13.12.2001 | Oleksandr Stepanenko, Chortkiv

We continue the discussion on suicide


In April issue of ’Prava ludyny’ V. Beloded initiated the discussion on the problem of suicides. To provoke a discussion the author treated the topic in a paradoxical way. Until now only one reader joined the discussion.
I tried to get maximally reliable statistical data on suicides in our region, but in vain. Even if such statistics exist in prosecutor’s offices, it is not accessible to laymen. I know that such statistics was not and is not accounted for in medical establishments. I suspect that ’official’ data on suicide in Ukraine now and then appearing in mass media are not quite correct. It is understandable, because the topic is profound and limitless, and it seems to be impossible to describe it by using exact methods of any science. Anyone, who attentively read Leo Tolstoy’s ’Anna Karenina’, would, perhaps, agree with me. As well it is evident that the problem shall be investigated in earnest, impartially and without any guarantees of success.

I recollect that our professor of psychiatry A. Noshchenko began his lecture on suicide with such words: ’In the socialist society there no objective reasons to cause suicide. The reasons exist, there, in the capitalist world, where people are not sure of their future, where one man to another behaves as a wolf...’, and so on. Meanwhile, the lecturer’s face was sly, and until now I am not sure whether he was serious or made a clown of himself. When the situation did not demand to ideological cliches, professor Noshchenko made an impression of a sound doctor. ’It is rather difficult to understand another person’s unhealthy soul, but a psychiatrist cannot do his duty without this attempt’, this remark also belongs to him.

Not an outside observer, but even the person, who is going to commit suicide, cannot fully explain the motives. A lot of complexities and difficult questions appear immediately after the definition of a suicide as a premeditated termination of one’s own life. First of all, where is the exact boundary dividing a premeditated act from a spontaneous one. For example, a teenager girl is taken to the intense care ward, who took a lethal overdose of pills to protest against her mother’s prohibition to go to a dance. After several hours of treatment she already blames herself for the stupid act and cannot explain was it a premeditated act or she was going just to ’scare’ mother. So was it a genuine suicide or a piece of a family theater? Here is another recent example. A man, after a slight conflict with his wife took a poison intended for extermination of Colorado bugs. Next day he commented his act so: ’I do not know what struck me’. The experience shows that most suicides are committed in a fit of passion, and, if saved, the victims are sorry for their actions. It is difficult to describe this phenomenon better than Flaubert did in the scene of suicide of Emma Bovari.

Yet, the complexity of the problem does not mean that it should not be investigated. Each suicidal case must be investigated very seriously as a part of the great problem of death and life. We should investigate this problem in Ukraine not only because of certain growth of suicides and changes in the structure of suicide-causing factors, but also because ’man, his life and health... are proclaimed as the superior social value’ (Article 3 of the Constitution). Nonetheless, I have not observed even the initiative attempt of the state to collect the raw data.

Soviet psychiatry (as, maybe, criminalistics and sociology) obviously ’limped’ towards social simplification of the phenomenon. We were taught that the Western studies of suicide reasons were too ’biological’ and too ’psychological’. The both approaches contained a rational component. Some relations may be regarded as more or less statistically grounded, for example, the high level of suicides among jobless, servicemen, people condemned to incarceration, drug addicts, sexual minorities, etc. All this can be explained by social problems and features of the ’aggressive’ environment. Nonetheless, the comparison of the suicide level in the countries with the similar living standard (e. g. Denmark and the Netherlands) testifies against the exaggeration of social causes. In Denmark the level is 23-30 cases per 100 thousand population, whereas in the Netherlands the level is 6-9. It seems obvious that poetical, reflecting, imaginary people run a greater risk of suicide (let us recollect Esenin, Mayakovsky, Tsvetaeva, Khvyliovy), although the communist power is not quite innocent in these cases.

Western psychiatrists – Lambrozo’s followers, who proved the ’hereditary inclination to suicide’ in many genealogical lines and even analyzed its dependence on the from of the scull, also had a reason, I think, but their reasoning was also not without simplification. After all, the ’hereditary inclination’ is predominantly psychopathological features of an individual. This casts doubt on the use of the term ’suicide’ in the case of unconscious actions of a psychically unhealthy person (a person, killing itself hallucinations or depression is not considered as committing a suicide by definition, as well applying aggression to other people it is not considered as a culprit).

My colleague V. Beloded also somewhat simplifies the problem, explaining the growth of suicides with decreasing religious beliefs. One may agree with most Beloded’s arguments, but it is possible to believe ion God in different manners. Periods of religious fanaticism, when human life stopped to be a self-sufficient value, are just characterized with splashes of violence and suicide. History registered even peculiar ’psychical epidemics’ (more often in 14-17 centuries), when the believers committed mass ritual suicides in expectation of the Apocalypse. After all the civil war and the red terror in Russia may be regarded as a peculiar ’epidemic of violence’, as a suicide of the national scale...

I am not a professional psychologist, so I may be mistaken, but it seems obvious that it is absolutely impossible to explain all suicides with factor. It is possible to analyze only the risk factors of suicide; among them there will be biological, social and psychological factors in all possible relations and combinations. We must regard everything: age, profession, family conditions, hereditary factors and quality of nourishment. Maybe even the arrangement of stars and Moon must be taken into account, to say nothing of ecological factors. By the way the higher level of suicide in towns-satellites of atomic power stations, noted by Beloded, may be theoretically explained both by the traditional distrust to the ecological safety of atomic stations (named radio-phobia or ’post-Chernobyl syndrome of the doomed’) and by the toxic influence of small dozed of ionizing radiation on the nervous system. In every concrete case of suicide a combination of several causes may be observed that make an individual loose the goal of further living. I. Pavlov, a Nobel Prize winner in physiology, wrote: ’The life becomes worthless, when the goal of living is lost. In the notes left before suicide it is often written that the life became meaningless. Normally the goal of living is limitless and inexhaustible. The tragedy of those, who commit suicide, consist in short-term or long-term inhibition of the goal reflex’. Pavlov’s remark hits the nail on the head. Indeed, suicides are rarely committed by people, whose life is rich, meaningful and harmonic. The richness of life may have (consciously or subconsciously) different coloring: religious, artistic or philosophical. It may be named differently: ’Super-Ego’ by Nietzsche or ’self-elevating deception’ by Pushkin. The name is not important. It is important when this source of life energy is developed enough to overcome life problems. A man achieves this goal not at once, but by a long creative inner efforts. The fact that disproportionately more suicides are committed by young people may be explained by unshaped outlook and goals. The state, church, school, informational environment, closest friends and, as well as one’s own efforts – all this must help young people in the formation process. And what about nature? The weaker and impressive is a person, the warmer and softer must be the environment.

The fact that in the modern Ukraine the ruined ideological myths have not yet been replaced with new ones, more suitable to the current situation, causes a peculiar disorder in the minds of the young generation and obviously does not encourage the ’goal reflex’. I fully support the worries of V. Beloded that modern mass media abound in programs that cultivate the lack of soul and senseless consumerism, negate the fundamental spiritual values, including human life itself as a generous gift of the Creator (or Nature, if you prefer this version). But it is unreasonable to out into one pile drugs, rock and homeopathy. What concerns such forms of recreation as concerts, it is not bad in my opinion, provided that they encourage good-natured communication and develop soul and mind. The more positive values and connections a young person accumulates, the less is the probability that the person will want to stop life. The superior value of life is Life itself, it must be an axiom, together with another axiom of the absolute inadmissibility of taking one’s life.

Nonetheless, I do not pretend that the problem discussed has a radical solution. It is as impossible as the creation of a social system without problems, and ideal religin or the science that will make our life happy. While the mankind exists, there will exist paradoxes and contradictions in its life, and any attempts to cut the Gordian knot will result unpredictably. Myself, as a physician, is especially interested in the topic of physical sufferings and death. The latter often can do what doctors cannot – to stop the sufferings. I mean incurable diseases, in particular, oncological ones. I do not think that euthanasia in such cases is the ’less evil’. I do not know anything which is lesser evil... I know that it must be sought for, not only by professional physicians.

If colleague Beloded or some other reader of ’Prava ludyny’ will continue the discussion of the topic, I will greet it.

To conclude my notes I want to tell about one case that I observed 9 years ago. A patient named Yablon was directed from the preliminary prison to our hospital four times on end. Each time he cut open his veins in protest against the actions of the investigating officer (the term of the preliminary detention was overdue, besides, the convict suspected that he was framed). The preliminary prison administration regarded the suicidal attempts as tricks to make guilty the investigating officer and the administration. My first address to the prosecutor’s office was futile (’Doctor, whom do you protect? He is a criminal-recidivist’). Two later times the man was brought to us in a critical condition, and I addressed the oblast prosecutor’s office. It appeared that the illegal actions on the side of the investigating officer really took place. I heard that he was punished. Nonetheless, the culprit was convicted...

I met him several years later. He thanked me for the salvation of his life and said: ’I have been released for a week, doctor. It is terrible to recollect that I, a bloody fool, could kill myself because of some bastard.’

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