"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.