The Forms of Lunacy.
The special symptoms of each form of madness will on consideration be found sufficient to account for difficulties in forming anything like an accurate estimate of the relative amount of suicide in each of its forms. For example, in mania, sudden outbursts of violence may either end in instant self-destruction, or the sudden violence causes such precautions to be at once taken, that suicide is not practicable. In melancholia the chances of a self-inflicted death being allowed to occur, are much greater, because the patient is inoffensive, and the disease is of long continuance; the sufferer has often daily opportunities for months; and thus we find melancholia credited with the largest number. In monomaniacs, again, the project of suicide is often matured in their brains, whilst they hide their delusions; until a sudden outburst of suicide or crime startles the relations, who have only been saying to each other just before, “the patient is safe enough, the only thing the matter with him is the presence of a delusion.”
To imbecility, again, we do not find many cases allotted; the imbecile has not mind enough to feel his grievances sufficiently strong to make him exert himself to end them.
In the Reports of the English Lunacy Commissioners the cases of dementia are subdivided into two classes, ordinary and senile, each giving about as many cases as mania.
Abercrombie remarked, that the most striking peculiarity of melancholia is the propensity to self-murder; under a conviction of overwhelming and helpless misery, the feeling of life to be a burden, arises; and this is succeeded by a determination to quit it. A singular modification is sometimes seen, in which with the desire of death, there exists a sense of the sin of suicide; and to avoid this sin, another idea arises, viz., to bring about the death by committing a murder, and so to be executed. Several instances have been described, in which the insane murderer has distinctly avowed this process of reasoning, disclaiming any malice against the person he had killed, who by the way was generally a child, and in one case the reason for choosing a child was also explained by the lunatic, which was to avoid the risk of sending out of the world a person in a state of unrepented sin.
In the north-western and central parts of Europe madness and suicide coincide in intensity.
Osiander stated that the scale of madness among the European states has much resemblance to the comparative suicide rates.
On an approximate estimation I find that the Germanic stock has 2 madmen per 1,000 persons, the Celtic-Latin has 1 madman per 1,000 persons, the Slavonic has 0·6 only.
It is estimated that there are about 300,000 mad persons in the Old World, of whom Germany, France, and England, give the greater number.
The French and Italian statistics of insane suicides are not subdivided, and so are not available to show the relative proportions of the forms of insanity; the German numbers give the following result in recent years, 1875 et seq.:─
| Forms of Lunacy. | Per Cent. | |
|---|---|---|
| Males. | Females. | |
| Religious mania | 0·7 | 0·6 |
| Monomania | 0·6 | 0·5 |
| Melancholia | 68·7 | 69· |
| Brain fever | 5· | 2·8 |
| Mania | 5·1 | 2·6 |
| Imbecility | 5·7 | 5·0 |
| Unnamed | 14·2 | 19·5 |
With regard to our own country, the last Report of the Lunacy Commissioners for England and Wales shows that of 13,581 patients admitted to the register of lunatics for 1882, 3,877 were stated to have a suicidal propensity, viz., 1,785, or 26·8 per cent. of the males; and 2,092, or 30·2 per cent. of the females.
The total number of lunatics in charge for the year 1882 was 76,765, and of these 17 committed suicide: 10 males and 4 females in asylums, 1 male before admission, and 1 male and 1 female while “on leave.” There were 17 suicides also in the year 1881. This small number of actual deaths speaks volumes for the care and attention which must be bestowed on the suicidal patients.
The proportion of suicidal tendency was higher among pauper than among well-to-do lunatics.
The highest rate of suicidal propensity was found in cases of melancholia, a proportion of 57, compared to mania 21, ordinary dementia 16, senile dementia 15, and idiocy 8.
The states of family life gave these proportions: marriage 32, celibacy 24, and widowhood 29, and of married persons, more females than males.
The Report also subdivides these cases with respect to the causes assigned for the insanity; the following were the most fertile causes, with the relative proportions:─
Domestic trouble, 9·7 (twice as many females as males); adverse circumstances, 6·0; overwork, worry, 7·5; religious excitement, 3·6; love affairs, 1·9; nervous shock, 1·4; alcoholic excess, 12·1 (nineteen males to six females); sexual excess, 0·5; sunstroke, 0·7; venereal disease, 0·3; self-abuse, 1·0; accidents, 3·2; pregnancy and parturition, 3·6; change of life (females), 2·9; privation, 2·0; old age, 3·0; bodily disease, 11·0; hereditary transmission, 22·8; and previous attacks, 15·8.
In England it is not practicable to form any reliable estimate of the true proportion of insane suicides, as compared with those occurring from disease and mental trouble. On the Continent an attempt is made in most States to assign the proportion; but it is easy to point out the difficulty of the task and the numerous errors that are liable to creep into such calculations. The following rates per 1,000 suicides have been published in the “Asylum Journal,” vol. 27: France, 300 insane per 1,000; Belgium, 470; Prussia, 333; Italy, 343; and Bavaria, 342.
M. Prévost, in a learned investigation of cases of voluntary death, estimated that 18 per cent. occurred in insane persons.
I have made careful investigation into all the cases of suicide which I have observed, and all those cases upon which I have held inquests, as the Deputy for Dr. Danford Thomas, in Middlesex, and I have found that in 20 per cent. only had the deceased ever exhibited symptoms of insanity obvious to the friends and relations.
The suicide rates of the great German lunatic asylums are higher than those of our English ones. Dr. Löwenhardt, of the great asylum at Sachsenburg, states that the average number of suicidal deaths in that institution is 5 per cent., a large proportion; for in the asylum of Illenau 3 per cent. only killed themselves, and in the asylum of Halle, only 1·7 per cent.
The varying rates of suicidal death in asylums depend very much on the qualities of the nurses on the staff, and on the relative number of patients attached to each attendant, for nothing but a constant and lynx-eyed survey will prevent the self-destruction of a large proportion of lunatics, when they have a wave of suicidal tendency passing over their minds.
[CHAPTER XV.]
EPIDEMIC SUICIDE; SUICIDE FROM IMITATION, AND DESIRE FOR NOTORIETY.
In relation to lunacy and mental disturbance, I must now refer to the question of Epidemic and Imitational Suicide.
No crime seems to have so strong a tendency to spread by example and imitation as this one. Epidemics have occurred on many occasions, and I have already mentioned an epidemic of suicide taking place among the soldiers of Tarquinius Superbus.
At Alexandria, in the time of the Ptolemies, an epidemic was originated by Hegesias the philosopher, who discoursed so eloquently on the numerous trials of this life and the pleasures of death, that numbers of persons destroyed themselves; and the philosopher was banished.
When Xanthus, a city of Lycia, was conquered by Brutus, the citizens slew themselves by hundreds.
At Miletus the women committed suicide in large numbers, because their husbands and lovers were detained by the wars: they hanged themselves; the frenzy was checked by an edict that their bodies were to be dragged naked through the streets. Other examples of wholesale suicide are shown by the people of Sidon, who burned their city and themselves when besieged by Artaxerxes Ochus, by the Tyrians when conquered by Alexander, and by the Acheans when defeated by Metellus.
At Marseilles, an old historian records that at one time the young women made it quite a habit to kill themselves when their lovers were not constant to them.─(Esquirol.)
Large numbers of suicides were committed by Christians in the terrible times of persecution in the reigns of Nero, Decius, and Diocletian.
In the dancing mania and the follies of Tarantulism in Naples, between 1500 and 1600, the patients often thronged in crowds to the sea shore, and rushed singing into the waves, as Lecky narrates.
An epidemic of drowning affecting women alone also occurred at Lyons; these cases had no apparent cause; it was checked by an order to expose all the bodies naked in the market. See Spon, “Histoire de la Ville de Lyon,” 1676, and Primerosius Jacobus, “De mulierum morbis,” 1665.
Sydenham is the authority for the statement that suicide prevailed to an alarming degree in Mansfield in the year 1697; and at Versailles, in 1793, 300 persons killed themselves. At Rouen in 1806, at Stuttgardt in 1811, epidemics occurred. In Valois an epidemic of hanging took place in 1813, see Sydenham, “Complete Works,” vol. ii. In July and August 1806, 300 persons committed suicide in Copenhagen; these cases formed a distinctly marked epidemic. Suicide is almost epidemic, or endemic, in connection with the disease Pellagra in Italy, Spain, and the South of France. It is said that one-third of the victims of this disease kill themselves. This scourge appears to be a nervous affection, associated with erythema and degeneration of the skin, and dependent partly on the effect of the sun, especially in spring, and partly on the consumption of unhealthy maize as food; its most usual termination is in dementia.
Groups of Suicides from Imitation, almost amounting to minute epidemics, have occurred from several churches, monuments, and elevated structures, their great height being the incentive to the victim to throw himself off; such are the Duomo of Milan, St. Peter’s at Rome, the Campanile of Giotto, Florence, the Vendôme Column, Paris, the Monument, London, the Suspension Bridge at Clifton, and the Archway at Highgate; from this last viaduct, which is protected only by a low wall, there have been four suicides in as many months; in response to repeated representations from Dr. Danford Thomas and myself, the Local Board have at last undertaken to put up a railing on this bridge.
After the suicide of Lord Castlereagh, a large number of persons put an end to their lives in the same manner. Several imitational suicides and suicidal attempts occurred in 1841, following the drowning of a young woman in the Thames. She left a letter behind her, explaining her unfortunate love affairs; her case made a great noise at the time, and much public fuss and public sympathy were shewn on her behalf, and no doubt led to her successors’ deaths.
After a tragedy at Pentonville, in 1842, in which a man cut the throats of his children and then committed suicide himself, there were within a week two similar cases.
At a meeting of the French Academy of Medicine, 1827, Dr. Costel related that, in Paris, at the Hotel des Invalides, a soldier having hung himself on a post, his example was in a very short time followed by twelve other invalided soldiers. The post was removed, and there were no more cases in the building for a considerable period.
Legoyt narrates that the drama of “Chatterton,” by M. de Vigny, when performed in Paris, caused many persons to kill themselves in imitation of the hero; and he asserts that the same effect has followed, in France, the study of Ugo Foscolo’s “Jacopo Ortis,” Byron’s “Manfred,” Chateaubriand’s “René,” Constant’s “Adolphus,” and Lamartine’s “Raphael.”
Dr. Ebrard, in “Le Suicide,” 1870, condemns the teaching of the stories of the Stoics and their suicides to schoolboys, thinking it blameworthy to familiarise the youthful mind with the idea of self-destruction.
In Germany, many references in the literature of our time may be found, in which the study of Pessimism,─the doctrines of Schopenhauer (d. 1860), are blamed for decoying men to self-destruction.
The following notice is cut from a newspaper, April 1885:
No less than seven suicides effected or attempted were reported in Paris one day last week. At five in the morning, a packing-case maker in the Faubourg St. Martin, named Rozette, took a dose of laudanum, and was removed to a hospital in a critical state; at seven, a messenger was found hanging in his lodgings at an hotel in the Rue de Chartres; about the same time a concierge at 16, Rue Chalgrin, committed suicide with charcoal; at eight, a retired tradesman, aged 62, killed himself by firing a revolver in his mouth; at one, a man living in the Place de la Chapelle, stabbed himself with a shoemaker’s knife; at four, a porter at the Central Markets shot himself with a revolver; and lastly, at ten in the evening, a tailor, living at the Rue Bonaparte, shot himself twice in the head while riding in a cab.─Galignani.
I have reason to believe that it is perfectly true (although it has been denied) that a very considerable number of French officers and men slew themselves in the confusion and headlong retreat which followed the general advance of the English line, at the close of the battle of Waterloo, when the confusion was made worse confounded by the additional onslaught of the Prussians from the flank.
M. Legoyt also narrates this statement as authentic, and there is no inherent improbability in it, if we consider that among those who fled, were the “Old Guard” who had never known defeat.
The love of notoriety also comes in for mention in this place. One man has killed himself by attaching his body to a rocket, and then setting fire to the fuse; nothing but a desire to be notorious seems to explain this action. Another man threw himself into the crater of Mount Vesuvius. Empedocles, the philosopher, threw himself into the crater of Mount Etna.
Soon after the death of Miss Moyes the first of a series of suicides from the Monument, London, Elam narrates that a lad took poison with the intent to kill himself; when questioned by the police, he answered, “I wished to be talked about, like the woman who threw herself off the Monument.” And this is a very fair example of many instances of voluntary death, but whether it forms a good public policy to call those sufferers insane is questionable: personally, I think that such persons are encouraged by the neglect to stigmatise them as criminals.
It is not every suicide from a dangerous height that is caused by imitation; there does undoubtedly exist a peculiar form of fascination, apt to arise from a sense of insecurity, such as occurs to a person standing on a cliff or a house top, and I am convinced that this fascination does cause many involuntary suicides.
Mental debility is a cause of it, and so is dyspepsia, and I expect that like lack of courage it is a matter of lack of health. Other forms of this weakness are occasionally seen; some men dare not trust themselves with a razor, and others have a terror of handling a revolver.
Improvement of health, strong mental effort, and custom remove these unpleasant feelings.
[CHAPTER XVI.]
BODILY DISEASES; INSOMNIA, SPIRITUALISM, HEREDITY, AND ALCOHOLISM.
Incurable bodily diseases, and the accompanying pain of some other disorders, are not uncommon causes of a voluntary death. It has been estimated that incurable diseases are even more powerful as a cause than very painful ones.
The heavy voluntary death rate of persons afflicted with pellagra has been already noticed, as has the dictum of Pliny that the presence of stone in the bladder constitutes a fair reason for self-destruction. Not long ago I held an inquest on the body of a medical man who hung himself to avoid the pain and worry of an apparently incurable stricture of the urethra.
Continental statisticians have calculated that bodily disease causes 8 per cent. of Italian suicides, 13 per cent. of French, 10 per cent. of Norwegian, and 12 per cent. of Prussian suicides. These are voluntary deaths, not deaths during delirium accompanying disease.
Loss of sight, and loss of hearing, are both causes of increased suicide rate; in Prussia it has been estimated that persons having suffered such deprivation contribute a rate almost double that of persons not so afflicted.