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Malcolm Ingram , MD, is Retired Consultant Psychiatrist, at the Southern General Hospital , Glasgow, Scotland. He is Former Lecturer in Psychological Medicine at University of Glasgow. His research interests and publications include work on obsessional neurosis and personality, psychiatric aspects of abortion, and the efficacy of teaching. He has always had an interest in psychiatry and literature, lecturing on Johnson and Boswell and James Joyce, and also on psychiatric disorder in composers such as Schumann and Donizetti. He also studies the diary or journal as a  literary form.

On the 28th March, 1941, aged fifty-nine, she drowned herself in the river Ouse, near her Sussex home. Two suicide notes were found in the house, similar in content; one may have been written ten days earlier, and it is possible that she may have made an unsuccessful attempt then, for she returned from a walk soaking wet, saying that she had fallen. They were addressed to her sister Vanessa and to her husband Leonard. To him, she wrote:

'Dearest, I feel certain I am going mad again. I feel we can't go through another of those terrible times. And I shan't recover this time. I begin to hear voices, and I can't concentrate. So I am doing what seems the best thing to do. You have given me the greatest possible happiness. You have been in every way all that anyone could be. I don't think two people could have been happier till this terrible disease came. I can't fight any longer. I know that I am spoiling your life, that without me you could work. And you will I know. You see I can't even write this properly. I can't read. What I want to say is I owe all the happiness of my life to you. You have been entirely patient with me and incredibly good. I want to say that - everybody knows it. If anybody could have saved me it would have been you. Everything has gone from me but the certainty of your goodness. I can't go on spoiling your life any longer.

I don't think two people could have been happier than we have been.

V.'

After writing this note she left Monk's House, Rodmell - her home - at 11.30 am, taking her walking stick, and crossed the water meadows to the river, where she put a large stone in the pocket of her coat.

Her body was not recovered until the 18th April when it was discovered by children a short way downstream. Her husband identified the body, and an inquest was held the following day at Newhaven. The verdict, in the standard phrase of the time, was 'suicide while the balance of her mind was disturbed.' She was cremated privately at Brighton on 21st April, and her ashes scattered under one of the pair of elms at Monk's House.

What symptoms and events preceded her death? For how long had she been depressed? Some forty years later, her husband, Leonard Woolf, described her last year and suicide in one of the volumes of his autobiography. Feminist critics have been suspicious of his motives, but he was a pedantically accurate man who kept brief but detailed daily records of his activities throughout the marriage. His account is, at the very least, chronologically accurate, as he had access to these diaries, and to his wifes'lengthier journals, both made at the time of the events. He describes - the accurate timing is typical - '319 days of headlong and yet slow-moving catastrophe' between sending off the proofs of her biography of Roger Fry to the printers on 13th May, 1940, and her suicide on 28th March, 1941. Yet he writes that she was only ill latterly - 'loss of control of her mind began only a month or two before her suicide.' While conceding that the period between April 1940 and January 1941 was stressful for everyone, especially in Southern England, with air-raids and the mounting threat of invasion, Leonard thought 'she was happier for the most part, and her mind more tranquil than usual.'

In May and June, 1940, they had discussed between themselves and with friends what action they would take in the event of a German invasion. They had no illusions about the way in which a politically active, intellectual Jew and his wife would be treated by the Nazis. 'We agreed that if the time came we would shut the garage door and commit suicide,' Leonard wrote. In June, 1940, Adrian Stephen, her psychoanalyst brother, provided the Woolfs with lethal doses of morphine to use in the event of a German invasion. This was a joint decision by the couple, and not an indication of depression or morbid suicidal thoughts on her part. Nor did she use the morphine when she decided to end her life.

In February 1940 Virginia contracted 'influenza', and spent the first three weeks of March in bed. Such attacks were not uncommon over the last twenty years of her life. It is difficult to know if they were common colds, aggravated by bronchitis, and whether they elicited minor mood swings, which were then cautiously managed by her husband and her doctors. As in this case, the time spent in bed was often disproportionate to the diagnosis of 'influenza'. At other times these symptoms coexisted with lengthy headaches which incapacitated her, and which, unless treated with bed rest, could lead to overt mood swings.

For the rest of the year she was energetic and productive; in November, 1940, she was writing three works simultaneously. By December she had finished the draft of her last novel, Between the Acts. Her letters in that month often mention shaking hands, and by the end of the year there is a hint of depression and self-criticism when she writes to her friend and general practitioner Octavia Wilberforce: 'I've lost all power over words, can't do a thing with them.' The effects of war were being brought home to them; their London house and business in Mecklenburg Square had been bombed, and all its furniture, their papers, and their printing press arrived at the cottage, and had to be sorted and accommodated. But by early 1941 she was planning to re-read the whole of English literature and embarked on the project. In February Elizabeth Bowen visited her fellow writer, found no sign of illness and years afterwards chiefly recalled her loud laughter.

Leonard Woolf had noted the first symptoms of 'serious mental disturbance' on 25th January,1940, her birthday, while she was revising the draft of Between the Acts. She had enjoyed writing the book, finishing the first draft at the end of the previous November, and writing then: 'I am a little triumphant about the book...I've enjoyed writing almost every page.' When her final depression became entrenched, the idea that the book was a failure became a firm conviction, but during this revision the fear arose, only to pass off after ten or twelve days.

Leonard always took immediate action. 'For years I had been accustomed to watch for signs of danger in V's mind; and the warning symptoms had come on slowly and unmistakeably; the headache, the sleeplessness, the inability to concentrate. We had learnt that a breakdown could always be avoided, if she immediately retired into a cocoon of quiescence when the symptoms showed themselves. But this time there were no warning symptoms.' The only other breakdown to have a sudden onset had been in 1915 - her most severe and lengthy illness.

The writer John Lehmann, at that time working for the Woolfs at the Hogarth Press, saw her in the weeks before her death, and received one of Virginia's last letters. He had been asked to read the final draft of Between the Acts, and by this time she was convinced that the book was worthless. In his Recollections Lehmann describes her state of mind in March, 1941. 'I became more and more conscious of the fact that Virginia seemed unusually tense and nervous, her hand shaking now and then, though she talked absolutely clearly and collectedly.' She had brought the draft of Between the Acts, and 'Virginia immediately began, now rather confusedly, to say that it was no good at all, couldn't be published, must be scrapped. Very gently, but with great determination, Leonard rebuked and contradicted her...'

In the next few days Lehmann read the draft of the novel: 'The first thing tht I noticed was that the typing - her own typing - and the spelling were more eccentric, more irregular than in any typescript of hers I had seen before. Each page was splashed with corrections, in a way that suggested that the hand that had made them had been governed by a high voltage electric current.'

Lehmann then received a letter from her saying the book was silly and trivial, and couldn't be published, with a covering letter from Leonard saying that she was on the verge of a breakdown. Both were probably written the day before her death. 'By the time they reached me it was all over.....I was aware ...of an undertow of sadness, melancholy, of great fear, but the main impression was of a creature of laughter and movement.'

Another witness was her general practitioner, Octavia Wilberforce, a descendant of William Wilberforce. At that time she was also running a dairy farm near at hand, and for some months had kept the Woolfs supplied with extra butter and cream in that time of shortages. She had visited Monks House frequently from January 1941 on, but a formal consultation did not take place until 17th March. Three days earlier Virginia had discussed one of her last short stories with Dr Wilberforce and told her that it had left her 'desperate - depressed to the lowest depths.'

Dr Wilberforce when newly qualified worked as a locum physician in Graylingwell Asylum for a month or two, but her psychiatric knowledge, like that of most doctors at the time, was rudimentary, although she had read some Freud. At Leonard's request she examined Virginia on the 26th March, the day before her death. The doctor was ill with influenza and rose from her sick-bed for the consultation. Virginia told her that it was 'quite unnecessary to have come' and did not answer her questions frankly. She was generally 'resistive', and demanded a promise that she would not be ordered to have a 'rest cure' - that is, an admission to a psychiatric nursing home - before she would submit to a physical examination.

Octavia Wilberforce, in letters written over the next few days is obviously taken aback by the suicide. She phoned a physician friend for reassurance. On the 28th she wrote: 'I am haunted by V and my own failure ot help'. She visited Leonard who told her that when he married he knew nothing of her 'affliction'. He told her of its recurring nature, the many opinions they had had, and of her happy nature. On the 29th she visited him again, when he told her that after their visit on the 26th Virginia seemed cheerful and quite different.

But she had been depressed earlier. and not only for the ten or twelve days noted by her husband. Her diary for the 8th March reads: 'I mark Henry James's sentence: Observe perpetually. Observe the oncome of age. Observe greed. Observe my own despondency. By that means it becomes serviceable.'

Whatever the duration, Leonard was seriously concerned about her by the 17th of March. She was able to dissemble. Even after that date she wrote coherent and cheerful letters to a number of friends. She probably tried to conceal her depression and her suicidal ideas from her doctor and her husband. Dr Wilberforce saw her earlier on the 22nd March. Virginia had wanted to interview her about one of her relatives - a cousin Octavia - planning to write a portrait of her. At that time Virginia was proccupied with her own forebears, especially her father. Dr. Octavia tried to jolt her by telling her she was her own worst enemy. She wrote later: 'I thought this family business was all nonsense, blood thicker than water balderdash. Surprised her anyway.' It is clear that the doctor had no inkling of the imminent suicide. At this point Leonard cannot have informed her in detail about his wife's previous history, especially her past suicidal attempts, or their serious nature.

Some critics have made much of the war and the threat of invasion as 'causes' of her suicide. Immediately after her death Leonard and Octavia Wilberforce felt that the war had reminded her of her illness in the first world war. Current events turned her mind to death, but not to suicide, until near the end. Only six months before her death, on 2nd October 1940, she made an entry in her journal, during a time of air-raids, imagining what it would be like to die in one. 'I shall think - oh I wanted another ten years - not this.....'

She recorded her views on suicide, while in good health, in the thirties, in correspondence with the composer Ethel Smyth, one of the few friends in whom she confided about her past illnesses. On 30 10 30 she wrote: 'By the way, what are the arguments against suicide? You know what a flibberti-gibbet I am: well there suddenly comes in a thunder clap a sense of the complete uselessness of my life. It's like suddenly running one's head against a wall at the end of a blind alley. Now what are the arguments against that sense - "Oh it would be better to end it"? I need not say that I have no sort of intention of taking any steps: I simply want to know.....what are the arguments against it?'

Six months later, on 29 3 31, she returns to the subject: 'Why did I feel violent after the party? It would be amusing to see how far you can make out, with your insight, the various states of mind which led me, on coming home, to say to L:- "If you weren't here, I should kill myself - so much do I suffer."'

A few days later she heard Beatrice Webb discussing suicide, and on 8th April wrote to her: 'I wanted to tell you but was too shy, how much I was pleased by your views upon the possible justification of suicide. Having made the attempt myself, from the best of motives as I thought - not to be a burden on my husband - the conventional accusation of cowardice and sin has always rather rankled.

Suicide was an ever-interesting topic, and she could regard it with cool detachment when she was well, although she allows herself here to believe that her past attempt was reasonable and altruistic.. As for death, her adolescence was so replete with deaths of parents and siblings that for the rest of her life she felt the presence of the dead, and their memory, as strongly as that of the living, to the extent that her sense of reality was sometimes disturbed by the vividness of the past.

From these accounts an accurate diagnosis of her final illness can be made. From the suicide note alone, most psychiatrists would make a confident diagnosis of severe depression. She says that she is not only depressed, but going 'mad' again; she is beginning to hear voices. She can't concentrate, can't read or write. She shows self-blame, believing that she is spoiling her husband's life. She feels hopeless, can't go on any longer. She believes suicide is the best course. Lehmann's memoir shows that her self-criticism was quite unjustified, exemplified by her low opinion of her novel which she had thought well off a few months earlier. Reassurances about the book and about her recovery had been frequent and unavailing. When examined by Dr Wilberforce the day before her death, she had at first refused to discuss her symptoms or to admit that there was anything wrong. Each of these symptoms is typical of severe depression. The only atypical item in the letter is her clear admission that she is ill - that she is going mad and has a 'terrible disease'.

With this well-documented, and ultimately fatal episode in mind, it will be easier to trace the long and complicated history of her past attacks, both serious and mild.

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