With an initial publication date of 1840, The Anatomy of Suicide is perhaps the oldest book I’ve ever reviewed.  A fair question would be what such an old text could teach us today.  The answer is both universal truths that haven’t changed in nearly two centuries and the things that have changed.  It’s good to know what was believed so we can see how we’ve made progress in our understanding and acceptance of suicide over time.

Antiquity

Since antiquity, there have been three “causes” for suicide:

1. Avoiding pain or personal suffering
2. Vindication of one’s honor
3. To provide an example for others

The first is perhaps the most common and the heart of Shneidman’s psychache (see The Suicidal Mind).  In more recent times, less has been said about honor.  In America’s Generations, I summarized a progression of honor over time – and it’s not moving in a positive direction.  The idea of suicide as an example for others is definitely an extreme case of the protection against people taking advantage of others that is often exposed in the ultimatum game.  (See The Evolution of Cooperation and SuperCooperators.)

Justifiable Suicide?

While most people would agree with a general prohibition of suicide, many recognize that it’s not absolute.  In historical times, suicide was justifiable if one expected to fall into enemy hands and therefore to be tortured and murdered.  The water gets murkier when we speak of people who believed that they could no longer contribute to society or who were completely destitute and therefore decided to end their own life.

Today, in some countries, there is the concept – often well regulated – of suicide when a person is afflicted with a terminal illness.  So, while we share a general aversion to suicide, in some countries for some limited circumstances, we do accept that it should remain an option.

Compelled to Live

No one can be compelled to live.  Suicide: Inside and Out demonstrates how it’s impossible – even in an inpatient setting – to compel someone to live.  They must want to live.  You can reduce means.  You can try to remove every harm.  But in the end, you can’t prevent someone from suicide if they want to do it.

There’s a consensus that people who are suicidal learn what to say to inpatient doctors to allow them to get out.  (See How Not to Kill Yourself as one example.)  While the illusion of control is comforting (see Compelled to Control), it’s not reality.

Law and Consequences

No law can be made without the threat of some consequences.  The most dangerous situation is when the other person has nothing to lose.  Laws prohibiting suicide are problematic because the consequences must mean something to someone for whom not even life means something.  Threats of exposing the bodies to public display or some form of humiliation is one avenue that has been tried – with limited or no apparent success.  Being prevented from being buried on church grounds or even requiring burial at a crossroads has not made a measurable impact.  So, too, have penalties and forfeitures been levied upon the families of those who die by their own hand.  The result of these strategies has provided strong disincentive for coroners to accurately report suicides because of the repercussions.

Suicide is something that remains largely beyond the reach of the law.  Perhaps that’s just one reason why it’s not against the law in most parts of the world – the consequences don’t work.

Irredeemable

What if you “knew” that nothing that you could possibly do would ever make up for the pain, hardship, and sorrow that you had caused others?  What if nothing that you could do could get you back to having at least a neutral impact on the world?  Being hopeless, self-loathing, or irredeemable would seem to lead to a sense that suicide is the right option.  After all, if you can’t make it better, you can at least exit the situation.

Of course, it’s not possible to say that you’re irredeemable, but in the throes of cognitive constriction and suicidal crisis, it may seem that way.  (See Capture for more.)  Rick Snyder in The Psychology of Hope explains that hope is a cognitive construct that relies both on waypower – or know-how – and willpower – the desire and drive to do.  Roy Baumeister explains in Willpower how willpower itself is an exhaustible resource.  In most cases, not knowing how to compensate for past harms (real and imagined) leads to an exhaustion of willpower.

How He Lives

It’s not how a man dies that matters, it’s how he lives.  It’s a simple cliché with a deeper meaning.  Often, suicide is evaluated as the final and ultimate act of a person’s life.  In doing so, it invalidates all the other good that they have done and minimizes them to a single moment.  Too often, suicide is the result of people believing that they’ve not lived well.  Whether that’s because of unrealistic expectations or the belief that living well means a life without struggle and loss doesn’t matter.  What matters is that those that choose suicide have judged themselves and their circumstances harshly.

False Medicine

Before ending, I should say that one must overlook the quasi-medical practices of the past that we’ve long since discovered did more harm than good.  There are references to bleeding people to let out the bad humors.  Similarly, there are references to disproven theories about phrenology.  It would be irresponsible to take medical advice from a text that is nearly two centuries old – but also irresponsible to discard the entire text because of some errors.  The truth is that every work has some errors.  Some are larger and some are smaller.  Our goal should be to take what’s valuable and leave the rest.

When Life Is Unbearable, Death Is Desirable, and Suicide Justifiable

Too often, the brief and momentary troubles are perceived as persistent, personal, and pervasive.  (See The Suicidal Mind).  Our goal in preventing suicide shouldn’t be the absolute prohibition or punishment of those who consider it.  Instead, we should endeavor to reduce suffering, to make life more bearable, and to make death undesirable.  Instead of removing the scales between reasons for living and reasons for death, we should find ways to pile on more reasons for living.

Maybe if we can look deeply at how people see themselves and how they’ve seen themselves over time, we’ll finally find a way to reduce suffering through a better understanding of The Anatomy of Suicide.