PHYSICAL CAUSES OF SUICIDE.
Influence of climate—The foggy climate of England does not
increase the number of suicides—Average number of suicides in
each month, from 1817 to 1826—Influence of seasons—Suicides
at Rouen—The English not a suicidal people—Philip Mordaunt’s
singular reasons for self-destruction—Causes of French
suicides—Influence of physical pain—Unnatural vices—Suicide
the effect of intoxication—Influence of hepatic disease
on the mind—Melancholy and hypochondriasis, Burton’s
account of—Cowper’s case of suicide—Particulars of his
extreme depression of spirits—Byron and Burns’s melancholy
from stomach and liver derangement—Influence of bodily
disease on the mind—Importance of paying attention to it—A
case of insanity from gastric irritation—Dr. Johnson’s
hypochondria—Hereditary suicide, illustrated by cases—Suicide
from blows on the head, and from moral shocks communicated to
the brain—Dr. G. Mantell’s valuable observations and cases
demonstrative of the point—Concluding remarks.
The following are the physical causes which are commonly found to
operate in producing the suicidal disposition—viz., climate, seasons,
hereditary predisposition, cerebral injuries, physical suffering,
disease of the stomach and liver complicated with melancholia and
hypochondriasis, insanity, suppressed secretions, intoxication,
unnatural vices, and derangement of the _primæ viæ_. These causes can
only act by influencing sympathetically the brain and nervous system,
and in that way interfering with the healthy operations of the mind.
Much will, of course, depend upon the physical conformation of the
individual exposed to such agents. Should he labour under an hereditary
predisposition to insanity, or to suicidal delirium, a very trifling
corporeal derangement may call into existence the self-destructive
propensity, and _vice versa_. It will be our object to consider
_seriatim_ all the physical agents just enumerated.
Among the causes of suicide, the foggy climate of England has been
brought prominently forward. The specious and inaccurate conclusions
of Montesquieu on this point have misled the public mind. The climate
of Holland is much more gloomy than that of England, and yet in that
country suicide is by no means common. The reader will perceive from
the following tabular statement that the popular notion of the month of
November being the “suicide’s month” is founded on erroneous _data_.
The average number of suicides in each month, from 1817 to 1826, was as
follows:—
January 213
February 218
March 275
April 374
May 328
June 336
July 301
August 296
September 246
October 198
November 131
December 217
————
3133
It has been clearly established that in all the European capitals,
when anything approaching to correct statistical evidence can be
procured, the _maximum_ of suicide is in the months of June and July;
the _minimum_ in October and November. Temperature appears to exercise
a much more decided influence than the circumstances of moisture and
dryness, storms or serenity. M. Villeneuve has observed a warm, humid,
and cloudy atmosphere to produce a marked bad effect at Paris; and
that so long as the barometer indicated stormy weather, this effect
continued.[44] Contrary, however, to the opinion of Villeneuve, it
appears that by far the fewer number of suicides occur in the autumn
and winter at Paris, than in the spring and summer.
_Number of suicides for seven years._
In Spring 997
In Summer 933
In Autumn 627
In Winter 648
When the thermometer of Fahrenheit ranges from 80° to 90° suicide is
most prevalent.
The English have been accused by foreigners of being the _beau-ideal_
of a suicidal people. The charge is almost too ridiculous to merit
serious refutation. It has clearly been established that where there is
one suicide in London, there are five in Paris. In the year 1810, the
number of suicides committed in London amounted to 188; the population
of Paris being near 400,000 less than that of London. From the year
1827 to 1830, no less than 6900 suicides occurred; that is, an average
of nearly 1800 per annum. Out of 120,000 persons who ensured their
lives in the London Equitable Insurance Company, the number of suicides
in twenty years was only fifteen; so much for the English being _par
excellence_ disposed to suicide.
The causes which frequently lead to self-destruction in France are,
defective religious education, _ennui_, and loss at dice or cards.
In considering the circumstances which produce this disparity in the
number of voluntary deaths in the two countries, we must bear in mind
the moral and religious habits of the people. When Christianity is not
acknowledged as a matter of vital importance in the affairs of man;
when morality is considered only as a conventional term, conveying
no definite idea to the mind, it is natural that there should exist,
co-relative with this tone of feeling, a marked recklessness of human
life. Some notion may be formed of the state of religious feeling in
Paris, when our readers are informed of the existence in the French
metropolis of a “society for the mutual encouragement of suicide,” all
the members of which, on joining it, swear to terminate their existence
by their own hands, when life becomes insupportable.
Dr. Schlegel dwells at much length on the abandoned state of Paris, and
after giving us some important statistical evidence, he alludes to the
gross immorality of the people, and denounces the French capital as “a
suffocating boiling cauldron, in which, as in the stew of Macbeth’s
witches, there simmer, with a modicum of virtue, all kinds of passions,
vices, and crimes.”
Alluding to the peculiarities of the French people, particularly their
indifference to human life, an eminent writer observes, speaking of
their notions of suicide, that a Frenchman asks you to see him “go
off,” as if death were a place in the _malle poste_. “Will you dine
with me to-day?” said a Frenchman to a friend. “With the greatest
pleasure;—yet, now I think of it, I am particularly engaged to shoot
myself; one cannot get off _such_ an engagement.” This is not the
suicide _à la mode_ with us. We ape at no such extra civilization
and refinement. 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 tied with cherry-coloured ribbons. When we do
shoot ourselves, it is done with true English gravity. It is no joke
with us. We have no inherent predilection for the act; no “hereditary
imperfection of the nervous juices,” as Montesquieu, with all the
impudence and gravity of a philosopher, asserts, forcing us to commit
suicide. “Life,” said a man who had exhausted all his external sources
of enjoyment, and had no internal ones to fly to, “has given me a
headache; and I want a good sleep in the churchyard to set me to
rights,” to procure which, he deliberately shot himself.[45]
A late French writer thus attempts to account for the prevalence
of suicide in France:—“The external circumstances which tend to
suggest the idea of suicide are very numerous, at the present day, in
France; but more particularly so in the capital. The high development
of civilization and refinement which prevails here—the clash of
interests—the repeated political changes—all contribute to keep the
moral feelings in a perpetual state of tension. Life does not roll
on among us in a peaceful and steady current; it rushes forward with
the force and precipitation of a torrent. In the terrible _mêlée_,
it often happens that the little minority, which has obtained a
footing high above the multitude for a time, falls down as suddenly as
they have risen. The struggles of life are full of miscalculations,
disappointments, despair, and disgust. Hence the general source of
our frequent suicides. But there are other causes in operation; and
not the least, the strange turn that plays and spectacles have lately
taken. The public taste has undergone a complete revolution in this
respect. Nothing is more patronized now at the theatre than the display
of crime unpunished, human misery unconsoled, and a low literature,
impregnated by a spurious philosophy, declaiming against society,
against domestic life, against virtue itself; applauding the vengeance
of the assassin, and recognising genius only as it is seen in company
with spleen, poison, and pistols. We appeal to all who read the novels
of the present day, and who visit the theatres, whether what we say is
not the fact.”
It has been questioned whether physical suffering often originates
the desire for suicide. Too many lamentable cases are on record to
prevent us from coming to an opposite conclusion. Esquirol has justly
observed, that “He who has no intervals of ease from corporeal pain;
who sees no prospects of relief from his cruel malady, fails at length
in resignation, and destroys his life in order to put a period to his
sufferings. He calculates that the pain of dying is but momentary, and
commits the act in a cool and meditated despair. It is the same in
respect to _moral_ condition, that drives the hypochondriac to suicide,
who is firmly persuaded that his sufferings are beyond imagining; that
they are irremediable, either from some fatal peculiarity in his own
constitution, or the ignorance of his physicians. It is a remarkable
feature in hypochondriasis, and in no other disease, that there is
such a fear of death and a desire to die combined. Both fears proceed
from the same pusillanimity. Finally, it may be remarked that the
hypochondriac talks most of death; often wishes his attendants to
perform the friendly office; even makes attempts on his own life,
but rarely accomplishes the act. The most trifling motive, the most
frivolous pretext, is a sufficient excuse for procrastinating, from day
to day, the threatened catastrophe.”
The following case occurred in a provincial mad-house, in France. An
apothecary who was confined there was haunted with _ennui_, and was
always begging his companions to put him to death. At length, an insane
patient was admitted, who instantly complied with the apothecary’s
request. They both watched an opportunity, got out of a window in the
back yard, and from thence into the kitchen. They pitched upon the
cook’s chopper, and the apothecary laying his head on a block, his
companion deliberately and effectually severed it from his body. He was
seized, and examined before a tribunal, where he candidly confessed
the whole transaction, and observed that he would again perform the
same friendly office for any unhappy wretch who was tired of his
existence![46]
Lucinius Cæcinius, the prætor, subdued by the pain and _ennui_ of a
tedious disease, swallowed opium. Dr. Haslam relates the case of a
gentleman who destroyed himself to avoid the tortures of the gout.
It is recorded that the pain of the same disease drove Servius the
grammarian to take poison. Pliny informs us that one of his friends,
Corellius Rufus, having in vain sought relief from the pangs of a
disease under which he was labouring, starved himself to death at
the age of sixty-seven. It is related of Pomponius Atticus and the
philosopher Cleanthes, that they both starved themselves to death in
order to get rid of physical pain. In the course of these attempts,
the corporeal sufferings were removed—probably in consequence of the
great exhaustion and attenuation; but both individuals persevered till
death took place, observing that as this final ordeal must one day
be undergone, they would not now retrace their steps or give up the
undertaking.
Few, perhaps, are aware how frequently suicide results from the habit
of indulging, in early youth, in a certain secret vice which, we are
afraid, is practised to an enormous extent in our public schools. A
feeling of false delicacy has operated with medical men in inducing
them to refrain from dwelling upon the destructive consequences of
this habit, both to the moral and physical constitution, as openly and
honestly as the importance of the subject imperatively demands.
Medical men are, in the most enlarged acceptation of the term,
guardians of the public health; and no fastidious desire to avoid
saying what might possibly offend the taste of some, ought to keep
them from discharging what may be termed a sacred duty. The physical
disease, particularly that connected with the nervous system,
engendered by the pernicious practice alluded to, frequently leads
to the act of self-destruction. We have before us the cases of many
suicides in whom the disposition may clearly be traced to this cause.
This habit most seriously affects the brain and nervous system; and
insanity, hypochondriasis, and melancholia, in their worst forms, are
frequently the baneful consequences.
If disease, structural or functional, of the abdominal viscera gives
rise to the disposition to commit suicide, it will not require much
ingenuity to establish the fact that the habitual indulgence in
intoxicating liquors may originate a similar feeling.
It has been already established by statistical evidence, that, in
a very large proportion of the cases of insanity admitted into the
asylums and hospitals devoted to the reception of this unhappy class
of patients, the mental impairment can clearly be traced to habits of
intemperance.
The brain and nervous system become materially affected in those who
indulge frequently in “potations pottle deep.” Delirium tremens,
softening of the cerebral substance, palsy, epilepsy, extreme
hypochondriasis, are daily witnessed as the melancholy effects of
intoxication.
M. Falret knew the case of a man who always felt disposed to cut his
throat when under the influence of spirits. No reasoning could induce
him to abstain from his favourite draught. The inevitable consequences
were pointed out to him; he was reasoned with, and threatened with
confinement in a mad-house; but nothing had the desired effect. One
Sunday evening, after having drunk several glasses of spirits, although
not sufficient to produce complete inebriation, he stabbed himself to
the heart, and died in a few minutes.
Incurable indigestion and organic disease of the liver are very
commonly met with in habitual drunkards. In such persons, the
constitution of the mind appears to undergo a complete change. At first
it may not be perceptible, and the patient may not be conscious of it
himself, but the mental disease will, sooner or later, unequivocally
evince itself.
In such cases, the medical man has fearful odds to contend against.
A young man, who had become insane in consequence of long continued
intoxication, made violent efforts to maim himself, and especially to
pull out his right eye, which appeared to give him great offence. Rest,
temperance, seclusion, the application of half a dozen leeches to the
temple, and a few doses of opening medicine, restored him, in about a
fortnight, to the full possession of his faculties.
Many cases of suicide, in those who have a natural predisposition to
it, arise from the brain sympathizing with the liver; nor can this
be a matter of surprise to any one who has felt the depression of
spirits incident to disease of that organ. So many cases have occurred
from this cause, that some writers, from not finding, on subsequent
dissection, any organic lesion of the brain, have referred it to
diseased viscera only. But as we find that the insanity ceases when the
liver is restored to health, there is no reason for supposing that the
mental alienation is, in these instances, any other than the effect of
disease of the brain.
J. C., about fifty years of age, was insane for two years. He was
formerly in respectable circumstances, and employed in the situation of
writer in an office. He made several attempts on his life. He had been
in the habit of drinking spirits very freely, and had a disease of the
liver which appeared of some standing. At the time of his admission
into Hanwell asylum, under the care of Sir W. Ellis, he was in a most
emaciated state; his legs scarcely able to support him. His face and
body also were covered with an eruption; tongue furred; his stools
very dark: he was much depressed, and always moaning most piteously;
complained of heat and numbness in his head, and pain in all his limbs.
Leeches and cold lotions were applied to his head, his bowels opened
by calomel and colocynth, and he went into the warm bath every other
day. He was much relieved by these means. He still continued, however,
to moan as before. His tongue remained furred, and stools unhealthy.
He took five grains of blue pill every alternate night for some time.
These were then left off awhile; no improvement taking place, he began
the pills again, and continued them for two months, with evident
advantage. His tongue was clean; he was less depressed; became strong,
and gained flesh; the biliary secretions were much improved. He is now
occupied in the office; and every day, as the action of the liver seems
to improve, his mind makes a corresponding advance.
There is no more frequent cause of suicide than visceral derangement,
leading to melancholia and hypochondriasis. It has been a matter of
dispute with medical men whether hypochondriacal affections have their
origin in the mental or physical portion of the economy. Many maintain
that the mind is the seat of the disease; others, that the liver and
stomach are primarily affected, and the brain only secondarily. In
this disputed point, as in most others, truth will generally be found
to lie between the two extremities. That cases of hypochondria and
melancholia can clearly be traced to purely mental irritation cannot
for one moment be disputed; and that there are many instances in
which the derangement appears to have commenced in one of the gastric
organs, is as equally self-evident. Whatever may be the origin of these
affections, there can be no doubt of their producing most disastrous
consequences. Burton’s account of the horrors of hypochondria is truly
graphic. “As the rain,” says Austin, “penetrates the stone, so does
this passion of melancholy penetrate the mind. It commonly accompanies
men to their graves. Physicians may ease, but they cannot cure it; it
may lie hid for a time, but it will return again, as violent as ever,
on slight occasions, as well as on casual excesses. Its humour is like
Mercury’s weather-beaten statue, which had once been gilt; the surface
was clean and uniform, but in the chinks there was still a remnant of
gold: and in the purest bodies, if once tainted by hypochondria, there
will be some relics of melancholy still left, not so easily to be
rooted out. Seldom does this disease produce death, except (which is
the most grievous calamity of all) when these patients make away with
themselves—a thing familiar enough amongst them, when they are driven
to do violence to themselves to escape from present insufferable pain.
They can take no rest in the night, or, if they slumber, fearful dreams
astonish them. Their soul abhorreth all meat, and they are brought to
death’s door, being bound in misery and in iron. Like Job, they curse
their stars, for Job was melancholy to despair, and almost to madness.
They are weary of the sun, and yet afraid to die, _vivere nolunt et
mori nesciunt_. And then, like Æsop’s fishes, they leap from the frying
pan into the fire, when they hope to be cured by means of physic—a
miserable end to the disease; when ultimately left to their fate by a
jury of physicians, are furiously disposed; and there remains no more
to such persons, if that heavenly physician, by his grace and mercy,
(whose aid alone avails,) do not heal and help them. One day of such
grief as theirs is as a hundred years: it is a plague of the sense, a
convulsion of the soul, an epitome of hell; and if there be a hell upon
earth, it is to be found in a melancholy man’s heart. No bodily torture
is like unto it; all other griefs are swallowed up in this great
Euripus. I say the melancholy man then is the cream and quintessence
of human adversity. All other diseases are trifles to hypochondria;
it is the pith and marrow of them all! A melancholy man is the true
Prometheus, bound to Caucasus; the true Tityrus, whose bowels are still
devoured by a vulture.”
“Dull melancholy——
She’ll make you start at ev’ry noise you hear,
And visions strange shall to your eyes appear.
Her voice is low, and gives a hollow sound;
She hates the light, and is in darkness found;
Or sits by blinking lamps, or taper small,
Which various shadows make against the wall.
She loves nought else but noise which discord makes,
As croaking frogs whose dwelling is in lakes;
The raven hoarse, the mandrake’s hollow groan,
And shrieking owls, that fly i’th’ night alone;
The tolling bell, which for the dead rings out,
A mill, where rushing waters run about.
She loves to walk in the still moonshine light,
And in a thick dark grove she takes delight;
In hollow caves, thatch’d houses, and low cells,
She loves to live, and there alone she dwells.”
“There are individuals who, from various physical or moral causes,”
says Esquirol, “fall into a state of corporeal torpor and mental
depression. They complain of want of appetite, dull pain in the head,
sense of heat in the stomach and viscera, borborygmi, and constipation
of the bowels; while they exhibit little or no indication of disease.
In the female sex, the natural secretions become suspended. As the
complaint advances, the features alter, and the countenance exhibits
anxiety; the complexion becomes pale or sallow; there is a sense of
tightness, or even pain, in the epigastrium; a kind of compression
in the head, which prevents them from fixing their attention, or
arranging their thoughts; a general torpor or lassitude, which keeps
them inactive. They dislike to move out, and love to loll about on a
sofa; they are irritated if you advise them to take exercise; they
abandon their ordinary avocations, neglect their domestic concerns,
become indifferent to their nearest connexions; in short, they will
neither converse, nor study, nor read, nor write, shunning society, and
being impatient of the inquiries and importunities of friends. In this
state they become filled with gloomy ideas (_idées noires_), despair
of ever being better, desire or even invoke death, and sometimes
destroy themselves, from a conviction that they are no longer capable
of fulfilling their duties in society. These people are perfectly
sane on all subjects of conversation; their impulse to suicide being
strong in proportion to the activity of their former avocations, and
the importance of their former duties. I have seen their disease (for
it is a disease) continue for months, and even years. I have seen it
alternate with mania and with perfect health. I have seen patients who
would be six months of the year maniacal or in sound health, and the
other six months tormented with these gloomy ideas and impulses to
suicide.”
In confirmation of this view of Esquirol’s, the following cases are
related:[47]—A gentleman of apparently sound constitution, aged 32, was
married to a woman whom he affectionately loved. His affairs became
deranged a few years after his marriage, which greatly discouraged
him, and rendered him inactive, but without apparently affecting his
health. He now embarked in a speculation which promised much advantage,
and at first applied himself to business with unremitting assiduity.
In the course of a month he encountered some difficulties, which
depressed him beyond measure. He considered himself ruined, refused to
quit his bed, and would not superintend his workmen, from a conviction
that he was no longer capable of directing their operations. He
complained of headache, heat in his stomach, &c. His affection for
his wife and children, his pecuniary interests, all failed to rouse
him from this moral and physical prostration. He reasoned sanely on
the critical state of his affairs, and yet made no effort to rescue
himself from his difficulties. Eight days passed in this way, when
all at once he sprung from his bed in perfect integrity of mind and
body. He resumed instantaneously all his activity for business, all
his affection for his family. The same state, however, recurred ten
or twelve times since, at irregular intervals, caused in general by
trifling contrarieties of business, which, under other circumstances,
would be considered as nothing. During several of these paroxysms he
had impulses to suicide; but this dreaded catastrophe has not yet taken
place.
A female was admitted into the Salpetriere on the 23d of September,
1819, in the 34th year of her age, and fourteen years after marriage.
At the age of 21 she had a child, after which she was affected with
an ulcer in the foot, which was healed in six months. From this time
she was troubled with cardialgia, at first slight, but afterwards
with intense pain and vomiting of her food. At the age of 33 she
became irresolute in her ideas and actions. She expressed an aversion
for those things which she had been previously pleased with, and was
occasionally incoherent. After suffering from other derangements
of her general health, she abandoned her household affairs, became
quite despondent, and tried more than once to commit suicide. In this
state she was admitted into the hospital, and was put upon diluents,
low diet, &c. As she shewed indications of having recovered, she was
allowed to return to her family; but in a short period she was harassed
with gloomy ideas, despaired of recovery, and expressed a desire to
quit life, the duties of which she said she was no longer able to
fulfil.
In the case of Cowper, we have a melancholy instance of hypochondriasis
leading to suicidal mental derangement. That the poet’s mind was
unsound when he attempted to kill himself, must be evident to those who
are conversant with the history of his life. He never appears to have
been free from hypochondriacal disorder. In a letter to Lady Hesketh,
he says, “Could I be translated to paradise, unless I could leave my
body behind me, my melancholy would cleave to me there.” A friend
procured him the situation of reading clerk to the House of Lords,
forgetting that the nervous shyness which made a public exhibition of
himself “mortal poison,” would render it impossible for him ever to
discharge the duties of his office. This difficulty presented itself
to the mind of the poet, and gloom instantly enveloped his faculties.
At his request, his situation was changed to that of clerk of the
journals; but even before he could be installed into office he was
threatened with a public examination before the House. This made him
completely wretched; he had not resolution to decline what he had not
strength to do: the interest of his friend, and his own reputation
and want of support, pressed him forward to an attempt which he knew
from the first could never succeed. In this miserable state, like
Goldsmith’s traveller,
“To stop too fearful, and too faint to go,”
he attended every day for six months at the office where he was to
examine the journals in preparation for his trust. His feelings were
like those of a man at the place of execution, every time he entered
the office door; and he only gazed mechanically at the books, without
drawing from them the least portion of information he wanted. As the
time of his examination approached, his agony became more and more
intense; he hoped and believed that madness would come to relieve him;
he attempted also to make up his mind to suicide, though his conscience
bore stern testimony against it; he could not by any argument persuade
himself that it was right; but his desperation prevailed, and he
procured from an apothecary the means of self-destruction. On the day
before his public appearance was to be made, he happened to notice a
letter in the newspaper, which to his disordered mind seemed like a
malignant libel on himself. He immediately threw down the paper, and
rushed into the fields, determined to die in a ditch; but the thought
struck him that he might escape from the country. With the same
violence he proceeded to make hasty preparations for his flight; but
while he was engaged in packing his portmanteau his mind changed, and
he threw himself into a coach, ordering the man to drive to the Tower
wharf, intending to throw himself into the river, and not reflecting
that it would be impossible to accomplish his purpose, in that public
spot, unobserved. On approaching the water, he found a porter seated
upon some goods; he then returned to the coach, and drove home to
his lodgings in the Temple. On the way, he attempted to drink the
laudanum, but as often as he raised it, a convulsive agitation of his
frame prevented its reaching his lips; and thus, regretting the loss
of the opportunity, but unable to avail himself of it, he arrived half
dead with anguish at his apartments. He then closed the door and threw
himself on the bed, with the laudanum near him, trying to lash himself
up to the deed; but a voice within seemed constantly to forbid it;
and as often as he extended his hand to the poison, his fingers were
contracted, and held back by spasms. At this time some of the inmates
of the place came in, but he concealed his agitation; and as soon as
he was left alone, a change came over him, and so detestable did the
deed appear, that he threw away the laudanum, and dashed the phial to
pieces. The rest of the day was spent in heavy insensibility, and at
night he slept as usual; but on waking at three in the morning, _he
took his penknife and laid with his weight upon it, the point being
directed towards his heart_. It was broken, and would not penetrate. At
day-break he rose, and passing a strong garter round his neck, fastened
it to the frame of his bed. This gave way with his weight; but on
securing it to the door, he was more successful, and remained suspended
until he had lost all consciousness of existence. After a time, the
garter broke, and he fell to the floor, so that his life was saved; but
the conflict had been greater than his reason could endure. He felt
a contempt for himself not to be expressed or imagined. Whenever he
went into the street, it seemed as if every eye flashed upon him with
indignation and scorn. He felt as if he had offended God so deeply that
his guilt could never be forgiven, and his whole heart was filled with
pangs of tumultuous despair.[48]
When Cowper had once admitted the thought of self-destruction, he could
not go into the street without meeting with something to tempt or drive
him to the act. It seemed to him as if the whole world had conspired
to make death by his own hand inevitable. When he ventured into the
streets, after the failure of all his efforts, a ghastly shame and
alarmed suspicion were his torments; and perhaps nothing in Cowper’s
autobiography goes deeper into the heart than the following description
of his sufferings.
“I never went into the street but I thought the people stood and
laughed at me, and held me in contempt; and could hardly persuade
myself but that the voice of conscience was loud enough for any one
to hear it. They who knew me, appeared to avoid me, and if they spoke
to me, seemed to do it in scorn. I bought a ballad of one who was
singing it in the street, because I thought it was written on me. I
dined alone, either at a tavern, where I went in the dark, or at the
chop-house, where I always took care to hide myself in the darkest
corner of the room. I slept generally an hour in the evening, but it
was only to be terrified in dreams; and when I awoke, it was some time
before I could steadily walk through the passage into the dining-room.
I reeled and staggered like a drunken man. The eyes of man I did not
fear; but when I thought that the eyes of God were upon me, (which I
felt assured of,) it gave me the most intolerable anguish. If, for a
moment, a book or a companion stole away my attention from myself, a
flash from hell seemed to be thrown into my mind immediately; and I
said within myself, ‘What are these things to me, who am damned?’”
Cowper is not the only instance, however, of a man of exquisite taste
and genius whose life has been rendered miserable by hypochondria.
We have alluded elsewhere to Byron’s morbid sensitiveness, and the
reader’s attention is now called to the influence of hypochondriasis
on the poet’s mind. He says in his journal, “What can be the reason
I awake every morning in actual despair and despondency?” He had a
great apprehension of insanity. In order to overcome his melancholy,
considering that his diet had much to do with it, he put himself under
a strict regimen, avoiding most scrupulously all animal food. He states
that his diet for a week consisted of tea and six dry biscuits per
diem. After having indulged in an ordinary dinner, he writes, “I wish
to God I had not dined now; it kills me with heaviness; and yet it
was but a pint of bucellas, and fish. Oh, my head! how it aches!—the
horrors of indigestion!” Again he says, “This head was given me to ache
with.” After a severe fit of indigestion, he writes, “I’ve no more
charity than a vinegar cruet. Would that I were an ostrich, and dieted
on fire-irons! O fool! I shall go mad!”
Burns suffered much from indigestion, producing hypochondria. Writing
to his friend, Mr. Cunningham, he says, “Canst thou not minister to
a mind diseased? Canst thou speak peace and rest to a soul tost on a
sea of troubles, without one friendly star to guide her course, and
dreading that the next surge may overwhelm her? Canst thou give to
a frame tremblingly alive to the tortures of suspense the stability
and hardihood of a rock that braves the blast? If thou canst not do
the least of these, why wouldst thou disturb me in my miseries with
thy inquiries after me?” From early life, the poet was subject to a
disordered stomach, a disposition to headache, and irregular action of
the heart.
He describes, in one of his letters, the horrors of his complaint:—“I
have been for some time pining under secret wretchedness. The pang
of disappointment, the sting of pride, and some wandering stabs of
remorse, settle on my life like vultures, when my attention is not
called away by the claims of society, or the vagaries of the muse. Even
in the hour of social mirth my gaiety is the madness of an intoxicated
criminal under the hands of an executioner. My constitution was
blasted _ab origine_ with a deep incurable taint of melancholy that
poisoned my existence.”
Nothing can be more interesting to a physician who is endowed with
only a moderate share of the spirit of observation than to watch the
progress of hypochondriasis in a number of patients, especially in
regard to its effect on the mind. They always struggle, more or less in
the beginning, with the lowness and dejection which affect them; and
it is not until many a severe contest has taken place between their
natural good sense and the involuntary suggestions which arise from
the obscure and painful feelings of the diseased nerves, that a firm
belief in the reality of such thoughts gains a full conquest over their
judgment. A firm belief in any one perception never takes place until
it has acquired a certain degree of force; and as all impressions which
arise from the viscera of the abdomen are naturally obscure, we see
the reason why these must continue for a great length of time, or be
often repeated, before they can withdraw a person’s attention from the
ordinary impression of external objects, which are clear and distinct,
and before they acquire such a degree of vividness as to destroy the
operations of reason.
We meet every day with hypochondriacs in whom the disease is
just beginning to be formed, and who, being possessed of a good
understanding, seem unwilling to tell, even to their medical friends,
the singular, and often melancholy, thoughts with which they are
tormented. They acknowledge them to be unreasonable, and yet insist
that they cannot help believing in them. A very curious display of this
kind of struggle between the habitudes of reason and the approach of
delirium is to be found in the diary of an hypochondriac, from which we
make the following extract:—
“On the 14th of November, the idea that some person intended to kill
me sprung up suddenly and involuntarily in my mind, and yet, I must
confess, there was no reason why I should have harboured this thought,
for I am convinced that no one ever formed such a cruel design against
me. People who had a stick in their hands I looked on as murderers.
As I was walking out of town, a countryman happened to follow me, and
I was instantly filled with the greatest apprehension, and stood still
to let him pass. I asked the fellow in a threatening voice, and with
a view of intimidating him from his purpose, what was the name of the
town before us. The man answered my question and walked on, and I found
great relief, because he was no longer behind me.
“In the evening, I observed some water in the glass out of which I
commonly drink, and I instantly believed it was poisoned. I therefore
washed it carefully out, and yet I knew, at the same time, that I
myself had left the water in it.
“18th November.—At particular periods I believe all mankind have
conspired to murder me. I think I am deprived of my office; that I am
doomed to die of hunger; and, to add to all this, I am tormented with
horrid doubts concerning futurity, and these thoughts persecute me like
furies. Those whom I used to love most, I now hate. I avoid my best
friends, and my dear wife appears to me a much worse kind of woman than
she really is.
“I cannot describe the exertion it requires to conquer in society the
aversion I feel to my fellow-creatures, and to prevent my ill-humour
from breaking out against the most innocent people. When it really does
so, I spare no one. I am sorry for it afterwards, but then I am too
proud to acknowledge my error.
“I find myself so enraged on seeing a stupid, vacant countenance, that
I have almost an irresistible inclination to box the person’s ears to
whom it belongs: the refraining from it is a severe effort.
“20th November.—A boy with a face like a satyr met me, and occasioned
me the greatest uneasiness. Although he did nothing to displease me, I
was forced to go to him, and tell him that I was sure he would die on
the gallows.
“23rd November.—My sensibility is often extreme, and then my best
friends become insupportable to me. To their expressions of regard
I am either purposely cold or else I answer by rude and offensive
speeches. I can seldom explain to myself the reason of this too great
sensibility. If two people whisper to each other in my presence, I grow
uneasy, and lose all command of mind, because I think they are speaking
ill of me; and I often assume a satirical manner in company, in order
to frighten them. Anxiety, dreadful anxiety, seizes me, if a person
overlooks my hand at cards, or if a person sits down beside me when I
am playing the harpsichord.”
“From numerous facts which have come within my own observation,” says a
distinguished living medical authority,[49] “I am convinced that many
strange antipathies, disgusts, caprices of temper, and eccentricities
which are considered solely as obliquities of intellect, have their
source in corporeal disorder.
“The great majority of these complaints, which are considered as purely
mental, such as irascibility, melancholy, timidity, and irresolution,
might be greatly remedied, if not entirely removed, by a proper system
of temperance, and with very little medicine. There is no accounting
for the magic-like spell which annihilates for a time the whole energy
of the mind, and renders the victim of dyspepsia afraid of his own
shadow, or of things, if possible, more unsubstantial than shadows.
“It is not likely that the great men of the earth should be exempt
from these visitations any more than the little; and if so, we may
reasonably conclude, that there are other things beside ‘conscience’
which ‘make cowards of us all,’ and that, by a temporary gastric
irritation, many an ‘enterprise of vast pith and moment’ has had ‘its
current turned away,’ and ‘lost the name of action.’
“The philosopher and the metaphysician, who know but little of these
reciprocities of mind and matter, have drawn many a false conclusion
from, and erected many a baseless hypothesis on, the actions of men.
Many a happy thought has sprung from an empty stomach; many a terrible
and merciless edict has gone forth in consequence of an irritated
gastric nerve. Thus health may make the same man a hero in the field
whom dyspepsia may render imbecile in the cabinet.”
The following case will shew how powerfully indigestion may affect the
mind’s operations:—
A young lady, after eating some heavy paste, was attacked by a
sensation of burning heat at the pit of the stomach, which increased
till the whole of the upper part of the body, both externally and
internally, appeared to her to be all in flames. She rose up suddenly,
left the dinner table, and ran into the street, from which she was
immediately brought back. She soon came to herself, and thus described
her horrible ideas. She declared that she had been very wicked, and had
been dragged into the flames of hell. She continued in a precarious
situation for some time. Whenever she experienced the burning sensation
of which she first complained, the same dreadful thoughts occurred to
her mind. She seized hold of whatever was nearest to prevent her from
being forced away; and such was her alarm that she dreaded to be alone.
This lady had long been distressed by family concerns, and harassed by
restless and sleepless nights, which greatly affected her health.
Dr. Johnson used to declare that he inherited “a vile melancholy” from
his father, which made him “mad all his life, or, at least, not sober.”
Insanity was his constant terror. Boswell says that, at the period when
this great philosopher was giving to the world proofs of no ordinary
vigour of understanding, he actually fancied himself insane, or in a
state as nearly as possible approaching to it.
Murphy says, “For many years before Johnson’s death, so terrible was
the prospect of final dissolution that when he was not disposed to
enter into the conversation which was going forward, he sat in his
chair, repeating the well-known lines of Shakspeare—
“To die, and go we know not where.”
Like Metastasio, he would not, if he could help it, permit the word
death to be pronounced in his presence. Boswell once introduced
the topic in the course of conversation, which made Johnson highly
indignant. He observed, that he never had a moment in which it was not
terrible to him.
Three or four days before he died, he declared that he would give one
of his legs for a year more of life. The ruling passion was exhibited
strong in death. At Dr. Johnson’s own suggestion, the surgeon was
making slight punctures in the legs, with the hope of relieving his
dropsical affection, when he cried out, “Deeper! deeper! _I want length
of life_, and you are afraid of giving me pain, which I do not value.”
If we had not a thorough conviction that this fear of death was but the
result of physical disease, which no moral and religious principles
could subdue, Dr. Johnson’s conduct towards the end of his life would
excite a feeling in our mind towards him very opposite to that of
respect.
With reference to suicide, there is no fact that has been more clearly
established than that of its hereditary character. Of all diseases to
which the various organs are subject, there are none more generally
transmitted from one generation to another than affections of the
brain. It is not necessary that the disposition to suicide should
manifest itself in every generation; it often passes over one, and
appears in the next, like insanity unattended with this propensity. But
if the members of the family so predisposed are carefully examined, it
will be found that the various shades and gradations of the malady will
be easily perceptible. Some are distinguished for their flightiness of
manner, others for their strange eccentricity, likings and dislikings,
irregularity of their passions, capricious and excitable temperament,
hypochondriasis and melancholia. These are often but the minute shades
and variations of an hereditary disposition to suicidal madness. A
gentleman suddenly, and without any apparent reason, cut his throat.
The father had always been a man of strong passions, easily roused, and
when so, was extremely violent. The brother was a man of impulse; he
always acted by fits and starts, and therefore never could be depended
upon. The sister had a strange, unnatural, and superstitious horror
of particular colours and odours. A yellow dress caused a feeling
approaching to syncope, and the smell of hay produced great nervous
excitement. The grandfather had been convicted of homicide, and had
been confined for two years in a mad-house.
Andral relates the case of a father who died from the effects of
disease of the brain; the mother died sane. They had six children,
three boys and three girls. Of the boys, the eldest was a man of
original mind; the second was very extravagant in his habits, and was
ultimately confined in a mad-house; the third was extremely violent in
his temper. Of the girls, one had fits of apoplexy, and became insane;
the other died at her accouchement, with symptoms of derangement; the
third died of cholera, not, however, until she exhibited indications of
mental aberration.
A case more singular than the last is recorded. All the members of a
particular family, being hereditarily disposed, exhibited, when they
arrived at a certain age, a desire to commit self-destruction. It
required no exciting cause to develope the fatal disposition. No wish
was expressed, or attempt made, to overpower the suicidal inclination,
and the greatest industry and ingenuity were exercised by the parties
in order to effect their purpose. In two cases, the propensity was
subdued by proper medical and moral treatment; but, just in proportion
to its being suppressed, did the idea of suicide appear to fix itself
resolutely in the mind. The desire came upon the individuals like the
attacks of intermittent fever.
A. K., a man aged 57, was twice married. He was a shoe-maker by trade;
but not having received any education, his wife was compelled to attend
to all his accounts. He had experienced, when young, a blow on the
head, which occasionally gave him pain. He became very intemperate in
his habits, and at particular intervals he exhibited an uncontrollable
temper, quarrelled with everybody, neglected his business, abused his
wife, and became extravagant and melancholy. During the paroxysm he
would exclaim—“_Oh, my unlucky head! I am again a lost man!_” When the
attack subsided, he returned to his business, was affectionate to his
wife and family, most humbly begged her pardon for having ill-treated
her, and expressed the greatest contrition for his conduct. These
attacks came on at regular intervals. He procured a piece of rope for
the purpose of hanging himself, and for some months carried it about
with him in his pocket for that purpose. During one of his fits he
effected his object. His grandfather had strangled himself, and his
brother and sister had attempted suicide.
Dr. Gall knew several families in which the suicidal propensity
prevailed through several generations. Among the cases he mentions
is the following very remarkable one:—“The Sieur Ganthier, the owner
of various houses built without the barriers of Paris, to be used as
_entrepôts_ of goods, left seven children, and a fortune of about two
millions of francs to be divided among them. All remained at Paris,
or in the neighbourhood, and preserved their patrimony; some even
increased it by commercial speculations. None of them met with any real
misfortunes, but all enjoyed good health, a competency, and general
esteem. All, however, were possessed with a rage for suicide, and all
seven succumbed to it within the space of thirty or forty years. Some
hanged, some drowned themselves, and others blew out their brains.
One of the first two had invited sixteen persons to dine with him one
Sunday. The company collected, the dinner was served, and the guests
were at the table. The master of the house was called, but did not
answer; he was found hanging in the garret. Scarcely an hour before,
he was quietly giving orders to the servants, and chattering with
his friends. The last, the owner of a house in the Rue de Richelieu,
having raised his house two stories, became frightened at the expense,
imagined himself ruined, and was anxious to kill himself. Thrice they
prevented him; but soon after, he was found dead, having shot himself.
The estate, after all the debts were paid, amounted to three hundred
thousand francs, and he might have been forty-five years old at the
time of his death.”
Falret, whose researches have thrown much light on this affection,
believes that it is more disposed to be hereditary than any other kind
of insanity. He saw a mother and her daughter attacked with suicidal
melancholy, and the grandmother of the latter was at Charenton for
the same cause. An individual, he says, committed suicide in Paris.
His brother, who came to attend the funeral, cried out on seeing the
body—“What fatality! My father and uncle both destroyed themselves; my
brother has imitated their example; and twenty times during my journey
hither I thought of throwing myself into the Seine!”
Gall also relates the case of a dyer, of a very taciturn humour, who
had five sons and a daughter. The eldest son, after being settled in
a prosperous business with a family around him, succeeded, after many
attempts, in killing himself by jumping from the third story of his
house. The second son, who was rather taciturn, had some domestic
troubles, lost part of his fortune at play, and strangled himself at
the age of thirty-five. The third threw himself from the window into
his garden, but did not hurt himself; he pretended he was trying to
fly. The fourth tried one day to fire a pistol down his throat, but was
prevented. The fifth was of a bilious, melancholic temperament, quiet,
and devoted to business; he and his sister shewed no signs of being
affected with their brothers’ malady. One of their cousins committed
suicide.
Among the physical causes of self-destruction, insidious affections
of the brain must stand prominently forward. It is not often that the
physician is permitted to examine after death the state of this organ;
but there can be no doubt that, in the great majority of instances, the
brain will be found to have undergone a serious structural alteration.
“During the last twenty-five years,” says Dr. G. Mantell, “many cases
of suicide have come under my notice in which the mental hallucination
which led to self-destruction has depended on lesions of the brain,
occasioned by slight or neglected injuries of the head, to which
neither the patient nor his friends attached any importance. In several
instances of self-destruction, without any assignable moral cause, and
in which no previous signs of fatuity or insanity were manifested,
I have found, upon a post mortem examination, either circumscribed
induration or softening of the brain, or thickening and adhesions of
some portions of its membranes. The conviction was forced upon my
mind that very many of the _so called_ nervous or hypochondriacal
affections, which are generally considered as imaginary and dependent
on mental emotions, are ascribable to physical causes, and frequently
originate from slight lesions of the brain.”
The learned doctor relates the following cases in illustration of his
views:—
“A respectable tradesman, between fifty and sixty years of age, of
temperate habits, was knocked down during an electioneering contest,
and struck his head on the ground. He was stunned for a few minutes by
the shock, and slightly bruised above the right temple, but experienced
no further inconvenience, and the circumstance was considered of no
consequence.
“About six months after the event, he was seized, one evening, with
rigors and a pain over the right brow; a smart reaction took place,
which terminated in perspiration, and the following morning, the
symptoms disappeared. A similar paroxysm came on daily for five or six
days; the attack was considered intermittent, and, I believe, bark was
freely administered. At the end of a week, the patient was well. After
this period, he was subject to occasional pain over the right brow,
accompanied with great mental despondency, the prevailing apprehension
being that of eternal damnation. This state would continue for an
uncertain time, the duration varying from a few days to three weeks;
and by slow degrees he would lose all trace of disease, regain his
accustomed cheerfulness, and be able to transact the affairs of an
extensive business.
“About two years from the occurrence of the accident, I saw him, at the
request of his friends, while he was labouring under great despondency,
which his relations assured me arose from some religious opinions
he had imbibed; and I found that the medical treatment had been in
accordance with such a notion. My inquiries led to the detection of the
injury he had received two years previously, but neither the patient
nor his friends would allow that there was any connexion between the
blow and the symptoms under which he now suffered. Both general and
local bleeding appeared to me necessary; a strict regimen was adopted,
and he regained his usual flow of spirits, and expressed himself much
better than he had been for years. The occasional use of leeches, and
a rigid abstinence from fermented liquors, spirits, and stimuli of all
kinds, maintained this favourable condition for a considerable time;
but his occupation led him to occasional excess in diet, and a moderate
quantity of wine or beer invariably brought on despondency and its
accompanying hallucination; in other words, when the system was kept in
a tranquil state, the cerebral functions were not impaired; but when
excited, the morbid manifestations of the mind were produced.
“During one of these attacks he cut his throat, and expired in the
course of a few hours. A short time previous to his death, when greatly
exhausted by the loss of blood from his wound, his intellect was
unclouded, and he expressed to me his astonishment at what he had done,
and assured me he had no reason for acting thus; but it was an impulse
which he could not resist.
“The only abnormal appearance upon inspecting the body after death was,
a circumscribed adhesion of the dura mater to the pia mater, to the
extent of about two inches in diameter, over the upper and anterior
portion of the right hemisphere of the brain, opposite to the spot
where the blow of the head had been inflicted some years previously.
“I will not presume to offer any comment on a case which I am well
aware presents nothing unusual, my only object being that of calling
particular attention to those slight injuries of the head which,
although unmarked by any striking symptoms at the moment of their
occurrence, may give rise to the most distressing results years after
their infliction, and when the original cause of disordered action
is forgotten, and can no longer be detected; and of pointing out the
possibility that many cases of suicide, apparently referrible to moral
causes only, may be found to result solely from physical derangement
of the organ through which the manifestations of the mind must be
displayed. It is under circumstances of this kind that the medical
philosopher, in his painful duty of exploring the relics of mortality,
may have the high gratification of protecting the memory of an
unfortunate individual from the censure of a world but too apt to judge
harshly, and thus afford a lasting consolation to those by whom that
memory will be cherished and revered.”
No complaints can be more insidious than those connected with the
brain. An apparently slight blow on the head in early life has been
known, if not to give rise at the time to actual disease of the
sentient organ, to predispose the person to attacks of cerebral
derangement when exposed to the influence of causes so trivial as to be
incapable, under any other circumstances, of producing any effect. The
following case will demonstrate that moral irritation may derange the
structure of the brain as effectually as any physical injury:—
A gentleman in early life was exposed for a few weeks to an amount
of mental excitement almost sufficient to bring on a severe maniacal
attack. He complained for some time of a sensation in his head as if
some person was hammering on his brain. In the course of a few years he
apparently recovered. During a tour through Italy, he had a renewal
of his old sensation, and became liable to head-aches, giddiness,
and severe attacks of indigestion. He placed himself under the care
of an Italian physician of eminence, who did his best to restore him
to health. Instead of improving, the symptoms of his disease became
more apparent; and one morning he was found dead on the floor of
his dressing-room, having with a penknife effectually divided the
carotid artery. On examining the brain, extensive _ramollissement_ was
discovered. In this case the structural disease originated in a _moral
shock_, the effects of which remained suspended for some years, and
then gave rise to the train of symptoms that drove the unfortunate man
to terminate his life. It is one of the most important facts connected
with this subject, that mental excitement may produce as extensive and
serious organic disease as that which so commonly follows the receipt
of physical injury. With a knowledge of this fact, how cautious we
ought to be in pronouncing an opinion as to the absence of disease of
the brain in cases of suicide resulting from an apparently trifling
departure from mental quietude, without being intimate with the
previous history of the individual.
“The English,” says Montesquieu, “frequently destroy themselves
without any apparent cause to determine them to such an act, and even
in the midst of prosperity. Among the Romans, suicide was the effect
of education; it depended upon their customs and manner of thinking:
with the English, it is the effect of disease, and depending upon
the physical condition of the system.” A young man, twenty-two years
of age, was intended by his parents for the church. He disliked the
profession exceedingly, and absolutely refused to take orders. For
this act, at once of integrity and disobedience, he was forced to
quit his father’s house, and to exert his inexperienced energies for
a precarious subsistence. He turned his thoughts to several different
employments; and, at length, he went to reside with a family, where
he was treated with great kindness, and where he appeared to enjoy
a degree of tranquillity. His enjoyment, however, was not of long
continuance, for his imagination was assailed by gloomy and distressing
reflections. His life became more and more burdensome to him, and
he considered by what method he should put an end to it. He one day
formed the resolution of precipitating himself from the top of the
house, but his courage failed him, and the execution of the project was
postponed. Some days after, he took up a pistol with the same design
of self-destruction. His perplexities and terrors returned. A friend
of this unhappy youth called upon Pinel one day to inform him of the
projected tragedy. Every means of prevention were adopted that prudence
could suggest, but the most pressing solicitations and friendly
remonstrances were in vain. The propensity to suicide unceasingly
haunted him, and he precipitately quitted the family from whom he had
experienced so many proofs of friendship and attachment. Financial
considerations prohibited the suggestion of a distant voyage or a
change of climate. He was therefore advised, as the best substitute,
some constant and laborious employment. The young melancholic,
sensibly alive to the horror of his situation, entered fully into
Pinel’s views, and procured an engagement at Bled Harbour, where he
mingled with the other labourers with a full determination to deserve
his stipulated wages. But, completely fatigued and exhausted by the
exertion of the first two days of his engagement, he was obliged to
have recourse to some other expedient. He entered into the employment
of a master-mason, in the neighbourhood of Paris, to whom his services
were peculiarly acceptable, as he devoted his leisure hours to the
instruction of an only son. No situation, apparently, could have been
more suitable to his case than one of this kind, admitting of alternate
mental and bodily exercise. Wholesome food, comfortable lodgings, and
every attention due to misfortune, seemed rather to aggravate than to
divert his gloomy propensities. After the expiration of a fortnight,
he returned to his friend, and, with tears in his eyes, acquainted
him with the internal struggles which he felt, and the insuperable
disgust of life, which bore him irresistibly to self-destruction. The
reproaches of his friend affected him exceedingly, and, in a state
of the utmost anxiety and despair, he silently withdrew, probably to
terminate a hated existence by throwing himself into the Seine.
When laying down rules for the physical treatment of suicide, we have
developed our view as to the influence of derangement of the _primæ
viæ_, suppressed secretions, &c., on the healthy state of the mind;
and we have only to refer the reader to that portion of the work for
information on these points. In discussing the important question
whether suicide invariably results from mental derangement, numerous
instances have been brought forward that may be undoubtedly traced to
that cause, therefore it will not be necessary to recapitulate in this
chapter what has been there advanced.