This essay is based on a brief presentation as part of a panel discussion on Jewish attitudes toward mental illness. Using the story of King Saul as a focal point, I will explore some of the issues around mental illnesses in historical figures, suicide in Jewish history and the discussion of “Medical Assistance in Dying” which has entered Canadian culture, health care and law. I would like to point out that I am a psychiatrist, not a biblical scholar or a theologian. As such, my emphasis is on psychological and social responses to suicide, not on the religious considerations as such.

Some readers may notice that I have chosen a title which evokes the 1994 film, “The Madness of King George.”

King George III of England has also attracted interest as an historical figure who suffered from some form of mental disorder. Students of the history of medicine and psychiatry have devoted considerable effort to attempting to diagnose such figures retrospectively. (Vincent Van Gogh receives similar diagnostic attention.) While the question of Saul’s “correct” psychiatric diagnosis is worth exploring, it is not my focus here. Rather, the central facts of Saul’s life, as recounted in the Books of Samuel, establish him as a tragic figure, clearly afflicted by mental disorder, whose erratic behaviours led both to personal anguish and the ultimate collapse of his political, military and familial ambitions.

My goal is to explore the way his illness and eventual suicide illustrate Jewish attitudes toward mental illness and suicide.

There is abundant evidence in the biblical story of Saul that he struggled with troubling psychological and behavioural symptoms. He is described as demonstrating periods of severe melancholy, alternating with episodes of ecstasy. Saul behaved impulsively, flew into rages, was extremely suspicious and ultimately despairing. When his army was resoundingly defeated by the Philistines, he asked his attendant to kill him so he would not be captured by his enemies. When the armour-bearer refused,  Saul fell on his sword and ended his own life.

Jewish attitudes toward suicide revolve around the distinction between so-called “rational suicide” and suicide in the context of extreme distress and a feeling of being compelled to kill oneself. The first, described as “b’daat,” translated as “with knowledge,” is associated with the strong prohibition against suicide in Jewish tradition.

The Talmud, the accumulated code of Jewish law, says, “For him who takes his own life with full knowledge of his action, no rites are to be observed.” Historically, a person who had died by suicide while regarded as being in full possession of his or her faculties, would be buried outside of the boundary of the cemetery. Interestingly, though the person who had died by this “rational” suicide would not receive rites usually performed out of respect for the dead, the survivors of such a suicide would receive whatever rites and respect would ordinarily be performed for the sake of comforting living mourners.

The second category includes those whose suicides are carried out in the context of severe mental or physical distress or in an impulsive fashion. Such an individual is described as an “anuss,’ meaning “a person under compulsion.”

The first example of an anuss in Jewish history was King Saul. In the agony of defeat, aware of the treatment he would anticipate receiving if he was captured by the Philistines, Saul ended his life. This is reflected in the phrase. “anuss K’Shaul,” meaning “as distressed as Saul.”

As suicide has come to be viewed as an expression of mental disorder or extreme distress, the majority of suicides are considered to fall into this second category. As such, they are not regarded as responsible for their actions and are accorded the same considerations and rites as those dying from any other cause. When a person dies by suicide in the throes of mental illness, he or she is viewed as dying of an illness as real and relentless as any other fatal condition.

How might this intersect with the evolving social attitudes toward the request for medical assistance in dying, sometimes referred to as “physician-assisted suicide?” Arguably, even though the law requires the individual to be competent to consent when requesting this intervention, the principle that eligibility requires “intolerable suffering” in the context of an “irremediable medical condition” would surely support a view of such as person as being “as distressed as Saul” and therefore deserving of a highly sympathetic and respectful response by the community.

Paradoxically, current Canadian law seeks to exclude individuals whose primary medical diagnosis is that of a mental disorder from access to mental assistance in dying. This, however, is a topic for another day.

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