IntroductionThe arguments for and, particularly, against suicide are very similar to those that concern euthanasia and since they have already been discussed at length in this book and elsewhere I won't reiterate them here.[1,2]
One of the difficulties facing the Christian who wishes to arrive at an ethical understanding of suicide is that the Bible has little to say about it either directly or indirectly, probably because it was an extremely rare event in ancient Jewish society. This lack of clear scriptural guidance was a problem for the early church fathers who were obliged to draw upon a mixture of pagan and rabbinic tradition in formulating their view. When looked at more closely we see that the church's attitude in this, as in so many areas, is shaped by that of society around it. Moreover, society's attitudes towards suicide have changed dramatically and are still changing.
Thus, there is a lack of a constant point on this issue which is perhaps why Christians themselves have a range of opinions on suicide and why so many Christians object to it from an emotional point of view, but find it difficult to say why they do or to justify their objection from biblical argument.
Again, this isn't the place to conduct a detailed exploration of the knotty ethical issues as seen from a biblical perspective but it might, perhaps, assist Christians in formulating their own views to consider the history of the development of ideas concerning suicide in western society and in the church.
Our Western cultural inheritance is part Hellenic and part Judaic. Suicide, euthanasia, infanticide and abortion were all widely practised in the ancient Graeco-Roman world but suicide mostly amongst the elite. It was forbidden, for example, for slaves to take their own lives since they were the property of their owner. However, contrary to popular belief, suicide and euthanasia did not enjoy widespread approval in the ancient world. The Pythagoreans, who were instrumental in formulating the Hippocratic Oath, were opposed to all forms of suicide. So were Socrates, Plato and Aristotle. Plato's objection was principally religious, Aristotle's economic and political.
Aristotle believed the attainment of the human form to be of great moral significance; the destruction of human life at any stage was thus morally offensive and penalties for doing so should be graded to the degree to which the human form had been reached. In committing suicide a person was also committing an offence by robbing the State of one's civic and economic contributions. Plato's view was that we didn't create ourselves, we are the property of the gods; it is therefore presumptuous of us to desert our station before being relieved.
This complemented the prevailing Judaic view derived from the rabinnic interpretation of Jeremiah 10:23 'A man's life is not his own; it is not for man to direct his steps' and Ezekiel 18:4 `For every living soul belongs to me... the father as well as the son'. The Talmud states that the time of death is determined by God and therefore none dare anticipate his decree. The notion of the sacredness of life which runs through the Old Testament made suicide an unthinkable act and suicide was a rare event as it is, indeed, in primitive societies today. Suicide, in sociological terms, appears to be inversely proportional to hardship and adversity.
As William James put it, `sufferings and hardship do not, as a rule abate the love of life; they seem, on the contrary, usually to give it a keener zest. The sovereign source of melancholy is repletion. Need and struggle are what excite and inspire us; our hour of triumph is what brings the void. Not the Jews of the captivity, but those of Solomon's glory are those from whom the pessimistic utterances in our Bible come.' The Jews, who until recently, endured hardship for centuries were little given to suicide and this is perhaps why there is so little reference to it in the Bible. Had the Bible been written by ancient Greeks it is likely that the situation would have been different.
Excluding the Apocrypha there is a total of six suicides in the Bible: Abimelech (Jdg 9:50-57), Samson (Jdg 16:28-31), Saul (1 Sa 31:1-4), Saul's armour-bearer (1 Sa 31:5), Ahithophel (2 Sa 17:23), Zimri (1 Ki 16:17-19) and Judas Iscariot (Mt 27:3-5). In all cases except Samson (whose act might be more suitably considered and thus condoned as a military sacrifice) and Saul's armour-bearer, although the suicide was not condemned by the writer the subject was regarded as a bad man.
Moreover, there is the clear implication in some cases that their death was a punishment from God. Abimelech had killed his seventy brothers and his death was interpreted as God's revenge for doing this... `Thus God repaid the wickedness that Abimelech had done to his father by murdering his seventy brothers'. Saul (1 Ch 10:13-14) had been `unfaithful to the Lord; he did not keep the word of the Lord, and even consulted a medium for guidance, and did not enquire of the Lord. So the Lord put him to death.'
Ahithophel had conspired with Absolom to depose David and Zimri murdered King Elah of Israel... `so he died because of the sins he had committed, doing evil in the eyes of the Lord and walking in the ways of Jeroboam and in the sin he had committed and had caused Israel to commit.' Finally Judas Iscariot condemned himself, `I have sinned by betraying innocent blood'; the evil in his behaviour is indicated from the preceding reference to `Satan entering Judas' whilst Luke appears to present the apostles' reaction to Judas's suicide as the due desert of a bad man.
Suicide was regarded by the later Jews living at the time of Christ as a heinous sin and Josephus tells us that the body of a suicide was not buried until after sunset and then carried to the grave without the normal funeral rites. The part of the Talmud known as the Misnah (most of which was compiled in the first century BC) is explicitly hostile towards suicide, stating `whenever a person of sane mind destroys his own life he shall not be bothered with at all'. Rabbi Ismael states `one chants over his body a dirge with the refrain: 'woe be unto thee who hanged thyself'' to which Rabbi Eleazer responds 'Leave him in the clothes in which he died, honour him not, nor damn him. One does not tear one's garments on his account, nor take off one's shoes, nor does one hold funeral rites for him; but one does comfort the family, for that is honouring the living.' This passage is interesting in that it appears to draw a distinction between suicides that were or were not occasioned by mental illness with the implication that those that were were perhaps exonerated. Moreover, it implies that in some cases suicide was seen as a sign of pathology, a view later developed by the Medieval Church.
Over against this tradition of hostility towards suicide the Jews had a counter-tradition in which suicide undertaken for religious reasons including mass suicide was regarded with veneration. This veneration is understood in the context of the doctrine of Kiddush ha-shem, ie `sanctification of the divine name' which stated that suicide could be acceptable or even glorifying to God if one thereby avoided becoming a vehicle for desecration of his name in instances of rape, slavery or forced religious conversion. The best known example of this is Massada but mass suicides amongst persecuted Jewish communities continued to feature in Germany, France and Britain during the Middle Ages.
The Early Church
Although none of the Jewish-Christian Apostles left teachings relating to suicide it is apparent that the early church took over Jewish traditions in its contrary attitude towards the sacredness of life and the excusability of suicide for religious reasons. For example, the second generation non-Jewish leaders such as Polycarp and Clement writing towards the end of the first century expressed a decisive objection to infanticide and abortion, which was not Greek or Roman in origin.
However, martyrdom was highly regarded by the early church and the boundary between it and suicide proved to be a narrow one. Tertullian addressing Christians in prison who were awaiting martyrdom, encouraged and strengthened them by citing the example of famous suicides including Lucretia, Dido and Cleopatra. Chrysostom and Ambrose both applauded Palagia, a girl of 15 who threw herself off the roof of a house rather than be captured by Roman soldiers. In Antioch, a woman called Domnina and her two daughters drowned themselves to avoid rape, an act which, as in the case of the Jews, was venerated.
Jerome also approved of suicide for religious reasons and did not condemn austerities which undermine the constitution and which might be regarded as slow suicide. He recounts, with the greatest admiration, the life and death of a young nun named Belsilla who imposed such penalties on herself that she died. Martyrdom eventually became so popular amongst the more fervent believers such as the Donatists that it threatened the credibility and, in places, the very existence of the church. How to respond to this fervour was a difficult task for leaders of a religion founded on Jesus's voluntary submission to death and whose early leaders had all been slain in the course of duty.
It was Augustine who finally rose to the challenge and who is credited with clarifying Christian thinking on this subject by synthesising Platonic and Jewish traditions in a way that gave greater emphasis to the former. In `The City of God' he carefully weighed up the various arguments for and against suicide, concluding that suicide was always wrong, that it was a violation of the sixth commandment and never justified even in religious extremis. By the 5th century suicide was regarded by the church as sinful in all circumstances.
The Medieval Period
The most systematic argument against suicide in medieval Christianity came from Thomas Aquinas who, in his Summa Theologica, presented three main objections:
- it is a violation of natural law according to which everything naturally keeps itself in being and prescribes self love,
- it is a violation of moral law, being an injury to the person's community and
- it is a violation of divine law because of the sixth commandment.
Perhaps because of these stern warnings suicide appears to have been a relatively uncommon event during the Middle Ages. However, suicides and suicide attempts did occur thus forcing the church to consider what might be the most appropriate response. What emerged from this further deliberation was the view that self murder was a sin and a crime but it could also be a sign of pathology. During the Middle Ages sin was very much a matter of practical morality: a person's wish to end their life was something to be understood and prevented and, if at all possible, treated.
Although we have become familiar with the severe social sanctions imposed on completed suicides by contemporary society (refusal of burial rites, exposure and mutilation of the body, confiscation of property, etc) all of which betray the very great fear people had then of suicide, recent researches have also shown that the medieval church pursued an energetic treatment policy for those who were feeling suicidal. Numerous guides survive which were written to instruct clergy how to go about ministering to those who were suicidal. These guides placed special emphasis on the diagnosis of the underlying motivation which, interestingly for us in the twentieth century, was usually related to breakdown in key relationships.
Treatment consisted, then as now, of keeping the person under close observation, keeping them busy, making them comfortable with warmth, food and music, and prescribing a form of cognitive therapy drawing on exhortation, the citation of successful case histories and absolution. These activities reveal that the medievals clearly recognised that a person's judgment and perception could be strongly influenced by their mood.
These same researches also reveal that even in cases of actual suicide the medieval church still maintained a fairly enlightened view: Clergy were expected to hold inquests and the records reveal that in the majority of the verdicts the suicide was attributed to a disturbance of the mind. As in the case of Jewish tradition this enabled the dead person to receive formal rites of burial. Throughout this period we see a dissonance between what the theologians taught, what the clergy practised and what the general public believed. `Folk' superstitions concerning actual suicides -- such as their burial at crossroads -- proved remarkably resistant to change and persisted right up until the mid-nineteenth century.
The Seventeenth Century Onwards
In the seventeenth century, under the influence of the new spirit of enquiry, the more educated classes began to question the prevailing view that suicide was always wrong. John Donne, who was for a while himself prone to suicidal urges, wrote a treatise called Biathanatos in which he tried to prove (rather unsuccessfully as it happens) that self murder was not a sin. Interestingly, he cites as support the contemporary practice of euthanasia in which female relatives of those who were dying and for whom nothing more could be done would assist death by removing the patient's pillows. Donne records that this was common practice and that it was regarded as a `pious act', reflecting the fact, again, of a wide divergence between what the church taught and what society as a whole actually practised. The term `suicide' was first coined by Walter Charlton in 1651 as a bid to rid it of the criminal and sinful associations which had previously stuck to it. Although his exercise at moral sanitisation failed the term itself stuck.
Many thinkers in the eighteenth century attempted to justify suicide; for example, Hume  said that such acts were not a sin since everyone has the free disposal of his own life, an argument drawing upon an interpretation of natural rights. He also claimed that no part of scripture condemned suicide and thus regarded it as merely a `retirement from life' which did no real harm to society. Voltaire defended suicide on the grounds of extreme necessity and pointed out that if suicide is a wrong against society then the homicide of war was far more harmful. Goethe, having experienced suicidal thoughts himself was also ready to condone it. Kant, however, upheld the principle of the sacredness of human life and regarded suicide as an act that was `degrading' and which represented a failure of `duty', although not the hard-nosed kind of duty understood by the capitalists.
Despite the efforts of these progressive thinkers and writers the nineteenth century brought a hardening of attitudes towards suicide within western society which is hard to explain except in terms of the effects of capitalism, the influence of utilitarians like Malthus and Bentham, and the waning influence of the church. Under the influence of the Industrial Revolution men and women came increasingly to be regarded as units in a profit-making enterprise. Each member of the working classes was regarded as living under an obligation of duty to his country, his employer and his family, a notion which was pure Aristotle.
Aristotle had argued that those who attempted suicide should be punished and it comes as no surprise to find that laws were introduced in the early nineteenth century to punish those who attempted suicide or who assisted others to end their lives. Just as in the ancient world the upper classes (particularly those of a more artistic bent) were spared the indignity of imprisonment and for a while suicide even came to enjoy a bit of a vogue amongst the romantics. The lower classes, however, could expect a sentence of 10 days with compulsory counselling from a clergyman. Subsequently even stiffer sentences were imposed and between 1944 and 1955 13% of the 40,000 who attempted suicide were prosecuted; 308 of these were sent to jail and even in 1955 a man received a two year jail sentence, although this was subsequently reduced to a month.
Suicide only ceased to be an indictable offence in 196l and continues to be an offence for those who aid or abet, counsel or procure the suicide of another (Suicide Act 1961). The ostensible aims of such sentences were to discourage suicide as a phenomenon, although it is hard to be sure that some of the wish to punish wasn't due to misplaced anger towards those who were regarded as a social nuisance, a spirit which lives on in many medical wards and admissions units.
The nineteenth century was a time in which men started to collect data and to apply scientific method to the social evils of the day. Professor Olive Anderson  has written extensively about suicide at this time. Her researches indicate that, despite the prohibitions, suicide rates in the UK started to climb, especially among men, from the mid-1800s onwards. Although the sociologist Emile Durkheim blamed the `anomie' of modern industrial society, the process of industrialisation cannot be entirely held to blame since suicide rates were highest in the old county towns. At this time suicide continued to be associated in the public eye with sin but the finding that it also showed a strong association with alcohol abuse, poor physical health and poverty sensitised the public towards a more sympathetic and understanding attitude, itself assisted by the rise of the popular novel in which the suicides of the wronged, abandoned and destitute often featured.
However, poverty was also popularly identified in many a Victorian mind as the just deserts of a life given over to sin; considerable debate thus took place over which of the poor should be seen as `deserving' and which were beyond help . Under these combined influences those who saw themselves as having a responsibility to promote public order developed a variety of social and ? philanthropic programmes to combat suicide.
First onto the scene were members of the various Christian denominations, most of them from the evangelical wing, who worked alongside prisoners remanded on charges of attempting suicide and established a number of missions, culminating in the Salvation Army's Anti-suicide Bureau of 1907 which acted much as the Samaritans do nowadays. Parallel to these social developments psychiatrists were beginning to take a keen interest in suicide and the new asylums had to deal with enormous numbers of suicide attempters, far more than were actually seen in the remand prisons. The clientele of the three services differed... the poor and destitute continued to occupy the police cells whilst middle-class clients with financial troubles tended to attend the Bureau.
Emile Durkheim, in his book Le Suicide , made an exhaustive survey of the various causes of suicide then known to exist and reached an important conclusion: that social causes are of predominant importance in determining suicide and that the strength of suicidal tendency within societies is in direct proportion to its degree of social cohesion. Where social solidarity is strong suicide will be an uncommon event; thus, the common finding that religious adherence is associated with low suicide rates, a finding which still holds true today. Conversely, where social cohesion breaks down, as in times of economic stress, suicide rates rise, a view which holds interest for those concerned about rising unemployment, the breakdown of the family unit, the decline of religion and the collapse of community structures.
A Psychiatric Comment
This is not the place to review the history of suicide from a psychiatric perspective save to remind ourselves that the notion that suicide might be a sign of mental pathology is an ancient one. Many patients found in psychiatric settings have suicidal thoughts and these usually resolve when the underlying cause or depression is treated. With the exception of pharmacotherapy many of the techniques used in psychiatry nowadays to help the depressed and suicidal are broadly similar to the kinds of cognitive psychotherapeutic interventions offered by the medieval church. That these are successful in the individual situation there is no doubt, but it is equally true that all attempts, many of them ingenious, to prevent suicide as a phenomenon have been dismal failures.
This is because the majority of those who commit suicide are not actually in contact with psychiatric services. This is a fact of great importance since the present government has taken it upon itself to judge the quality of psychiatric services on the basis of local suicide rates, a move which betrays a staggering ignorance of history, medicine and epidemiology. Thus, the advent of psychiatry and the development of antidepressants haven't had any appreciable impact upon the steady rise in the suicide rate which has proceeded (with temporary diminutions during wartime and the conversion of cookers from coal to natural gas) unabated. Suicide rates are rising, particularly at present among young men. The only positive feature is that the rate appears to be falling among the elderly, perhaps as a result of improved medical care and support facilities.
What conclusions can we draw from this brief survey?
l. The robust finding that suicide is commoner in certain sociodemographic groups and in certain societies reflects the fact that public attitudes are as important as actual circumstances in determining whether someone will actually kill themself.
Suicide rates in the West, especially in Roman Catholic countries, are on the low side when compared with countries such as Japan. Suicide is also less common during wartime and times of national crisis. Conversely, suicide rates increase after a celebrity takes their life or a suicide is displayed on television. Any effort to deal with suicide as a phenomenon must thus take into account the importance of public opinion.
Deliberate Self Harm (which is responsible for approximately 10% of all acute medical admissions in District General Hospitals) is a socially-sanctioned means of expressing distress and soliciting help. Attempts to reduce it must therefore target the determinants of public opinion and Christians should question and criticise the kind of role models proffered by the media. We should also recognise that 99% of sermons in this country are preached to those in churches who are already believers; the rest of the general public is indoors watching TV.
2. In Western society suicide has usually been regarded as a sign of pathology in both the mental and the social sphere. Depression is present in the majority of suicide victims; depression is also the commonest specific psychiatric disorder in western society. Most of the depression in the community is known only to GPs; hence the current joint Royal College (GPs and Psychiatrists) programme to raise consciousness about depression and its treatability. Churches would do well to become aware of the problem of depression and its treatment since Christians are by no means immune from depression or suicidal thinking.
Christians would also do well to become more concerned about social justice and more vocal in their opposition to the real social evils of society. Alcoholism, marital breakdown and unemployment are far more serious issues than, say, the New Age movement or whether women should be ordained.
3. Christian attitudes towards suicide have changed greatly over the centuries and hitherto arrived at no fixed point. What principles can we extract from scripture?
Firstly, the brief review of biblical suicide seems to suggest that, in these cases at least, suicide was the consequence of sin. However, these recorded examples are not at all representative of the `ordinary' kind of suicide encountered in clinical practice; thus, the biblical suicides cannot be used to extrapolate a Christian ethic towards suicide per se.
We should also recognise that despair even to the point of suicide was something experienced by a number of other Bible figures who are clearly presented in a favourable light; one thinks immediately of Paul but there are also Job, David, Jeremiah and Elijah. This should cause us to be cautious in condemning the Christian who experiences despair or suicidal thoughts and I frequently use these biblical examples in clinical practice to reassure patients that their despair and suicidal thinking is an authentic Christian experience. God doesn't test us further than we are able to bear... but we are able to bear considerably more than we care to think.
To be able, then, to survive such an experience and to retain faith, however weak, at such times is a glorious witness and a glorious testimony to God's faithfulness. To know this, when suffering from depression and to find oneself commended for such faith instead of left feeling guilty can be an enormously liberating experience. Secondly, there are certain principles regarding the sacredness of human life which merit careful attention in building a suicide ethic, but it is equally clear that there are certain situations, condoned by the Bible, in which it is legitimate to take or even surrender life. Thus, even from a Christian standpoint, the sanctity of life is not an inviolable ethic. The principal religious objection to the taking of life is the Platonic assertion that we are not our own. This statement is almost always misunderstood, which weakens its impact in ethical debate. The crucial Christian emphasis in this debate is not that we are created beings, but that it is GOD who has created us. This involves a critical change of emphasis and springs the debate out of the theatre in which man discusses what happens to man into a wider metaphysical arena in which man is very much the weaker partner in intellect and understanding. Most importantly, a person's right to life is conferred to them by God and not by one's parents, partner or the rest of society.
More importantly, this right is a unilateral contract between God and man and is therefore non-negotiable. It is this which distinguishes Jesus's voluntary death on the cross from ordinary suicide since Jesus, as God, had the right to lay down his life in this way; hence his statement in John 10: 17-18 `I lay down my life only to take it up again. No-one takes it from me, but I lay it down of my own accord. I have authority to lay it down and authority to take it up again.' The implication is that ordinary human beings don't have this prerogative. However, the question remains 'Are there ever circumstances which render it legitimate to end one's own life?' The ancient Jews and early Christians clearly thought so. Nowadays we face new dilemmas concerning medicine's increasing ability to sustain and prolong life beyond that determined by natural processes. This inevitably forces us to examine whether any refusal of treatment in such cases is necessarily tantamount to suicide, which is a subject for another day.