-a disease that can be treated
Most of the thirteen hundred Canadians who kill themselves every year give clear warning of their intent — but not enough people believe them. Why are they more likely to take their own lives in peace than in war? In B. C. than in the Maritimes? In spring than in winter? Doctors are beginning to learn the answers
CANADA IS LOSING thirteen hundred people a year through self-murder, say the coroners’ reports, but the actual number of suicides is probably much higher: many suicides, according to police and medical authorities, are disguised so as to appear to be natural deaths or accidents.
Suicide is about six times as common in Canada as murder. It kills more than twice as many people in this country as fires do. and about two hundred more each year than tuberculosis. Though attempting to commit suicide is a crime, little is done to prevent it. and a strange taboo prevents most Canadians from even mentioning it.
Four times as many men commit suicide as women. It is three times as prevalent among whites as among Negroes. Protestants arc three times as likely to kill themselves as are Catholics or Jews, and suicide occurs more often among the single, widowed, or divorced living in urban areas — the sad, solitary citizens of the cities — than among married people in the same districts. It is highest among the highand low-income groups, lowest in the middle classes. It is three times as common among people who are overweight as among people w'hose weight is normal.
Suicide is most common in the months of maximum sunlight — spring and early summer — and in the early morning hours between five and eight. The Atlantic provinces have the lowest suicide rates in Canada, British Columbia and Alberta the highest.
The highest incidence of suicide in the w'orld occurs in West Berlin, w'hich has an annual rate of 33.9 per 100,000 inhabitants. Next comes Japan, with 24.1. Austria (22.8) and Denmark (22.5) follow. The lowest rates occur in Egypt, Mexico and Ireland. The United States has a rate of 10, while Canada has 7.5. However, the figure in Canada, and possibly other Western countries, is undoubtedly lower than the real rate, because of the stigma attached to suicide and the ability of relatives and friends to cover up the cause of death.
FOR THOSE WHO FAIL, JAIL
Suicide increases in times of peace and declines sharply in times of war. Broadly speaking, it increases with age after fifteen, reaching a peak between forty-five and sixty-five, after w'hich it slacks off.
In Canada, almost all suicides committed or attempted occur as a result of the disease of depression: jailing those who fail in the attempt makes about as much sense as punishing people for pneumonia. Yet that is precisely what can
— and does — happen. Under the Criminal Code of Canada, attempted suicide is punishable by up to six months in jail and a fine of $500, or both. Furthermore, Protestant. Catholic and Jewish faiths regard suicide as an ecclesiastical sin.
While depression and stigma are associated with self-destruction in this country today, suicide has been an accepted, if eccentric, form of behavior in other places and other eras.
Jn the third century before Christ, Zeno, founder of the Stoic school of philosophy, took his own life when he fell and injured his finger. He was eighty-eight. An English squire of the early nineteenth century killed himself to avoid the bother of getting dressed in the morning, while a French dandy at the court of Louis XVI slit his throat in a fit of pique after his valet nicked his face shaving him.
Waves of suicide have swept over Europe, such as the Dancing Sickness of the fourteenth century, in which thousands of people danced themselves to death. Whole villages in Russia w'ere wiped out in the seventeenth century w hen it was believed by a certain religious sect that the Antichrist was coming. Men. women and children hurled themselves onto pyres or bricked themselves up into their houses to perish. In the fourth century, members of a sect called the Circumcellions killed themselves by the hundreds in the belief that this would ensure their immediate salvation.
The Christian Church took no official stand on suicide until the fifth century, when St. Augustine became alarmed at the number of Christians taking the shortcut to glory. Since life on earth was regarded as a brief interval before the true and eternal life, and since sin was the thing Christians were supposed to avoid, many of the faithful removed both the temptation to sin and themselves at the same time.
The Church w'as losing souls right and left
— or, at any rate, live bodies — and suicide was therefore declared a sin. Christian burial was denied to the suicide, and the body could not be placed in consecrated ground.
This denial of rites is a carryover into Christianity of the pagan horror of suicide. Mankind has always had a terror of the bodies of people who have met death violently, either by murder or suicide. It was felt that the spirit of such a corpse would be especially vengeful, and elaborate precautions were taken to make sure it would not be able to return.
Dismemberment — and burial of the parts in different places — was considered elfective
magic in Africa, while in ancient Athens the right hand of a suicide was cut off and buried apart from the rest of the body, in the belief that a one-handed ghost couldn’t do much damage. In Ireland, funeral processions of suicides used to go to the burial grounds by one route and return by another, to outwit any spirits who might try to return home, and at Metz during the Middle Ages the body of a suicide would be put in a barrel and thrown into the Moselle River, to float downstream and do its haunting elsewhere. In many parts of Europe bodies of suicides were taken out not through the door of a house but through an opening cut especially for that purpose and immediately afterward sealed so the ghost could not re-enter.
At one time in England suicides were hanged on gibbets and left to rot indefinitely, but later this custom was abandoned and the corpse of a suicide was buried at a crossroads with a stake driven through the heart and a stone placed on the face. When the body was thus pegged and weighted, it was felt that the ghost would not be able to walk, and in any case would be confused as to which of the four roads to follow. THE CROWN PROFITED BY DEATH
This grisly custom w'as followed for the last time as recently as 1823. when a man called Griffiths was buried not far from Buckingham Palace. Such was the force of public indignation (the law had not been enforced for many years) that a month later this statute was repealed: burial of suicides could then take place in a churchyard, but at night, and without funeral rites.
England also turned suicide into a profitable affair for the Crown by employing the law of forfeiture, by which the entire estate of a suicide was forfeited to the Crown. It was not until 1870 that this practice was abolished: a few years later burial of suicides was permitted at normal hours instead of only at night, but to this day in England no life insurance is paid to the survivors of anyone who takes his life “while of sound mind.” (In Canada, insurance companies pay on any suicide if the policy has run for two years: for shorter periods, they give the beneficiary the premiums already paid.)
The Roman Catholic Church permits Christian burial, if it is proved that the suicide was committed as a result of mental illness. The Jewish faith holds the same view, but for other suicides burial cannot take place on consecrated ground, no eulogy is given, and no public mourning is carried out. There are. however, two extenuating circumstances for Jew's: no child under the age of thirteen can be held responsible for such an act, and there is no stigma attached to suicide if it is done to escape torture or capture by an enemy.
Speaking of present-day conditions in Canada, Rabbi Abraham Feinberg of Toronto said recently: "1 have never refused to bury a suicide in consecrated ground, because nobody who takes his own life does so in the possession of his normal faculties. In my opinion, there is no such thing as a sane suicide.”
Some members of the medical profession would disagree with this opinion. Certainly suicide of a person suffering a painful terminal disease can be carried
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out in full rationality, and in politics or love suicide-with-a-purpose has always been an effective, though irrevocable, means of making a point.
Jan Masaryk, the foreign minister of Czechoslovakia, jumped from his office window in a magnificent gesture of defiance so that all the world would see how he felt about the Communist oppressors of his country, and the cause of the suf-
fragettes in England was helped incalculably by the suicide of an adherent who threw herself under the hooves of the King's horse in the 1913 Derby.
But it is not this type of suicide that should concern us today in Canada: it is the tragic, preventable suicide that takes place during depressive illness.
Within the last decade, and especially within the last three years, new methods
of treating this baffling condition have been discovered, and our most effective means of prevention will prove to be early diagnosis of depression, which masks itself under a host of ordinary ailments. It can underlie asthma, heart disease. ulcers, obesity, alcoholism, migraine, arthritis, or a host of other physical ills.
"At a conservative estimate,” one doctor has commented, "fifty percent of the
people a doctor sees in his consulting room are not organically ill. They are depressed. Depression is the most common illness a doctor in general practice has to deal with.”
But in spite of the advances made in getting the public to accept the fact that mental illness is just as much a medical problem as measles and a good deal more serious, there is still a hard core of prejudice against such an acceptance. Meanwhile Canadian psychiatrists are trying to persuade general practitioners to recognize depression where they see it first, in the consulting room.
Depression is a reaction to the loss of something loved, it may be the loss of a person, through death or desertion, or of money, or of position, or of health. It does not come suddenly; it is a condition that gradually worsens. Often it follows some physical illness, such as flu or hepatitis.
Some of its symptoms arc: loss of appetite, insomnia, apathy, decreased energy, feelings of guilt, and loss of libido. The depressed person walks stiffly, he cannot smile easily. Two visible signs are the typical turned-down mouth and the peculiar peaked folds of skin over the eyelid known as the Veraguth Fold. Cartoonists have always drawn sad people or sick people with peaked eyes, evidence of a perceptive observation of humanity.
“The most easily recognized symptom of depression is quite simply the facial expression,” Dr. Heinz Lehmann, clinical director of Verdun Protestant Hospital, recently told a group of McGill medical students, “and anyone who is recognized as being depressed is also recognized as being a potential suicide.”
Karl Menninger, the famous American psychiatrist, puts it even more strongly in his work The Human Mind: "All deeply depressed people are potential suicides. The responsibility is with relations and friends.”
“Suicide,” he goes on to say, “is never caused by a single thing, such as ill health, unrequited love, grief over an erring daughter. Nor is it ever the first symptom of the mental state which it terminates.”
Dr. Lehmann feels that the public must be taught to heed people who threaten to commit suicide, because they very often carry out the threat. "So many people who have killed themselves have expressed their intention beforehand.” he says. “Most of them announce it and court help and talk about it. If only we didn’t have the preconceived idea that when a person says such a thing it can't be serious. These warnings are as serious a symptom as the pain of an inflamed appendix, and when they occur we should drop everything and get help.”
Any unexplained change in behavior is a possible signpost of depression, according to Dr. Henry Durost, a Montreal psychiatrist. “If an easy, outgoing person grows silent and withdrawn, we might suspect that this person is becoming depressed and as such could be a potential suicide.” he says. From his experience in private practice and at the Verdun Hospital. Durost has developed an instinct. “If a patient comes to me with a history of preoccupation with suicide, if he complains that he wakes unusually early in the morning, that he’s lost his appetite and is losing weight and no longer is interested in anything — if he seems to have a derogatory attitude towards himself and expresses a strong sense of guilt — my cars twitch. I feel that this person could be in the greatest danger, and I also feel he's potentially dangerous to others, particularly his family.”
As well as being the reaction to loss, depression is a manifestation of hate and
revenge. The depressed person is angry; his capacity to love has been paralyzed by a pervading feeling of hate. Strong delusional feelings of guilt in depressed people are sometimes signs of their unconscious desires for revenge. Instead of saying: “I hate you. you are bad. I will kill you.” the depressed person changes it into: “I despise myself. 1 am unworthy, I ought to be dead.” and gets on with the job. But it is not in the depths of a depression that the patient is most likely to kill himself or to harm others. In its very worst phase, the patient simply has not the energy or the ability to concentrate enough to commit suicide. Paradoxically. it is most often within two or three months of “recovery” that most suicides take place.
Fifty years ago there was no treatment for suicidal patients other than custodial care. Then insulin shock was found effective in some conditions of mental illness. After insulin, electro-convulsive therapy was discovered to be useful in treating depression.
Why a jolt of electricity passing from an electrode on one side of a person’s head to one on the other should prove beneficial instead of disastrous is not known, but after sometimes only two or
three sessions of shock treatment the suicidal inclinations of depressed people simply disappear. There is. however, a growing feeling in medical circles that electric shock may cause damage to the brain, and for this reason anti-depressant drugs, which accomplish the same thing by chemical means, arc now taking the place of more drastic measures. By far the most important feature of these drugs is the fact that they can be taken orally and prescribed in the office of the general practitioner, where depression can be spotted by an alert doctor in its early Mages and arrested.
“Every doctor's office should be a suicide-prevention station." says Dr. Jerome A. Motto of San Francisco.
In Canada we do nothing to prevent suicide till after the attempt, though there have been prevention programs in other countries for more than half a century. In 1906. in New York, a Baptist minister named Harry Marsh founded the National Save-a-l.ife League, which says it has helped to rescue more than 50,000 people from suicide. The Los Angeles General Hospital houses a Suicide Prevention Centre, where the social history of attempted suicides is gathered; the patients are sent on to other institutions for help. An international study centre has been set up in Vienna, and in Chicago, if you dial L.O 1-9595, the People’s Church Anti-Suicide Project will respond with quick advice, a doctor, a minister, or even a fire truck.
In this country, our after-the-event "care” led. in 1958. to the laying of 267 charges of attempted suicide; 75 of those
charged were fined and 56 were jailed.
I asked Allen MacLeod, commissioner of penitentiaries, whether he thought this law served any useful purpose. He rose from his desk in Ottawa and walked over to the window: he stood looking out at the Gatineau Hills before replying.
"No. I don't.” he said finally. "This law has no useful effect because most people don't know it exists, and people making genuine attempts at suicide won't be deterred by it because they won’t anticipate failure."
"Of course.” he went on. "there is al-
ways the character who crawls out on l.ions Gate Bridge in Vancouver and ties up traffic for three hours while everyone rushes around getting nets and fire trucks — you have to do something about him. But there again. I wonder if jail is the answer.”
Depression, except as it comes under the vague category of Mental Health, has as yet no stature: we do not celebrate Stop Suicide Week. Specialists in psychiatry have hidden defensively behind the convenient shield of "too few. too overworked, too misunderstood.” General
piaetitioners, for the most part, have not dared to admit that since at least half of their practice consists of psychotherapy, rather than physical treatment of organic complaints, they have a clear obligation to inform themselves of recent developments in psychiatry.
I he Canadian public has an even clearer obligation to discard its Nellielike attitude that nice people don’t commit suicide and if they do it isn’t polite to mention it. The fact is. they do. And the tragedy is. most of them wouldn’t if they got help in time. ★