Sir: Dr Gordon's paper (Psychiatric Bulletin, August 2002, 26, 285-287) on the suicide bomber is a cogent reminder that psychiatrists are sometimes guilty of trying to explain all disagreeable and unusual behaviour in terms of disorder. This tendency to medicalise behaviour was challenged last century by Émile Durkheim, who refuted the prevailing view that suicide was always associated with mental illness and the assertion that people who kill or damage themselves do so because of the temporary disturbance of mind, and raises philosophical as well as psychiatric issues.

In contemporary psychiatry, the notion that suicide must be ‘due to illness’ is reinforced by classification systems such as ICD-10 (World Health Organization, 1992) and by ‘rating scales’ implying severity of disorder. Durkheim identified several social dynamics that could lead to suicide and it is the category of altruistic suicide that neatly describes suicide bombers. Altruistic suicide refers to self-inflicted death owing to powerful beliefs, resulting in individuals losing their sense of autonomy. When a central belief that life is but a temporary prelude to everlasting utopian existence is one of these regulatory norms, the definition of suicide itself becomes ambiguous and the role of psychiatry as a valid therapeutic intervention is also questionable.