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Theories of suicide : a review of social attitudes and sociological and psychological theories, and their… Wallis, Ian Douglas 1960

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THEORIES OF SUICIDE: A Review of Social Attitudes and Sociological and Psychological Theories, and their Social Work Implications. by IAN DOUGLAS WALLIS Thesis Submitted i n P a r t i a l Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK i n the School of Social Work Accepted as conforming to the standard required for the degree of MASTER OF SOCIAL WORK School of Social Work 1960 The University of B r i t i s h Columbia In presenting t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree that permission f o r extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e . I t i s understood tha t copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be allowed without my w r i t t e n permission. Department of S o CLycJ2 The U n i v e r s i t y of B r i t i s h Columbia Vancouver 8, Canada. Date io j (i) ABSTRACT It i s becoming increasingly apparent that suicide is a socio-psychiatric phenomenon with etiological roots in both the social system and in the individual personality. Suicide as a problem i s worth studying for only as further research sheds light on the complexity of motives and causes can c l i n i c a l and educative programmes be improved and social policies and changes be introduced. In the past the treatment of attempted suicide has been the prerogative of psychiatry but with the realization that the suicide act has important social aspects, the place of the social worker is being given greater emphasis. This thesis examines social attitudes toward s e l f -destruction as they have evolved through the course of the history of c i v i l i z a t i o n . It reviews the major theories which have been advanced to account for the occurrence of suicide, classifying them broadly into two groups: those which assign the causes to various forms of social disorganization and those which assign the causes to psychic disturbances and disorders. It is recognized that these approaches to the problem — the sociological and the psychological — are complementary and that a consideration of their mutual relevance is especially important in planning the establishment of effective preventive services. The existing treatment and preventive f a c i l i t i e s are c r i t i c a l l y examined as Is the present state of the law regarding suicide. It is concluded that the law rests on ecclesiastical postulates which no longer appear binding in a predominantly secular society. Some proposals for the development of a treatment and prevention programme are made in light of the experimental work of the Suicide Prevention Center in Los Angeles. ( i i ) Table of Contents page Chapter 1. Suicide as a Human Problem and a Public Issue. 1. The Problem of Suicide 1 A. Dimensions of the Problem 1 B. Suicide as a Personal and Family Tragedy 1 C. Suicide as a Professional and C l i n i c a l Problem...... * 2 D. The Varieties of Suicidal Expression.. 3 2. Social Attitudes Toward Suicide...... 4 A. Historical Attitudes... 5 (i) Primitive Peoples 5 ( i i ) Eastern Peoples 7 ( i i i ) Jewish People..... 9 (iv) The Classical World 10 (v) The Christian World 12 B o Contemporary Attitudes 16 3. The Etiology of Suicide 21 4. Implications fer the Study of Suicide 22 Chapter 2. The Sociology of Suicide 1. Early Theories of Suicide 23 2. Durkheim's Theory of Suicide. 25 A. Extra-Social Factors 25 B. Egoistic Suicide 27 C. A l t r u i s t i c Suicide « 32 D. Anomic Suicide......................... 33 E. Suramar y............................... 36 3. C r i t i c a l Appraisal of Durkheim's Theory..... 36 4. Halbwach's Theory of Suicide 43 5. Sociological Co-ordinates of Suicide,. 43 A. Suicide and Climate........... 44 B. Ecological Distribution...,,.,,,,..... 45 C. Urban and Rural Differences.., 48 D. Marital Status. 51 E. Age and Sex........................... 52 F. War . . . . . . . . . . . , . . . . o . . . . . . . . . . . . * * . . * * ^ 3 G. Socio-Economic Status................. 54 H. The Business Cycle 60 6. Summary of the Sociological Insights 61 (iii) page Chapter 3. The Psychology of Suicide. 1. Early Theories of Suicide . • 63 2. Contemporary Theories of Suicide....... 66 A. Non-Psychoanalytic Theories...... 66 B. Psychoanalytic Theories of Suicide 69 3. C r i t i c a l Appraisal of the Psychoanalytic Theories of Suicide...... 78 4. Attempted Suicide 81 5. C l i n i c a l Correlates of Suicide 85 A. Psychiatric Classifications of Suicidal Persons.. 86 B. Motivational Determinants and Cl i n i c a l Classification..., 88 C. The Methods of Self-Destruction and their Significance. 89 D. Alcoholism and Suicide. 90 E. Suicide and the Aged.,... 91 F. Prodromal Aspects of Suicide..... 92 Chapter 4. Implications for Social Policy and Services 1. An Outline for the Strategy of a Mental Health Programme 95 A. Findings of Sociological and Psycholo-gical Studies 95 B. The Need for a Synthetic Approach 96 C. The Treatment and Prevention of S u i c i d e . « s . . . « . « » . . o . . » o . . . . . . . . . 98 D. Recommendations for a Suicide Control Programme 99 E. The Need for Continuing Research. 103 2. Suicide and the Law.................... 104 A. The Legal Status of Suicide...... 104 B. Sources of the Law: A C r i t i c a l Analysis 104 C. A Critique and a Proposal 108 Appendices Bibliography ACKNOWLEDGEMENTS I should like to express my appreciation to Mr. Adrian Marriage, my thesis advisor, for his contribution of creative ideas and for his criticisms and valuable suggestions* His acute sense of sociological relevance helped me to see the problem of suicide in i t s broader perspective* A special vote of thanks goes to a former instructor of mine, Mrs. Dorothy Murphy of the Department of English, McMaster University, who provided me with an introduction to the many suicides recorded in the pages of literature and who stimulated me to pursue further this facet of the subject; and to Mrs. Dorothy Wallis.who generously gave of her time in the proof-reading of the material. Finally, I wish to acknowledge my indebtedness to my wife Marian. She spent countless hours in editing and typing the early drafts and offered encouragement from the time the ideas for this thesis were conceived unt i l their translation into the finished product. CCv) A STUDY OF SUICIDE A Review of Historical and Contemporary-Social Attitudes and the Sociological and Psychological Theories of Suicide, and Their Implications for Social Policy. Chapter 1. Suicide as a Human Problem and a P u b l i c Issue. l o The Problem of Suicide. A. Dimensions of the Problem In Canada, during 1958, 1271 persons, or 7.5 per 100,000 population, decided that l i f e was no longer worth l i v i n g and committed suicide.*' A breakdown of f i g u r e s shows that B r i t i s h Columbia with 172 suicides (11.1 per 100,000) had the highest rate i n the country. Ontario and the P r a i r i e Provinces followed.' The peak f i g u r e fox Canada of 9.9 occurred i n 1930 and the lowest l e v e l , 6.1, was recorded in 1944." The rat e has remained, on the whole, constant in the past ten years. B. Suicide as a Personal and Family Tragedy. Whether i t be successful or unsuccessful, whether i t be the sequential outcome of a mental disorder, a disturbance of interpersonal r e l a t i o n s , physical pain, or any combination of these, the s e l f - d e s t r u c t i v e act represents a t r a g i c event. It involves f o r the s u i c i d e , before h i s death, overwhelming f e e l i n g s 1. The s u i c i d e m o r t a l i t y rates per 100,000 population for somaother countries are presented for purposes of comparison: Denmark, 24.1; Switzerland, 21.8; Japan, 20.5; Sweden, 18 s6; France, 15.3; England and Wales, 10.8; United States, 10.1; Holland, 6.5; I t a l y , 6.4; Spain, 5.9; E i r e , 2.3. "Mo r t a l i t y from Suicide." Epidemiological and V i t a l S t a t i s t i c s Report. (Geneva, Switzerland: World Health Organization), v o l . 9:4 (1956), pp. 250-253. 2. V i t a l S t a t i s t i c s 1958. Dominion Bureau of S t a t i s t i c s , Health and Welfare D i v i s i o n , V i t a l S t a t i s t i c s Section, The Queen's Prin t e r and C o n t r o l l e r of Stationery, (1959). 3. "The Increasing Concern About Suicides." Maclean's, v o l . 73:11 (21 May 1960), p . i 2 . of hopelessness, and for the would-be s u i c i d e , much the same emotions with the a d d i t i o n , a f t e r the unsuccessful attempt, of shame, g u i l t and hu m i l i a t i o n . It involves for the family anguish, shame and probably self-reproach. Often the s u i c i d a l act comes as a t o t a l surprise to the r e l a t i v e s and associates of the deceased, creating an aura of mystery and even i n t r i g u e , and g i v i n g r i s e to wild speculations as to antecedent causes and to queries as to whether the event might have been prevented, C 0 Suicide as a Professional and C l i n i c a l Problem, The physician, the lawyer and the legislat o r , , the clergyman, the s o c i o l o g i s t , the p s y c h i a t r i s t and the s o c i a l worker are a l l concerned with the problem of s u i c i d e , i t s causes and i t s prevention. T r a d i t i o n a l l y the r o l e of the physician has been the repair of the damaged body of the unsuccessful s u i c i d e . The lawyer and the l e g i s l a t o r have been concerned with the l e g a l aspects of sui c i d e with i t s status as a cri m i n a l offense and with measures to modify and reform the law. The clergyman's r o l e as a pastoral counsellor to the bereaved and s u f f e r i n g family and t o the depressed contemplate* of sui c i d e i s widely recognized. The s o c i o l o g i s t * s i n t e r e s t i n the subject, p r i m a r i l y t h e o r e t i c a l , has been comparatively recent and centres on the intervening conceptual v a r i a b l e s operative i n the causation of s u i c i d e . The p s y c h i a t r i s t has been perhaps the most c l o s e l y i d e n t i f i e d with the treatment of the attempted s u i c i d e He sees the act as 3. i n d i c a t i v e of intra-psychic stresses and c o n f l i c t s and he formulates h i s treatment plan on the basis of h i s diagnosis of the psychic determinants. The increasing awareness of s u i c i d e as a s o c i o - p s y c h i a t r i c phenomenon, the r e a l i z a t i o n that i n t e r -personal as well as intra-psychic f a c t o r s are operative and contributing as determinants of the s u i c i d a l attempt has r e s u l t e d i n a greater emphasis being given to the r o l e of s o c i a l casework in the treatment programme. I t i s recognized that an important fac e t of any programme i s the improved s o c i a l f unctioning of those who threaten or attempt to k i l l themselves, and i n t h i s area <— the patent's or c l i e n t ' s s o c i a l f unctioning - the caseworker makes a valuable c o n t r i b u t i o n , D. The v a r i e t i e s of s u i c i d a l expression. Psychoanalytic t h e o r i s t s hold that i n addition to immediate and d i r e c t acts of s e l f - d e s t r u c t i o n , there are subtle, i n d i r e c t and often prolonged forms of sui c i d e which manifest themselves i n a v a r i e t y of ways. Few wri t e r s have presented an a n a l y t i c viewpoint as a r t i c u l a t e l y and with such extensive documentation as Menninger.^ He contends that asceticism, 1. K a r l Menninger, Man Against Himself. New York, Harcourt, Brace & Company, 1938. 4 4. martyrdom, neurotic i n v a l i d i s m and "purposive" a c c i d e n t s 1 are forms of either c h r o n i c 2 or f o c a l 3 s u i c i d e . Drawing extensively 4 5 from the writings of Lecky and Mason , and from h i s own p r a c t i c e , he describes a number of h i s t o r i c examples and c l i n i c a l cases of martyrs and a s c e t i c s whose provacative behaviour and s e l f - i n f l i c t e d hardships were, he believes, the f u l f i l l m e n t of unconscious s u i c i d a l wishes. Among the most prominent of the h i s t o r i c a l f i g u r e s i n Menninger*s account were S t Q Francis of A s s i s i , Simeon S t y l i t e s and John Brown (of Harper's Ferry fame) D Numerous other personages and sects are al s o c i t e d . 2. S o c i a l A t t i t u d e s Toward S u i c i d e . A t t i t u d e s toward s u i c i d e are conditioned by the s o c i a l e t h i c , and t h i s , i n turn, i s determined i n important ways by r e l i g i o u s b e l i e f s . The influence of broad r e l i g i o u s philosophies on a t t i t u d e s toward s u i c i d e has tended throughout the hi s t o r y of c i v i l i z a t i o n to be somewhat inconsistent, and from an examination of the l i t e r a t u r e on the subject i t would seem that i n a l l times and i n a l l places a t t i t u d e s varying from condemnation to 1. He a l s o includes i n t h i s l i s t alcoholism, a n t i - s o c i a l behaviour, c r i m i n a l i t y , sexual d e v i a t i o n s , polysurgery and malingering. (To the many who do not subscribe to the orthodox psychoanalytic viewpoint the r e l a t i o n s h i p between these phenomenon and the s u i c i d a l impulse may be remote and untenable.) 2. T h i s is^lefined as slow, drawn-out s u i c i d e . 3. By t h i s i s meant s e l f - d e s t r u c t i v e a c t i v i t y concentrated on the body. 4. W.E.H. Lecky, History of European Morals, London, Longmans, Green & Co„, 1911. 5. James Arthur Mason, H i s t o r i c Martyrs of the P r i m i t i v e Church, London, Longmans, Green & Co., 1905. acceptance have exist e d , o c c a s i o n a l l y in harmony but more often i n c o n f l i c t with each other. These a t t i t u d e s , i n some of t h e i r d i v e r s i t y , w i l l now be surveyed. A) H i s t o r i c a l A t t i t u d e s , ( i ) P r i m i t i v e Peoples. The a t t i t u d e s and moral judgments of p r i m i t i v e people toward s e l f - d e s t r u c t i o n vary considerably. The act may be taken as a matter of course with neither approval nor disapproval being attached to i t ; i t may be highly censured, or i t may be regarded as honourable and courageous. Among those peoples who attach a decided stigma to s u i c i d e the performance of elaborate r i t u a l s to prevent the ghost of the body from vexing the l i v i n g i s common. The soultbf the s u i c i d e i s considered t o be an e v i l s p i r i t which has f o r f e i t e d i t s r i g h t of entry to the a f t e r - l i f e and so stigmatized that i t i s destined to e v e r l a s t i n g damnation and torment by good s p i r i t s . In A f r i c a , Dahomeans and the T s h i regard s u i c i d e as a crime on the grounds that the l i f e of every man belongs to the monarch.1' The Bogos regard i t as a great i n d i g n i t y b e l i e v i n g that a man should never despair to the point of surrendering himself. In Burma, the Karens, who c a l l s u i c i d e a cowardly a c t , deny the 1. Louis I. Dublin, and Bessie Bunzel, To Be or Not To Be; A Study of Suicide, New York, Harrison Smith and Robert Haas, 1933, p. 140. 2. I b i d . body honourable b u r i a l . The Paharis of India consider i t a crime and believe that the soul of one who so offends s h a l l not be admitted into heaven but must hover e t e r n a l l y as a ghost between 2 heaven and h e l l . Both the Dyaks and the Kayans of Borneo believe that the soul of the sui c i d e goes to a sp e c i a l place where i t i s 3 tormented. Suicide (except to escape capture, to follow a beloved one to the land of s p i r i t s , or to avoid r i d i c u l e ) i s considered a s i n by the Ashanti of the Gold Coast. The dead body of the su i c i d e i s decapitated and the headless trunk cast into the 4 bush. Among North American Indians the Omahas beli e v e that the soul of a sui c i d e ceases to e x i s t . The Thompson Indians of B r i t i s h 5 Columbia hold a s i m i l a r b e l i e f . Among the Zuni of New Mexico, the Yahgans of T i e r r a del Fuego, and the Andaman Islanders, the act i s extremely r a r e . 6 In contrast, a number of p r i m i t i v e groups do not stigmatize s u i c i d e and, indeed, may encourage i t under c e r t a i n circumstances. The Accra negroes of the B r i t i s h Gold Coast see nothing wrong in 1. I b i d . 2. Ibjjl, 3. Dublin and Bunzel, To Be or Not To Be, p. 139 4. R. S. Rattray, Ashanti Law and C o n s t i t u t i o n , Oxford, Clarendon Press, 1929, pp. 299-301. 5. Dublin and Bunzel, To Be or Not To Be, p. 140. 6. Otto Klineberg, S o c i a l Psychology, New York, Henry Holt & Co., 1954, p. 120. See al s o Ruth Benedict, Patterns of Culture, New York, The New American L i b r a r y , 1953, pp. 107-108. 7. suicide."*" In North America, the Chippewas hold that suicide is foolish but not a blameworthy act. Amongst the Navaho, Greek, Cherokee, Ojibway, and Sioux Indians where there are no strong 2 prohibitions against self-destruction, the act is fairly common. Aged Polar and Hudson Bay Eskimos, feeling themselves helpless and economically useless, consider i t their duty to terminate their 3 lives. Amongst the Dobu and the F i j i Islanders suicide is not infrequent and is permissible.^ (ii ) Eastern Peoples. In the Orient the institutionalized custom of "suttee" was, until the mid-nineteenth century, quite prevalent. Although the earliest and most sacred of Brahmin books, the Rigveda, did not commend i t , the practice received religious sanction when priests altered the original text to make i t read as though suttee were officially authorized. "They taught that voluntary death was the surest passport to heaven and that the dutiful wife could, by immolating herself, atone for the sinsi of her husband, free the latter from punishment, and open to him the gates of paradise."^ 1. Dublin and Bunzel, To Be Or Not To Be. p.139 2. Ibid 3. Leo W. Simmons, The Role of the Aged in Primitive Society. New Haven, Yale University Press, 1945, p.229. 4-.. Reo F. Fortune, Sorcerers of Dobu. London, George Routledge & Sons, Ltd. 1932, passim. 5. Dublin and Bunzel, To Be Or Not To Be. p.154. 8. One w r i t e r , Maine, 1 believed that the p r a c t i c e was sanctioned because of the Hindu d i s l i k e of allowing widows to own property. Suttee, death by drowning, s e l f - d e c a p i t a t i o n , b u r i a l a l i v e and other common forms of self-immolation were consistent with a r e l i g i o u s philosophy which taught the doctrine of d e n i a l of the f l e s h and elevation of the s o u l . The body was regarded as a mere accident in the plan of redemption, a vestment to be cast o f f when necessary, a dwelling to be r e l i n q u i s h e d at the d i s c r e t i o n of i t s tenant. "The underlying t h e s i s of the whole r e l i g i o n was that of an all-pervading soul i n nature." The i n d i v i d u a l s o u l , a f t e r death, l o s t i t s personal i d e n t i t y and was absorbed into Brahma, the world-soul. Since the body stood in the way of the return to the world-soul, i t was derided and maltreated. S i m i l a r l y , i n Buddhist sacred writings there e x i s t c o n t r a d i c t i o n s . The taking of any form of l i f e i s s t r i c t l y prohibited and a man i s obligated to l i v e out h i s apportioned span of l i f e . Yet these teachings were not wholly accepted and s u i c i d e came to be s o c i a l l y and r e l i g i o u s l y sanctioned. Se l f - d e s t r u c t i o n a f t e r m i l i t a r y defeat or dethronement, in memory of an ancestor and i n protest against p o l i t i c a l p o l i c i e s was common. Other honourable causes of su i c i d e i n China were insolvency, personal i n s u l t , dishonour, and a d e s i r e for revenge (inv o l v i n g the adversary i n l e g a l proceedings 1. Henry Sumner Maine, Lectures on the Early History of I n s t i t u t i o n s London, John Murray, 1914. p. 335-336, 2. Dublin and Bunzel, To Be Or Not To Be, p. 158. 3. Durant, W i l l , The Story of C i v i l i z a t i o n , Part I, Our O r i e n t a l  Her itage, New York, Simon and Schuster, 1954, pp. 428-436. 9. and harassing him by ghostly v i s i t a t i o n s ) . Although baser motives for suicide were prohibited i n r e l i g i o u s writingsthe a t t i t u d e toward the act remained a condoning one. In contrast to other r e l i g i o n s of the East, Islam has always accorded severe disapprobation to the s u i c i d a l a c t . Mohammed taught that God has prescribed to every man h i s "kismet" and that He had decreed the time of each person's death. It followed, therefore, that to be d i s s a t i s f i e d with one's l o t and to consider s e l f - d e s t r u c t i o n was immoral. Repeatedly, i n the Koran, su i c i d e i s expressly forbidden. Such r e l i g i o u s p r o h i b i t i o n s have served to deter Moslems from the act even to t h i s day. ( i i i ) The Jewish People. The Old Testament, a record of the h i s t o r y of the Hebrew people, notes four instances of s u i c i d e : Samson, Saul, Abimelech, and A h i t o p h e l . It gives no i n d i c a t i o n that they were viewed with disfavour and indeed the l a s t , A hitophel, i s recorded as having received t r a d i t i o n a l b u r i a l i n the sepulchre of h i s f a t h e r . 1 Later, as Williams points out, "both Orthodox Jewish and C h r i s t i a n i n t e r p r e t e r s had to res o r t to a somewhat strained i n t e r p r e t a t i o n of the S i x t h Commandment i n order to stigmatize s u i c i d e as a s i n . " 2 Probably the f i r s t Jewish writer to express the l a t e r view was Josephus (37-95 A D ) h i s t o r i a n and warrior. When threatened with capture by the Romans, h i s army advocated mass s e l f - d e s t r u c t i o n but he prohibited i t on the grounds that (1) i t was against natural law, and (2) the s o u l , a g i f t of God, could 1. II Samuel, XVII, 23. 2. G l a n v i l l e Williams, The Sanctity of L i f e and the Criminal Law, New York, A l f r e d A. Knopf, 1957, p. 249. 10. not be v o l u n t a r i l y cast from the body without s i n being involved i n the a c t . "After Josephus the p r o h i b i t i o n against s u i c i d e i s frequently found in Jewish s c r i p t u r e and that part of the Talmud known as the Mishnah provides that the person who destroys h i s own l i f e i s to be given no funeral r i t e s . " 1 There has been, however, some departure in p r a c t i c e from these p r o h i b i t i o n s e s p e c i a l l y i n times of/group c r i s i s . Durant gives a v i v i d account of Jews i n Germany, England, and France who, during pogroms i n the time of Crusades, committed sui c i d e en masse rather than repudiate t h e i r f a i t h as a condition for continued l i f e . But aside from s e l f - d e s t r u c t i o n during 2 persecutions, suicide among Jews has been r e l a t i v e l y uncommon, (i v ) The C l a s s i c a l World The a t t i t u d e s of the c l a s s i c a l world to the act of s e l f -destruction were by no means uniform. Pythagoras, to whom many of the wisest sayings of a n t i q u i t y were a t t r i b u t e d , i s said to have forbidden men "to depart from th e i r s t a t i o n in l i f e without the order of t h e i r commander, that i s , of God." 3 Plato held s u i c i d e to be immoral on r e l i g i o u s grounds but admitted exceptions of the most e l a s t i c character.^ A r i s t o t l e condemned the act on 1. Ibid ., p. 251. 2. Dublin and Bunzel (p. 179-180) off e r the explanation that the teachings of the Old Testament regarding the sacredness of l i f e have had a profound influence on the mind of the Jew and have deterred him from t h i s act. 3. Lecky, European Morals, p. 212. 4. The exceptions (extreme sorrow, state judgment, shame, poverty and d i s t r e s s ) tended to destroy the s i g n i f i c a n c e of h i s condemnation. 11. civic grounds as being an injury to the state. Plutarch held i t to be an affront to human dignity, and an act of cowardice unworthy of man. The Cynics, Epicureans, and Stoics favoured suicide and, indeed, rather actively encouraged i t . Diogenes, the Cynic, writes: "A wise man wil l quit l i f e when oppressed with severe pain, deprived 1 of his senses or vrtien labouring under desperate diseases." But i t was left to the Stoics to extol the virtues of self-destruction and no one among them wrote more eloquently of its desirability than Seneca. His words, recorded by Lecky, remain perhaps the most moving defence of the act ever made. The attitude of the Greek and Roman world toward suicide was, on the whole, a permissive one. At a l l times in antiquity there were certain circumstances that were considered legitimate reasons 2 for suicide. That the act was not considered immoral follows from the classical viewpoint on death. "The main object of the pagan philosophers was to dispel the terrors the imagination has cast around death, and by destroying this last cause of fear to secure the liberty 3 of man. Since this point of view is in striking contrast to that of the Christian concept of death as a consequence of sin, with the growth and expression of Christianity came new and revolutionary concepts of morality. 1. Dublin and Bunzel, To Be Or Mot To Be. p.194 2. Sumner suggests that in classical times a general weariness of l i f e accounted for the readiness to commit suicide. (Folkways, Boston,Ginn and Company,1906. Lecky (European Morals, p . l l l l ) points, as motives for suicides in antiquity, to codes of honour, indifference to death, fear of torture and a desire of self-sacrifice in religious rites. 3. Ibid, p.210 12. (v) The C h r i s t i a n World That the moral a t t i t u d e s of the C h r i s t i a n Church d i f f e r e d markedly from those of the non-Christian world i s c l e a r l y manifest when the Church's judgment regarding tiie e t h i c s of s u i c i d e i s reviewed. Since the time of St. Augustine the Church has opposed the act with great determination, regarding i t as form murder. Lecky writes: They c a r r i e d t h e i r doctrine of the s a n c t i t y of human l i f e to such a point that they maintained dogmatically that a man who destroys h i s own l i f e has committed a crime si m i l a r both i n kind and magnitude to that of an ordinary murderer, and they at the same time gave a new character to death by t h e i r doctrines concerning i t s penal nature and concerning the future d e s t i n i e s of the s o u l . 1 Yet so strong a censure came gradually. There i s no d i r e c t condemnation of suicide i n the New Testament and l i t t l e t o be found among the very e a r l y C h r i s t i a n s who, were, indeed, morbidly obsessed with death. Those were the days when, instead of learning how t o l i v e , men studied how to d i e . The C h r i s t i a n b e l i e f was that earthly l i f e had but one obj e c t i v e , one aim: to prepare one for the hereafter. Refraining from s i n f u l conduct which would r e s u l t i n e v e r l a s t i n g chastisement was the supreme duty, but since many inherent desires tended toward s i n , the r i s k of f a i l u r e was great. As a r e s u l t , many C h r i s t i a n s , rather than y i e l d to temptation, committed s u i c i d e . 1. Lecky, European Morals, p. 45. 2. Williams, The Sanctity of L i f e , p. 254. 13 Two motives for s e l f - d e s t r u c t i o n were regarded i n the early Church with some tolerance and h e s i t a t i o n - martyrdom and the preservation of c h a s t i t y . 1 " i t was e s p e c i a l l y good i f the believer could commit sui c i d e by provoking i n f i d e l s to martyr him, or by •2 3 a u s t e r i t i e s so severe as to undermine the c o n s t i t u t i o n . " Mason 4 and Lecky have given i n t e r e s t i n g accounts of the suicides of a number of ea r l y e c c l e s i a s t s , eminent and humble a l i k e , and Dublin and Bunzel quote St. Cyprian as having said that "the C h r i s t i a n s were i n v i n c i b l e because they did not fear death and d i d not defend themselves against attack but rather gave t h e i r blood and l i v e s t o escape from a c r u e l and wicked world." Many of the ea r l y Church Fathers expressed i n t h e i r w r itings considerable admiration for those who destroyed th e i r l i v e s for a noble cause. The sect whom St. Augustine p a r t i c u l a r l y noted for t h i s p r a c t i c e was the Circumcelliones. These people, self-appointed apostles of death and beyond the pale of the church, not only a c t i v e l y pursued martyrdom by d e f i l i n g pagan temples, but, when a l l other expedients f a i l e d , leapt i n ex a l t a t i o n from l o f t y 1. Lecky gives a short and i n t e r e s t i n g account of suicides motivated by such considerations. St. Pelagia, a g i r l of f i f t e e n , and a famous C h r i s t i a n lady, Domnina, both took t h e i r l i v e s to avoid being raped by Roman persecutors. The former was warmly eulogized by St. Chrysostom and St. Ambrose of Milan. (European Morals, p. 46). 2. Williams, The Sanctity of L i f e , p. 255. 3. Mason, H i s t o r i c Martyrs, pp. 85-105 & 290-292. 4. Lecky, European Morals, p. 49. 5. Dublin and Bunzel, To Be Or Not To Be, p. 199. 1 c l i f f s . 14. It was probably in reaction to religious excesses that St. Augustine became the first ecclesiast to denounce suicide under a l l circumstances and in doing so he became the "chief 2 architect of the later Christian View." In The City of God he 3 argues the matter at length. His position is lucidly summarized by Dublin and Bunzel who wrote: He concludes that suicide is never justifiable, even in the case of a woman whose honor is in danger. He bases this opinion on the arguments that suicide precludes the possibility of repentence; that i t is a form of homicide and therefore a violation of the Sixth Commandment; that a person who k i l l s himself or herself has done nothing worthy of death; and finally that suicide to escape violation is at best, the commission of a greater sin to escape a lesser. While granting that virgin suicides are worthy of a l l compassion, he holds that not even actual violation is sufficient excuse for self-murder. After asking how pollution of the body can defile one who does not consent to the act, he argues that bne can s t i l l be chaste in spite of forced pollution, as, on the contrary one may be unchaste from impure desires, though the body be kept inviolate* At the same time St. Augustine found himself in a dilemna regarding those suicides who had already been canonized by the Church; and he was obliged to admit certain exceptions -1. Lecky, European Morals, p. 49. 2. Williams, The Sanctity of Life, p. 255. 3. Williams examines St. Augustine's stand on suicide, counters his arguments,and concludes that they were, in the main, rationalizations. He,Writes: "The true reason for Augustine's stand against suicide appears plainly enough from the historical events of his age. These indicated that a prohibition of suicide was a necessary corollary of the church's other teaching, which would, without this corollary, have operated, and did in fact operate, as an incitement to suicide. If death means annihilation, there can be no point in suicide except as an escape from suffering. But i f a man's l i f e on earth is merely a period of waiting for a divine glory to be revealed, the true believer is naturally subject to the temptation to accelerate his eternal bliss, unless'.a new religious rule is devised to forbid i t . " p.256. 15. suggesting that St. Pelagia, fox example, had received a d i v i n e xevelation which absolved hex from the r u l e s applying to ordinary mortals. 1 By the time of Thomas Aquinas, s e l f - d e s t r u c t i o n had come to be considered a crime as well as a s i n . In h i s monumental work, Summa Theological, which c o d i f i e d church teachings and law, Aquinas framed the a t t i t u d e toward su i c i d e which the Roman Church has held c o n s i s t e n t l y ever since. He xegaxded i t an unpaxdonable offence fox three reasons. F i r s t , i t i s unnatural and consequently a mortal s i n . Secondly, i t i s an act i n j u r i o u s to the welfare of the community of which the s u i c i d e i s a member. T h i r d l y , l i f e i s a d i v i n e g i f t which has been bestowed upon man — a g i f t which God alone can abrogate, and anyone who would usurp supernal power 2 and tamper with h i s l i f e s i n s against God. These arguments against s u i c i d e , then, axe deeply rooted in b a s i c C h r i s t i a n tenets such as the duty of t o t a l surrender to God's w i l l , the sacredness of human l i f e and the s i g n i f i c a n c e attached to the moment of death. As a consequence of the condemnation of s u i c i d e there came in t o existence the p r a c t i c e of dishonouring the corpse. T h i s took the form of m u t i l a t i o n , dismemberment, and denial of C h r i s t i a n b u r i a l r i t e s . A number of w r i t e r s have dealt with the subject and Dublin and Bunzel 3 have drawn r i c h l y upon 1. Dublin and Bunzel, To Be Or Not To Be, pp. 201-202. 2. Edward Westexmaxck, O r i g i n and Development of Moral Ideas, London, Macmillan & Company, 1908, V o l . I I , pp. 252-254. 3. Dublin and Bunzel, To Be Or Not To Be, pp. 203-208. 16. t h e i r works to depict quite g r a p h i c a l l y the i n d i g n i t i e s and a t r o c i t i e s p r a ctised on the body of the s u i c i d e . Apart from sporadic outbreaks of s u i c i d e occasioned by epidemics and r e l i g i o u s and p o l i t i c a l persecutions, r e l i g i o u s p r o h i b i t i o n during the centuries when Church and State were inseparable acted as a strong deterrent influence. B i t t e r c l e r i c a l opposition, the f o r c e of condemnatory public opinion and severe penalties against attempted s u i c i d e were so e f f e c t i v e that r e l a t i v e l y few people had the temerity to take t h e i r own l i v e s . 1 B) Contemporary A t t i t u d e s . Beginning i n the sixteenth century new trends of thought in opposition to C h r i s t i a n Orthodoxy were developing. "Geographical discovery, urbanization, commercialism and i n d u s t r i a l i z a t i o n , the growth of l i b e r a l i s m , the crude beginnings of s c i e n t i f i c techniques and the development of the c r i t i c a l s p i r i t — a l l these combined to undermine r e l i g i o u s authority and to promote secularism and greater freedom of thought." The dogmas of the church, long unchallenged, came under c r i t i c a l s c r u t i n y . John Donne was one of the e a r l i e s t t o question the t r a d i t i o n a l a t t i t u d e toward s u i c i d e . In Biathanatos, published posthumously i n 1646, he attacks both the p a t r i s t i c point of view and the b e l i e f that s u i c i d e was the most i r r e m i s s i b l e of s i n s . 1. I b i d , pp. 203-208 2. W i l l . Durant, The Story of C i v i l i z a t i o n , Part VI, The Reformation. New York, Simon and Schuster, 1957, pp. 14-25. 17. He concludes that self-homicide (as he c a l l e d i t ) i s not a v i o l a t i o n of moral law nor i s i t an i r r a t i o n a l a c t . Since Donne's t h e s i s was not soundly reasoned i t s influence on the p r e v a i l i n g a t t i t u d e was l i m i t e d . During the "Age of Enlightenment", about one hundred years l a t e r , c r i t i c i s m of e x i s t i n g i n s t i t u t i o n s reached i t s height. It was an epoch when philosophy, having thrown o f f i t s bondage as theology's servant, became boldly secular and skeptical.''' Thinkers came to concern themselves with every aspect of human conduct, including s e l f - d e s t r u c t i o n . Hume's "Essay on Suicide" proved to be a document of considerable i n f l u e n c e . He i n s i s t e d that the act was f r e e from imputation of g u i l t and blame and that condemnation of i t was incompatible with l i b e r t y . In France, c r i t i c i s m of e x i s t i n g i n s t i t u t i o n s , p r a c t i c e s and a t t i t u d e s was even stronger than i n England. Before Donne, Montaigne had sharply questioned the current a t t i t u d e toward suicide but c h i e f l y due to the influence of Montesquieu, V o l t a i r e , and Rousseau — protagonists of i n t e l l e c t u a l and r e l i g i o u s freedom and opponents of dogmatism and e c c l e s i a s t i c a l authority «~ 3 France l e g a l i z e d s u i c i d e by a statute i n 1790. The writings of Immanuel Kant on the subject helped shape 4 (probably i n d i r e c t l y ) German a t t i t u d e s toward s u i c i d e . In The 1. Ibi d , p. 16. 2. Dublin and Bunzel, To Be Or Not To Be, p. 209-210, 3. Williams, The Sanctity of L i f e , p, 266. 4. I n d i r e c t l y because Kant's philosophy profoundly influenced the thinking of the German i d e a l i s t s , and they, in turn, influenced German p o l i t i c a l ideas and i n s t i t u t i o n s . 18. C r i t i q u e of P r a c t i c a l Reason and the Metaphysic of E t h i c s , Kant declared that since human l i f e was sacred i t must be preserved at a l l c o s t s . The moral law, he s a i d , was a c a t e g o r i c a l imperative, a u n i v e r s a l and necessary law, inherent i n reason i t s e l f . Human existence, he held, was an end i n i t s e l f and worthy of continuance. To terminate i t v o l u n t a r i l y was to follow a p r i n c i p l e of s e l f love — a p r i n c i p l e u n f i t as a unive r s a l law of nature and therefore immoral. As Dublin and Bunzel^peftnt out, Kant reached the same conclusion regarding the act of suicide as have Judaism, Islam and C h r i s t i a n i t y but h i s l o g i c followed a d i f f e r e n t course. Schopenhauer, too, argued against suicide but on the grounds that moral freedom, the highest e t h i c a l i d e a l , can only be attained by a d e n i a l of the w i l l to l i v e and sui c i d e i s not such a deni a l since true d e n i a l means r e j e c t i n g the joys and not the sorrows of l i f e . The s u i c i d e , he s a i d , i s desirous of l i v i n g — he i s discontented only with those conditions of l i f e which a f f e c t him. Suicide i s , i n short, not a negation of the w i l l and 2 therefore not j u s t i f i a b l e . By the l a t e nineteenth century the s p i r i t of in v e s t i g a t i o n was markedly manifesting i t s gradual evolution from abstract e t h i c a l disputation to s t a t i s t i c a l and medical i n q u i r y . Yet the l a s t 75 years has not been without i t s a r t i c u l a t e apologists and 1. Dublin and Bunzel, To Be Or Not To Be, p. 220. 2. Yet t h i s was not the way i n which Schopenhauer has been popularly interpreted. 19 0 c r i t i c s of s u i c i d e , William James with h i s c a l l t o v i t a l existence expressed i n h i s essay " i s L i f e Worth L i v i n g ? " the conviction that r e l i g i o u s f a i t h and the enhancement of harmonious human r e l a t i o n s h i p s through s a t i s f y i n g work made l i f e worth l i v i n g r e -gardless of what i s brought. He wrote, "Be not a f r a i d of l i f e . B elieve that l i f e i£ worth living,and your b e l i e f w i l l help create the f a c t . " 1 In h i s E t h i c s of Suicide, Sidney Hook writes, "Any system of thought which absolutely refuses to countenance su i c i d e as a r a t i o n a l p o s s i b i l i t y i s either i r r e s p o n s i b l y o p t i m i s t i c or „2 u t t e r l y immoral. He proceeds t o review s i x t r a d i t i o n a l arguments against s e l f - d e s t r u c t i o n , counters f i v e of them and suggests that the s i x t h argument — the c r u e l t y of i n f l i c t i n g pain upon one's f r i e n d s and family — cons t i t u t e s the only j u s t i f i a b l e deterrent. Yet sometimes even love and f r i e n d s h i p , he b e l i e v e s , must be s a c r i f i c e d . Hook writes: " I f the sacredness of human l i f e be invoked to f u r n i s h grounds against a l l forms of s e l f - d e s t r u c t i o n , then we are duty bound in l o g i c and in humanity to adopt the same a t t i t u d e toward war and c a p i t a l punishment." 3 He i n s i s t s that i t i s not l i f e i t s e l f that i s worth l i v i n g , but only the good l i f e . From t h i s , two c o r o l l a r i e s , he bel i e v e s , must 1. William James, " i s L i f e Worth L i v i n g , " i n , The W i l l to B e l i e v e , New York, Longmans, Green & Co., 1927, p. 62. 2. Sidney Hook, "The E t h i c s of Suicide", International Journal of  E t h i c s , V o l . 37, 1927, p. 175. 3. Hook, International Journal of E t h i c s , v o l . 37 (1927) p. 186. 20, follow: (1) No r a t i o n a l morality can compel us t o perpetuate l i v e s that are i r r e t r i e v a b l y blasted by accident or b i r t h , or b l i g h t e d by some h o r r i b l e malady before which remedial measures are unavailing; and more important, (2) no s o c i a l morality can be equally binding .Upon everyone unless a s o c i a l reconstruction makes possible a more equable d i s t r i b u t i o n of the n e c e s s i t i e s of l i f e . 1 Fedden holds that s e l f - d e s t r u c t i o n i s a matter of i n d i v i d u a l d i s c r e t i o n , that t h e o r e t i c a l l y i t i s not wrong though i t may, i n s p e c i f i c instances, be i r r e s p o n s i b l e . He o f f e r s an explanation f o r the p r e v a i l i n g condemnatory a t t i t u d e s toward s u i c i d e . Suicide shows a contempt for s o c i e t y . It i s rude. As Kant says, i t i s an i n s u l t to humanity i n one-s e l f . This most i n d i v i d u a l i s t i c of a l l actions d i s t u r b s society profoundly. Seeing a man who appears not to care for the things which i t p r i z e s , society i s compelled t o question a l l i t has thought d e s i r a b l e . The things which makes i t s own l i f e worth l i v i n g , the s u i c i d e boldly j e t t i s o n s . Society i s troubled, and i t s natural and nervous reaction i s to condemn the s u i c i d e . Thus i t b o l s t e r s up again i t s own v a l u e s . 2 3 A l b e r t Camus, the French n o v e l i s t and playwright , wrote in 1955, "Even i f one does not believe in God, s u i c i d e i s not 1. I b i d . 2. H. Romilly Fedden, Suic i d e , London, W.B. Saunders, 1938, p. 42. 3. A society's moral values are r e f l e c t e d , often complexly, i n i t s l i t e r a t u r e . In the poetry of the Romantics a longing for death i s often f o c a l and can be interpreted as a response to t h e i r sense of a l i e n a t i o n and perhaps, too, as a protest against the society of t h e i r day. The theme of s u i c i d e has been used c e n t r a l l y and dramatically and without d i r e c t condemnation i n the nineteenth centurykby Ibsen i n The Wild Duck and Hedda Gabbler, by Chekov in Ivanov and The Seagull, and in the twentieth century by Eugene O'N e i l l i n D i f f ' r e n t . Dynamo, and Mourning Becomes E l e c t r a and by Arthur M i l l e r in A l l my Sons and Death of a Salesman. 21. legitimate ... even within the l i m i t s of n i h i l i s m i t i s possible to f i n d the means to proceed beyond n i h i l i s m . " 1 The subject of the morality of s u i c i d e has been disputed f o r over two thousand years and there i s l i t t l e hope of obtaining consensus on the matter. A t t i t u d e s toward the act have, in that time, ranged on a continuum from condemnation to approval. I t seems safe t o say, however, that the balance of contemporary C h r i s t i a n thought i s against s u i c i d e . Yet one can detect a d e f i n i t e trend away from t r a d i t i o n a l morality and i n the d i r e c t i o n of a " s o c i a l morality? — a morality more in harmony with the i n s i g h t s of s o c i a l and medical sciences. This trend i s r e f l e c t e d in the evolution of the law as i t a p p l i e s to s u i c i d e . 3. The E t i o l o g y of Suicide The l a t e nineteenth century ushered i n a new era of s c i e n t i f i c i n v e s t i g a t i o n i n t o human problems. Nowhere was the new s p i r i t of inquiry better exemplified than in the writings of Emile Durkheim on the subject of s u i c i d e and Sigmund Freud on the subject of the processes of depression. Their works, s o c i o l o g i c a l l y and psychoanalytically oriented, r e s p e c t i v e l y , c o n s t i t u t e the 2 frames of reference basic to much of the research which followed. It i s generally agreed that the most promising l i n e s of inquiry have been and continue to be those which look to the s o c i a l structure and to personality for e t i o l o g i c a l clues to 1. A l b e r t Camus, The Myth of Sisyphus and Other Essays, (trans, by J u s t i n O'Brien), New York, A l f r e d A. Knopf, 1958, (From the Preface). 2. Accompanying t h i s i n v e s t i g a t i o n or perhaps as a r e s u l t of i t was a demand for a more f u n c t i o n a l , u t i l i t a r i a n consideration of morality. 22. s u i c i d e . It i s , then, the sociology of s u i c i d e and the psychology of s u i c i d e which w i l l be examined i n the next two chapters. 4. Implications far the Study of Suicide. The study of s u i c i d e , i t s causes and e f f e c t s , serves a dual fun c t i o n : i t permits an examination and a r e s u l t i n g c l a r i f i c a t i o n of the i n s i g h t s derived from the s o c i a l and medical sciences, and i t points to or suggests, f o l l o w i n g from such an examination, the most appropriate and e f f e c t i v e preventive measures on the therapeutic, educational and s t r u c t u r a l l e v e l s * Chapter 2 The Sociology of S u i c i d e . 1. Early T h e o r i e s 1 of S u i c i d e . The e a r l y " s c i e n t i f i c " i n vestigations of s u i c i d e were medical or f o r e n s i c i n o r i e n t a t i o n , but by the t h i r d decade of the nineteenth century empirical data i n the form of s t a t i s t i c a l t ables came to be' included in these works. This innovation marks the crude beginnings of the s o c i o l o g i c a l approach to the subject. One such study of s u i c i d e was that of E s q u i r o l , the French a l i e n i s t . His Mental Maladies: A T r e a t i s e on Insanity deals in the main with the r e l a t i o n s h i p between su i c i d e and i n s a n i t y but he devotes a s u b s t a n t i a l section t o a presentation of s t a t i s t i c a l data on age and sex d i s t r i b u t i o n , of the influence of 2 climate and of methods used in s e l f - d e s t r u c t i o n . Winslow's Anatomy of Suicide, published i n 1840, represents another e a r l y i n v e s t i g a t i o n of the subject. The author, a physician, concerns himself p r i m a r i l y with medical matters and questions of medical 3 jurisprudence but he does f u r n i s h some s t a t i s t i c s . Just a f t e r the middle of the n i t B teenth century two important works appeared dealing thoroughly with the subject. The book Du Suicide, S t a t i s t i q u e , 1. The writer does not believe that these e a r l y works on s u i c i d e c o n s t i t u t e what can properly be termed u n i f i e d "theory"; rather, they represent contributions, often fragmentary, to f a c t u a l data. For t h i s reason the term " t h e o r i e s " may be somewhat misleading. 2. Jean Etienne Dominique E s q u i r o l , Mental Maladies: A T r e a t i s e on  Insanity, ( t r a n s l . E.K. Hunt) Ph i l a d e l p h i a , Lea and Blanchard, 1845. C i t e d in Dublin and Bunzel, To Be Or Not To Be, p. 227. 3. Forbes Winslow, The Anatomy of Suicide, London, Henry Renshaw, 1840. 24. Medecine, H i s t o i r e et e g i s l a t i o n , written by L i s l e in 1856, contains "many s t a t i s t i c a l tables g i v i n g the number of s u i c i d e s , t h e i r geographic d i s t r i b u t i o n , the influence of climate and seasons, age and sex c l a s s i f i c a t i o n s , professions and occupations, education, methods and causes." 1' The lengthy study of B r i e r r e de Boismont published in 1865 contains d e t a i l e d s t a t i s t i c s and a discussion of 2 causes of p h y s i o l o g i c a l f a c t o r s and l e g a l issues. M o r s e l l i ' s Suicide, An Essay on Comparative Moral S t a t i s t i c s , published i n 1881, represents a major contribution to the l i t e r a t u r e on the subject. Although written by a p s y c h i a t r i s t , the work i s primarily s o c i o l o g i c in o r i e n t a t i o n . It examines the influences on s u i c i d e of cosmic, ethnic, s o c i a l , " i n d i v i d u a l b i o l o g i c a l " and " i n d i v i d u a l psychological" f a c t o r s , discusses the s i g n i f i c a n c e of ethnic and i n d i v i d u a l d i f f e r e n c e s in the methods of s e l f - d e s t r u c t i o n , r e l a t e s s u i c i d e to Malthusian and Darwinian p r i n c i p l e s , and 3 f i n a l l y suggests broad therapeutic measures for i t s prevention. In 1882 the book Suicide, Studies on i t s Philosophy, Causes, and Prevention appeared. The author> O'Dea, discusses s u i c i d e in r e l a t i o n to the r e l i g i o u s b e l i e f s , moral tenets and laws extant 1. P i e r r e - E g i s t e L i s l e , Du Suicide; S t a t i s t i q u e , Medecine, H i s t o i r e  et L e g i s l a t i o n , P a r i s , J.B. B a i l l i e r e , 1856. Quoted i n Dublin and Bunzel, To Be Or Not To Be, p. 227. 2. Alexander Jacques Francois B r i e r r e de Boismont, Du Suicide et de l a  F o l i e Suicide, P a r i s , L i b r a i r i e Germer B a i l l i e r e , 1865. IbIB, p. 228 3. Henry M o r s e l l i , Suicide, An Essay on Comparative Moral S t a t i s t i c s , London, C. Kegan Paul & Co. 1881. 25, at various stages in the h i s t o r i c evolution of c i v i l i z a t i o n . He examines what he terms "personal" and " s o c i a l " causes, (the l a t t e r being for him the predispositions inherent i n c e r t a i n categories of such f a c t o r s as age and sex, occupation, domestic l i f e , "education and l i t e r a t u r e " , race and n a t i o n a l i t y ) and concludes with proposals for measures of prevention. 1 2. Durkheim's Theory of Suicide, Durkheim's t r e a t i s e on s u i c i d e i s regarded as a s o c i o l o g i c a l c l a s s i c . In i t he attempts t o analyze the r e l a t i o n s h i p between suicide and various s o c i a l and natural phenomena. His point of departure i n t h i s work i s the negation of what he terms " e x t r a - s o c i a l factors"—psychopathy, the c h a r a c t e r i s t i c s of race and heredity, cosmic f a c t o r s such as climate and seasonal temperature, and the psychological mechanism of imita t i o n — - a s possible causes of s u i c i d e . A Extra-Social Factors For Ourkheim psychopathic states can bear a d i r e c t r e l a t i o n s h i p to s u i c i d e only i f every suicide were considered to be, i n i t s e l f , a mental disease or a manifestation of i n s a n i t y ; t h i s p o s s i b i l i t y Durkheim strongly denies. Employing s t a t i s t i c a l data he attempts to show that there was no p o s i t i v e c o r r e l a t i o n i n nine named European countries between the number of insane persons and the number of s u i c i d e s . 1. James J . O'Dea, Suicide, Studies on i t s Philosophy, Causes, and  Prevention, New York, G.P. Putnam's Sons, 1882. 2. Ourkheim uses the term "psychopathic" i n a d i f f e r e n t sense from that common today. He i s r e f e r r i n g to a l l forms of psychic d i s -functioning and mental d i s o r d e r s . 26. After an examination documented by statistics of race and heredity as potential determinants o f suicide Durkheim asks: "Does not this prove that the cause of the variations of suicide cannot be a congenital and invariable impulse, but the progressive action of social l i f e ? " ^ He concludes that there exists no definite and automatic predisposition to suicide (except in the insane) but rather a general "aptitude" which assume a variety of forms depending on circumstances which permit but do not specifically cause suicide,, Durkheim notes that suicide is more prevalent in the temperate zone of Europe and he attempts to disprove the conclusions or Morselli and Ferni who, also observing this fact, ascribed i t to the mysterious effects of heat acting as a suicide stimulant on cerebral functioning. Using statistical tables he shows that the number of suicides in Europe is greatest in the spring and summer and in the morning and afternoon of the twenty-four hour period. He attributes this not to any cosmic or natural force but rather to the intensification of social l i f e at these times. Durkheim next examines the hypothesis that imitation is a cause of suicide. He criticized the theory that imitation is the main source of a l l collective l i f e and holds that, Certain as the contagion of suicide is from individual to individual, imitation never seems to propogate i t so as to effect the social suicide-rate. Its radiating influence 1 0 Mile Durkheim, Suicide, (Originally published in 1897) trans 8 by John A.Spaulding and George Simpson, Glencoe, The Free Press, 1951, P. 102a 27. i s always very r e s t r i c t e d ; and what i s more, int e r m i t t e n t . In short, then, Durkheim dispatches those theses which require recourse to i n d i v i d u a l and e x t r a - s o c i a l causes in the explanation of s u i c i d e . He suggests that the r e s u l t of h i s process of elimination has not been t o t a l l y negative. He writes: We have i n f a c t shown that for each s o c i a l group there i s a s p e c i f i c tendency to s u i c i d e explained neither by the organic-psychic c o n s t i t u t i o n of i n d i v i d u a l s nor the nature of the physical environment. Consequently, by e l i m i n a t i o n , i t must nec e s s a r i l y depend upon s o c i a l causes and be in i t s e l f a c o l l e c t i v e phenomenon; some of the f a c t s examined, e s p e c i a l l y the geographic and seasonal v a r i a t i o n s o f 2 s u i c i d e , had d e f i n i t e l y l e d us to t h i s conclusion. B. E g o i s t i c S u i c i d e . Durkheim holds that currents of s u i c i d e are not r e l a t e d to personal and i n d i v i d u a l concomitants but rather to the s o c i a l structure and i t s ramifying functions, and that there are s o c i a l types of s u i c i d e i d e n t i f i a b l e and c l a s s i f i a b l e by the causes which produce them. Once the s o c i a l determinants have been i s o l a t e d , i n d i v i d u a l suicide may, he b e l i e v e s , be placed in i t s proper e t i o l o g i c a l s e t t i n g . The three types a r r i v e d at by Durkheim are e g o i s t i c s u i c i d e , a l t r u i s t i c s u i c i d e , and anomic s u i c i d e . From an examination of r e l i g i o u s a f f i l i a t i o n , marriage and the family, and p o l i t i c a l and national communities, Durkheim i s 1. I b i d . , p. 140. 2. Ibid., p. 145. 28. led to the f i r s t of h i s three categories of s u i c i d e , namely, e g o i s t i c s u i c i d e . This may be defined as the i n s u f f i c i e n t presence of society i n the i n d i v i d u a l or the lack of i n t e g r a t i o n of the i n d i v i d u a l into the society in which he l i v e s . 1 Accordingly, when the s o l i d a r i t y of group l i f e isweakened, when the i n d i v i d u a l i s l e s s subject to group c o n t r o l , and when s o c i a l f o r c e s throw him onto h i s own resources, the tendency toward suicide i s greater. Durkheim f i r s t examines what he terms " r e l i g i o u s s o c i e t y " . Showing, by use of s t a t i s t i c a l compilations, that the s u i c i d e r a t e i s highest i n predominantly Protestant countries and lowest i n purely C a t h o l i c countries and Jewish communities, he o f f e r s an i n t e r p r e t a t i o n f o r these f a c t s . He suggests that Protestant propensity for s e l f - d e s t r u c t i o n i s r e l a t e d to i t s 2 animating s p i r i t of f r e e i n q u i r y , which grows out of or follows n a t u r a l l y from the overthrow of t r a d i t i o n a l tenets; that schisms, taking the form of a d i v e r s i t y of b e l i e f s and p r a c t i c e s , serve to weaken common bonds. "We thus reach the conclusion that the s u p e r i o r i t y of Protestantism with respect to suicide r e s u l t s from i t s being a l e s s strongly integrated church than the C a t h o l i c church. By contrast, he contends, C a t h o l i c thought p r o h i b i t s r e l i g i o u s individualism and d o c t r i n a l v a r i a t i o n , and demands 1. I b i d . , p. 258. 2. Durkheim points out that f r e e inquiry leads i n e v i t a b l y to increased knowledge and t h i s , i n turn, can further uproot r e l i g i o u s f a i t h , r e s u l t i n g i n a weakening of s o c i a l bonds, (p. 169). 3. I b i d . , pp. 152-159. 4. I b i d . , p. 159. 29. 1 conformity and submission to e c c l e s i a s t i c a l a u t h o r i t y . The r e s u l t i n g unity of the Roman Church thus operates to minimize 2 su i c i d e among i t s adherents. The low incidence of s u i c i d e amongst Jews can be 3 explained, Durkheim bel i e v e s , by the compactness and coherence of the Jewish community and by the strong f e e l i n g of s e l f -consciousness and onenesso For Durkheim, then, the deterrent e f f e c t s of r e l i g i o u s f a i t h on s u i c i d e cannot be a t t r i b u t e d to dogma but rather t o the f a c t that r e l i g i o n i s , i n i t s e l f , a society —• a society constituted of commonly held b e l i e f s and p r a c t i c e s which serve a cohesive, preservative, and i n t e g r a t i v e f u n c t i o n . Durkheim next considers the family and p o l i t i c a l s o c i e t y . He introduces two concepts, "the c o e f f i c i e n t of p r e s e r v a t i o n " 4 and "the c o e f f i c i e n t of aggravation", 5 and from the a p p l i c a t i o n of these concepts to s t a t i s t i c a l data he derives four laws: 1. Durkheim imputescthe low r a t e of s u i c i d e i n B r i t a i n to the features of s i m i l a r i t y between the Church of England and the Roman Ca t h o l i c Church, (pp. 160-161). 2. I b i d . , pp. 157-158. 3. Durkheim a t t r i b u t e s t h i s s o l i d a r i t y to the re a c t i o n of the Jewish people to t h e i r h o s t i l e surroundings, (pp. 159-160). 4. He defines t h i s as "the number showing how many times l e s s frequent suicide i s . i n one group than i n another at the same age." (p. 177). 5. This concept may be defined as "the number showing how many times more frequent s u i c i d e i s in one group than another at the same age." (p. 177). 30. -Too early marriages have an aggravating influence on suicide, especially as regards men. From twenty years, married persons of both sexes enjoy a coefficient of preservation in comparison with unmarried persons. •The coefficient of preservation of married persons by comparison with unmarried persons varies with the sexes0 Widowhood diminishes the coefficient of married persons of each sex, but i t rarely eliminates i t entirelyo 1 He holds that the immunity of married persons to suicide can be ascribed to one of two causes: matrimonial selection' or the influence of the domestic environment.^ By a series of deductions, statistically documented, he concludes that "the immunity of married persons in general is thus due, wholly for one sex and largely for the other, to the influence not of conjugal society but of the family society."^ Durkhein holds, too, that the greater number of members composing the family the less is the tendency of each member toward suicide. He writes: But for a group to be said to have less common l i f e than another means that i t is less power-fully integrated; for the state of integration of a social aggregate can only reflect the intensity of the collective l i f e circulating in i t . It is more unified and powerful the more active and constant is the intercourse among its members. Our previous 1. Ibid., pp 178-179 2. By this Durkheim means the Gtoice of an organically-psychologically superior mate. Allegedly, the end result of selection wi l l be the superiority of the married over the single population, (pp.180-181) 3. Durkheim distinguishes between conjugal society (the husband-wife unit) and family society (parents and children). Domestic en-vironment and family society refer to the latter, (pp. 185-189) 31 conclusion may thus be completed to read: j u s t as the family i s a powerful safeguard against s u i c i d e , so the more strongly i t i s constituted the greater i t s p r o t e c t i o n . 1 The t h i r d and f i n a l " s o c i e t y " examined by Durkheim i s p o l i t i c a l s o c i e t y . Perceiving that the s u i c i d e rate drops in times of war, p o l i t i c a l c r i s e s , and s o c i a l upheavals, he argues that only one explanation can account for t h i s phenomenon: Great social.disturbances and great popular wars rouse c o l l e c t i v e sentiments, stimulate partisan s p i r i t and p a t r i o t i s m , p o l i t i c a l and national f a i t h , a l i k e , and concentrating a c t i v i t y toward a s i n g l e end, at l e a s t temporarily cause a stronger in t e g r a t i o n of s o c i e t y . The salutary influence which we have j u s t shown to e x i s t i s due not to the c r i s i s but to the struggles i t occasions. As they for c e men t o c l o s e ranks and confront the common cause. Besides, i t i s comprehensible that t h i s integration may not be purely momentary but may sometimes o u t l i v e i t s immediate causes, e s p e c i a l l y when i t i s Intense. In concluding h i s a n a l y s i s of e g o i s t i c s u i c i d e Durkheim suggests that three propositions have been formulated: 1. Suicide v a r i e s inversely with the degree of i n t e g r a t i o n of r e l i g i o u s s o c i e t y . 2. Suicide v a r i e s inversely with the degree of i n t e g r a t i o n of domestic s o c i e t y . 3. Suicide v a r i e s inversely with the degree of integration of p o l i t i c a l s o c i e t y . 3 He writes: This grouping shows that whereas these d i f f e r e n t s o c i e t i e s have a moderating influence upon s u i c i d e , t h i s i s due not to s p e c i a l c h a r a c t e r i s t i c s of each but t o a c h a r a c t e r i s t i c common to a l l . R e l i g i o n does not owe i t s e f f i c a c y to the s p e c i a l nature of r e l i g i o u s sentiments, since domestic and p o l i t i c a l s o c i e t i e s both produce the same e f f e c t s when strongly integrated. T h i s , moreover, 1. I b i d . , p. 202. 2. I b i d . , p. 208. 3. I b i d . 32 we have already proved when studying d i r e c t l y the manner of d i f f e r e n t r e l i g i o n s upon suic i d e * Inversely, i t i s not the s p e c i f i c nature of the domestic or p o l i t i c a l t i e which can explain the immunity they confer, since r e l i g i o u s society has the same advantage«, The cause can only be found in a s i n g l e q u a l i t y possessed by a l l these s o c i a l groups, though perhaps to varying degrees. The only q u a l i t y s a t i s f y i n g t h i s condition i s that they are a l l strongly integrated s o c i a l groups. So we reach the general conclusion: su i c i d e v a r i e s inversely with the degree of integration of the sociaj. groups of which the i n d i v i d u a l forms a part. C. A l t r u i s t i c S uicide. The second broad category of suicide developed by Durkheim i s the a l t r u i s t i c . Drawing upon a f a i r l y extensive l i t e r a t u r e he c i t e s numerous examples of acts of s e l f - d e s t r u c t i o n among p r i m i t i v e groups and c l a s s i c o r i e n t a l s o c i e t i e s — acts compelled by a sense of duty, honour, or the joy of s a c r i f i c e . He reasons that one cause only can account for these a l t r u i s t i c s u i c i d e s : a l i m i t e d sense of personal i d e n t i t y and worth in persons l i v i n g i n an extremely cohesive society which r i g o r o u s l y governs custom and h a b i t . He writes: For the i n d i v i d u a l to occupy so l i t t l e place in c o l l e c t i v e l i f e he must be almost completely absorbed in the group and the l a t t e r , accordingly, very highly integrated. For the parts to have so l i t t l e l i f e of t h e i r own, the whole must indeed be a compact, continuous mass. And we have shown elsewhere that such massive cohesion i s indeed^that of s o c i e t i e s where the above pr a c t i c e s obtain. 1. I b i d . , pp. 208-209. 2. Ibid* P» 220-221. 33 And again: His person has so l i t t l e value that attacks upon i t by i n d i v i d u a l s receive only r e l a t i v e l y weak r e s t r a i n t . It i s thus natural for him to be yet l e s s protected against c o l l e c t i v e n e c e s s i t i e s and that society should not h e s i t a t e , f or the very s l i g h t e s t reason, to b i d him end a l i f e i t values so l i t t l e . 1 Durkheim admits to a probable r e l a t i o n s h i p between the phenomenon of a l t r u i s t i c s u i c i d e and pantheism but he denies that pantheism produces s u i c i d e . If the essence of pantheism, then, i s a more or l e s s r a d i c a l denial of a l l i n d i v i d u a l i t y , such a r e l i g i o n could be constituted only in society where the i n d i v i d u a l r e a l l y counts for nothing, that i s , i n almost wholly l o s t i n the group. For men can conceive of the world only i n the image of the small s o c i a l world i n which they l i v e . R e l i g i o u s pantheism i s thus only a r e s u l t and, as i t were, a r e f l e c t i o n of the p a n t h e i s t i c organization of s o c i a t y . 2 Another environment examined by Durkheim i n which a l t r u i s t i c s u i c i d e i s prevalent i s m i l i t a r y l i f e . Again, by a s e r i e s of deductions supported by s t a t i s t i c a l data, he attempts to show that m i l i t a r y l i f e demands such a high degree of impersonality, self-abnegation, and renunciation that i t i s conducive to s u i c i d e . D. Anomic Sui c i d e . The t h i r d type of suicide i n Durkheim's c l a s s i f i c a t i o n i s anomic s u i c i d e . He notes that i n time of economic c r i s i s the 34. rate of s u i c i d e r i s e s , but he a l s o observes that "even fortunate c r i s e s , the e f f e c t of which i s abruptly to enhance a country's prosperity, a f f e c t s uicide l i k e economic d i s a s t e r s . " 1 T h i s f a c t he supports with a b r i e f review of contemporary European p o l i t i c a l and economic events and with r e l a t e d s t a t i s t i c a l data. He o f f e r s a general explanation for t h i s phenomenon and poses a question: If therefore i n d u s t r i a l or f i n a n c i a l c r i s e s increase s u i c i d e s , t h i s i s not because they cause poverty, since c r i s e s of prosperity have the same r e s u l t ; i t i s because they are c r i s e s , that i s , disturbances of the c o l l e c t i v e order. Every disturbance of equilibrium, even though i t achieves greater comfort and a heightening of general v i t a l i t y , i s an impulse to voluntary death. Whenever serious readjustments take place in the s o c i a l order, whether or not due to a sudden growth or to an unexpected catastrophe, men are more i n c l i n e d to s e l f - d e s t r u c t i o n . How i s t h i s possible? How can something considered g e n e r a l l y to improve existence serve to detach men from i t ? Durkheim then attempts to answer these questions. He suggests that man's passions, needs, and f e e l i n g s are subject to an external f o r c e of r e s t r a i n t , namely society; that society plays the r o l e of moderating the i n d i v i d u a l ' s desires i n keeping with i t s s o c i a l requirements; and that society, acting c o l l e c t i v e l y as a r e g u l a t i v e mechanism, assigns to each i n d i v i d u a l h i s place in the s o c i a l order and sets l i m i t s t o h i s ambitions and a s p i r a t i o n s . The r e s u l t , claims Durkheim, i s a sense of s e l f - s a t i s f a c t i o n and s t a b i l i t y . He writes: 35. This r e l a t i v e l i m i t a t i o n and the moderation i t involves, make men contented with t h e i r l o t while stimulating them moderately to improve i t ; and t h i s average contentment causes the f e e l i n g of calm, a c t i v e happiness, the pleasure in e x i s t i n g and l i v i n g which characterizes health for s o c i e t i e s as well as for i n d i v i d u a l s . Each persons i s then at l e a s t , generally speaking, i n harmony with h i s condition, and desires only what he may l e g i t i m a t e l y hope for as the normal reward of h i s a c t i v i t y . 1 He points out, however, that since i n times of c r i s e s and sudden t r a n s i t i o n s , society becomes temporarily unable to exercise i t s r e g u l a t i n g and c o n t r o l l i n g f u n c t i o n , the suicide r a t e increases. Economic d i s a s t e r s , or abrupt changes i n the d i s t r i b u t i o n of wealth and power, he holds, produce a d i s e q u i l i b r i u m , f a c i l i t a t e excessive s o c i a l m o b i l i t y , promote a whetting of unsatiable economic appetites and a weakening of the influence of t r a d i t i o n a l r u l e s , and found conditions to which the i n d i v i d u a l cannot adapt without extreme d i f f i c u l t y . As these d i s r u p t i v e forces then r e i n f o r c e each other, a state of deregulation or anomie e x i s t s . It i s Durkheim*s contention that i n the sphere of trade and industry the lack of organization causes a chronic state of anomie. He quotes f i g u r e s to show that " i n d u s t r i a l and commercial functions are r e a l l y among the occupations which f u r n i s h the greatest number of s u i c i d e s . Economic anomie i s not the only anomie which gives r i s e to s u i c i d e . Noting what 3 he terms "the p a r a l l e l development of divorces and s u i c i d e s " , 1. I b i d . , p. 250. 2. I b i d . , p. 257. 3. I b i d . , p. 273. v 36, Durkheim a t t r i b u t e s i t to the state of conjugal anomie produced by divorce. E. Summary. In summary, then, Durkheim dismisses those theories of suicide which would explain the causes of the phenomenon in terms of personal motives and environmental and hereditary f a c t o r s , and he develops instead three " i d e a l types" of s u i c i d e , e g o i s t i c , a l t r u i s t i c and anomic. The f i r s t i s seen as a manifestation of the gross incompleteness of the i n d i v i d u a l ' s integration into s o c i e t y , h i s excessive i n d i v i d u a t i o n and h i s sense of s o c i a l i s o l a t i o n . The second, i n contrast, i s seen as symptromatic of an overly-strong group attachment, a subordination of i n d i v i d u a l to group i n t e r e s t s , and a loss of personal values and a d i s t i n c t i d e n t i t y . The t h i r d i s an expression of the absence f o r the. i n d i v i d u a l of the d i s c i p l i n e and regulations customarily prescribed by soci e t y , and the l o s s of a sense of o r d e r l i n e s s , equilibrium, and o r i e n t a t i o n . 3. C r i t i c a l Appraisal of Durkheim's Theory. Basic to an understanding of Durkheim's wr i t i n g s i s an understanding of h i s view of society and of the r e l a t i o n s h i p of the i n d i v i d u a l to the s o c i a l group. In respect to t h i s he adopted a p o s i t i o n 1 r a d i c a l l y opposed to the p r e v a i l i n g i n d i v i d u a l i s t i c 1. Thi s has been termed by T a l c o t t Parsons as " s o c i o l o g i s t i c " p o s i t i v i s m . (The Structure of S o c i a l A c t i o n , Glencoe, The Free Press, 1949, pp. 343-344). 37 1 versions of the main t r a d i t i o n of p o s i t i v i s t i c thought. Dublin and Bunzel have l u c i d l y outlined Durkheim*s conception of s o c i e t y . A society c o n s i s t s not only of the sum of i t s members, but a l s o of the in t e r a c t i o n s of these i n d i v i d u a l s upon each other, plus the material things which play an e s s e n t i a l part i n community l i f e . In consequence, s o c i a l thinking i s not determined e x c l u s i v e l y by the consciousness of i n d i v i d u a l s , or even by the sum t o t a l of the i n d i v i d u a l ideas current at any given time, f o r i t s nature i s a l t e r e d by the very f a c t that these d i f f e r e n t ideas have fused. Any society i s q u a l i t a t i v e l y d i f f e r e n t from the several constituents forming i t ; and whether or not a person may choose to p a r t i c i p a t e i n group a c t i v i t y , he cannot escape from the pressure which the group exerts. The patterns of l i f e and the pr a c t i c e s that p r e v a i l , l a r g e l y determine h i s a c t i o n s . Among forces external to the i n d i v i d u a l v o l i t i o n i s the s u i c i d a l tendency which i s a s o c i a l product — a s o c i a l f a c t with which we must reckon. In other words, there exists always in society a c o l l e c t i v e force ( i n t h i s case towards sui c i d e ) which i s constantly exerting upon the i n d i v i d u a l , a pressure, the action of which i s not greatly influenced by h i s personal psychology, h i s ideas or h i s d e s i r e s . 2 In h i s repudiation of the " p o s i t i v i s t " p o s i t i o n and hi s r e j e c t i o n of explanations of behaviour in terms of psychological 3 v a r i a b l e s , Durkheim t r a v e l l e d extremely far i n the opposite d i r e c t i o n . An u n f l i n c h i n g advocate of the " r e a l i s t " p o s i t i o n , he postulated an independent s o c i a l r e a l i t y e x t r i n s i c to human pers o n a l i t y , held society to be a l o g i c a l construct and i n s i s t e d on the s e l f - s u f f i c i e n c y of s o c i o l o g i c a l explanations of behaviour. Durkheim's c r i t i q u e of the e a r l i e r attempts t o explain v a r i a t i o n s i n the ra t e of sui c i d e by recourse to e x t r a - s o c i a l 1. I b i d . , p. 307. 2. Dublin and Bunzel, To Be Or Not To Be, pp. 228-229. 3. In p a r t i c u l a r d i d Durkheim take exception to Gabriel Tarde's view that i m i t a t i o n was the psychological mechanism which made l i f e p o s s i b l e . 38. f a c t o r s had been subject to c r i t i c i s m . Harry A l p e r t reviewing the Spaulding-Simpson t r a n s l a t i o n of Le Suicide describes the method of e l i m i n a t i o n as being used i n an "extravagent and c a v a l i e r " manner.'1' While Durkheim ably demonstrated, for the most part on empirical grounds, that previous theories embodying the f a c t o r s of climate, race, heredity, psychopathic s t a t e s , and imit a t i o n are incapable of y i e l d i n g a s a t i s f a c t o r y and acceptable s o l u t i o n to the problem, he d i d not succeed i n showing that they can have nothing to do with i t . For the modern reader Durkheim's dismissal of mental disorders as a determinant of s u i c i d e may i n d i c a t e gross shortsightedness and a serious f a i l i n g , but as Parsons points out: The psychopathological views he c r i t i c i z e s are p r i m a r i l y those which a t t r i b u t e s u i c i d e to a s p e c i f i c , hereditary psychopathological condition and he i s able to show e a s i l y that t h i s cannot account for the s i g n i f i c a n t v a r i a t i o n s of s u i c i d e r a t e s . His arguments do not, however, apply to the "environmental" and " f u n c t i o n a l " types of mental disturbance of which our understanding has been so greatly increased i n the l a s t generation, especially^through psychoanalysis and r e l a t e d movements. C r i t i c s have pointed to the crudeness of Durkheim's s t a t i s t i c a l techniques and to h i s oft-times forced use of s t a t i s t i c s 3 when they helped support h i s contentions. There i s some j u s t i f i c a t i o n f o r such a c r i t i c i s m , as even a cursory examination of the study w i l l show, but one should not lose sight of the 1. Harry A l p e r t , (from a book review of the Simpson-Spaulding e d i t i o n of Durkheim's Le Suicide) American S o c i o l o g i c a l Review, v o l . 16, 1951, P. 566. 2. Parsons, S o c i a l A c t i o n , pp. 325-326. 3. A l p e r t , e s p e c i a l l y , c r i t i z e s t h i s c h a r a c t e r i s t i c i n Durkheim's work Simpson and Parsons comment on the lack of s t a t i s t i c a l r e -finement but neither consider i t p a r t i c u l a r l y d e t r a c t i n g . 39. broader perspective. For the body of empirical f a c t ( i . e . , the s t a t i s t i c a l data) was of secondary importance, serving as a v e h i c l e for framing concepts and developing theory. Parsons has pointed t h i s out. He writes: In the s o c i a l f i e l d most a v a i l a b l e s t a t i s t i c a l information i s on a l e v e l which cannot be made to f i t d i r e c t l y into the categories of a n a l y t i c a l theory... In any event, i t i s out of the question that in the.usual sense of s t a t i s t i c a l "elegance" he should be held to have accomplished rigorous s t a t i s t i c a l v e r i f i c a t i o n of h i s conceptual scheme. What i s true i s , rather, that by means of a very broad and elementary s t a t i s t i c a l a n a l y s i s he has been able to bring out c e r t a i n broad features of the f a c t s about s u i c i d e and the v a r i a t i o n s in i t s r a t e ... But the very broadness and lack of refinement of the s t a t i s t i c a l method i s perhaps an advantage from the viewpoint of the present i n t e r e s t ... It i s almost c e r t a i n that r e f i n e d s t a t i s t i c a l a n a l y s i s of the data by modern techniques would reveal many complexities of which Burkheim was not aware, but i s very u n l i k e l y that any such a n a l y s i s would make i t possible t o " r e f u t e " Durkheim on the^broad basis on which h i s a n a l y s i s properly r e s t s . The conceptual scheme used by Durkheim for the purpose of typing v a r i e t i e s of s u i c i d e i s , i n r e a l i t y , an instrument f o r c l a s s i f y i n g and analyzing types of s o c i a l organization, f o r , i n essence, Durkheim was using h i s theory of s u i c i d e as a means of developing general theories of s o c i a l phenomena. Perhaps the severest t e s t of the relevancy and v a l i d i t y of Durkheim*s types of suicide l i e s , then, not in the d i r e c t i o n of s t r i c t v e r i f i c a t i o n of h i s hypothesis by more modern s t a t i s t i c a l techniques but rather in the d i r e c t i o n of t e s t i n g h i s categories 1. Parsons, S o c i a l Action, p. 328-329. 40. of a n a l y t i c a l theory in r e l a t i o n to other kinds of behaviour. As A l p e r t 1 has r i g h t l y pointed out, the theory of s u i c i d e as embodied in h i s book Le Suicide reveals Durkheim's b r i l l i a n c e and o r i g i n a l i t y , h i s astuteness in s o c i o l o g i c a l a n a l y s i s , h i s genius for bringing i n d i v i d u a l f a c t s i n t o r e l a t i o n with one another within a meaningful conceptual framework, h i s f o r c e f u l and persistent demonstration that even the apparently highly personal act of s e l f - d e s t r u c t i o n i s e x p l i c a b l e only in terms of s o c i a l processes and s o c i a l structures, and h i s concern with phi l o s o p h i c a l implications and p r a c t i c a l considerations as well as t h e o r e t i c a l g e n e r a l i z a t i o n s . Le Suicide remains as timely and germane today as when i t was written s i x t y years ago. As Henry and Short have wr i t t e n : Durkheim's was the f i r s t t h e o r e t i c a l and empiric exploration of the persistent v a r i a t i o n s of suicide i n r e l a t i o n to s o c i o l o g i c v a r i a b l e s . His t h e o r e t i c a l types of s u i c i d e and h i s frame of reference for t h e i r i n t e r p r e t a t i o n remain basic to a l l research by s o c i o l o g i s t s i n t h i s a r e a . 2 4. Halbwach's Theory of S u i c i d e . Durkheim's approach to the study of s u i c i d e was c a r r i e d forward, tested and applied further by h i s student, Maurice Halbwachs, in h i s work intended as a supplement to 1. A l p e r t , Am. Soc, Rev., v o l . 16, 1951, p. 566. 2. Andrew F. Henry and James F. Short, J r . , "The Sociology of Suicide", in Clues to Suicide (ed. by Edwin S. Shneidman, and Norman L» Farberow, New York, McGraw-Hill Book Company, Inc., 1957, p. 58. 41. 1 Le S u i c i d e . Halbwachs examines s u i c i d e i n r e l a t i o n to comparative urban and r u r a l r a t e s , trends i n rates i n d i f f e r e n t countries, m a r i t a l status, r e l i g i o u s a f f i l i a t i o n , homicide, p o l i t i c a l and economic c r i s e s , alcoholism, and psychopathic s t a t e s . Rather than attempting to amass new s t a t i s t i c s from o r i g i n a l records, he c r i t i c a l l y re-examines the s t a t i s t i c a l tables published by Durkheim and M o r s e l l i . By bringing i n t o juxtaposition f a c t o r s not previously believed to be relevant and studying trends in one set of f a c t o r s i n terms of the other, he disturb s some of the old theories and i s able t o advance new explanations h i t h e r t o ignored or dismissed. One of the most i n t e r e s t i n g hypotheses put forward concerns the high incidence of sui c i d e among men as compared to women. This d i f f e r e n c e i n rates i s usually a t t r i b u t e d to diff e r e n c e s 2 in the psychological c o n s t i t u t i o n of men and women. Although Halbwachs does not have conclusive data he o f f e r s s t a t i s t i c s which show that when both attempted and successful suicides are taken i n t o consideration women appear to show as great a tendency toward su i c i d e as do men. He then examines the methods used by men and women and f i n d s that whereas men choose rather r e l i a b l e methods of k i l l i n g themselves, women se l e c t those which are l e s s c e r t a i n to 1. Maurice Halbwachs, Les Causes du Suici d e , P a r i s , L i b r a i r e F e l i x Alcan, 1930. 2. Durkheim, himself, suggests that a woman's mentality i s l e s s developed than a man's and that she i s more " i n s t i n c t u a l . " (Durkheim, p. 272.) 42. cause death. The trend i n rat e s over a period of years, Halbwachs shows, must be viewed i n r e l a t i o n to the population growth and the changing predominance of old or young people, for the sui c i d e r a t e i s much higher among old than among young people. Although the rat e i n most European countries i s increasing, Halbwachs demonstrates that the increase has been at a decreased r a t e . He suggests that a point of s t a b i l i z a t i o n w i l l probably be reached in each country — a point peculiar to that country. Halbwachs* discussion of the r e l a t i o n between psychopathologic states and suicide marks a new d i r e c t i o n of thought on the subject of s e l f - d e s t r u c t i o n . Dispensing with s t a t i s t i c a l data, he attempts to devise a theory of causation of suicide which avoids the t r a d i t i o n a l dual approaches of the s o c i o l o g i s t and the p s y c h i a t r i s t . As Parsons has noted, Halbwachs sees no a n t i t h e s i s between the s o c i a l and psychological explanations of s u i c i d e ; rather he considers them complementary.1' For Halbwachs there i s but one cause for s u i c i d e : the detachment of the i n d i v i d u a l from society and h i s r e s u l t i n g sense of s o c i a l i s o l a t i o n . He holds that i t matters l i t t l e whether i s o l a t i o n has i t s roots i n psychic d i s f u n c t i o n i n g or i n external conditions. The merit of Halbwachs' works l i e s i n the s i m p l i c i t y of the s t a t i s t i c a l a n a l y s i s , i n the imaginative re-examination of the data basic t o and underlying M o r s e l l i ' s and Durkheim's 1. Parsons, S o c i a l A c t i o n , p. 326. 43. thesis, and in the forthright endeavour to integrate two seemingly opposed areas of investigation into one promising line of inquiry. Alpert calls Halbwachs1 study a necessary complement to Durkheim's and quotes Marcel Mauss, a student.of the subject, as having referred to Les Causes du Suicide as the "indispensable corrective" to Le Suicide,^" 5. Sociological Co-ordinates of Suicide. After the publication of Durkheim's treatise there gradually developed, primarily in an attempt to test his 2 hypotheses, a substantial body of empirical data. Investigations, although empirical in nature, were carried out within the broad theoretical framework developed by Durkheim. To permit a more systematic presentation and discussion of research findings a number of summary topical categories are used. 1. Alpert.,Am. Soc.• Rev, vol. 16, 1951, p. 565-567. 2. The theme, i f not the focus, of much of this research is relating, often implicitly, the etiology and differing rates of suicide to the strength of the relationship system (or the degree of group solidarity) using as indices ecological d i s t r i -bution, urban-rural differences, marital status and age. The classic statement in this approach i s , of course, Durkheim's but others have followed. Dublin and Bunzel (152) writing about primitive societies contend that to understand the reasons for suicide and the at-titudes toward i t in any given primitive society, one must closely examine the social organization of that society. They suggest that the greater the emphasis on individuality and on personal acquisition, the greater will be the number of suicides and the less the act will be stigmatized. Where there is less personal striving for leadership, possessions and recognition, suicide, they hold, will not be as prevalent and the attitude towards i t much more prohibitive. Faris, (Social Disorganization , New York, Ronald Press, 1948, p. 66) borrowing from Halbwachs, holds that social isolation promotes abnormal behaviour, of which suicide is but one manifestation. 44 A) Suicide and Climate e S t a t i s t i c a l data, past and present, have c o n s i s t e n t l y shown that the greatest number of suicides occur i n the spring and e a r l y summer, and the fewest i n the winter season. E a r l y i n v e s t i g a t o r s such as M o r s e l l i , Lombroso and F e r r i a t t r i b u t e d t h i s phenomenon to the mysterious e f f e c t s of climate on the human organism. 1 M o r s e l l i has written: Suicide and madness are not influenced so much by the intense heat of the advanced season as by the e a r l y spring and summer, which seize upon the organism not yet acclimatized and s t i l l under the influence of the c o l d season. And t h i s applies to the f i r s t c o l d weather. Durkheim, vigourously opposing the cosmic explanation, ascribed seasonal v a r i a t i o n s i n s u i c i d e frequency to the increased tempo of s o c i a l l i f e i n the Northern Hemisphere i n May, June and 3 J u l y , and i t s decrease in November, December and January. Miner, a s t a t i s t i c i a n , processing the date from the o f f i c i a l compilations of nearly t h i r t y European countries (covering a period of one hundred years), writes: The maximum frequency of s u i c i d e occurs in May or June, the minimum i n December or January. T h i s appears to be an e f f e c t of weather per s e . 4 1. Durkheim, Suicide, pp. 104-113. 2. M o r s e l l i , S u i c i d e , p. 72. 3. Durkheim, Suicide, pp. 119-122. 4. John Rice Miner, "Suicide and i t s Relation to C l i m a t i c and Other Factors", The American Journal of Hygiene, Monographic S e r i e s , no. 2, J u l y , 1922, p. 111. 45 Dublin and Bunzel examined the monthly v a r i a t i o n s i n suic i d e frequency during the years 1910-1923 in a number of American c i t i e s located i n broadly scattered geographic areas. A f t e r taking i n t o account c l i m a t i c d i f f e r e n c e s i n the widely spread l o c a l i t i e s , they conclude that the same seasonal f l u c t u a t i o n i s , with some very minor d i f f e r e n c e s , prevalent everywhere, and that the maximum number of suicides occur i n the early part of the year, coincident with the coming of spring weather. 1 Almost i d e n t i c a l f i n d i n g s were dis c l o s e d by an examination of the influences of seasonal f a c t o r s on s u i c i d e i n New York c i t y during the same period of time and in England 2 and Wales from 1921 to 1925. The contentions of M o r s e l l i , Miner, and others that climate i n i t s e l f accounts for the f l u c t u a t i n g r a t e of sui c i d e at d i f f e r e n t times of the year are highly debatable. Durkheim*s hypothesis that changes i n s o c i a l l i f e are responsible for seasonal v a r i a t i o n s i n sui c i d e i s more tenable as far as i t goes. It suggests promising l i n e s of inquiry — perhaps i n the d i r e c t i o n of i n v e s t i g a t i n g the r e l a t i o n of seasonal changes i n s u i c i d e frequency to economic trends and t h e i r implications for s o c i a l l i v i n g . B) E c o l o g i c a l D i s t r i b u t i o n Cavan, examining the d i s t r i b u t i o n of a l l s u i c i d e s 1. Dublin and Bunzel, To Be Or Not To Be, p. 87. 46 occuring i n Chicago during the years 1919 to 1921, i s o l a t e d four d i s t r i c t s i n which the s u i c i d e rate was high. These areas were characterized by s h i f t i n g populations, a preponderance of cheap ho t e l s , rooming houses and restaurants — i n short, areas of extreme s o c i a l and personal d i s o r g a n i z a t i o n . 1 Studies of the ecology of s u i c i d e in other c i t i e s have on the whole substantiated Cavan*s f i n d i n g s . Schmid showed that i n Seattle and Minneapolis s u i c i d e tends to predominate i n the c e n t r a l l y located, disorganized sectors. The high degree of r e s i d e n t i a l m o b i l i t y , the impersonality and anonymity of c i t y l i f e , the ineffectualness of s o c i a l norms in the c o n t r o l of i n d i v i d u a l behaviour and the r e s u l t i n g s o c i a l disorganization are responsible, he believed, for the 2 3 high r a t e of s u i c i d e . Far i s ' study of Providence and Mowrer*s 4 a n a l y s i s of suicide in Chicago (using a longer period of time and therefore a greater number of cases than d i d Cavan) i n general confirm Cavan's pattern of d i s t r i b u t i o n of r a t e s . Sainsbury sets out to t e s t the hypothesis that d i f f e r e n c e s i n the s u i c i d e r a t e s of London boroughs w i l l d i s c l o s e t h e i r s o c i a l d i f f e r e n c e s . He found thalithe boroughs showed: 1. Ruth Shonie Cavan, Suic i d e , Chicago, University of Chicago Press, 1928, pp. 77-105. 2. C a l v i n Schmid, " S o c i a l Saga of Two C i t i e s , An E c o l o g i c a l and S t a t i s t i c a l Study of S o c i a l Trends i n Minneapolis and St. Paul," The Minneapolis Council of S o c i a l Agencies Monograph Series No 0 1, Minneapolis, pp. 370-380 and "Suicide i n S e a t t l e , 1914-1925: An E c o l o g i c a l and B e h a v i o u r i s t i c Study," Uni v e r s i t y of Washington Publications in the S o c i a l Sciences, V o l . 5 (October 1928). 3. Far i s , S o c i a l Disorganization, p. 208. 4. E. R. Mowrer, Disorganization Personal and S o c i a l , P h i l a d e l p h i a , J.B. L i p p i n c o t t Co., 1942, pp. 347-350. 47 Significant differences between their suicide rates, and a remarkable consistency in rank order of rate over three decades in spite of considerable changes in the composition of their populations. A significant correlation of suicide rates with rates for the following characteristicsr social isolation (e.g. persons living alone, and in boarding-houses)j social mobility (e.g. daily turnover of population, and number of immigrants); and two of the indices of social disorganization (divorce and illegitimacy). Sainsbury holds that by plotting on a map of North London the distribution of some 409 suicides, the relations are corroborated. He writes: The findings (are related) to the ecological structure of London, i.e. the unplanned process by which, in the course of i t s growth, districts with particular social attributes have been differentiated. Suicide rates were highest in the West End and North-West London where both class and spatial mobility are highest, small flat and boarding-house accommodation preponderates, r shared mores are absent, and relationships impersonal. •Suicide rates were low in the peripheral southern boroughs where family l i f e and stability prevail, and in many of the working-class districts whose residents are locally born and where l i f e is more neighbourly. The ecological approach, with i t s identification of the social conditions in a defined geographical unit in reference to pathologies, is a fruitful one. 1. Peter Sainbury, Suicide in London: An Ecological Study. London, Chapman & Hall Ltd. 1955, p. 90. 2. Ibid. 48, C) Urban and Rural Differences, That there is a direct relationship between the degree of urbanization and suicide rates has been shown in a number of sociological studies. Miner, analyzing extensive European statistics covering the period from 1871 to 1905, concludes that the suicide rate 1 is usually higher in urban than in rural communities. Halbwachs gives figures which show that in France the suicide mortality rate among the rural population in considerably lower than among 2 the urban. Comparative American statistics are examined by Dublin and Bunzel with some interest findings. They show that with the growth of urbanism came a progressive increase in suicide frequency in the f i r s t three decades of the twentieth century and a greater spread between urban and rural suicide rates. They statistically demonstrate that the changes cannot be attributed to a pronounced difference in the age distribution of the urban and rural population. Using data in a study by 3 Hoffman they point out, too, that in general, the larger a city 4 is the higher is its suicide rate. A striking demonstration of the relation of urbanism to suicide can be seen by comparing, as did Dublin and Bunzel, the 1. Miner, Am. J. Hygiene, Monogr. 2, 1922, p.27 2. Halbwachs, Les Causes du Suicide, p. 172. 3. Frederick L. Hoffman, "The Suicide Record for 1931" The  Spectator. June 9,1932. 4. Dublin and Bunzel, To Be Or Not To Be. pp. 78-79« 49, low s u i c i d e rates i n the states of the r u r a l American South with the higher rates of the more urbanized states of the North, East, and Midwest. 1 As might be expected, though, the s u i c i d e r a t e s i n larger southern urban centres such as New Orleans, Memphis, and A t l a n t a are considerably higher than those in t h e i r 2 environs. In order to examine the s t a t i s t i c s with more pr e c i s i o n than a simple urban-rural d i v i s i o n permits Cavan i n her book Suicide makes a three-part d i v i s i o n of communities i n each state of the United States (on the basis of population) into r u r a l and towns ( l e s s than ten thousand people), secondary c i t i e s (ten thousand to one hundred thousand) and p r i n c i p a l c i t i e s (over 100,000). Commenting on her f i n d i n g s she writes: From these data i t becomes apparent that while in general the r a t e increases from r u r a l through secondary c i t i e s to the p r i n c i p a l c i t i e s , there i s on the one hand no d e f i n i t e and consistent r a t i o between the three r a t e s , and on the other there are numerous exceptions, cases i n which the secondary c i t i e s and even the r u r a l sections rank higher than the p r i n c i p a l c i t i e s . In the t h i r d place, the r u r a l r a t e in some states i s much higher than the rate of the secondary and even of the p r i n c i p a l c i t i e s i n other s t a t e s . Mere ruralness or urbanness does not f i x the r a t e , although i n adjacent states (that i s , under similar s o c i a l conditions) a c e r t a i n r e l a t i o n s h i p may be detected. Thus, in the West, Middle West, and South the tendency i s for the p r i n c i p a l c i t i e s to exceed the secondary c i t i e s , which i n turn exceed the r u r a l d i s t r i c t s . 1. I n t e r e s t i n g l y enough, the P a c i f i c coast states record the highest s u i c i d e rates in the United States. Perhaps the " f r o n t i e r " and anomic c h a r a c t e r i s t i c s of the region are i n part responsible. 2. Z.. Dublin and Bunzel, To Be Or Not To Be, p. 81. 50. Ia the northeastern states another pattern tends to predominate. In New Jersey, for instance, the r a t e for p r i n c i p a l c i t i e s i s 12 a8 s u i c i d e s per 100,000; for secondary c i t i e s , 11.9; and for r u r a l sections, 13.7. The same r e l a t i o n s h i p and almost the i d e n t i c a l rates hold for New York. Rhode Island, Massachusetts, New Hampshire, and Vermont a l l have r u r a l r a t e s which equal or exceed the r a t e s not only of secondary c i t i e s but of primary c i t i e s as w e l l . O f f e r i n g an explanation for the d i s p a r i t y between urban and r u r a l s u i c i d e r a t e s , Henry and Short write: One of the c r i t i c a l d i f f e r e n c e s between r u r a l and urban l i v i n g i s in the s t a b i l i t y and c o n t i n u i t y of family and neighborhood l i f e . The strong c o n t r o l exercised by the neighbors on the farm or in the small town contrasts sharply with the anonymity and impersonality of l i f e i n the c i t y . These c h a r a c t e r i s t i c s of the c i t y are magnified in the c e n t r a l , disorganized sectors. The steady r i s e i n suicide from the t i g h t l y k n i t r u r a l community to the anonymity of the c i t y may r e f l e c t the strong r e l a t i o n a l systems of the r u r a l small-town dweller and the r e l a t i v e i s o l a t i o n from meaningful r e l a t i o n s h i p s of many of the inhabitants of large c i t i e s . 2 The c h a r a c t e r i s t i c s of c i t y l i f e ( g r a p h i c a l l y depicted o 4 in the writings of Park and Burgess ° and Wirth ) can be explained on the basis of three v a r i a b l e s : number, density and degree of 1. Cavan, Suicide, pp. 46-48. 2. Henry and Short, "The Sociology of Suicide", i n Clues to Suicide, P. 61. . 3. Robert E. Park, Ernest W. Burgess, Roderick p. McKenzie, The C i t y , Chicago, University of Chicago Press, 1928. 4. Louis Wirth, "Urbanism As a Way of L i f e " , American Journal of  Sociology, V o l . 44, J u l y , 1938, pp. 1-24. 51. heterogeneity,^" Writers investigating the causes for the high incidence of suicide in cities tend to emphasize the first two variables and overlook the third with its implications for religious and socio-economic differences, D) Marital Status, The investigations of Durkheim, Halbwachs and others amply demonstrate the complexity of the relation between suicide and marital status. The difficulty in a quantitative analysis i s , of course, to hold constant variables which, i f uncontrolled and unaccounted for, would produce a distorted statistical picture. The following quotation is a fair statement of research findings. The degree of involvement in meaningful relation-ships with other persons is greater, on the average, for the married than for the single, widowed, or divorced. The married are by definition involved in at least one more meaningful relationship than the non married. When the effects of age and sex are held constant, the suicide rate of the married is lower than the rate of the single, the widowed, or the divorced. Suicide is highest for the divorced. When the factor of age is held constant, suicide is higher for the widowed than i t is for the single, up to the age of thirty-five. From age thirty-five on, however, the suicide rate of the single is higher than that of the widowed. Strength of the relational system is related to the widowed and single categories in an extremely complex manner. It is probably weaker for the widowed than for the single at the younger ages, when widowhood comes as a greater shock and young family responsibilities are most likely to be disrupted. On the other hand, i t is probably stronger for the widowed during the older age periods, when they are more likely to have the benefit of relations with their children grown to adulthood and when the single find their re-lationships curtailed by increasing morality of their 52. 1 age group. Such f i n d i n g s are consistent with the supposition that the propensity for s u i c i d e decreases when the i n d i v i d u a l i s involved i n a web of s o c i a l r e l a t i o n s h i p s . E) Age and Sex. Dublin and Bunzel in t h e i r compendium examine q u a n t i t a t i v e l y the f a c t o r s of age and sex as r e l a t e d to s u i c i d e . Summarising American and European s t a t i s t i c a l data they draw a number of conclusions. F i r s t , numerically the number of c h i l d r e n 2 (up to age f i f t e e n ) who commit s u i c i d e i s n e g l i g i b l e . Second. i n adolescence (15-19) the female s u i c i d e r a t e i s s l i g h t l y 3 higher than the male but for neither sex at t h i s time i s s u i c i d e a serious problem. T h i r d , for men the s u i c i d e r a t e increases with age: from a f i g u r e of ten s u i c i d e s per 100,000 population i n the age range 20 to 24, i t increases to 40 in the range 40 to 54 and then to 66 in the age range 65 to 74. f o u r t h , for women the s u i c i d e rate increases l e s s r a p i d l y with age: from a f i g u r e . of s i x per 100,000 population i n the age range 20 to 24 i t increases by about ten in the range 40 to 54 years of age and ; remains f a i r l y constant. 4 F i f t h , the s u i c i d e mortality r a t e for 1. Henry and Short, "Sociology of Suicide" in Clues to Suicide, pp 61-62. 2. Dublin and Bunzel, To Be Or Not To Be, p. 39. 3. Dublin and Bunzel in discussing reasons for t h i s speculate that the emotional i n s t a b i l i t y and i n t e l l e c t u a l ferment of adolescence i s of greater i n t e n s i t y for the female and that in a d d i t i o n there i s , for her, the possible complication of pregnancy out of wedlock (p. 45). 4. Dublin and Bunzel obtained t h i s data, covering a twenty-year period, from the s t a t i s t i c a l department of a large American l i f e insurance company. 53. Negro males at any age i s l e s s than one-half of the r a t e for white males, but the r a t e for Negro females i s over one-half that of the white female r a t e . 1 Henry and Short suggest an explanation for these f a c t s : Gerontologists point out that one of the chief problems of the aged i s that of funding meaningful groups with which t o associate. Our c u l t u r e , with i t s emphasis on conjugal r e l a t i o n s h i p s , makes i t more d i f f i c u l t f o r family bonds to remain i n t a c t and strong with the aging process. Further, the degree of involvement in r e l a t i o n s h i p s within the "family of o r i e n t a t i o n " v a r i e s with age simply as a function of parental m o r t a l i t y . By age f i f t y - f i v e to s i x t y - f o u r , the p r o b a b i l i t y that at leas+ one of the two parents w i l l be dead weakens the strength of the r e l a t i o n a l system of those persons who maintain contact with t h e i r parents through the years ... It seems probable that our c u l t u r a l pattern of female dependency i s r e f l e c t e d i n the lowered s u i c i d e rates of aged females. That i s , while aged males may be allowed to d r i f t , thus weakening the strength of th e i r r e l a t i o n a l bonds, the aged mother i s more l i k e l y to be taken care of by one of her c h i l d r e n . 2 F) War. Examination of research data confirms Durkheim's observation that the s u i c i d e r a t e decreases i n time of war. During the American C i v i l War therate, according to the a v a i l a b l e s t a t i s t i c s , f e l l noticeably in both the North and the 1. Henry and Short suggest that the female i n the Negro community enjoys a prestige p o s i t i o n at l e a s t equal to that of the male and that t h i s may help to account for her proportionately higher s u i c i d e r a t e . (Suicide and Homicide, Glencoe, The Free Press, C 1954, p. 87-88.) 2. Henry and Short "Sociology of Suicide" in Clues to Suicide, pp. 62-63. 54. South,^ and in the Franco-Prussian War there was a decline 2 in the number of suicides in France, Germany and Austria. Ten militant nations recorded a decrease in the incidence of 3 suicide during World War 1. The figures for suicides registered in the Metropolitan Police District (Greater London) from the years 1938 to 1951 show a marked decline during the war years, 1939 to 1945.4 The explanation for this reduction in numbers advanced 5 by Durkheim has been, with some minor variations, subscribed to 6 by most researchers. G) Socio-Economic Status. Morselli was one of the earliest investigators to examine the relationship between suicide and what he termed "the professions". 'He wrote: It was, indeed, presumable that those least disposed to suicide would be those the farthest removed from the difficulties of l i f e , that is to say, those living at the charge of others, or without any profession; their average i s , in 1, Dublin and Bunzel, To Be Or Hot To Be. p. 111. 2« Ibid,,pp. 111-112. 3. Ibid., P. HI. 4. E. Stengel, Nancy G. Cook and I.-S. Kreeger, Attempted Suicide Its  Social Significance and Effects, London, Chapman & Hall Ltd.3Maudsley Monographs, 1958, No. 4, p. 27. 5. See p. 32 of this thesis 6. Dublin has a further explanation: the high degree of employment and the minimizing of personal problems during wartime. (Louis I. Dublin, Health Progress 1936 to 1945. Metropolitan Life Insurance Co.i New York, 1948.) 55. fact, much below that of the population in general ... Equally low is the probability of the classes addicted to agriculture, pastoral l i f e , forestry, ... The category also of the labouring people, for the most part composed of individuals not devoted to fixed occupations (porters, journeymenj labourers, ploughmen, shoeblacks, scavengers, gravediggers, workmen without a trade, etc) furnish few suicides; among the men the average of these is under the general average, and among the women only slightly above i t , but a l l the professions and trades which, by habits and muscular or psychical occupation, bring women near to man, tend to raise, and sometimes in an extraordinary degree, their inclination to suicide. 1 Miner, reviewing the official figures of England and Wales, Australia, and four continental European countries from 1881 to 1911, concludes: Suicide rates are low among farmers and others employed in steady manual labor in the open air, while the professions (except the clergy and teachers), officials, capitalists, soldiers, innkeepers, and migratory labourers show high rates. Low economic status, when stable, is associated in general with low suicide rates. The statistics given by the Registrar-General for England and Wales for the year 1927 are cited by Dublin and Bunzel. White male suicides were analyzed by occupation ( using age-standardized data), and i t was found that labourers, both skilled and un-skilled, had rates below the average rate for a l l civilian males while professional and white-collar groups had above average rates. The class designated "never occupied", in which the very rich, dependents, unemployed, transients, inmates of 1. Morselli, Suicide, pp. 243-245. 2. Miner, Am. J. Hygiene. Monogr. 2, 1922, p . l l l 56 i n s t i t u t i o n s and others were indis c r i m a t e l y grouped together, exhibited the highest r a t e . 1 Sainsbury c i t e s the Registrar-General's f i g u r e s for the periods 1921-23 and 1930-32„ These show that suicide rates are conspicuously higher at the upper end of the socio-economic scale but tend to r i s e again at the low end s The f i g u r e s contraindicate what one might expect — a progressive increase in suicides on a continuum from lower to upper socio-economic c l a s s and Sainsbury holds that something more than wealth and position must be considered i f d i f f e r e n c e s i n r a t e s are to be accounted f o r . He o f f e r s as a p l a u s i b l e explanation the f a c t o r s of community cohesion and occupational m o b i l i t y , suggesting that the high incidence of s u i c i d e among hotel and domestic personnel i s a t t r i b u t a b l e to the s o c i a l l y i s o l a t e d and impersonal l i v e s they lead, while in contrast, the low r a t e of s u i c i d e among coalminers 3 and railway workers i s a t t r i b u t a b l e to t h e i r sense of group s o l i d a r i t y . In h i s own study of suicide in the London boroughs, Sainsbury demonstrates that the r a t e tends to increase with s o c i o -4 economic status. 1. Dublin and Bunzel, To Be Or Not To Be, p. 402, 2. I n t e r e s t i n g l y enough, o f f i c i a l Netherland s t a t i s t i c s show a comparatively low s u i c i d e r a t e for domestics, (S, Gargas, "Suicide i n the Netherlands," American Journal of Sociology, march, 1932, V o l , 37:5, p. 707, 3. Sainsbury, op, c i t . , p. 19. (Sainsbury's f i n d i n g s d i r e c t l y contradict those of M o r s e l l i . The d i f f e r e n c e s are probably due to errors in the e a r l y method of c o l l e c t i n g data, to v a r i a b i l i t y in s o c i a l c l a s s s c a l e s , now and i n M o r s e l l i ' s day, to the f a c t of h i s t o r i c a l change). 4. I b i d . , p. 73. He points out that a lack of consistency in the r e l a t i o n s h i p between status and s u i c i d e e x i s t s in some boroughs, and holds that the f a c t o r of s o c i a l disorganization must be taken into account in any explanation; . He writes: "socio-economic status c o r r e l a t e s with s u i c i d e to a smaller degree than do s o c i a l m o b i l i t y and i s o l a t i : o n , t which seem to be the ultimate processes responsible for l o c a l v a r i a t i o n s i n s u i c i d e ; they account for the d i f f e r e n c e s both in neighbourhoods and in c l a s s e s . " 57 o Because the o f f i c i a l m o r t ality data in the United States provide no d e f i n i t e index of socio-economic status, the research i n that country i n t o the a s s o c i a t i o n between su i c i d e and the socio-economic factor has been l i m i t e d to small, s p e c i a l i z e d s t u d i e s . 1 One such study i s that undertaken by Weiss. C l a s s i f y " ing and analyzing data on the t o t a l number of c e r t i f i e d s u i c ides recorded in the C i t y of New Haven from 1936 to 1950, he writes: In general, members of the lower socio-economic classes had lower s u i c i d e rates than d i d members of the upper socio-economic c l a s s e s . This was true even with age, sex, and n a t i v i t y - a d j u s t e d data. (This r e l a t i o n was analyzed for white persons only, so that race was not a f a c t o r . There was no evidence that r e l i g i o u s a f f i l i a t i o n played any important part i n s u i c i d e rates i n New Haven.) Females i n the lower s o c i o -economic classes had extremely low s u i c i d e r a t e s . A g e - s p e c i f i c data, however, revealed that t h i s r e l a t i o n of low s u i c i d e r a t e to low socio-economic class reversed i t s e l f for males 65 years and older: i . e . , rates for lower c l a s s males demonstrated a steady increase i n each advancing age period, but upper c l a s s male rates leveled a f t e r the age of 65, and i n that older age group, rates for lower c l a s s males were considerably higher than those f o r upper c l a s s males. These patterns r e l a t i n g to socio-economic status and s u i c i d e were consistent and s t a t i s t i c a l l y s i g n i f i c a n t . Weiss o f f e r s an explanation for h i s f i n d i n g s : It might be possible to account f o r t h i s tendency on the b a s i s of d i f f e r e n c e s in r e l i g i o n . It has been noted that 56 or 57 per cent of the l o c a l population are of Roman C a t h o l i c f a i t h . Catholicism as a basic factor could be considered, however, only i f both of two suppositions were proved to be true: that New Haven C a t h o l i c s have lower s u i c i d e r a t e s than do n o n ^ a t h o l i c s , and that 1. A number of studies have been c a r r i e d out by l i f e insurance companies and the r e s u l t s reported in t h e i r s t a t i s t i c a l b u l l e t i n s . 2. J.M.A. Weiss, "Suicide: An Epidemiologic A n a l y s i s " , P s y c h i a t r i c  Quarterly. V o l . 28, 1954, pp. 249-250. 58. Ca t h o l i c s are more concentrated i n the lower classes (which i s probably s o , ) . However, i t has already been indicated that recent evidence elsewhere i n North America and i n t e r n a l evidence i n t h i s study i n New Haven do not confirm the f i r s t supposition. Other reasons for the r e l a t i o n s h i p might be that members of the "upper" socio-economic cla s s e s carry heavier burdens,of r e s p o n s i b i l i t y ; these persons may be more affe c t e d by f l u c t u a t i n g economic conditi o n s . It may be that mores and taboos concerning su i c i d e vary i n the d i f f e r e n t socio-economic c l a s s e s . Another p o s s i b i l i t y i s that members of the lower socio-economic classes choose o u t l e t s other than s u i c i d e f or t h e i r aggressive impulses. 1 In a sim i l a r context — the r e l a t i v e status of d i f f e r e n t groups and t h e i r d i f f e r i n g s u i c i d e r a t e s ~ Henry and Short write: White persons are about three times morejkikely to k i l l themselves than are Negroes and males have a rate about three times the rate f or females; women are le s s prone to su i c i d e than men and Negroes are l e s s susceptible than whites. Suicide i s more common among the p r i v i l e g e d groups i n American society than among the downtrodden.., While suicides occur i n su b s t a n t i a l numbers at both extremes of the socio-economic s c a l e , data from the l i f e insurance companies show that they are concentrated among the W e l l - t o - d o . A common theme runs through the d i f f e r e n c e s i n s u s c e p t i b i l i t y to sui c i d e of these groups. In every case, the category with highest status p o s i t i o n i s the category with the highest s u i c i d e r a t e . Males,because of th e i r greater involvement i n the occupational system, enjoy a status p o s i t i o n somewhat higher than females. The superior status p o s i t i o n of whites as compared with Negroes i s obvious. Those at the top of the economic scale enjoy high status as compared with those le s s fortunate .. These data show that s u s c e p t i b i l i t y to sui c i d e r i s e s with status p o s i t i o n . 1. J,M»A, Weiss, P s y c h i a t r i c Quarterly, V o l . 28, 1954, pp. 247-248. t 2. Henry and Short, "Sociology of Suicide" i n Clues to Suicide, p. 60. 59 8 Powell, i n a study of 426 suicides in Tulsa, Oklahoma, holds that the psychological f a c t o r s operative in s e l f - d e s t r u c t i o n are rooted in anomie and he postulates that anomie d i f f e r s in q u a l i t y and extent from one socio-occupational group t o another according to the r e l a t i o n s h i p between the s e l f and the p r e v a i l i n g success ideology. Finding that i n h i s s e r i e s the highest incidence of s u i c i d e occurred at opposite ends on a socio-economic continuum, he o f f e r s the explanation that for the u n s k i l l e d labour group anomie takes the form of a d i s s o c i a t i o n characterized by occupational d i s c o n t i n u i t y , downward m o b i l i t y , a lack of presence of the r e g u l a t i n g mores of the wider soc i e t y , an absence of an i n t e r n a l i z i n g of the success ideology, and the absence of a subculture on which to draw for o r i e n t a t i o n ; for the p r o f e s s i o n a l -managerial group anomie takes the form of an envelopment characterized by a compulsive adherence of the s e l f to the success ideology, an i n a b i l i t y of the s e l f to reconstruct i t s own ends from the raw material (concepts) presented to i t by the c u l t u r e l i v i n g by unexamined d i r e c t i v e s of the culture with a consequent p a r a l y s i s of c r i t i c a l f a c u l t i e s , and the lack of inner coherence. 1 Of the r e l a t i o n s h i p of self-destructiveness to anomie, Powell says: s..occupation provides function and determines the i n d i v i d u a l ' s s o c i a l status which i s an index to h i s conceptual system. The conceptual system i s the source of anomie, which i s a primary v a r i a b l e in s u i c i d e . Therefore, s u i c i d e i s c o r r e l a t e d with occupation. 1. Elwin H. Powell, "Occupation, Status, and Suicide: Toward a Re-d e f i n i t i o n of Anomie", American S o c i o l o g i c a l Review, V o l . 23:2, 1958, pp. 131-139. 2. I b i d . , p. 133. 60. <H) The Business Cycle. A number of i n v e s t i g a t o r s have demonstrated with the use of a v a r i e t y of s u i c i d e and business i n d i c e s the existence o f a negative r e l a t i o n s h i p between the s u i c i d e r a t e and f l u c t u a t i o n s i n the rate of business a c t i v i t y . Examining the influence of the business c y c l e on s o c i a l phenomena i n B r i t a i n , the United States, France, and Germany from 1854 to 1913, Thomas writes of s e l f - d e s t r u c t i o n : I t i s not s u r p r i s i n g that the greatest number of s u i c i d e s occur during business depression. The high negative c o r r e l a t i o n seems to i n d i c a t e that the economic f a c t o r i s predominant i n causing the f l u c t u a t i o n s i n the s u i c i d e r a t e . Unemployment and pauperism are probably the most serious f a c t o r s b r i n g i n g about an increase i n s u i c i d e f o r the working c l a s s . Enforced l i q u i d a t i o n and business f a i l u r e are probably important f a c t o r s f o r the upper c l a s s e s . 1 In a paper e n t i t l e d P r o s p e r i t y . Depression, and the Suicide Rate Hurlburt attempts to demonstrate that a causal r e l a t i o n s h i p e x i s t s between fl u c t u a t i o n s i n the business c y c l e and the s u i c i d e r a t e . Unlike Thomas, however, he does not subscribe to the primacy of the economic component. He writes: The economic f a c t o r i s but one o f many diverse elements entering i n t o the determination o f the s u i c i d e r a t e , and i t i s doubtless impossible to segregate t h i s f a c t o r i n order to determine i t s r e l a t i v e importance. However, by means of contrasting the c y c l i c a l f l u c t u a t i o n s o f business a c t i v i t y with the c y c l i c a l f l u c t u a t i o n s of the s u i c i d e r a t e we obtain r e s u l t s which i n d i c a t e a c e r t a i n degree of causal r e l a t i o n s h i p between p r o s p e r i t y , depression, and the s u i c i d e r a t e : ( l ) Between 1902 and 1925 the s u i c i d e r a t e revealed a tendency t o d e c l i n e i n years of p r o s p e r i t y and to advance i n years of depression. (2) The s u i c i d e rate r e g i s t e r e d 1. Dorothy Swaine Thomas, S o c i a l Aspects of the Business Cycle. New York, A l f r e d A. Knopf, 1927, p. 115. 61 i t s greatest increases in years of acute economic d i s t r e s s , namely, 1907, 1908, and 1921„ (3) The s u i c i d e r a t e r e g i s t e r e d i t s greatest decreases during the period of abnormal prosperity between 1916 and 1920. * Comparing the Registrar-General's s t a t i s t i c s for the 1920-23 period of prosperity and the 1930-32 period of depression, Sainsbury notes that while s u i c i d e rose i n the 1930-32 depression the greatest increase occurred in the upper socio-economic classes (professional) and white c o l l a r business persons). He comments: It would seem, then, that poverty becomes an important factor in s u i c i d e according to i t s context. The indigenous poor, to whom poverty i s an accepted feature of t h e i r p o s i t i o n in a s t a t i c h i e r a r c h i c a l society, t o l e r a t e i t with equanimity. This a t t i t u d e does not f o s t e r s u i c i d e . A change from comparative affluence to poverty, or l o s s of employment, i s , however, more d i s r u p t i v e , since the person a f f e c t e d often 2 f a i l s to adjust himself to h i s a l t e r e d circumstances. 6. Summary of the S o c i o l o g i c a l Insights. The s o c i o l o g i c a l approach to the e t i o l o g y of suicide (with i t s c e n t r a l t h e s i s that the nature and incidence of the phenomenon v a r i e s with p o s i t i o n in the s o c i a l system) makes i t abundantly clear that i d i o s y n c r a t i c features and peculiar disorders of i n d i v i d u a l personality alone cannot account for the causes of s e l f - d e s t r u c t i o n . The examination of the intervening s o c i o l o g i c a l v a r i a b l e s has demonstrated that s u i c i d e i s intimately r e l a t e d to 1. Walter C. Hurlburt, "prosperity, Depression and the Suicide Rate" American Journal of Sociology, V o l . 37, 1932, p. 719. 2. Sainsbury, Suicide i n London, pp. 21-22. 62. gross s t r u c t u r a l d i s f u n c t i o n l o g r e f l e c t e d i n s o c i a l d i s o r g a n i z a t i o n , s o c i a l i s o l a t i o n , excessive i n d i v i d u a t i o n , anonymity and r o o t -lessness — i n short, to p r e v a i l i n g c h a r a c t e r i s t i c s and conditions of group l i f e . The s o c i o l o g i c a l approach serves, then, as a necessary c o r r e c t i v e to the psychological or i n d i v i d u a l approach. Chapter 3, The Psychology of S u i c i d e 0 1. E a r l y T h e o r i e s 1 of S u i c i d e In the middle nineteenth century, a number of physicians and p s y c h i a t r i s t s turned t h e i r attention to the problem of s u i c i d e and began to investigate what they usually termed i t s " i n t e r n a l causes". A review of t h e i r writings indicates that they tended to a t t r i b u t e the act to either pathological conditions 2 of the brain and other body organs or to a l i e n a t i o n of the mind. Winslow was one of the e a r l i e s t to concern himself with the medical aspects of s e l f - d e s t r u c t i o n . In The Anatomy of Suicide, he describes the autopsies of s u i c i d e s he performed and suggests that the commonest f i n d i n g s were "diseases and l e s i o n s " of the b r a i n , such as, "chronic meningitis" and "varicose veins" and "diseases and l e s i o n s of other organs", such as, "degeneracy of the l i v e r and kidneys", abnormal p o s i t i o n of stomach, and abdominal tumours. He contends that h i s f i n d i n g s demonstrate the r e l a t i o n between s u i c i d e and "morbid" conditions of the organism. 1. Again, the present writer points out that the term "theory" as used heremay be misleading, as i t r e f e r s to speculative theories derived from a set of often quite unrelated hypotheses. 2. An exception to t h i s l i n e of thought i s commented on by Z i l b o o r g who notes that i n 1840 T i s s o t , in a monagraph e n t i t l e d De l a Manie de  Suicide et de 1* e s p r i t de l a Revolte, presaged a psychoanalytic view-point by formulating the concept of h o s t i l i t y f i r s t being turned outward and then inward against the s e l f . (Gregory Z i l b o o r g , " D i f f e r e n t i a l Diagnostic Types of Suicide", Archives of Neurology and Psychiatry, V o l . 35, 1936, pp. 270-291), 3. Winslow, Anatomy of Suicide, c i t e d in M o r s e l l i , S u i c i d e , p. 292. 64. In h i s work Mental Maladies: A T r e a t i s e on Insanity, E s q u i r o l asserts emphatically that s u i c i d e i s , per se, proof of i n s a n i t y 1 a n d n e holds that h i s autopsy f i n d i n g s (which c o n s i s t e n t l y 2 showed morbid conditions of the brain) supports h i s contentions. He gives prominence, too, to the r o l e of hereditary t r a i t s as 3 precursory f a c t o r s i n psychical degeneration. A number of writers of the period, among them L i s l e , B r i e r r e de Boismont, F a l r e t and Darwin, and l a t e r Strahan, adopted and i n some cases further expanded E s q u i r o l * s theory of s u i c i d e . 4 It was not u n t i l the l a t t e r part of the century that the climate of medical opinion began to change and s u i c i d e came to be regarded as an act not incompatible with states of mental normality. Two of the f i r s t proponents of the "sanity theory of s u i c i d e " were M o r s e l l i and 0*Dea. In an examination of what he terms " i n d i v i d u a l psychological influences", M o r s e l l i r e j e c t s the then p r e v a i l i n g dichotomy of moral-physical causes of s u i c i d e a»»d reduces them to one determining p h y s i o l o g i c a l cause which he describes as 1. O'Dea, Suicide, pp. 257-259. (Esquirol*s thinking on the subject had profound influence on h i s contemporaries and many physicians to t h i s day subscribe to h i s view that the act of s u i c i d e i s alone s u f f i c i e n t evidence of mental di s o r d e r . (Stengel, Cook and Ereeger, Attempted Suicide, London, Chapman and H a l l L t d . , 1958). 2. Morselli, Suicide, p. 292, 3. I b i d . , p. 291. 4. I b i d . , p. 4. (See a l s o O'Dea, pp. 258-259 and Franco F e r r a c u t i , "Suicide in a C a t h o l i c Country", in Clues to Suicide, p. 71). 5. O'Dea, Suicide, pp. 257-258. 6. M o r s e l l i equates moral with psychological. 65. suffering and "despair at not having gained or at having lost that which, in the emotional condition of passion, was valued more than l i f e . " 1 This despair, he holds, is the product of an abnormally 2 excited, morbid condition of the brain a condition which disturbs the functions of the constitution and manifests itself 3 in "unsatisfied passions" and an excessive egoism. In his work Suicide, Studies on its Philosophy. Causes. and Prevention. O'Dea maintains that generally certain conditions or moral, intellectual and physical temperament are conducive to melancholy which in turn promotes suicide,^ while more specifically: ...nervous, and especially cerebro-spinal irritation, is the immediate physical cause of suicide and a 'fixed idea', the mental analogue of the physical Irritation, is the immediate mental cause of suicide,5 1. Ibid.. p. 300. 2. For Morselli, these may be conditions or organic pathology (chronic diseases, cancer, syphilis, etc.,) psychopathology (melancholia, "monomania", imbecility, etc.j) or both. p. 298. 3. Ibid. Morselli's explanation (physiological in its frame of reference) for the causes of suicide is somewhat inconsistent with his thesis that self-destruction is a social phenomenon. He contends that the "personal motive are but a small and infinitestimal portion of the collective motives", that "each one has his own passions and wishes to satisfy but only because these follow the common course and are developed in a prescribed atmosphere", and that "the individuality of our wants and tendencies is absorbed in the aggregate of social wants and tendencies", (p.274) yet he does not explicitly relate the two levels of causality which he discusses—the physiological and the social. He infers, however, that the individual's "unsatisfied passions" and egoism are, i f not produced by social forces, reinforced by them. 4. O'Dea, Suicide, p. 256 5. Ibid. t p. 251 66 o 2. Contemporary Theories of S u i c i d e A number of theories have been advanced to account for the psychic determinants of s u i c i d e . To f a c i l i t a t e as systematic an approach as possible to the examination of these often diverse t h e o r i e s , they w i l l be divided into two categories; non-psychoanalytical and psychoanalytical. A) Non-Psychoanalytic Theories. Clark holds that basic to a l l s u i c i d e s i s an inversion, an i n c e s t , or an o n a n i s t i c motive. The r e s u l t i s an imbalance i n the w i l l to l i v e , an increase of intrapsychic tension, an a f f e c t i v e f i x a t i o n of i n f a n t i l e attachment, and f i n a l l y , a s u i c i d a l a c t . 1 Gordon believes that man, being a s o c i a l animal, possesses as an i n t r i n s i c element i n h i s personality a capacity to adapt to what he (Gordon) terms "universal l a w — t h e progressive evolution of the s o c i a l environment". He contends that s u i c i d e represents a f a i l u r e i n the adaptive process — a d e n i a l and s h i r k i n g of the duty of the i n d i v i d u a l as an i n t e g r a l part of 2 the u n i v e r s a l whole. In a paper c a l l e d The Psychology of Suicide C r i c h t o n - M i l l e r a t t r i b u t e s the act to the i n d i v i d u a l ' s i n a b i l i t y to adapt himself and holds that i t c o n s t i t u t e s a f i n a l regression from r e a l i t y . 1. L.P. Clark, "A Study of the Unconscious Motivations in Suicides," New York Medical Journal, v o l . 116, 1922, pp. 254-263. 2. R.G. Gordon, "Certain Personality Problems in Relation to Mental I l l n e s s With Special Reference to Suicide and Homicide", B r i t i s h  Journal of Medical Psychology, v o l . 9, 1922, pp. 60-66. 67. He proposes that the motivations for suicide be classified into three groups: f i r s t , physical pain (including anticipated pain) and frustration of instinctual needs (of which the sexual is the most frequently thwarted); second, social sufferings and fears including remorse for wrong doings and an impulse towards expiation, and an exaggerated self-love which prohibits the acceptance of any form of social humiliation; third, doubts and dreads pertaining to the hereafter and manifest in the suicides of Messianic character in which there occurs a supreme sacrifice of the total personality for some redemptive purpose."'' Davidson believes that the individual at the time of his suicide act has reached the limit of his resources and has lost his goal. The immediate situation so preoccupies and controls him that his field of conscious awareness becomes restricted to the extent that he exhibits a disregard for l i f e i t s e l f . An "organic depression" follows and the higher centres of the brain are unable to cope with and direct the incoming impulse to make decisions. The individual then ceases to w i l l , surrenders to imagination and is unable to protect himself against further harmful impulses. The next step in the sequence 2 is self-destruction. For Williams there are two dominant reasons for suicide: disappointment and frustration. But since such feelings 1. H. Crichton-Miller, "The Psychology of Suicide", British Medical Journal, vol. 2, August 8,1931, PP. 239-241. 2. G.M. Davidson, "The Problem of Suicide", Medical Record, vol,139 1934, pp. 24-28. 68 are experienced by a l l he postulates the presence in the r i g i d personality of a strong narcissistic component which cannot accept defeats or combat reverses and i s unable to adapt easily to re a l i t y . The result i s suicide. 1 Goitein expresses the opinion in his a r t i c l e Mind of Murder that the suicide drive occurs as a compensation for the homicidal impulse directed against members of the immediate 2 family. Approaching suicide from the psychobiological viewpoint. Lewis attributes the act to the f i n a l breakdown of the adaptive process. For him, the suicide i s : "...not able to adapt in the midst of so-called higher-level contradictions because of some lack of compensatory adjustment, which i s in no way a conscious or deliberate proceeding, but ...belongs in the realm of general patterns forming an integral part of the personality. Mills gives prominence to weather as a contributing factor. Suicides represent for him that portion of the population which i s unable to deal successfully with psychological stress of l i f e , and psychological stress, he says, i s always intensified 4 by bad weather. 1. E.Y. Williams, "Some Observations on the Psychological Aspects of Suicide", Journal of Abnormal and Social Psychology, v o l . 31, 1936, p. 260-265. 2. P.L. Goitein, "Mind of Murder", Journal of Criminal Psychopathology, v o l . 3, 1952, pp. 625-647, Cited in Norman L. Farberow, "Personality Patterns of Suicidal Mental Hospital Patients", Genetic Psychology  Monographs, v o l . 42, 1950, pp. 3-79. 3. N.D.C. Lewis, "Studies on Suicide, Part I , Preliminary Survey of Some Significant Aspects of Suicide", Psychoanalytic Review, vol. 20, 1933, pp. 241, 273. 4. C.A. Mil l s , "Suicide and Homicide in Their Relation to Weather Changes". American Journal of Psychiatry, vol. 91, 1934, pp. 669-677. 69. In his monograph Psychopathologie de Suicide. Delmas declares that anxiety is the one condition necessary to cause suicide. Without i t , he holds, there can be no suicide,^" Bermann, a Spanish psychiatrist, interprets the suicide act as a form or revenge against a particular person (usually a relative or lover) or against society as a whole. He suggests that the suicide feels inadequate and, consciously or unconsciously hates the civilization which leaves him with such a feeling. This then breeds a resentment which culminates in suicide. He cites a number of cases with which he has been familiar: children and adolescents who wanted their indifferent parents to experience anquish: a paramour who sought vengeance against a faithless mistress; and a bomb-throwing anarchist who killed himself and others as an expression of revenge against an economic class. B. Psychoanalytic Theories of Suicide.^ Freud's theory of depression, the psychodynamics of which have been outlined in his classic paper Mourning and Melancholia. 1. A.Delmas, "Psychopathologie du Suicide". Medicin, vol. 12,1931, p. 154-160. 2 . Gregorio Bermann, "Suicide as Revenge" (an abstract by G.M. Davidson) Archives of Neurology and Psychiatry, vol. 31, 1934, pp.659-660. 3 . Analytically-oriented writers, when examining the psychogenesis of voluntary death, tend not to distinguish between successful and attempted suicide except in terms of differences in the strength of the death instinct or in the intensity of guilt feelings. They subscribe to the view that the underlying dynamics of successful and attempted suicide differ quantitatively but not qualitatively. The present writer in reviewing the psychoanalytic theories, therefore, make no distinction between these two categories — - v i z . , successful and attempted suicides. 70 and h i s postulation of a death i n s t i n c t provide the framework for h i s psychoanalytic theory of suicide and for i t s modification and extension by other a n a l y t i c w r i t e r s * 1 Z i l b o o r g , summarising Freud's theory of depression, writes: * 0 * I n a case of a pathologic depression the patient, through i d e n t i f i c a t i o n with a person toward whom h i s f e e l i n g s have always been highly ambivalent, loves and hates himself. Since h i s own ego has become h i s love object, he f e e l s detached from r e a l i t y and therefore experiences a sense of poverty of the ego. The unconscious sadism o r i g i n a l l y d i r e c t e d against the object, he f e e l s detached from r e a l i t y and therefore experiences a sense of poverty of the ego. The unconscious sadism o r i g i n a l l y d i r e c t e d against the object, reenforced by a sense of g u i l t , produces the singular phenomenon of the person's becoming s a d i s t i c toward himself. Fiaid himself states: It i s t h i s sadism, and only t h i s , that solves the r i d d l e of the tendency to s u i c i d e which makes melancholia so i n t e r e s t i n g — a n d so dangerous. As the pr,imal condition from which i n s t i n c t - l i f e proceeds we have come to recognize a s e l f - l o v e of the ego which i s so immense, in the fear that r i s e s up at the menace of death we see l i b e r a t e d a volume of n a r c i s s i s t i c l i b i d o which i s so vast, that we cannot conceive how t h i s ego can connive i t s own 1. Bergler has pointed out that psychoanalytic theories concerning s u i c i d e are r e p l e t e with c o n t r a d i c t i o n s , and that t h i s s i t u a t i o n i s , i n large measure, explainable by the f a c t that Freud postulated at d i f f e r e n t times two theories to account for s u i c i d e : the theory of l i b i d i n o u s d r i v e s (the l i f e i n s t i n c t versus the death i n s t i n c t , or the constructive forces versus the destructive f o r c e s ) , and the theory of g u i l t f e e l i n g s because of unconscious aggression. He believes that as a r e s u l t e a r l i e r conceptions have not bean adequately coordinated with l a t e r d i s c o v e r i e s . (Edmund Bergler, "Problems of Suicide", The P s y c h i a t r i c Quarterly Supplement.vol. 20, 1946, pp.261-275) 2. Gregory Z i l b o o r g , " D i f f e n e n t i a l Diagnostic Types of Suicide", Archives of Neurology and Psychiatry, v o l . 35,,1936, p. 275. 71 o d e s t r u c t i o n . It i s true we have long known that no neurotic harbours thoughts of s u i c i d e which are not murderous impulses against other r e - d i r e c t e d upon himself, but we have never been able to explain what in t e r p l a y of forces could carry such a purpose through to execution. Now the a n a l y s i s of melancholia shows that the ego can k i l l i t s e l f only when, the object-cathexis having been withdrawn upon i t , i t can t r e a t i t s e l f as an object, when i t i s able to launch against i t s e l f the animosity r e l a t i n g to an o b j e c t — t h a t primordial reaction on the part of the ego to a l l objects in the outer world. Thus in the regression from n a r c i s s i s t i c object-choice the object i s indeed abolished, but in s p i t e of a l l i t proves i t s e l f stronger than the ego's s e l f . 1 Zilboorg sees s u i c i d e as an archaic form of a u n i v e r s a l response to intra-psychic c o n f l i c t and s t r e s s , a psychobiologic phenomenon whose force i s derived from the s e l f - p r e s e r v a t i o n i n s t i n c t . Through s u i c i d e , he holds, the i n d i v i d u a l achieves fan t a s i e d immortality and fame and an unobstructed r e a l i z a t i o n of hedonistic deals. Z i l b o o r g gives prominence to the features of unconscious h o s t i l i t i e s , s p i t e , i d e n t i f i c a t i o n with a dead person, o r a l incorporation, and marked incapacity to love others. Menninger i s the chief exponent of Freud's concept of the death i n s t i n c t and the a r c h i t e c t of a s e r i e s of t h e o r e t i c a l assumptions attempting to explain the phenomenon of s u i c i d e . He v i s u a l i z e s the act as the r e s u l t of the i n d i v i d u a l ' s destructive 1. Sigmund Freud, Mourning and Melancholia, i n C o l l e c t e d Papers, v o l . 4 (Trans, by Joan R i v i e r e ) , London, The Hogarth Press, 1956, pp. 162-163. 2, Gregory Z i l b o o r g , "Suicide Among C i v i l i z e d and P r i m i t i v e Races", American Journal of Psychiatry, v o l . 92, 1936, pp. 1347-1369. See a l s o Considerations on Suicide with P a r t i c u l a r Reference to that of the Young", American Journal of Orthopsychiatry, v o l . 7, 1937, pp. 15-31. 72. tendencies winning out over the constructive tendencies and he postulates the presence of three components in a l l suicide cases: "the wish to k i l l " , (conscious hate, aggression, blame, elimination, annihilation, and revenge), "the wish to be killed", (conscious guilt feelings, submission, masochism, self-blame, and self-accusation), "the wish to die", (hopelessness, fear, despair, and pain).''' For him attenuated or slow forms of self-destruction are of significance, for they are manifestations of the gradual ascendency of the death instinct over the l i f e instinct. These forms express themselves in asceticism, martyrdom, neurotic invalidism, alcoholism, anti-social behaviour, psychosis, 2 self-^nutilation, malingering, frigidity, and impotence. In his book Man Against Himself Menninger has recapitulated his thesis point by point. The most salient of these follow: ... the best theory to account for a l l the presently known facts is Freud's hypothesis of a death-instinct, or primary impulses of destructive-ness, opposed by a life-instinct or primary impulses of creativeness and constructiveness... ...according to Freud's conception both the destructive and constructive tendencies are originally self-directed but become increasingly extraverted in connection with birth, growth, and l i f e experiences. In his contacts with others, the individual first reacts with extraversion of his aggressive tendencies followed by an extraversion of the erotic or constructive tendencies which by fusion with the former may achieve varying degrees of neutralization of the destructiveness from total to almost none. 1. Karl Menninger, "Psychoanalytic Aspects of Suicide", International  Journal of Psychoanalysis, vol. 14, Part 3 , 1933, pp. 376-390. See also N.L. Farberow and E.S. Shneidman, "Suicide and Age" in Clues to Suicide pp. 41-49. 2. Menninger, Man Against Himself, passim, 73. ... when there i s a f o r c i b l e i n t e r r u p t i o n in these external investments or when too great d i f f i c u l t y i s encountered i n maintaining them, the destructive and constructive impulses revert back upon the person of t h e i r origin;, that i s , are turned back upon the s e l f . ... here again, i f defusion occurs, the destructive tendencies lead and may permanently p r e v a i l so that s e l f - d e s t r u c t i o n to a lesser or greater degree supervenes; and that i n t h i s event one can trace evidences of the wish to k i l l , and the wish to be k i l l e d , and also the e r o t i c i z e d forms of these two wishes. ... i n those instances i n which the s e l f - d e s t r u c t i v e impulses are overtaken and p a r t i a l l y but not completely ne u t r a l i z e d we have the many forms of p a r t i a l or chronic s e l f - d e s t r u c t i o n , i ... i n those instances i n which the s e l f - d e s t r u c t i v e impulses too far precede or exceed the n e u t r a l i z i n g constructive impulses, the r e s u l t i s that dramatic example of immediate s e l f - d e s t r u c t i o n known as su i c i d e . ... the close scrutiny of the deeper motives for s u i c i d e would confirm t h i s hypothesis i n that there appear r e g u l a r l y to be elements from at l e a s t two and possibly three sources. These are, (1) impulses derived from the primary aggressive-ness c r y s t a l l i z e d as a wish to k i l l , (2) impulses derived from a modification of the p r i m i t i v e aggressiveness, the conscience, c r y s t a l l i z e d ss the wish to be k i l l e d , and (3) I believe there i s evidence that some of the o r i g i n a l primary s e l f -d i r e c t e d aggressiveness, the wish to d i e , j o i n s hands with the more sophisticated motives and adds to the t o t a l v e c t o r i a l force which impels the p r e c i p i t a t e s e l f - d e s t r u c t i o n . Read and Pollack are other wr i t e r s who accept the Freudian theory. Read a l s o stresses the factor of the suicid e ' s unconscious 1. Menninger, Man Against Himself, pp. 71-72. 74 expectation of an eternal union with a l o s t loved one or with God and of h i s fantasy of being, thereby, i n harmony with the i n f i n i t e , 1 while Pollack adds that i n s t a b i l i t y of mood and 2 d i f f i c u l t y i n sexual adjustment occurs frequently. Like Z i l b o o r g , O'Connor emphasizes the aspect of immortality, suggesting that s u i c i d e i s a reversion to an early state of "power-narcissism" wherein omnipotence i s achieved. Jamieson looks to excessively strong s e l f - l o v e and aggressiveness as the prime psychodynamic determinants of s e l f - d e s t r u c t i o n and r e l a t e s them to the regressive and immature tendencies of 4 an i n f a n t i l e p e r s o n a l i t y . Palmer, too, stresses early influences b e l i e v i n g that the basic cause i n the majority of sui c i d e attempts i s an arrested psychosexual development — an arr e s t due usually to the absence of parents (through death or separation) at c r u c i a l stages i n the i n d i v i d u a l ' s e a r l y l i f e . He contends that while s p i t e i s frequently present, i t i s a r a t i o n a l i z a t i o n unconsciously devised to disguise developmental 5 defects of the psychic apparatus. 1. C.S. Read, "The Problem of Suicide", B r i t i s h Medical Journal, v o l . 1, 1936, pp. 631-634. 2„ Benjamin Pollack, "A Study of the Problem of S u i c i c e " , P s y c h i a t r i c  Quarterly, v o l , 12, 1938, pp. 306-330. 3. W.A, O'Connor, "Some Notes on Suicide", B r i t i s h Journal of  Medical Psychology, v o l . 21, 1948, pp, 222-228. 4. Gerald R. Jamieson, "Suicide and Mental Disease: A C l i n i c a l A n a l y s i s of One Hundred Cases", Archives of Neurology and Psychiatry, v o l . 36, J u l y 1936, pp. 1-11. 5. D.M. Palmer, "Factors in Suicide Attempts: A Review of Twenty-Five Consecutive Cases", Journal of Nervous and Mental Disease, v o l 0 93, 1941, pp. 421-442.. 75, On the basis of t h e i r study of s u i c i d a l tendencies in c h i l d r e n , Bender and Schilder a r r i v e at what they term a "preliminary formulation": Suicide for the c h i l d i s an attempt to avoid a f r u s t r a t i n g and i n t o l e r a b l e s i t u a t i o n , a s i t u a t i o n c o n s i s t i n g of the deprivation (or the assumption of deprivation) of love. Aggressive f e e l i n g s are i n c i t e d , arousing g u i l t and the aggressive-ness i s turned inward. These f e e l i n g s may be i n t e n s i f i e d by c o n s t i t u t i o n a l f a c t o r s , by i d e n t i f i c a t i o n with an aggressive parent, or by both. The s u i c i d a l attempt a l s o c o n s t i t i t e s a r e t a l i a t i o n against the s o c i a l m i l i e u , and a way of securing more love. The s u i c i d a l death represents a reunion with the love object, l i v i n g or dead. 1 Schechter, examining the motivational f a c t o r s in children and adolescents, o f f e r s conclusions which are in substantial agreement with the f i n d i n g s of Bender and S c h i l d e r . He i s p a r t i c u l a r l y impressed with the aspect of a r e a l or threatened l o s s of a love object, considering i t to be 2 the primary dynamic. Fenichel's theory of s u i c i d e has been restated in an abridged form by Jackson: Fenichel extends Freud's ideas, s t a t i n g , in essence, that suicide i s the outcome of a strong ambivalent 1. Lauretta Bender and Paul S c h i l d e r , " S u i c i d a l Preoccupation and Attempts in Children", American Journal of Orthopsychiatry, v o l . 7, 1937, pp. 225-234. 2. M. D. Schechter, "The Recognition and Treatment of Suicide in Children," in Clues to Suicide, p. 141. 7 6 . dependence on a sadistic superego and the necessity to get rid of an unbearable guilt tension at any cost. He mentions that the desire to live means to feel a certain self-esteem, and to feel supported by the protective forces of the superego. When this feeling vanishes the original feeling of annihilation which the individual experienced as the deserted, hungry baby reappears. Since the superego is made up of introjects which represent incorporated love objects, suicide involves the murder of the original object whose incorporation helped to create the superego. Along with the self-murder goes the hopeful illusion that forgive-ness and reconciliation will be attained by the killing of the punishing superego and the regaining of union with the protective superego. Garma emphasized two components: loss of a vitally important libidinous object and aggression secondarily turned against the ego. The act becomes for the suicide a method of regaining the lost object and a way of liberating himself from a hostile en^ vironment. He adds that hereditary constitution is a factor of 2 paramount importance. Bergler in his paper Problems of Suicide advocates the differentiating of suicide types on a three-fold basis — the "introjection type", the "hysteric type", and "miscellaneous types". Of the first he writes: ...The suicide of the introjection type is a person labouring under the deepest feeling of guilt because of his over-dimensional psychic masochism. To counteract this reproach, pseudo-aggression is 1 . Otto Fenichel, The Psychoanalytic Theory of Neurosis,. Mew York, W6W. Norton and Co., 1 9 4 5 , PP. 4 0 0 - 4 0 1 . Cited in Don D. Jackson "Theories of Suicide", in Clues to Suicide, pp.11-12. 2 , A. Garma, "Sadism and Masochism in Human Conduct", (Part 1 1 ) Journal of Clinical Psychopathology and Psychotherapy, vol, 6 , 1 9 4 4 , PP. 3 5 5 - 3 9 0 . 77. m o b i l i z e d — t h e fantasy of the k i l l i n g and disappointex. The disappointment i s always self-provoked, by choice of, and attachment t o , the disappointing person. The f e e l i n g of g u i l t i s s h i f t e d from the masochist act to a pseudo-aggressive one. 1 The second type, the h y s t e r i c , i s characterized by what he terms "negative magic gestures" of an unconscious dramatization of how one does not want to be treated, coupled with an i n f a n t i l e misconception of a death which lacks f i n a l i t y . The t h i r d type, the miscellaneous, i s composed of other s u i c i d e s such as those who project t h e i r superegos outwardly and hear voices d i r e c t i n g them to k i l l themselves. Bergler i s of the opinion that the d e c i s i v e factor in s u i c i d e i s not the overwhelming i n t e n s i t y of g u i l t f e e l i n g s but rather the defusion of i n s t i n c t s leaving the death i n s t i n c t no longer attenuated by the 2 l i f e i n s t i n c t . Moss and Hamilton f i n d three c o - e x i s t i n g unconscious and p a r t i a l l y conscious determinants of the s u i c i d e a c t : f i r s t , an expectation of greater impending s a t i s f a c t i o n taking the form of an eternal reunion in death with a loved one, the f o r c i n g of consideration or g r a t i f i c a t i o n otherwise unattainable from the s o c i a l environment, or the pleasure of s p i t e or r e t r i b u t i o n ; 1. Edmund Bergler, "Problems of Suicide", P s y c h i a t r i c Quarterly  Supplement, v o l . 20,.Part 2, 1946, pp. 265-266. 2. Bergler, P s y c h i a t r i c Quarterly Supplement, v o l , 20, 1946, pp, 261-275, 78. secondly, h o s t i l i t y d i r e c t e d toward prominent persons upon whom censure was placed f o r present f r u s t r a t i o n which because of anxiety became s e l f - d i r e c t e d ; t h i r d , an expression of f u t i l i t y and despair and an abandoning of any promise of improvement in 1 present circumstances* In h i s review of su i c i d e theories, both psychoanalytic and non-psychoanalytic, Jackson suggests that the underlying motives of the act can be reduced to three basic ones: (1) S e l f - d i r e c t e d aggression. This category may or may not include the concept of a death i n s t i n c t . It does include p a r t i a l s u i c i d e , such as multiple operations, accident proneness, and so f o r t h . (2) Rebirth and r e s t i t u t i o n . A u t h o r i t i e s who discuss s u i c i d e i n c h i l d r e n and i n schizophrenics are e s p e c i a l l y apt to mention the concept of doing away with the "bad me" in order to make a new beginning. Events ranging from running away from home to departing from l i f e represent a continuum which includes the sorrow of those l e f t behind and the joy of f i n d -ing someone who r e a l l y cares. (3) Despair, l o s s of self-esteem, and the r e a l or imagined l o s s of the love object. Many experts... point t o the l o s s of something that precedes a s u i c i d e . There may be the l o s s of health or f a c i l i t i e s as in malignant cancer or o l d age; or the kind of l o s s that occurs i n ...drop of s o c i a l status or prestige, or the l o s i n g of a mate... 2 3. A C r i t i c a l A p p raisal of the Psychoanalytic Theories of Suicide. Psychoanalytic theories of su i c i d e are subject to a number of j c r i t i c i s m s . F i r s t , there i s the question of the t e n a b i l i t y of the theory of the death i n s t i n c t . The t h e s i s that suicide r e s u l t s when aggressive impulses are turned inwardly against the 1. Leonard Moss and Donald Hamilton, "Psychotherapy of the S u i c i d a l Patient", American Journal of Psychiatry, v o l . 112, 1956, pp. 814-820. 2. Don D« Jackson, "Theories of Suicide", in Clues to Suicide, p. 15. 79. self, (when Thanotos, the death instinct, masters Eros, the l i f e instinct) is popular in clinical circles. The formula, skilful and original as i t i s , fails to establish a definite clinical or even theoretical criterion which adequately explains suicide* The formula may be fundamentally correct but i t is too general to be of any real value, for according to i t every individual in the world is in danger of taking his l i f e . The death instinct theory as an element in Freudian metapsychology and as an explanatory pivotal point i s , in its application to suicide, tautological, for to say that the death instinct gains the upper hand over the l i f e instinct is merely an elaborate way of saying that the individual does injure or k i l l himself. Perhaps an equally important criticism of the theory is that the only evidence for the presence of the cause of suicide, i.e. the death instinct, is the occurrence of its effect, i.e., death. »Secondly, there has been a failure on the part of theorists to distinguish qualitatively between suicide and attempted suicide. Analytic writers have tended to theorize on the assumption that the psychodynamic factors operative in the two forms of suicide are the same, that consummated suicide is simply an exaggerated form of attempted suicide. There is evidence however, to support the view that this is not the case, that successful and unsuccessful suicides often represent different kinds of acts and different motivations. Thirdly, there has been a characteristic disregard evident in most of the psychoanalytic literature for the part played in personality processes by social and cultural 80. f a c t o r s 1 and an i n c l i n a t i o n to view s o c i a l disorganization as an 2 extension of personal d i s o r g a n i z a t i o n . The model offered by a n a l y t i c w r i t e r s to explain the causes of s e l f - d e s t r u c t i o n i s p r i m a r i l y a bio-psychological one and excludes a consideration 3 of those determinants emanating from the s o c i a l s t r u c t u r e . Conspicuously absent, for example, i n psychoanalytic theories of suicide i s any attempt to account for the en masse voluntary deaths of persecuted ethnic or r a c i a l groups such as the Jews during World War I I , for the drowning in maritime d i s a s t e r s of those who, ref u s i n g rescue, choose to remain at the side of a loved one who must, by reason of c h i v a l r y , custom or pro t o c o l , go down with the ship, and for the s e l f - i n f l i c t e d death of the spy who takes a capsule of poison upon threat of capture. F i n a l l y , and probably the most fundamental c r i t i c i s m of the psychoanalytic theories of sui c i d e i s the question of the s c i e n t i f i c v a l i d i t y of psychoanalytic concepts. The methodology of a n a l y t i c i n v e s t i g a t i o n i s unsound. There i s a marked lack of substantiation of conclusions by v e r i f i e d d a t a , a dependence on u n r e l i a b l e anecdotal evidence, an almost t o t a l want of 1. Notable exceptions are to be found i n the writings of Fromm, Horney, H.S. S u l l i v a n and Kardiner. 2. A paper which examines the r e l a t i o n s h i p between these two forms of disorganization i s Herbert Blumer's " S o c i a l Disorganization and Individual Disorganization", American Journal of Sociology,vol, 42:2, 1937, pp. 871-877. 3. Zilboorg c a t e g o r i c a l l y denies the v a l i d i t y of the s o c i o l o g i c a l approach and r e f e r s to sui c i d e s t a t i s t i c s as "well nigh useless". American Journal of Orthopsydtfetry, v o l . 7, 1937, pp. 18-20. Menninger r e f e r s only i n c i d e n t a l l y to the major s o c i o l o g i c a l works on s u i c i d e . (Man Against Himself, 1938) 81. experimental evidence, and an i n d i f f e r e n c e to the use of c o n t r o l groups. There i s an overgeneralization of conclusions and a couching of statements of hypotheses in such an obscure, complex, and ambiguous manner that^he a p p l i c a t i o n of a process of s c i e n t i f i c a l l y proving or disproving becomes extremely d i f f i c u l t . 1 F a c i l e and even dramatic exposition may come to serve as a veneer 2 i n the absence of c l i n i c a l l y documented, corroborative f a c t s . These c r i t i c i s m s of the psychoanalytic theories of s u i c i d e apply (with the exception of the f i r s t ) i n some diminished form to the non-psychoanalytic t h e o r i e s . Psychoanalytic concepts are u s e f u l , however, i f used as " s e n s i t i z i n g " rather than d e f i n i t i v e concepts. S e n s i t i z i n g 3 concepts or instruments lack precise reference, s p e c i f i c a t t r i b u t e s and clean-cut i d e n t i f i c a t i o n . They r e s t on a general sense of relevancy, are amenable to improvement and refinement, and serve to sharpen perception and to stimulate imagination and diagnostic s k i l l s . 4. Attempted Suicide. Students of s u i c i d e have tended to formulate dynamic 1. The same c r i t i c i s m s apply to the methodology of psychoanalytic investigations in other areas such as the meaning of r e l i g i o n to the i n d i v i d u a l and the s o c i a l i z a t i o n of the c h i l d , 2. For a more complete and d e t a i l e d c r i t i q u e of psychoanalytic theory see Read Bain, "Sociology and Psychoanalysis", American S o c i o l o g i c a l  Review, v o l . 1:2, 1936, pp. 203-220, H.J. Eysenck, Uses and Abuses of Psychology, Harmondsworth, Penguin Books Ltd., 1959, (Chapter 12), E r i c h Fromm, Sigsmmnd Freud's Mission, New York, Harper and Brothers, 1959, ( e s p e c i a l l y Chapter 10). For a c r i t i c i s m of s o c i a l theory — a c r i t i c i s m a p p l i c a b l e in many respects to psychoanalytic theory — see Herbert Blumer, "What i s Wrong With S o c i a l Theory?", American S o c i o l o g i c a l  Review, v o l . 19:1, 1954, pp. 3-10. 3. The term i s Blumer's. I b i d . 82. theories by extrapolation — from what has been learned i n c l i n i c a l studies of patients who have attempted su i c i d e — on the i m p l i c i t assumption that those who take t h e i r own l i v e s and those who attempt to take t h e i r own l i v e s are but one group. A number of recent w r i t e r s , however, have offered data to support the view that the psychodynamic patterns i n many s u i c i d a l attempts are quite d i f f e r e n t from the patterns i n successful s u i c i d a l a c t s . In t h e i r monograph e n t i t l e d Attempted Suicide, I t s S o c i a l  S i g n i f i c a n c e and E f f e c t , 1 Stengel, Cook and Kreeger report the fi n d i n g s of in v e s t i g a t i o n s they recently c a r r i e d out in London. They studied f i v e groups of attempted suicides composed of 630 successive admissions to three d i f f e r e n t types of London h o s p i t a l s over c e r t a i n periods of time and one c o n t r o l l e d group c o n s i s t i n g of 117 suicides on whom there were coroner's r e p o r t s . They then conducted p s y c h i a t r i c and s o c i a l work follow-up interviews using a comprehensive scheme which yielded much d e t a i l e d information. Drawing on t h i s information and on the medical and psychiatric data obtained while the persons had been i n h o s p i t a l , Stengel, Cook and Kreeger conclude that the sui c i d e and the attempted su i c i d e c o n s t i t u t e two d i f f e r e n t though overlapping types and that the attempted s u i c i d e has d i s t i n c t i v e c h a r a c t e r i s t i c s and functions which r e f l e c t a d i s c e r n i b l e pattern of s o c i a l behaviour. They repudiate the theory that the s e l f - d e s t r u c t i v e tendency i s the primary motivating for c e leading to attempted suicide on the basis 1. Stengel, Cook, and Kreeger, Attempted Sui c i d e . 83 that (a) comparatively few persons who make s u i c i d a l attempts l a t e r k i l l themselves and (b) among those who attempt s u i c i d e only a minority have t r i e d i t before. They hold that c e r t a i n s o c i a l f a c t o r s and features must be considered in order to understand the s i g n i f i c a n c e of the s u i c i d a l attempt. F i r s t , i s the "appeal function" — a function consciously or unconsciously inherent in most, i f not a l l , attempts at s u i c i d e . The i n d i v i d u a l does not wish death, nor does he expect to d i e , but rather he seeks to manipulate the community and to receive i t s attention and sympathy. Secondly, there i s the "ordeal character" of the s u i c i d a l attempt. By t h i s i s meant an urge in the person to challenge f a t e and h i s w i l l i n g n e s s to accept the outcome of the a c t , i . e . , s u r v i v a l , without demure — i n short, a gamble which proves to be an ordeal but which must be undertaken. T h i r d l y , there are the s o c i a l e f f e c t s of the attempt: i t s profound consequences for the i n d i v i d u a l such as the a n x i e t i e s accompanying admission to h o s p i t a l , and the r e l a t i o n s h i p , often strained, with family and f r i e n d s . In c l o s i n g , the authors again emphasize that the underlying motives for suicide and attempted s u i c i d e must be d i f f e r e n t i a t e d . They write: . . . i f we want to treat a l l who commit s u i c i d a l acts as one population, we must r e a l i z e that i t i s a population of people who have made s u i c i d a l attempts with a minority who have k i l l e d themselves. To make the f a t e of that minority the condition of f u l l membership of that population, and to tr e a t the majority as i n f e r i o r members, i s impermissible. 1 The f i n d i n g s of Weiss reported in h i s paper "The Gamble 1. I b i d . , p. 130. 84 With Death i n Attempted Suicide", are s i m i l a r to those of Stengel, Cook and Kreeger. He emphasizes the aspects of manipulation of the extrapsychic environment as an accessory function of attempted s u i c i d e , and the a f f i n i t y of the psychodynamic f a c t o r s involved with those of gambling. Holding that h i s conclusions are substantiated by c l i n i c a l evidence derived from personal interviews with 156 h o s p i t a l p a t i e n t s , Weiss writes: ...attempts can be categorized i n three c l a s s e s ; (1) aborted successful s u i c i d e s , i n which the attemptor t r u l y intended to end l i f e and was cer t a i n that he would die as a r e s u l t of h i s ac t i o n , (2) true s u i c i d a l attempts, i n which the attemptor thought that he might die as a r e s u l t of h i s action but was not c e r t a i n , and (3) s u i c i d a l gestures, i n which the attemptor was ce r t a i n that he would not d i e as a r e s u l t of hi s a c t i o n . From the data now a v a i l a b l e , the psychodynamics of the aborted successful s u i c i d e appears to be similar to or i d e n t i c a l with the dynamics of the completed successful s u i c i d e . The dynamics of the s u i c i d a l gesture are r e l a t e d p r i m a r i l y to the need to influence someone to do something, and not to the intention to end l i f e . The dynamics of the true s u i c i d a l attempt are complicated, and involve i n a l l cases a discharge of s e l f - d i r e c t e d aggressive tendencies through a gamble with death (of varying l e t h a l p r o b a b i l i t y ) , i n most cases an appeal for help, and i n some cases a need for punishment and a t r i a l by o r d e a l , 1 The in v e s t i g a t i o n s of others support many of the conclusions a r r i v e d at by Stengel et a l and by Weiss. Schmidt, O'Neal, and Robins made a c l i n i c a l and follow-up 1. James M.A. Weiss, "The Gamble With Death i n Attempted Suicide", Psychiatry, v o l . 20, 1957, p. 25. 85. study of 1 0 9 persons who, having unsuccessfully attempted suicide, were brought to a general hospital in St. Louis. These investigators believed i t important to distinguish between the serious attempt and the "gesture" attempt. Establishing criteria for this differentiation and classifying the patients accordingly, they found 3 5 to be serious and 7 4 to be gesture,''' A follow-up eight months later revealed that only two of the 1 0 9 patients successfully committed suicide after the 2 i n i t i a l unsuccessful attempt. The psychiatric and medical data on 2 3 7 cases of attempted suicide in Malmo, Sweden were examined by Dahlgren who, following them up two to seven years later found that fourteen had successfully taken their 3 lives, 5 , Clinical Correlates of Suicide, There are a number of studies reported in the psychiatric literature on the subject of suicide which are concerned neither with the formulation of theories of causation 1 , The investigators diagnosed two-thirds of the 1 0 9 persons as suffering from some psychopathological condition or another. There was no evidence to indicate that seriousness of intent was related to the absence or presence of mental disorder. 2 , Edwin H. Schmidt, Patricia O'Neal, E l i Robbins, "Evaluation of Suicide Attempts as Guide to Therapy, Clinical and Follow-Up Study of One Hundred Nine Patients", Journal of the American  Medical Association, vol. 1 5 5 s i , 1 9 5 4 , PP 5 4 9 - 5 5 7 . 3 , K,G, Dahlgren, On Suicide and Attempted Suicide. Lu.nd, 1 9 4 5 , cited in Stengel et a l . , Attempted Suicide, pp. 1 9 - 2 1 86, nor with the s p e c i a l and d i f f e r e n t i a t i n g c h a r a c t e r i s t i c s of attempted s u i c i d e . Rather, they are concerned with such aspects as p s y c h i a t r i c c l a s s i f i c a t i o n , the c o r r e l a t i o n of the psy-choanalytic concepts accounting for sui c i d e motives i n i n d i v i d u a l s to p s y c h i a t r i c c l a s s i f i c a t i o n , the methods of se l f - d e s t r u c t i o n and t h e i r s i g n i f i c a n c e for intent and success, the r o l e of alcoholism i n s u i c i d e , the problem of s u i c i d e i n old age and prodromal aspects (warning symptons). A. P s y c h i a t r i c C l a s s i f i c a t i o n s of S u i c i d a l Persons, Lendrum, examining data on 1000 consecutive cases of attempted suicide (363 men and 637 women) admitted to a general h o s p i t a l i n Detroit between 1927 and 1930, found that 234 were c l e a r l y p s y c h i a t r i c a l l y c l a s s i f i a b l e and that in these 234 alcoholism and psychopathic personality were the commonest diagnoses made.1 Jamieson reviewed the c l i n i c a l records of 100 patients who committed suicide a f t e r being discharged from mental h o s p i t a l s i n New York State. He found that the commonest diagnostic grouping by far was manic-depresive psychoses (46 persons) with i n v o l u t i o n a l melancholia and "schizophrenic-paranoidal" conditions (19 and 15 persons) 2 r e s p e c t i v e l y coming next. Piker analyzed the medical and p s y c h i a t r i c records of 1817 persons who attempted suicide in C i n c i n n a t t i and were brought to a general h o s p i t a l . He 1. Frederick C. Lendrum, "A Thousand Cases of Attempted Suicide", American Journal of Psychiatry, v o l . 13, 1933, pp. 479-500. 2. -\ Jamieson, Arch. Neuro. Psychiat. v o l , 36, 1936, pp. 1-11. 87. believed only about seven per cent of the cases could be properly classified as psychotic,"*- Pollack's study of 51 suicides and attempted suicides showed that the largest number occurred among cases of schizophrenia with manic-depressive psychosis and 2 involutional melancholia following in order of decreasing frequency. In his study of 33 patients who committed suicide either while in mental hospital or within a year after discharge, Wall found the highest proportion to be suffering from manic-depressive psychosis with 3 schizophrenic psychosis the next highest. Levy and Southcombe examined nation-wide suicide statistics and the records of the Eastern State Hospital, Washington, and report two interesting findings; the incidence of suicide in institutions is twenty-eight times greater than among the general population, and of the fifty-eight patients who took their lives in the Hospital since its opening in 1891 twenty^nine has been diagnosed as schizophrenics (mainly \ 4 of the paranoid type; and eleven as manic-depressives, Schmidt, O.'Neal and Eobiiis in the St. Louis study (already referred to) found that the clinical entities in the order of their most frequent occurence were manic-depressive depression, dementia, psychopathic 1. Philip Piker, "Eighteen Hundred and Seventeen Cases of Suicidal Attempt; A Preliminary Statistical Survey", American Journal of  Psychiatry, vol, 95:1, 1938, pp 97-105. 2. Pollack. Psychiat. Quart, vol.. 12, 1938, pp 306-330. 3. J.H.Wall, "The Psychiatric Problem of Suicide", American Journal  of Psychiatry, vol. 101, 1944, pp. 404-406. 4. Sol Levy and R.H. Southcombe, "Suicide in a State Hospital for The Mentally 111", Journal of Nervous and Mental Disease, vol.117,1953, pp. 504-514* 88 per s o n a l i t y , chronic alcoholism, h y s t e r i a and schizophrenia. These inve s t i g a t o r s a l s o r e l a t e d diagnoses to the degree of seriousness of intent and found that those s u f f e r i n g from manic-depressive disord e r s , dementia and h y s t e r i a could be c l a s s i f i e d as serious i n t h e i r intent to d i e , while those s u f f e r i n g from chronic alcoholism and psychopathy could be c l a s s i f i e d as not serious in th e i r i n t e n t . 1 The question of whether the suicide act per se i s an i n d i c a t i o n of mental disorder has been discussed by a number of wri t e r s without consensus. It would seem a matter of semantics rather of substance and w i l l probably remain unsettled as long as there i s no agreement about the d e f i n i t i o n of "normal" and "abnormal" conditions of mind. B. Motivational Determinants and C l i n i c a l C l a s s i f i c a t i o n . In h i s paper e n t i t l e d "The Psychodynamic Motivational Factors in Suicide", Hendin reports h i s grouping of 100 would-be suic i d e patients at Bellevue P s y c h i a t r i c Hospital in New York C i t y on the basis of s i m i l a r i t i e s i n c l i n i c a l and psychodynamic f i n d i n g s . He writes:. The main groupings ... were: 1. Those with s p i t e or desir e to force love as a dominant motive, (a) The r e a c t i v e depression -g r o u p — p r i m a r i l y lovers' quarrels with low s u i c i d a l intent; (b) The character disorder group, with minimal intent and an attempt to manipulate the environnvetft. 2. Loss of loved object, (a) The neurotic group unsuccessfully seeking re-establishment of necessary object attachment; (b) The passive dependent, e l d e r l y group. 3. G u i l t , (a) Predominantly the schizophrenic group. 2 1. Schmidt et a l , J . American Med. As., v o l . 155:1, 1954, pp. 544-557. 2. Herbert Hendin, "Psychodynamic Motivational Factors i n Suicide", The P s y c h i a t r i c Quarterly, v o l . 25, 1951, pp. 672-677. 89 C. The Methods of Self-Destruction and Their S i g n i f i c a n c e , Lendrum*s examination of the methods used in a l l known successful suicides in Detroit over a four year period indicates that the methods i n order of effectiveness were poisons, asphyxia, firearms, and hanging. Noting that men are more successful than women i n k i l l i n g themselves but that women have a higher incidence of unsuccessful attempts, Lendrum o f f e r s the I •is : explanation that the mechanical methods employed by men such as shooting or hanging are more dangerous, whereas the methods of women include the use of r e l a t i v e l y innocuous household poisons such as iodine and merchurochrome. He r e j e c t s the theory that the d i f f e r e n c e i n successful s u i c i d e rates between the sexes i s 1 due to a dif f e r e n c e in the degree of i n t e n t . Jamieson divide s the methods of sui c i d e into " a c t i v e or aggressive" ( i . e . , hanging, jumping, and shooting) and "passive or receptive" ( i . e . , poisons and drowning) and f i n d s an equal proportion of men and women in h i s two categories. He suggests that conscious determinants i n choice of method such as suggestion and a v a i l a b i l i t y of means are as important as the unconscious determinants such as 2 symbolisms. Stengel, Cook, and Kreeger demonstrate that the degree 3 of intent and the dangerousness of method are p o s i t i v e l y correlated 1. Lendrum, Amer. J . Psychiat. v o l . 13, 1933, pp. 479-500. 2. Jamieson, Arch. Neuro, Psychiat., v o l . 36, 1936, pp. 1-11. 3. Stengel et a l , Attempted Sui c i d e , p. 113. 90. and that failure in the attempts of women can most often be related to the slight degree of intent and relative harmlessness of method.^ In addition to the 100 cases mentioned earlier, Hendin analyzed the data on another 500 patients in the same hospital who had attempted suicide* Examining the difference in rate of attempts between men and women, he concludes that intent is of greater 2 importance than method in determining success or failure. D. Alcoholism and Suicide. Batchelor reviews 200 consecutive cases of attempted self-destruction admitted to a general hospital in Edinburgh in the years 1950-1952. His findings and the conclusions he draws from 3 them are outlined in his paper "Alcoholism and Attempted Suicide". Concerning his findings, he writes: A family history of alcoholism in first-degree relatives was found in 28.5 per cent. Many of the subjects came from homes "broken by parental alcoholism. 19.5 per cent of the cases were under the influence of alcohol at the time of their suicidal attempt. Forty-three (21,5 per cent.) of the cases gave a personal history of excessive drinking. , ... A further 16 (18 per cent) individuals who were under the influence of alcohol at the time of their suicidal attempts, were not pathological drinkers. 1. IbicU. p. 89 and p. 98. 2. Herbert Hendin, "Attempted Suicide", Psychiatric Quarterly, vol. 24, 1950 pp. 39-46. 3. Few papers in the literature deal entirely with the relationship between suicide and alcoholism. This one i s an exception. 4. I.S.C. Batchelor, "Alcoholism and Attempted Suicide", Journal of  Mental Science , vol, 100, pp. 451-461. 91, His conclusions follow: (a) Though r a r e l y wholly or mainly the cause of a s u i c i d a l attempt, alcoholism i s a s i g n i f i c a n t f actor in about 30 per cent, of these a c t s , and in men about twice as often as in women. (b) Parental alcoholism d i s r u p t i n g the home, may contribute to the personality disorders which r e s u l t i n s u i c i d e . (c) Alcoholism and s u i c i d e have frequently s i m i l a r or i d e n t i c a l psychopathological bases. Alcoholism may be a f r a c t i o n a l s u i c i d e , prepare the way for s u i c i d e , or provide a s u b s t i t u t e . (d) Alcoholism may f a c i l i t a t e a s u i c i d a l attempt by r e l e a s i n g i n h i b i t i o n s : and i t may also render i t l e s s e f f e c t i v e . Such attempts, though often impulsive, are often also serious. (e) A r e l a t i v e l y small amount of alcohol i s more potent i n t h i s than a large excess. ( f ) The "chronic a l c o h o l i c " does not t y p i c a l l y commit s u i c i d e . Sufferers from psychopathic and depressive states who repeatedly abuse a l c o h o l , frequently attempt or commit s u i c i d e : the intermittency o f t h e i r drinking may expose them more to the stress of i n t o l e r a b l e c o n f l i c t s . 1 £. Suicide and the Aged. In h i s discussion of the association of suicide o with o l d age based on h i s and h i s co-worker's f i n d i n g s and on 3 those of O'Neal, Robins, and Schmidt, Batchelor points out that i n t h i s age group su i c i d e and attempted s u i c i d e f a l l i n t o s i m i l a r i f not i d e n t i c a l c l i n i c a l categories, for an attempt i s , he believes, 1. Ibid.„ 2. I.R.C, Batchelor and M.B. Napier, "Attempted Suicide in Old Age", B r i t i s h Medical Journal, v o l . 2, 1953,.pp. 1186-1190. 3, P. O'Neal, £. Robins and E.H. Schmidt, "A P s y d l a t r i c Study of Attempted Suicide i n Persons Over Sixty Years of Age", Archives of Neurology and Psychiatry, v o l . 75, 1956, pp. 275-284. 92. r a r e l y a gesture or threat but an act which has f a i l e d for reasons other than seriousness and determinations He contends that the majority of the s u i c i d a l aged are s u f f e r i n g from psychoses — usually from the depressive phase of manic-depressive psychosis, and that some of the co-existing features of insomnia, tension, a g i t a t i o n , hypochondriacal complaints, delusions of poverty, and fear of f a t a l i l l n e s s or of in s a n i t y are usually present, Batchelor believes that ph y s i c a l i l l n e s s and p a r t i c u l a r l y degenerative disease i s the major p r e c i p i t a t i n g f a c t o r serving to diminish c o n t r o l over behaviour, to diminish resistence to s t r e s s and to enhance brooding and excessive i n t r o s p e c t i o n . He a l s o recognizes the s i g n i f i c a n c e of s o c i a l f a c t o r s , holding that the mental i l l n e s s (in i t s e l f not a s u f f i c i e n t explanation for s u i c i d e ) , cannot be divorced l i f e circumstances. In p a r t i c u l a r , he sees as the important p r e c i p i t a t i n g f a c t o r s f e e l i n g s of l o n i i n e s s , l o s s of a loved one, retirement from employment, changed domestic circumstance, and f i n a n c i a l w o r r i e s . 1 F. Prodromal Aspects of Suicide. A number of writers have given prominence in t h e i r i n v e s t i g a t i o n s to the prodromal or warning symptoms aspects of s u i c i d e . Jamieson and Wall studied the case records of tWBnty-five patients who committed suicide in a New York State mental h o s p i t a l 1. I.R*C. Batchelor, "Suicide i n Old Age", in Clues to Suicide, p. 143-151. 93. over a twenty year period. They concluded that by the observation of c e r t a i n pre-raonitory signs the incidence of sui c i d e couldwbe appreciably reduced. These signs are: (1) Severe hypochondriacal and n i h i l i s t i c ideas, with veiled death wishes in the trend, (2) Insomnia; not the actual sleeplessness i t s e l f but the apprehension and agony concerning i t s possible e f f e c t s . (3) Persistent b e l i e f i n l o s i n g control of oneself, of "going insane," and analogous ideas. (4) Sense of g u i l t with persistent b e l i e f and concern about punishment, e s p e c i a l l y by torture of one kind or another. (5) Evidence of aggressiveness as indicated by s u r l y , impatient, and i r r i t a b l e a t t i t u d e s together with a s s a u l t i v e tendencies. 1 Fairbanks looks for depression, r i g i d , p ersonality, disap-pointments over seemingly unmodifiable s i t u a t i o n s , and a family h i s t o r y of sui c i d e which, she be l i e v e s , lessen resistance to the 2 idea. Davidson in h i s s e r i e s notes expressions of g u i l t , un~ worthiness, " f u l f i l l m e n t of one's destiny", disillusionment • 3 and i n s e c u r i t y following the l o s s of a loved one. Drewry reports that he i s e s p e c i a l l y mindful of the signs of depression, insomnia, 4 g u i l t , past h i s t o r y of attempts and statements of death wishes. Raphael, Power and Berridge interviewed 3021 students over a f i v e -year period at the mental hygiene service of the University of 1. Gerald R, Jamieson and James H, Wall, "Some P s y c h i a t r i c Aspects of Suicide," P s y c h i a t r i c Quarterly, v o l . 7, 1933, p. 228. 2. R.E. Fairbanks, "Suicide," Journal of American Medical A s s o c i a t i o n , v o l . 98, 1932, pp. 1711-1714.. 3. G.M. Davidson, "The Mental State at the Time of Suicide", P s y c h l a t r i c  Quarterly Supplement, v o l . 15, 1941, pp. 41-50, 4. P.H. Drewry J r . , "Some Aspects of Suicide", V i r g i n i a Medical  Monograph, v o l . 69, 1942, pp. 252-256. ^ 9 4 o Michigan and found that in some 313 the p o s s i b i l i t y of suicide could not be overlooked. They described the student with s u i c i d a l tendencies as ov e r - s e n s i t i v e , shy and self-conscious, anxious, d e l i c a t e l y balanced from the emotional standpoint, and immature in under standing and judgment• 1 1, Theophile Raphael, Sadye Power, and Lloyd Berridge, "The Question of Suicide as a Problem in College Mental Hygiene," American Journal of Orthopsychiatry, v o l . 7, 1937, pp. 1-14. Chapter 4. Implications for Social Policy and Services 1. An Outline for the Strategy of a Mental Health Programme. A. The Findings of Sociological and Psychological Studies. Sociological studies strongly suggest that suicide is the outcome of a failure in the operation of the mechanisms of social control and that i t is an indication of a state of social disorganization. Such disorganization, badly manifesting itsel f in the prevailing conditions of so cial isolation, detachment, diminished group solidarity, freedom from social control, anomie and rootlessness, enhances the probability of suicide. Research findings" have empirically borne out the association of suicide with social disorganization. The contrast between the low rates associated with agricultural regions and stable isolated religious groups and the high rates in industrial urban regions furnishes one important confirmation. Mother is the association of low rates with family l i f e and the presence of children. Further substantiation is given by the increase of the suicide rate in those countries undergoing the process of industrialization. Occupational data, while not as easy to interpret, differ in suicide rates in such manner as to contribute to the same generalization. Perhaps the most important fact, however, is the association of the highest rates within large cities with the nDst intensely mobile and detached populations; the hobo, hotel and rooming-house populations. These peoples, as have been shown from the study of deviant behaviour and mental disorders, constitute 96 the most disorganized population of any s i z e that i s to be found i n modern c i t i e s . Psychological studies of the s u i c i d e process ind i c a t e that a c r i s i s , often severe, i n the l i f e - o r g a n i z a t i o n of the i n d i v i d u a l i s an important determining factor in self-destruction„ Such a c r i s i s may reveal i t s e l f in a mental disorder or in a serious a f f e c t i v e disturbance with depressive f e a t u r e s . B. The Need for a Synthetic Approach. The s o c i a l and behavioural sciences have always been plagued by the problem of the l e v e l s of c a u s a l i t y in the explanation of substantive phenomena, and nowhere has t h i s problem been better exemplified than in the study of the causes of s u i c i d e , where s o c i o l o g i c a l and psychological f a c t o r s have t r a d i t i o n a l l y been examined in i s o l a t i o n . More and more, however, are students of the problem coming to the r e a l i z a t i o n that the determinants of s u i c i d e are rooted, as are the determinants of other forms of 1 deviant behaviour, in both personality and s o c i a l structure, and that an " e i t h e r - o r " approach i s no longer tenable. The l i t e r a t u r e i s r e f l e c t i n g the emergence of a synthetic 1, It i s to t h e i r c r e d i t that the s o c i a l work profession, for so long deluged with p s y c h i a t r i c and p a r t i c u l a r l y a n a l y t i c concepts, i s becoming increasingly cognizant of the relevance of s o c i o l o g i c a l and anthropological concepts. 97 s o c i a l science from which concepts can be drawn both s e l e c t i v e l y and e c l e c t i c a l l y , although attempts at integration i n reference to the problem of suicide are s t i l l infrequent, Simpson has written: The basic problem for s o c i a l research must be to i n t e r r e l a t e the l i f e - h i s t o r i e s of i n d i v i d u a l s u i c i d e s and attempted s u i c i d e s with s o c i o l o g i c a l v a r i a b l e s , on the hypothesis that c e r t a i n s o c i a l environments may (a) induce or (b)perpetuate or (c) aggravate the s u i c i d e - p o t e n t i a l . If we can c o r r e l a t e for masses of data, suicides or attempted suicides with t h e i r having been induced, perpetuated, or aggravated by c e r t a i n s o c i a l environments, then we are in a p o s i t i o n to e s t a b l i s h laws of generalized occurrence. 2 1. For an account of the need for such a science and f o r some of the attempts at synthesis at the t h e o r e t i c a l and p r a c t i c a l l e v e l s see: Ivan Belknap and Hiram J . Friedsam, Age and Sex Categories as S o c i o l o g i c a l  V a r i a b l e s in the Mental Disorders of Later Maturity, in So c i a l Perspectives  on Behaviour, Herman D. Stein and Richard A. Cloward, Glencoe, The Free Press, 1958. August Hollingshead and Frederick C. Redlich, S o c i a l Class and Mental  I l l n e s s , New York, John Wiley & Sons, Inc., 1958. Herbert Bisno, The Place of the Undergraduate Curriculum in S o c i a l work  Education, (A project Report of the Curriculum Study, Vol.. I I ) , New York, Council on S o c i a l Work Education, 1959. Werner W. Boehm, The S o c i a l Casework Method in S o c i a l Work Education, (A project of the Curriculum Study, V o l . X), New York, Council on S o c i a l Work Education, 1959. Herman D. St e i n , "Some S o c i o l o g i c a l Concepts in Casework P r a c t i c e . " Smith College Studies in S o c i a l Work, February, 1959, pp. 64-75. Thomas Rhys Williams, "The Personal-Cultural Equation in S o c i a l Work and Anthropology." S o c i a l Casework, v o l , 40:2, February, 1959, pp. 74-80. William V. G i o s e f f i , "Culture as an Aspect of the T o t a l Personality." S o c i a l Casework, vol.,40:3, March, 1959, pp. 115-119. Arnold W. Green, Culture, Normality, and Personality C o n f l i c t , i n S o c i a l  Perspectives on Behaviour Herman D, Stein and Richard A. Cloward, Glencoe, The Free Press, 1958. 2, Durkheim, Suicide, pp. 25-36 . (from Simpson's Introduction). 98 C. The Treatment and Prevention of Suicide. The i n s t i t u t i o n a l i z e d responses of society to suicide take the form of medical and s o c i a l services and l e g a l measures. The former i s considered here. Treatment resources for those who attempt suicide are on the whole l i m i t e d . A person admitted to the Emergency Ward of a general h o s p i t a l i s given medical a t t e n t i o n , followed by a perfunctory p s y c h i a t r i c examination ( i f deemed necessary), and then usually discharged. Some h o s p i t a l s i n s i s t on a more thorough examination i n order to assess the seriousness of in t e n t , gauge the p o s s i b i l i t y of a r e c u r r i n g attempt, and a r r i v e at a decision concerning d i s p o s i t i o n — whether i t be discharge, continued p s y c h i a t r i c treatment or commftal to an i n s t i t u t i o n . 1 Few h o s p i t a l s provide a follow-up s e r v i c e . In London and i n New York a person considering suicide may telephone, day or night, to public health 2 a u t h o r i t i e s for help, and in the larger c i t i e s i n the Netherlands a treatment team i s on c a l l twenty-four hours a day to go to the place of residence of anyone contemplating s u i c i d e . A number of organizations and associations have been formed to offer a personal service to the would-be s u i c i d e . These include 1. The Vancouver General Hospital follows t h i s procedure as:'policy. Through an interview with the doctor i n charge of the Emergency Ward, the writer learned that the majority of pat i e n t s , a f t e r p s y c h i a t r i c assessment and medical r e p a i r , are discharged home. 2. R.D. Dripps, M.E. Linden, Morris, and W.P. P h i l l i p s , "Medical, S o c i a l and Legal Aspects of Suicide." Journal of the American Medical  A s s o c i a t i o n , v o l . 171:5, December, 1959, pp. 523-527. 99 the Salvation Army's Ant i - S u i c i d e Bureau in London, the Suicides' A i d Society in West B e r l i n , the National Save-a-Life League with headquarters in New York, the Emergency C l i n i c for Depression i n 1 Stockholm, Rescue Incorporated in Boston and the Suicide Prevention Center in Los Angeles. D. Recommendations for a Suicide Control Programme. The writer suggests that any programme aimed at the prevention of s u i c i d e through the treatment services given to emotionally d i s t u r b e d and i r r a t i o n a l l y behaving persons who have t r i e d to take the i r own l i v e s must include i n i t s broad o u t l i n e at least f i v e measures: f i r s t , the immediate reporting of s u i c i d e s and attempts to responsible public health o f f i c e r s ; secondly, the provision of immediate medical a t t e n t i o n ; t h i r d l y , p s y c h i a t r i c assessment and treatment where indicated for a defined period of time; f o u r t h l y , the recognition that the s u i c i d e gesture i s a device to gain sympathy and attention and the i n s i g h t to r e a l i z e that these should be accorded; f i f t h l y , a follow-up service by the S o c i a l Service Department of the h o s p i t a l and the P u b l i c Health unit in the community. Two c o r o l l a r y measures with broad implications are a l s o suggested: s t r i c t e r c o ntrols 3 over the p r e s c r i b i n g of l e t h a l and a d d i c t i v e drugs , and a l e s s 1. This non-sectarian organization, located in the Boston C i t y H o s p i t a l , i s patterned after A l c o h o l i c s Anonymous. It i s headed by a p r i e s t who makes r e f e r r a l s to various l o c a l s o c i a l agencies. P s y c h i a t r i c consultation i s a v a i l a b l e . The organization i s supported by voluntary contributions and a programme of p u b l i c education i s a l s o c a r r i e d out by some of these organizations. 2. A recommendation regarding l e g a l aspects i s also made in the following s e c t i o n . 3. A.E. Bennett, "Suggestions for Suicide Prevention", in Clues to Suicide, p. 192. 100 » sensationalistic approach by the press in the reporting of suicides and attempted suicides. Perhaps the most comprehensive existing programme aimed at the prevention of self-destruction is that of the Suicide Prevention Center (know as SPC) in Los Angeles. A brochure published by the organization explains its operation and its objectives: The Suicide Prevention Center (SPC) was established for the evaluation, referral, treatment, follow-up and over-all prevention of suicidal behaviour. It was conceived as an agency specifically designed to meet the problem of suicide with an extensive scientifically developed program, incorporating knowledge and techniques gained by the Co-Directors from over a decade of intensive personal investigation of the problem... The activities of the SPC are directed toward three primary goals. These goals are: (l) First and foremost, to save lives. Specifically, this means that the SPC is set up to make psychiatric, psychological and sociological evaluations and then to make referrals or give treatment to persons who are in the midst of a suicidal crisis. The goal here is not only to save a l i f e at that particular time but, equally important to institute those therapeutic procedures which wil l reduce the possibility of an individual's attempting or committing suicide at some time in the future. (2) The second goal is to demonstrate that such a Center can play a vital role in the health and welfare activities of a large metropolitan community., and can establish itself so that the community would eventually wish to maintain and support i t ; further that such a Center might serve as a pilot project or "model" for other communities to copy and adapt to their own specific needs. (3) Third, to collect and collate heretofore un-available data regarding suicidal phenomena and to employ this scientific information to develop and test hypotheses concerning suicide. This procedure will lead to more accurate preduction and hopefully, will lead ultimately to lower suicide rates. 1. • Suicide Prevention Center. University of Southern California Press, I960. 101 The Suicide Prevention Center grew out of a recognition of the magnitude of the suicide problem in the Los Angeles area — a problem against which there had been d i r e c t e d l i t t l e organized community e f f o r t . The s t a f f , described as a "socio-psychological" professional team i s composed of the two project d i r e c t o r s (Shneidman and Farberow), two p s y c h i a t r i s t s , two p s y c h i a t r i c s o c i a l workers, three c l i n i c a l psychologists and a b i o m e t r i c i a n . 1 The Center estimates that there are at least 6000 i n d i v i d u a l s who t r y to take t h e i r l i v e s each year in the Los Angeles area. I t s c l i e n t s are i n the main those who have attempted suicide and who, as a r e s u l t , have been h o s p i t a l i z e d in the Los Angeles County General H o s p i t a l . In a d d i t i o n , r e f e r r a l s are received from other agencies, physicians and from contemplators of s u i c i d e themselves. The method of treatment i s described in the brochure: The SPC addresses i t s e l f p r i m a r i l y to the intrapsychic (tensions within the person) and s o c i a l behaviour — rather than to the purely medical aspects of the attempt. Within the SPC, the processing of an i n d i v i d u a l c o n s i s t s of extensive p s y c h i a t r i c interviews, psychological t e s t i n g , and s o c i a l work in v e s t i g a t i o n (the l a t t e r often dealing with family and other s i g n i f i c a n t persons). For each i n d i v i d u a l processed, s p e c i f i c recommendations for r e a l i s t i c treatment and assistance are made. Each person i s r e f e r r e d for treatment on the basis of h i s or her i n d i v i d u a l needs to a community agency, a public or private treatment f a c i l i t y , and sometimes for psychotherapy to the SPC i t s e l f . Arrangements Sae madehforicobtjaining follow-up 1. I b i d . 2. I b i d . 102. data so that information i s funnelled back to the SPC from the treatment resources, permitting the SPC to evaluate the effectiveness of various methods of treatment of s u i c i d e . The Center emphasizes a close working r e l a t i o n s h i p with mental health and other agencies in the community. L i a i s o n has been established with the c i t y , county, and state departments of health, the Welfare Planning Council, the coroner's o f f i c e and 2 the P o l i c e Department. The research a c t i v i t i e s and goals of the Suicide Prevention It i s a manifest t r u t h that there i s a fundamental r e l a t i o n s h i p between c l i n i c a l p r a c t i c e and r e s e a r c h -that c l i n i c a l p r a c t i c e i s improved l a r g e l y through the f i n d i n g s of research e f f o r t s . A t o t a l program on suicide must therefore include not only the saving of l i v e s today but the i n v e s t i g a t i o n of why i n d i v i d u a l s take t h e i r l i v e s so that s u i c i d a l behaviour — on the basis of increased knowledge concerning i t s causes — can be prevented in the f u t u r e . In l i n e with t h i s reasoning, the SPC (while primarily a l i f e - s a v i n g agent) has b u i l t within i t s operations c a r e f u l l y designated research procedures, With t h i s i n mind, a s p e c i f i c proportion of^ s t a f f time i s devoted to basic research a c t i v i t i e s . The data for these studies consist of s u i c i d e notes, d e t a i l s of the p s y c h i a t r i c case h i s t o r i e s , psychological t e s t s , s o c i a l service data, information from the Coroner's O f f i c e , e c o l o g i c a l and s o c i o l o g i c a l date from the community, et c . (Names of i n d i v i d u a l s are, of course, never used.) To date we have been able to formulate and t e s t a number of s p e c i f i c hypotheses and, most inpo r t a n t l y , the general r e s u l t s of t h i s procedure — in an area of great public health importance — seem promising, 3 Center are worth noting: 1. I b i d . 2. I b i d . 3. I b i d . 103, The Center has one source of f i n a n c i a l support, a five-year (1958-63) grant from the U.S. Public Health Service. Steps are apparently being taken, however, to e s t a b l i s h a "Suicide Prevention Centre, Incorporated", an organization which hopes to be the r e c i p i e n t of private donations. 1 The Los Angeles programme, an ambitious and pioneering experiment, might well serve as the model in the inauguration of a s u i c i d e prevention service in c i t i e s such as Vancouver where s p e c i a l i z e d treatment f a c i l i t i e s for dealing with the problem of s e l f - d e s t r u c t i o n are 2 v i r t u a l l y non-existent. There i s another dimension to the question of the prevention of s u i c i d e : the s t r u c t u r a l dimension. It i s recognized that since the i n d i v i d u a l s e l f has i t s being in the s o c i a l process, any large-scale c o r r e c t i v e measures must come as a r e s u l t of s t r u c t u r a l reorganization and changes. The examination of the components of s o c i a l disorganization indicates the d i r e c t i o n s such modifications 3 should take. £. The Need for Continuing Research. Although s u i c i d e claims more l i v e s i n Western countries than 1. I b i d . 2. It i s of i n t e r e s t to note that the P r o v i n c i a l Mental Hospital at Essondale keeps no separate record of the number of patients admitted because of a suicide attempt. Only by examining each admission s l i p can the number be determined. 3. The great emphasis i n contemporary society on the goals of a c q u i s i t i o n and success and a corresponding de-emphasis on the means by which the goals may be achieved i s probably an important factor in the genesis of s o c i a l d i s o r g a n i z a t i o n . Any consideration of possible modes oi re-organization would need to be cognizant of t h i s emphasis. 104. tuberculosis, polio, alcoholism, arthritis, rheumatism, or multiple sclerosis, there has been comparatively l i t t l e research undertaken. Yet much needs to be done, for clinicians s t i l l lack indicative procedures for making accurate diagnosis of the suicide process. The magnitude of the suicide problem has not as yet been firmly established, i.e. the number of people who commit and attempt suicide. Information on this would be an effective fi r s t step in considering the public health responsibility in this area. 2, Suicide and the Law. A) The Legal Status of Suicide. The person who attempts suicide is adjudged "felo de se" 1 or felony against the self, and is open to prosecution. The Criminal Code of Canada states: Everyone who a) Counsels or procures a person to commit suicide, or b) Aids or abets a person to commit suicide, whether suicide ensues or note, is guilty of an indictable . offense and is liable to imprisonment for 14 years. Everyone who attempts to commit suicide is guilty of an offense punishable on summary conviction. Turner has written: Murder consists in the unlawful taking of a human l i f e . It has therefore always been a felony even though the l i f e which the man takes is hia own, the malice afore thought in such case being in the usual case the intention of the man to bring his own existence to an end, which has led to the crimebeing often called self-murder... Suicide is a felony, and therefore an attempt to commit i t is an attempt to commit a felony.^ B) Sources of the Law: A Critical Analysis The attaching of penal sanctions to the act of suicide derives "Felo de se" does not mean the felony but the felon himself. Criminal Code of Canada, Section 212, 213. The offender may be sentenced to two years' imprisonment* J.W.Cecil Turner, Kenny's Outlines of Criminal Law, Cambridge, The University Press, 1952, p. 138 1. 2. 3 . 105 from e c c l e s i a s t i c a l laws and archaic secular p r a c t i c e s which, in time, came to r e i n f o r c e each other. E a r l y theologians condemned s e l f - d e s t r u c t i o n as s i n f u l for a number of reasons: f i r s t , the act i s a breach of the s i x t h commandment; second, i t i s a v i o l a t i o n of natural law; t h i r d , i t i s cowardly; and f o u r t h , i t i s held that since God gives l i v e to man only God can terminate i t . The canons which were i n s t i t u t e d by the church councils of the f i r s t milennium expressly forbade b u r i a l r i t e s for suicides and r e f l e c t the influence of the writings of the early theologians. 1 Later in England elements of canon law as i t applied to s u i c i d e were incorporated into the common law and the act came to be regarded not only as a sin but a crime as w e l l . The way in which penal sanctions originated from secular p r a c t i c e s has been s u c c i n c t l y stated by a l e g a l w r i t e r : Attempted suicide became a crime in England by a rather roundabout process. Every f e l o n f o r f e i t e d h i s goods to the King, and i t was but a simple step to declare suicide a felony, in order to escheat the estate of the s u i c i d e to the King's treasury. Suicide having been accepted as a crime, i t n a t u r a l l y followed that attempted suicide a l s o became punishable. 2 1. The early theologians had not demanded the mutilation of the dead body of the s u i c i d e and Williams, following Bayet, has suggested that the p r a c t i c e of dishonouring the corpse represents an i n t r u s i o n into the church of the pre-Christian popular abhorrence of s u i c i d e . He writes: " l i k e so much else in e c c l e s i a s t i c a l p r a c t i c e and b e l i e f , i t i s a pagan intru s i o n upon the simple philosophy of the Gospels." (p. 258). It was not u n t i l the second decade of the nineteenth centur that the custom of b u r i a l at a crossroads with a stake driven through the body and a stone covering the face (intended to prevent the body from r i s i n g as a vampire or ghost) was formally abolished by law in England. (Williams, The S a n c t i t i t y of L i f e , pp. 257-260.) 2. "Problems of Suicide: The Changing Legal A t t i t u d e . " (Unsigned), The S o l i c i t o r ' s Journal, v o l . 103, October, 1959, p. 821. 106. It became the p r a c t i c e of the Crown in the eighteenth century to waive the f o r f e i t u r e in cases where the s u i c i d e had not been committed f o r the purpose of avoiding conviction of f e l o n y . Thus the F o r f e i t u r e Act of 1870 which abrogated f o r f e i t u r e for s u i c i d e "d i d no more than give l e g a l e f f e c t to the established p r a c t i c e . " 1 It was commonplace for coroners' j u r i e s to return a v e r d i c t of insanity rather than one of f e l o de se in order to ensure the 2 deceased a church b u r i a l and h i s family the r i g h t to h i s property. The prevalence of the v e r d i c t , Williams notes, prompted the maxim that " i n England you must not commit s u i c i d e , on pain of being regarded as a c r i m i n a l If you f a i l and a l u n a t i c i f you succeed." It i s probable that the arguments against suicide devised by the spokesmen of the p r i m i t i v e church (and s t i l l o ffered today) are r a t i o n a l i z a t i o n s , for i t i s apparent that i f s e l f - d e s t r u c t i o n were not e x p l i c i t l y p r o h i bited, the f a i t h f u l , considering h i s l i f e on earth as merely a temporary period of waiting before h i s union with God, might be sorely tempted to expedite matters by h i s own hand. An examination of these t h e o l o g i c a l arguments against suicide reveals t h e i r unsoundness and even t h e i r sophistry. To hold that 1. Williams, The Sanctity of L i f e , p. 262. 2. I b i d . East has pointed out that in the year 1928 in England of the 4,846 inquests i n t o s u i c i d e , the v e r d i c t of f e l o de se was returned in only 88. (W. Norwood East, Medical Aspects of Crime, The Blakiston D i v i s i o n , McGraw-Hill Book Company, Inc., London, 1936, p. 276. 3. Williams, The Sanctity of L i f e , p. 263 107. suicide i s a v i o l a t i o n of the Sixth Commandment i s to equate suicide with homicide. Yet, there are obvious differences between the act of rampant h o s t i l i t y wreaked upon another and r e s u l t i n g in h i s death and the act of v o l u n t a r i l y and q u i e t l y putting an end to one's own l i f e . For, as Williams has pointed out, a man may i n t e n t i o n a l l y destroy himself for a noble cause but he does not have the r i g h t to k i l l others for that same cause. 1 Thus the question of the morality of suicide cannot be resolved by recourse to l o g i c a l deduction from the p r o h i b i t i o n of murder. Suicide, i t i s contended, i s "unnatural" and therefore immoral and s i n f u l . The word "unnatural", here equated with "immoral", i s u n i n t e l l i g i b l e 2 and devoid of concrete connotation. The argument that suicide i s contrary to natural law i s , then, the a p p l i c a t i o n of the method of arguing from an assumed "nature" to morals. 3 Yet, i f s e l f -destruction were contrary to man's nature, i t would not occur. Too, not every negation of a basic i n s t i n c t i s immoral, otherwise, as Fedden has pointed out, the c e l i b a t e would be a sinner for he 4 denies the i n s t i n c t of sex. A t h i r d argument against suicide i s that i t i s cowardly. Replying to t h i s proposition, Williams writes: ...the only l i n e between cowardice and caution (or 1. Ibid., p. 256. 2. Hook has suggested that the word i s "promiscuously" used and serves to b l i n d the user to the f a c t that he has already passed judgment. He strongly advocates i t s discontinuance i n e t h i c a l evaluation. (Hook, Internat. J . of E t h i c s , v o l . 37, 1927, pp. 173-188.) 3. Williams, The Sanctity of L i f e , p. 264. 4. Fedden, Suicide, p. 282. 108 wise r e t r e a t ) i s that the coward does not do what he ought to do. To brand the s u i c i d e as a coward i s , therefore, to beg the question whether there i s a duty to go on l i v i n g . * F i n a l l y to i n s i s t that l i f e i s God-given and can therefore be ended only by God, i s an i l l o g i c a l deduction from an assumed " i s " to an "ought". A cogent re p l y was that of P l i n y , the Roman n a t u r a l i s t and encyclopedist: "the existence of poisonous herbs with which 2 one may so e a s i l y k i l l oneself i s a benevalent g i f t from God." The censure of s u i c i d e , r e f l e c t e d as i t i s in law, then, i s part of a p a r t i c u l a r system of r e l i g i o u s b e l i e f and as Williams suggests "need not be accepted by the p o s i t i v i s t or indeed by anyone who does not accept the t r a d i t i o n a l eschatology. C) A C r i t i q u e and a Proposal. The laws dealing with homicide r e s t upon a u t i l i t a r i a n consideration of the most apparent kind: the protection of the members of s o c i e t y . But the p r o h i b i t i o n of s e l f - d e s t r u c t i o n i s not founded on a l i k e consideration of public s e c u r i t y . Rather i t i s the expression of a philosophical a t t i t u d e derived from and s t i l l deeply rooted in the t h e o l o g i c a l concept of i n d i v i d u a l s i n . The question a r i s e s , " i s t h i s concept applicable to a s o c i o - p s y c h i a t r i c phenomenon whose determinants are, to a considerable degree, beyond the i n d i v i d u a l ' s c o n t r o l ? " A growing body of opinion would offer a negative r e p l y . Many, regarding l i f e no longer as an absolute value, observing a d i s j u n c t i v e r e l a t i o n s h i p between law and morality, 1. Williams, The Sanctity of L i f e , p. 256. 2. Ibid., p. 265. 3. Ibid., p. 257. 109. and recognizing the l i m i t a t i o n s of the cri m i n a l law as applied to the problem of s u i c i d e , c a l l f o r an a b o l i t i o n of a l l penal sactions attached to the a c t . This does not necessar i l y imply an endorsement of s e l f - d e s t r u c t i o n or a disregard for the sa n c t i t y of human l i f e ; nor does i t represent the expression of a negatively i n d i v i d u a l i s t i c , l i b e r a l i s t i c or a n a r c h i s t i c a t t i t u d e of mine. Rather i t r e f l e c t s the conviction that s u i c i d e i s a form of deviant behaviour which i s beyond the scope of the criminal law and i t recognizes that punishment of an attempt at sui c i d e cannot act as an e f f e c t i v e deterrent on an i n d i v i d u a l who has already demonstrated a readiness to terminate h i s l i f e . 1 As an instrument for reform and r e -education, then, punishment i s of dubious value. Some have argued that criminal proceedings ensure the i n d i v i d u a l with s u i c i d a l 2 tendencies of adequate physical and p s y c h i a t r i c care. Such an argument, as Mannheim has pointed out, i s a serious indictment of the p r e v a i l i n g system of mental health s e r v i c e s . He writes:'jlt should not be beyond the wits of men to devise an adequate scheme dealing with human problems of t h i s kind outside the criminal law." The i n s i g h t s derived from s o c i o l o g i c a l and psychological studies of the determinants of s e l f - d e s t r u c t i o n make i t abundantly clear that one who attempts su i c i d e i s not a w i l l f u l l y perverse person r e q u i r i n g moral c o r r e c t i o n . In view of t h i s i t i s proposed by the present writer that i n the case of the mentally disordered 1. Hermann Mannheim, Criminal j u s t i c e and S o c i a l Reconstruction, London, Routledge and Kegan Paul Ltd., 1949, p. 10. 2./ East, Medical Aspects of Crime, p. 142. 3. Mannheim, Criminal J u s t i c e , pp. 10-11. 110. and the emotionally disturbed who attempt death by the i r own hand (suicide attempts which might be termed " p a t h o l o g i c a l " ) , the law, without penal sanctions, should be invoked to permit an intervention, taking the form of treatment s e r v i c e s . Unless committable to an i n s t i t u t i o n , the person should be subject to r e s t r a i n t at the d i s c r e t i o n of an informed magistrate a f t e r consultation with c l i n i c i a n s and for a b r i e f and d e f i n i t e period of time only. Two a d d i t i o n a l safeguards would be necessary: a b o l i t i o n of a public hearing, and granting of wide m a g i s t e r i a l powers as to choice of place and condition of det e n t i o n . 1 S e l f - i n f l i c t e d death, however, may be the terminating act of the s e t t l e d p h i losophical r e s o l u t i o n of a r a t i o n a l mind. The present writer holds that i f t h i s be the case the i n d i v i d u a l should, by law, be free to r e j e c t treatment services offered him and to dispose of h i s l i f e as he sees f i t . In short, for what Shneidman has termed the " l o g i c a l s u i c i d e " 2 (for example, those i n great physical pain) there should be no l e g a l or moral i n t e r d i c t i o n . As Williams has written: Ultimately, society cannot stop a f r e e man from committing s u i c i d e , nor should i t t r y . What can be done i s to make sure that the determination upon s e l f - d e s t r u c t i o n i s f i x e d and unalterable. 1. A committee formed by the Council of the B r i t i s h Medical Association in 1947 made similar suggestions: the introduction of a guardianship procedure for the care and protection of would-be s u i c i d e s . (Council of the B r i t i s h Medical A s s o c i a t i o n , "The Law Relating to Attempted Suicide." B r i t i s h Medical Journal Supplement, v o l . 1, May 17, 1947, p.l03 0 2. Edwin S. Shneidman, "The L o g i c a l , Psychological, and E c o l o g i c a l Environments of Suicide.'.'. C a l i f or n i a v s Health, State Department of  Public Health, v o l . 17:22, May 15, 1960, pp. 193-200. 3. Williams, The Sanctity of L i f e , p. 293. Bibliography Books. 1. Benedict, Ruth. Patterns of Culture. New York, The New American L i b r a r y , 1953. 2. Bisno, Herbert. The Place of the Undergraduate Curriculum in S o c i a l Work Education. (A Project Report of the Curriculum Study, V o l . I I ) , New York, Council on S o c i a l Work Education, (1959). 3. Boehm, Werner W. 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