In 1918-19, the ‘Spanish Flu’, sometimes also known as the ‘Spanish Lady’, is estimated to have killed over 50 million people worldwide. What is less well-known is that many others succumbed to its effects on mental wellbeing and died by suicide as a result. Indeed, while there is no evidence, thus far, to show that COVID-19 has had such an impact, there is extensive historical evidence to demonstrate that the illness was considered complicit in numerous suicides around the globe. What is also evident is that influenza was in many cases not a lone actor, but part of a cast that included personal, social and economic factors. Whilst Spanish Flu and COVID-19 are very distinct viruses, they can be seen to echo one another in their complex impact on mental health. The Institute for Mental Health at the University of Birmingham holds vital expertise in contemporary self-harm and suicidality. What might an exploration of such behaviours in the wake of a historical pandemic offer to researchers and, more pointedly, to those fetishizing medicine without recourse to wider experience and knowledge? Professor Chris Whitty, England’s Chief Medical Officer, recently said that ‘science will in due course ride to our rescue’, and others have since more-floridly echoed his rhetoric; but what if that jockey has no saddle to steady them and no insight as to what comes after jumping the fence?
Building on recent historical research at the University into coroners inquests, as well as expertise in the history of psychiatry here and at the University of Huddersfield, we have begun to consider the influence that previous pandemics have had on mental health. Through an exploration of historic newspapers from Britain, Ireland, Australia, and the United States, we can see that people at the time saw a clear correlation between pandemics and suicide, even in the nineteenth century.
During the ‘Russian Flu’ of the 1890s, for example, lethargy, lassitude, nervousness, neurasthenia and psychosis were amongst the list of psychological impacts well-known to physicians, but there was often the more general hope that these would be temporary or short-lived. In October 1918, in one Australian newspaper, a commentator on the Spanish Flu was at pains to stress:
… there is no need for despair about one's weakness or depression—as the poisons of the disease are eliminated from the system the accustomed vigour and ability are bound to return. This is a fact. And I state it because (for want of faith in this respect) not a few suicides have occurred.
This, however, was to underestimate the virus’s longer-term effects on its victims’ mental health. In each of the countries we have explored, we have found evidence of people labouring under post-influenzal depression and of lives made unbearable, even after the infection had passed. Within this context, the c.1918 image of a ‘new flu’ monster hitting a man on the head is particularly apposite, especially as we might expect images to be much clearer in their links between the flu and its appalling symptoms of respiratory failure. Newspaper headlines described individuals who were ‘crazed by influenza’, and who turned to suicide as a ‘cure’. While this may be shocking to some reading this blog today, we can begin to get a sense of some of the often-overlooked individual responses to the pandemic, but the choices around suicide were often more complex. For instance, the Hackney Gazette reported in January 1919 that ‘a young Hackney woman [died by] suicide after recovering from the 'flu. She had stated that she felt she would never be well again, and did not want to burden her family and fiancé’. In cases such as these, it is difficult to know what impact the First World War must have had on everyday lives and mental wellbeing. Following the devastating losses in the conflict, tens of thousands of people turned to spiritualism in a bid to seek answers, but if the senseless loss of life played a part in post-influenzal suicide, that information seems lost in what had simply become matter-of-fact for everyone. In 1921, an Australian woman, Jesse (47), an insurance collector, drowned herself in a river, leaving a note saying she felt ‘“too ill to carry on”’. In Britain, Sir Howard (55) took his life in 1926 after repeated bouts of flu had left him depressed and “worrying very much about his health”.
While the devastating effect on mental wellbeing is clear to see in these examples, the belief that pandemics leave only a relatively short-term trace on both the body and the mind are not borne out by the evidence. Within that longer-term story, the links between suicide and infection can be missed and historical data such as this enables us to shed a light on the implications of physical infection. The evidence presented here recognises the people behind what are often bare statistics on infection and mortality rates. Certainly, we can see there was a substantial minority of individuals affected by what we might call ‘Long Spanish Flu’, to borrow a phrase from the current discussions.
However, historian Mark Honigsbaum reminds us of the cultural contingency of disease. The ‘psychoses of flu’ have been long abandoned by psychiatry, and with them observations of the psychological impact of flu, and patients’ ‘phenomenological experience’. Considering current findings, as well as the rediscovery of viral influence on inflammation and its connection to mental health, we suspect that that Honigsbaum’s concern surrounding recording experience is now misplaced. Whilst past pandemic-related suicide might on the surface cut across nation, gender and class, our work will drill down further into the historical data to reveal the nuances behind suicidal reasoning. Through deeper scrutiny of the methodologies and the language used around these deaths, as well as social and geographic considerations, we will contribute to the IMH’s work in understanding the culture and decisions underpinning suicidality in the age of Covid.
 ‘Chief Scientific Advisor and Chief Medical Officer Briefing on Coronavirus (COVID_19): 21 September 2020’, Prime Minister’s Office, 10 Downing Street, Department of Health and Social Care, and Sir Patrick Vallance (accessed: 25/09/2020), https://www.gov.uk/government/speeches/chief-scientific-advisor-and-chief-medical-officer-briefing-on-coronavirus-covid-19-21-september-2020--2.
 ‘Forged by Fire: Burns Injury and Identity in Britain, c.1800-2000’, AHRC Standard Grant, AH/N0064X/1 (accessed: 30/10/2020), https://www.birmingham.ac.uk/research/applied-health/research/forged-by-fire.aspx
 The authors are grateful to the University of Huddersfield’s Covid-19 Project Awards for the funds to carry out some of this research.
 ‘Some Health Notes: Influenza’, The Geelong Advertiser, October 1918, p. 9.
 ‘Crazed by Influenza, Man Commits Suicide’, New Britain Herald, 18 December 1918, p. 1; ‘Suicide Cure for Influenza’, Harrisburg Telegraph, 22 January 1919, p. 5.
 Andrea Tanner, ‘The Spanish Lady Comes to London: The Influenza Pandemic 1918–1919’, The London Journal: A Review of Metropolitan Society Past and Present, 2002, 27 (2), 51-76, n.45 p. 72.
 ‘Influenza Victim’s Suicide’, The Evening Journal [Adelaide], 22 October 1921, p. 5.
 Rob Ellis, Rebecca Wynter and Rob Light, 'Body and Mind: Are we adequately prepared for the toll this pandemic will take on mental health?', History Today, October 2020, https://www.historytoday.com/archive/behind-times/body-and-mind (accessed: 29/10/2020).
 Mark Honigsbaum, ‘The art of medicine: “An inexpressible dread”: psychoses of influenza at fin-de-siecle’, The Lancet, 381 (23 March 2013), 988-989, 989.