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Book Review   |    
History of Suicide: Voluntary Death in Western Culture
Andrew Edmund Slaby, Ph.D., M.D.
Psychiatric Services 1999; doi:
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by George Minois (1995); translated from the French by Lydia G. Cochrane; Baltimore, Johns Hopkins University Press, 1999, 387 pages, $35.95

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Albert Camus stated in Le Mythe de Sisyphe in 1942 that there is but one truly serious philosophical problem—suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy, or, as Shakespeare said through Hamlet, "To be, or not to be: that is the question."

So too George Minois traces the evolution of philosophical thought on self-inflicted death over three millennia. The power of the work is that the data supplied provide insights not only for philosophers but also for psychiatrists, economists, historians, epidemiologists, anthropologists, and literary scholars interested in the multiple factors that impact the decision to die by one's own hand and ways in which such deaths may be reported. Although genetic factors determining impulsivity and manifestation of psychiatric illness clearly play a critical role, other factors impact the force of these variables.

Ironically, we learn that while many philosophers of the absurd reflected on suicide, most not only did not die by suicide but also rejected the idea of voluntary death. Camus and Voltaire rejected suicide. Jean Paul Sartre felt it was abandonment of all liberty, and Karl Jaspers "the absolute action that transgresses life." Others, less cynical, often did not—for example, Seneca and Pythagoras.

The apparent suicide of Socrates, we learn, is debatable. Politically disenfranchised, he had no choice but to be killed or swallow hemlock because he refused to flee. The author also poignantly notes that with rare exceptions, such as Johannes Robeck, authors of treatises on suicide seldom died by it. They did not write apologies for voluntary death, but rather sought to demonstrate that when life becomes physically or mentally too burdensome, suicide may be a legitimate option.

The author argues cogently that while those who have historically proclaimed the absurdity of the world most vocally are not the ones most likely to leave it voluntarily, those who have committed suicide appear to be those most attracted to worldly values. In some ways this phenomenon is a historical validation of a tenet of cognitive therapy, or, as Bertrand Russell once said, it is not the experience that happens to you, but what you do with the experience that happens to you.

Statistics about suicide, we find, have been obfuscated not only by religious and political norms but also by the means available by social class to die. For instance, in the Middle Ages, suicide appears to have been rampant among commoners, but not among nobles, who had means of self-homicide. Craftsmen and women had to seek rivers or the rope to die, while the gentry could expose themselves to death through crusades, war, hunting, and tourneys, which allowed a sublimation of suicidal tendencies. Hence, suicides historically have been reported as greater among peasants.

While ecclesiastical suicides were handled discretely, factors such as a relatively privileged status and strong group cohesion limited priestly suicides. Early Christians glorified self-sacrifice, and many who were unhappy with life's lot sought voluntary self-sacrifice through martyrdom that carried with it the promise of heaven.

Minois reveals some amazing contradictions among leading Christian thinkers. St. Thomas More did not dare to overtly challenge the moral prohibitions of the Catholic Church, but in 1515, in fiction, he stated that when the natives of the ideal island realm of Utopia were stricken with painful and incurable illness, they could take their own lives.

Finally, the development of capitalism appears to have made a sizable contribution to the rise of the suicide rate. The loss of the solidarity systems of the guilds and corporations coupled with the insecurity and instability that are an integral part of capitalism—which is founded on individualism, competition, and acceptance of risk—left individuals to face financial ruin alone.

In the end, despite all, the author concludes, in discussing the move from philosophical suicide among the ancients to romantic suicides of the 19th century, that suicide occurred where it had always occurred— "in huts and shops, and always for the same reason, suffering." One finds support from this scholarly volume for what clinicians have always known to be true. People who die by suicide do not want to die. They simply want to end the pain. If there were another way to end the pain, they would choose it.

Dr. Slaby is clinical professor of psychiatry at New York University and New York Medical College.

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