Marriage, Celibacy, Widowhood.

Having regard simply to numbers, there are most suicides among the unmarried, next among the married, then among widowed persons, and lastly, among persons divorced and separated.

Bachelors kill themselves oftener than married men; but in Italy, France, Switzerland and Saxony, married women oftener than virgins. Widows surpass widowers in frequency of suicide, and it has been suggested by statistics that widowhood in this respect brings woman nearer to man than any other social condition.

Wars tend to raise the rate among women, because they make so many widows; the suicide rate of widows rose in a sudden leap in Germany and in France, when the last war broke out, and remained over and above the rate of virgins and wives for two years after.

Married men have, throughout, the lowest rate; suicide is more frequent among celibate men than among virgins.

Divorce causes more male suicide than female.

Among men, allowing for extant numbers of each class, we find these resultant proportions for 1882:─

Countries.Married.Single.Widowed.
France100104160
Italy100114198
Wurtemburg100147162

Taking France as an example, the following proportions are found among the suicides, after excluding males under fifteen years of age, and females under eighteen:─

The Sexes.Celibate.Married.Widowed.
Men422·14271·71737·0
Women80·0080·87121·0

That is, unmarried men fewer than widowers. Unmarried women a trifle fewer than married women.

In Prussia, curiously enough, these states are altered; married men kill themselves the most often, and married women kill themselves the least often.

Italy, again, resembles France.

In New York, for 1883, of 124 men and 27 women who killed themselves, 78 were married, 43 single, and 24 widowed or divorced.

Another curious remark has been made, whenever and wherever the marriage rate is falling, the suicide rate is increasing, and the reverse. The first case is shown, of late years, by France, Germany, England, Austria; in Italy and Switzerland, from 1875, and in Belgium, from 1873 to 1876.

On the other hand, Holland, Norway and Finland, show an increase in the number of marriages, and a tendency to a lower suicide rate.

The presence of children to married life affects the suicide rate; they restrain the mother more than the father, in married life and widowhood; whilst they have the contrary effect on divorced persons.

In France, for example, the suicide loss among the married, where there are children, is 205 per million men to 45 per million women; where there are no children, it is 470 per million men to 158 per million women; and among widowed persons, where there are children, the rate is 526 per million men to 104 per million women; and where there are no children, it is 1,004 per million men to 238 per million women.

Bertillon remarks that widows are much less anxious than widowers to marry again; that many widows become so to their peace and happiness, and the isolation and bereavement of widowhood are usually overbalanced by woman’s noblest virtue and care, maternal love; where there is no such outcome needed, suicide fastens its fangs on the mind.

[CHAPTER XIV.]
INSANITY IN RELATION TO SUICIDE.

It is not my intention in these pages to enter into a lengthened discussion of the once much debated question as to whether suicide be invariably a proof of pre-existing insanity.

It is sufficient for my purpose that a certain number of suicides are definitely insane, and that in these cases the act has been committed in consequence of some delusion from which the patient was suffering. Such a one may have been insane on a single point, and no other; or he may have been entirely demented.

But there certainly are other cases, in which no symptoms of mental disease can be discovered; either in the history of the deceased, or in his recent actions, appearance, or conduct. “There is no lunacy present where the sense of weariness of life is in exact relation to existing circumstances; where obvious moral causes exist which satisfactorily account for the deed; when the resolve has been fixed deliberately, and might have been abandoned had the circumstances become altered; and in which we discover, after honest and impartial search, no other sign or symptom of mental derangement. When a man prefers dissolution to a miserable or contemptible life, or one full of mental and physical ills, Morality and Religion must charge him with the deed; Insanity need not claim him for her own.”

The instinct of self-preservation is not so strong as to prevent men altogether from being tired of life, and seeking their own deaths. They may have exhausted all the available sources of pleasure, their business may have gone wrong, or their honour may have suffered, poverty and loss of position may be at hand, their difficulties may seem entirely beyond their power to surmount, and they calmly and deliberately arrange to leave behind them a life which has become unbearable; such an act may be unwise, and is certainly presumptuous, but it has in it no sign of disease.

And again, the existence of insanity cannot be affirmed in those suicides, which have taken place in every age of the world, and are not quite obsolete even now,─those cases of voluntary death among natives of uncivilized countries, which form a part of either their political, social, or religious institutions.

“Just as madness may exist, without any idea of suicide, so suicide may take place, the effect of a full and free determination, formed by a healthy mind, and executed with the coolness and complete system of precautions of the most perfect logic,” says Maudsley, and he carries with him the greater part of higher class medical opinion.

All our necessities, our desires, and our passions, produce a mental and bodily struggle; every want of man, though necessary to his perfection, involves victims to mental failure, and consequently either to crime or suicide. Even religion is frequently found to lead to disorder of intellect, from too great abstraction of thought from our earthly duties; while, on the other hand, mental failure is often shewn by religion becoming so absorbing a theme that it causes a patient to forget his worldly responsibilities.

The following authorities, who have specially studied the state of mind in cases of voluntary death, inclined to the doctrine that all suicides are insane: Esquirol, Falret, Bourdin, Winslow, Chevrey, Foderé, and Davey.

Forbes Winslow especially was the champion of this opinion; he distinctly wrote, no healthy mind ever permitted the act; but then in his time a wave of special tenderness to all criminals overshadowed the country; and exists even now, for our paupers are far less well cared for than our gaol birds.

M. Foderé, Professor of Medical Jurisprudence at Strasburg, used to say of voluntary death, “a suicide must be insane;” but this was a colloquial remark, rather than a medical dogma.

M. Falret, in his treatise on “Suicide and Hypochondriasis,” says, “suicide is necessarily an act of delirium;” perhaps it is to a medical man who considers hypochondriasis and hysteria to be insanity.

In the year 1777 this question of the coincidence of suicide with insanity was gravely argued before the Parliament at Paris, but the decision was put aside on a question of form, and never settled by them.

Dr. J. G. Davey read an essay before the Bath and Bristol Branch of the British Medical Association a few years back, in which he proved to his own satisfaction that “suicide is at all times, and under all circumstances, the effect of a positive brain disease;” but his arguments fail to explain the cases where two persons commit the act together; are we to suppose such disease of brain to be contagious? He mentions such a case, but without explanation. See Asylum Journal of Mental Science, vol. vii. 108, and xvi. 406.

It may be only a coincidence, but it is a fact, that almost without exception the supporters of the theory that all suicides are insane have been medical attendants in asylums.

Closely connected with unsoundness of mind is the disease epilepsy and its consequences; as is well known, the less violent forms, those in which the convulsive seizures are less obvious, are more liable to end in mental impairment, and thence in suicide, than are the more well-developed cases of convulsion. And among the modes of exhibiting its effects, it must not be forgotten that epilepsy is in some cases apt to show itself, not in a physical spasm but in a nerve storm, burst of passion, and what not: compare the opinion of Trousseau, in “L’Union Medicale,” 1861; he says:

“It may even safely be asserted that if a man who has presented no previous mental disturbance, or any sign of lunacy or furor, is not under the influence of alcohol, or any other drug, commit murder or suicide, he is epileptic, and has suffered a complete paroxysm, or has had epileptic vertigo.”

This very sweeping assertion does not commend itself to me, nor is it, so far as I can ascertain, generally accepted as reliable; it is too far reaching and dogmatic; it is one thing to believe epilepsy may be revealed by a burst of violence, and quite another thing to decide that every act of sudden passion is epilepsy, i.e., disease, and therefore blameless.

Blandford, in his work on “Insanity,” states: “That sane people commit suicide is a fact that must be apparent to every one who exercises common sense in looking upon the subject. The hundreds of poor persons who are brought to our hospitals, half drowned, or with throats half cut, are not insane in any medical sense of the word. Of course there are insane persons who are suicidal.”

M. Leuret epigrammatically sums up the causes of self-murder in the three words, madness, want, and crime.

The “Lancet,” in the autumn of last year, in an editorial article, remarked:

“Without hair-splitting, the great majority of suicides are perfectly well aware of the nature of the act they are performing, and do a deed with a so far intelligent purpose of escaping from a misery which seems unendurable, or because of some terror or shame that for the time overwhelms.

“It is heart-breaking and brain-tearing trouble that causes it, in the (hope or) belief that dying is sleep, or eternal oblivion.”

Dr. Gray, in the American Journal of Insanity, vol. xxxiv., writes, in regard to the United States: “Suicide is always an unnatural act, but in the large proportion of cases, if not in the majority, it is committed by sane people.”

Bucknill and Tuke, “Psychological Medicine,” state definitely, “it cannot be disputed that suicide may be done in a perfectly healthy state of mind,” ... “neither can it be doubted that it is the effect of a cerebro-mental disease in many cases.”

M. F. Dabadie, the author of a famous French work on Suicide, remarks, “if physiologists had endeavoured simply to establish that suicide was frequently a sign of madness, no one would have denied them; but to pretend, as some French physiologists have done, that every suicide is insane, is to insult history and common sense, and to expose oneself to ridicule.”

Des Etangs, in his work, “Suicide in France, from 1789 to 1860,” analyses and reviews the causation of 210,000 cases; he is fully convinced of the very large number of persons who kill themselves from sane motives, and with a sane mind.

He narrates numerous instances in which suicides have left their reasons for the act, written out at length, and these reasons, in most cases, shew “une lucidité parfaite.”

M. Littré remarks, “Quand un homme expose clairement les raisons qui l’empêchent de vivre plus longtemps, et quand ces raisons sont réeles et non pas imaginaires, quel motif y-a-t-il de lui denier la liberté morale, telle que nous la connaissons chez chacun de nous?”

In this place may suitably be mentioned the sad death of the Afghan surgeon Mahomed Ismail Khan, who had studied medicine in England, had taken his diplomas, and had then found all avenues to making a living in England closed to him on account of his nationality, colour, &c. (he could not return to his Indian home, having lost caste there); he, poor fellow, after making repeated efforts to obtain a situation that would support him, and after having exhausted his private means, drank prussic acid in bed at his lodgings. He left behind him a long and detailed history of himself, ending in a dissertation on suicide and its permissibility.

This essay, from its great medical and psychological interest, was offered to the editor of one of our leading medical journals for publication, but this was declined, on the ground that the arguments in favour of suicide were so delusive that it would be a public error to disseminate them. History repeats itself, for I find Voltaire narrates that he knew a professional man who, before killing himself, wrote an essay on suicide, and sent it for publication to the authorities of his native town, in 1769; the town council refused to publish it, assigning as their reason, that it would encourage men to quit a life, of which so much ill could be said.

It may be stated here, as a generalization, that whilst the medium course of life is the safest, the extremes of riches and indulgence, and their reverse, poverty and asceticism, both increase the suicide rate in about an equal proportion.

Post-mortem examination has not as yet disclosed any definite brain lesion, even in positive insanity, so that the discovery of a brain blemish associated with suicide is hardly to be expected. There have not been any large number of investigations into the post-mortem appearances of the brain in deaths from suicide in this country; in Wurtemburg, however, for two years, 1873-1875, a special examination was ordered in all cases of suicide in the insane, without any very valuable result being arrived at, viz., definite lesions of the brain existed in 45 per cent. of the cases, definite disease of other organs in 16 per cent., and negative results in 39 per cent.

Bucknill and Tuke divide insane suicides into three classes: 1. The monomania of self destruction; 2. In melancholia, death is chosen as the lesser evil; 3. Delusional, as when the sufferer hears a voice commanding him to act on its behests.

It must not be forgotten that the criminal law of England allows the possibility of a lunatic committing a murder in a lucid interval; and so also a lunatic may be held to kill himself in a lucid interval.