Journal of Medical Humanities

, Volume 34, Issue 3, pp 347–368 | Cite as

The Art of Dying as an Art of Living: Historical Contemplations on the Paradoxes of Suicide and the Possibilities of Reflexive Suicide Prevention

  • Kristian PetrovEmail author


The main aim of this paper is to reconstruct different aspects of the history of ideas of suicide, from antiquity to late modernity, and contemplate their dialectical tension. Reflexive suicide prevention, drawing on the ancient wisdom that the art of living is inseparable from the art of dying, takes advantage, it is argued, of the contradictory nature of suicide, and hence embraces, rather than trying to overcome, death, pain, grief, fear, hopelessness and milder depressions. This approach might facilitate the transformation of inner shame to inter-personal guilt, which is the precondition for coping with losses through grieving that is shared with others. The traditional projection of suicide on the ‘Other’, reinforced by modernity’s bio-political suppression of death, has inhibited development of good suicide prevention. Awareness of the ambiguity and ambivalence found in suicide may work as a resource when measures are taken to address as many causal mechanisms as possible, and bringing special emphasis to external factors.


Suicide Death Reflexive Prevention Bio-Power History of Ideas Existential Philosophy 



The article is written at the Centre for Baltic and East European Studies and the School of Historical and Contemporary Studies at Södertörn University. I wish to give gratitude to the Region Västra Götaland Public Health Committee, particularly Mr. Lars Paulsson and Mr. Rutger Grahm, for generous financial and intellectual support. I would also like to thank the two JOMH reviewers for valuable comments, as well as my former colleague, Patrik Möller, for introducing me to and raising my interest in suicidology.


1 Most of the results in this article were originally developed when the author was working on a report for Swedish health authorities (Petrov 2010). All translations from Swedish and German sources are the author’s.

2 For an earlier attempt at criticising prevailing simplistic tendencies in the conceptualisation of suicide, and instead stressing the latter’s intrinsic complexity and mystery, see Kobler (1980). Kobler does not, however, share an historical or cultural perspective and is more interested in the implications for contemporary clinical practice. It should be emphasised that a certain ‘rationalisation’ of suicide in this paper is perhaps inevitable. Not least is the problem of an essentially scholarly nature, being rooted in an argumentative structure, aiming at defining and explaining. I hope, however, to be able to recognise the equivocalness of suicide while trying to avoid unnecessary reductions or totalisations.

3 I approach the concepts of medicine and the problems of human existence in analogy to how Reinhart Koselleck (1972) analyses the basic concepts of modern politics in the quality of changing and contestable, but constitutive and authoritative, resources that encapsulate experiences and unleash expectations.

4 Coercive psychiatric treatment efforts can for some patients counteract the possibility to improve their mental health (Parrish 1993). Compulsory care of suicidal persons, in order to prevent suicide more specifically, might even, as some argue (Holm and Sahlin 2009), in particular cases result in an increased suicidal behaviour. It also seems that measures that would benefit men might simultaneously disadvantage women, and vice versa (Durkheim 1897/1951, 237). When we openly talk about suicide, we can assume that more people with anxiety problems can be listened to and helped, while others, with depressive symptoms, might receive a spark in their passivity and be incited to commit suicide.

5 The English suicide draws on the Latin particles sui, by yourself, and caedere, to kill, i.e. resulting in the compound meaning self-killing.

6 “Drown” exemplifies a euphemism, the German “Freitot” a eulogy, “self-murder” a dysphemism, while “suicide” is more of an orthophemism.

7 In early modern law, felo de se (“felon of himself”) was the legal term for the crime of suicide, literally denoting the person who had taken his own life knowingly and willingly (“felo-de-se, n.” 2012). Semantically, this implies that the offender was not only declared guilty of having committed the act of self-murder, but also, perhaps even more so, of being a self-murderer (a felon).

8 The extensive paraphrasing has not always had the intention to embellish or conceal something noble or reprehensible. A metonymy is not necessarily a euphemism. Writers during antiquity had simply limited linguistic resources at their disposal when it came to expressing suicide abstractly (Daube 1972, 407). What in the 2nd century AD had been named autothanatos, previously under the name of autocheir (by one’s own hand), was originally referring to someone who kills his own, his clan, kin or family, and only later, in a figurative sense, someone who kills himself (van Hooff 1990, xv; Droge and Tabor 1992, 7).

9 A medical diagnosis produces identity and conjures up a meaningful reality that previously did not exist; it can thus reward and acknowledge but also stigmatise (Johannisson 2006).

10 The renowned Swedish suidologist Jan Beskow has suggested that we, as a starter, should distinguish between “anxiety-suicide,” “depression-suicide,” and “indignity-suicide” in order to avoid the generic term’s blurry implication of censure and condemnation (personal communication at a Suicide Prevention West meeting in Gothenburg, 31 August 2010).

11 This process of abstraction can instructively be understood from the viewpoint of how other modern basic concepts, such as within politics, have developed. They begin to be used by more and more people, exceeding their original context; they become abstract, but also future-oriented, mobilising and ideologically contestable. The concepts begin to summarise what have hitherto been seen as unique and individual phenomena into a general, even accelerating, process, inspiring confidence or causing anxiety, imagined to have no historical parallels (Koselleck 1972, XVIf). The concept of suicide was increasingly becoming associated with modernity and was seen as a function of an unstoppable modernisation. It became a negative, albeit controversial, symbol of the status of civilisation.

12 “For this reason the Father loves me, because I lay down my life, that I may take it again. No one takes it from me, but I lay it down of my own accord. I have power to lay it down, and I have power to take it again; this charge I have received from my Father” (John 10:17–18, Revised Standard Version).

13 In 1997, 39 members of the American quasi-Christian UFO cult Heaven’s Gate committed collective suicide. The sect did not advocate suicide in principle, but ‘martyrdom’ as an opportunity to avoid humanity’s imminent metaphorical suicide, or genocide (wars, environmental disasters), given that the door to the kingdom of heaven had appeared. It can hardly be mistaken about how the sect’s contempt for the world and extreme dualism—the body is a temporary shell and a “vehicle”—excuse suicide (as ‘martyrdom’) and help to incite its built-in death wish: “It is also possible that part of our test of faith is our hating this world, even our flesh body, to the extent to be willing to leave it without any proof of the Next Level’s existence…” (Applewhite 1996).

14 Foucault essentially mentions bio-politics only in passing. The term had been used by others before him, and today it represents different meanings in various contexts. Unlike bio-power, bio-politics has come to be marked more by his successors than by Foucault himself (cf. Lemke 2011; Espesito 1998). In this paper, the post-Foucault theoretical development is ignored, and the term bio-politics is used solely to denote the technical implementation of bio-power, i.e. the specific form of governance that controls populations/bodies and subjugates them during modernity.

15 It is also telling that it was during the époque of bio-power in the 19th century when the raison d’État became superior that attempted suicide was criminalised (Werner 2000, 44). Even before the establishment of bio-power, however, during the Middle Ages, there were ‘bio-political’ tendencies in suicide prevention. In times of famine and pestilence, there was simply an interest to prevent people to die ‘in vain.’ Foucault for some reason avoids mentioning that the condemnation of suicide was much stronger in pre-modern Europe, which in part seems to contradict his thesis.

16 Egoism and altruism are according to Durkheim about the individual’s degree of integration in the group (that one has nothing to live for, or on the contrary, to have strong reasons to sacrifice oneself for others); anomie is about the collapsed regulation of the individual by the collective. Fatalistic suicides occur when the individual is forced to sacrifice himself for a despotic collective.

17 The traffic policy produced in 1997 focused on the (absolute) elimination of risk factors rather than, as earlier, on the (relative) reduction of deaths and injuries. In international comparison, casualties of traffic accidents in Sweden were already low at the time, but the innovative thing about the policy was that it reflected a new uncompromising attitude; the deaths and lifelong sufferings caused by traffic accidents were no longer to be accepted. The road safety policy thus moved the responsibility away from the individual road-user to the designers of the system (Whitelegg and Haq 2006, 7). Applied to suicide, this would mean that the act no longer is regarded as an individual but as a collective matter. If one during the Middle Ages forbade people to commit suicide, or even contemplate about it, one is now striving towards a society in which no one is supposed to be left out or at least feel excluded.

18 The home page is dedicated to “all of Sweden’s disadvantages, its [sic] defenders and preservers,” and is administrated by a person who sees an intrinsic end in the defence of child pornography, sexism, prostitution, racism, weapon availability and liberal drug laws.

19 Suicide tolerance can be seen as a suicidal factor. It is possible to see it as an effect of, or a correlation to, a high suicide rate, in a more open, mobile and individuated society (Jansson 1998, 162). There are also results pointing in the opposite direction, which suggest that tolerance can also contain preventive power (Beskow 2000a, 100).

20 This could be compared with the role of the sacred confessions during the Middle Ages when persons were able to confess their suicidal and sinful despair (Minois 1999, 34; cf. Hoven et al. 2009, 16).

21 Cf. Sofia Coppola’s Virgin Suicides (1999), Johan Renck’s Downloading Nancy (2008), Lars von Trier’s Antichrist (2009) and Christopher Nolan’s Inception (2010).

22 Giotto de Bondone, “The seven vices: Despair,” 1306. Fresco in the Scrovegni Chapel in Padua.

23 In an authoritative Swedish psychiatric introduction to suicidology, associations are drawn from suicidality (suicidalitet) that can be interpreted as ‘feminine’: “[The word suicidality] speaks about a condition of suffering. Yet it is beautiful, soft and melodic” (Beskow et al. 2005, 51).

24 The Swedish Vision Zero has been criticised from medical direction for becoming a self-defeating prophecy. Holm and Sahlin (2009) argue that a vision zero target for suicide reduction contains a risk that mere suicide rates will be focused instead of more complex underlying factors; the suicide act which, so to speak, would not be allowed to exist, could be more shameful; and the vision can, as they contend, lead to more cases of compulsory treatment with increased risk of suicide. Moreover, Holm and Sahlin suggest that the vision zero denies the possibility of ‘free’ and ‘rational’ suicides, and therefore it is difficult to reconcile it with the physician-assisted, self-chosen ending of life during incurable disease.

25 There are numerous clinical cases that indicate how an encounter with death can be a vital part in a cure of suicidal behaviour or alcoholism (see Beskow 1994, 25). The idea that the fear of death can be a suicidal component can at least be dated back to the Epicureans during antiquity (van Hooff 1990, 189).

26 One could, of course, argue that digital technologies have become a double-edged sword. On the one hand, the restless pursuit in social media of comparing and improving one’s status while exposing one’s self to the constant threat of unintentionally triggering the circulation of unfavourable personal rumours might for people with already low self-esteem become a factor of decreasing well-being and a sense of lost community (see Denti et al. 2012). On the other hand, the use of mobile phones and social media enable boundless communicative networking and, as in the case of the Arab Spring in 2011, they can be used to unleash never before anticipated horizons of social as well as political progress (Sohail and Chebib 2011).

27 One must not underestimate the importance of affiliation and the contact seeking aspect of suicidality. Arendt (1951/1979, 171f, 180) has demonstrated that one driving force of people who during the interwar period were deprived of their citizenship for committing crimes could be that they, once in prison, were granted rights, in contrast to the degrading life of statelessness. Also those in the Middle Ages or early modern times, one might add, who were sentenced to death for a heinous suicidal murder could look forward to being seen and respected as somebody (in the community) in the role of the death sentenced subject. Not least was the offender entitled to receive Holy Communion and the priest’s forgiveness.


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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.School of Historical and Contemporary StudiesSödertörn UniversityHuddingeSweden

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