Edited by John Donnelly
Contemporary Issues in Philosophy; series editors, Robert M. Baird and Stuart E. Rosenbaum. 212 pp
Prometheus Books, Buffalo, NY. 1990
ISBN 0-87975-595-4
This book is a collection of essays on suicide. There are three sections, dealing with background history, definitions, and the rationality and morality of suicide. John Donnelly, the editor, has written a 16-page introduction. It is very short and can act only as a guide toward what to expect from each author. Readers may find the introduction more useful as a revision after reading the essays. There are brief notes and references at the end of each contribution.
In a book of carefully reasoned arguments it is somewhat surprising to see the editor state: “Of course millions of people unsuccessfully attempt suicide every year.” Certainly millions of people in North America may swallow large quantities of pills or cut themselves with razors, but it is likely that only a minority are trying to kill themselves. The term “attempted suicide” has been useful, but in the interests of accuracy “deliberate self-harm”, “self-injury” or even “parasuicide” is preferable.
The historical background section includes essays by Seneca, Immanuel Kant, David Hume and St. Thomas Aquinas. There are five chapters in the section on definitions, and the rather mixed collection in the third part includes works by Edwin S. Schneidman, Thomas S. Szasz and Joyce Carol Oates. The pieces by Shneidman (reprinted from a 1965 article) and Szasz (1971) seem, curiously, more out of date than those of Seneca and Hume, which were published 2000 and 200 years ago respectively. Seneca’s arguments in particular have a present-day feel about them.
Shneidman is evangelical and enthusiastic about prevention. We are now coming to a much more modest view than his. It has to be acknowledged that attempts to change the frequency of suicide in society have been quite without success, and even in individual cases we can legitimately boast only of postponing suicide, not of preventing it.
Szasz destroys his case by overstating it. He adopts the extreme libertarian point of view and, to support his case, denies that suicide can be the product of disorders. He has elsewhere1 argued convincingly that mental illness is a logical absurdity, but here he seems to deny that illnesses or disorders can result in suicide. In the light of what was known even in 1971 about major depression, substance abuse, schizophrenia and organic brain disorders, this position seems disingenuous. Szasz would not expend any effort to prevent people from killing themselves — even, presumably, a woman in a post-partum confusional state or a previously healthy elderly person suffering from an acute major depression. In spite of this, one of his assertions needs to be addressed very seriously. He states that “coerced psychiatric interventions may increase rather than diminish the suicidal person’s desire for self-destruction”. There seems to be no more evidence to refute this argument now than there was in 1971.
There are well-argued discussions on intention as an important criterion in the definition of suicide (by Glenn C. Graber and William E. Tolhurst), and the reader will certainly be interested in the distinction between weak and strong intentions.
Suicide: Right or Wrong? does not pretend to be a practical guide, but I shall certainly reread many of these essays. Clinicians can so easily become narrowly focused in dealing with the everyday reality of suicide risk; it is refreshing to be able to step outside the confines of medical and legal constraints. Reading this book may not make much difference to our clinical decisions, but it serves as a reminder of what complicated attitudes society has toward suicide. As doctors, particularly psychiatrists, we sometimes feel that society requires us to do mutually exclusive things: to allow people the freedom and dignity to manage their own lives (and deaths?) and both to predict suicide accurately (impossible) and to prevent it (impractical).
In summary, I recommend this book most highly. It could serve as a handy and comforting companion to anyone who deals even remotely with the vexed questions raised by self-injurious behaviour and self-inflicted death.