Suicide in the Byzantine Empire (G. Tsoukalas, 2013)

NOTE: The following article is taken from Psychiatriki 2013, 24:55–60

Portrait of Gemistus Pletho, detail of a fresco by acquaintance Benozzo Gozzoli, Palazzo Medici Riccardi, Florence, Italy
Portrait of Gemistus Pletho,

Studying the suicide in the Byzantine Empire is difficult due to the limited number of references to it. Their number is greater in the early years of the Empire, mainly because of the persecution of Christians and gradually decreases. The attitude of the Church also gradually hardens, as well as the law. The law was strictly followed to the West, but as far as the Eastern Empire is concerned there are no references of punishment, confiscation of property or vandalism of dead bodies mentioned. Avoiding public humiliation after a public crime or a military defeat, religious redemption, emotional disturbance and debts, are the main cause of suicide. There are some references of mass suicides, while women suicides are relatively fewer, if the early Christian years are excluded. Suicide is more acceptable to the pagans because of their lifestyle. The therapeutic approach comes mainly through the treatment of depression. Aretaeus and Galen cite some ways to deal with the disturbance in the internal balance of black bile. Their view echoes through the centuries and the subsequent doctors embrace it. At least after the 9th century, more importance is given to the patient’s bliss. Gemistus Pletho tried to revive the Platonic view of suicide shortly before the end of the Empire. The Church forbids Christian burial and troubled soul hovers in an intangible journey.


The references to suicide from the 4th to the 15th century in the Byzantium are extremely limited, which explains the reason why the issue has not been studied extensively.1–2 The attitude of most religions towards the suicide is negative, so the Jewish and Christian religion condemn suicide. These religions, being the antipode of individualism, accept reality as a single entity, focusing on the divine element, around which all the other elements are developed, that is the human and the cosmic, the animate and the inanimate, the rational and the irrational. Life belongs to the divine factor of the reality, which determines the rhythm of beings throughout the whole range of their existence. Each one adapts and submits to the cycle of life and death, determined by the divine element. The human thus is not entitled to disrupt the cycle of life and therefore killing another human being or himself is prohibited and considered as the highest contempt for God who created him.3–6 Suicide has been studied only in the references of removal of own life in the Greek Novel from Antiquity to the Comnenian period.2 According to the Romans, nobles’ suicide shortly before an inevitable death, as in the end of lost a battle or after a disgraceful act, is an acceptable fact,1 although by the 3rd AD century the Roman law punishes suicides strictly.7 Since the 5th century AD the references get fewer and are mainly confined to the hagiographic literature.

The sources mentioning suicides or suicide attempts are primarily religious or secular discourses, in which suicide is generally and often referred as an irreverent act. The Byzantine law punishes self-destruction as well as those who lead others to forced suicide, such as a ruler that leads to suicide a slave who has done some penal offense.1 The therapeutic approach to prevent suicide is found in the treatment of depression and mania and is mainly expressed by Aretaeus and Galen, even if they lived earlier than the creation of the Empire.8

Suicide in the early Christian years of the Empire

St. John Chrysostom praises the Martyr Domina, who drowned her two daughters--Bernike and Prosdoke--and then drowned herself to avoid rape.
St. John Chrysostom praises the Martyr Domina, who drowned her two daughters–Bernike and Prosdoke–and then drowned herself to avoid rape.

Despair is a terrible evil and unhealable passion that erodes the human soul. It destroys everything sound in him, it delivers him to the disaster and pushes him to end his life.9 The despair of the Christian martyrs during the persecutions led some of them to suicide in order to avoid rape or humiliation. John Chrysostom says that the three witnesses Bernike, Prosdoke and Domnine, fell into the river near the city of Hierapolis and drowned to avoid humiliation.10 He even connects their act to a Cristian baptism.1 The tendency of Christians to end their life or cause death because of the pagans, during their persecution, was not considered as suicide in the early years of the Church. It is certain that Christianity invites suicide in a way in which other major religions do not. In the early years of Christianity the faithful Christian can commit suicide if he believes that the time of sin is close, while the suicidal death of a martyr is treated with sympathy by the Church to such an extent that it is not considered as suicide.9

The reason of suicide and the causes that led to self-destruction were often attributed to the forces of evil, and which overcome those with weak faith. There are however quotes like this from the teaching of St. Athanasius, in which the Saint, trying to explain what leads a man to self-destruction, simply says “these are only known by God”.11

Suicide in the Byzantine Empire

During the first centuries of the Byzantine Empire the references to suicide are associated with political upheavals and the change in the fate of the aristocracy members. The defeat in a battle or the guilt for a public crime led militaries or politicians of the Empire to choose suicide over public humiliation. The act is equivalent to common murder and the suicide’s property is confiscated.7 Then the law changed and the property was confiscated only in cases where suicide was committed to avoid the consequences of the law.12

Lausaic History of Palladius

The Church condemns suicide and forbids Christian burial, provided the perpetrators were of a sound state of mind, as in this case the suicide has surrendered his soul to the devil. Those who commit suicide on account of distress, grief or lack of courage have no right to Christian burial.13 The first mention of a suicide burial ban is cited in Lausiac History at about 419, where a priest forbids the burial of two nuns who had committed suicide.14 The suicide’s widow is excluded from bereavement and can get married immediately, while in the case of instigator, the punishment was a 10-year exile.1 Regarding the suicides’ corpses, called “viothanon” or “viothanaton” buried in Kynegion, an area where those executed in Istanbul were buried.15 Relatives should not face penance, except for abstaining from meat, they should attend the Divine Liturgy from the antechamber and finally raise a cross at the point of death of the suicide.2

Over the years the nobles’ or militaries’ suicides continued, with examples the suicides of Maximinianus Augustus, Magnentius, Arbogastes and Gerontios. For Gerontios especially, because of the fact that he was British, it was considered that he perceived “the insane of the barbarian kind” and preferred to be burned alive than surrender.16 To the antipode suicides of the ordinary people were confined among the Christians, due to the reaction of the Church, but were increased among the pagans as they were more vulnerable to violence, or because the act was considered as a form of reaction.1 The philosopher Iamblichus, having been involved in the pagan apposition, was captured by Christians and drank poison to die.1 We have now reached the time when pagans commit suicide to save themselves from Christians. The most prominent cases are those of Maximos of Ephesus, patrician Phocas, Asclepiodotos. Ordinary soldiers are often victims of depression and attempted suicide. In this case, an enquiry is conducted and in case of cowardice follows a disgraceful retirement or death.17–18 Suicides of women were also reduced and limited mainly to emotional reasons, such as loss of a loved one.1 Thus Miroslava, the daughter of the Bulgarian ruler Samuel, threatened to commit suicide if not allowed to marry her lover Ashot. There were also cases of suicides of women who could not stand living anymore with their husbands, whom they abhorred.2,19


There are references of mass suicides like those in the time of Theodosius II, when many were unable to collect the tax required by Attila,20 or when the Phrygian Montanists refused to change their religion coerced by Justinian.1 The exploitation of the poor by the rich or the debt burden often led to suicide. Since the middle Byzantine period and later, suicides are rarely mentioned in relation to the later years of the empire. This means either that there were generalized and thus ceased to be a memorable event, or that they had become more acceptable since the transition of pagans to Christianity. Perhaps suicides simply were not recorded anymore. The few references concern plots and plans of revolution in the army, as in the cases of Agallianos Kontoskelles and Eustathios Argyros.1

Suicide was rarely mentioned in medical books of the time, and according to them the reason was depression, mania or the imbalance of one of the four bodily humors.1,18 In the last centuries of the Empire the references are even more rare and the causes more accidental, such as intolerable life, avoiding execution, demons and passions. Georgios Plethon Gemistos (1360–1452) had a strange vision about suicide, which he recorded in his essay “Book of Laws”. Suicide kills only what is mortal in the immortal soul. The soul is separated from the body and thus all the vicissitudes that can affect its well being, the so-called “eudaemony”.1,21 Plethon proposes in his writings a way of “rational withdrawal”, probably influenced by the course of the Empire, a conscious attempt to escape from the grim realities of the years immediate before the Fall.1

Suicide in literature

Except from the love romances, drama and humorous texts, suicide as a literary motive is encountered in poetry. In humorous poems a crummy husband begs to drink poison in order to avoid his talkative wife.1 The bulk of reports relating to suicide were found in hagiographic literature, which is caused by demonic forces, when the victim is under spell having lost his mind and the control of himself.1 Saint Pachomius says many eremites committed suicide since they did not realize that they had been possessed by unclean.22

The therapeutic approach to suicide


Aretaeus, in his work entitled “On melancholy and On Mania”, correlates mania with crisis of melancholy and projects their periodicity, and the fact that mania frequently affects the youngsters whereas depression the elders.23 He thinks that the cause of the disease is found in the blood and bad humors,23 while especially melancholy implicates the black bile.24 However, he indicates that the main cause of the disease can be found on the nerves. Patients are calm or very serious or unreasonably inert, they get furious, they are smelly, they have agitated sleep, insomnia, irrational fear, they change opinion easily, they are shameless, petty, simplistic, prodigal, exaggerated, they avoid people, they get frightened by dreams, they complain about life, they wish death. Many people’s mental state leads to derangement and stupefaction and the feeling ends up in sorrow and depression, causing resolute anger, sadness and melancholy. Patients are suspected of poisoning and misanthropy, they are considered superstitious, they feel hatred for life and may lead to suicide.23 He is also the first to recognize the impaired function of neurovascular centers in the hypothalamus and the reticular formation,8 indicating that the patients are very slim while eating a lot, their intestines are dry without stools, their skin breaks down, the color is dark green, the pulses are small, inert, inactive, frequent as due to cold, and the urine is sparse, containing acids and bile.23

For its treatment he suggests an etiopathologic approach to the disease. Thus he removes blood from the liver, in which the black bile is produced, while, at the same time, he administers drugs that inhibit its production, such as absinthe juice. Concurrently, he places a suction cup to the head, so that a direct effect on diseased nerves is created. He also suggests a supportive treatment with proper diet, often warm baths, gentle rubbing, swinging and administration of laxatives.8,24 Vomitives are also provided for the elimination of black bile.

Aretaeus also considers that melancholy is the beginning and part of the mania, leading to convulsions and paralysis and in this case hellebore should be administered. In advanced disease asphalt, sulfur and astringent soil that contains aluminum and hydrochloric acid should be used.24 Mania is a chronic confusion of mind and the cause lies in the head and the area of hypochondria. Nocturnal emissions, lust and venereal pleasures are also characteristic symptoms. Eventually, they isolate and lament for their plight, which also can lead to suicide.23

Four Humors Drawing
Four Humors Drawing

Galen generally agrees with Aretaeus that suffering, fear, unwillingness to eat or drink, dark thoughts, are all associated with causes and symptoms of melancholy and self-destruction is a major risk.25 Galen recognised emotional states as factors in disease. Some problems were for Galen purely emotional in origin: one patient worried obsessively that the mythical Atlas would grow tired or sick and drop the sky, crushing the earth. This patient’s anxiety, according to Galen, had developed into melancholia, an overabundance of black bile, which, when accumulated in the brain, caused delirium, aggressive or suicidal behaviour and other psychological problems. Anxiety is, along with anger, the emotion Galen mentions most often as a cause of disease. Both could cause or exacerbate epilepsy; along with diet, temperament, lifestyle and environmental factors could contribute to any number of feverish illnesses; anxiety, in particular, could trigger a sometimes fatal syndrome of insomnia, fever and wasting, or transform into melancholy.26

Although Aretaeus and Galen lived on the early Byzantine Empire, their views on depression and mania survived through the centuries, and marked the therapeutic approach of these diseases.

Due to the fact that love often led to suicide, Ovid gave the remedies for love, or Remedia amoris. Some of them are that the lover should cure the wound of love when it is still fresh and new, without waiting, because being on time is almost a medicine. Moreover a lover should be busy and avoid idleness and excessive sleep. Going to the country could also help, but the lover should know that the recovery process will be very painful, mainly because he needs to forget his beloved and think ill of her, and no pills or witchcraft will alleviate the pain. A lover who wants to recover from the lovesickness should pay attention to his beloved’s faults and show no grief. Most importantly, the lover should not avoid intercourse, because if he remains alone he will become sad. Finally, a certain diet should be followed, where onions should be avoided, he should eat rue because it sharpens the eyesight and drink wine, but only the perfect amount only, otherwise the lover might feel too drowned by alcohol, or the wine might have prepared his heart for love.27

Constantine examines patients' urine
Constantine examines patients’ urine

The next generation of physicians having a great influence on Byzantine thoughts was that of the Arabic physicians. Among them were Rhazes (865–923), Haly Abbas (994) and Avicenna (980–1037), whose thoughts were developed from the Byzantine compilers. Avicenna’s work gained notice to the West by the second quarter of the thirteenth century. The thoughts of these Arabic physicians and philosophers influenced the whole world because they were translated into Latin by Constantinus Africanus (1010–1087) Constantinus recognized the three types of melancholy as indicated by Galen, and added a variety of causes and symptoms related to melancholy. With him, the association of lovesickness, acedia, and mourning with melancholy was introduced. As for the cures for all illnesses associated with melancholy, purgatives and coitus were recommended. It should be noticed that the same cures are recommended for all the illnesses likened to melancholy.28 One observes a circle with the Arabs being affected by the Byzantines and the knowledge returning filtered and refreshed to the West and Byzantium.

The seriously ill sought their healing often in sanctuaries  and if their situation persisted they resorted to sacred grounds of the church, seeking treatment by the patron Saint at the crucial moment.1 The patient’s treatment in hospitals, as for example in the Guesthouse of the Pantocrator in Constantinople, where there was a remote psychiatric ward, can be derived indirectly through the reports of the hospital of the city of Cairo (873 AD). The hospital operated according to Byzantine standards and the mentally ill were treated with extreme caution, always focusing in the bliss of the patient, that is his mental tranquility.29


The references to suicide in the Byzantine empire are numerically much less than expected and their largest number is recorded between 4th and 6th century. In late antiquity, in many cases, such as military defeat or disgrace, suicide was considered an offense consistent with the code of honor, a moral duty. During the early Christian period, suicides proliferate and sometimes are treated with sympathy. Then the attitude of both the church and the legislature hardens. Despite the strict laws though, in Greek literature resources it is not mentioned any case of indignities inflicted upon the suicide’s body or ravages and arbitrary confiscation of his property, in contrast to what happened in the Western Empire.1–2 Perhaps the attitude of the society or the medical influence in favour of the victim, overrode the law. Mental patient or mentally ill, the suicidal always triggered the society, creating feelings of sympathy or repulsion, depending on the reason and time of commitment of the act. Melancholy, mania, depression, emotional frustration, shame, demonic forces, redemption, loss, debts, religion, tortures, such diverse concepts which still all resulted in their zenith in the self-destruction of the mortal body, with the hope of a better trip of the soul in the “afterlife.”


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