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.