CHAPTER 1 SUICIDE AND PSYCHOPATHIC STATES

THERE are two sorts of extra-social causes to which one may, a priori, attribute an influence on the suicide-rate; they are organic-psychic dispositions and the nature of the physical environment. In the individual constitution, or at least in that of a significant class of individuals, it is possible that there might exist an inclination, varying in intensity from country to country, which directly leads man to suicide; on the other hand, the action of climate, temperature, etc., on the organism, might indirectly have the same effects. Under no circumstances can the hypothesis be dismissed unconsidered. We shall examine these two sets of factors successively, to see whether they play any part in the phenomenon under study and if so, what.

I

The annual rate of certain diseases is relatively stable for a given society though varying perceptibly from one people to another. Among these is insanity. Accordingly, if a manifestation of insanity were reasonably to be supposed in every voluntary death, our problem would be solved; suicide would be a purely individual affliction.

This thesis is supported by a considerable number of alienists. According to Esquirol: “Suicide shows all the characteristics of mental alienation.”—“A man attempts self-destruction only in delirium and suicides are mentally alienated.” From this principle he concluded that suicide, being involuntary, should not be punished by law. Falret and Moreau de Tours use almost the same terms. The latter, to be sure, in the same passage where he states his doctrine, makes a remark which should subject it to suspicion: “Should suicide be regarded in all cases as the result of mental alienation? Without wishing to dispose here of this difficult question, let us say generally that one is instinctively the more inclined to the affirmative the deeper the study of insanity which he has made, the greater his experience and the greater the number of insane persons whom he has examined.” In 1845 Dr. Bourdin, in a brochure which at once created a stir in the medical world, had enunciated the same opinion even more unreservedly.

This theory may be and has been defended in two different ways. Suicide itself is either called a disease in itself, sui generis, a special form of insanity; or it is regarded, not as a distinct species, but simply an event involved in one or several varieties of insanity, and not to be found in sane persons. The former is Bourdin’s thesis; Esquirol is the chief authority holding the other view. “From what has preceded,” he writes, “suicide may be seen to be for us only a phenomenon resulting from many different causes and appearing under many different forms; and it is clear that this phenomenon is not characteristic of a disease. From considering suicide as a disease sui generis, general propositions have been set up which are belied by experience.”

The second of these two methods of proving suicide to be a manifestation of insanity is the less rigorous and conclusive, since because of it negative experiences are impossible. A complete inventory of all cases of suicide cannot indeed be made, nor the influence of mental alienation shown in each. Only single examples can be cited which, however numerous, cannot support a scientific generalization; even though contrary examples were not affirmed, there would always be possibility of their existence. The other proof, however, if obtainable, would be conclusive. If suicide can be shown to be a mental disease with its own characteristics and distinct evolution, the question is settled; every suicide is a madman.

But does suicidal insanity exist?

II

Since the suicidal tendency is naturally special and definite if it constitutes a sort of insanity, this can be only a form of partial insanity, limited to a single act. To be considered a delirium it must bear solely on this one object; for, if there were several, the delirium could no more be defined by one of them than by the others. In traditional terminology of mental pathology these restricted deliria are called monomanias. A monomaniac is a sick person whose mentality is perfectly healthy in all respects but one; he has a single flaw, clearly localized. At times, for example, he has an unreasonable and absurd desire to drink or steal or use abusive language; but all his other acts and all his other thoughts are strictly correct. Therefore, if there is a suicidal mania it can only be a monomania, and has indeed been usually so-called.

On the other hand, if this special variety of disease called monomanias is admitted, it is clear why one readily includes suicide among them. The character of these kinds of afflictions, according to the definition just given, is that they imply no essential disturbance of intellectual functions. The basis of mental life is the same in the monomaniac and the sane person; only, in the former, a specific psychic state is prominently detached from this common basis. In short, monomania is merely one extreme emotion in the order of impulses, one false idea in the order of representations, but of such intensity as to obsess the mind and completely enslave it. Thus, ambition, from being normal, becomes morbid and a monomania of grandeur when it assumes such proportions that all other cerebral functions seem paralyzed by it. A somewhat violent emotional access disturbing mental equilibrium is therefore enough to cause the monomania to appear. Now suicides generally seem influenced by some abnormal passion, whether its energy is abruptly expended or gradually developed; it may thus even appear reasonable that some such force is always necessary to offset the fundamental instinct of self-preservation. Moreover, many suicides are completely indistinguishable from other men except by the particular act of self-destruction; and there is therefore no reason to impute a general delirium to them. This is the reasoning by which suicide, under the appellation of monomania, has been considered a manifestation of insanity.

But, do monomanias exist? For a long time this was not questioned; alienists one and all concurred without discussion in the theory of partial deliria. It was not only thought confirmed by clinical observation but regarded as corollary to the findings of psychology. The human intelligence was supposed to consist of distinct faculties and separate powers which usually function cooperatively but may act separately; thus it seemed natural that they might be separately affected by disease. Since human intelligence may be manifested without volition and emotion without intelligence, why might there not be affections of the intelligence or will without disturbances of the emotions and vice versa? Applied to the specialized forms of these faculties, the same principle led to the theory that a lesion may exclusively affect an impulse, an action or an isolated idea.

Today however this opinion has been universally discarded. The non-existence of monomanias cannot indeed be proved from direct observation, but not a single incontestable example of their existence can be cited. Clinical experience has never been able to observe a diseased mental impulse in a state of pure isolation; whenever there is lesion of one faculty the others are also attacked, and if these concomitant lesions have not been observed by the believers in monomania, it is because of poorly conducted observations. “For example,” writes Falret, “take an insane person obsessed by religious ideas who would be classified among religious monomaniacs. He declares himself divinely inspired; entrusted with a heavenly mission he brings a new religion to the world…. This idea will be said to be wholly insane; yet he reasons like other men except for this series of religious thoughts. Question him more carefully, however, and other morbid ideas will soon be discovered; for instance, you will find a tendency to pride parallel to the religious ideas. He believes himself called upon to reform not only religion but also to reform society; perhaps he will also imagine the highest sort of destiny reserved for himself. … If you have not discovered tendencies to pride in this patient, you will encounter ideas of humility or tendencies to fear. Preoccupied with religious ideas he will believe himself lost, destined to perish, etc.” All of these forms of delirium will, of course, not usually be met with combined in a single person, but such are those most commonly found in association; if not existing at the same moment in the illness they will be found in more or less quick succession.

Finally, apart from these special manifestations, there always exists in these supposed monomaniacs a general state of the whole mental life which is fundamental to the disease and of which these delirious ideas are merely the outer and momentary expression. Its essential character is an excessive exaltation or deep depression or general perversion. There is, especially, a lack of equilibrium and coordination in both thought and action. The patient reasons, but with lacunas in his ideas; he acts, not absurdly, but without sequence. It is incorrect then to say that insanity constitutes a part, and a restricted part of his mental life; as soon as it penetrates the understanding it totally invades it.

Moreover, the principle underlying the hypothesis of monomania contradicts the actual data of science. The old theory of the faculties has few defenders left. The different sorts of conscious activity are no longer regarded as separate forces, disunited, and combined only in the depths of a metaphysical substance, but as interdependent functions; thus one cannot suffer lesion without the others being affected. This interpenetration is even closer in mental life than in the rest of the organism; for psychic functions have no organs sufficiently distinct from one another for one to be affected without the others. Their distribution among the different regions of the brain is not well defined, as appears from the readiness with which its different parts mutually replace each other, if one of them is prevented from fulfilling its task. They are too completely interconnected for insanity to attack certain of them without injury to the others. With yet greater reason it is totally impossible for insanity to alter a single idea or emotion without psychic life being radically changed. For representations and impulses have no separate existence, they are not so many little substances, spiritual atoms, constituting the mind by their combination. They are merely external manifestations of the general state of the centers of consciousness, from which they derive and which they express. Thus they cannot be morbid without this state itself being vitiated.

But if mental flaws cannot be localized, there are not, there cannot be monomanias properly so-called. The apparently local disturbances given this name always derive from a more extensive perturbation; they are not diseases themselves, but particular and secondary manifestations of more general diseases. If then there are no monomanias, there cannot be a suicidal monomania and, consequently, suicide is not a distinct form of insanity.

III

It remains possible, however, that suicide may occur only in a state of insanity. If it is not by itself a special form of insanity, there are no forms of insanity in connection with which it may not appear. It is only an episodic syndrome of them, but one of frequent occurrence. Perhaps this frequency indicates that suicide never occurs in a state of sanity, and that it indicates mental alienation with certainty?

The conclusion would be hasty. For though certain acts of the insane are peculiar to them and characteristic of insanity, others are common to them and to normal persons, though assuming a special form in the case of the insane. There is no reason, a priori, to place suicide in the first of the two categories. To be sure, alienists state that most of the suicides known to them show all the indications of mental alienation, but this evidence could not settle the question, for the reviews of such cases are much too summary. Besides, no general law could be drawn from so narrowly specialized an experience. From the suicides they have known, who were, of course, insane, no conclusion can be drawn as to those not observed, who, moreover, are much more numerous.

The only methodical procedure consists of classifying according to their essential characteristics the suicides committed by insane persons, thus forming the principal types of insane suicide, and then trying to learn whether all cases of voluntary death can be included under these systematically arranged groups. In other words, to learn whether suicide is an act peculiar to the insane one must fix the forms it assumes in mental alienation and discover whether these are the only ones assumed by it.

In general, specialists have paid little heed to classifying the suicides of the insane. The four following types, however, probably include the most important varieties. The essential elements of the classification are borrowed from Jousset and Moreau de Tours.

I. Maniacal suicide.—This is due to hallucinations or delirious conceptions. The patient kills himself to escape from an imaginary danger or disgrace, or to obey a mysterious order from on high, etc. But the motives of such suicide and its manner of evolution reflect the general characteristics of the disease from which it derives—namely, mania. The quality characteristic of this condition is its extreme mobility. The most varied and even conflicting ideas and feelings succeed each other with intense rapidity in the maniac’s consciousness. It is a constant whirlwind. One state of mind is instantly replaced by another. Such, too, are the motives of maniacal suicide; they appear, disappear, or change with amazing speed. The hallucination or delirium which suggests suicide suddenly occurs; the attempt follows; then instantly the scene changes, and if the attempt fails it is not resumed, at least, for the moment. If it is later repeated it will be for another motive. The most trivial incident may cause these sudden transformations. One such patient, wishing to kill himself, had leaped into a river—one that was generally shallow. He was seeking a place where submersion was possible when a customs officer, suspecting his intention, took aim and threatened to fire if he did not leave the water. The man went peaceably home at once, no longer thinking of self-destruction.

2. Melancholy suicide.—This is connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the bonds which connect him with people and things about him. Pleasures no longer attract; he sees everything as through a dark cloud. Life seems to him boring or painful. As these feelings are chronic, so are the ideas of suicide; they are very fixed and their broad determining motives are always essentially the same. A young girl, daughter of healthy parents, having spent her childhood in the country, has to leave at about the age of fourteen, to finish her education. From that moment she contracts an extreme disgust, a definite desire for solitude and soon an invincible desire to die. “She is motionless for hours, her eyes on the ground, her breast laboring, like someone fearing a threatening occurrence. Firmly resolved to throw herself into the river, she seeks the remotest places to prevent any rescue.” However, as she finally realizes that the act she contemplates is a crime she temporarily renounces it. But after a year the inclination to suicide returns more forcefully and attempts recur in quick succession.

Hallucinations and delirious thoughts often associate themselves with this general despair and lead directly to suicide. However, they are not mobile like those just observed among maniacs. On the contrary they are fixed, like the general state they come from. The fears by which the patient is haunted, his self-reproaches, the grief he feels are always the same. If then this sort of suicide is determined like its predecessor by imaginary reasons, it is distinct by its chronic character. And it is very tenacious. Patients of this category prepare their means of self-destruction calmly; in the pursuit of their purpose they even display incredible persistence and, at times, cleverness. Nothing less resembles this consistent state of mind than the maniac’s constant instability. In the latter, passing impulses without durable cause; in the former, a persistent condition linked with the patient’s general character.

3. Obsessive suicide.—In this case, suicide is caused by no motive, real or imaginary, but solely by the fixed idea of death which, without clear reason, has taken complete possession of the patient’s mind. He is obsessed by the desire to kill himself, though he perfectly knows he has no reasonable motive for doing so. It is an instinctive need beyond the control of reflection and reasoning, like the needs to steal, to kill, to commit arson, supposed to constitute other varieties of monomania. As the patient realizes the absurdity of his wish he tries at first to resist it. But throughout this resistence he is sad, depressed, with a constantly increasing anxiety oppressing the pit of his stomach. Hence, this sort of suicide has sometimes been called anxiety-suicide. Here is the confession once made by a patient to Brierre de Boismont, which perfectly describes the condition: “I am employed in a business house. I perform my regular duties satisfactorily but like an automaton, and when spoken to, the words sound to me as though echoing in a void. My greatest torment is the thought of suicide, from which I am never free. I have been the victim of this impulse for a year; at first it was insignificant; then for about the last two months it has pursued me everywhere, yet I have no reason to kill myself…. My health is good; no one in my family has been similarly afflicted; I have had no financial losses, my income is adequate and permits me the pleasures of people of my age.” But as soon as the patient has decided to give up the struggle and to kill himself, anxiety ceases and calm returns. If the attempt fails it is sometimes sufficient, though unsuccessful, to quench temporarily the morbid desire. It is as though the patient had voided this impulse.

4. Impulsive or automatic suicide.—It is as unmotivated as the preceding; it has no cause either in reality or the patient’s imagination. Only, instead of being produced by a fixed idea obsessing the mind for a shorter or longer period and only gradually affecting the will, it results from an abrupt and immediately irresistible impulse. In the twinkling of an eye it appears in full force and excites the act, or at least its beginning. This abruptness recalls what has been mentioned above in connection with mania; only the maniacal suicide has always some reason, however irrational. It is connected with the patient’s delirious conceptions. Here on the contrary the suicidal tendency appears and is effective in truly automatic fashion, not preceded by any intellectual antecedent. The sight of a knife, a walk by the edge of a precipice, etc. engender the suicidal idea instantaneously and its execution follows so swiftly that patients often have no idea of what has taken place. “A man is quietly talking with his friends; suddenly he leaps, clears a parapet and falls into the water. Rescued immediately and asked for the motives of his behaviour, he knows nothing of them, he has yielded to irresistible force.” “The strange thing is,” another says, “that I can’t remember how I climbed the casement and my controlling idea at the time; for I had no thought of killing myself, or, at least I have no memory of such a thought today.” To a lesser degree, patients feel the impulse growing and manage to escape the fascination of the mortal instrument by fleeing from it immediately.

In short, all suicides of the insane are either devoid of any motive or determined by purely imaginary motives. Now, many voluntary deaths fall into neither category; the majority have motives, and motives not unfounded in reality. Not every suicide can therefore be considered insane, without doing violence to language. Of all the suicides just characterized, that which may appear hardest to detect of those observed among the sane is melancholy suicide; for very often the normal person who kills himself is also in a state of dejection and depression like the mentally alienated. But an essential difference between them always exists in that the state of the former and its resultant act are not without an objective cause, whereas in the latter they are wholly unrelated to external circumstances. In short, the suicides of the insane differ from others as illusions and hallucinations differ from normal perceptions and automatic impulses from deliberate acts. It is true that there is a gradual shading from the former to the latter; but if that sufficed to identify them one would also, generally speaking, have to confuse health with sickness, since the latter is but a variety of the former. Even if it were proved that the average man never kills himself and that only those do so who show certain anomalies, this would still not justify considering insanity a necessary condition of suicide; for an insane person is not simply a man who thinks or acts somewhat differently from the average.

Thus, suicide has been so closely associated with insanity only by arbitrarily restricting the meaning of the words. “That man does not kill himself,” Esquirol exclaims, “who, obeying only noble and generous sentiments, throws himself into certain peril, exposes himself to inevitable death, and willingly sacrifices his life in obedience to the laws, to keep pledged faith, for his country’s safety.” He cites the examples of Decius, of Assas, etc. Falret likewise refuses to consider Curtius, Codrus or Aristodemus as suicides. Bourdin excepts in this manner all voluntary deaths inspired not only by religious faith or political conviction but even by lofty affection. But we know that the nature of the motives immediately causing suicide cannot be used to define it, nor consequently to distinguish it from what it is not. All cases of death resulting from an act of the patient himself with full knowledge of the inevitable results, whatever their purpose, are too essentially similar to be assigned to separate classes. Whatever their cause, they can only be species of a single genus; and to distinguish among them, one must have other criteria than the victim’s more or less doubtful purpose. This leaves at least a group of suicides unconnected with insanity. Once exceptions are admitted, it is hard to stop. For there is only a gradual shading between deaths inspired by usually generous feelings and those from less lofty motives. An imperceptible gradation leads from one class to the other. If then the former are suicides, there is no reason for not giving the same name to the latter.

There are therefore suicides, and numerous ones at that, not connected with insanity. They are doubly identifiable as being deliberate and as springing from representations involved in this deliberation which are not purely hallucinatory. This often debated question may therefore be solved without requiring reference to the problem of freedom. To learn whether all suicides are insane, we have not asked whether or not they act freely; we have based ourselves solely on the empirical characteristics observable in the various sorts of voluntary death.

IV

Since the suicides of insane persons do not constitute the entire genus but only a variety of it, the psychopathic states constituting mental alienation can give no clue to the collective tendency to suicide in its generality. But between mental alienation properly so-called and perfect equilibrium of intelligence, an entire series of intermediate stages exist; they are the various anomalies usually combined under the common name of neurasthenia. Let us therefore see whether they, in cases devoid of insanity, do not have an important role in the origin of the phenomenon we are studying.

The very existence of insane suicide suggests the question. In fact, if a deep affection of the nervous system is enough to create suicide, a lesser affection ought to exercise the same influence to a lesser degree. Neurasthenia is a sort of elementary insanity; it must therefore have the same effects in part. It is also a much more widespread condition than insanity; it is even becoming progressively more general. The total of abnormalities thus termed may therefore be one of the factors with which the suicide-rate varies.

Besides, neurasthenia may reasonably predispose to suicide; for by temperament neurasthenics seem destined to suffer. It is well known that pain, in general, results from too violent a shock to the nervous system; a too intense nervous wave is usually painful. But this maximum intensity beyond which pain begins varies with individuals; it is highest among those whose nerves have more resistance, less in others. The painful zone begins earlier, therefore, among the latter. Every impression is a source of discomfort for the neuropath, every movement an exertion; his nerves are disturbed at the least contact, being as it were unprotected; the performance of physiological functions which are usually most automatic is a source of generally painful sensations for him. On the other hand, it is true that the zone or pleasure itself also begins at a lower level; for the excessive penetrability of a weakened nervous system makes it a prey to stimuli which would not excite a normal organism. Thus insignificant occurrences may cause such a person excessive pleasures. Seemingly he must gain on one side all that he losses on the other and, thanks to this compensatory action, he should not be less well armed than others to sustain the conflict. This is not the case however, and his inferiority is real; for current impressions, sensations most frequently reproduced by the conditions of average life, are always of a definite intensity. Life therefore is apt to be insufficiently tempered for this sufferer. To be sure, he may live with a minimum of suffering when he can live in retirement and create a special environment only partially accessible to the outer tumult; thus he sometimes is seen to flee the world which makes him ill and to seek solitude. But if forced to enter the melée and unable to shelter his tender sensitivity from outer shocks, he is likely to suffer more pain than pleasure. Such organisms are thus a favorite field for the idea of suicide.

Nor does this situation alone make life difficult for the neuropath. Due to this extreme sensitivity of his nervous system, his ideas and feelings are always in unstable equilibrium. Because his slightest impressions have an abnormal force, his mental organization is utterly upset at every instant, and under the hammer of these uninterrupted shocks cannot become definitely established. It is always in process of becoming. For it to become stable past experiences would have to have lasting effects, whereas they are constantly being destroyed and swept away by abruptly intervening upheavals. Life in a fixed and constant medium is only possible if the functions of the person in question are of equal constancy and fixity. For living means responding appropriately to outer stimuli and this harmonious correspondence can be established only by time and custom. It is a product of experiments, sometimes repeated for generations, the results of which have in part become hereditary and which cannot be gone through all over again everytime there is necessity for action. If, however, at the moment of action everything has to be reconstructed, so to speak, it is impossible for this action to be what it should be. We require this stability not only in our relations with the physical environment, but also with the social environment. The individual can maintain himself in a society definitely organized only through possessing an equally definite mental and moral constitution. This is what the neuropath lacks. His state of disturbance causes him to be constantly taken by surprise by circumstances. Unprepared to respond, he has to invent new forms of conduct; whence comes his well-known taste for novelty. When, however, he has to adapt himself to traditional situations, improvised contrivances are inadequate against those derived from experience; and they therefore usually fail. Thus the more fixed the social system, the more difficult is life there for so mobile a person.

This psychological type is therefore very probably the one most commonly to be found among suicides. What share has this highly individual condition in the production of voluntary deaths? Can it alone, if aided by circumstances, produce them, or does it merely make individuals more accessible to forces exterior to them and which alone are the determining causes of the phenomenon?

To settle the question directly, the variations of suicide would have to be compared with those of neurasthenia. Unfortunately, the latter has not been statistically studied. But the difficulty may be indirectly solved. Since insanity is only the enlarged form of nervous degeneration, it may be granted without risk of serious error that the number of nervous degenerates varies in proportion to that of the insane, and consideration of the latter may be used as a substitute in the case of the former. This procedure would also make it possible to establish a general relation of the suicide-rate to the total of mental abnormalities of every kind.

One fact might lead us to attribute to them an undue influence; the fact that suicide, like insanity, is commoner in cities than in the country. It seems to increase and decrease like insanity, a fact which might make it seem dependent on the latter. But this parallelism does not necessarily indicate a relation of cause to effect; it may very well be a mere coincidence. The latter hypothesis is the more plausible in that the social causes of suicide are, as we shall see, themselves closely related to urban civilization and are most intense in these great centers. To estimate the possible effect of psychopathic states on suicide, one must eliminate cases where they vary in proportion to the social conditions of the latter; for when these two factors tend in the same direction the share of each cannot be determined in the final result. They must be considered only where they are in inverse proportion to one another; only when a sort of conflict exists between them can one learn which is decisive. If mental disorders are of the decisive importance sometimes attributed to them, their presence should be shown by characteristic effects, even when social conditions tend to neutralize them; and, inversely, the latter should be unable to appear when individual conditions contradict them. The following facts show that the opposite is the rule:

1. All statistics prove that in insane asylums the female inmates are slightly more numerous than the male. The proportion varies by countries, but as appears in the table on the preceding page, it is in general 54 or 55 for the women to 46 or 45 for the men.

Koch has compared the results of the census taken of the total insane population in eleven different states. Among 166,675 insane of both sexes, he found 78,584 men and 88,091 women, or 1.18 insane per 1,000 male and 1.30 per 1,000 female inhabitants.19 Mayr has discovered similar figures.

There is the question, to be sure, whether the excess of women is not simply due to the mortality of the male being higher than that of the female insane. In France, certainly, of every 100 insane who die in asylums, about 55 are men. The larger number of women recorded at a given time would therefore not prove that women have a greater tendency to insanity, but only that, in this condition as in all others, they outlive men. It is none the less true that the actual insane population includes more women than men; if, then, as seems reasonable, we apply the argument from the insane to the nervous, more neurasthenics must be admitted to exist at a given moment among females than among men. So, if there were a causal relation between the suicide-rate and neurasthenia, women should kill themselves more often than men. They should do so at least as often. For, even considering their lower mortality and correcting the census figures accordingly, our only conclusion would be that they have a predisposition to insanity at least as great as that of men; their lower figure of mortality and their numerical superiority in all censuses of the insane almost exactly cancel each other. But far from their aptitude for voluntary death being either higher or equal to that of men, suicide happens to be an essentially male phenomenon. To every woman there are on the average four male suicides (Table IV, p. 71). Each sex has accordingly a definite tendency to suicide which is even constant for each social environment. But the intensity of this tendency does not vary at all in proportion to the psychopathic factor, whether the latter is estimated by the number of new cases registered annually or by that of census subjects at a given moment.

TABLE IV *—Shore of Each Sex in the Total Number of Suicides

2.Table V shows the comparative strength of the tendency to insanity among the different faiths.

TABLE V *—Tendency to Insanity Among the Different Religious Faiths

Insanity is evidently much more frequent among the Jews than among the other religious faiths; we may therefore assume that the other affections of the nervous system are likewise in the same proportion among them. Nevertheless, the tendency to suicide among the Jews is very slight. We shall even show later that it is least prominent in this religion. In this case accordingly suicide varies in inverse proportion to psychopathic states, rather than being consistent with them. Doubtless this does not prove that nervous and cerebral weaknesses have ever been preservatives against suicide; but they must have very little share in determining it, since it can reach so low a figure at the very point where they reach their fullest development.

If Catholics alone are compared with Protestants, the inverse proportion is less general; yet it is very frequent. The tendency of Catholics to insanity is only one-third lower than that of Protestants and the difference between them is therefore very slight. On the other hand, in Table XVIII (see p. 154), we shall see that the former kill themselves much less often than the latter, without exception anywhere.

3. It will be shown later (see Table IX), p. 101, that in all countries the suicidal tendency increases regularly from childhood to the most advanced old age. If it occasionally retrogresses after the age of 70 or 80, the decrease is very slight; it still remains at this time of life from two to three times greater than at maturity. On the other hand, insanity appears most frequently at maturity. The danger is greatest at about 30; beyond that it decreases, and is weakest by far in old age. Such a contrast would be inexplicable if the causes of the variation of suicide and those of mental disorders were not different.

If the suicide-rate at each age is compared, not with the relative frequency of new cases of insanity appearing during this same period, but with the proportional number of the insane population, the lack of any parallelism is just as clear. The insane are most numerous in relation to the total population at about the age of 35. The proportion remains about the same to approximately 60; beyond that it rapidly decreases. It is minimal, therefore, when the suicide-rate is maximal, and prior to that no regular relation can be found between the variations of the two.

4. If different societies are compared from the double point of view of suicide and insanity, no greater relation is found between the variations of these two phenomena. True, statistics of mental alienation are not compiled accurately enough for these international comparisons to be very strictly exact. Yet it is notable that the two following tables, taken from two different authors, offer definitely concurring conclusions.

Thus the countries with the fewest insane have the most suicides; the case of Saxony is especially striking. In his excellent study on suicide in Seine-et-Marne, Dr. Leroy had already observed the same fact. “Usually,” he writes, “the places with a large number of mental diseases also have many suicides. However these two maxima may be completely distinct. I should even be inclined to believe that, side by side with some countries fortunate enough to have neither mental diseases nor suicides … there are others where mental diseases only are found.” The reverse occurs in other localities.

Morselli, to be sure, reaches slightly different conclusions.24 But this is because, first, he has combined the insane proper and idiots under the common name of alienated.25 Now, the two afflictions are very different, especially in regard to the influence upon suicide provisionally attributed to them. Far from predisposing to suicide, idiocy seems rather a safeguard against it; for idiots are much more numerous in the country than in the city, while suicides are much rarer in the country. Two such different conditions must therefore be distinguished in seeking to determine the share of different neuropathic disorders in the rate of voluntary deaths. But even by combining them no regular parallelism is found between the extent of mental alienation and that of suicide. If indeed, accepting Morselli’s figures unreservedly, the principal European countries are separated into five groups according to the importance of their alienated population (idiots and insane being combined in the same classification), and if then the average of suicides in each of these groups is sought, the following table is obtained:

TABLE VI—Relations of Suicide and Insanity in Different European Countries

On the whole it appears that there are many suicides where the insane and idiots are numerous, and that the inverse is true. But there is no consistent agreement between the two scales which would show a definite causal connection between the two sets of phenomena. The second group, which should show fewer suicides than the first has more; the fifth, which from the same point of view should be less than all the others, is on the contrary larger than the fourth and even than the third. Finally, if for Morselli’s statistics of mental alienation those of Koch are substituted, which are much more complete and apparently more careful, the lack of parallelism is much more pronounced. The following in fact is the result:

Another comparison made by Morselli between the different provinces of Italy is by his own admission very inconclusive.

5. In short, as insanity is agreed to have increased regularly for a century and suicide likewise, one might be tempted to see proof of their interconnection in this fact. But what deprives it of any conclusive value is that in lower societies where insanity is rare, suicide on the contrary is sometimes very frequent, as we shall show below.

The social suicide-rate therefore bears no definite relation to the tendency to insanity, nor, inductively considered, to the tendency to the various forms of neurasthenia.

If in fact, as we have shown, neurasthenia may predispose to suicide, it has no such necessary result. To be sure, the neurasthenic is almost inevitably destined to suffer if he is thrust overmuch into active life; but it is not impossible for him to withdraw from it in order to lead a more contemplative existence. If then the conflicts of interests and passions are too tumultuous and violent for such a delicate organism, he nevertheless has the capacity to taste fully the rarest pleasures of thought. Both his muscular weakness and his excessive sensitivity, though they disqualify him for action, qualify him for intellectual functions, which themselves demand appropriate organs. Likewise, if too rigid a social environment can only irritate his natural instincts, he has a useful role to play to the extent that society itself is mobile and can persist only through progress; for he is superlatively the instrument of progress. Precisely because he rebels against tradition and the yoke of custom, he is a highly fertile source of innovation. And as the most cultivated societies are also those where representative functions are the most necessary and most developed, and since, at the same time, because of their very great complexity, their existence is conditional upon almost constant change, neurasthenics have most reason for existence precisely when they are the most numerous. They are therefore not essentially a-social types, self-eliminating because not born to live in the environment in which they are put down. Other causes must supervene upon their special organic condition to give it this twist and develop it in this direction. Neurasthenia by itself is a very general predisposition, not necessarily productive of any special action, but capable of assuming the most varied forms according to circumstances. It is a field in which most varied tendencies may take root depending on the fertilization it receives from social causes. Disgust with life and inert melancholy will readily germinate amongst an ancient and disoriented society, with all the fatal consequences which they imply; contrariwise, in a youthful society an ardent idealism, a generous proselytism and active devotion are more likely to develop. Although the degenerate multiply in periods of decadence, it is also through them that States are established; from among them are recruited all the great innovators. Such an ambiguous power could not therefore account for so definite a social fact as the suicide-rate.

V

But there is a special psychopathic state to which for some time it has been the custom to attribute almost all the ills of our civilization. This is alcoholism. Rightly or wrongly, the progress of insanity, pauperism and criminality have already been attributed to it. Can it have any influence on the increase of suicide? A priori the hypothesis seems unlikely, for suicide has most victims among the most cultivated and wealthy classes and alcoholism does not have its most numerous followers among them. But facts are unanswerable. Let us test them.

If the French map of suicides is compared with that of prosecutions for alcoholism, almost no connection is seen between them. Characteristic of the former is the existence of two great centers of contamination, one of which is in the Ile-de-France, extending from there eastward, while the other lies on the Mediterranean, stretching from Marseilles to Nice. The light and dark areas on the maps of alcoholism have quite a different distribution. Here three chief centers appear, one in Normandy, especially in Seine-Inferieure, another in Finisterre and the Breton departments in general, and the third in the Rhone and the neighboring region. From the point of view of suicide, on the other hand, the Rhone is not above the average, most of the Norman departments are below it and Brittany is almost immune. So the geography of the two phenomena is too different for us to attribute to one an important share in the production of the other.

The same result is obtained by comparing suicide not with criminal intoxication but with the nervous or mental diseases caused by alcoholism. After grouping the French departments in eight classes according to their rank in suicides, we examined the average number of cases of insanity due to alcoholism in each class, using Dr. Lunier’s figures. We got the following result:

The two columns do not correspond. Whereas suicides increase sixfold and over, the proportion of alcoholic insane barely increases by a few units and the growth is not regular; the second class surpasses the third, the fifth the sixth, the seventh the eighth. Yet if alcoholism affects suicide as a psychopathic condition it can do so only by the mental disturbance it causes. The comparison of the two maps confirms that of the averages.

At first sight there seems to be a closer relation between the quantity of alcohol consumed and the tendency to suicide, at least for our country. Indeed most alcohol is drunk in the northern departments and it is also in this same region that suicide shows its greatest ravages. But, first, the two areas have nothing like the same outline on the two maps. The maximum of one appears in Normandy and the North and diminishes as it descends toward Paris; that of alcoholic consumption. The other is most intense in the Seine and neighboring departments; it is already lighter in Normandy and does not reach the North. The former tends westward, and reaches the Atlantic coast; the other has an opposite direction. It ends abruptly in the West, at Eure and Eure-et-Loire but has a strong easterly tendency. Moreover, the dark area on the map of suicides formed in the Midi by Var and Bouches-du-Rhone does not appear at all on the map of alcoholism. (See Appendix I).

In short, even to the extent that there is some coincidence it proves nothing, being random. Leaving France and proceeding farther North, for example, the consumption of alcohol increases almost regularly without the appearance of suicide. Whereas only 2.84 liters of alcohol per inhabitant were consumed on the average in France in 1873, the figure rises in Belgium to 8.56 for 1870, in England to 9.07 (1870-71), in Holland to 4 (1870), in Sweden to 10.34 (1870), in Russia to 10.69 (1866) and even, at Saint Petersburg to 20 (1855). And yet whereas, in the corresponding periods, 150 suicides per million inhabitants occurred in France, Belgium had only 68, Great Britain 70, Sweden 85, Russia very few. Even at Saint Petersburg from 1864 to 1868 the average annual rate was only 68.8. Denmark is the only northern country where there are both many suicides and a large consumption of alcohol (16.51 liters in 1845). If then our northern departments are distinguished both by their tendency to suicide and their addiction to alcohol, it is not because the former arises from the latter and is explained by it. The conjunction is accidental. In general, much alcohol is drunk in the North because of the local rarity of wine and its cost, and perhaps because a special nourishment calculated to maintain the organism’s temperature is more necessary there than elsewhere; and on the other hand the originating causes of suicide are especially concentrated in the same region of our country.

The comparison of the different states of Germany confirms this conclusion. If they are classified both in regard to suicide and to alcoholic consumption, (see above), it appears that the group showing most suicidal tendency (the third) is one of those where least alcohol is consumed. Genuine contrasts are even found in certain details: the province of Posen is almost the least affected by suicide of the entire Empire (96.4 cases per million inhabitants), yet it is the one where most alcoholism is found (13 liters per capita); in Saxony, where suicide is almost four times as common (348 per million), only half as much alcohol is consumed. It is to be noted, finally, that the fourth group, that of the lowest consumption of alcohol, is composed almost exclusively of southern states. From another standpoint, if suicide occurs there less than in the rest of Germany, this is because its population is either Catholic or contains large Catholic minorities.

Thus no psychopathic state bears a regular and indisputable relation to suicide. A society does not depend for its number of suicides on having more or fewer neuropaths or alcoholics. Although the different forms of degeneration are an eminently suitable psychological field for the action of the causes which may lead a man to suicide, degeneration itself is not one of these causes. Admittedly, under similar circumstances, the degenerate is more apt to commit suicide than the well man; but he does not necessarily do so because of his condition. This potentiality of his becomes effective only through the action of other factors which we must discover.

Bibliography.—Falret, De l’hypochondrie et du suicide, Paris, 1822.—Esquirol, Des maladies mentales, Paris, 1838 (V. I, p. 526-676) and the article Suicide in ,Dictionnaire de medecine, in 60 vols.—Cazauvieilh, Du suicide et de l’alienation mentale, Paris, 1840—Etoc-Demazy, De la folie dans la production du suicide, in Annales medico-psych., 1844.—Bourdin, Du suicide consideré comme maladie, Paris, 1845.—Dechambre, De la monomanie homicide-suicide, in Gazette Medic., 1852.—Jousset, Du suicide et de la monomanie suicide, 1858.—Brierre de Boismont, op. cit.—Leroy, op. cit.—Art. Suicide, in Dictionnaire de medicine et de chirurgie pratique, V. XXXIV, p. 117.—Strahan, Suicide and Insanity, London, 1894. Lunier, De la production et de la consommation des boissons alcooliques en France, Paris, 1877.—By the same, art. in Annales medico-psych., 1872; Journal de la Soc. de stat., 1878.—Prinzing, Trunksucht und Selbstmord, Leipzig, 1895.

In so far as insanity itself is purely individual. Actually it is partly a social phenomenon. We shall return to this point.

Maladies mentales, v. 1, p. 639.

Ibid., v. I, p. 665.

Du suicide, etc., p. 137.

In Annales medico-psych., v. VII, p. 287.

Maladies mentales, v. I, p. 528.

See Brierre de Boismont, p. 140.

Maladies mentales, 437.

See article, Suicide, in Dictionnaire de medicine et de chirurgie pratique.

These hallucinations must not be confused with those tending to deceive the patient as to the risks he runs; for example, to make him mistake a window for a door. In the latter case, there is no suicide as defined above, but accidental death.

Bourdin, op. cit., p. 43.

Falret, Hypochondrie et suicide, p. 299-307.

Suicide et folie-suicide, p. 397.

Brierre, op. cit., p. 574.

Ibid., p. 314.

Maladies mentales, v. I, p. 529.

Hypochondrie et suicide, p. 3.

Koch, Zur Statistik der Geisteskrankheiten, Stuttgart, 1878, p. 73.

See below, Bk. II, Chap. 2.

Koch, op. cit., p. 139-146.

Koch, op. cit., p. 81.

Op. cit., p. 238.

Op. cit., p. 404.

Morselli does not expressly say so, but it appears from the figures he gives. They are too high to represent cases of insanity only. Cf. the Table given in Dechambre’s Dictionnaire where the distinction is made. Morselli has evidently given the total of the insane and the idiots.

We have omitted only Holland from the European countries reported upon by Koch, the information given concerning the intensity of the tendency to suicide there not seeming sufficient.

Op. cit., p. 403.

Completely conclusive proof of it, to be sure, has never been given. Whatever the increase has been, the coefficient of acceleration is not known.

See Bk. II, Chap. IV.

A striking example of this ambiguity is seen in the similarities and differences between French and Russian literature. The sympathy accorded the latter in France shows that it does not lack affinity with our own. In the writers of both nations, in fact, one perceives a morbid delicacy of the nervous system, a certain lack of mental and moral equilibrium. But what different social consequences flow from this identical condition, at once biological and psychological! Whereas Russian literature is excessively idealistic, whereas its peculiar melancholy originating in active pity for human suffering is the healthy sort of sadness which excites faith and provokes action, ours prides itself on expressing nothing but deep despair and reflects a disquieting state of depression. Thus a single organic state may contribute to almost opposite social ends.

According to the Compte general de l’administration de la justice criminelle, for 1887. See Appendix I.

De le production et de la consommation des boissons alcooliques en France, p. 174-175.

See Appendix I.

See Lunier, op. cit., p. 180 ff. Similar figures applying to other years are to be found in Prinzing, op. cit., p. 58.

The consumption of wine indeed varies rather inversely to suicide. Most wine is drunk in the Midi where suicides are least numerous. Wine is, however, not to be regarded as a guarantee against suicide for this reason.

See Prinzing, op. cit., p. 75.

To illustrate the influence of alcohol the example of Norway has occasionally been cited, where alcoholic consumption and suicide have shown a parallel decline since 1830. But in Sweden alcoholism has diminished also and proportionately, while suicide has continued to increase (115 cases per million in 1886-88, instead of 63 in 1821-30). The situation is the same in Russia.

To give the reader all sides of the question we must add that the proportion of suicides ascribed to occasional or habitual drunkenness by French statistics rose from 6.69 in 1849 to 13.41 per cent in 1876. But first, by no means all such cases are attributable to alcoholism properly so-called, nor must this be confused with simple intoxication nor frequentation of a bar. Whatever the exact meaning of these figures, moreover, they do not prove that the abuse of spiritous liquors plays a large role in the suicide-rate. Finally, it will be shown later why no great value can be attached to the information thus given by statistics concerning the presumptive causes of suicide.