During the first period of a man’s life the greatest danger is not to take the risk. – Kierkegaard
According to the 19th century philosopher Søren Kierkegaard, there are three types of lives which a person can lead: the aesthetic life, the ethical life, and the religious life. The person who leads the aesthetic life aims solely at the satisfaction of his desires. If, for example, heroin is what he desires, then he will do whatever it takes to get hold of heroin. In circumstances in which heroin is cheap and legal, this need not include any immoral behaviour. However, in circumstances in which heroin is expensive or illegal, this is likely to include lying, stealing, and much worse. As the aesthete adapts his behaviour to the circumstances in which he finds himself, he does not have a consistent, coherent self.
In marked contrast to the aesthete, the person who leads the ethical life behaves according to universal moral principles such as ‘do not lie’ and ‘do not steal’, regardless of the circumstances in which he finds himself. As the person has a consistent, coherent self, he leads a higher type of life than that of the aesthete.
Despite this, the highest type of life is not the ethical life but the religious life, which shares similarities with both the aesthetic and the ethical lives. Like the aesthetic life, the religious life prioritises individual circumstances and leaves open the possibility of immoral behaviour. However, like the ethical life, the religious life acknowledges the existence and authority of universal, determinate moral principles, as embodied in and promulgated by social norms and conventions. By acknowledging moral principles and yet prioritising individual circumstances, the religious life opens the door for moral indeterminacy. For this reason, the religious life is a life of constant ambiguity and constant uncertainty, and hence of constant anxiety. Anxiety, says Kierkegaard, is the dizziness of freedom.
For Kierkegaard, a paradigm of the religious life is that of the biblical patriarch Abraham, as epitomised by the episode of the Sacrifice of Isaac. According to Genesis 22, God said to Abraham,
Take now thy son, thine only son Isaac, whom thou lovest, and get thee into the land of Moriah; and offer him there for a burnt offering upon one of the mountains which I will tell thee of.
Unlike the aesthete, Abraham clearly recognises the existence and authority of moral principles. However, unlike the moralist, he prioritises individual circumstances over moral principles, and thus obeys God’s command to kill Isaac. As Abraham is about to slay Isaac, an angel appears and calls out to him,
Abraham, Abraham … Lay not thine hand upon the lad, neither do thou any thing unto him: for now I know that thou fearest God, seeing thou hast not withheld thy son, thine only son from me.
At that moment, a ram appears in a thicket, and Abraham spares Isaac and sacrifices the ram is his stead. Abraham then names the place of the sacrifice Jehovahjireh, which translates from the Hebrew as, ‘The Lord will provide’. The teaching of the Sacrifice of Isaac is that the conquest of doubt and anxiety, and hence the exercise of freedom, requires nothing less than a leap of faith. It is by making such a leap of faith, not only once but over and over again, that a person, in the words of Kierkegaard, ‘relates himself to himself’ and becomes a true self. Although choice is made in the instant, the consequences of making a choice are irredeemable and everlasting, and this risk and responsibility give rise to intense anxiety.
Pity is a feeling of pain caused by a painful or destructive evil that befalls one who does not deserve it, and that might well befall us or one of our friends, and, moreover, to befall us soon. Thus, it is not felt by those who no longer have anything to lose, or by those who feel that they are beyond misfortune. Pity is all the stronger if evil is repeated frequently or if it arises from a source from which good could have been expected. It may also be felt if no good ever befalls a person, or if he cannot enjoy it when it does, or if it does only once the worst has already happened. A person feels pity for those who are like him and for those whom he knows, but not for those who are very closely related to him and for whom he feels as he does for himself. Indeed, the pitiful should not be confounded with the terrible: Amasis wept at the sight of his friend begging, but not at that of his son being led to death. To feel pity, one must believe in the goodness of at least some people, which is why pity is most commonly felt by the young, and most keenly for those of noble character.
Sleep is a privation of waking and, inasmuch as they are opposites, sleep and waking must appertain to the same part of an animal. Moreover, the criterion of sense perception by which a waking person is judged to be awake is identical to that by which a sleeping person is judged to be asleep. If waking consists of nothing other than the exercise of sense perception, then the organ by which animals sleep or wake is the same as that by which they perceive. Sense perception is a movement of the soul through the body; as such, it is neither an exclusive property of the soul nor an exclusive property of the body.
Living things such as plants that partake of growth but that do not have the faculty of sense perception do not sleep or wake. Of those living things that do wake or sleep, there is none that is either always asleep or always awake. Organs lose power when they are over-worked, and so it is also with the organ of sense perception. It is impossible for any animal to perpetually actualise its powers, for which reason every animal that wakes must also sleep. Conversely, the faculty of sense perception exists to be exercised, and every animal that sleeps must also wake. Almost all animals have been observed to partake in sleep, whether they are aquatic, aerial, or terrestrial. Not so testaceous animals (animals with a firm, calcareous shell such as oysters and clams), although our reasoning leads us to suppose that they must. By definition, an animal is any creature with sense perception. Creatures with sense perception also have feelings of pain and pleasure and consequently appetites, but plants have none of these affections. That the nutrient part is more active when the animal is asleep suggests that sense perception is not required for growth and nutrition.
Some animals are endowed with all the modes of sense perception whereas others with only some. No animal when asleep is able to exercise any of the modes of sense perception. Each sense has something peculiar such as seeing or hearing, and something common whereby the person perceives that he is seeing or hearing. This common and controlling sensory activity chiefly subsists in association with the sense of touch, for the sense of touch can exist apart from all the other senses, but none of the other senses can exist apart from the sense of touch. As all animals are endowed with the sense of touch, they are all capable of waking and sleeping.
There are several types of causes, namely, the final, efficient, material, and formal. The final cause of sleep is the conservation of animals, which cannot continually be moving. The exercise of sense perception or of thought is the highest end for any animal, and this implies that (1) the waking state is the highest end for any animal, (2) sleep belongs of necessity to every animal.
As has already been demonstrated in another work, controlling sense perception originates in the same part of the organism in which originates movement. This locus of origination is one of three determinate loci, namely, that which lies midway between the head and the abdomen. In sanguineous animals, this corresponds to the region of the heart.
In sanguineous animals food ultimately turns into blood. Blood is contained in the veins, which originate from the heart. Sleep arises from the evaporation attendant upon the process of nutrition. The matter evaporated is hot and rising. Once it has risen to the brain, which is the coolest part of the body, it condenses and falls back down again to the region of the heart, resulting in sleep and then in fantasy. Thus sleep-inducing substances produce a feeling of heaviness in the head, as do fatigue, illness, and extreme youth. Awakening occurs once digestion is complete and the finest and purest blood, which is found in the head, has been separated from the thickest and most turbid blood, which is found in the lower extremities. Sleep resembles epilepsy in that it involves a kind of seizure that paralyses the primary sense organ and prevents it from actualising its powers. However, sleep is only one form of impotence of the perceptive faculty, which can also be rendered impotent by unconsciousness, asphyxia, and swooning.
ON DREAMS De Insomniis
Sense perception and intelligence are the only faculties by which knowledge is acquired. As no animal when asleep is able to exercise any of the modes of sense perception, it may be concluded that it is not by sense perception that dreams are perceived. But neither is it only by opinion or intelligence, for in dreams it is asserted not only that some approaching object is a man or a horse, which is an exercise of opinion, but also that the object is white or beautiful, which requires at least some element of sense perception. In dreams as in waking moments, it is common to reason about that which is perceived – that is, to think something else over and above the dream presentation – and this too is an exercise of opinion.
The faculty which produces illusory effects during waking moments is identical with that which produces them during sleep. The sun may appear to be only one foot wide, but this illusion does not occur without actually seeing or otherwise perceiving something real. Even to see wrongly or to hear wrongly can only happen upon seeing or hearing something real. It has been assumed that sleep implies an absence of sense perception; it may be true that the dreamer perceives nothing, yet it may be false that his faculty of sense perception is unaffected. Thus, the senses may provide impulses to the primary sense organ, though not in the same manner as during waking moments.
Let us then assume that sleeping and dreaming both appertain to the same faculty of sense perception. In On the Soul, it has been established that the faculty of presentation is identical with that of sense perception, even though the essential notion of a faculty of presentation is different from that of a faculty of sense perception. Since presentation is the movement set up by a sensory faculty upon discharging its function, and since a dream appears to be a presentation, it follows that dreaming is an activity of the faculty of sense perception, but that it belongs to this faculty as a presentative.
The affection due to objects that produce sense perception is present in the organ of sense perception not only when the perceptions are actualised, but even when they have departed. Just as with projectiles moving in space, the movement continues even though that which set up the movement is no longer in contact with that which is being moved. So it is that, if one turns the gaze from sunlight to darkness, one sees nothing owing to the light still subsiding in the eyes. Also, if one looks a long time at one colour, that to which one transfers the gaze appears to be of that same colour. There are many other such phenomena.
As demonstrated by the case of mirrors, the sensory organs are acutely sensitive to even a slight qualitative difference in their objects. The eye in seeing is affected by the object seen, but it also produces a certain effect upon it. For instance, if a woman chances during the menstrual period to look into a highly polished mirror, the surface of it will grow cloudy with a blood-coloured haze. This stain is very hard to remove from a new mirror, but easier to remove from an older mirror. Thus, it is clear that stimulatory motion is set up even by slight differences, and that sense perception is quick to respond to it; and further that the eye is not only affected by its object, but also produces a certain effect upon it.
Let us then assume that the impressions of an object of perception remain even after the object has departed, and, further, that they are themselves objects of perception. Let us also assume that sense perception can be deceptive in the presence of emotions such as fear, desire, and anger. This explains why people in the delirium of fever sometimes think that they see animals on their chamber walls. The cause of such illusions is that the faculty by which the controlling sense judges is not the same as that by which it perceives. False judgements arise because appearances result not only from its object stimulating a sense, but also from the sense alone being stimulated in the same manner as by the object. Thus, to a person in a sailing ship it may appear that the land is moving, when in reality it is the person’s eye that is being moved by the ship.
During sleep, owing to the inaction of the particular senses, stimulatory movements from causes within the body present themselves with greater impressiveness.
Like the eddies which are being ever formed in rivers, so stimulatory movements are each a continuous process, often remaining as they first started, but often being broken into other forms by collisions with obstacles. This explains why dreams do not occur immediately after a meal or in infants; in each of these cases, the violence of internal movement is such as to obliterate any sensory impressions, or to distort them into unhealthy dreams. Once food has been digested, the blood becomes calm and pure once again. This enables stimulatory movements to be preserved in their integrity and a clear image to be presented.
Not every presentation that occurs during sleep is necessarily a dream, for it is possible for the sleeping person to dimly and, as it were, remotely perceive light and sound and other external stimuli. Indeed, it is quite possible that, of waking or sleeping, while the one is present the other is also present in a certain way. Such occurrences should not be called a dream, and neither should the true thoughts, as distinct from the mere presentations, that occur during sleep.
ON DIVINATION IN SLEEP De Divinatione per Somnum
The divination that takes place in sleep, and that is said to be based on dreams, cannot be dismissed lightly. At the same time, it cannot easily be accounted for. It is claimed that the sender of such dreams is God, but this is difficult to reconcile with the fact that those to whom he sends them are not the best and wisest, but merely the commonplace. At the same time, none of the other possible causes appear probable.
Divinatory dreams must be regarded either as tokens or as causes of the events that they contain, or else as coincidences, or as more than one, and possibly all, of these. Even scientific physicians say that one should pay attention to dreams, and it is reasonable even for speculative philosophers to share in this belief. For the movements which occur in the body during waking moments are generally eclipsed by waking movements. However, this is not the case during sleep, when even trifling movements seem considerable. For instance, dreamers fancy that they are affected by thunder and lightning when there is but a faint ringing in their ears, or that they are walking through a fire when there is but a slight warming over certain parts of their body. As the beginnings of all events are small, the beginnings of diseases or other bodily affections are more evident in sleep than in waking moments.
Neither is it improbable that some dreams are the causes of the actions which they contain. It is clear enough that potential or actual waking actions often shape our dreams, in which they may even be played out or repeated. In such cases, the daytime movements have paved the way for the dream movements. Conversely, it must be that dream movements can pave the way for daytime movements, and thus that dreams can shape our waking actions.
That having been said, most so-called prophetic dreams are mere coincidences, particularly if they are extravagant or remote in place or if the dreamer does not have any initiative over the dream content. In waking moments, it is common for a person to mention a thing and then to find that it comes to pass. Why, then, should such an occurrence not also be common in sleep?
Dreams occur in inferior people and in certain of the lower animals, and are neither sent by God nor designed for the purpose of divination. However, they do have a divine aspect as Nature is divinely planned, though not itself divine. According to the gambler’s maxim, ‘If you make many throws your luck must change’, and so it is that people who are garrulous and excitable and who have many dreams are likely to have their dreams fulfilled.
That many dreams have no fulfilment is only to be expected, since another more influential movement could mean that that which is about to happen is not in every case that which is now happening. These beginnings from which no consummation follows are nonetheless real beginnings; they constitute natural tokens of certain events, albeit events that did not come to pass.
Some divinatory dreams do not involve the beginnings of future events, but are extravagant in time, place, or content, or are not extravagant but the dreamer does not have any initiative over the dream content. They may be a simple matter of coincidence, or they may result from distant movements that are perceptible to the sleeping soul. Such movements are more perceptible at night because then the air is less disturbed, and because people are more sensitive to slight movements during sleep than during waking moments. Divinatory dreams occur in inferior and commonplace people because their minds are derelict or totally vacant and so more conductive of alien movements. Divinatory dreams are particularly common or vivid in people who are liable to derangement because their normal mental movements are beaten off by the alien movements. People often have vivid dreams about those whom they are close to: just as acquaintances recognise and perceive one another from a distance, so they do with regards to the movements respecting one another.
Skilful dream interpretation calls upon the faculty of observing resemblances. Dream presentations are analogous to the forms reflected in water; if the motion in the water is great, the reflection bears no resemblance to its original. In such cases particular skill is required.
Suicide was defined by the sociologist Emile Durkheim as applying to ‘all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result’. In the UK there are around 5500 recorded suicides every year, and suicide is one of the leading causes of death among young adults. While deliberate self-harm is more common in women, completed suicide is three times more common in men. This may be because men are more likely to use violent and effective methods of suicide, or because men with suicidal thoughts find it more difficult to obtain and engage with the help and support that they need. According to the Office for National Statistics, the population group with the highest suicide rate is men aged from 25 to 44 years old, with a suicide rate of about 18 per 100,000 per year. One major problem with figures such as this one is that they reflect reported suicides, which in turn reflect verdicts reached in coroners’ courts. Actual suicide rates may be considerably higher.
Demographic risk factors for suicide
At the individual level, a person’s risk of committing suicide can be increased by a number of demographic and social risk factors. Demographic risk factors for suicide include being male; being relatively young; and being single, widowed, or separated or divorced. Certain occupational groups such as veterinary surgeons, farmers, pharmacists, and doctors have been found to be at a higher risk of suicide. This is probably to do with their training and skills, and with their easy access to effective means of committing suicide, such as prescription-only drugs and firearms. Social risk factors for suicide include being unemployed, insecurely employed, or retired; having a poor level of social support as is often the case for the elderly, prisoners, immigrants, refugees, and the bereaved; and having been through a recent life crisis such as losing a close friend or relative or being the victim of physical or sexual abuse.
Clinical risk factors for suicide
As well as demographic and social risk factors, a person’s risk of committing suicide can also be increased by a number of clinical risk factors. The most important predictor of suicide is a previous act of deliberate self-harm, and a person’s risk of completing suicide in the year following an act of deliberate self-harm is approximately 100 times greater than that of the average person. Conversely, up to half of all people who complete suicide have a history of deliberate self-harm. Suicidal behavior tends to cluster in families, so a family history of deliberate self-harm also increases a person’s risk of suicide. This is perhaps because suicide is a learned behaviour or, more likely, because family members share a generic predisposition to psychiatric disorders that increase suicidal risk, such as schizophrenia, depression, bipolar disorder, personality disorders, and alcohol dependence. Some of these psychiatric disorders, for example, personality disorder and alcohol dependence or schizophrenia and depression may, and often do, coexist. People with a psychiatric disorder who are resistant to their prescribed medication or non-compliant with it are also at a higher risk of suicide, as are people experiencing certain specific symptoms such as delusions of persecution, delusions of control, delusions of jealousy, delusions of guilt, commanding second person auditory hallucinations (for example, a voice saying ‘Take that knife and kill yourself’), and passivity which is the feeling that one’s feelings, desires, and actions are under the control of an external agency. Physical illness can also increase the risk of suicide, and this is particularly the case for physical illnesses that are terminal, that involve chronic pain or disability, or that affect the brain. Examples of such physical illnesses include cancer, early-onset diabetes, stroke, epilepsy, multiple sclerosis, and AIDS.
Fighting suicidal thoughts
If you are assailed by suicidal thoughts, the first thing to remember is that many people who have attempted suicide and survived ultimately feel relieved that they did not end their lives. At the time of attempting suicide they experienced intense feelings of despair and hopelessness, because it seemed to them that they had lost control over their lives, and that things could never get better. The only thing that they still had some control over was whether they lived or died, and so committing suicide seemed like the only option left. This is never true.
Some of the thoughts that may accompany suicidal thoughts include:
– I want to escape my suffering.
– I have no other options.
– I am a horrible person and do not deserve to live.
– I have betrayed my loved ones.
– My loved ones would be better off without me.
– I want my loved ones to know how bad I am feeling.
– I want my loved ones to know how bad they have made me feel.
Whatever thoughts you are having, and however bad you are feeling, remember that you have not always felt this way, and that you will not always feel this way.
The risk of someone committing suicide is highest in the combined presence of (1) suicidal thoughts, (2) the means to commit suicide, and (3) the opportunity to commit suicide. If you are prone to suicidal thoughts, ensure that the means to commit suicide have been removed. For example, give tablets and sharp objects to someone for safekeeping, or put them in a locked or otherwise inaccessible place. At the same time, ensure that the opportunity to commit suicide is lacking. The surest way of doing this is by remaining in close contact with one or more people, for example, by inviting them to stay with you. Share your thoughts and feelings with these people, and don’t be reluctant to let them help you. If no one is available or no one seems suitable, there are a number of emergency telephone lines that you can ring at any time. You can even ring 999 for an ambulance or take yourself to an Accident and Emergency department. Do not use alcohol or drugs as these can make your behavior more impulsive, and significantly increase your likelihood of attempting suicide. In particular, do not drink or take drugs alone, or end up alone after drinking or taking drugs.
Make a list of all the positive things about yourself and a list of all the positive things about your life, including the things that have so far prevented you from committing suicide (you may need to get help with this). Keep the lists on you, and read them to yourself each time you are assailed by suicidal thoughts. On a separate sheet of paper, write a safety plan for the times when you feel like acting on your suicidal thoughts. Your safety plan could involve delaying any suicidal attempt by at least 48 hours, and then talking to someone about your thoughts and feelings as soon as possible. Discuss your safety plan with your GP, psychiatrist, or key worker and commit yourself to it. See Figure 19.1 for an example of a safety plan. Sometimes even a single good night’s sleep can significantly alter your outlook, and it is important not to underestimate the importance of sleep. If you are having trouble sleeping, speak to a doctor.
Example of a safety plan
1. Read through the list of positive things about myself.
2. Read through the list of positive things about my life and remind myself of the things that have so far prevented me from committing suicide.
3. Distract myself from suicidal thoughts by reading a book, listening to classical music, or watching my favourite film or comedy.
4. Get a good night’s sleep. Take a sleeping tablet if necessary.
5. Delay any suicidal attempt by at least 48 hours.
6. Call Stan on (phone number). If he is unreachable, call Julia on (phone number). Alternatively, call my key worker on (phone number), or the crisis line on (phone number).
7. Go to a place where I feel safe such as the community centre or the sports centre.
8. Go to the Accident and Emergency Department.
9. Dial 999 for an ambulance.
Once things are a bit more settled, it is important that you address the cause or causes of your suicidal thoughts in as far as possible, for example, a mental disorder such as depression or alcohol dependence, a difficult life situation, or painful memories. Discuss this with your GP or another healthcare professional, who will help you to identify the most appropriate form of help available.
Insomnia, – difficulty in falling asleep or staying asleep – affects 30 per cent of people. It is usually a problem if it occurs on most nights and causes distress or daytime effects such as fatigue, poor concentration, poor memory, and irritability. These symptoms may predispose you to accidents, to depression and anxiety, and to medical disorders such as infections, high blood pressure, obesity, and diabetes.
Insomnia can be caused or aggravated by poor sleep habits, depression, anxiety, stress, physical problems such as pain or shortness of breath, certain medications, and alcohol or drug use. Short-term insomnia specifically is often caused by a stressful life event, a poor sleep environment, or an irregular routine.
If you are suffering from insomnia, there are a number of simple measures that you can take to resolve or at least lessen the problem:
1. Have a strict routine involving regular and adequate sleeping times (most adults need about seven or eight hours of sleep every night). Allocate a time for sleeping, for example, 11pm to 7am, and do not use this for any other activities. Avoid daytime naps, or make them short and regular. If you have a bad night, avoid ‘sleeping in’ because this makes it more difficult to fall asleep the following night.
2. Have a relaxing bedtime routine that enables you to relax and ‘wind down’ before bedtime. This may involve doing breathing exercises or meditation or simply reading a book, listening to music, or watching TV.
3. Many people find it helpful to have a hot drink: if this is the case for you, prefer a herbal or malted or chocolaty drink to stimulant drinks such as tea or coffee.
4. Sleep in a familiar, dark and quiet room that is adequately ventilated and neither too hot nor too cold. Try to use this room for sleeping only, so that you come to associate with sleep.
5. If you can’t sleep, don’t become anxious and try to force yourself to sleep. The more anxious you become, the less likely you are to fall asleep, and this is only likely to make you more anxious! Instead, get up and do something relaxing and enjoyable for about half an hour, and then try again.
6. Take regular exercise during the daytime, but do not exercise in the evening or just before bedtime because the short-term alerting effects of exercise may make it more difficult for you to fall asleep.
7. Try to reduce your overall levels of stress by implementing some simple lifestyle changes.
8. Eat an adequate evening meal containing a good balance of complex carbohydrates and protein. Eating too much can make it difficult to fall asleep; eating too little can disturb your sleep and decrease its quality.
9. Avoid caffeine, alcohol, and tobacco, particularly in the evening. Also avoid stimulant drugs such as cocaine, amphetamines, and ecstasy. Alcohol may make you fall asleep more easily, but it decreases the quality of your sleep.
10. If insomnia persists despite these measures, seek advice from your doctor. In some cases, insomnia may have a clear and definite cause that needs to be addressed in itself – for example, a physical problem or a side-effect of medication.
Behavioural interventions such as sleep restriction therapy or cognitive-behavioural therapy can be helpful in some cases and are preferable to sleeping tablets in the long-term. Sleeping tablets can be effective in the short-term, but are best avoided in the longer term because of their side-effects and their high potential for tolerance (meaning that you need progressively higher doses to achieve the same effect) and dependence. Sleeping remedies that are available without a prescription often contain an antihistamine that can leave you feeling drowsy the following morning. If you decide to use such remedies, it is important that you do not drive or operate heavy machinery the next day. Herbal alternatives are usually based on the herb valerian, a hardy perennial flowing plant with heads of sweetly scented pink or white flowers. If you are thinking about using a herbal remedy, speak to your doctor first, particularly if you have a medical condition or allergy, if you are already on medication, or if you are pregnant or breast-feeding.