1996, Mercier Press ISBN 1 85635 1 49 1
This book is a most welcome and long-overdue addition to the subject of suicide. It is also a brave book, for as Kelleher acknowledges in his title, and in his whole approach, questions of suicide inevitably involve sociological and psychological aspects of human behaviour which are notoriously difficult to square with each other. Perhaps the main thing is that this book represents a frank and determined start upon a subject which has been largely avoided so far in Ireland although it merits our best attention.
Kelleher has taken the practical decision to accept statistical and other information about “suicide” without attempting to define what suicide is, even though this lack of definition must call into question the validity of the statistics. There is no reason to believe that coroners here are more consistent in the criteria they apply than they are elsewhere – in Britain, for example, it has been said that no two coroners would agree on the exact definition of suicide! And Kelleher naturally has to discuss statistical trends in foreign data, since there is (as he points out) little data available yet on the Irish situation. His own studies in Cork are leading the way here, but he acknowledges clearly that his understanding of the subject is seriously curtailed by the lack of other comparable work. For example, in discussing changes in family life, he comments: “The issue of the relationship between homosexuality and suicidal behaviour is far from clear … To date in Ireland, there has been no study of suicide among the gay community.” Nevertheless, the reader may be left with an anecdotal impression that there is a relationship – something which I feel is uncalled-for at this stage of our knowledge.
The statistical evidence which Kelleher cites points to an alarming rise in the rate of suicides for males between the ages of 15 and 24: “Suicide is now the second most common cause of death, after road accidents, among 15 to 24 year-old Irish males.” The concern which he feels about this particular statistic seems really to be the driving force in the book. As a doctor, he is chiefly concerned to save lives, and it doesn’t take much imagination to realize that young and healthy male lives may seem proportionally more valuable than others in the medical perspective. There are fewer suicides among young women, he assures us (though he does not engage at all with the fact that women attempt suicide more often than men), and he looks to social factors like unemployment and the change in traditional family values for an explanation. He takes a frankly moral stance – “Scripture tells us that we must work out our salvation through fear and trembling … Traditional societies have clear-cut and well-defined rites de passage, while the secular, modern world offers many invitations, but little purposeful direction.” In examining this extremely worrying trend, he brings in other social statistics to try and understand what is making the young men kill themselves: “The numbers in third level education almost doubled between 1976 and 1990… Surprisingly, education has a relationship with suicide. Durkheim believed that excessive individuation could lead to egotistical suicides …” Having put forward this idea, he goes on to imply that the improved performance of females in third level education (which surely, according to Durkheim, should have led them also to be more suicide-prone?) “puts extra pressure on boys”. It is all too easy to read this as implying that girls really ought to continue to under perform in order to safeguard young men from ‘egotistical suicide’! I feel quite sure that Kelleher did not intend this reading, but in common with many of his reasonings by association, it seems to reveal a fundamental lack of consistency within his own approach. Later in the book, he seems willing to give the same importance to anecdotal ‘evidence’ about “copy-cat” suicides (which he predictably lays at the door of the media) as he gives to much better grounded hypotheses. I suppose in a word, I felt that there was a lack of rigour in his approach.
Kelleher seems primarily concerned with the moral dimensions of his subject, though his chapter headed “The Morality of Suicide, Assisted Suicide and Euthanasia” comes next to last and consists mainly of brief impersonal notes about historical religious attitudes. However, he opens the chapter thus: “When I first began this work with the late Dr Maura Daly in 1982, I took it for granted that to intentionally end one’s life was immoral. That is how I was reared to think. As a doctor, however, one is trained to separate the person from his actions …” I felt that the book records his intense struggle to reconcile these two positions. When it comes to young men having road “accidents” while under the influence of drugs, he can see no sense or dignity in self-inflicted death; on the other hand, he can accept and even admire (as he was “reared” to do) the death on hunger-strike of Terence MacSwiney. His own personal attitudes seem an accurate and clear reflection of the attitudes of his generation in Ireland, perhaps. The “doctor” however falls very often into diagnosing (post hoc ergo propter hoc) the suicide as mentally ill and somehow therefore morally exempted. There is no logical connection here, only the very personal distress and courage which mark this book even in its driest passages. Kelleher’s closing words honestly reflect the perplexity he feels, and which I strongly suspect most of his readers will feel also, about the subject:
“Such is the enigma of suicide.”