From the late eighteenth century until the present, suicide has become a fundamental issue for professional Europeans' understanding of themselves and especially of the supposed health of their societies. From the second half of the eighteenth century onward, medical doctors, moral statisticians, sociologists, psychologists, and other professionally trained and university-educated experts produced increasing numbers of studies on suicide. Prior to 1750, suicide had been a popular theme for commentary from moralists, philosophers, and, above all, theologians and clerics. Of course, these groups of commentators have continued to write on the topic through the modern period, but the emergence of doctors, sociologists, and psychologists, among others, in the debates surrounding suicide has been a hallmark of the modern era. Claiming to offer complete or partial answers to the issue and causes of suicide, these professional groups increasingly asserted their own pivotal roles in analyzing the problems of European societies. Suicide was supposedly a modern problem that required expert commentary and intervention.

So dramatic was the proliferation of work on suicide that by the second half of the twentieth century, an independent field of study, suicidology, took shape first in the United States and then in Europe and around the world.Footnote ¹ In the late nineteenth and early twentieth centuries, convenient and reasonably comprehensive bibliographies on suicide in Europe could be compiled and published.Footnote ² Today, computerized databases on suicide need to be updated daily.Footnote ³ In light of this tremendous amount of information, one could make the case that the last topic that needs further analysis is suicide.

Yet suicide has only recently become a subject of interest to another group of professionally trained experts, namely, historians. European historians, for example, have begun to turn their attention to analyzing evolving definitions and portrayals of suicide. They have produced studies of suicide in early modern and modern England, France, Russia, and early modern Germany.Footnote ⁴ Historians of modern German-speaking Central Europe have entered this new development somewhat more slowly. Nevertheless, the recent publications of Ursula Baumann's Vom Recht auf den eigenen Tod: die Geschichte des Suizids vom 18. bis zum 20. Jahrhundert and Gerd Mischler's Von der Freiheit, das Leben zu lassen: Kulturgeschichte des Suizids show that suicide as a topic for social and cultural historians of modern Central Europe is becoming more established.Footnote ⁵

At the risk of oversimplifying academic arguments, most recent historical work on suicide in the modern era falls into two different schools of thought. First, there are those who trace the history of suicide to identify the chronology of its interpretation. Such scholars are interested in the models of interpretation that have been applied to the phenomenon in the course of the eighteenth, nineteenth, and twentieth centuries. Within this school of thought, one leading model focuses on the transition in understanding suicide from a moral failing or a crime to a medical or psychological condition.Footnote ⁶ In Europe this transition is usually placed in the late eighteenth or early nineteenth century and is associated with the increasing prominence of professional groups such as medical doctors and psychologists in modern societies. Further, the development of more elaborate hospital systems and psychiatric facilities in the last two to three centuries is usually part of the analysis of suicide as a modern “medical” or “psychological” phenomenon.Footnote ⁷ The present article follows in large measure the logic of this school of thought and also understands suicide as a topic of professional analysis based in clinics and hospital wards.

The second school of thought on suicide analyzes the topic and surveys laws and medical opinions about it but seeks to free the phenomenon from the constraints of professional categories and definitions. For scholars who use this model, the transition from religious to medical authorities in debates on suicide has not necessarily been a liberating development since professional authorities still define our understanding of individual acts. Some experts involved in the debates about suicide would like to see a movement toward what in German is sometimes called “Freitod or Bilanztod.”Footnote ⁸ Their hope is that by placing the subject of suicide in a historical context, one can conclude that suicide is essentially the product of an individual moral decision, one freely chosen after a full and rational consideration of the circumstances of one's life.

The role of terminal illness as a justification for suicide often underlies these discussions about a freely chosen death. Thus, some of the most recent work on suicide is driven by a contemporary political agenda. Contemporary medical and psychological professionals argue that one must be careful in distinguishing between those suicidal acts considered free and rational choices and those that result from people's biological, social, or psychological instability.Footnote ⁹ The two sides in this wide-ranging debate can find a middle ground, however, by realizing that some people commit suicide after making a rational and ethical choice and other people commit suicide when, because of despair, distress, or disability, they can no longer imagine a better future or remember a better past. This article does not directly enter these contemporary debates but contributes to them indirectly by analyzing medical and psychological practices and attitudes toward suicide.Footnote ¹⁰ Our understanding of how and to what effect modern-era medical and psychiatric experts entered these debates about suicide and attempted suicide is thereby deepened.

Following the general pattern of increased interest in suicide as a historical topic, this article analyzes it as a cultural and social phenomenon in Vienna in the early 1930s. In particular, the current study looks at several cases of attempted suicide in Vienna to analyze and evaluate how expert opinion became critically important to debates about the health of individuals and of Austrian society as a whole. This article does not attempt to give full accounts of the evolution of various professional perspectives on suicide—such an undertaking would deserve a book-length study. Rather it establishes a framework for how attempted suicides in Vienna might have been understood and categorized in the 1930s.Footnote ¹¹ At the same time, this article investigates how those people who had attempted suicide sometimes resisted the imposition of professional categories and institutional power by manipulating or inverting the very categories used to explain suicide. The bulk of this article discusses several case histories to examine the related issues both of professional perspectives on suicide and popular attitudes toward these perspectives. In these case histories, people took the opportunity to respond to the experts who examined them.

One fascinating aspect of conducting research on suicide in modern Vienna is the level of attention that professional and popular circles gave the topic in the nineteenth and early twentieth centuries. One does not want to reinforce the cliché of the Habsburg capital as the morbid center of Central Europe. Historically speaking, however, this cliché had considerable power even among Viennese professional groups. For example, many people believed that the rate of suicide in the city was high and that it constituted a “modern epidemic.” Many intellectuals and academics researched the topic and offered a variety of theories on its origins, nature, and prevention. Rates of suicide in modern Vienna may not always have been as high as or even higher than those in other European cities (statistics on suicide have long been recognized as problematic, and there is intense debate about their reliability and meaning),Footnote ¹² but interest in the topic remained lively in the Austrian capital throughout the nineteenth and well into the twentieth century. From Leopold Auenbrugger in the late eighteenth century to Sigmund Freud and his circle in the early twentieth century, suicide was an important, indeed critical, topic if one was to understand modern Austrian or European societies.

Scholarly and popular interest in suicide owed something to the significant number of suicides by prominent people in the Habsburg Empire and the Austrian Republic during the nineteenth and early twentieth centuries. Newspapers reported, sometimes in great depth, on the suicide of well-known academics, members of the literati, or politicians.Footnote ¹³ A short list of well-known suicides should suffice to demonstrate the point: Ferdinand Raimund (1836), Adalbert Stifter (1868), Eduard van der Null (1868), Nathan Weiss (1883), Otto Weininger (1903), Ferdinand von Saar (1906), Ludwig Boltzmann (1906), Richard Gerstl (1908), Ludwig Gumplowicz (1911), Victor Tausk (1919), and Herbert Silberer (1923).Footnote ¹⁴ Several children of prominent Austrians also committed suicide: Ernst Mach's son Heinrich (1894), Arthur Schnitzler's daughter Lilli (1928), and Hugo von Hofmansthal's son Franz (1929).Footnote ¹⁵ Suicides involving public figures or their offspring helped keep scholarly and popular interest in the topic strong throughout the late nineteenth and early twentieth centuries.

Consciously and subconsciously, directly and indirectly, many of those writing about suicide linked it to modernity. Indeed, with the exception of modernity itself, perhaps no other topic was so widely discussed in Vienna than suicide. It figured prominently in popular literature; it was frequently a subject of newspaper reports; and many of Vienna's leading thinkers and professionals wrote studies about it.Footnote ¹⁶ Well-known Austrian writers treated the subject of suicide in their work and often from a sympathetic point of view. One thinks of Arthur Schnitzler's Der Ehrentag or Ferdinand von Saar's Ausser Dienst.Footnote ¹⁷

Many Austrian academics and professionals believed that the urge to kill or act of killing oneself was a sign of a distinctly modern malaise or disintegration. Using statistics, psychological categories, or cultural concepts, they attempted to show how a rise in suicide or attempted suicide rates related to industrial development and dislocation, to the breakdown of social or cultural norms, or to problems in the family, workplace, or the religious community, to cite a few of the prominent types of argument used. Their methods of analysis, points of emphasis, and conclusions were usually widely different, but most of the experts in Vienna could agree that suicide and modernity were linked. These intellectual, academic, and popular debates about suicide and its meaning in modern Austria constitute the intellectual and cultural background against which the case studies presented below should be understood. An examination of individual cases of attempted suicide in the early 1930s should reveal important dimensions about Austrians' understanding of themselves and their “health” specifically in the modern era.

In the 1920s and 1930s, a person who attempted suicide would almost certainly have ended up in Vienna's complex of psychiatric institutions. When authorities discovered a suicide attempt, the person who attempted suicide was usually evaluated by a local public doctor, the staff at the Psychiatric Clinic at the General Hospital, and, if deemed necessary, by professionals at Steinhof, Vienna's primary facility for mental health patients.Footnote ¹⁸ Along the way, local police and judicial officials might have conducted their own evaluations as well. All of these officials sought to determine what path a patient would take through the maze of Vienna's various medical institutions. That prescribed path often depended on language taken directly from the medical and psychological examinations.

This article focuses exclusively on examinations, evaluations, and medical histories conducted at the Psychiatric Clinic of Vienna's General Hospital and at Steinhof.Footnote ¹⁹ After a person who had attempted suicide was brought to the clinic, evaluations followed a certain pattern with some variations.Footnote ²⁰ The clinical staff would interview both the person involved and possibly family members and friends. The interviews were often recorded verbatim and sometimes included direct quotation from the person who had attempted suicide. The clinical staff was dedicated to making the interview as professional and complete as possible because it formed part of the basis for the diagnosis and prescribed treatment.Footnote ²¹ The staff usually undertook a brief physical exam, checking the dilation of the patient's eyes and her or his reflexes, listening to a patient's lungs and heart, and perhaps checking the pulse. Obvious physical problems, such as tremors or wounds, were noted. Patients were also often questioned about alcohol consumption, smoking, venereal disease, and, in the case of women, pregnancy. In their evaluations of those who had attempted suicide, the clinical staff looked for a wide range of medical, psychological, and social information. Stays in the clinic typically lasted several days to a week; a shorter stay often meant that a patient was being transferred to Steinhof presumably for more extensive evaluation.

What the evaluations do not reveal, at least not in a complete fashion, are the professional staff's interpretation of the evidence collected. The clinicians usually provided a diagnosis of the patient's condition, but these judgments were often perfunctory and generic. Typically, the clinical diagnosis of a person who had attempted suicide would be “psychogenic depression,” a catchall term for a variety of psychological conditions.Footnote ²² A close reading of the documents, however, suggests a great deal about how both the clinicians and patients understood attempted suicide. These medical histories constituted elaborate negotiations among several players. The players negotiated over particular definitions of suicide and its possible treatment to be sure, but they also engaged the issue of whose authority determined the definitions and treatments in the first place. The case studies reveal just how patients and staff members struggled for control over the terms of the debate. As much as medical and psychological experts wanted to exert their power and authority over patients through examination, evaluation, and prescribed treatments, these same patients sometimes knew how to manipulate the language of suicide to negotiate their way free of further medical or psychological evaluation. Case studies of attempted suicide in Vienna often reveal elaborate verbal contests with very real consequences for the patients involved.

The Language of Suicide: Categories under Debate

Before turning to a few patients' histories in particular, let us examine some of the categories that were debated in these case studies more explicitly. One line of inquiry that often came up in the interviews with those who had attempted suicides had to do with heredity. Following the medical and psychological thinking of the day, the clinical staff emphasized possible family connections in trying to identify the source of the suicidal attempt. In the case studies presented below, concerns about heredity and suicide play an explicit role only once. In many cases, however, heredity was a critical background issue.

A second major category that shapes these medical histories is gender. Throughout the modern period, European experts on suicide had always drawn several distinctions between men and women in the matter of suicide. Statistically, more men than women committed suicide; that is, men more often succeeded in killing themselves than did women. One reason, it was claimed, was that men often selected more violent methods—using guns or hanging—to kill themselves than did women, who supposedly preferred such methods as gas or sleeping agents. The argument went that the more violent methods indicated a more serious intent to complete the act. It was often thought that more women than men attempted suicide, but this was also a matter of some debate.Footnote ²³ The statistics on attempted suicides were and are even more problematic than those for completed suicides.Footnote ²⁴ What is clear is that suicide was believed to reveal underlying gender differences, and that belief is reflected in the language of the case studies from Vienna's Psychiatric Clinic. Assumptions about gender definitions and identities are involved in virtually every case below.

A hard-nosed social historian might claim that most of these cases of attempted suicide reveal more about Vienna's social problems and class relations than they do about people's physical or psychological state. If people were depressed and desperate, they had good reason to be. Poverty, domestic abuse, and abandonment were quite possibly the root causes of suicidal actions.Footnote ²⁵ Although it is dangerous to link general social and economic developments to individual suicide attempts and even more so to try to associate a given event or movement with a specific act, the doctors and patients at the Psychiatric Clinic and at Steinhof did interpret suicide against the backdrop of the turbulent post-World War I era in Vienna and Austria. In addition to the problems common to all European societies at the conclusion of the war—demobilization, revamping of economies for peace-time production, coping with human and material losses—Austria was confronted with some particular difficulties in the 1920s and 1930s.

First, there was the question of national survival and organization. The rump state that succeeded a multinational empire might have been united with a “greater Germany” in the years immediately following the war. Once it became clear that this would not be the case, Austria as a small, independent state in Central Europe would have to deal with deep and abiding social and economic problems and fissures. The new republic had to sort out several problems such as paying war debts, handling refugees from across the empire, and caring for and eventually sending back patients hospitalized in Vienna to their new home countries. Steinhof, which alongside its psychological functions had also served as a field hospital during the war, had to wait for several years after 1918 until it could repatriate all of its wounded soldiers to their newly created countries.Footnote ²⁶

Austria remained under tremendous pressure economically in the interwar period. The Great Depression following 1929 and specifically the collapse of the Creditanstalt in June 1931, which is often cited as having worsened the economic situation in Germany as well, had serious consequences in Vienna and Austria. Thus, issues such as economic uncertainty, long-term unemployment, and financial survival were part of the background against which doctors and patients discussed, interpreted, and struggled over the meaning of suicide attempts. It was not surprising that references to material conditions in Vienna were a frequent part of patient histories. The social and economic situation in Austria remained troubled throughout the Seipel, Dollfuss, and Schuschnigg years and deteriorated completely in the mid and late 1930s as Austria slid from its own brand of authoritarianism and fascism toward eventual annexation in 1938 into the Nazi fold.Footnote ²⁷ Judging from both the domestic and international scenes, Austrians had many reasons to be uncertain and unnerved in the 1930s. Still, mapping these general historical patterns and national developments onto individual case histories is often impossible. On the other hand, one can occasionally point to a specific historical link between events and suicide attempts—for example, the wave of suicides, especially among Austrian Jews, in the months immediately following the Anschluss.Footnote ²⁸

In the cases below, drawn primarily from the early 1930s, we encounter people mainly from the social and economic margins of Viennese society. As all writers on suicide in the modern era have shown, however, we still have to explain why certain individuals commit such rash acts, what “triggers” a suicide attempt, when these same desperate social conditions would have applied to a large percentage of Vienna's population. Still, it was widely accepted that personal misfortune and psychological instability may have combined to bring people to a point where they could contemplate suicide. This combination of factors was certainly in the minds of the clinical staff at the General Hospital. How to understand the relationship of social or class-based circumstances and psychological factors was one of the basic questions under consideration in these discussions of suicide.

Finally, the most obvious and central themes of the debates in the medical histories of those people who attempted suicide were illness or disease, sickness or health, and stability or instability. These terms could be understood as physical or mental conditions, but in the case of one who attempted suicide, the patient's mental health was usually under debate. The outcome of the evaluation, the diagnosis and suggested treatment, depended in large measure on who won this part of the debate, who could control these definitions, and who ultimately had authority over deciding what was suicide or a suicide attempt. To understand the issues surrounding attempted suicide in Vienna and the dialogue between patients and professionals with their often competing notions of what suicide meant, we turn now to a detailed analysis of some case histories.Footnote ²⁹

A Review of Selected Case Histories

Ruth, a thirty-two-year-old Jewish woman from Vienna's Leopoldstadt, attempted suicide in the early 1930s. According to her sister, Ruth had been depressed since the death of their father. The clinical staff at the Psychiatric Clinic of the General Hospital also discovered that her brother and another sister had committed suicide ten years earlier. Was there a familial pattern or hereditary cause at work in her case? Ruth's other sister had killed herself with Lysol, the household cleaning product. Ruth had also tried to kill herself with Lysol at her father's gravesite at the Zentralfriedhof in Vienna. As Ruth told the staff at the clinic, she believed that without her father she was “not able to deal with life.” The staff also noted that Ruth had money problems. Before she had been sent to the Psychiatric Clinic, police and public health officials in Simmering, the Viennese district in which the Zentralfriedhof is located, had pumped Ruth's stomach and recorded that she would not answer even basic questions. They had sent Ruth on to the clinic with the observation that she claimed to be “tired of life,” (lebensüberdrüssig). Ruth's case involved primarily family issues; she had apparently been shattered by the death of her father and the ensuing responsibility to take care of herself. Moreover, two siblings had committed suicide and, in the case of her sister, had even provided a model of how to do it.

The clinical staff was not very forthcoming in their evaluation of Ruth. They gave her a diagnosis of “psychogenic depression,” which was in this context a term used to cover a multitude of conditions and was not a precise clinical diagnosis, at least not one that demanded a definite treatment at the General Hospital in Vienna. Despite Ruth's seeming instability and family background, the staff listed her as “better” (gebessert) and sent her home after a stay of approximately ten days. The staff's reason for optimism in Ruth's case stemmed from the observation that she was unlikely to repeat a suicide attempt because she had obtained enough money to live. No mention was made of how this money was acquired.Footnote ³⁰

Ruth's evaluation does not make explicit whether the staff arrived at this conclusion independently or if Ruth pressed it on them. One key question in the struggle to define the nature of a suicide attempt was whether one intended to repeat the act. It was always one of the questions asked of the patients, and how they answered this question went a long way in determining their diagnosis and treatment. Ruth did, however, end up at Steinhof in 1935. Her patient history from that stay revealed that she had also been sent to Steinhof in 1921 and again in 1934. In addition, Ruth had spent time at the Sanatorium in Inzersdorf in 1924 and 1932.Footnote ³¹ Therefore, Ruth had significant experience with psychiatric institutions, all of which had a difficult time helping her. In 1935, following Ruth's stay of exactly one month, the Steinhof staff released her to be cared for at home (häusliche Pflege).Footnote ³²

The case of Andrew, a thirty-one-year-old leather worker, further exemplifies the emphasis that the Viennese debates placed on psychological stability and the threat of repeating a suicide attempt. In the early 1930s, Andrew was brought to the Psychiatric Clinic. He had already been there at least once—four years earlier when he had also attempted suicide. On both occasions, Andrew tried to end his life with gas. When asked why he wanted to kill himself, Andrew cried and said simply that “nothing makes him happy anymore.”Footnote ³³ He added that he had suicidal thoughts for days. His previous psychiatric evaluation indicated that Andrew had even attempted suicide ten years earlier by plunging himself into the Danube.Footnote ³⁴

In Andrew's case, the clinical staff had more information about him than was usual with most patients. Putting together all of his medical and psychological evaluations, the staff actually had a history of Andrew's suicide attempts, something that was extremely rare in these cases. The evaluations revealed that Andrew had dire financial problems, was divorced, was hard-pressed to support his two children, and had endured frequent confrontations with his ex-mother-in-law. After reviewing all of his files, the clinical staff concluded that Andrew's root problem, however, was chronic alcoholism and sent him to Steinhof where a center for the treatment of alcoholism had been established after World War I. The staff thought that Andrew had repeatedly contemplated suicide primarily as a result of his prolonged drinking or while under the influence of alcohol. Andrew had begun consuming alcohol regularly at eighteen and said that he could not handle much—“six or seven beers would finish him.” At the time of his last evaluation, Andrew claimed that that he now drank “very little”—only three or four glasses of wine a day.Footnote ³⁵

Andrew was almost certainly an alcoholic, and his condition may have led to the social, economic, and personal problems that the staff listed as part of his evaluation. Chronic alcoholism may even have been a medical reason behind his several suicide attempts. Andrew could not very convincingly claim that he would not attempt suicide again when he had already tried to kill himself at least three times over the space of fifteen years and on at least two of those occasions had ended up in the Psychiatric Clinic of Vienna's General Hospital. Moreover, a diagnosis of chronic alcoholism as a cause of a suicide attempt was a standard interpretation at the Psychiatric Clinic. From the staff's perspective, this diagnosis had one logical conclusion: sending Andrew to the new clinic established for the treatment of alcoholism. Sending a patient like Andrew to this new center also had the advantage of saving the clinical staff from having to make any further precise diagnosis of his psychological condition—a medical-physical condition overrode, at least in the short term, any further consideration. Moreover, by sending Andrew to the alcohol treatment center, the clinical staff followed a short, bureaucratic path rather than a long, complicated, therapeutic one and made alcoholism, rather than suicide, the root problem.Footnote ³⁶

The staff at Steinhof already knew Andrew. Four years earlier, he had spent two months in Steinhof's care for the same condition.Footnote ³⁷ During that stay at Steinhof, Andrew related to the staff some of his long-standing problems, including family and work hardships. He had been unemployed off and on. At his initial evaluation, Andrew stated that suicidal thoughts had been with him for many years and that he could not rule out future attempts on his life. Noting that Andrew was extremely thin and that his hands shook, the staff noted further that he had no legal or police-related troubles. Andrew was assigned to one of the pavilions at Steinhof and began a work regimen that eventually included outdoor activities. The staff reported that Andrew felt entirely comfortable at the complex, thought no more of suicide, slept well, and had even gained weight. By the late summer, Steinhof released Andrew to home care.Footnote ³⁸ When he later began drinking again, Andrew contemplated suicide and returned to the Psychiatric Clinic and to Steinhof where his cycle of treatment began anew.Footnote ³⁹

In the early 1930s, the psychiatric staff at the General Hospital sent another patient, Johann, to Steinhof with a diagnosis of chronic alcoholism. Johann had also attempted suicide. He admitted to being a heavy drinker and that he fought frequently with his wife, from whom he was presently separated. On the day of this suicide attempt, Johann had been drinking and had fought with his wife again. Enraged by the argument, he had cut both of his wrists. During his evaluation, Johann maneuvered for space with the clinical staff; he assured them that he regretted his actions and would not attempt suicide in the future. At the time, he was also unemployed. The prospect of a new job might have improved his outlook considerably. Despite all of the economic and personal dimensions to Johann's attempted suicide, the clinical staff did not pursue his case very far. After defining him as a chronic alcoholic, the staff held Johann only one day before delivering him to the alcohol treatment center.Footnote ⁴⁰

Men and women who could not be categorized as alcoholics or shown to have some other physical ailment stood a better chance of being released from the Psychiatric Clinic after their evaluations. Similarly, if the staff could not categorize a patient's conditions, then that patient too could often avoid further examination. The case of Anna is a good example of the latter. She was forty-five in the early 1930s when she, according to her account, was involved in an accident that health officials originally believed was a suicide attempt. Accidents and suicides were often difficult to distinguish. The famous Friedhof der Namenlosen, Cemetery of the Nameless (or Unknown), along the banks of the Danube southeast of the city of Vienna contained many victims who had drowned in the water. Whether they had fallen in the river by accident, jumped from a bridge, or merely waded into the water with no intention of emerging was extremely difficult to determine.Footnote ⁴¹

When Anna came to the Psychiatric Clinic, she told the staff that she had been taking a sleeping agent for years. Late one March night, she again took a sleeping agent. Thereafter, she wanted to make herself some tea, which was her habit. When the water to make the tea boiled over, gas was somehow released. Because of the effects of the sleeping agent, Anna claimed, she was not strong enough to turn off the gas. She assured the staff that she had never contemplated suicide! Despite the presence of two common and “feminine” methods for committing suicide—sleeping agents and gas—the staff believed Anna's version of what had happened. Her medical history from the clinic cites no medical, personal, social, or psychological reasons—alcoholism, poverty, domestic abuse, depression—that individually or in combination might have led her to attempt suicide. After spending a few days in the clinic, Anna claimed she was “better,” and the staff sent her home.Footnote ⁴²

Believing her story, the clinical officials did not believe it necessary to label Anna with a psychological condition, not even the generic “psychogenic depression.” Nor did the staff feel compelled to link her act, which she denied as a suicide attempt, with other factors in her life. Therefore, they released Anna without any further professional evaluation. Other experts might have reacted differently. After probing for psychological or social instability in her life, they might have judged Anna's act as no accident but an attempted suicide. In this case, however, Anna was able to define not only her immediate act, but also what it said about her psychological state of mind. She was therefore released from the clinic and its experts and had no official diagnosis.

The patient history of Maria, a fifty-one-year-old divorcee, presented a different outcome to the negotiations between patient and clinical staff. In their evaluation, the staff listed a variety of motives and conditions for why Maria might have attempted suicide in the early 1930s. She had taken a drug that rendered her unable to give intelligible answers to initial questions about her actions and motives. She had attempted suicide at least once before. A few days later, Maria gave her examiners a long litany of her problems and difficulties. She had been accused of theft and was afraid she would have to go to court. Claiming that the charges were all false, Maria said that a mistake had been made. While she did indeed have debts to pay, Maria denied stealing anything. Her thirty-year-old son had said she was profligate in court. Adding to Maria's woes, a recent operation had left her dazed and confused. Whether this was a continuing condition is not clear from the documents. Moreover, her ex-partner was living with a new lover, an old friend of hers, in the same building in which she resided. Finally, Maria claimed to have suffered since 1896—that is, for over thirty years—from feelings of anxiety and agitation. Maria had a wide variety of economic, social, emotional, and psychological problems that might have brought her to the point of committing suicide.

The Psychiatric Clinic at the General Hospital completed its profile of Maria in a few days and sent her to Steinhof. The staff had made the simple comment that Maria had “not been cured” of her medical and psychological problems nor did she seem to have any immediate relief in sight for her numerous personal difficulties.Footnote ⁴³ The staff did not attempt to give Maria's case a formal diagnosis, perhaps concluding that her problems were severe and obvious enough—she repeatedly broke down and wept when being questioned—to warrant further psychological evaluation. They did not attempt to treat her while at the Psychiatric Clinic, nor did they give her much room or time to negotiate her way out of further treatment.Footnote ⁴⁴ In Maria's case, the power and the authority were almost completely on the side of the clinical staff; they claimed control over her immediate future, and Maria was therefore institutionalized for further examination at Steinhof.

Maria stayed at Steinhof for five weeks that year. She told the Steinhof staff much of what she had related at the Psychiatric Clinic. She stressed her sense of abandonment and her worries about financial affairs. Her physical examination included information about the scars she had acquired from the operation mentioned above. Finally, Maria added that she felt as if she had been living in a “dream,” by which she clearly meant that she was almost unaware of her surroundings at the time she had been brought to the Psychiatric Clinic. After some time at Steinhof, however, Maria reported that she was very sorry for her actions and that she saw her financial difficulties in a new light—in a worst-case scenario she could sell her apartment to pay her bills. She was eventually allowed to leave the facility on her own.Footnote ⁴⁵

Maria was released from Steinhof because she was able to reframe the terms of the debate about her suicide attempt. Regretting her actions—an important consideration and indication for the medical and psychological professionals whether at the Psychiatric Clinic or at Steinhof—Maria could imagine a more stable economic and personal future. Nevertheless, her own suggestion that she could, in difficult circumstances, sell her property indicates that Maria probably would remain on Vienna's social margins and might attempt suicide again.

An analysis of other cases of attempted suicide makes clear how wide was the variety of psychological and social factors under discussion in Vienna's debates about suicide. Alice, a young woman of twenty-four, attempted suicide and came to the Psychiatric Clinic in the early 1930s. Having used a then-popular means, gas, to attempt suicide, Alice explained her act by saying that she felt threatened at work and at home. As a domestic servant, she had quarreled—seemingly a frequent occurrence—with her employer. In a formal deposition, one of Alice's acquaintances said that she seemed “normal” except that the loss of her parents weighed heavily on her. Alice herself said that she felt very alone in the world and wanted a new and better job. Otherwise, she could not promise that she would not repeat the suicide attempt.Footnote ⁴⁶

This last statement set Alice's case apart from most of the attempted suicides being evaluated at the clinic in Vienna. During the formal evaluation, patients usually claimed that they were free of further suicidal thoughts and intentions. On the other hand, there were also clearly many cases when those who had attempted suicide one or more times stated that they would do so again or that they could not say whether they were likely to try again. Alice's case emphasizes again how critical the question was to the professionals because patients' answers at least in part determined their diagnoses and treatments. The medical and psychological staff had the power and authority to give definitions and meanings to these individuals' acts—e.g., was the person a continuing danger to her or himself; did the case warrant further evaluation? In their judgment, Alice's case certainly did. After giving her a diagnosis of “psychogenic depression,” the staff did not send Alice home after their treatment had made her “better,” as was the practice with some of the earlier attempted suicides examined above. Alice was instead placed under police observation when she was released from the Psychiatric Clinic. Alice's treatment demonstrates another approach to dealing with attempted suicide in Vienna during the 1920s and 1930s. In this instance, the police, not hospital authorities, were allowed to oversee the immediate future of a young woman and to determine whether she was a continuing threat to herself.Footnote ⁴⁷

In the 1930s suicide and suicidal intentions were linked to virtually every aspect of Viennese society and culture. An example is the case of Elizabeth. A young, single woman, Elizabeth was also an unemployed domestic when she came to the Psychiatric Clinic after a suicide attempt. The staff believed that Elizabeth's depression had been caused by a difficult homosexual affair. At the time of her psychiatric evaluation, Elizabeth was twenty-six and trying to find work. Apparently, her partner had moved to the town of Payerbach in Lower Austria. In searching for work there, Elizabeth was keeping a promise to a friend, presumably this same partner, whom Elizabeth now feared she would lose. Exactly why Elizabeth believed that she had failed to keep this promise and attempted suicide is not explained in the patient history.Footnote ⁴⁸ Elizabeth's alleged homosexuality and her apparent sexual frustrations as underlying causes for her rash act are not analyzed at any length in the documents from the clinic and are offered as implied suggestions for her suicide attempt. The staff may have thought that as a homosexual Elizabeth needed treatment in any case; her suicide attempt was simply further evidence of this. The staff at the General Hospital kept Elizabeth for less than two days before sending her to Steinhof for further evaluation.Footnote ⁴⁹

Unfortunately, Elizabeth would spend much of her adult life in and out of Steinhof. In this case from the early 1930s, Elizabeth spent only the better part of a week at Steinhof before being released as “healed” (geheilt). Clearly, however, she needed additional help. In her interview, Elizabeth recalled that she had already been at Steinhof in 1928, but she refused to talk about that stay as it was too embarrassing (peinlich). Further, Elizabeth added that she had recently been hospitalized in Klosterneuburg for two and one-half months and that she had earlier earned money through prostitution.Footnote ⁵⁰ In fact, the Steinhof report from her 1928 stay states that the police had cited Elizabeth three times for prostitution and that she had been raped at the age of fourteen.Footnote ⁵¹ Finally, she was brought to Steinhof no fewer than five times and as late as the early 1960s! Footnote ⁵²

Elizabeth's problems, including prostitution and economic hardship, were certainly enough to bring her repeatedly to the Psychiatric Clinic and to Steinhof and to place her at intervals under the supervision of medical and psychological professionals. These professionals seemed just as overwhelmed with Elizabeth's problems as she was and could not help her in any fundamental way. From the late 1920s to the early 1960s, her life was periodically evaluated. Although Elizabeth was on several occasions released from Vienna's institutions as “healed,” clearly she was not. Elizabeth needed more attention and assistance than Vienna's medical and psychological professionals were able or willing to give her.

The negotiations, debates, and struggles that transpired between patients and clinical staff could take many interesting turns and involved many different explanatory models. The struggle over definitions and authority regarding suicide was not simply a matter of two opposing sides always making the same arguments and taking the same positions. In these debates, there could be paradoxical outcomes. A case in point is the story of Laura, a young, single woman who attempted suicide in the early 1930s. Laura's persistence in attempting suicide and the clinical staff's reaction to her repeated attempts were remarkable. Whether she was firmly resolved to end her life is an open question, but Laura undoubtedly made several attempts to do so. On one occasion, she had attempted suicide by inhaling large amounts of coal dust. The attempt that brought her to the clinic involved her apparently taking poison. Her partner, returning from collecting his unemployment compensation, found her semiconscious at home. Finding several packets of an unknown powder in the apartment, he contacted the local authorities and stayed with Laura, especially when she threatened to jump out a window. Refusing to have her stomach pumped, Laura could not explain why she was prepared to commit suicide, except to say that there were many domestic squabbles that kept racing through her head. Finally, Laura said that she could not rule out further attempts on her life. Nevertheless, the clinical staff released her. The staff diagnosed her as suffering from “depression,” but they believed that she could be sent home in any case.Footnote ⁵³ Given Laura's repeated attempts at suicide and her reluctance to promise not to attempt taking her life again, the staff's reaction seems at odds with their observations. Laura did not aid her own cause. She gave the staff every reason to evaluate her further and to hold her longer.

In most instances, the staff worked under the assumption that further professional treatment could help prevent future suicide attempts. Nevertheless, Laura achieved her release, the desired result of many of those who attempted suicide. Why did the staff release Laura? The most logical answer is that the clinical staff saw themselves as the final arbiter of Laura's health and stability. The doctors determined that after a week under their observation that Laura's condition had truly improved; in the language of the evaluations, she was “better.”Footnote ⁵⁴ In other words, they interpreted their role not just as clinicians and diagnosticians but also as healers, professionals who could help or possibly cure people like Laura. In her particular case, they determined that despite all of Laura's statements to the contrary, she was not a threat to herself.

As we have seen above, after patients had undergone clinical observation, had stayed for a few days' treatment in the Psychiatric Clinic of the General Hospital, or had been transferred for a longer stay at Steinhof, Viennese medical professionals often stated that their patients were “better,” a declaration that rested on the assumption of the professionals' therapeutic ability. This was the doctors' way of projecting power and authority over patients and, by extension, over Austrian society. As Laura's story shows, this tendency to decide cases in a seemingly arbitrary fashion could lead to idiosyncratic diagnoses and treatments. On the other hand, all the information that the clinical staff used in making their judgments may not be available. In the last analysis, however, the clinicians were consistent. Regardless of their diagnosis or the treatment they prescribed, the clinicians claimed authority to judge the evidence, to name conditions, and to recommend further action—and whether or not that action included treatment.

Before turning to a few general conclusions, an examination of two final case studies will illustrate clearly how clinical evaluations of those who attempted suicide were intricately related to questions of power and authority in Vienna during the 1920s and 1930s. Both of these cases concern men who eventually lost the battle to determine their own fates.

A twenty-year-old enlisted man in the Austrian army, Heinrich attempted suicide in 1936. Heinrich hated the military and in frustration drank too much and then tried to jump out of a window. When he was questioned about this action, Heinrich said that he could not recall anything. He did say that if he had to stay in the military he would certainly kill himself. As Heinrich stressed, he was an auto mechanic, not fit to be a soldier, and had a condition that the military authorities should have noted when they had examined him before induction. According to Heinrich, he had suffered from a childhood disease that made it difficult for him to breathe. Since the onset of that illness, he had also become very nervous. The military medical staff had examined him for only two minutes, however. Now, he was in the military and could not abide it. When asked if he thought anyone in the military was against him, Heinrich said, “of course … I noticed immediately that they were against me.”Footnote ⁵⁵ Heinrich later clarified that he did not mean his military comrades. Presumably he meant the officers.

The psychiatric staff questioned him further and concluded that Heinrich was a psychopath with strong hysterical tendencies. To be more accurate, in their letter to the military, the clinical staff said that Heinrich was not truly suffering from a mental illness but, rather, displaying psychopathic and hysterical symptoms. They recommended that Heinrich not continue in the army but would defer to the military command's decision. Sometime later the military reached a decision and sent someone to pick up Heinrich who presumably returned to active duty.Footnote ⁵⁶

In this instance, Heinrich tried to use the language of illness and attempted suicide to his favor. He wanted to convince the medical and psychological authorities that he was unfit for military duty. Heinrich negotiated well and used most of the categories—physical ailments and temporary psychological instability—familiar to the clinical staff. The staff reacted, however, in a halfhearted fashion to Heinrich's attempts to define his health and suitability for the military. They recognized his psychological symptoms but decided that he had no serious underlying mental illness. Although they recommended that Heinrich not be returned to the army, they left the final decision to military officials. In the end, Heinrich lost the ability to define his own physical and mental health primarily because the medical and clinical authorities to whom he appealed, powerful as they were, could not or would not compete with military officials over the fate of a twenty-year-old conscript. Heinrich's immediate future was not worth clinical experts' crossing political and professional swords with the military.

Finally, there is the case of Dr. Ludwig, whose medical history is quite long and detailed.Footnote ⁵⁷ He spent almost two weeks in 1934 under observation at the Psychiatric Clinic before being released in “better” condition—meaning the staff considered him not to be a risk to himself anymore. Ludwig's story and his suicide attempt were complicated and compelling. Trained as a medical doctor in Russian-controlled territory, Ludwig had been born in Vilnius and went to medical school in Woronesch (Voronež or Воронeж). He had moved to Vienna in 1922 but had been unable to find work as a medical doctor, a situation that depressed him greatly according to his own account and that of his wife. For the next ten years, Ludwig had earned meager wages working for a press before being fired. Since that time, he had been mostly unemployed, and his family had endured financial hardships. So many business matters had gone wrong, and Ludwig believed that bad luck followed him everywhere. In a last desperate attempt to help his financial situation, he had taken his remaining money and lost it while gambling at Baden.Footnote ⁵⁸ After this last shock, Ludwig had attempted to kill himself with gas. Having had suicidal thoughts for quite a while, Ludwig related that although he had failed killing himself this time, he would have more success next time. Both Ludwig and his wife agreed that they had a good family life (they had one child) and that if he could only find work as a medical doctor, he would be freed of his suicidal thoughts immediately.Footnote ⁵⁹

For several days, the clinical staff interviewed Ludwig extensively. Time and time again, he insisted that he would attempt suicide in the future. On one occasion, Ludwig told members of the staff that there were situations in which “the death of a husband could help a family.”Footnote ⁶⁰ Different members of the staff evaluated him, and only after an evaluation with a high-ranking member of the clinic did Ludwig finally admit that his act was a mistake and that he should deal with his extreme economic problems and his family's plight in a different way. Ludwig held out hope that a better job and prospects for his family existed in Russia. A company was willing to pay for him to travel to Russia—his wife and child would for the time being remain in Vienna—and he trusted that things were on the right path. Two days later, Ludwig was released from the confined section of the clinic into the open section. After being observed for three more days, Ludwig was released to pursue his better possibilities in the Soviet Union at the height of Joseph Stalin's Five-Year Plans and at the beginning of the waves of purges in that country.Footnote ⁶¹

The doctors at the clinic clearly took control of defining Ludwig's condition and its “treatment.” They found no history of depression or suicide in his family. Although they observed him for an extended period, they did not think it necessary to send Ludwig on to Steinhof. Instead the doctors released him with the comment that he was “better.” However, Ludwig's immediate prospects were not certain, and returning to the Soviet Union could not have seemed all that promising. The clinical staff worked hard with Ludwig to convince him of their version of his attempted suicide. That is, Ludwig was not mentally ill or even particularly unstable; he just needed better economic prospects, the opportunity to practice the profession for which he had trained, and the ability to reintegrate himself into his family life as head and primary breadwinner. To get Ludwig to reach these conclusions, the clinical staff exerted continuous and considerable pressure—in fact, they badgered him into accepting this vision of his future.Footnote ⁶² It would be interesting to see how Ludwig and his family fared after his release from the Psychiatric Clinic. Did they reunite in Russia? Did Ludwig find work there? Or did Ludwig remain in Vienna, living on the margins of society, perhaps contemplating and attempting suicide again as some of the other patients evaluated at the Psychiatric Clinic apparently had done? We do not know; Ludwig's story seems to end with his release from the Psychiatric Clinic.