The friends and loved ones of suicide victims are at increased risk of all sorts of mental health difficulties themselves, but we know very little about what happens in societies where suicide is acceptable or encouraged.

As I write this, it is almost exactly two weeks before the anniversary of the suicide of someone I was once friends with. It’s completely unsurprising to me to find that I’m thinking about them as the anniversary comes up, even though the actual death was some years ago. There’s a wealth of fascinating data in the literature about, not merely suicide, but about the mental health of those left behind when someone suicides, and from this research we know that the friends, relatives, and loved ones of suicide victims are at increased risk of all sorts of mental health difficulties themselves, largely because those around the suicide tend to be left with very mixed and complex emotions (sadness, guilt, anger, shame, and happiness which can itself cause even more guilt) which can be very difficult to work through. A person’s suicide can leave those around them with “pathological” grief (the vast majority of griefs being entirely normal and healthy despite not being any fun to go through), depression, anxiety, post-traumatic stress symptoms, and an increased risk of suicide themselves. It’s a very important discussion here in Canada, where we’re in the process of re-assessing our legal and ethical rules about physician-assisted suicide and, for good or ill, it’s becoming easier for people with chronic illnesses to end their lives on their own terms. We know quite a lot about the negative effects of suicides in societies where suicide is seen as bad, but we know very little about what happens in societies where suicide is acceptable or encouraged.

Many cultures throughout history have perceived suicide as a good thing, at least sometimes. In regions where resources are scarce, many cultures had rituals in place which allowed, or more rarely obligated, the elderly to end their own lives so that they would not be a drain on the community. Suicide may be seen as a heroic option, as with Socrates drinking hemlock to spite his Athenian accusers or the tradition of disgraced Roman senators ending their own lives so that their families would not be held accountable for their crimes. The Japanese famously have their tradition of seppuku or, more recently, kamikaze, while it’s difficult to read modern news without reading about suicide bombings in one part of the world or another. We know little about how those left behind after such deaths grieve beyond what we learn from romanticized stories, but it would seem to logical to assume that while friends and loved ones grieve for the departed, such suicides are probably less traumatic (because they came as less of a surprise or because they’re seen as having accomplished something, if nothing else).

The fantasy parallels are endless. Orcish warriors fearlessly hurl themselves onto the spears of their enemies just to  draw blood. Dwarven phalanxes stand fast and sing their own funeral dirges in the face of certain death because that’s what dwarves have always done. Elves “cross the sea” when they grow too weary of endless life, which I realize not everyone takes as a metaphor for dying but which I personally have a hard time hearing as anything else. None of these societies have the Judaeo-Christian proscription against suicide, but each presumably has their own complex rules about it. It may be unthinkable for an orc to kill itself out of depression but encouraged for it to fight heedless of its own life. Elven societies might consider suicide perfectly acceptable in the face of the weight of years, or then again, might consider it even more horrific because of so much more potential being lost. I would imagine that halflings consider suicide an abomination but I would wonder if dragons consider it the finest of all deaths because it’s the ultimate act of agency and dominance.

There’s also the question of what form of suicide a society accepts. The Inuit supposedly had several different rituals for “proper” suicide, while suicide by any means other than seppuku seems to be considered dishonourable in the Japanese texts I’m reading through. Trolls in a D&D-type setting might have to have a complex suicide ritual by necessity; after all, if they jump off of a cliff they’ll just wake up a few hours later. Dragons can probably kill themselves however they wish but I would imagine there’s considerable shame in not properly either securing or disposing of a hoard first. The means that a creature picks might profoundly change how those left behind view the suicide, and I have this vivid image of a dragon being resurrected again and again by its disapproving family because it keeps performing some death ritual incorrectly.

We often have this idea that suicide is universally taboo, because it’s considered such a grievous sin in Western society, but the fact is that in many cultures it’s been an accepted part of life and, in some cases, even an intrinsic part of the social structure. Designing a society with a unique view of death and suicide can be a way to distinguish it from similar cultures in a campaign setting, and the complexities around it can easily turn into the driving force behind a storyline. Of course, suicide being a difficult subject for many people, it’s yet another concept that has to be approached with great care by a storyteller lest it hit a bit too close to home, but when used effectively it has the potential to be a powerful storytelling tool. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on August 8, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system.