Ian Marsh, Suicide: Foucault, History and Truth (Cambridge: Cambridge University Press, 2010), pp. xii + 251, £19.99/$34.99, paperback, ISBN: 978-0-531-13001-1.

Abstract

The linkage of mental illness and suicide is, for the most part, accepted uncritically within medicine and psychiatry, by healthcare agencies and the media. Ian Marsh’s Suicide: Foucault, History and Truth attempts to understand how suicide came to be read as the consequence of some form of internal pathology, and has thus been absorbed into the domain of psychiatry. The book draws on the work of Michel Foucault, applying the ‘analytics of truth’ as a strategy for critically examining the pathologisation of suicide. The author examines how authoritative knowledge is established, objects and subjects are defined, and truths disseminated in professional accounts of suicide. Marsh begins with mapping a contemporary ‘regime of truth’ that constitutes suicide as pathological in nature, examining how a link between pathology and suicide is constructed and positioned as self-evident. The extent to which suicide has become primarily an issue of psychiatric care is illustrated by reference to psychiatrists’ clinical practices and their roles as advisors on government policy, and as editors of medical journals and authors of books. Marsh highlights how psychiatrists have developed ‘knowledge communities’ by means of certain ‘rhetorical strategies’, which allow them to achieve authority and construct the concepts and objects that make a link between pathology and suicide. The dissemination of professional truths through non-professional channels is also considered. Drawing on the World Health Organization’s guidelines on media reporting of suicide, Marsh argues that, a narrow picture of suicide is constructed based on the notion that suicide is an issue of individual mental health. In the next section of the book, Marsh delves into the ‘history of the present’ and draws on historical accounts ‘to call into question the presumed naturalness or inevitability of contemporary truths of suicide’ (p. 78). He first cites evidence from ancient Greece and Rome to illustrate that, at other times and places, suicide was not always interpreted as pathological in origin. The emergence and eventual dominance of medical theories in relation to suicide occurred much later, in the early decades of the nineteenth century. Suicide was initially conceived as a morbid action of the body, later as an internal impulse, and eventually as a symptom of degeneracy (p. 116). The asylum provided the emerging psychiatric profession with the opportunity to observe and treat suicidal patients, and therefore produce new truths (p. 117). In this discussion, Foucault’s historicist approach is employed to analyse specific historical medical texts and practices that relate to suicide; an analytic strategy absent in histories of the medicalisation of madness (p. 8). It is this close examination of medical explanations, in order to understand the cultural and historical forces involved in the construction of suicide, that makes Marsh’s study a refreshing contribution to histories of suicide and the asylum. The ‘psy’ discourses and practices of the early twentieth century acted to extend the notion of pathology as the primary cause of suicide, as well as to challenge the authority of psychiatry. Marsh examines how the emergence of psychoanalysis introduced new theories of suicidal behaviours and new practices that were based on a pathologised ‘psyche’. During the twentieth century, a variety of distinct professional groups emerged (social workers, counsellors, psychologists and psychiatric nurses), each offering their own form of ‘pastoral’ care. Importantly, though, psychiatrists’ position of authority is not fully eroded, as ultimately the psychiatrist intervenes when suicide seemed likely. ‘Psy’ disciplines, such as psychoanalysis, offers an alternative means that extended the possibilities of conceiving suicide in terms of individual pathology, rather than mounting a serious challenge to the doctrine produced by nineteenth-century psychiatry. Suicide: Foucault, History and Truth is a successful application of an historicist, Foucauldian, analytical approach to the subject of suicide. By emphasising the many possibilities for thought, action and experience that exist with respect to suicide, Marsh’s provocative study encourages us to ‘think against the present’ (p. 230), to critique existing truths and ask new questions. This is a highly engaging book that can be recommended to researchers and professionals interested in history, psychology, psychiatry and sociology.