Looking at Suicide
"I wish I could explain it so someone could understand it," an unnamed woman scratches in her suicide note. "There's just this heavy, overwhelming despair -- dreading everything." She concludes: "I wish that I could disappear without hurting anyone. I'm sorry."
Suicide tends to overwhelm people -- victims, survivors, anyone. Our minds instinctively recoil from it. But in Night Falls Fast: Understanding Suicide, Kay Redfield Jamison guides us through the issue safely, leading us from unnamed anxieties to a broad, comprehensive perspective.
Jamison's last book, a bestselling memoir of manic depression titled An Unquiet Mind, brought the mysteries of psychopathology home through an understated, personal account. But in Night Falls Fast, Jamison bonds personal and clinical experiences even more potently. She describes individual cases poignantly but sets those tales within a grid of information.
Suicide isn't just a single, isolated pain, Jamison explains, but a societal epidemic with recognizable symptoms. Worldwide, suicide is the second leading cause of death among females aged 14 to 44, and for males it ranks fourth. In Night Falls Fast, Jamison adjusts personal experiences into these patterns, carefully accounting for the psychological, biological, and societal factors. She shows us which people are most at risk for suicide and how those people can be overwhelmed by compounded distress. The stories hurt, each one, but then they make sense.
Throughout the book, Jamison argues that suicide cannot be treated as merely a rejection of life's meager portions. In one of the book's most moving passages (the chapter on suicide notes) we hear suicide victims trying carefully to relieve their friends of responsibility. "No one is to blame for my doing this," a 20-year-old desperately assures her survivors. "It's just that I could never become reconciled with life itself. God have mercy on my soul."
Although each note stings, together they form Jamison's argument: People tend to commit suicide to end prolonged depression, not to avoid problems. Often, suicides speak of lifelong battles against forces they cannot understand or control; novelist William Styron explains, "The gray drizzle of horror induced by depression takes on the quality of physical pain...comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room." Suicide seems, then, no cowardly response to manageable issues, but the last stage of a long and debilitating disease.
By seeing suicide as an epidemic, Jamison suggests, we as a society can avoid feeling so overwhelmed by it. "My hope," she explains, "was to find a way to maintain an individual perspective -- through an emphasis on the psychology of suicide and an extensive use of the words and experiences of those who seriously attempted to, or eventually did, kill themselves -- but to keep that individual perspective firmly grounded in the sciences of psychopathology, genetics, psychopharmacology, and neurobiology."
And she has done just that. The book first invokes Jamison's friend Jack Ryan, a manic-depressive overwhelmed by suicidal urges and unable to seek help. Next, Jamison offers a historical, global perspective on suicide, helping the reader to see just how personal and how planetary suicide can be. In the bulk of the book, she then breaks the problem into three manageable chunks: the psychology of suicide, the biology of suicide, and the prevention of suicide.
In the first section, Jamison considers how people decide to self-destruct. She catalogues how a suicide explains his feelings, how muddied perspectives and life troubles collaborate in his downfall, how illnesses erode his ability to cope, and how he finds a way to end his struggle.
The second section of the book focuses on the physical characteristics of suicides. After a quick look at suicide as an evolutionary dilemma, Jamison helps us to pick through scientific data of suicides' genetics. She then patiently explains the basics of neurobiology: how various neurotransmitters can run afoul and how they can be treated.
The third section considers the social problem of suicide. Jamison sympathizes with the shame and confusion of survivors, while pressing us to recognize how we can reduce the death toll. Doctors can become more finely attuned to the warning signs, she insists. Common catalysts -- like guns, alcohol, and pills -- can be better monitored. New drugs can pull patients through the most dangerous stages of depression.
As Jamison admits at the close of Night Falls Fast: "Looking at suicide...is harrowing." But with her erudite and patient guidance, readers really can orient themselves in the confusing rush of emotion, science, and statistics that accompany suicides. Through reading Jamison's sensitive study, we can pass from feeling overwhelming confusion to feeling fortified by overwhelming evidence. The subject is difficult, but Jamison's controlled, smooth writing and sure-minded analysis make this an important book for everyone to read.
At once the most relentless and the most
sympathetic book Jamison has produced, written
with an edifying urgency that surpasses her
previous volumes. Jamison persuasively uses
numbers to demonstrate that suicide is a vast
public health crisis...
NY Times Book Review
Publishers Weekly - Publisher's Weekly
Providing historical, scientific and other helpful material on suicide, Jamison (An Unquiet Mind), a Johns Hopkins psychiatry professor, makes an excellent contribution to public understanding with this accessible and objective book. There is, she asserts, a suicide every 17 minutes in this country. Identifying suicide as an often preventable medical and social problem, Jamison focuses attention on those under 40 (suicides by those who are older often have different motivations or causes). Citing research that suicide is most common in individuals with mental illness (diagnosed or not), particularly depression and manic depression, she clearly describes the role of hormones and neurotransmitters as well as potential therapies, including lithium and other antidepressants. Jamison presents fascinating facts about suicide in families and in twins, gender disparities, and the impact of the seasons and times of day. She also provides poignant portraits of those who have committed suicide--from the explorer Meriwether Lewis to a high-achieving Air Force Academy graduate--as well as stories from her own experience. Historical perspective on how different societies have viewed suicide gives context, especially on methods and common locales (in the U.S., San Francisco's Golden Gate bridge is the most popular spot). Critical of her profession for not recognizing suicidal tendencies more readily, Jamison scolds the media and firearms industry as well. The book effectively brings suicide out of the closet, gives general readers insight into symptoms and should increase national awareness of the problem. (Oct.) Copyright 1999 Cahners Business Information.
Author of An Unquiet Mind, Kay Redfield Jamison knows her subject. As an MD and Professor of Psychiatry at Johns Hopkins University School of Medicine, Jamison is an excellent researcher. As a manic depressive, she knows the blackness of the suicidal mind-set. She therefore approaches her subject with both organization and empathy. Her book, as she describes it, is about suicide as a social as well as a medical problem. "Specifically, it is about why suicide occurs, why it is one of our most significant health problems, and how it can be prevented" (p.21). Jamison focuses on the prevalence of suicide in those under 40. Suicide is the second leading cause of death among college students, third among the general population of the young; it is a more consistent killer of the young than either war or AIDS and is treated as a virus by the Center for Disease Control. Jamison carefully examines first the psychology, then the biology, of suicide before she tackles the problems and questions of prevention, balancing research statistics with case studies and even anecdotes from her personal experience. Because of its topic, this is a difficult book. The reader's progress, however, is eased not only by Jamison's expertise and depth of feeling, but also by the elegant flow of her prose. This is a must read for teachers of the young. KLIATT Codes: ARecommended for advanced students, and adults. 1999, Random House/Vintage, 432p, notes, index, 21cm, 99-311227, $14.00. Ages 17 to adult. Reviewer: Patricia A. Moore; Academic Resource Ctr., Emmanuel College, Boston, MA (retired), March 2001 (Vol. 35 No. 2)
Jamison--herself a manic-depressive who has attempted suicide and now a professor of psychiatry at Johns Hopkins School of Medicine--brings a special urgency to this study. The personal and the professional blend seamlessly here, allowing Jamison to illuminate the darkest recesses of the human mind. The result is forthright, moving, and impressively unsensational. (LJ 10/1/99) Copyright 2000 Cahners Business Information.
An internationally recognized authority on depressive illnesses, and a survivor of suicide, weaves together a psychological and scientific exploration of suicide with personal essays about individual suicides. She traces the reasons underlying suicide, looking into the journals, drawings, and farewell notes of suicides, and discusses biological and psychological factors in suicide and new treatments for mental illness. The author is a professor of psychiatry at the Johns Hopkins University School of Medicine, as well as honorary professor of English at the University of St. Andrews in Scotland. Annotation c. Book News, Inc., Portland, OR (booknews.com)
Suicide rates for Americans under 40, the cohort on which this book focuses, have tripled in the past 45 years. Although it makes no attempt to explain why this is so, this is a superb interdisciplinary look at self-murder. Janison (Psychiatry/Johns Hopkins School of Medicine), author of the bestselling memoir An Unquiet Mind (1995) about her own struggle with manic-depressive illness, here looks at suicide through literary, historical, anthropological, psychological, biochemical, genetic, and epidemiological lenses. She emphasizes the highly disproportionate suicide rates among those suffering from the major mental and mood disorders of depression, manic-depression, and schizophrenia. Jamison also notes a continuum running from risk-taking behavior to suicidal thoughts to actually killing oneself and notes that while approximately 30,000 Americans commit suicide each year, 500,000 attempt to do so ("Ambivalence saturates the suicidal act," she writes). With much interesting anecdotal material and data from the vast scientific literature on suicide, Jamison ranges far and wide over such topics as suicide notes, national styles in killing oneself (the Germans favor hanging, while in the US, guns are used in about 60 percent of suicides), and seasonal factors (contrary to popular belief, most suicides take place not during winter but during the late spring and summer). Her study is also greatly enhanced by several essays, in which Jamison delves into the suicide of noteworthy people. She writes particularly insightfully on the difficulty of predicting suicidal behavior and on the sensibility of the suicide, who usually lives with an anguished "sense of the unmanageable, of hopelessness,of invasive negativity about the future." Although her data on suicide sometimes seem overwhelming and a few individual statistics a bit loose, Jamison's book generally is a very well written, substantial, and consistently interesting study of a wrenching existential and societal problem that has reached epidemic proportions. (First printing of 175,000)
From the Publisher
"Jamison writes with authority, clarity and clinical reserve. Powerful as her medicine is, her poetic accounting of this dark death is more affecting still."Baltimore Sun
"Jamison brings us face to face with the suicidal mind in a manner so intense and penetrating that, paradoxically, the immersion in despair she offers is a source of great pleasure."The Washington Post Book World
"This powerful book will change people's livesand, doubtless, save a few."Newsday
"A profound and impassioned bookit will stand as the authoritative study of suicide for many years."William Styron, author of Darkness Visible
"[Jamison] writes not only in fierce opposition to suicide, but also in passionate vindication of life."The New York Times Book Review
Read an Excerpt
Summer evenings at the Bistro Gardens in Beverly Hills tended toward the long and languorous. My friend Jack Ryan and I went there often when I lived in Los Angeles, and I invariably ordered the Dungeness crab and a scotch on the rocks. Not so invariably, but from time to time, Jack would use the occasion to suggest we get married. It was an idea with such patent potential for catastrophe that neither of us had much of an inclination to take the recurring proposal with too much gravity. But our friendship we took seriously.
This particular evening, having hooked and tugged out the last bits of crab, I found myself edgily knocking the ice cubes around in my whisky glass. The conversation was making me restless and uneasy. We were talking about suicide and making a blood oath: if either of us again became deeply suicidal, we agreed, we would meet at Jack's home on Cape Cod. Once there, the nonsuicidal one of us would have a week to persuade the other not to commit suicide; a week to present all the reasons we could come up with for why the other should go back on lithium, assuming that having stopped it was the most likely reason for the danger of suicide (we both had manic-depressive illness and, despite the better and often expressed judgment of others, had a tendency to stop taking our lithium); a week to cajole the other into a hospital; to invoke conscience; to impress upon the other the pain and damage to our families that suicide would inevitably bring.
We would, we said, during this hostage week, walk along the beach and remind the other of all of the times we had felt at the end of hope and, somehow, had come back. Who, if not someone who had actually been there, could better bring the other back from the edge? We both, in our own ways and in our own intimate dealings with it, knew suicide well. We thought we knew how we could keep it from being the cause of death on our death certificates.
We decided that a week was long enough to argue for life. If it didn't work, at least we would have tried. And, because we had years of cumulative experience with lifestyles of snap impetuousness and knew how quick and final a suicidal impulse could be, we further agreed that neither of us would ever buy a gun. Nor, we swore, would we under any circumstances allow anyone else to keep a gun in a house in which we lived.
"Cheers," we said in synchrony, ice and glass clinking. We sealed our foray into the planned and rational world. Still, I had my doubts. I listened to the details, helped clarify a few, drank the rest of my scotch, and stared at the tiny white lights in the gardens around us. Who were we kidding? Never once, during any of my sustained bouts of suicidal depression, had I been inclined or able to pick up a telephone and ask a friend for help. Not once. It wasn't in me. How could I seriously imagine that I would call Jack, make an airline reservation, get to an airport, rent a car, and find my way out to his house on the Cape? It seemed only slightly less absurd that Jack would go along with the plan, although he, at least, was rich and could get others to handle the practicalities. The more I thought about the arrangement, the more skeptical I became.
It is a tribute to the persuasiveness, reverberating energies and enthusiasms, and infinite capacity for self-deception of two manic temperaments that by the time the dessert soufflés arrived we were utterly convinced that our pact would hold. He would call me; I would call him; we would outmaneuver the black knight and force him from the board.
If it has ever been taken up as an option, however, the black knight has a tendency to remain in play. And so it did. Many years later -- Jack had long since married and I had moved to Washington -- I received a telephone call from California: Jack had put a gun to his head, said a member of his family, and "put a bullet through his brain."
No week in Cape Cod, no chance to dissuade. A man who had been inventive enough to earn a thousand patents for such wildly diverse creations as the Hawk and Sparrow missile systems used by the U.S. Department of Defense, toys played with by millions of children around the world, and devices used in virtually every household in America; a Yale graduate and lover of life; a successful businessman -- this remarkably imaginative man had not been inventive enough to find an alternative solution to a violent, self-inflicted death.
Although shaken by Jack's suicide, I was not surprised by it. Nor was I surprised that he had not called me. I, after all, had been dangerously suicidal myself on several occasions since our Bistro Gardens pact and certainly had not called him. Nor had I even thought of calling. Suicide is not beholden to an evening's promises, nor does it always hearken to plans drawn up in lucid moments and banked in good intentions.
I know this for an unfortunate fact. Suicide has been a professional interest of mine for more than twenty years, and a very personal one for considerably longer. I have a hard-earned respect for suicide's ability to undermine, overwhelm, outwit, devastate, and destroy. As a clinician, researcher, and teacher I have known or consulted on patients who hanged, shot, or asphyxiated themselves; jumped to their deaths from stairwells, buildings, or overpasses; died from poisons, fumes, prescription drugs; or slashed their wrists or cut their throats. Close friends, fellow students from graduate school, colleagues, and children of colleagues have done similar or the same. Most were young and suffered from severe illness; all left behind a wake of unimaginable pain and unresolvable guilt.
Like many who have manic-depressive illness, I have also known suicide in a more private, awful way, and I trace the loss of a fundamental innocence to the day that I first considered suicide as the only solution possible to an unendurable level of mental pain. Until that time I had taken for granted, and loved more than I knew, a temperamental lightness of mood and a fabulous expectation of life. I knew death only in the most abstract of senses; I never imagined it would be something to arrange or seek.
I was seventeen when, in the midst of my first depression, I became knowledgeable about suicide in something other than an existential, adolescent way. For much of each day during several months of my senior year in high school, I thought about when, whether, where, and how to kill myself. I learned to present to others a face at variance with my mind; ferreted out the location of two or three nearby tall buildings with unprotected stairwells; discovered the fastest flows of morning traffic; and learned how to load my father's gun. It was not the kind of education one expected to receive in high school.
The rest of my life at the time -- sports, classes, writing, friends, planning for college -- fell fast into a black night. Everything seemed a ridiculous charade to endure; a hollow existence to fake one's way through as best one could. But, gradually, layer by layer, the depression lifted, and by the time my senior prom and graduation came around, I had been well for months. Suicide had withdrawn to the back squares of the board and become, once again, unthinkable.
Chillingly, although the privacy of my nightmare had been of my own designing, no one close to me had any real idea of the psychological company I had been keeping. The gap between private experience and its public expression was absolute; my persuasiveness to others was unimaginably frightening.
Over the years, my manic-depressive illness became much worse, and the reality of dying young from suicide became a dangerous undertow in my dealings with life. Then, when I was twenty-eight years old, after a damaging and psychotic mania, followed by a particularly prolonged and violent siege of depression, I took a massive overdose of lithium. I unambivalently wanted to die and nearly did. Death from suicide had become a possibility, if not a probability, in my life.
Under the circumstances -- I was, during this, a young faculty member in a department of academic psychiatry -- it was not a very long walk from personal experience to clinical and scientific investigation. I studied everything I could about my disease and read all I could find about the psychological and biological determinants of suicide. As a tiger tamer learns about the minds and moves of his cats, and a pilot about the dynamics of the wind and air, I learned about the illness I had and its possible end point. I learned as best I could, and as much as I could, about the moods of death.
From the Hardcover edition.