interest was the doctrine Adler had attempted to spread in the 1930s in the face of European nationalist totalitarianism—and has a selfish motive to hurt others by his act; the suicide “hurts others by dreaming himself into injuries or by administering them to himself.” This damaging pattern is not seen as morally blameworthy, however, but as the occasion for therapy directed toward expanding the patient’s social interests.

Alfred Adler, “Suicide,” from Superiority and Social Interest: A Collection of Later Writings, eds. Heinz L. Ansbacher and Rowena R. Ansbacher (Evanston, IL: Northwestern University Press, 1964), pp. 248-252.



The frequent fact of suicide is surrounded by mystery for the average observer. When he is not personally touched by the suicide of someone near to him, he usually resorts to a superficial explanation which occasionally makes the suicide comprehensible, but usually leaves it incomprehensible. The members of the suicide’s intimate and wider circles also usually find the occurrence strange and inexplicable. This does not seem very significant, since, in general, an understanding of human nature and thinking directed toward prophylaxis cannot be taken for granted.

Attempts at explanation often begin with the frequency of suicide among mentally disordered individuals, especially depressed persons, to all of whom suicide appears as a way out of their distress even if by their words they seem to reject it. Thus the approximately normal person is inclined to regard suicide as an entirely pathological phenomenon.

 Situational Factors

Even so, there are certain situations from which the normal person regards suicide as the only way out. These are situations which are too distressing and unalterable, such as torment without any prospect for relief, inhumanly cruel attacks, fear of discovery of disgraceful or criminal actions, suffering of incurable and extremely painful diseases, etc. Surprisingly enough, the number of suicides actually committed for such reasons is not great.

Among the so-called causes for suicide, disregarding the cases of the psychologically ill, loss of money and unpayable debts take the first place. This gives us much to think about. Disappointed and unhappy love follow in frequency. Further frequent causes are permanent employment, for which the individual may or may not be responsible, and justified or unjustified reproaches.

Another cause is suicide epidemics which, puzzling as this may be, do occasionally happen. Harakiri, although on the decline, still exists among the Japanese. Among women and girls, suicide or attempted suicide takes place relatively frequently at the time of menstruation. Lastly, suicides increase strikingly after the age of fifty. All these facts ought to be explicable through Individual Psychology.

It is not surprising that qualified and unqualified circles often endeavor to work for the reduction of suicides. So far as we can see, such attempts have not succeeded in reducing the suicide rate. This is because individuals who turn to associations for the prevention of suicide would only be those who still regard the future with a certain amount of hope. In our time, the number of suicides is unchanged, possibly even increasing.

 The Interpersonal Factor

The frequency of suicide is a serious accusation against the none-too-great social interest of mankind. In view of this, a comprehensive exploration of this puzzling phenomenon is urgently needed.

Among inner, endogenous causes, Individual Psychology considers only the style of life which is established out of heredity and environmental influences by the individual’s own creative power with his incomplete, humanly limited insight. In addition, one must determine the external, exogenous cause which reveals the inadequate preparation of the individual in question for the urgent situation before him. When the self-consistent life style thus clashes with the external situation, the extent to which the individual stands the test of living with other in society becomes apparent.

Observations of Individual Psychology have shown that every step of an individual is directed toward the successful solution of a presently imminent task in accordance with the total conception of his self-consistency. What the individual considers success is always a matter of his subjective opinion. Our experience has also shown that all tasks which the individual may have to meet require, without exception, adequate social interest for their correct solution. Each individual is so joined to society that he can make no movement, think no thought, and express no feeling without testifying to the degree of his connectedness with society, to hi social interest. From this is follows that suicide is a solution only for one who in the face of an urgent problem has arrived at the end of his limited social interest.

This coming to the end of their limited social interest shows itself in all failures, be they active or passive, in their greater development of the inferiority complex. That the suicide departs from the line of social interest is quite obvious. All forms of working together, of living together, and of fellowship are lacking. Further, it must certainly be admitted that this departure occurs in an active way. The activity has a particular curve, however, in that it runs apart from social life and against it, and that it harms the individual himself, not without giving pain and sorrow to others.

The suicide generally gives little or no (conscious) thought to the shock which he causes others. But this difficulty in the way of a further understanding can be resolved. Could it not be that he would have to eliminate others from his thoughts before he could commit suicide? In some cases his social interest might well be great enough for that. Moreover one finds quite frequently, by contrast, that in his last letter or words the suicide hints as asking forgiveness for the sorrow he has afflicted. The movement and the direction of the suicide cannot avoid the fact of sorrow to another. And perhaps there are many on the brink of suicide who, through greater social interest, are deterred from afflicting this sorrow to another.

The “other” is probably never lacking. Usually it is the one who suffers most by the suicide.

Predisposing Factors

 Individual Psychology continuously seeks to understand the unity and self-consistency of the individual. We are prepared for failures and try to prevent them, always in the conviction that the origin of a misconception of life and its organization can be traced back into early childhood. Therefore we must try to find the type of child which can be regarded as the potential suicide type. Studies of the past life and the childhood of suicides and of those who have attempted it always bring to light those traits which we have found in similar forms in all those failures who combine lesser social interest with a relatively large degree of activity. Suicidal persons have always been problem children, spoiled at least by one side of the family, very complacent, and oversensitive. Very often they showed hurt feelings to an unusual degree. In case of a loss or defeat, they were always poor losers. While they seldom made a direct attack against others, they always showed a life style which attempted to influence others through increased complaining, sadness, and suffering. A tendency to collapse under psychological pain when confronted with difficult life situations often stood out, in addition to increase ambition, vanity, and consciousness of their value for others. Fantasies of sickness or death, in which the pain of others reaches its highest degree, went parallel with this firm belief in their high values for others, a belief which they usually acquired from the pampering situations of their childhood. I have found similar traits in the early history of cases of depression, whose type borders on that of the suicide, and also of alcoholics and drug addicts.

Among the early childhood expressions of the suicide one also finds the deepest grieving over often negligible matters, strong wishes to become sick or to die when a humiliation is experienced, tantrums with willful self-injury, and an attitude towards others as if it were their duty to fulfill his every wish. Occasionally inclinations toward self-accusation come to the fore which elicit the sympathy of others, deeds of exaggerated foolhardiness which are performed to frighten others, and at times stubborn hunger strikes which intimidate the parents. Sometimes one finds ruses in the nature of a direct or indirect attack against others, acts of aggression followed by suicide, or only fantasies, wishes, and dreams which aim at a direct attach while suicide follows later.

Examples of suicide in the family have an attraction for those of similar tendency, as do the example of friends and well-known persons and special places associated with suicide.


Reduced to the simplest form, the life style of the potential suicide is characterized by the fact that he hurts others by dreaming himself into injuries or by administering them to himself. One will seldom go wrong in determining against whom the attack is aimed when one has found who is actually affected most by it. We find in the suicide the type who thinks too much of himself, too little of others, and who is unable sufficiently to play, function, live, and die with others. Rather, with an exaggerated consciousness of his own worth, he expects with great tension results which are always favorable for him.

The idea of suicide, like all other mistaken solutions of course always breaks out in the face of an urgent confronting exogenous problem for which the individual in question has an insufficient social interest. His greater or lesser activity then determines the direction and development of the symptoms. The symptoms can be done away with through an understanding of the context.

The psychiatrist will do well to keep his diagnosis of a potential suicide to himself, but to take all precautions. He must not tell it to others, but must see to it that something is done for the patient to enable him to find a better, more independent, socially oriented attitude toward life.

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from Psychopathology of Everyday Life
from Contributions to a Discussion on    Suicide
from Mourning and Melancholia
from The Psychogenesis of a Case of    Homosexuality in a Woman
from The Economic Problem of    Masochism


Freud was born in Freiberg in Mähren, in what is now Czechoslovakia. His intellectual gifts were apparent early on, and at 17, he entered the University of Vienna to study medicine. He published his first academic paper at 20 on neurology. In 1885, while studying with the neurologist Jean-Martin Charcot in Paris, Freud began to perceive that mental illness might have entirely psychological origins apart from organic causes. These studies gave way to an interest in psychology, and in 1895, he co-published Studies in Hysteria with the physician Josef Breuer; hysteria, he believed, was the result of repressed desires. This work also introduced Freud’s notion of free association, a technique through which the psychoanalyst may uncover the hidden workings of the unconscious by allowing the patient to freely associate “random” thoughts in his or her mind. Perhaps Freud’s best known work, The Interpretation of Dreams (1899), analyzed the complexly symbolic and frequently sexually oriented operations underlying the process of dreaming. A controversial study of 1905, Three Essays on the Theory of Sexuality, outlined his theories of infantile sexuality and the stages of human psychological and sexual development.

After initial ostracism by the Viennese medical community, the first International Psychoanalytical Congress of 1908 marked the beginning and recognition of the analytical movement in psychology. Freud’s many theories—including the Oedipus complex, the tripartite structure of the mind (ego, id, superego), as well as his speculations on the psychoanalytical aspects of myth, religion, and culture—underwent revision throughout his long life. His legacy includes the concepts of repression, defense mechanisms, “Freudian slips,” projection, and many others. His deterministic, anti-rational, and, some would say, pessimistic views of the importance of unconscious drives and instincts in human conduct radically altered the way people viewed the world and themselves. Despite a history of criticism and attempts to declare him obsolete, Freudian and neo-Freudian psychoanalytic theory is still in use by practitioners worldwide, and it continues to influence such diverse fields as history, art, and sociology.

The selections presented here outline Freud’s views on suicide. In The Psychopathology of Everyday Life (1901), Freud argues for an unconscious drive for suicide and illustrates the human tendency to view self-inflicted injuries as unintentional. Indeed, according to Freudian death-instinct theory, suicide is the prototypal death. Contributions to a Discussion on Suicide (1910) contains Freud’s speculations on the causes of suicide in secondary schools. In Mourning and Melancholia (1917) and The Economic Problem of Masochism (1924), Freud discusses how the dynamics among internal psychological forces can lead to self-destruction or punishment. By using a case study in The Psychogenesis of a Case of Homosexuality in a Woman (1920), Freud argues that suicide stems from infantile fantasies. He does not, however, discuss suicide in the circumstances of painful and ultimately terminal illness, as in his own case.

In 1923, Freud was diagnosed with cancer of the palate. The growth was removed but recurred, and during the 16 years between diagnosis and death, he underwent over 30 operations, as well as repeated fittings, cleanings, and refittings of a prosthesis for his jaw. He retrained himself to speak, but his voice never recovered its clarity. When the Nazis came to power, he considered exile, but resisted it until the occupation of Vienna in spring l938. During that spring, over 500 Austrian Jews committed suicide, but Freud rejected the idea even when it was raised by his daughter Anna. In June 1938, he fled to London, where he had further surgery, but by August, the pain was severe and the smell from his ulcerated cancer so foul, it was reported, that his pet dog would cringe from him. Freud had long had an agreement with his physician Max Schur, also in exile in London, that Schur would help him end his life when the cancer had progressed too far, and on September 21, 1939, Schur injected Freud with morphine, followed by further injections the following day; Freud died on September 23.

Sigmund Freud, Ch. 8:Erroneously Carried Out Actions.” (1901)from The Psychopathology of Everyday Life,  ed. and tr. A. A. Brill (1914).  Online at , pp. 198-206.
“Contributions to a Discussion on Suicide,” Vol. 11, 1957,  pp. 231-32; “Mourning and Melancholia,” Vol. 14, 1957, pp. 250-52; “The Psychogenesis of a Case of Homosexuality in a Woman,” Vol. 18, 1955, pp. 160-163; “The Economic Problem of Masochism,” Vol. 19, 1961, pp. 168-70, all from The Standard Edition of the Complete Psychological Works of Sigmund Freud,  ed. and tr. James Strachey (London: The Hogarth Press, 1953-74).



It is known that in the more serious cases of psychoneuroses one sometimes finds self-mutilations as symptoms of the disease. That the psychic conflict may end in suicide can never be excluded in these cases. Thus, I know from experience, which some day I shall support with convincing examples, that many apparently accidental injuries happening to such patients are really self-inflicted. This is brought about by the fact that there is a constantly lurking tendency to self-punishment, usually expressing itself in self-reproach, or contributing to the formation of a symptom, which skillfully makes use of an external situation. The required external situation my accidentally present itself or the punishment tendency may assist it until the way is open for the desired injurious effect.

Such occurrences are by no means rare even in cases of moderate severity, and they betray the portions of unconscious intention through a series of special features—for example, through the striking presence of mind which the patients show in the pretended accidents:

One of my boys, whose vivacious temperament was wont to put difficulties in the management of nursing him in his illness, had a fit of anger one morning because he was ordered to remain in bed during the forenoon, and threatened to kill himself: a way out suggested to him by the newspapers. In the evening, he showed me a swelling on the side of his chest which was the result of bumping against the door knob. To my ironical question why he did it, and what he meant by it, the eleven-year-old child explained, “That was my attempt at suicide which I threatened this morning.” However, I do not believe that my views on self-inflicted wounds were accessible to my children at that time.

Whoever believes in the occurrence of semi-intentional self-inflicted injury—if this awkward expression be permitted—will become prepared to accept through it the fact that aside from conscious intentional suicide, there also exists semi-intentional annihilation—with unconscious intention—which is capable of aptly utilizing a threat against life and masking it as a casual mishap. Such mechanisms are by no means rare. For the tendency to self-destruction exists to a certain degree in many more persons than in those who bring it to completion. Self-inflicted injuries are, as a rule, a compromise between this impulse and the forces working against it, and even where it really comes to suicide, the inclination has existed for a long time with less strength or as an unconscious and repressed tendency.

Even suicide consciously committed chooses its time, means and opportunity; it is quite natural that unconscious suicide should wait for a motive to take upon itself one part of the causation and thus free it from its oppression by taking up the defensive forces of the person. These are in no way idle discussions which I here bring up; more than one case of apparently accidental misfortune has become known to me whose surrounding circumstances justified the suspicion of suicide.

For example, during an officers’ horse-race one of the riders fell from his horse and was so seriously injured that a few days later he succumbed to his injuries. His behavior after regaining consciousness was remarkable in more than one way, and his conduct previous to the accident was still more remarkable. He had been greatly depressed by the death of his beloved mother, had crying spells in the society of his comrades, and to his trusted friend had spoken of the taedium vitae. He had wished to quit the service in order to take part in a war in Africa which had no interest for him. Formerly a keen rider, he had later evaded riding whenever possible. Finally, before the horse-race, from which he could not withdraw, he expressed a sad foreboding; in the light of our conception, it is not surprising that his premonition came true. It may be contended that it is quite comprehensible without any further cause that a person in such a state of nervous depression cannot manage a horse as well as on normal days. I quite agree with that, only I should like to look for the mechanism of this motor inhibition through “nervousness” in the intention of self-destruction here emphasized.

Another analysis of an apparently accidental self-inflicted wound, detailed to me by an observer, recalls the saying, “He who digs a pit for others falls in himself.”



I.  Introductory Remarks

Gentlemen,—You have all listened with much satisfaction to the plea put forward by an educationalist who will not allow an unjustified charge to be levelled against the institution that  is so dear to him.  But I know that in any case you were not inclined to give easy credence to the accusation that schools drive their pupils to suicide.  Do not let us be carried too far, however, by our sympathy with the party which has been unjustly treated in this instance.  Not all the arguments put forward by the opener of the discussion seem to me to hold water.  If it is the case that youthful suicide occurs not only among pupils in secondary schools but also among apprentices and others, this fact does not acquit the secondary schools; it must perhaps be interpreted as meaning that as regards its pupils the secondary school takes the place of the traumas with which other adolescents meet in other walks of life.  But a secondary school should achieve more than not driving its pupils to suicide.  It should give them a desire to live and should offer them support and backing at a time of life at which the conditions of their development compel them to relax their ties with their parental home and their family.  It seems to me indisputable that schools fail in this, and in many respects fall short of their duty of providing a substitute for the family and of arousing interest in life in the world outside.  This is not a suitable occasion for a criticism of secondary schools in their present shape; but perhaps I may emphasize a single point.  The school must never forget that it has to deal with immature individuals who cannot be denied a right to linger at certain stages of development and even at certain disagreeable ones.  The school must not take on itself the inexorable character of life: it must not seek to be more than a game of life.

II.  Concluding Remarks

Gentlemen,—I have an impression that, in spite of all the valuable material that has been brought before us in this discussion, we have not reached a decision on the problem that interests us.  We were anxious above all to know how it becomes possible for the extraordinarily powerful life instinct to be overcome: whether this can only come about with the help of a disappointed libido or whether the ego can renounce its self-preservation for its own egoistic motives.  It may be that we have failed to answer this psychological question because we have no adequate means of approaching it.  We can, I think, only take as our starting-point the condition of melancholia, which is so familiar to us clinically, and a comparison between it and the affect of mourning.  The affective processes in melancholia, however, and the vicissitudes undergone by the libido in that condition, are totally unknown to us.  Nor have we arrived at a psycho-analytic understanding of the chronic affect of mourning.  Let us suspend our judgement till experience has solved this problem.



Melancholia, therefore, borrows some of its features from mourning, and the others from the process of regression from narcissistic object-choice to narcissism.  It is on the one hand, like mourning, a reaction to the real loss of a loved object; but over and above this, it is marked by a determinant which is absent in normal mourning or which, if it is present, transforms the latter into pathological mourning.  The loss of a love-object is an excellent opportunity for the ambivalence in love-relationships to make itself effective and come into the open.  Where there is a disposition to obsessional neurosis the conflict due to ambivalence gives a pathological cast to mourning and forces it to express itself in the form of self-reproaches to the effect that the mourner himself is to blame for the loss of the loved object, i.e. that he has willed it.  These obsessional states of depression following upon death of a loved person show us what the conflict due to ambivalence can achieve by itself when there is no regressive drawing-in of libido as well.  In melancholia, the occasions which give rise to the illness extend for the most part beyond the clear case of a loss by death, and include all those situations of being slighted, neglected or disappointed, which can import opposed feelings of love and hate into the relationship or reinforce an already existing ambivalence.  This conflict due to ambivalence, which sometimes arises more from real experiences, sometimes more from constitutional factors, must not be overlooked among the preconditions of melancholia.  If the love for the object—a love which cannot be given up though the object itself is given up—takes refuge in narcissistic identification, then the hate comes into operation on this substitutive object, abusing it, debasing it, making it suffer and deriving sadistic satisfaction from its suffering.  The self-tormenting in melancholia, which is without doubt enjoyable, signifies, just like the corresponding phenomenon in obsessional neurosis, a satisfaction of trends of sadism and hate which relate to an object, and which have been turned round upon the subject’s own self in the ways we have been discussing.  In both disorders the patients usually still succeed, by the circuitous path of self punishment, in taking revenge on the original object and in tormenting their loved one through their illness, having resorted to it in order to avoid the need to express their hostility to him openly.  After all, the person who has occasioned the patient’s emotional disorder, and on whom his illness is centred, is usually to be found in his immediate environment.  The melancholic’s erotic cathexis in regard to his object has thus undergone a double vicissitude: part of it has regressed to identification, but the other part, under the influence of the conflict due to ambivalence, has been carried back to the stage of sadism, which is nearer to that conflict.

It is this sadism alone that solves the riddle of the tendency to suicide which makes melancholia so interesting—and so dangerous. So immense is the ego’s self-love, which we have come to recognize as the primal state from which instinctual life proceeds, and so vast is the amount of narcissistic libido which we see liberated in the fear that emerges at a threat to life, that we cannot conceive how that ego can consent to its own destruction. We have long known, it is true, that no neurotic harbours thoughts of suicide which he has not turned back upon himself from murderous impulses against others, but we have never been able to explain what interplay of forces can carry such a purpose through to execution. The analysis of melancholia now shows that the ego can kill itself only if, owing to the return of the object-cathexis, it can treat itself as an object—if it is able to direct against itself the hostility which relates to an object and which represents the ego’s original reaction to objects in the external world. Thus in regression from narcissistic object-choice the object has, it is true, been got rid of, but it has nevertheless proved more powerful than the ego itself.  In the two opposed situations of being most intensely in love and of suicide the ego is overwhelmed by the object, though in totally different ways.



We are led into quite another realm of explanation by the analysis of the attempt at suicide, which I must regard as seriously intended, and which, incidentally, considerably improved her position both with her parents and with the lady she loved.  She went for a walk with her one day in a part of the town and at an hour at which she was not unlikely to meet her father on his way from his office.  So it turned out.  Her father passed them in the street and cast a furious look at her and her companion, about whom he had by that time come to know.  A few moments later she flung herself into the railway cutting.  The explanation she gave of the immediate reasons determining her decision sounded quite plausible.  She had confessed to the lady that the man who had given them such an irate glance was her father, and that he had absolutely forbidden their friendship.  The lady became incensed at this and ordered the girl to leave her then and there, and never again to wait for her or to address her—the affair must now come to an end.  In her despair at having thus lost her loved one for ever, she wanted to put an end to herself.  The analysis, however, was able to disclose another and deeper interpretation behind the one she gave, which was confirmed by the evidence of her own dreams.  The attempted suicide was, as might have been expected, determined by two other motives besides the one she gave: it was the fulfilment of a punishment (self-punishment), and the fulfilment of a wish.  As the latter it meant the attainment of the very wish which, when frustrated, had driven her into homosexuality—namely, the wish to have a child by her father, for now she ‘fell’ through her father’s fault. The fact that at that moment the lady had spoken in just the same terms as her father, and had uttered the same prohibition, forms the connecting link between this deep interpretation and the superficial one of which the girl herself was conscious.  From the point of view of self-punishment the girl’s action shows us that she had developed in her unconscious strong death-wishes against one or other of her parents—perhaps against her father, out of revenge for impeding her love, but more probably against her mother too, when she was pregnant with the little brother.  For analysis has explained the enigma of suicide in the following way: probably no one finds the mental energy required to kill himself unless, in the first place, in doing so he is at the same time killing an object with whom he has identified himself, and, in the second place, is turning against himself a death-wish which had been directed against someone else.  Nor need the regular discovery of these unconscious death-wishes in those who have attempted suicide surprise us (any more than it ought to make us think that it confirms our deductions), since the unconscious of all human beings is full enough of such death-wishes, even against those they love.  Since the girl identified herself with her mother, who should have died at the birth of the child denied to herself, this punishment-fulfilment itself was once again a wish-fulfilment.  Finally, the discovery that several quite different motives, all of great strength, must have co-operated to make such a deed possible is only in accordance with what we should expect.



After these preliminaries we can return to our consideration of moral masochism. We have said that, by their behaviour during treatment and in life, the individuals in question give an impression of being morally inhibited to an excessive degree, of being under the domination of an especially sensitive conscience, although they are not conscious of any of this ultra-morality. On closer inspection, we can see the difference there is between an unconscious extension of morality of this kind and moral masochism. In the former, the accent falls on the heightened sadism of the super-ego to which the ego submits; in the latter, it falls on the ego’s own masochism which seeks punishment, whether from the super-ego or from the parental powers outside. We may be forgiven for having confused the two to begin with; for in both cases it is a question of a relationship between the ego and the super-ego (or powers that are equivalent to it), and in both cases what is involved is a need which is satisfied by punishment and suffering. It can hardly be an insignificant detail, then, that the sadism of the super-ego becomes for the most part glaringly conscious, whereas the masochistic trend of the ego remains as a rule concealed from the subject and has to be inferred from his behaviour.

The fact that moral masochism is unconscious leads us to an obvious clue. We were able to translate the expression ‘unconscious sense of guilt’ as meaning a need for punishment at the hands of a parental power. We now know that the wish, which so frequently appears in phantasies, to be beaten by the father stands very close to the other wish, to have a passive (feminine) sexual relation to him and is only a regressive distortion of it. If we insert this explanation into the content of moral masochism, its hidden meaning becomes clear to us. Conscience and morality have arisen through the overcoming, the desexualization, of the Oedipus complex; but through moral masochism morality becomes sexualized once more, the Oedipus complex is revived and the way is opened for a regression from morality to the Oedipus complex. This is to the advantage neither of morality nor of the person concerned. An individual may, it is true, have preserved the whole or some measure of ethical sense alongside of his masochism; but, alternatively, a large part of his conscience may have vanished into his masochism. Again, masochism creates a temptation to perform ‘sinful’ actions, which may then be expiated by the reproaches of the sadistic conscience (as is exemplified in so many Russian character-types) or by chastisement from the great parental power of Destiny. In order to provoke punishment from this last representative of the parents, the masochist must do what is inexpedient, must act against his own interests, must ruin the prospects which open out to him in the real world and must, perhaps, destroy his own real existence.

The turning back of sadism against the self regularly occurs where a cultural suppression of the instincts holds back a large part of the subject’s destructive instinctual components from being exercised in life. We may suppose that this portion of the destructive instinct which has retreated appears in the ego as an intensification of masochism. The phenomena of conscience, however, lead us to infer that the destructiveness which returns from the external world is also taken up by the super-ego, without any such transformation, and increases its sadism against the ego. The sadism of the super-ego and the masochism of the ego supplement each other and unite to produce the same effects. It is only in this way, I think, that we can understand how the suppression of an instinct can – frequently or quite generally – result in a sense of guilt and how a person’s conscience becomes more severe and more sensitive the more he refrains from aggression against others. One might expect that if a man knows that he is in the habit of avoiding the commission of acts of aggression that are undesirable from a cultural standpoint he will for that reason have a good conscience and will watch over his ego less suspiciously. The situation is usually presented as though ethical requirements were the primary thing and the renunciation of instinct followed from them. This leaves the origin of the ethical sense unexplained. Actually, it seems to be the other way about. The first instinctual renunciation is enforced by external powers, and it is only this which creates the ethical sense, which expresses itself in conscience and demands a further renunciation of instinct.

Thus moral masochism becomes a classical piece of evidence for the existence of fusion of instinct. Its danger lies in the fact that it originates from the death instinct and corresponds to the part of that instinct which has escaped being turned outwards as an instinct of destruction. But since, on the other hand, it has the significance of an erotic component, even the subject’s destruction of himself cannot take place without libidinal satisfaction.

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from The Anatomy of Suicide: Can Suicide be Prevented by Legislative Enactments?


The ninth son in a family that had lost its American property in the War of Independence and returned to England, the physician Forbes Winslow was born in Pentonville, London. He was educated at University College, London and the Middlesex Hospital. In 1835, he joined the Royal College of Surgeons of England, and subsequently received his M.D. from Aberdeen in 1849. He supported his own education through writing: he was a reporter for the Times and also wrote medical manuals for students. His work Physic and Physicians (1842) was a two-volume collection of anecdotes about doctors. Winslow’s rise to prominence as an expert on cases of insanity was furthered by his writings, The Anatomy of Suicide (1840), The Plea of Insanity in Criminal Cases (1843), and The Incubation of Insanity (1845).

In 1847, Winslow founded two private insane asylums in Hammersmith, where he experimented with humane treatment of mental illnesses. Winslow continued to write about insanity; he founded the Quarterly Journal of Psychological Medicine in 1848 and wrote many papers for legal and medical instruction. He was instrumental in gaining acceptance for the plea of insanity in criminal cases, including cases of suicide (felo de se). He died in Brighton in 1874.

In these excerpts from The Anatomy of Suicide, Winslow, though he sees suicide as a crime against God and man, insists that laws punishing suicide (which were still in effect in England at the time) were both unjust, since they punished the family rather than the alleged offender, and ineffective, since they did not serve as a deterrent to suicide. He is particularly interested in the way in which a kind of reasoning about suicide, a sort of obsessive perseveration with thoughts of suicide, can invite the act, particularly if it is believed to be justifiable. The remedy, for Winslow, is Christian moral education.

Forbes Winslow, The Anatomy of Suicide, Ch. 16, “Can Suicide Be Prevented by Legislative Enactments?—Influence of Moral Instruction.” London: Henry Renshaw, 1840, pp. 36-44, 334-339.



The only legitimate object for which punishment can be inflicted is the prevention of crime.  “Am I to be hanged for stealing a sheep?” said a criminal at the Old Bailey, addressing the bench.  “No,” replied the judge; “you are not to be hanged for stealing a sheep, but that sheep may not be stolen.”  Every punishment, argues Beccaria, which does not arise from absolute necessity is unjust.  There should be a fixed proportion between crimes and punishments.  Crimes are only to be estimated by the injury done to society; and the end of punishment is, to prevent the criminal from doing further injury, as well as to induce others from committing similar offenses.

The act of suicide ought not to be considered as a crime in the legal definition of the term.  It is not an offense that can be deemed cognizable by the civil magistrate.  It is to be considered a sinful and vicious action.  To punish suicide as a crime is to commit a solecism in legislation.  The unfortunate individual, by the very act of suicide, places himself beyond the vengeance of the law; he has anticipated its operation; he has rendered himself amenable to the highest tribunal—viz., that of his Creator; no penal enactments, however stringent, can affect him.  What is the operation of the law under these circumstances?  A verdict of felo-de-se is returned, and the innocent relations of the suicide are disgraced and branded with infamy, and that too on evidence of an ex-parte nature.  It is unjust, inhuman, unnatural, and unchristian, that the law should punish the innocent family of the man who, in a moment of frenzy, terminates his own miserable existence.  It was clearly established, that before the alteration in the law respecting suicide, the fear of being buried in a cross-road, and having a stake driven through the body, had no beneficial effect in decreasing the number of suicides; and the verdict of felo-de-se, now occasionally returned, is productive of no advantage whatever, and only injures the surviving relatives.

When a man contemplates an outrage of the law, the fear of the punishment awarded for the offence may deter him from its commission; but the unhappy person whose desperate circumstances impel him to sacrifice his own life can be influenced by no such fear.  His whole mind is absorbed in the consideration of his own miseries, and he even cuts asunder those ties that ought to bind him closely and tenderly to the world he is about to leave.  If an affectionate wife and endearing family have not influence in deterring a man from suicide, is it reasonable to suppose that he will be influenced by penal laws?

If the view which has been taken in this work of the cause of suicide be a correct one, no stronger argument can be urged for the impropriety of bringing the strong arm of the law to bear upon those who court a voluntary death.  In the majority of cases, it will be found that some heavy calamity has fastened itself upon the mind, and the spirits have been extremely depressed.  The individual loses all pleasure in society; hope vanishes, and despair renders life intolerable, and death an apparent relief.  The evidence which is generally submitted to a coroner’s jury is of necessity imperfect; and although the suicide may, to all appearance, be in possession of his right reason, and have exhibited at the moment of killing himself the greatest calmness, coolness, and self-possession, this would not justify the coroner or jury in concluding that derangement of mind was not present.

If the mind be overpowered by “grief, sickness, infirmity, or other accident,” as Sir Mathew Hale expresses it, the law presumes the existence of lunacy.  Any passion that powerfully exercises the mind, and prevents the reasoning faculty from performing its duty, causes temporary derangement.  It is not necessary in order to establish the presence of insanity to prove the person to be labouring under a delusion of intellect—a false creation of the mind.  A man may allow his imagination to dwell upon an idea until it acquires an unhealthy ascendancy over the intellect, and in this way a person may commit suicide from an habitual belief in the justifiableness of the act.  If a man, by a distorted process of reasoning, argues himself into a conviction of the propriety of adopting a particular course of conduct, without any reference to the necessary result of that train of thought, it is certainly no evidence of his being in possession of a sound mind.  A person may reason himself into a belief that murder, under certain circumstances not authorized by the law, is perfectly just and proper.  The circumstance of his allowing his mind to reason on the subject is a prima facie case against his sanity; at least it demonstrates a great weakness of the moral constitution.  A man’s morale must be in an imperfect state of development who reasons himself into the conviction that self-murder is under any circumstances justifiable.

We dwell at some length on this subject, because we feel assured that juries do not pay sufficient attention to the influence of passion in overclouding the understanding.  If the notion that in every case of suicide the intellectual or moral faculties are perverted, be generally received, it will at once do away with the verdict of felo-de-se.  Should the jury entertain a doubt as to the presence of derangement, (and such cases may present themselves,) it is their duty, in accordance with the well-known principle of British jurisprudence, to give the person the benefit of that doubt; and thus a verdict of lunacy may be conscientiously returned in every case of this description.

Having, we think, clearly established that no penal law can act beneficially in preventing self-destruction,—first, because it would punish the innocent for the crimes of the guilty; and, secondly, that, owing to insanity being present in every instance, the person determined on suicide is indifferent as to the consequences of his action, —it becomes our province to consider what are the legitimate means of staying the progress of an offence that undermines the foundation of society and social happiness.

In the prevention of suicide, too much stress cannot be laid on the importance of adopting a well-regulated, enlarged, and philosophic system of education, by which all the moral as well as the intellectual faculties will be expanded and disciplined.  The education of the intellect without any reference to the moral feelings is a species of instruction calculated to do an immense amount of injury.  The tuition that addresses itself exclusively to the perceptive and reflective faculties is not the kind of education that will elevate the moral character of a people.  Religion must be made the basis of all secular knowledge.  We must be led to believe that the education which fits the possessor for another world is vastly superior to that which has relation only to the concerns of this life.  We are no opponents to the diffusion of knowledge; but we are to that description of information which has only reference “to the life that is, and not to that which is to be.”  Such a system of instruction is of necessity defective, because it is partial in its operation.  Teach a man his duty to God, as well as his obligations to his fellow-men; lead him to believe that his life is not his own; that disappointment and misery is the penalty of Adam’s transgression, and one from which there is no hope of escaping; and, above all, inculcate a resignation to the decrees of Divine Providence.  When life becomes a burden, when the mind is sinking under the weight of accumulated misfortunes, and no gleam of hope penetrates through the vista of futurity to gladden the heart, the intellect says, “Commit suicide, and escape from a world of wretchedness and woe;” the moral principle says, “Live; it is your duty to bear with resignation the afflictions that overwhelm you; let the moral influence of your example be reflected in the characters of those by whom you are surrounded.”

If we are justified in maintaining that the majority of the cases of suicide result from a vitiated condition of the moral principle, then it is certainly a legitimate mode of preventing the commission of the offence to elevate the character of man as a moral being.  It is no legitimate argument against this position to maintain that insanity in all its phases marches side by side with civilization and refinement; but it must not be forgotten that a people may be refined and civilized, using these terms in their ordinary signification, who have not a just conception of their duties as members of a Christian community.  Let the education of the heart go side by side with the education of the head; inculcate the ennobling thought, that we live not for ourselves, but for others; that it is an evidence of true Christian courage to face bravely the ills of life, to bear with impunity “the whips and scorns of time, the oppressor’s wrong, and the proud man’s contumely;” and we disseminate principles which will give expansion to those faculties that alone can fortify the mind against the commission of a crime alike repugnant to all human and Divine laws.

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from Mental Maladies: A Treatise on Insanity


Jean-Étienne Esquirol is considered the most renowned French psychiatrist of the 19th century. He was born in Toulouse to a destitute but influential family. After traveling to Paris for a career in medicine, Esquirol formed a close bond with Philippe Pinel. Esquirol eventually succeeded his teacher in 1811 as the chief psychiatric administrator at the Salpêtrière Hospital in Paris. In 1825, he was named chief physician of the Charenton Asylum, where he established an international reputation for his work in creating more humane conditions for the mentally ill.

Along with Pinel, Esquirol was offended by the conditions present in European mental institutions—in 1818, after a three-year tour of mental hospitals around France, he wrote a memoir addressed to the minister of the interior in which he presented his findings, describing the plight of the mentally ill and its negative reflection on their custodians. He was a pioneer in advocating humane treatment of the mentally ill; along with his colleague Guillaume Ferrus, Esquirol was a key player in the law reforms of 1838 that led to improved conditions in asylums. Esquirol realized Pinel’s vision of a “therapeutic community,” in which physicians and patients lived communally in a psychiatric environment. As an example of such ideals, Esquirol’s private patients were invited to eat at the same table as his family.

Esquirol also pioneered the method of using explicit clinical observations to accomplish a systematic analysis of mental disturbances. Among his accomplishments are the invention of the term “hallucination” and a more accurate distinction between mental retardation and insanity. His influential work Mental Maladies: A Treatise on Insanity (1838) is recognized as the first modern attempt in clinical psychiatry to classify mental disorders; the work elucidates both biological and behavioral causes for mental illness, recognizing that some mental illness may be caused by emotional disturbance rather than organic brain damage. The text remained a standard for 50 years, and Esquirol’s writings also strongly influenced the treatment and perception of the mentally ill in England. Esquirol died in Paris in 1840.

Esquirol was one of the first psychiatrists to organize a statistical report of suicides; for example, he researched the most common methods of suicide, and he compared rates of suicide in neighboring countries. From his clinical experiences, he was inclined to believe that a suicidal nature is involuntary and often hereditary, and therefore should not be morally condemned or punished by law. Esquirol’s views anticipate the beginning of the transition—though it would not occur with full force until the time of Freud and Durkheim, nearly a century later—from the conception of suicide as a sin and a crime to the conception of it as the product of psychological and social forces beyond an individual’s control. The transition moves to seeing suicide as the product of illness, not as a voluntary, deliberate act that can be wrong.

In these selections excerpted from Mental Maladies, Esquirol takes a clinical perspective on the causes of and motives for suicide. His perceptive observations are coupled with what now seem quaint theories of medicine, but they do represent an important early attempt to interpret suicide as a symptom or sequela of mental illness and to identify predisposing factors for suicide. For Esquirol, suicide is an “effect of disease”; it is to be understood as a symptom of “mental alienation,” that is, mental illness. He provides a striking portrait of an insane asylum of the time as he discusses methods for preventing suicides there.

Jean-Étienne-Dominique Esquirol, Mental Maladies: A Treatise on Insanity, tr. E. K. Hunt. Philadelphia: Lea and Blanchard, 1845, pp. 253-317.


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.

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