The theology of the Middle Ages, including that of Thomas Aquinas’ Summa Theologia and Dante’s Inferno, was unambiguous in the condemnation of suicide. Church law could not have been more severe. Was this total condemnation effective in stopping suicide? We cannot be certain, given our sketchy knowledge of the lives of ordinary people in the distant past. However, the most extensive studies of medieval suicide paint a picture surprisingly similar to today’s situation A commentator on Alexander Murray=s SuicideintheMiddleAgesobserves: “The profile of medieval suicide does not seem to differ in essentials from modern suicide. Its causes were various and personal; mental illness and overwhelming stress were frequently acknowledged. So the Middle Ages were not peculiar; they were neither too primitive for suicide to exist; nor too religious to obviate individual desperation.”ciii A similar conclusion is drawn by Georges Minois in surveying the Middle Ages. For reasons of poverty, sickness, jealousy, hopeless love and honor, suicides had their way despite peril to their souls, posthumous injury to their bodies, and the distress caused to their relatives.civ
Although the invention of the term suicide in the seventeenth century signified a shift, which was already occurring and presaged further change in the centuries that followed, neither church law nor secular law changed quickly. Most European nations decriminalized suicide in the eighteenth and nineteenth centuries. English law still made it a felony until 1961; Ireland until 1993. The United States was always more lenient but some states still have a law against it.cv
The larger change over the centuries was one of attitude, a tendency to find exculpatory factors for the individual while the act itself was still condemned. The most common factor was a judgment of noncomposmentis, not guilty by reason of insanity. In seventeenth-century England, one out of ten suicides was so judged; by the nineteenth century nearly all cases of suicide were taken to be indications of mental sickness.cvi That judgment seems largely vindicated by twentieth-century scholarship. Studies in Europe, the United States, Australia, and Asia have shown the “unequivocal presence of severe psychopathology in those who die by their own hand; indeed, in all of the major investigations to date, ninety to ninety-five percent of people who committed suicide have a diagnosable psychiatric illness.”cvii
The distinction between the action that is thought to be criminal or immoral and the actor, who may not be morally responsible, has allowed even the stiffest opponents of suicide to exercise compassion in actual cases of suicide. Thus, Jewish law continues to have a strong stricture against suicide but Jews refrain from judging the individual case of suicide.cviiiThe Roman Catholic Church, since the Second Vatican Council, has moved toward a similar position. Everything is done to comfort grieving relatives. No disrespect, such as exclusion from consecrated burial grounds, is shown to the deceased. The Catholic Church is here living up to one of its most basic principles: God alone is ultimate judge. No religious official can judge the mind and motives of the person who has committed suicide.
The recognition that mental illness affects most people who commit suicide has, on the whole, been a positive and helpful development. The only drawback is that the “presence of psychopathology” could be equated with a complete explanation of suicide. Differences among kinds of suicide could be obscured and different kinds and degrees of mental illness might also get downplayed. The presence of mental sickness answers some questions while raising others. Underneath the mental disturbance there are still questions about what suicide means both to the individual attempting it and to the community where it occurs. One can continue to ask these questions even while drugs are being prescribed or psychotherapy is tried.
The explanation of mental illness does not do full justice to the complexity of suicide. Concerning the label of insanity, James Hillman writes: “Justice is performed by defamation of character. To be saved from being found a murderer, one was defined a lunatic....The ‘sane’ suicide was consequently hushed up or disguised as an accident.”cix Despite today=s greater openness about suicide, there are still many disguised cases and a strong resistance to the idea that someone “rationally” decided to end his or her life.
Is Suicide Natural?
The question of whether some activity is “natural” is usually related to a concern with morality. In the first half of the twentieth century the main school of ethics denied that there is a connection between the natural and the moral. In the second half of the century, for a variety of reasons, such as war crimes, ecology, and feminism, the question returned. To say that the natural is moral (or the moral is natural) would be too simplistic. Nonetheless, the question of what is natural cannot be avoided nor can the question of some link between the natural and the moral.
One route that people take in assessing what is natural for humans is to look at the historical record. If something has always been present, as far as we can tell, that fact would seem to count for its being natural. For example, the Kinsey Reports and subsequent studies of homosexuality strongly suggest that homosexuality has always been present in the human population. In the past, one of the most frequent uses of the term “unnatural” has been in reference to homosexuality. Data that show the existence of homosexuality throughout the centuries shift the burden of proof to those who call it unnatural. The question becomes not how can homosexuality be natural but why should it be called unnatural.
If one approaches “natural” in this way, another ambiguous term that usually shows up is “normal.” If something is always present, cannot it be called “normal”? The only unequivocal meaning of norm/normal is mathematical; the statistician decides what is the mean and median. To be normal is to fall within some expected range toward the middle of a group. Talking about what is normal can work against any minority of people in the population. In statistical terms, the left-handed or the homosexual person is not the norm. The danger comes when being different – outside the norm – slides into being thought sick, immoral or unnatural. The term “abnormal” certainly acquired these connotations so that it would be unfair to say that a left-handed person or a homosexual person is abnormal. Homosexuality is neither normal nor abnormal.
A consistent meaning of humanly natural refers to what we are born with, the powers of the unique person. Historical studies help to determine the range of those powers. The “natural” in this meaning is amoral, simply the given capacity from which human actions flow. The activities of a person are morally good if they are in accord with these powers, transforming possibility into actual practices. An action is immoral if it violently conflicts with the human organism and the capacity to partake in the human community. An immoral act is in this sense unnatural, a direct attack on what constitutes the naturally human.
A common way to dismiss all talk about what is natural and unnatural is to say that since murder or rape or stealing are present throughout history they cannot be called unnatural; that is, they are natural to human beings.cx This objection misses the mark. Murder or rape is indeed the activation of natural powers but they are destructive uses of the natural and therefore deserve to be called unnatural. The capacity to murder is natural; the act of murder is unnatural. If anyone and everyone engaged in it there would eventually be no human nature and no human community.
This relation between the terms natural and unnatural is not so paradoxical as it may seem. A similar use of language is found elsewhere. For example, the capacity to act rationally is the precondition for acting irrationally; animals other than humans cannot act irrationally; they act non-rationally. There is a clear distinction between the irrational, as a destructive force, and the non-rational, as a different way of doing things. Similarly, only a professional can act unprofessionally; other people are simply non-professionals. Acting unprofessionally connotes moral failure. Thus, a humanly natural being is the only one that can act unnaturally. What is not natural may be a positive complement to the natural, but what is unnatural has almost always indicated a distortion or destruction of the natural.
On the question of whether suicide is natural, it is helpful to acknowledge that the capacity for suicide is. James Hillman writes: “Without dread, without the prejudices of prepared positions, without a pathological bias, suicide becomes ‘natural’. It is natural because it is a possibility of our nature, a choice open to each human psyche.”cxi I agree with the second sentence that suicide is a possibility of our nature but the first sentence may imply too much. The actual performance of suicide is other than natural – either a personal act that is more than natural or else a supremely unnatural act. On the face of it, no human act is more unnatural – the destruction of the human person and its human nature.
The judgment in past centuries that suicide is an unnatural act remains generally convincing. But in addition to recognizing the exculpatory presence of mental illness, two other qualifications are needed. First, it seems possible that some individuals today are not violently opposing their natures so much as listening to their organism telling them: enough, it is time. Contemporary medicine has extended their life but a stop seems called for.
The other qualification of suicide as unnatural is the dimension that Hillman digs for. The person who chooses suicide is taking an option available for all of us, a power natural to the human. The suicidal person can be a threat to our complacency, forcing us to ask ourselves if we have chosen to live or merely not chosen to die. He or she forces us to ask what kind of life we are living and whether that is all there is. Hillman writes: “The impulse to death need not be conceived as an anti-life movement; it may be a demand for an encounter with absolute reality, a demand for a fuller life through the death experience.”cxii
In summary, suicide is both natural and unnatural. It is natural insofar as the capacityfor suicide is humanly natural. The actof suicide, however, is, with some possible exceptions, unnatural, a destruction of the nature in the person who commits the suicide. One can also say that suicide is a normal occurrence in the human race, that is, subject to statistical predictability. For the individual person, however, suicide is not normal. Alexander Murray concludes his survey of suicide in the Middle Ages with the observation “How normal the picture has been.”cxiii What that means is that in comparison to the Middle Ages the present era has similar patterns of suicide.
Although suicide may be normal for the human race, Emile Durkheim, in his classic work, Suicide,found great variations among ethnic, religious, educational, age and other groups.cxiv What is normal among Swedish Lutherans is not normal among Jews; the Swedes have a high rate of suicide, the Jews have a low one. In educational terms, the normal rate of suicide goes up according to the educational level. In comparing war and peace, the normal rate of suicide goes down in wartime. Durkheim was looking for a sociological law that would encompass all the variances. He found a rule that did explain the frequency of suicide in most groups, namely, the rate of suicide varies inversely with the solidarity of the group.
A higher rate of suicide seems to be the price we pay for the increasing individualism of modern times. Thus, the normality of suicide increases in modern times. In recent decades it certainly has among some groups, especially teenagers and young adults. But the statistical normality of twenty-year-old men committing suicide does not lessen the abnormality of individuals committing suicide. The fact that something is a normal part of human experience is neither an explanation nor an approval of individual cases of suicide.
Suicide as Developmental?
For a person to think about suicide is both natural and normal, that is, part of human development. The commission of suicide, however, except as a possible culmination of human development, is unnatural and abnormal. The process of human development is endlessly mysterious and varied. I suggested that Kübler-Ross’ stages of dying may throw light on stages of living. The stages of dying consist in a dialectic of yes and no: yes to life, no to death; no to life, yes to death; yes to life inclusive of dying. From earliest infancy, the process of affirming life through both the partial denial and the partial acceptance of death is at work.
The possibility of suicide is a developmental moment that people may reach quite early in life, as soon as choice is possible. There are recorded cases of children as young as six-years-old committing suicide. The thought of such a possibility may frighten adults, but trying to block out a child’s awareness of suicide will not work. “Until we can choose death, we cannot choose life. Until we can say no to life, we have not really said yes to it, but only have been carried along by its collective stream.”cxv
A parallel can be found in the child’s ability to tell lies as the precondition of a moral commitment to the truth. Until he or she has an interior life that makes dissimulation possible, the child cannot sort out truth from falsehood. Fanciful stories by a small child are not lies; they are a necessary part of learning how to tell the truth. A person who could not tell a lie would be humanly under developed.
As soon as an interior life leads to playing with images and language, the thought of suicide provides a limit case for experimentation. “Suicide fantasies provide freedom from the actual and usual view of things.”cxvi Most children and teenagers have at some time entertained the question: “I wonder how they would feel if I killed myself?” Only a tiny minority of these young people move from vague fantasy to actually planning their own deaths. Some of them go so far as to put the plan into practice.
We do not know what percentage of attempted suicides are desperate attempts to get help. No doubt there is ambivalence in many cases, which is often indicated by the means that are chosen. An overdose of pills may or may not be an accident; it may be either an attempt to end one=s life or else a cry for attention. More girls than boys attempt (or seem to attempt) suicide, but more boys succeed. Girls often do not know how much of an overdose is needed to cause death, but that ignorance may be part of their ambivalence about whether they really want finality. The estimate of half a million people a year in the United States who need treatment for attempted suicide suggests the confusion and mixed feelings that are usually present in the attempt to end one’s life.
The mixed feeling about whether one wishes to live or die is related to the phenomenon of people trying to slowly kill themselves or acting in a way that makes death quite likely. Karl Menninger coined the term “chronic suicide” for this kind of activity; Edwin Shneidman’s “sub-intentional death” seems to cover the same phenomenon.cxvii In some respects this is a more puzzling issue than the 30,000 plus who are officially listed as suicides. Why do hundreds of thousands of people seem to be intent on dying by reason of automobile accidents, alcohol, or daredevil sports?
For the teenager, life-threatening risks are less likely to be a case of chronic suicide than a case of the illusion of invulnerability. The assumption is that death is for the sick and aged, not the nineteen-year-old motorcyclist. However, when a forty-year-old man is constantly acting in ways that are obviously dangerous to his health and safety, one has to wonder whether the drive for death has overtaken the wish to live.
Every individual takes calculated risks every day. Every time an individual gets into an automobile in the United States he or she risks being one of the hundred that day who do not get out alive. Crossing the street in New York or London is certainly life-threatening. Smoking can kill you, then again it might not. How far should one go in avoiding danger? An outsider may think someone has calculated the odds very poorly in regard to smoking, climbing mountains, or working on the bomb squad, but some risk-taking is not proof of chronic suicide. Only when the individual lives by a pattern in which the odds are terrible and no good purpose seems to be served by the risk has a line been crossed. Exactly where that line is may be unclear to the individual or to friends who would like to help.
One of the things that seems to be at work in chronic suicide is that the calculation of a balance between partial denial and partial acceptance of death has not been consciously worked out and integrated into one’s adult development. Death has been banished from consciousness only to become encysted in the soul. While a clear choice to commit suicide could not be further from the person=s mind, a hastening of death is at the center of a person’s life. The person may seem to act with fearless bravado and an exaggerated lust for life, but the seductive lure of dying actuallyunderlieseachactivity.
The problem here is not the failure to recognize one’s mortality but, rather, doing it in a duplicitous way that distorts the cycle that says yes and no to death. Many people who commit suicide are manic-depressive. This disease is a startling exaggeration of the yes and no stages. In the manic stage, the person overflows with life, often displaying extraordinary talent and creativity. In the depressive stage, life withdraws to the point of a paralysis of activity. Each cycle can increase the distortion of up and down, until the organism cannot sustain such jolts, and suicide then results. There is nothing romantic about this form of suicide. The control of manic-depression by drugs has been one of the welcome developments of modern medicine. Successful treatment means having the “normal” mood swings that people have, including sometimes feeling elated and at other times feeling depressed.
Carrying out suicide is not what anyone expects of a middle-aged, healthy person. When it happens, there is shock and the feeling that life has been aborted prematurely. The relatives and close friends of the deceased person feel conflicted about how this could have happened. As for the person who attempts suicide, it is noteworthy that in Raymond Moody’s study of near-death experiences, the one group that did not have a pleasant experience were the attempted suicides.cxviii The organism seems to be saying: Not yet; you still have work to do.
James Hillman makes the paradoxical claim that suicide is delayed death rather than premature death; suicide is “the late reaction of a delayed life which did not transform as it went along.”cxix The person has failed to go through some of life’s small dyings and renewals. Suicide is an urge for transformation but the means taken are too literal, too hasty, and too violent. The treatment to prevent suicide would have to include going through the death experience – for example, feelings of despair – to arrive at a newness of life.
“Until modern times,” writes Robert Neale, “what every Tom, Dick and Harry has known is that you come to an end in order to come to a new beginning”cxx In trying to prevent suicide one has to move with the rhythm of yes and no, and be willing to wait for new life instead of trying to return to the old. “In the keeping of a kind of death vigil together, the panic reaction diminishes and with it the hasty assault on death.”cxxi
Such delicate counseling, when a person’s life hangs in the balance, requires great skill. Sometimes a professional counselor is not available and a close friend may be the last link to life for the person who is suicidal. But the care and concern of one or a few friends sometimes makes all the difference on the side of life. A friend once recounted to me how, while sitting on a bridge and ready to jump, he was dissuaded by the fact that a couple of people would feel bad.
The urge to suicide does not usually increase as one ages. There has been some increase in the suicide rate among the very old but most of that refers to people who think that their dying is being over extended by medical technology. Healthy, old people are mainly concerned with living each day, not planning their deaths. Even people who have been diagnosed with a fatal illness are not prime candidates for suicide. Those who have learned to wait throughout life are content to wait for death. The process of yes and no may have been telescoped into six months or a year but the dying person is not inclined to speed up the process further.
When the sick are properly cared for, suicide is not an overriding issue. The biggest demand for the legalization of physician-assisted suicide has come from the middle-aged who are worried about whether anyone will care for them when they are old. Suicide is not a common demand in hospices. If pain can be controlled and no external factors overwhelm them, the dying do not clamor for suicide. Kübler-Ross writes: “Within the last twenty years only one person asked me for an overdose. I didn’t know why and I sat down and asked him: ‘Why will you have it’?”cxxii It turned out that he was concerned that his mother could not bear the situation.
Patients who have been told that they have only weeks or months to live often have a better sense of life as a rhythm of yes and no. The impulse is not to choose death but to accept that there is a greater power than one’s choice. A near-death experience or an attempted suicide can make one sensitive to death as a constant companion who does not have to be invited into one’s life. After having attempted suicide, Gloucester, in KingLear, says: “You ever-gentle gods, take my breath from me/Let not my worser spirits tempt me once again/To die beforeyouplease.”
Is Suicide Dignified?
I have pointed out that the fundamental question about dying with dignity is whether we are referring to the dying patient or to the community of care givers. Is dignity something one tries to hold on to as life ebbs away or is dignity what is deserved by the dying person whatever his or her condition?
Advocates of legalized suicide are very much concerned with the first meaning of dignity. A person’s dignity, they assume, consists in retaining rational control of one’s faculties. Rather than become dependent on others for performing ordinary bodily functions, a person should have the right to end his or her life. While he or she still has some dignity left, suicide should be an available option. Few people would deny that this argument has some merit. Unless one believes in an absolute prohibition of suicide by God, it is difficult to see why suicide should not be acceptable in some circumstances. Who better to decide than the individual whose life is in question?