If symptoms persist. .
THERE are few decisions more irreduc- ibly personal, one might have supposed, than the decision to kill oneself, yet ever since Durkheim people have been sifting the suicide statistics to prove that suicide is but an epiphenomenon of the Dow Jones Index or the temperature records of the Meteorological Office. Indeed, there is an entire discipline known as suicidology, and many are the academic reputations that have been made by, for example, measuring the neurochemicals in the brains of 'successful' suicides.
Only a few of my patients, I am glad to say, have killed themselves. I remember in particular the lady with total body pain, which extended even into her hair which suffered, she said, from something like continual electric shocks. We ascribed these unusual sensations to her detailed knowledge of her husband's extra-marital affair. Alas, one day she threw herself off the hospital roof and, passing the window of the ward in which the professor was giving a disquisition on chronic renal failure, brought the grand medical round for that week to an abrupt halt.
A propos of jumping patients, I knew of a large general hospital whose psychiatric ward was strategically placed on the sixth floor. At the instance of the consultants, however, the ward was moved downstairs to the ground floor: not for the patients' safety, of course, but for the preservation of the roofs of the consultants' cars.
For every person who killed him or herself, there are at least 20 who take an overdose, usually without serious suicidal intent, more often to bring a boyfriend or parents to heel. If blackmail is a cry for help, then overdoses are cries for help. This type of behaviour, rare before 1960, is known variously as parasuicide, attempted suicide, self-poisoning and de- liberate self-harm. It is the second most common medical (as against surgical) emergency leading to hospital admission; there are about 100,000 cases a year.
How doctors hate these parasuicides! The stomach pump is put into operation as much to punish as to treat: it relieves the doctor's feelings, even if it does not prevent recidivism.
I was called away from the casualty department one morning by a sister who had an histrionic psychopath on her ward. The psychopath had climbed out on to the window ledge and was threat- ening to jump.
'You've got to do something,' said the sister, pushing me towards the window.
'If you must kill yourself,' I said to the psychopath, 'would you mind doing it in private? You'll make a mess on the pavement and we're terribly busy.'
'Bastard!' shouted the psychopath, and jumped — back into the ward, of course.
There are people who make a career of such gestures. Sometimes they end in tragedy, more often in farce. Last week I was called by the police about a patient of mine whose collected suicide notes would make a small volume. This time she had jumped into the canal.
'Did she drown?' I asked.
'The water only came up to her ankles,' said the policeman. 'Can I bring her to the surgery?'
My heart sank.
Theodore Dalrymple
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