Book Review

Leaving You: The Cultural Meaning of Suicide

N Engl J Med 2003; 349:2276-2277December 4, 2003

Article

Leaving You: The Cultural Meaning of Suicide
By Lisa Lieberman. 175 pp. Chicago, Ivan R. Dee, 2003. $24.95. ISBN: 1-56663-496-2

During the weeks and months that followed the horrific events of September 11, 2001, I could not help noticing that the op-ed pages of America's newspapers took great pains to make clear that the terrorists who steered jets into the World Trade Center towers and the Pentagon were not real suicides. The implication was that they had nothing in common with the troubled, depressed souls we think of, often with compassion, when we hear the profoundly unsettling word “suicide.”

I thought of this recently as I read Lisa Lieberman's Leaving You, a collection of essays that explore the history of our attitudes toward self-destruction. Lieberman understands that for most of recorded history, suicide has primarily been seen not as a private act of desperation, but as a public statement with a larger social resonance. Suicides were often depicted not as miserable, helpless victims but as rational masters of their own fates, sacrificing themselves in the name of protest, idealism, or subversion. By the standards of antiquity, the terrorists of September 11 could well have seen themselves as modern-day versions of Samson, who knew that as he pulled down the Philistine temple, he, too, would die. The suicide of Cato, the Roman general who threw himself on his sword rather than accept defeat, was considered to be a heroic expression of man's free will.

Only in the past few centuries, Lieberman points out, has suicide come to be seen as exactly the opposite: the product not of autonomy but of complex psychodynamics often rooted in depression or some other form of mental illness. Suicide has become a problem to be diagnosed, treated, and prevented — the domain of the psychiatrist, the sociologist, and more recently, the psychopharmacologist, who have supplied us with what Lieberman calls “our most comforting assumption about self-destruction: that individuals who kill themselves are entirely passive, that they do not seriously intend to die.” Those who commit suicide are seen as victims, not protagonists. Lieberman seeks to buck this trend, to reclaim suicide from the experts and, in doing so, to restore some of its larger significance and its dignity. As she puts it, “The thread that runs through all of [these essays] is my appreciation of self-destruction as a meaningful gesture, a statement that holds more than private significance.”

Lieberman traces what she calls “the victim-oriented approach” and what others have called “the medicalization of suicide” to 18th-century France, when an increasing number of classically inspired suicides (“the Roman mode of death,” it was called) threatened the public order. “Like Rome, France appeared to be crumbling from within, adrift intellectually, ridden with vice, and plagued with political instability,” writes Lieberman. “In this setting, self-destruction seemed less an affirmation of personal freedom than a manifestation of national despair.” Something had to be done.

Just as Saint Augustine had stemmed the tide of early Christian suicides by redefining suicide as a sin, not a path to martyrdom, French alienists and moral statisticians (the forerunners of psychiatrists and sociologists) sought to reduce the incidence of self-destruction by interpreting suicide as neither heroic nor sinful but, rather, the desperate act of unhappy people. (The influential alienist Jean-Étienne-Dominique Esquirol went so far as to describe suicide as a symptom of insanity.) “The consequence of removing morality from the equation was that it also removed volition,” writes Lieberman. “Presuming that no one in his or her right mind wanted to die, psychiatrists felt no qualms about disregarding the stated motivations of potential suicides in order to rid them of their delusions.” In essence, the professionals had taken suicide away from the suicidal.

Lieberman, who teaches modern European cultural history at Dickinson College, in Pennsylvania, is a spirited and, at times, lyrical writer who makes insightful connections. She compares, for instance, the suicide of Holocaust survivor Jean Améry to that of Socrates and contrasts the terminally ill who contemplate self-destruction with the 19th-century Native Americans who killed themselves rather than be absorbed by a nation that denied them any meaningful future. Her attempt to restore a measure of dignity to “the so-called victim” is, I think, a brave and important counterweight to the prevailing and often patronizing medical model. She stacks the deck, however, by relying heavily on examples from antiquity (Cato, Socrates, Seneca) and literature (Werther, Anna Karenina, Emma Bovary). I would have liked to see her parse the cultural meaning of less celebrated suicides: that of the depressed man who took a fatal overdose and left a note saying, “I can't win,” for instance, or, for that matter, Lieberman's own grandfather, who killed himself during the Great Depression and whom she mentions only briefly. (I wondered, too, about implications for prevention. Would Lieberman, who has worked at a suicide hotline, have us accept at face value the teenage boy who says he wants to kill himself “like Kurt Cobain”?)

Certainly, every suicide has a cultural meaning that we must listen to and learn from, but though it can provide clues to the cause of the act, it rarely tells the whole story. For that, we need the psychological, sociological, and biologic nuances as well. Indeed, in the case of the September 11 terrorists, a more complex picture has emerged over time. Now the terrorists seem to have been neither martyrs nor cowards, but troubled, vulnerable young men ripe to be swept away by a cause — more akin, perhaps, to those cultists who swallowed poisoned Kool-Aid and followed Jim Jones to their deaths in the Guyana jungle than to clear-eyed Cato.

George Howe Colt, M.A.
P.O. Box 244, Whately, MA 01093