Book Review

History of the Human Sciences

25(1) 135139
The Author(s) 2012
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DOI: 10.1177/0952695111413848
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Chris Millard
Queen Mary, University of London

Ian Marsh, Suicide: Foucault, History and Truth. Cambridge: Cambridge University
Press, 2010. 251 pp. ISBN: 9780521130011
Studies of suicide suicidology constitute a field that crosses many other
disciplinary boundaries. Epidemiology, sociology and psychology are just three of the
umbrella terms under which the study of suicide has flourished. Much of this work
acknowledges some sort of debt to Emile Durkheims Suicide (1897) as the first
modern study, before elaborating upon the cognitive patterns, brain neurochemistry,
childhood experiences, or social circumstances that are central in the prediction and
thus prevention of the act. Very few consider that the very term suicide may have
a history, a set of conditions of possibility, a fundamental contingency of its own.
Ian Marsh a practising mental health professional attempts to do this, bringing the
insights and conceptual apparatuses of Michel Foucault to bear on suicide. His central
aim is to destabilize contemporary meanings of suicide by demonstrating them to
be the product of specific historical contexts and practices. His explicitly Foucauldian
genealogy of the concept, tracing its changes and continuities through history, is
intended to open up a space where other meanings and strategies, foreclosed by current
understandings, can be thought and used. The results are mixed, however: impeccably
relativist intentions and an admirably thorough grasp of Foucaults work cannot quite
keep this text afloat as it navigates to a present that is a quarter of a century on from the
great philosopher-historians death. This reviewer is trained as a 20th-century historian,
thus most of the close critique will be focused there. It is perhaps unsurprising that
I should find that the faults in Marshs arguments appear most clearly in that period.
The first striking thing about the book is its rather mechanistic application of
Foucauldian concepts. The outline of his analytic strategy that constitutes the second
chapter gets rather bogged down in Foucault block-quotations and G. C. Prados elaboration of genealogy (1320), then jumps to Ian Hacking on agency and subjectivity

Corresponding author:
Chris Millard, School of History, Queen Mary, London, E1 4NS, UK
Email: chris.millard@hotmail.co.uk

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(simply described as influenced by Foucaults work [21]), before finishing off with a
list of subdivided questions with which he wants the book to engage (234).
This is not to say that mental health professionals are necessarily ill-equipped to
develop the insights of Foucault: this combination can produce much enlightening work
that of David Armstrong (1983, 2002), for instance. Here, however, the references to
Foucault begin in Marshs first two chapters, and continue, at intervals, more or less
consistently throughout the book. This is an admirably thorough justification for using
Foucaults ideas and terminologies, but it begins to sound repetitive. It recalls literary
critic Al Alvarezs comment on Durkheimian studies of suicide, that Durkheims influence on the lesser men who have followed him has been curiously deadening. Perhaps
because his authority was so massive, they seem to have accepted the letter of his law,
rather than its spirit (Alvarez, 1972: 115). Certainly Foucaults immense creativity, his
wry satire and relentless inventiveness are rather absent from Marshs text. This is not a
fatal fault by any means, but it makes some of the book a little more like hard work than it
needs to be.
That said, the books second part, mapping and problematizing the contemporary
regime of truth with regard to suicide, is engaging and largely compelling. Marsh
exposes some of the more hardline biological reductionism in suicidology by looking
at Kay Redfield Jamiesons work, the practice of a post-suicide psychological autopsy
and how media guidelines on the reporting of suicide produce and reinforce a compulsory ontology of pathology in relation to suicide (4351). He then goes on to point out
some of the problems in this compulsory pathology, principally that it excludes or forecloses other readings. This section and the final one on the work of the British playwright
Sarah Kane which is an interesting and a well-judged dip into close reading, as well as
the complicated relationship between the literary and regimes of truth are the high
points of the book. These analyses are allied with and produced through his compelling
reiteration of the Foucauldian position that suicide, as a discursively constituted
phenomenon, will always resist complete description ... as a cultural product it lacks any
unchanging essence that could act as a stabilizing centre by which to secure such a
description (67).
The problems begin when Marsh embarks upon his history of the present. Perhaps
he bites off more than can reasonably be chewed in a 250-page book: going from the year
66 to 1981 in 115 pages certainly seems like something of an overreach. He is able to do
this largely because the Middle Ages are dealt with in less than a page, going from CE 66 in
Rome to 1590 in Aldgate, London through St Augustine of Hippo (867). Making ancient
Greece and Rome function as relatively virtuous others before skipping ahead to the 18th
century seems an aptly Foucauldian flaw to re-enact, but it can only be compounded by the
feeling that historical work has (or should have) moved on; that flaws exist in the works of
iconic and brilliant intellectuals does not make them any less flaws, after all.
Such a temporal sweep seriously undermines the critical power of Foucaults tools
(a pitfall not altogether avoided by Foucault himself), with huge homogenized swaths
of history, bracketed by epistemic ruptures. The tendencies in Foucaults work, repeated
here by Marsh, are eloquently summed up by Gary Gutting as the tense Hegelian combination of anarchic and totalitarian tendencies: a fascination with conflicting complexities (so that every thought is almost limitlessly qualified and complemented)

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along with an ultimately triumphant compulsion for unity, so that all the complexity
is relentlessly organized (Gutting, 1994: 342). It is this compulsion for unity in the
absence of Foucaults creativity that ends up adversely affecting Marshs work.
The history of suicide continues in conventional secularization and medicalization
veins, stopping for a close reading of Esquirols 1821 entry under SUICIDE in the
Dictionnaire des sciences medicales (10014) that feels more predictable than enlightening; the ground is very well trodden, with Berrios and Mohanna (1990) being only
the most obvious example of having been here before. Marsh energetically maintains his challenge to the belief that suicide somehow possesses some unchanging
essence ... [d]ifferent cultures, at different times, produce different forms of selfaccomplished death (89); it somewhat undercuts the (genuinely) radical nature of
this challenge to run it on such conventional rails. We are also treated to an interesting, if brief, diversion into St Augustines Hospital, Chartham, through records
held at the East Kent Archives Centre, but this feels a little like a badge displayed to
increase his purchase among academic historians, as a meagre 4 pages are devoted to
it (15962).
The most serious flaws of this history at breakneck speed surface most visibly in
chapter 10. Marsh engages with the work of Karl Menninger as an exemplar of the
psy disciplines, emergent in the 20th century and theorized by Nikolas Rose (1998).
However, choice of an American psychoanalyst to represent these trends immediately
begs the question: where are we? Even confining ourselves to the Anglo-Saxon world,
this is a serious question. In the United States, the Menninger familys psychoanalytic
influence through involvement with military testing and the academic establishment was
large. In Britain, beneath the long shadow of Aubrey Lewiss eclecticism, the impact of
psychoanalysis is much harder to gauge. In continental Europe things become even more
complicated as the Frankfurt Schools fusion of Marx and Freud arguably psychoanalysiss most prominent use there was more about cultural critique than specifically
psychiatric practice. Marshs claim that [p]sychoanalysis, as practice and theory, flourished in the United States and in Europe, and came to be hugely influential, alongside
other psy disciplines (181) is something of an overstatement.
Marshs idea that psychiatric dominance was challenged during the 20th century
brushes over the different registers of knowledge about the psychic (Which knowledges
were challenged? In what ways?), reinforcing it as unsustainably monolithic. The challenge
that he sees from Emile Durkheim deserves close attention, for it is one of the more confusing passages in the book. He positions Durkheim as formative of a certain sociological
style of thought, which rejected Esquirols idea of individual pathology (182). However, he
goes on to claim that the argument that suicide could not be considered a form of psychopathology in itself ... was a position that was no longer seriously defended by the time
Le Suicide appeared. Similarly, to argue for the non-existence of a suicidal monomania
was to construct something akin to a straw man to attack (183). It seems as if Marsh
is undercutting his own assertion of a challenge to psychiatry, a position that he
reinforces by claiming that sociologists have continued to work without ever seriously
challenging the dominance of psychiatric practice in relation to suicide (184). This
leaves Marsh open to charges of constructing a straw man of his own, and unable to
account for Durkheims pervasive influence.

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However, the dismissal of Durkheim turns into a much more serious omission when
Marsh completely neglects the work and influence of epidemiological psychiatrist Peter
Sainsbury, whose monograph Suicide in London (1955) is explicitly Durkheimian; it
informed huge numbers of psychiatric studies of suicide in Britain, and provided a platform for such renowned experts such as Brian Barraclough, who worked with Sainsbury
at the research centre at the Graylingwell Hospital in Chichester. This fusion of Durkheim and clinical psychiatry within the discipline of psychiatric epidemiology is something of a glaring omission, and is part of the reason why Marsh cannot engage with
sociologys influence, even though he acknowledges Durkheims stature in suicidology.
Related to this omission is a similar neglect of the phenomenon of attempted suicide, a behaviour pattern coded by some psychiatrists as a cry for help rather than a
genuine bid for suicide. This is an (apparently) durable psychiatric trope which surfaces in the 19th century in George Savages work as suicidal tendencies [where] there
is much more cry than wolf (Savage, 1884: 16970), and quite differently in the 1950s
and 1960s in the work of Erwin Stengel where he finds a social element in the pattern of
most suicidal attempts (Stengel, 1958: 22). Attempted and completed suicide are
intimately related, and even become mutually constitutive in the post-1945 era. To omit
this reading of suicidal behaviour on the grounds that it is not suicide, is to take the
psychiatrists at their word that these phenomena are different, and therefore to beg a
rather large part of the question about the construction of suicide.
So Marsh falls here on two counts: his lack of differentiation between the various psy
disciplines leads him to emphasize the work of Karl Menninger and completely miss Peter
Sainsbury, which severely limits his analysis for the British context. He also leaves out a
large part of the story of suicide and how its meanings are stabilized, by his total neglect
of attempted suicide. Through this he equates the internalist mental medicine of the
19th century with the neurochemical psychiatry of the late 20th and early 21st centuries,
and ends up with a precise mirror image of the pendulum narrative of Edward Shorter
(1997), a Foucauldian dark side to Shorters biologically reductionist progressivism.
However, this book is useful. It provides a thorough justification for a postmodern
treatment of suicide; it deals with current ideas and practices in suicidology in a consistently anti-essentialist and critical way. If solely written to engage with and challenge
mental health professionals, it has much to recommend it. However, it falls short of the
mark as a history of suicide, a valid criticism given the subtitle. Histories are always
histories of the present in one way or another, but with this kind of temporal overreach,
only the most simplistic path can be inscribed upon that which we call the past.
Bibliography
Alvarez, A. (1972) The Savage God. London: Random House.
Armstrong, D. (1983) Political Anatomy of the Body: Medical Knowledge in Britain in the
Twentieth Century. Cambridge: Cambridge University Press.
Armstrong, D. (2002) New History of Identity: A Sociology of Medical Knowledge. London: Palgrave.
Berrios, G. and Mohanna, M. (1990) Suicidal Behaviour. Clinical Section, in G. Berrios and
R. Porter (eds) A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders.
Athlone: Continuum International.

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Durkheim, E. (2002[1897]) Suicide: A Study in Sociology, Routledge Classics series. London:

Routledge.
Gutting, G. (1994) Michel Foucaults Phanomenologie des Krankengeistes, in M. S. Micale and
R. Porter (eds) Discovering the History of Psychiatry. Oxford: Oxford University Press.
Rose, N. (1998) Inventing Our Selves: Psychology, Power and Personhood. Cambridge: Cambridge
University Press.
Sainsbury, P. (1955) Suicide in London, Maudsley Monograph no. 1. London: Chapman & Hall.
Savage, G. (1884) Insanity and Allied Neuroses: Practical and Clinical. London: Cassell.
Shorter, E. (1997) A History of Psychiatry: From the Era of the Asylum to the Age of Prozac.
New York: John Wiley & Sons.
Stengel, E. S. (1958) Attempted Suicide: Its Social Significance and Effects, Maudsley Monograph
no. 4. London: Chapman & Hall.

Biographical note
Chris Millard is a PhD candidate at the School of History and the Centre for the History of the
Emotions at Queen Mary, University of London. His PhD thesis concerns the focusing of
psychiatric and psychological attention upon suicidal gestures as a cry for help in Britain after
1945. He has wider interests in the history of psychiatric epidemiology, psychological testing, and
the history of self-damage.