Hektoen International

A Journal of Medical Humanities

Suicide: always a tragedy?

JMS Pearce
Hull, England

The tragedy of suicide is well expressed in “The romantic suicide: Karoline von Günderrode” by Nicolás Roberto Robles.1 We all try hard to understand this act. Self-destructive urges are an ubiquitous but often ignored or suppressed aspect of all human life. But what makes a person take their own life is often a matter of conjecture rather than certainty. Fancy pseudoscientific words, arbitrary judgments and an assumed morality pervade much of the huge literature.

As Robles notes, in young people copycat suicides such as those that followed the death of Marilyn Monroe, or peer pressures, especially those of the social media, may underlie the act. Romantic pledges, like that of Günderrode, can be terribly sad.

But there prevails an almost sacerdotal belief that suicide is necessarily the result of an illness, which we glibly call depression. This medicalizes the act. Medicalization is a specious practice increasingly common in the setting of the varying symptomatic vagaries of normal human sentiments and their expression.

A man I knew well, admired and was fond of, at the age of 64 had attained both an elevated position and respect in his work. He was dedicated to his job at the cost of recreational hobbies. He was not immune to occasional lapses of marital infidelity and flamboyant behavior, but these never impeded his innate decency or his work. Significantly, his family had long since flown the nest and he retained no close links with them.

Retirement at 65 was then obligatory. He complained how loss of work, professional status and friendships enforced by retirement would change his life. He confessed how he dreaded the day. With no overt warning, he died by taking a mixture of barbiturates and alcohol. This came as a profound shock to many. But not perhaps to those in whom he had confided his anxieties. I had failed to observe any trace of depressive illness, just his regret that those things he valued most were to be irretrievably lost.

In the context of his life and his values, it was not difficult to see how in his judgment suicide was a rational solution to life’s problems as he perceived them.

The pain and suffering of terminal illness may understandably be relieved by suicide. Religious dictates apart, perhaps suicide is not invariably a tragedy. Schneidman wrote, “In almost every case, suicide is caused by psychological pain, which I call psychache.”2 But the many books about suicide are filled with such words as: helplessness, depression, emotional dysregulation, mood disorders, cultural values etc. They are descriptive, and speculative rather than explanatory. The physician should step back from arbitrary judgments of what makes someone else’s life worthwhile to them. Depression is not always the explanation. There may be occasions when we should respect the implied admonition of Arthur Hugh Clough in “The Latest Decalogue”:

Thou shalt not kill; but needst not strive
Officiously to keep alive


  1. Robles, Nicolás Roberto. “The romantic suicide: Karoline von Günderrode.Hektoen International, Summer 2022.
  2. Shneidman, ES. “Suicide as psychache.” J Nerv Ment Dis. 1993 Mar;181(3):145-7.

JMS PEARCE is a retired neurologist and author with a particular interest in the history of medicine and science.

Summer 2022



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