Some people view suicide as the ultimate sacrifice, because in their terms a person leaves his life in this world and ‘intentionally’ passes to the next. Others see it as a sin or as an unforgivable crime. Between these views runs a spectrum of attitudes based on religious, ethical, sociological and psychological factors.

Suicide is the cause of death resulting directly or indirectly from actions of the victim that he or she knew would produce that result. This classic definition was given by the founder of modern sociology, the Frenchman Emile Durkheim (1859-1917), in 1897. The growing incidence of suicide in Europe during that time alarmed him; and he believed the root causes were social rather than psychological.

Types and methods of suicide

Durkheim classified suicides as ‘altruistic’ – in which someone takes his own life out of duty, to gain honour and to avoid shame, as practised in traditional small-scale societies; as ‘egotistic’ – suicide produced by the growth of individualism and lack of social ties; and ‘anomic’ – resulting from social disintegration. Until quite recently many countries held suicide to be a criminal offence (although how the successful suicide was to be put on trial was never explained). Attempted suicide was also a crime, and a survivor of a suicide pact was charged with the unlawful killing of the other person. Now, as then, any sudden unexpected death is still subject to an inquest. Suicide is not presumed and therefore has to be proved to the satisfaction of the coronor. Thus suicides are greatly under-recorded, since so many people take their own lives indirectly, but nevertheless deliberately, through over-drinking (perhaps dying in a road crash), or by overwork that almost certainly leads to an early heart attack. Specialists agree that the true number of suicides worldwide far exceeds the published statistics.

Doctors have come to differentiate between the true suicide attempt, where the aim is to end life, and the ‘parasuicide’, in which a deliberate act of self-harm is not really intended to result in death. Such self-mutilation is often the classic ‘cry for help’. In the United States, suicide using firearms, which are so widely available there is, not surprisingly, common; in contrast, in Britain guns are rarely used, and hanging is more frequent. The change from coal gas to non-toxic natural gas in British homes in the 1960s ended the once common method of suicide by ‘sticking one’s head in the gas oven’. The most used method of suicide now is self-poisoning with medicinal substances. Particularly lethal is a combination of sleeping pills and alcohol. Doctors have become increasingly aware of the dangers of prescribing sleeping drugs, especially barbiturates, which may be used in a suicide attempt. For this reason, too, safer drugs are being developed by the pharmaceutical industry.

Drug addicts sometimes kill themselves by deliberately taking an overdose, although it is difficult for doctors and pathologists to distinguish between an accidental and a deliberate drug overdose.

Social trends in suicide

About one person in 500 of the population commits suicide in Western Europe. Women make the attempt more often than men do, but their success rate is lower, and in fact men kill themselves in larger numbers. Social groups with above-average proneness to suicide are the elderly, the sick, the mentally ill, alcoholics and drug addicts; it could be argued that every suicide (or attempted suicide) is mentally unstable at the time he or she commits the act. Among suicide-prone occupations are those that employ soldiers, policemen, doctors and students, all in various ways stressful occupations. Unmarried and childless people are more likely potential victims, especially those living in densely populated urban centres, than are people sharing a partnership or living in a family. Widowers and teenage girls are especially vulnerable, and suicide among the under-30s has been increasing in industrialized countries in recent years. The highest suicide rates are in Scandinavia and the countries of Western continental Europe.

These findings confirm Durkheim’s thesis that marriage and family or neighbourhood integration tends to prevent suicide. Isolation, living alone, divorce, unemployment: these are all risk factors. The female suicide rate has risen with women’s changing roles in society. Also periods of economic recession – the 1930s and now the 1980s – appear to correlate with an increase in the suicide rate.

Motives, attitudes, treatment

Suicide may be a reaction to a situational crisis, or an impulsive gesture. It may be regarded by the victim as an act of aggression or revenge towards society, as well as one of self-punishment. Some psychologists believe depression and suicide indicate what can only be called a spiritual crisis in the individual. However, only a minority of those who attempt to take their lives can be formally classified as mentally ill. For the rest, the cause is better described as an inability to cope with the demands of life. The teenage girl rejected by her boyfriend, or the bankrupt faced with huge debts, may make a parasuicide attempt as a ‘cry for help’. Consulting a doctor to complain about something remote from the real problem may be the first sign of an impending suicide, but it is very hard to detect. With effective treatment such as counselling or other help, in time both the teenage girl and the bankrupt may find their life worth living again. Society’s attitudes to suicide are perhaps less moralis-

In recent years organizations have been set up in cities to offer a sympathetic ear for people distressed enough to be contemplating suicide. A well-known example of such an organization is the Samaritans, a nationwide group of volunteers who are willing to talk – and listen – sympathetically to anyone thinking about suicide. The effectiveness of such ‘help-lines’ in preventing suicide is unproven, although the number of people making telephone calls to them has risen dramatically in the last few years.