First of all my thanks to Edel James for inviting me to speak here this evening and apologies I couldn’t be here earlier due to having to see patients for therapy. A few months ago I spoke at a conference on suicide and logotherapy which I organised with Gay and my thoughts on the subject, which I won’t repeat here, are on Youtube if you type in the title of my paper ‘Saying Yes to Life in Spite of Everything’ followed by my name. The link is also on my website: www.logotherapyireland.com for anyone interested.
So many suicides are committed out of acts of despair or disgust with life; so much seems obvious. They are frequently attributed to depression and other mental disorders and to drug and alcohol abuse. Stress factors such as financial difficulties, family problems or troubles in interpersonal relationships are issues too. Economic factors such as unemployment, poverty, homelessness, discrimination, bullying and prejudice may also trigger suicidal ideation. 15%-40% of people leave a note, as one of my friends did who hanged himself from a tree when he was 19. Genetics seems to account for between 38%-55% of suicidal behaviour. Half of all people who die by suicide are thought to have a major depressive disorder which increases the risk of suicide 20-fold. I have been asked by the charity Aware to give a talk on ‘Depression and the Search for Meaning’ in St. Patrick’s Hospital in Dublin at 7pm on Wednesday March 13th and I would like to invite anyone interested to come along to this free talk.
20% of suicides have had a previous attempt and the presence of self-harm is related to increased suicide risk. About 25%-40% of those who complete suicide had contact with mental health services in the prior year. Substance abuse is the second most common risk factor after major depression and acute intoxication, especially when combined with the grief of a bereavement or the shock of a severe loss of love. Most people, statistically, who commit suicide are under the influence of sedative-hypnotic drugs when they commit suicide. There is an association between suicidality and physical health problems including chronic pain and cancer – also sleep disturbances and problem gambling. Psychological states must also be mentioned such as hopelessness, lack of pleasure, anxiousness, poor impulse control, social isolation, loss of love. A history of childhood sexual abuse and time spent in foster care are all regarded as risk factors in the aetiology. So we can see from this that it there are many variables present which will require a multidimensional approach by way of an answer, prevention or possible solution.
There is copycat suicide (suicide by contagion), which is known as the Werther Effect after the German philosopher and playwright Goethe’s book, The Sorrows of the Young Werther, where the greatest risk is in adolescents who romanticise death. Goethe’s work is a collection of letters written by Werther, a young artist of a highly sensitive and passionate temperament, written and sent to his friend Wilhelm. In these letters, Werther gives a very intimate account of his stay in the fictional village of Wahlheim. He is enchanted by the simple ways of the peasants there. He meets Charlotte, a beautiful young girl who is taking care of her siblings following the death of their mother. Despite knowing beforehand that Charlotte is already engaged to a man named Albert, who is in fact eleven years her senior, Werther falls in love with her. Although this causes Werther great pain, he spends the next few months cultivating a close friendship with both of them. His pain eventually becomes so great that he is forced to leave and go to Weimar. When he later returns to Wahlheim he suffers even more than he did before because Lotte and Albert are now married. Every day serves as a torturous reminder that Lotte will never be able to requite his love. Out of pity for her friend and respect for her husband, Lotte comes to the decision that Werther must not visit her so frequently. He visits her one final time, and they are both overcome with emotion after Werther’s recitation of a portion of Scottish epic poems. Werther had realized even before this incident that one of them — Lotte, Albert or Werther himself — had to die. Unable to hurt anyone else or seriously consider committing murder, Werther sees no other choice but to take his own life. After composing a farewell letter (to be found after he commits suicide), he writes to Albert asking for his two pistols, under a pretence that he is going ‘on a journey’. Lotte receives the request with great emotion and sends the pistols. Werther then shoots himself in the head, but does not expire until twelve hours after he has shot himself. He is buried under a tree, and the funeral is not attended by clergymen, Albert or by his beloved Lotte.
This theme finds resonance in Shakespeare’s Romeo and Juliet, a play about love, fate, time, chance and duality, where Romeo, believing Juliet to have died, drinks poison and Juliet, finding him dead, stabs herself with a dagger, causing feuding families to be reconciled as a result. The play ends with the Prince’s elegy: ‘For never was a story of more woe/ Than this of Juliet for her Romeo’.
The opposite of the Werther Effect is the Papageno Effect, which draws on coping mechanisms such as those provided by friends to help us through our experiences of the existential vacuum. Papageno is a character in Mozart’s Masonic opera The Magic Flute who, having lost the love of Papagena decides to hang himself, until three child-spirits appear to stop him.
There are rare rational suicides, altruistic suicides, suicide attacks such as suicide bombers, and mass suicide pacts. The leading methods are hanging, which is the most common, pesticide poisoning, and firearms and always this interplay between psycho-physico-social causes and existential and spiritual reasons.
There are many forms of suicide prevention from putting barriers in place on bridges and subway platforms to economic development to treatment programmes for drug and alcohol addiction to logotherapy, which seems to have the highest empirically verifiable rate of non-recidivism. There is little evidence that hotlines or antidepressants help. In terms of epidemiology, about 0.5% to 1.4% of the population take their own lives; it is the tenth leading cause of death in the world and males die three to four times more often by means of suicide than females, with China being the only exception here. It is greatest in those aged between 15 and 29 years of age.
So having set out some statistics by way of introduction and putting the subject in context, let me turn to Shakespeare, whom I have already mentioned as his range of depth and insight on nearly every important issue, including suicide and depression, is unsurpassed. The British Bard pens the famous following lines in Hamlet’s great soliloquy. It is an existential analysis on the meaning of life and death, which may be read as Shakespeare’s own.
‘To be, or not to be, that is the question:
Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles
And by opposing end them. To die—to sleep,
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to: ’tis a consummation
Devoutly to be wish’d. To die, to sleep;
To sleep, perchance to dream—ay, there’s the rub:
For in that sleep of death what dreams may come,
When we have shuffled off this mortal coil,
Must give us pause—there’s the respect
That makes calamity of so long life’.
For Shakespeare’s Hamlet, life is a kind of death. Being comes to look a lot like non-being, something like nothing. He suffers blows of fate. Fortune has frowned upon him. Hesitant Hamlet wonders whether death is a kind of sleep with one advantage: that of never having to get up in the morning. But Hamlet fears it too because he doesn’t know if it will bring more nothingness or Heaven. The choice is stark but simple: too endure going on and face one’s fate which will often include much suffering or end it all and take one’s life. That is why Albert Camus, the French philosopher, centuries later, would say that the question of suicide is the most philosophical of all questions as it concerns the very tissue of human existence itself – its worth or waste, its tragedies and triumphs, its tortures and tenderness, its purpose or purposelessness. The person who is contemplating suicide is confronting the very meaning of the question of being. Is it all much ado about nothing?
Macbeth had likewise pondered such perennial matters. After his wife died he is indifferent to his return to dust believing that life holds no meaning. Time marches mechanically on. Life is an illusion and we men merely players, phantasms, ghosts.
‘To-morrow, and to-morrow, and to-morrow,
Creeps in this petty pace from day to day,
To the last syllable of recorded time;
And all our yesterdays have lighted fools
The way to dusty death. Out, out, brief candle!
Life’s but a walking shadow, a poor player,
That struts and frets his hour upon the stage,
And then is heard no more. It is a tale
Told by an idiot, full of sound and fury,
The question is: is he right? That is certainly his experience but it is an experience in time not for all time. There is a saying we have all heard: we can’t see the forest for the trees. This sentence is a reminder not to lose sight of the scope; sometimes we need to see the big picture, the view from above. To this end, I would like to analyse an ancient Egyptian text on suicide, to see what it has to say to twentieth-century Ireland which, I believe, is a lot. Examining suicide through a long lens like this moves it out of individuality and particularity into objectivity and universality, thus creating a spiritual space and self-distancing, another, broader perspective and backdrop.
An Egyptian Text
The text is the ‘Dispute of a Man, Who Contemplates Suicide, with His Soul’. It is an anonymous text from the Egypt of the First Intermediate Period of 2,000 BC – an early historical reflection on the experiences of life, death, meaning and immortality. The first part is only imperfectly preserved and presents an argument between the Man and his Soul.
The Man is driven to despair by the trials, troubles and tribulations of a disordered age and wants to commit suicide – he desires to cast off a life that has become senseless to him. The Soul militates against the decision. The argument passes through three phases. The first part of the struggle between Man and Soul is concerned with life being a gift of the gods. Since life is not man’s property he cannot throw it away when life becomes a burden; one cannot shorten one’s allotted span. But Man pleads: the disintegration of personal and public order, the lack of meaning that results from this, so exceptional circumstances prevail and thus one may justify the violation of the rule before the gods.
In the second bout, the question of immortality arises. Man attempts to make the decision palatable to his Soul by promising proper burial provisions so that the soul’s sojourn in the Beyond will be pleasant. But the Soul knows nobody has come back from the afterlife to tell the living about the state of the soul in the Beyond. Man proves no less resistant than his Soul.
A third and final bout occurs: man has no peace of mind either through conventional belief or conventional scepticism! The Soul proceeds to attack the core of Man’s misery. Man is in anguish because he takes life too seriously. Why not simply despair? Man should enjoy the pleasures of the moment. ‘Pursue the happy day and forget care’. (This was a common argument at the time and can be seen in, for example, the ‘Song of the Harper’, another ancient text). This counsel sets off a spiritual crisis. Man is incensed by the banality and baseness of the advice and makes his distaste known:
‘Behold, my name will reek through thee
More than the stench of bird droppings
On summer days, when the sky is hot’.
Before this outburst Soul is silent, its resources exhausted and Man is alone with himself and his decision. The arguments of the Soul attempt to open ways out of an impasse that may induce a solution through suicide. These arguments suffer from a sense of unreality: life is God-given and can’t be thrown away at will; besides, one can’t be sure of a life beyond death so better hold on to what you have and finally, don’t be so serious about the meaning of life, just have a good time like everyone else. A twentieth-century German philosopher, Eric Voegelin, connects the Man of the ‘Dispute’ to contemporary man thus:
‘The situation of the Man in the “Dispute” then, would not differ very much from that of a man in our own time: to live in a society that lives by vulgar clichés of piousness, skepticism, and hedonism is trying enough to make a man look for an oasis of reality – even if, in order to reach it, he will not necessarily resort to the radical means of suicide’78.
The document of the ‘Dispute’ is a drama of existence. Its author rises above lamentation to dramatic judgement and action. The Man disengages himself from a disordered society and rejects conformism to become one with himself. The second part of the ‘Dispute’ articulates the experiences of reality and is organised in four sequences of tristichs, which is a poem consisting of three lines, which express Man’s revulsion at becoming a stench to himself by continuing life at the level of corrupt existence; the second sequence characterises life in the mode of unreality; the third one deals with death as liberator from the sickness of life; the fourth one, with the fullness of faith through death. Equivalent symbols may be found in the noetic and revelatory experiences of Plato and St. Paul, though more differentiated. The first line is repeated in each formulation:
‘To whom can I speak today?
One’s fellows are evil;
The friends of today do not love’.
The destruction of community among the people through destruction of their spirit is the great theme in this complaint. The love of men in community has disappeared or dissolved and the order emanating from the gods is gone. Everyone is for himself and has, therefore, become evil. This loneliness and lack of love and loss of character are described in the following tristich thus:
‘To whom can I speak today?
Faces have disappeared
Every man has a face downcast toward his fellows’.
The divine presence has withdrawn from the self and the people are no longer living in the flow of this Presence. The quiet despair is evident in the following lines:
‘To whom can I speak today?
There is no one contented of heart.
The man with whom one went no longer exists’.
Further tristichs dwell on the wickedness of man, on the social dominance of criminality, on ‘the dreary prospect of evil without end’.
What we are witnessing in this person’s experience of being lonely in a crowd; it is a typical experience such as many feel in a modern urbanised ‘society’; the dissolution of society, the disappearance of contentment and the phenomenon of alienation. It is a description of a society in disorder and of a soul in disarray. When this happens ‘man turns away from a life that has become senseless and contemplates suicide’. We may cite two of these suicide phrases:
‘Death faces me today
Like the recovery of a sick man,
Like going out into the open after confinement.
Death faces me today
Like the longing of a man to see his home again,
After many years that he was held in captivity’.
The man proceeds with metaphors of escape from this reality as a release from sickness and prison, a release from darkness, a returning home, etc. What results from such an escape is judgement in the Beyond. Let me quote the last group of tristichs:
‘Why surely he who is yonder
Will be a living god,
Punishing the sin of him who commits it
Why surely he who is yonder
Will stand in the barque of the sun,
Causing the choicest therein to be given temples.
Why surely he who is yonder
Will be a man of wisdom,
Not hindered from appealing to Re when he speaks’.
‘Re’ or ‘Ra’ is the ancient Egyptian god. It is the judgement in the Beyond, in which the man can participate because he is immortal, when he commits suicide in order to escape from a world from which he has become absolutely alienated and against which death is life. What we have is an analysis of a deficient existence and a disordered society. The truth of existence is the recovery of a sense of the divine order. But in the situation cited above, there is despair, and suicide seems the only sensible route to take. This would bring the man in question into immortality of course, into the company of the sun god which would bring the restoration of the empire of Egypt. Its order is supposed to manifest the ma’at – the divine-cosmic order, while the Pharaoh is supposed to be the mediator of this order to society. At the time of the author’s writing Egypt was in disorder because of the Pharaoh’s malfunctioning. The author of the text is on the brink of the insight that order (personal and social) depends ultimately on ‘Man’s existence in immediacy under God’84.
According to Voegelin, the Western philosopher in the 20th century AD finds himself in substantially the same position as the Egyptian thinker in the 20th century BC, in that both are disturbed by the disorder of the age and are in search of a reality no longer alive in the surrounding images. The arguments around belief and unbelief, order and disorder that are prevalent now were recognised by our predecessors of four thousand years ago.
What is different in the modern variant and which has no counterpart on the Egyptian scene is the ideological objections to doctrinal belief. The term alienation is employed to denote a certain mood of existence; it refers to a remoteness of God and such symbols of life being a prison crop up in the ‘Dispute’. The symbol ‘alienation’ expresses a feeling of estrangement from existence in time because it estranges us from the timeless. We thus become strangers in a world which compels conformity to a deficient mode of existence. Alienation is a mood of existence just as fundamental as anxiety’. In the case of the ‘Dispute’ there was the breakdown of imperial order; in our own time there is the breakdown of the institutions of Church and State. In both cases it’s a spiritual and philosophical crisis of meaning that’s at the heart of our unrest and malaise.
What we have in the language of the cosmological myth of the ‘Dispute’ is a symbolism suggestive of an acute suffering of a soul from alienation and the desire to preserve existence in truth against the pressure to conform to a deficient mode of existence. The mandate in the ‘Dispute’ for man is this: he must attune his existence to the order of the gods. That is the answer proposed. It is the imagery of immortality. Only when we exist in the tension of time and timelessness, in the flow of divine presence, can we hope to acquire meaning and order for our souls and our society. But the logos need not be identified with God, any god, if one happens to be an atheist. The important thing is to find one’s meaning, whatever that may be, and live a life in accordance with passion and purpose. Such a meaningful existence lived out to the full enables us to face our fate and shoulder suffering.
Suffering: An Analysis
Severe suffering can prompt suicidal ideation, intention, attempt or the act itself. Suffering, so, is the theme that needs to be addressed. Suffering seems to relate to man’s transcendence in that he goes beyond himself in his suffering in some mysterious way. Certainly suffering is inseparable from our (earthly) existence. Suffering intimidates even as it evokes our compassion, empathy, respect or love. In a spiritual context faith overcomes fear.
Medicine and therapy, particularly logotherapy, treat and try to help people often in their dire distress but the field of suffering is multi-dimensional. Suffering is broader than sickness. We can delineate physical suffering that affects us as a pain in our bodies (somatic), mental suffering which affects us in our minds (psychical) and moral suffering that pertains to the spiritual (noetic). Of course, the psychological accompanies both moral and physical suffering. The human person is a unity. He is whole only when the spiritual dimension of his existence is integrated with somatic and psychical aspects.
In so far as a person experiences evil he becomes a subject of suffering. Suffering is passive (homo patiens) and subjective in its metaphysical essence. There are many manifestations of suffering: sadness, pain, disappointment, discontent, despair. Existence, however, is essentially good; evil is a lack, a limitation, a deprivation, a distortion of good. The reality of suffering is explained through evil. People who suffer, share in the trials and tribulations of their common destinies. Suffering contains within itself the seeds of solidarity, communion even.
The question of suffering – its ‘why?’ – brings us on the quest for suffering’s meaning. We want to know the cause, the reason, the purpose, the point. There is, of course, physical pain in the animal world but the human person suffers in a unique way. The Book of Job in the Old Testament is a story of an old man who loses all his possessions, his children and finally he himself is affected by a serious illness. Three friends tell him he must have done something wrong. Suffering is a punishment for a crime committed. They justify the moral meaning of suffering. Suffering, so, is a justified evil but just Job challenges this presumption, this identification of suffering with punishment for sin. Surely it is not true that all suffering is a consequence of a moral fault? There are no reasons for Job’s suffering in the existential vacuum. In this Biblical text the why of suffering is seen as a test. Suffering is seen as being redemptive, as bringing forth goodness. Its why is located in the sublimity of the divine Love (as well as in Its justice). Suffering, thus interpreted, is seen through the order of love – love is the answer to the question of the meaning of suffering. This is a religious answer, where Original Sin is seen as the cause and death as the cure – and I confess I cannot give any other reason but that doesn’t mean there must be only a religious solution. Each man must carry his own cross. Yes. Each man endures his own crucifixion. Death is the dissolution of the psychophysical personality of man. The soul, believers assert, survives and subsists in separated form from the body. The spirit as such can never suffer or be sick. We suffer in mind and body but not in spirit. This is Frankl’s psychiatric credo. Behind the illness the person remains intact. Suffering ceases in the eschatological perspective of salvation (Christ, the Man of Sorrows, assumed sufferings into His very Self), as did the Suffering Servant in the Book of Isaiah. The Passion details the arrest, the humiliation, the blows, the scourging, the crowning with thorns, the mocking, the carrying the Cross, the crucifixion, the agony, the dying. Each of us has his private Garden of Gethsemane and Golgotha. From his prison the great Irish playwright, Oscar Wilde, wrote: ‘Where there is suffering there is holy ground’. Meaningful suffering is suffering for the sake of, for example, a sacrifice. In suffering the person becomes perceptive of values and the world becomes opaque to an other-worldly dimension. Wilde continues: ‘I used to live entirely for pleasure. I shunned sorrow and suffering of every kind. I hated both. I resolved to ignore them as far as possible, to treat them … as modes of imperfection. … They had no place in my philosophy. During the last few months I have … been able to comprehend some of the lessons hidden in the heart of pain. … Out of Sorrow have the worlds been built, and at the birth of a child or a star there is pain’. Those who love a lot suffer much.
All suffering is separation, estrangement, alienation as well as engendering deep insight and possibly profound change. In Christian terms the Passion leads to the Paschal Mystery; in more secular terms we can say Resurrection succeeds Crucifixion. Suffering is a trial, a burden to which humanity is subjected. Suffering can strengthen us as we shoulder it with hope that it doesn’t have the last word, that it will not deprive us of our dignity, for in suffering we find our soul. Think in the Christian Story of the presence of the Mother throughout – from the secret conversation with an angel to the Cross of Crucifixion – from Bethlehem to Calvary; and the consoling presence too of the Beloved Disciple, the one Jesus loved most. Think of Mary’s Presence and Compassion at Her Son’s Passion. It is every mother’s; it is every mother’s son. Suffering has salvific significance seen against this archetypal backdrop. Suffering endured contains with itself the call to courage and moral maturity. The meaning of suffering is not discovered at the merely human level but against a transtemporal dimension of ultimate meaning.
A man lay half dead and half naked after robbers had stolen from him and beaten him. Three travellers saw him on the road from Jericho to Jerusalem. A priest passed by. A Samaritan stopped, took him to an Inn and ministered to the man. He was sensitive to this suffering soul. Doesn’t there need to be a Good Samaritan in every nurse and in every neurologist, in every carer and in every contractor, in every teacher and in every therapist? This could realise the (Kantian) Kingdom of Ends – a civilisation of love amid a culture of death.
The secret meaning of suffering lies in its supernatural source, rooted in the mystery of divine Redemption (see Pope John Paul II’s Apostolic Letter of 1984, Salvifici Doloris).
Viktor Frankl’s Logotherapy
Viktor Frankl, the Viennese psychiatrist, Holocaust survivor, founder of logotherapy, and author of Man’s Search for Meaning, felt that the cause of suicide was an experience of meaninglessness. Again and again, in every study, it is the frustration of the ‘will to meaning’ that is singled out as the most perspicacious contributing factor in suicidality. It follows from this that any meaning-centred intervention, such as logotherapy, leading to attitudinal change, must be the preferred choice of treatment modality. Frankl asks whether it not conceivable that there is another dimension, a world beyond man’s world, a world in which ‘the question of an ultimate meaning of human suffering would find an answer’ (Man’s Search for Ultimate Meaning, p. 144). In the absence of that perspective we flounder.
It seems to be vitally important to address the whole person in his or her psycho-physical and spiritual totality/reality. Viktor Frankl’s logotherapy does just that and attempts to draw out of the person his or her meaning potentials (logos), which will offer hope and instil confidence. It is about discovering ways to flourish in all three dimensions of the person and to devote oneself to a cause or to a person in love, to practise self-distancing and self-transcendence so that the focus is always out of ego-absorption. The door to happiness opens outward, as Kierkegaard, the Danish philosopher, asserted. Frankl highlights three such pathways to meaning: realising creative values, experiential and attitudinal. We can, with the help of logotherapy, transform a personal tragedy into a triumph by employing the defiant power of the human spirit and mobilising that spiritual energy and resource for renewal and healing. As Frankl observed: when we are not able to change a situation we are challenged to change ourselves. Frankl teaches despairing people that it does not matter what we expect from life but rather what life expects from us. ‘Suffering’ Frankl writes, ‘makes human beings perceptive and the world transparent’. One of the techniques of logotherapy, called dereflection, enables such a change of orientation toward the logos. The self is not his symptoms; the person is not his pathology. The person is more than that, much more, and it is to that core of intactness beyond the illness that logotherapy addresses in its attempt to initiate attitudinal adjustment in the face of seemingly unbearable suffering such as an inoperable cancer. I hope in the near future that my graduating students from the Viktor Frankl Institute of Ireland will go on to set up logotherapy clinics around the country to help those in deep distress.
Finally, therefore, isn’t the robust realism of Frankl with his ‘tragic optimism’, as he calls it, more acceptable to us that either naive optimism or weary pessimism? For it is a position that recognises both the problematic (suffering, guilt, and death) and the positive (healing, meaning, and forgiveness) aspects of daily living, what Frankl calls the ‘tragic’ and ‘triumphant’ triads respectively. The great Jesuit theologian, Henri de Lubac, writes: ‘Suffering is the thread from which the stuff of joy is woven. Never will the optimist know joy …. Under the species of pain the substance of joy is there, already’.
Depressions and difficulties are like clouds darkening our day but they pass; above them undiminished shines the sun, on the meaning-horizon (logos) of life.
Let the last word on this theme go to G. K. Chesterton who, in his book Orthodoxy, opines: ‘Melancholy should be an innocent interlude, a tender and fugitive frame of mind: praise should be the permanent pulsation of the soul. Pessimism is at best an emotional half-holiday; joy is the uproarious labour by which all things live.
92 G. K. Chesterton, Orthodoxy, p. 118.