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.:─