Suicide Research Before Durkheim

Suicide Research before DurkheimAuthor(s): Robert D. Goldney, Johan A. Schioldann, Kirsten I. DunnSource: Health and History, Vol. 10, No. 2, The Physician as Historian (2008), pp. 73-93Published by: Australian and New Zealand Society of the History of MedicineStable URL: http://www.jstor.org/stable/40111304 .Accessed: 28/08/2011 14:47

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Suicide Research Before Durkheim

Robert D. Goldney, Johan A. Schioldann, and Kirsten I. Dunn

The casual reader could be forgiven for assuming that there had been little systematic research on suicide before the work of the French sociologist, EmileDurkheim,1 published in 1897. This historical review demonstrates that there had been extensive studies in the preceding centuries, addressing not only the importance of social factors, but also those factors which are now subsumed in the medical model. In fact, some earlier reviews can now be seen as more balanced and comprehensive than that of Durkheim. In the twentieth century the predominant focus of suicide research was on the importance of psychosocial factors, a focus which was undoubtedly a legacy of the influential work of Durkheim. Indeed, in 1971 A/vin Alvarez stated that the study of suicide had 'become the subject of intensive scientific research. The change began in 1897 with the publication of Emile Durkheim 's classic Suicide: A Study in

Sociology, '2 and more recently Alexander Murray noted that, l If the study of suicide had its own era it would divide into two ages, before and after that book ... Le Suicide ... which, more than any other, established its subject as a specialization. '?

Therefore it is not unexpected that many believe that there had not been any substantial suicide research before Durkheim, let alone any which had addressed illness and biological factors and their inter-relationship with society.

This paper will explore suicide research before Durkheim. It will not address the writings of ancient civilisations, other than to acknowledge the work of Anton van HoofiP and Geoffrey Seidel,5 who reviewed suicide in Greek and Roman times, and that of A. Venkoba Rao6 who has written on suicide in ancient India. Rather, it will refer to several references from

Health & History, 2008. 10/2 73

74 GOLDNEY, SCHIOLDANN & DUNN

the seventeenth and eighteenth centuries and then focus on the enormous increase in scientific research in the nineteenth century, research which culminated in excellent reviews of suicidal behaviour before the work of Durkheim.

Seventeenth Century In 1637 the English clergyman, John Sym, published what Richard Hunter and Ida Macalpine referred to as 'the first

English book on suicide,'7 entitled Lifes Preservative Against Self-Killing Or, An Vsefvl Treatise Concerning Life and Self- murder. Whilst written from a theological point of view, Sym noted perceptively that 'Self-murder is prevented, not so much by arguments against the fact; which disswades from the conclusion; as by the discovery and removall of the motives and causes, wereupon they are tempted to do the same: as diseases are cured by removing of the causes, rather than of their symptoms.'7 Hunter and Macalpine also referred to early work by John Donne in 1646, which essentially discussed moral issues associated with suicide.

Eighteenth Century A bibliography published in Leipzig in 1806 by Christian Friedrich Ludwig8 referred to a number of eighteenth century books on suicide. These included those of M. Alberti from 1744: De autochiria occulta; Ant Louis from 1767: Memoire sur ime question pour distinguer les suites du succide de celles de Vassasinat\ P. Camper, from 1744: Gedachter over de Kindermoord: en Zelfmoord; and I. G. Burkhard from 1786: Briefe iiber den Selbstmord, among others, although access to the original texts is limited.

In 1 790 two volumes entitled A Full Inquiry into the Subject of Suicide were published by the clergyman, Charles Moore.9 These included a substantial section on gambling and suicide, an association referred to previously by Peter Andreas Heiberg,10 who reported an increase in suicide in Denmark following the introduction of 'number lottery' in 1771. Moore noted that suicide did not imply 'permanent madness,' although he added, 'Yet it may be allowed, that there is a sort of madness in "every" act of suicide, even when all idea of lunacy is excluded.'11 For

Suicide Research Before Durkheim 75

those who may work in the forensic/legal setting and have to decide whether or not a suicide has been associated with psychotic illness, Moore's comment that 'Such distinctions of sanity and insanity are too fine spin to be just or equitable/11 is particularly pertinent. Indeed, it is doubtful if anyone in the

subsequent two hundred years has described that challenge more elegantly.

Moore was probably one of the first to comment on possible genetic factors, when he stated: 'But what adds to their wretchedness is, that this extreme dejection of spirits, this melancholy, this lunacy and propensity to suicide, like many other disorders, is not confined to the unhappy object in the first instance, but by attacking successive generations of the same family proves itself to be hereditary.'12

Moore observed that three quarters of suicides were by hanging, with males predominating two to one, and he was aware of the association between suicide and the 'excessive use of strong and spiritous liquors.'13 Some of his conclusions were somewhat speculative, such as his comments about suicide being perceived as 'the English malady,' because, as he so delightfully put it: 'the English are a nation so distempered by the climate, as to have a disrelish of everything, nay even of life.'14

Moore also referred to the concealment of suicide because of

prevailing attitudes, and noted that he had 'received information from private hands . . . that the practice of suicide really abounds in France as much at least as in England.'15 He also expressed his disbelief in the suicide rate in Geneva being reported as

eight times greater than in London, noting that 'the calculation of actual suicide in London cannot be made with the least

degree of precision from the number of inquisitions taken by Coroners.'16 Moore clearly possessed an enquiring mind with a critical appreciation of the shortcomings of the available data.

Nineteenth Century In 1807 the Danish physician Heinrich Callisen17 wrote that suicide was an illness,18- 19 and that model gradually gained in importance. Despite the clear description of Callisen, the medical model of suicide has been attributed primarily to the early- nineteenth century French physician Jean-Etienne Esquirol.20 However, Esquirol did not focus simply on a medical model,


and German Berrios and Mostafa Mohanna21 have stated that he had a broad view of suicide, consistent with contemporary theories which incorporate both illness and social factors in the postulated causation of suicide.

There were also significant changes in public attitudes to suicide in Europe in the first few decades of the nineteenth century. In England this was probably associated with the suicide of Lord Castlereagh, or the Marquis of Londonderry, in 1 822. He had been an influential and successful politician who suicided, almost certainly in association with a melancholic illness. He was not denied a funeral, as should have been the case, and that led to considerable public debate; debate which was given further impetus in 1823, when a twenty-two-year- old law student, Abel Griffiths, suicided and had the ignominy of being the last person to be buried at a cross roads. The rescinding of the law in regard to the treatment of the corpse of a suicide occurred soon after, and, certainly in England, this probably contributed to the emergence of more published work about suicide.

In 1828 George Burrows22 wrote extensively about suicide in his Commentaries on the Causes, Forms, Symptoms, and Treatment, Moral and Medical, of Insanity. He referred to it as 'a feature of melancholia,9 although he added that 'a doubt may naturally arise, whether it be not sometimes perpetrated by a sane mind.'23 Burrows referred to earlier French work, including that of Falret and Esquirol, and commented on the relationship of homicide and infanticide to suicide, the possibility that suicide was 'sometimes innate or hereditary,'24 and that suicide occurred in children.25 He provided comparative data between a number of European cities, demonstrating that the suicide rates were, in present terms, 60 per 100,000 in Copenhagen, 42 per 100,000 in Paris, and 20 per 100,000 in London.26 He also referred to work of Johann Ludwig Casper of Prussia, who documented 'mental alienation' and 'drunkenness and dissipation' as the two most common causes of suicide.27

Burrows stated that 'The medical treatment of the propensity to suicide, whether prophylactic or therapeutic, differs not from that which is applicable in cases of ordinary insanity,'28 and he was well aware of social influences, stating that 'periods of great scarcity and distress, and sudden revolutions, political or religious, are always active and universal agents in originating


insanity.929 He also articulated concern about contagion, or what is now often called 'copy cat' suicide, noting that 'there is another and still more influential cause, though unnoticed, of the increase of suicide, and that is, the rapid and immense increase of periodical journals ... the increase of suicide, I am convinced, is mainly attributable to these causes.'30

Social factors were also considered by other early commentators, including Karl Marx,31 who wrote a brief commentary in 1846, introducing German scholars to the memoirs of Jacques Peuchet, the archivist of the Paris Prefecture of Police, which had been published in 1838. Peuchet had

provided data on suicide in Paris, along with his interpretation of the influence of social factors. Marx wrote of the 'superiority of the French' 'socialist' writers in providing 'critical descriptions of social conditions,' and he referred to their 'direct warmth of feeling, a richness of intuition, a worldly sensitivity and insightful originality for which one searches in vain in all other nations.'32

Marx noted that Peuchet had referred to suicide as a 'deficient organisation of our society,' and that it occurred 'in all classes.' He referred to a number of causes, including 'consumptive illnesses, against which present-day science is inadequate and ineffective, abused friendship, betrayed love, discouraged ambition, family troubles, repressed rivalry,' and emphasised that 'The varieties of reasons motivating suicide make a mockery of the moralists' single-minded and uncharitable blaming.'33

In 1 840, in England, Forbes Winslow published The Anatomy of Suicide™ a comprehensive work supported by statistical data. The predominance of men and hanging was noted, and he also observed that 'marriage is to a certain extent a preventive of suicide.'35 Again due regard was given to the shortcomings of the statistics from which conclusions were drawn. For example, reference was made to the counting of suicides in Paris by fishermen retrieving bodies from their nets in the River Seine, but, as Winslow noted, 'the nets were only suffered to be down a stated number of hours, according to the season, certainly not upon an average half a day,' and he concluded that 'the number of bodies that escaped the nets must at least equal the number of those that are caught.'36 He also observed that 'the Government had lately refused the accustomed fee to the fishermen for each


corpse they brought, and that they would not continue to drag up the dead bodies/ thereby casting further doubt on the value of the statistics.37

Although Winslow was critical in assessing the available statistics, that sense of criticism seemed lost when he stated that 'it has clearly been established that where there is one suicide in London, there are five in Paris.' His speculation about why there were differences in English and French suicides rates was somewhat colourful, with him noting that 'we can be romantic without blowing out our brains. English lovers do not, when "the course of true love" does not run smooth, retire to some sequestered spot, and rush into the next world by a brace of pistols dyed with cherry-coloured ribbons. When we do shoot ourselves, it is done with true English gravity.'38

Similar sentiments were expressed by Casper, cited by Mauri tz Mortensen, who stated that 'An Englishman or German hides his sorrows, and puts a noiseless end to his joyless life in his lonely chamber. A Frenchman will even in this horrible instant make a spectacle of himself; he wants to leave with pomp; his neighbours should come running, cry for him etc; thus he allows himself to be seen and heard, as he leaves this world.'39

Such speculation was not uncritically accepted. The mid- nineteenth century Norwegian theologian and social researcher Eilert Sundt, whose work in the 1 850s and 1 860s would have been more influential if it had been published in a major language, noted in regard to Casper's work that 'I am not at all confident enough to agree with this author.'40 Sundt compiled data from Norway and other European countries, and it is fascinating that the suicide rate for Norway between 1826 and 1835 was 12 per 100,000, a figure identical to that in 1998. As a result of his research into the causes of suicide he concluded that 'if there is responsibility then it does not only rest on the individual who committed the act, but also on society.'41 This led Nils Retterstol to conclude that Sundt anticipated many of the ideas contained in Durkheim's more often quoted later work.42

Other significant French work in the 1850s was that of Edmond Lisle43 and Alexandre Brierre de Boismont44 in 1856. Lisle reviewed over fifty-two thousand suicides, and among the forty-eight postulated causes were insanity, debt, gambling, disappointed love, and the desire to avoid legal pursuit, as well as


the evocative descriptions of debauchery, nostalgia and disgust with marriage. Brierre de Boismont's data set was smaller, but still included over four thousand subjects, with similar factors being implicated with no fewer than eighteen causes. The extent of French contributions to mid-nineteenth century suicide research can be gauged by noting that bibliographies of the prestigious Annales Medico-Psychologiques contain references to 138 papers addressing issues associated with suicide between 1843 and 1878.

In 1858 John Bucknill and Daniel Tuke published what was to become the standard textbook of English psychiatry for many years.45 It contained a classification of four types of suicide, with suicide arising from suicidal monomania; melancholia; delusions and hallucinations; and the fourth type was where 'it must obviously be very difficult to determine, in such cases, whether the individual was, or was not, a free agent at the time.'46 In referring to what we now consider the nature versus nurture theories of causation, Bucknill and Tuke observed: 'the question so often asked, "Is suicide the result of cerebro-mental disease?" must be answered both affirmatively and negatively. That the act may be committed in a perfectly healthy state of mind cannot, for a moment, be disputed.'47 Then they discussed various modes of death, the influence on suicide of age, sex, marriage, and the seasons, as well as the possibility of hereditary transmission. Similar considerations are contained in other early standard texts, including that of Henry Maudsley in 1879.48

In 1864 the Finnish physician, Anders Saelan,49 wrote his doctoral dissertation on suicide in Finland from the statistical and forensic medicine perspective. Saelan used a psychological autopsy method to review 784 suicides, and he examined the relationship between suicide and age, sex, profession, and the seasons, as well as different methods of suicide, and potential methods of prevention. He noted that the majority had mental disorders, and he stated that the figure could have been higher but for relatives wanting to conceal mental problems or doctors not recognising the mental problems, issues which remain pertinent today. He noted that alcohol was associated with about 25 percent of suicides.

Saelan divided suicides into two groups: those with mental disorders and those without, and he urged treatment of the mentally ill. He also focussed on the role of societal conditions,


and noted that there would have to be changes before suicide rates reduced. He expressed reservations about the effect of publicity from books on the overall suicide rate. He discussed the complexity of the influence of religion and suggested that different social conditions, rather than religion itself may be important. Further, he referred to the importance of mens sana in corpore sano, a healthy mind and body. He also commented on the pointlessness of punishing suicidal behaviour, noting that the approach was no longer followed in new legislation in other countries.

In 1 869 the Danish philosopher, Rasmus Nielsen, a colleague of Soren Kierkegaard (who had himself considered writing a thesis on suicide in 1839), published Om Sindsformoerkelse: Bidrag til Selvmorderes Psykologi (On Melancholia: Contributions to the Psychology of Those who Commit Suicide),50 He referred to epidemiological issues of age and gender, and utilised the official Danish suicide statistics which had been established by Carl Kayser in 1846.51 However, he focussed more on the philosophical challenge of elucidating causes, rather than clinical issues.

In 1874, in Australia, George Stephen published a review of suicide in the state of Victoria. He recorded 67 definite and 58 'doubtful' suicides in 1863, compared with 72 definite and 79 'doubtful' suicides in 1872.52 He uncritically accepted that all were suicides, noting that it was the 'mistaken humanity of jurymen' who declined to find that suicide was definite at inquests. The overall figure would give a suicide rate of 20.7 per 100,000, and the definite suicide rate would have been 9.9 per 100,000. Stephen's work is essentially legalistic and moralistic, referring to 'suicidal murder,' and at one point he asserted that 'true religion is the only cure for it.'53 Indeed, his work did not reflect the increasingly scientific approach to suicide research in the nineteenth century.

It will be evident that no reference to early American work has yet been made. To the best of our knowledge there were no significant books devoted solely to suicide published in the United States in the nineteenth century, but there were certainly research reports and commentaries - for example those contained in the Journal of Insanity, the forerunner to the American Journal of Insanity, and the present day American Journal of Psychiatry.

Suicide Research Before Durkheim 8 1

Jerome Motto has published a comprehensive review of nineteenth century reports of suicide in this journal, commencing from the first issue in 1845.54 An epidemiological review of 184 suicides by Hunt demonstrated that use of firearms was the most common method for suicide for males.55 The editor, Amariah Brigham, also commented on the probable under-reporting of suicides,56 and, in addition, in his editorial note he made the often quoted comment in regard to media publicity: "That suicides are alarmingly frequent in this country is evident to all - and as a means of prevention, we respectfully suggest the propriety of not publishing the details of such occurrences.'57

In 1849, in the Journal of Insanity, George Cook58 commented on familial and genetic factors in suicide and stated that "the propensity to suicide is often transmitted from parents to children,959 although no data were presented to support that. However, he quoted the French physician, Falret, who had noted that 'of all the forms of melancholy, that which tends to self- murder is most frequently hereditary,'60 and there were clinical examples given to substantiate that claim.

The relative importance of mental disorders was addressed by members of the New England Psychological Society, whose secretary, B. D. Eastman, reported on their 1877 meeting, which addressed the propensity of suicide in melancholia, and it was noted that 'the suicidal impulse was almost always present at some stage of the disorder.'61 It is also of interest that in 1 878 in a paper entitled Suicide Not Evidence of Insanity, O. H. Palmer provided further illustration of the debate fore-shadowed by Moore in 1790, a debate which still exercises us today.62

Two seminal late-nineteenth century books devoted to suicide were by the Italian Enrico Morselli, published in 1879 and translated into English and German in 188 1,63 and by William Wynn Westcott, published in England in 1885.64

Morselli's work, which is encyclopaedic in content, is arguably the most important work of nineteenth century suicidology. Westcott was later to refer to it as a 'thoroughly scientific statistical work,' although he added that it was 'hardly a readable book, consisting almost entirely of statistics,'65 and Tuke referred to it as a 'laborious work for a mass of information.'66 It contains extraordinarily detailed statistics, focusing on Italy, but also including data from a number of other countries. Individual sections of the book included Increase and


Regularity of Suicide in Civilised Countries, Social Influences, Influences Arising out of the Biological and Social Conditions of the Individual, Individual Psychological Influences, and Methods and Places of Suicide, before he provided a Synthesis on the Nature and Therapeutics of Suicide,

Examples of his detailed and careful enquiry include analyses of age and suicide in different countries; education and suicide rates; and the "Relation of Madness with Suicide/ with the latter demonstrating an association between rates of 'mad

people' and suicide.67 Morselli also gave a very perceptive view of emotional or psychic pain, where he noted that: 'it is a gross tautological sophism to give the title of "moral suffering" to sorrow for a misfortune, to misery, privation, crossed love or jealousy, whilst they reserve the title of "physical suffering" to pain which arises from a mechanical injury, from an irritation of the peripheral nerves, or disease of the intestines. The cause is unequal, but the effect is the same . . . the expression of moral suffering is the same as that of physical suffering.'68

Morselli 's work undoubtedly influenced Emilio Motta, an Italian-speaking Swiss, who in 1890 published a bibliography, Biblio-grafia del Suicidio, which contained 647 entries.69 This has been referred to by Murray, who noted that Motta only included works after the sixteenth century and that it was therefore only 4a mere fragment of available writings.'70

A less statistically burdened work than that of Morselli was provided by Westcott in 1885 in his book Suicide: Its History, Literature, Jurisprudence, Causation and Prevention.64 It

ranges over a variety of data sources, and it is of interest that he noted that "now that a study of suicide as a fact has been instituted, it has fallen almost entirely into a statistical groove, to the neglect of research into the mental state and emotions of the unfortunate individuals who become victims.'71

Westcott addressed a number of issues, including rates and means of suicide, its causes, the effect of urban and rural life, the influence of mental disease, suicide from imitation and the effects of physical illness and hereditary factors. It is also fascinating that he included a chapter on suicide in animals, a surprisingly contemporary set of observations in view of recent ethological conceptualisations of suicide.72

Westcott was well aware of the importance of social issues, as in his preface he wrote: "The question [of suicide] is one well


worthy of the earnest consideration of the community; indeed, it may be legitimately regarded as one of our Social Problems, as it involves matters which are intimately connected with our social organisation, and is with propriety embraced in our legislative enactments.'73

In 1892 there were important reviews of suicide research published by Tuke66 and George Savage74 in England.75 76 Tuke presented an erudite historical perspective of suicide, noting that "there has been no period in authentic history in which, so far as we know, there has been immunity from the practice of self destruction. '77 He referred to biblical suicides and then to Greek and Roman perspectives, before noting how attitudes gradually changed over the centuries. His epidemiological review was predominantly of European countries, although data from the United States and Australia were also presented. There was said to be a 'suicidigenous' area 'in the centre of Europe ... where suicide reaches the maximum of its intensity, and around which it takes decreasing ratio to the limits of the northern and southern States.'78 Consistent with that observation were the reported low suicide rates of Finland and Russia, which is in marked contrast to present figures.79

Tuke had a critical appreciation of the limitations of some previous research. This is well illustrated in relation to those theories about suicidigenous areas and claims that suicide rates were related to geological formations or the weather. Thus Tuke stated that 'we confess that we accept the conclusions with considerable reserve, first, because the returns of suicide in different countries may differ in their completeness, and therefore may be misleading; and secondly, because the elements of the problem are so exceedingly complex that we are in great danger of referring a maximum amount of suicide to the wrong cause.'80 Such comments are no less pertinent today than when written by Tuke over one hundred years ago.

Many of Tuke's observations have stood the tests of time and subsequent more sophisticated statistical analyses. Thus male-to-female preponderance of suicide is virtually identical to that found today; it is still true that 'there is no doubt that agricultural distress increases the number of suicides'81; it is similarly the case that 'it would seem that divorce exercises a more injurious influence on the male than on the female sex'82; there is a higher rate of suicide among doctors; suicide


remains a reality in children; it is still true that 'the influence of imprisonment on the tendency to suicide . . . [is] well marked, especially in prisoners under 30 years of age'83; as is the fact that 'the influence of alcohol or beer in the production of suicide is not disputed'84; and it is also recognised that 'examples of hereditary suicide have occurred.'85 Tuke also addressed the issue of mental illness and insanity, and noted: 'that this number is very large is unquestionable, but it cannot be admitted for a moment that the suicidal act taken alone is any sign of insanity.'86

From a clinical point of view, allowing for variations in language, Savage's contribution is a surprisingly contemporary view of mental disorder and suicide. He acknowledged that suicide can occur with 'no other signs of insanity,' and he also noted that 'In some cases of slight emotional disorder there may be an intention to pretend to commit suicide,'87 a formulation which preceded the concept of the 'cry for help' by seventy years.88

His focus on depression is as pertinent today as it was when written. He stated that 'AH melancholic patients must be considered suicidal till they are fully known'89; that even 'Simple melancholia of very slight depth is a very common cause of suicide'90; and that 'Waves of depression occur in many neurotic but otherwise sane people, which often lead to suicide. '91 He also observed that self-mutilation was performed in order to give relief.92

With regard to delusional thinking, Savage noted that 'women who believe they are either injurious to their husbands or children, or that they are in the way, may sacrifice themselves,'93 a convincing description of what sometimes occurs in suicide after childbirth. He also stated that 'Voices may command,' and 'misery produced by constant occurrence of hallucinations, may act like constant pain.'94

Savage wrote perceptively that in clinical management 'some risk must be run sooner or later, and it is necessary in curable cases to recognise that the too constant presentation of the idea of distrust to the patient's mind keeps up the morbidly suicidal state.'95 This is important, as it is an excellent description of the dilemma facing clinicians treating those who are chronically suicidal.


Savage's work is not only notable for his clinical review of "insanity9 or mental disorder and suicide, but also for his categorisation of suicide. He observed that suicide could be either impulsive or deliberate, and the deliberate suicides included those with 'egotistical' and 'altruistic feelings.'96 Indeed, it has been argued that Savage rather than Durkheim deserves scientific precedence in the use of these categories of suicide.97

Conclusion

It is evident that increasingly during the eighteenth and nineteenth centuries the initial writings of theologians gave way to the present contemporary view of suicide being influenced not only by broad social issues, but also by specific factors such as the media, religion and occupation, as well as illness factors, both physical and mental. Indeed, even the hereditary predisposition to suicide had been canvassed, and there was also a sophisticated awareness of the statistical limitations and challenges involved in conducting research in this area.

In considering the development of the scientific approach to the study of suicidal behaviours, clearly there was a demystification of earlier often punitive religious views, with the gathering of empirical data. However, there was also a reaction to that, as illustrated by Westcott's comment in 1885 that such research had 'fallen almost entirely into a statistical groove.'98 That suggests that the ground was fertile for the subsequent sociological views of Durkheim.

The question arises as to why Durkheim's views should have become so influential. One possibility is that it is Durkheim's position as one of the founders of scientific sociology that has confounded the issue. His role in this regard is not in dispute, but it is probable that his use of the topic of suicide, in the manner that Eric Plaut described as 'a convenient example for illustrating his methodology of sociology,'99 along with the burgeoning of sociology as a discipline, have led to an uncritical acceptance that there had been little study of suicide before his work.

Whatever the reason may be, it is evident from this brief review that the scientific study of suicidal behaviour existed well before the work of Durkheim. Indeed, it is apparent that


much of it is often overlooked, whereas it warrants greater recognition, particularly as many earlier observations have not only stood the test of time, but also the rigour of sophisticated modern statistical analyses.

University of Adelaide

Acknowledgements This is a revised version of a chapter published in: Uutholdelige Liv: Om selvmord, eu tanas i og be handling av doe tide, edited by H. Herrestad, L. Mehlum (Oslo: Gyldendal Akademik, 2005).

We thank Professor Lars Mehlum for drawing our attention to the work of the Norwegian Sociologist, Eilert Sundt; Professor Jouko Lonnqvist for

referring us to the research of the Finnish physician, Anders Saelan; Ms A-M Kyrklund for providing an English translation of part of Saelan 's thesis; and to the Psykiatrisk Forskningsbibliotek, Risskov, and Jyllands Posten, Aarhus,

for retrieving Erik Schiodt's works on the Danish Suicide Tradition.

1. Emile Durkheim, Suicide: A Study in Sociology, translated by J. A. Spaulding and G. Simpson, (London: Routledge & Kegan Paul 1897, 1952).

2. Alvin Alvarez, The Savage God: A Study of Suicide (London: Wiedenfeld and Nicolson, 1971), 75.

3. Alexander Murray, Suicide in the Middle Ages (Oxford: Oxford University Press, 1998), 15.

4. Anton J. L. van Hooff, From Autothanasia to Suicide: Self-Killing in Classical Antiquity (London: Routledge, 1990).

5. Geoffrey Seidel, "Suicide in the Elderly in Antiquity," International Journal of Geriatric Psychiatry 10(1995): 1077-84.

6. A. Venkoba Rao, "Suicide in Ancient India," in World History of Psychiatry \ edited by John.G. Howells (London: Bailliere Tindall, 1975): 637-40.

7. Richard Hunter and Ida Macalpine, Three Hundred Years of Psychiatry 1535- 1860 (Oxford: Oxford University Press, 1963); John Sym, Lifes Preservative Against Self-Killing Or, An Vsefvl Treatise Concerning Life and Self-murder (London, 1637), 115; John Donne, B_a_ava_o_ (Baithanatos) : A Declaration of that Paradoxe, or Thesis, that Selfe-Homicide is not so Naturally Sinne, that it May Never he Otherwise, etc. (London: John Dawson 1646), 113.

8. Christian Friedrich Ludwig, lntroductio In Rem Litterariam Praxeos Medicae: Oder Einleitung in die Bucherkunde der praktischen Medizin (Leipzig: Siegfried Lebrecht Crusius, 1806); M. Alberti, De Autochiria Occults (Halae, 1744), 4; Ant. Louis, Memoire Sur Une Question Pour Distinguer les Suites du Succide de Celles de L'Assasinat (a Paris, 1767), 8; P. Camper, Gedachter over de Kindermoord-en Zelfmoord (Leuwaarden, 1774), 8; 1. G. Burkhard, Briefe Ober den Selbtsmord (Leipzig, 1786), 8.

9. Charles Moore, A Full Inquiry Into The Subject Of Suicide etc., (2 vols) (London: J. F. & C. Rivington, 1790).

1 0. Peter Andreas Heiberg, Rigsdalersedlens Haendelser (Copenhagen, 1 787-89).


11. Moore. 333. 12. Ibid.,31%. 13. Ibid, 364. 14. Ibid.,313. 15. Ibid.,342. 16. Ibid.,359. 17. Henrick Callisen, "Physisk Medizinske Betragtninger over Kjobenhavn,"

Stadens Beboere tilegnede, I-II Deel. ["Physical-medical comments concerning Copenhagen", dedicated to its inhabitants, In two parts] (Copenhagen , 1807-09).

1 8. Erik Schiodt, "Selvmordstraditionen i Danmark/' Medicinsk Forum 12(1 959): 43-52.

19. Johan Schioldann, Selvmordet i dansk litteratur. Foredrag. Dansk Psykiatrisk Selskab. Sommernwde i Odense [Unpublished paper presented to the Danish Psychiatric Society, Summer Meeting], 26 May 1978.

20. Jean-Etienne Esquirol, "Suicide," in Dictionaire des Sciences Medicates (Paris: Panckoucke, 1821).

21 . German E. Berrios and Mostafa Mohanna, "Durkheim and French Psychiatric Views on Suicide During the Nineteenth Century: A Conceptual History," British Journal of Psychiatry 156 (1990): 1-9.

22. George Burrows, Commentaries on the Causes, Forms, Symptoms, and Treatment, Moral and Medical, of Insanity (London: Thomas and George Underwood, 1828).

23. Ibid, 413. 24. Ibid 25. Ibid, 440. 26. Ibid, 445. 27. Ibid, 446. 28. Ibid, 449. 29. Ibid, 442. 30. Ibid, 447. 31. Karl Marx, Marx on Suicide, edited and translated by Eric Plaut and Kevin

Anderson, (Evanston: Northwestern University Press, 1999). 32. Ibid, 45. 33. Ibid, 41. 34. Forbes Winslow, The Anatomy of Suicide (London: Henry Renshaw, 1 840). 35. Ibid, 270. 36. Ibid, 275. 37. Ibid, 275. 38. Ibid, 132. 39. Mauritz Mortensen, "Eilert Sundt som selvmordsforsker: Nytt i Suicidologi."

Fra Forskning Til Forebyggning 1 (1998): 4. (Also published in English, 2001). Downloaded 3 1 July 2008 from: http://www.med.uio.no/ipsy/ssff/english/culture.html

40. Ibid, 4. 41. Ibid, 6. 42. Nils Retterstel, Selvmord [Suicide] (Oslo: Universitetsforlaget, 1 995). 43. Edmond Lisle, Du Suicide: Statistique, medecine, histoire et legislation (Paris:

Balliere. 1856). 44. Alexandra Brierre De Boismont, Du suicide et de lafolie suicide consideres

dans lettr rapports avec la statistique, la medicine et la philosophic (Paris: Balliere, 1856).

45 . John Bucknill and Daniel Tuke, A Manual of Psychological Medicine (London : John Churchill, 1858).

46. Ibid.,203. 47. Ibid 48. Henry Maudsley, The Pathology of Mind (London: Macmillan, 1 879). 49. Anders Saelan, Suicide in Finland in the Perspective of Statistics and Forensic


Medicine (Helsinki: J.C. Frenckell & Son, 1864). 50. Rasmus Nielsen, Om Sindsformoerkelse: Bidrag til Selvmorderes Psykologi

(Copenhagen, 1869). 51. Carl J. Kayser, Detailleret Fremstilling af og summariske Tabeller over

Selvmordi Kongeriget Danmark iAarene I 835-44: Statistisk Tabelvaerk (Copenhagen, 1847).

52. George Stephen, Suicide in Victoria (Melbourne: Samuel Mullen, 1874): 3. 53. Ibid.,1. 54. Jerome A. Motto, "Looking Back," in Suicidology, edited by Antoon A.

Leenaars, (North vale: Jason Aronson, 1993). 55. E. K. Hunt, "Statistics of Suicides in the United States," Journal of Insanity 1

(1845): 225-34. 56. Amariah Brigham, "Note by the Editor of the Journal of Insanity/* Journal of

Insanity 1 (1845): 232-4. 57. Ibid, 234. 58. George Cook, "Statistics of Suicides," Journal of Insanity 5 ( 1 849): 303-1 0 59. Ibid., 308. 60. Ibid. 61. B. D. Eastman, "Report of the Proceedings of the New England Psychological

Society," American Journal of Insanity 34 (1877): 98-101, 99. 62 . O. H. Palmer, "Suicide Not Evidence of Insanity," American Journal of Insanity

34 (1877): 425-61. 63. Enrico Morselli, // Suicidio: Saggio di statist ica morale comparata (Milano:

Dumolard, 1879); Morselli, Suicide: An Essay On Comparative Moral Statistics (London: Kegan Paul, 1881); Morselli, Der Selbstmord: Ein Kapitel aus der Moralstatistik (Leipzig: Brockhaus, 1 881 ).

64. William Wynn Westcott, A Social Science Treatise: Suicide; Its History, Literature. Jurisprudence, Causation, and Prevention (London: H. K. Lewis, 1885).

65. Ibid.,29. 66. Daniel H. Tuke, "Suicide," in A Dictionary of Psychological Medicine, edited

by Daniel H. Tuke, (London: J. & A. Churchill, 1892): 1230. 67. Morselli, 285. 68. Ibid 69. Emilio Motta, Bibliografia del suicidio (Bellinzona, 1 890). 70. Murray, 19. 71. Westcott, 69. 72. Robert D. Goldney, "Ethology and Suicidal Behaviour," in The International

Handbook of Suicide and Attempted Suicide, edited by K. Hawton and K. van Heeringen (Chichester: Wiley, 2000), 95-106.

73. Westcott, Preface. 74. George Savage, "Suicide and Insanity," in A Dictionary of Psychological

Medicine, edited by Daniel H. Tuke (London: J. & A. Churchill, 1892). 75. Robert D. Goldney and Johan A. Schioldann, Pre-Durkheim Suicidology: The

1892 Review of Tuke and Savage (Adelaide: Adelaide Academic Press, 2002). 76. Robert D. Goldney and Johan A. Schioldann, "Pre-Durkheim Suicidology,"

Crisis 21 (2000): 181-6. 77. Tuke, 1217. 78. Ibid., 1221. 79. Robert D. Goldney, Suicide Prevention (Oxford University Press: Oxford,

2008): 15. 80. Tuke, 1222. 81. Ibid, 1225. 82. Ibid, 1227. 83. Ibid., 1228. 84. Ibid, 1229. 85. Ibid.


86. Ibid. 87. Savage, 1230. 88. Norman Farberow and Edwin S. Shneidman, The Cry for Help (New York:

McGraw-Hill 1961). 89. Savage, 1232. 90. Ibid, 1231. 91. Ibid, 1232. 92. Ibid, 1231. 93. Ibid, 1232. 94. Ibid. 95. Ibid. 96. Ibid., 1231. 97. Robert D. Goldney and Johan A. Schioldann, "A Note Concerning Durkheim 's

Precedence in the Use of the Terms Egoistic and Altruistic Suicide," Suicide and Life Threatening Behavior 3 1 (2001): 1 1 3-4.

98. Westcott, 69. 99. Eric A. Plaut, Marx on Suicide in the Context of Other Views of Suicide and of

His Life, in Marx: 29.


Authors' Interest in the History of Medicine

Robert Goldney

It is just possible that geneticists may one day contribute to our understanding of why an individual may have an interest in the history of medicine. After all, there appear to be inherited contributions to an increasing range of behaviour and experiences! However, until that day 1 would prefer to think that 1 am driven by a sense of curiosity about the past, and an increasing realisation that our forebears were extra-ordinarily perceptive about a range of matters pertaining not only to medicine in general but to psychiatric practice in particular.

Psychiatry has a potentially important role in elucidating our understanding of historical events and figures. Thus the psychodynamics underlying the illnesses and achievements of both great and notorious historical and artistic figures provide endless speculation, about *what if.

* Indeed, 1 am reminded of a question posed in my UK membership examination, Would you have treated van Gogh?

*

It is undoubtedly an indication of getting older, but it is evident fix>m many recent publications that twenty- first century authors seem reluctant to cite articles more than ten years old, and authorities whom I have regarded as having engraved their work in stone are frequently ignored. This is not to deny the significant advances that have been made, but all too often one is reminded of the French: "Plus ca change, plus ca meme chose. '

This is illustrated well by concerns expressed about the delivery1 of psychiatric services. For example, in the first twenty-five years of the South Australian colony there was public concern documented in the press about the number of mentally disordered people in prisons; overcrowding in the initial lunatic asylum; where a new asylum should be situated; and there was also a perception that politicians didn 't listen to those entrusted with care of the afflicted. Such an historical perspective may provide solace to those frustrated by what may be seen initially as a contemporary1 problem!

Suicide Research Before Durkheim 9 1

The study of the history of medicine demonstrates that the changing conceptualisation of illness in terms of contemporaneous values, and the treatment offered by different societies at different periods provides insight into the importance of socio-cultural influences on both illnesses and their treatment. However, underlying those apparent differences is a commonality of humanity, which is the ever-present thread found in an exploration of the history of medicine.

Lest these comments be seen as an indication of living in the past, it is acknowledged that there have been great changes in the almost fifty years since I started practicing medicine. However, the development of medicine and psychiatry can only be fully appreciated with an historical perspective, as well as with a sense of humility that we are building on a long established tradition.

But perhaps all these comments are simply an attempt to rationalise one of life 's pleasures. Put simply, the history of medicine and psychiatry is fascinating.

Johan Schioldann

Having strong leanings towards the humanities (history, philosophy and languages), I came into medicine by default. However, being of medical background and yielding to paternal pressure, 1 finally decided to study medicine. Over the course of my university years I realised that medicine could provide me with a rich soil in which to cultivate my historical interests further. After graduating from Copenhagen University in 1969, it became clear to me that the best compromise between my original inclination and medicine would be to specialise in psychiatry. Much inspired by Lange-Eichbaum*s classic work, I first devoted my research career to the study of pathography, an essential but often much neglected or ignored discipline. Subjects of pathography have traditionally been famous persons in all areas of human achievement, but, in addition, the pathographical method is indispensable in historical research to assist historians in their quest for a better understanding and


explication of historical events, where national leaders or other important persons have played a significant role, and where personality or morbidity factors, physical or mental, have possibly been decisive ('psychopathology and political leadership '). Furthermore, the pathographical method is important in medicine especially with regard to casuistry-based refinement ofnosography and nosology.

My knowledge of several European languages has enabled me to study medical historical/psychopathological texts in their original. This is epitomised by my studies of August Wimmer's classic concept of the unfortunately internationally much disputed concept of psychogenic psychoses (1916), a concept which increases 'our awareness of the links between psychosis and our common humanity.

' I have also written extensively on the history of the introduction into medicine and psychiatry of the revolutionary lithium treatment of mood disorders, and with a main focus on the contributions of the Danish brothers Carl and Fritz Lange in the late 1800s and early 1900s, and John Cade in 1949.

Thus, this work is another illustration of why it is so important to study the history of medicine and psychiatry. Finally, I have conducted, and conduct, extensive studies of medical bibliography, pre-1900, this discipline also being of fundamental importance in systematic research into the history medicine and psychiatry.

Kirsten Dunn

On a personal level, the word * history

' draws immediate associations with ancient civilisations, born from an early fascination with Egyptian history and the BBC adaptation of Graves 'novels I, Claudius. However, in contemplating the term 'history of medicine, '1 find myself wonder ing ifl should be consideringthe accomplishments of Hippocrates, the renaissance of medicine during the sixteenth century, the rapid medical developments of the nineteenth century, or the outcomes of the chemotherapy treatment my father is currently receiving. The word 'history* is derived from the Greek historia, which translates to learning or knowing


by inquiry. If, quite literally, we are to learn by inquiry, then surely history incorporates classical antiquity, last week, and everything in between.

My interest in the history of medicine has a psychological focus which was piqued as a first-year university student. I can pinpoint the moment, sitting in a crowded lecture theatre, both captivated and horrified by descriptions of eighteenth century appmaches to the treatment of mental illness - images of trepanation are forever etched in my memory. 1 found myself similarly entranced several years later, listening to a patient with schizophrenia as she bravely shared the experience of her illness and the effects of her medication. The realisation that her story had brought an entire auditorium of students to their knees told me that I am not alone in my wonder about the impact of mental illness and continuing struggle to find effective treatments.

Both of these memories have more than mental illness in common, they are examples of history. History, whether it be ancient or modern, isfundamental not only to learning, but to our ability to evolve and progress. Few disciplines have made advances at the same rate as medicine, and as a result, medical history has tremendous depth. The literature offers endless accounts of medical gains, the best of which reflect the minds of those brave enough to persist with ideas and research perceived as controversial at the time and ground-breaking in hindsight. Whether we consider the history of medicine to be that from last millennium, or last week, it all forms part of an inspiring and daunting record of what we have achieved, where we have gone wrong, what we have learnt, and how far we still have to go.

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Suicide Research Before Durkheim

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