“By His Own Hand”: Socrates’ Suicide as an Affirmative Choice, A Reply to Rev. Christopher Dreisbach, PhD

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SECOND THOUGHTS

My column, “Socrates’ Choice: A Philosophical Perspective on Euthanasia, Suicide, and Assisted Suicide,” situated at the crossroads of society, psychiatry, and philosophy, was a response to an exchange on psychiatric aspects of physician-assisted suicide between fellow Psychiatric Times columnist H. Steven Moffic, MD and noted bio-ethicist Mark S. Komrad, MD, DFAPA. My column in turn has garnered several responses and rejoinders: “Solemnly Renouncing Physician-Assisted Suicide: A Response to Vincenzo Di Nicola” by Ronald W. Pies, MD, “A Philosophical Spark about the Fragility of Existence: A Response to Vincenzo Di Nicola” by Mexican family therapist and community organizer Claudia Goméz Robledo, and Rev. Christopher Dreisbach, PhD, Socrates’ Choice Offers Little Help In Determining the Moral Value of Medical Assistance In Dying: A Response to Vincenzo Di Nicola. I choose to reply to Rev. Dreisbach, PhD, since he most directly engages my argument as a theologian and philosopher. His commentary is cordial, yet we differ substantially in our reading of Socrates’ choice. While we share a commitment to critical inquiry through theology or philosophy, I wish to draw a critical distinction between that academic commitment and the commitments of clinicians.

Socrates was condemned and executed by the Athenian court. Thus, Rev. Christopher Dreisbach, PhD, affirms.

Understood. The point that my interlocutor does not fully appreciate is that it was nonetheless a choice. The import of Rev. Dreisbach’s approach is that since he was condemned to death and executed, Socrates’ death cannot be understood as a suicide, much less a choice. Now, one way to approach the meaning of “choice” is to qualify it as rational.¹ This approach has to reconcile 2 potentially adversarial values of Athenian society—piety and λόγος, romanized lógos or rational discourse. Since there was a divine ban on suicide in Athenian society, how then could suicide be a rational choice? For the Oxford classics scholar Bianca Dinkelaar, MPhil, the resolution is in Socrates’ invocation in Plato’s Phaedo of the will of the gods, expressed as ἀνάγκη, romanized anágkē, necessity, which we may interpret as compulsion or command¹:

[I]t is reasonable that one should not kill oneself [Socrates states] until god sends some necessity [ἀνάγκην τινὰ], such as is now the case for me (emphasis added by Bianca Dinkelaar).

My own approach is informed by this classical understanding of Socrates’ process inflected with a more contemporary take on choice, not so much due to necessity or compulsion by the gods as by the reductio existentiae or “existential reduction” of phenomenology.² That is why I cited the other examples—from prisoners’ suicides at Auschwitz to IRA militant Bobby Sands committing suicide in a British prison in Ulster—all of whom chose death in the face of unlivable predicaments.

The case I invoked about which I am most ambivalent about qualifying their suicide as a choice is French mystic-activist Simone Weil’s (1909-1943). She apparently made a choice, but it was not one that resonates with me and I consider it self-destructive tout court. I acknowledge as a student of the saints that there is a fine line between ascetic piety and self-abnegation on one hand and masochistic self-destruction on the other. Her death by starvation, a slow suicide, does not afford philosophy or theology as so many readers of her life and work have suggested—but psychiatry. She could have chosen to live meaningfully and to work as a partisan in the French resistance against the Nazis rather than starve herself in sympathy with the meager rations that prisoners of war received. Weil was supremely conflicted and embodied contradictions and paradoxes. An argument has been made for her as an anorexic.⁴ So, if Weil’s choice reflects the altered judgement of a major mental illness, all bets are off in terms of its philosophical-theological resonances as a free act. Nonetheless, her case gets us to the heart of the matter: does the spectrum of self-destructive actions from attempted suicide, completed suicide, euthanasia and physician-assisted suicide (PAS) represent a real choice? That is precisely why prominent critics of PAS or medical assistance in dying (MAiD) in Canada are alarmed to legally extend it those with mental illnesses.

While Rev. Dreisbach insists that we cannot consider Socrates’ death a “good death” as the word euthanasia implies, it was unmistakably a choice. It is either a historical matter to sort out based on the available text through Plato (who has been characterized as an unreliable narrator), or more profoundly for us, it is a question for philosophy. If Albert Camus⁵ was right to assert that suicide is the only serious philosophical question, that question starts for us with Socrates’ choice. (I feel compelled—back to anágkē, necessity again—to insist that suicide may be the first philosophical question and the last one if we choose to die, yet those of us who choose life are then faced with a whole series of philosophical puzzles, starting with, what do I do with the rest of my life?)

In fact, if I had to characterize the heart of existentialism in the versions of Camus or Jean-Paul Sartre, it would hinge on the word I chose for my formulation: Socrates’ choice. I did not write “suicide” or “death” but “choice.” In their version of existentialism, there are no givens. There are no determinants—social, biological, theological, or otherwise.

Rather this existentialist frame: “Thrown” (Martin Heidegger’s term from his phenomenology) into a “situation” (Sartre’s term for what I call a predicament and philosopher Alain Badiou calls an evental site—a place where an event could take place), nothing is taken as a given, nothing is final.⁶ Camus responded that such a situation is absurd, meaning that its significance has no anchor in either divine or human nature. Sartre went further, demanding absolute conscious agency which is why he rejected the Freudian unconscious. We are “condemned to freedom,” he declared, responsible for everything. Here is what Sartre wrote about war in Being and Nothingness⁷:

[I]f I am mobilized in a war, this war is my war; it is in my image and I deserve it. I deserve it first because I could always get out of it by suicide or by desertion; these ultimate possibles are those which must always be present for us when there is a question of envisaging a situation. For lack of getting out of it, I have chosen it.

Sartre might contextualize Socrates’ situation this way:

Socrates was not innocent of the charges against him. The sociopolitical war he found himself in was his war, his choice. And in the end, he made the charges against him his own by appropriating the sentence. Like the prisoners at Auschwitz facing almost certain death who affirmed the last vestiges of their humanity by choosing how they would die, Socrates made his death meaningful by making it his own. He chose to drink the hemlock himself—“by his own hand,” in the classical formulation.

While I am not a Sartrean, I do see my work in the legacy of phenomenology starting with Edmund Husserl interpreted by Heidegger and Sartre and radically redefined as objective phenomenology by Alain Badiou.⁸ Logic demands that we recognize Socrates’ choice—a forced choice, let us be clear—the very phrase inspired by novelist William Styron’s gut-wrenching story of Sophie’s choice.⁹ Yet, a choice nonetheless.

There is another tension here: I am working and writing as a natural philosopher. My discourse is outside the realm of magic, miracles, beliefs, and deistic commitments. I recognize these other discourses and find them moving or horrifying in turn, but they are not my authorities.^10,11

French philosopher Alain Badiou, who is an atheist that does not make a show of it, jumping up and down on the stage like a Richard Dawkins, Bill Maher or Sam Harris as a performance art, wrote a wonderful study of Saint Paul whom he considers in human terms as the founder of universalism.¹² Why is this relevant to this discussion?

Socrates was condemned for impiety, for not respecting the gods of the Athenians. Yet he was no atheist; he believed in other gods. The notion of atheism simply did not exist in antiquity although the roots of the critical inquiry of religion may be traced there: it is a comparatively modern position. And Socrates was committed above everything else to critical inquiry, questioning the basis of everything that was taken for granted by the Athenians. He did that through his peripatetic philosophy, walking around the agora engaging people in the issues of the day, pointing out contradictions, gaps and holes in their arguments in defending the status quo. Then as now, this did not make him a beloved figure. I do not think he would have been an easy man to know, even as a friend, because his love of the truth surpassed the bonds of friendship.¹³

In my construction of his choice and his death, Socrates affirmed the sentence against him by not escaping into exile or mounting a sophisticated defense with an expensive lawyer which his friends were ready to engage. Sartre calls these strategies “bad faith.”⁷ The word I just wrote, “sophisticated,” is in fact related to a group Socrates genuinely despised, the sophists, who were elaborately trained to win arguments persuasively by deploying rhetorical devices instead of plain speech. It was perhaps this history that Ludwig Wittgenstein had in mind when he wrote that: “Philosophy is a battle against the bewitchment of our intelligence by means of language.”¹⁴Socrates was known, then, not for sophistry and sophistication even if it was the order of the day in Athens, but for the simplicity of his life and of his words.

As an aside, I have heard from mentors who trained with Anna Freud in London that she rarely used jargon, not even her father’s psychoanalytic terms, and communicated in direct and simple observations about children. She too lived a life of dignity which very nearly came to an end at the hands of the Nazis in Vienna.

Philosophical Recklessness versus Psychiatric Responsibility

Philosophy is either reckless or it is nothing.

—Alain Badiou, Second Manifesto for Philosophy⁶

An inescapable part of the message in Rev. Dreisbach’s column is in his signature.¹⁵

What we write is authorized by our signature. In the past, writing was signed with a personal seal, reflecting the authority of the monarch or the Church. How we sign today is also significant. In our world, we sign as citizens of a given country or members of a profession or community of practice. In our profession, we declare conflicts of interest and are careful to separate our personal opinions from our affiliations. These are ways of affirming our commitments and distancing ourselves from contamination and irruptions. As such, our signatures are simultaneously affirmations and negations (more on this shortly); eg, a given research study examines the effect of a specific drug, but the funding source is at arm’s length and has no influence on its conclusions. The premodern theory of signatures, made contemporary by Italian philosopher Giorgio Agamben, asks whether a word, a concept, an activity, or even an object speaks for itself or if it represents a system or structure.¹⁵

Christopher Dreisbach, PhD, signed as a Reverend, a noble calling to elucidate theology and offer pastoral care. Let me get to the point: while we would wish for them to be complementary, in a fruitful dialogue among themselves, philosophy and theology and other disciplines we throw into the basket of the humanities, they are different and often incompatible domains. Both philosophy and theology are even further removed from clinical psychiatry.

The difference and the separator turns, I believe, on the question of authority. A legal discourse is founded on a constitution or other founding document which confers authority; ethnographic authority is founded on the accuracy and reliability of observers, above all, as noted anthropologist Clifford Geertz wrote, the fact that you were there while others were not; clinical authority is founded on medical training, experience, and judgement. Theology is (largely) founded on the interpretation of presumably divinely-inspired texts. Philosophy has taken many guises to claim authority or to refute it. If we peel away the “footnotes to Plato”—as Rev. Dreisbach recalled Whitehead’s critique—and scratch deeper, we find Socrates. This can take its authority from a reading of Plato and the usual scholarly scaffolding in the academy, or we can speak to the originary task of philosophy which was to get at the truth.

Why, having committed my entire career as an interdisciplinary scholar to this dialogue, would I assert that humanities on one side and clinical psychiatry are remote from, even incompatible with each other?

As my mentor in philosophy, Alain Badiou, affirmed, philosophy is reckless. Recklessness here means above all the rejection of authority through convention (society) or the gods (theology). Badiou goes as far as to say that this is the mark of a genuine subject, open to innovation and change, whereas the defenders of authority and convention are reactionary.⁶

Socrates founded philosophy on the notion that the truth is to be found elsewhere—not in social constructions which vary across place and time (for this, he was condemned for corrupting the youth) or an appeal to the gods based on faith, not reason (for which, he was condemned for impiety).

Yet, neither pastoral care nor clinical psychiatry can afford to be reckless because of their moral and clinical responsibilities, respectively. There are exceptions of course in such discourses as apophatic or negative theology or antipsychiatry, psychiatry’s dark shadow that I have characterized as “psychiatry against itself.”¹⁶ No matter how self-critical we are about our endeavors in psychiatry, we have an irrefutable responsibility for the care of our patients. The theoretical constructs of theology or academic psychiatry may be able to afford playing with negation and nihilism, but clinical psychiatry cannot.

Now, yoking the 2 functions together— being critical of psychiatry and being responsible to our clinical mandate is precarious. Can we be both reckless and responsible? Clinical work requires what Canadian physician-educator William Osler, MD, called aequanimitas—evenhandedness, a judicious balance between the evidence base weighted by the norms of our profession and our society, and the patient’s values and wishes.¹⁷

By invoking Socrates’ choice, I am trying to practice equanimity.

Like the abortion debate (clothed in the polarized euphemisms of prochoice and prolife), the American debate over free speech (the first amendment of the US constitution, a core commitment of liberals) or the right to bear arms (the second amendment, a core commitment of conservatives), the debate over suicide with all its attendant euphemisms creates paradoxes. Among them are personal values over authority, critical thought over clinical responsibility, evidence-based medicine over values-based practice.

Suicide at the Foundation of Western Thought

To conclude, Socrates’ choice is the foundational event of Western thought, just as the Akedah, the binding of Isaac, is the foundational event of Judaism. As I shared in my recent American College of Psychiatrists award lecture, the Akedah has troubled me all my conscious life.¹⁸

The similarities and differences are provocative and instructive. They concern 2 concepts central to philosophical and to psychoanalytic thought: negation and affirmation.

In the Akedah, God asks his subject Abraham to kill his own son as a test of his faith. Abraham intends to obey but is blocked at the last moment by an agent from God, an angel who says, “Lay not thine hand upon the lad.” Abraham affirms his faith, but Judaism receives a broader message: along with circumcision, another marking event that separates the Hebrews from surrounding tribes, the Akedah is understood in the Jewish tradition as an injunction. This is a negation as powerful as the laws that later came down from Sinai. It is the first “thou shalt not”—an injunction against human sacrifice.

Socrates is condemned to death by the Athenian court, an attempt to negate his teaching and his life. Instead, in a dual action, Socrates accepts his death as an active affirmation of his entire life, and a negation of corrupt Athens, which resounds to this day as a deafening condemnation of the very society that condemned him. In this, it is much like the death of Jesus of Nazareth, nominally at the hands of others, but in its most profound affirmation in Christian eschatology, a self-sacrifice to redeem humanity, to complete history.

I write this with assurance and without apology as a philosopher. Other traditions have other foundational discourses that are instructive and may be moving or even compelling for us. Yet, for me as a social philosopher, Socrates’ choice is my Declaration of Independence (USA, 1776), my Bastille Day (France, 1789), my Cinco de Mayo (Mexico, 1862), and my Festa della Repubblica (Italy, 1946). The lessons are clear:

• Take nothing for granted. (So much for authority).
• Knowledge is partial, provisional. (I am not quite ready to declare like Socrates that I know nothing, but I reserve the right to change my mind about everything).
• Beware of the Sophists and the sophistry of our day. (Ideology, hegemony, polarization).
• Listen carefully to people’s allegiances to avoid needless charges of blasphemy, treason, and other transgressions against the community. (Beware of cancel culture).
• The best mentors may be charged with corrupting the youth. (Cancel culture, again).
• We cannot know, as Rev. Dreisbach, PhD, argues, whether Socrates’ choice led to a good death or if he considered himself to have lived a happy life—yet the evidence strongly suggests that this was the case. (And the Western tradition with its Helleno-Roman Judeo-Christian foundations rests on it.)
• As a corollary, we cannot easily make that judgment about anyone else, as ancient Greek lawmaker Solon warned. (And we reserve the right to judge our own lives and deaths).
• What I do know and assert is that it was an event for those of us toiling in the vineyards of the Western tradition. (Where, rejecting negation and nihilism, it continues to bear much fruit.)

As for suicide and its aliases, draw from Socrates’ choice whatever lessons you will. Since Socrates’ choice is foundational for us, we can make one set of rational choices about suicide for ourselves yet, inspired by Socrates, grant that others may arrive at different and equally reasonable choices and we do not condemn them when they do.

I have already made my own commitments clear in “Part II: A Psychiatric Physician’s Practice” of my column on euthanasia. Although I will not counsel or abet suicide in any form, I will not deny the dignity of and my respect for other principled choices, even when it causes me pain.

Dr Di Nicola is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is professor of psychiatry & addictology at the University of Montreal. He is also clinical professor of psychiatry & behavioral health at The George Washington University and president of the World Association of Social Psychiatry (WASP). Dr Di Nicola has received numerous national and international awards, honorary professorships, and fellowships. Of note, Dr Di Nicola was elected a Fellow of the Canadian Academy of Health Sciences (FCAHS), given the Distinguished Service Award of the American Psychiatric Association (APA), and is a Fellow of the American College of Psychiatrists (FACPsych) and Fellow of the Royal Society of Canada (FRSC). His work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s publications include: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021).

Acknowledgements

In gratitude to Professor Constantine Georgiadis who supervised my Studentship as a high school student in the McMaster University Department of Philosophy. When I asked Prof. Georgiadis for a secondary text to help me understand Plato, he replied that it was better and ultimately easier to read Plato himself than his interpreters. “In Greek, I asked?” He nodded. “But I don’t know Greek!” “I will teach you,” Prof. Georgiadis affirmed. That was my first lesson in philosophy, an unfinished task more than 50 years later. I also wish to acknowledge thoughtful readings of this essay by John Farnsworth, PhD, and Allen R. Dyer, MD, PhD.

References

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