The Anatomy of Suicide

by Forbes Winslow

Many cases of suicidal insanity have been cured by removing the persons so unhappily afflicted from their own homes, friends, and relations. In these cases the physician has no little difficulty in persuading the friends of the invalid that a separation from old associations is absolutely indispensable; that without it, a return to sanity cannot be reasonably expected. When Dr. Willis undertook the cure of George III., he insisted, in the first instance, in dismissing all the old servants, changing the furniture, and removing everything from the king’s sight that might tend to awaken in his mind ideas of the past. The success that attended his treatment is said mainly to have depended on this circumstance.

Mr. ——, forty-seven years old, of a neuro-sanguineous temperament, was happy in his domestic circle, and his business had prospered until the year, 1830, from which period he was much harassed in the management of his affairs. In December, 1831, after a very trifling loss, he grew sorrowful and melancholy; his face was flushed, his eyes became blood-shot, his breathing was difficult, and he shed tears, incessantly repeating that he was lost. On the next and following days, he made several attempts to commit suicide, so that they were obliged to cover his apartment with wadding. He wished to strangle himself, tried to swallow his tongue, filled his mouth with his fist in hopes of suffocating himself, and then refused all nourishment. At the expiration of six days, the patient was brought to Paris, and entrusted to Esquirol’s care. From the moment of his arrival all desire to commit suicide vanished, and the patient appeared restored to reason. “The impression that I received,” said he, “on finding myself transported to a strange house cured me.” In fact, sleep, appetite, and a return of connected, and sometimes lively conversation, induced the belief that a cure was effected. Three weeks seemed enough for convalescence, when his wife and son came to fetch him. They passed two days at Paris to finish some business there, and then returned to the country. Scarcely had he arrived at his home when he felt himself impelled by the same desires, in consequence of which, he returned to Paris, transacted some business whilst he remained there, and appeared perfectly well. On returning to his home again, he made fresh attempts to commit suicide, struck his son, and those who waited upon him, and endangered the life of his wife. Neither the grief of his family, the watch placed over him, nor the pretended authority of those about him, could overcome these feelings. The patient passed several days without food; he tore up his linen to make a cord to hang himself, tied it round his neck, and got upon his bed in order to throw himself upon the floor; and at last, deceiving the watchfulness of his relations, escaped to throw himself into the river. He was immediately put into a carriage, and accompanied by his wife; but, notwithstanding the strait-waistcoat, he left no means untried to kill himself. On arriving at Paris, and being again confined, he became perfectly reasonable, and made no attempt to destroy himself during the six weeks that his second confinement lasted. There was reason to believe his cure complete. If he was asked why he did not overcome his terrible impressions at his own house as he did at Paris, he answered in an evasive manner, affirming that this time the trial had been long enough, that he was cured, and that he insisted upon returning home. “Deprived of my wife and son,” said he, “I am the most unhappy of men, and I cannot live.” “But if you are so unhappy here,” said Esquirol to him one day, “why do you not try to destroy yourself, as it is very easy to do so?” “I know not,” he replied; “but I am cured, and I wish to live.” This patient enjoyed the greatest liberty, and although no apparent precaution was taken to prevent his destroying himself, he never made the least attempt. He afterwards ceased to talk unreasonably; but Esquirol was never able to obtain an avowal of the motives which induced him to commit suicide at his own house, whilst he thought no more of it as soon as he came amongst strangers. On returning to his home for the fourth time, although he was able to transact important business, the same phenomena returned with equal violence.

M. ——, twenty-seven years old, after experiencing some reverses of fortune, became maniacal, with a tendency to commit suicide. The elevated situation of the room which he inhabited, the position of the staircase, the reiterated visits of his friends, “who came to contemplate his misfortunes,” and the despair of his wife, were so many circumstances which induced him to terminate his existence; and although he avowed that he had no motive for so doing, and that he was ashamed, and considered himself criminal for having attempted it, he left no means untried for more than a month to effect that end. When he was taken away from his home, and lodged in a ground-floor which led into a garden, the idea no longer harassed him. “It would be of no use,” he said; “I could never kill myself here; every precaution is taken to prevent me.”

A baker’s wife, of a lymphatic temperament, experienced a violent fit of jealousy, which caused her much distress, and induced her to watch her husband’s steps, who vented his discontent in threats and reproaches. At last, this unhappy woman, being unable to bear the feeling any longer, threw herself out of the window. Her husband ran to pick her up, and bestowed marks of the most attentive kindness upon her. “It is useless,” she said; “you have a wife no longer.” She refused every kind of nourishment, and neither the solicitations, tears, prayers of her relations, and those of her husband, who never quitted her room, were able to overcome her resolution. After seven days of total abstinence, Esquirol was called in. They hid from him the cause of the disease, but he observed that every time her husband approached the bed, her face became convulsed. The patient was told that she was about to be sent into the country, but that it was necessary for her to take a little nourishment in order to support the journey. A little broth which was offered her was accepted; but notwithstanding her attempts, she could only swallow a few drops. She tried again the following morning, but she expired in the course of the day. “Had this woman,” says Esquirol, “been removed from her home immediately after the accident, there is little doubt but she would have been restored. How could she desire to live, her distress being continually aggravated by the presence of her husband?”

The chief means of controlling the passions, and of keeping them within just bounds, is to form a proper estimate of the things of this life, of the relation of our present to a future state of existence, and of the influence which our actions in this world will have upon our happiness hereafter. Such a right estimate every rational man will labour to attain. He will endeavour, by correcting error, and acquiring such habits as are consistent with just sentiments, to withdraw the nourishment from the very root of passion, rather than be for ever fruitlessly occupied in merely pruning the luxuriance of some of its branches.

It may be useful to impress strongly upon the minds of those who have not sufficient command over their feelings, the persuasion that the indulgence of any passion to excess, and especially of the selfish and malevolent ones, is likely to be injurious to health, will certainly be destructive of serenity and comfort; and of course, by diminishing happiness, will frustrate its own aim and intention, and may, by repetition, acquire accumulated force and facility of excitement, become at length unconquerable and habitual, and according to its nature, violence, and frequency, will, in a greater or less degree, be subversive of happiness, and leave them more or less open to the attacks of insanity.

Such persons will therefore see it highly expedient, while under the influence of these impressions, to do all in their power to avoid them; to compare their urgent and apparent importance when they occur, with the probable diminution of the comfort and health of body and mind which they might induce; and to lay it down as a rule never to indulge any passion whatever, till, independently of moral considerations, and the notions of duty and obligation, they have deliberately reflected, whether the importance of the cause will be a sufficient counterbalance to the certain pain inflicted and the injury which may be thence derived to their health of body and ease and soundness of mind. A habit of such deliberation once acquired,—and it may be acquired by diligence and resolution,—will entirely put an end to exorbitant excitement, since by checking the very beginnings of emotion, its growth and progress will be altogether prevented.

And as every one has some weak point on which he is more open to a successful attack, some constitutional or habitual feeling, the approaches of which he cannot easily withstand, all persons who are convinced of the expediency and necessity of subduing their passions, if they would consult their own ease, will be aware of the importance of keeping a diligent watch, and placing a strong guard, upon the one that most easily and successfully besets them.

And whoever would secure a reasonable portion of present happiness will be sensible of the necessity of learning the art of contentment, which, difficult as it may seem to those who have not used themselves to check the wanderings of imagination, and to keep their desires within prudent bounds, not only appears indispensable, but easy, to the man who feels a lively and practical conviction of its wonderful tendency to multiply the sum of actual enjoyment.

With the same view of promoting and securing their own present felicity, such persons will see the propriety of acquiring habits of good nature, and of cultivating the emotions of benevolence. And as virtue seldom fails to bring her own dowry, contentedness and benevolence will infallibly introduce habits of cheerfulness, which, while they improve our happiness, act as powerful preservatives against disease, and as determined enemies of insanity.