An acquaintance of mine committed suicide two weeks ago. The act came as a complete shock to his friends and family, as the only risk factors present were those common to a significant fraction of the American adult population, and he had not recently talked about suicide, even in general terms. A middle-aged man, in average health, running a successful business, apparently happily married, and rational in his interpersonal interactions, abruptly decided that life was not worth living.
What went wrong? The explanation that immediately comes to most people’s minds is that he was insane. In other words, he was a profoundly flawed human being. Except as a response to trauma, our current medical model does not view insanity as something that strikes out of the blue, like measles or an automobile accident. Rather, it is an underlying metabolic condition, a chemical imbalance of the brain, something that a person is born with, although life history, especially early childhood events, can intensify it.
I do not know what precipitated Russell’s death, or the deaths of two other acquaintances who died under similar circumstances in the past year. I do think that the label of insanity becomes a convenient excuse for failing to examine what led the person to believe that his or her current life was not worth living. Sometimes the motives are understandable, for example, when a person has been battling chronic pain for which no relief has been successful, or has a progressive neurodegenerative disease. Sometimes there is a long history of delusional thinking and behavior, and the immediate perception of hopelessness has a strong delusional component, as with the schizophrenic who believes the CIA is about to kidnap him and whisk him away to a secret dungeon to be tortured. Most suicides, however, fall somewhere in between.
The assumption that suicide is an inherently insane act is comparatively recent in Western thought. In Medieval and early Modern Europe and Colonial America, self-murder was considered a grave sin, and one for which the sinner could not atone. Unless a suicide was so mentally deranged at the time of his death that he was incapable of distinguishing right from wrong (the legal standard used in court trials of murderers), he could not be buried in sacred ground, and it was assumed his soul went to Hell. Property was often forfeit to the state. Therefore, surviving family and friends had a strong stake, both emotional and financial, in persuading the coroner’s inquest that their relative was insane, introducing minor aberrancies of behavior that passed as normal at the time, and airing confidential information that forever tarnished the reputation of the deceased. This produced a species of circular reasoning which persists to this day: a person who said or did X subsequently committed suicide; therefore X must be insane behavior.
Attitudes were already beginning to change in Britain in the early 19th century when a particularly high-profile case brought the anomalies and contradictions in the existing system into sharp focus. The Marquess of Londonderry (better known in history as Lord Castlereagh), Britain’s Secretary of State for Foreign Affairs and Majority Leader in the House of Commons, committed suicide in 1822 under circumstances that left no doubt it was a deliberate and probably premeditated act. Introducing evidence at a public hearing that tended to support a verdict of insanity risked questioning the validity of legislation and diplomatic negotiations for some considerable time prior to the suicide, a vulnerability that opponents of the government were certain to exploit. There was also an embarrassing skeleton in the closet, which most contemporaries would have viewed either as evidence of extreme delusion, or of a character defect completely incompatible with public service. Specifically, His Lordship had complained privately to several friends that he was being blackmailed for a liaison with a male prostitute.
In his opening remarks at the Inquest, the Coroner argued that no person in his right mind would take his own life, and therefore it was unnecessary to submit any other evidence that the deceased was insane at the time of his death. Two people did testify, but confined their evidence to the three days prior to death and gave no specifics about the “disordered notions” under which Lord Londonderry labored. The jury returned a verdict of insanity.
This case became precedent and marked a shift from Coroner’s inquests in which a suicide was assumed to be sane, and the witnesses submitted as much evidence as possible of insanity to avoid a verdict of Felo de Sé, to inquests in which the suicide was assumed to be insane, and only in rare cases was evidence to the contrary presented. From a legal standpoint, the change brought the coroner’s inquest proceedings more into line with a standard trial and the presumption of innocence which is fundamental to British and American law. It had nothing to do with a shift in understanding of human psychology.
Today in America the sanity question does not affect inheritance rights or disposition of bodies, and only a minority of those people who believe in Hell are certain that sane people who commit suicide automatically end up there. The “insanity defense” at a coroner’s inquest therefore becomes mainly a way of avoiding awkward scrutiny of the circumstances leading up to the person’s death. Is this a good thing? For the immediate family, it often is, sparing the survivors painful rehashing of past events that cannot be changed. For society as a whole, it can look suspiciously like a denial process, as we stubbornly try to maintain the illusion that we live in an age and a country where despair is always delusional.