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An Epidemic of Death

Review of “Night Falls Fast: Understanding Suicide,” by Kay Redfield Jamison

Night Falls Fast, by Kay Redfield Jamison

Kay Redfield Jamison’s first publications were scientific papers and a massive textbook, and her writings for a more popular audience cleave to clean research standards even as they indulge the literary and the personal. An Unquiet Mind, her meditation on manic-depressive illness, eloquently describes a disease that is primarily biological in its origins. The book combines clinical data with confessional prose to evoke both horror and insight. Touched With Fire addresses the evolutionary questions around mental illness, and shows the flip side of that horror: inspired imagination and joyful creativity. Night Falls Fast braves the impossible topic of suicide. It is at once the most relentless and the most sympathetic book she 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 that makes us so uncomfortable that we willfully divert our attention from it. Every 17 minutes, she reports, someone in the United States commits suicide. Suicide ranks No. 3 among causes of death for young people generally, and it is No. 2 for college students. In 1995 (for example) more young people died of suicide than of AIDS, cancer, stroke, pneumonia, influenza, birth defects and heart disease combined. During the period from 1987 to 1996, more men under 35 died of suicide than of AIDS. Half a million Americans are taken to hospitals every year because of suicide attempts. Suicide was, according to the World Health Organization, responsible for almost 2 percent of deaths worldwide in 1998, which puts it well ahead of war and way ahead of homicide. And the rate of suicide is climbing steadily. One recent study showed that within its geographic area, the likelihood of a young man committing suicide has increased by 260 percent since the 1950’s. Half of those with manic-depressive illness will make a suicide attempt; one in five people with major depression will do the same.

Jamison balances the organic causes of suicide with the social ones. Neurological damage to the fetus, caused by alcohol or cocaine use, may predispose children to mood disorders that lead to suicide; lack of maternal attention may deprive them of early developmental stability; diet may work adversely on their brains. Genes not only for mental disease but also for impulsivity, aggression and violence may open them up to heavy risk. Jamison hopes that developing forms of biological analysis and neuro-imaging may someday lead us to the point at which we can identify the potentially suicidal brain long before suicidal action itself takes place, and offer protection.

Meanwhile, however, we could do a mammoth amount more than we do. Jamison attacks those in whom she sees intellectual or moral lapses with a clarity and wit so acerbic, so devastating and so precisely directed at its targets that one might think it had been developed by the United States military. She excoriates researchers who suggest that current technologies are adequate: “For scientists . . . to minimize the complexity of the chemical interactions within the brain or at the synapses would be a damning mistake, a late-20th-century equivalent of earlier, primitive views that deranged minds were caused by satanic spells or an excess of phosphorous and vapors.” She is equally outraged by sensationalist media that separate suicide from mental illness, and that carelessly foster suicidal ideas in their audience. And she turns the whole force of her wrath on the American health care system, which increasingly denies sufficient coverage and adequate therapy to the mentally ill.

Jamison shows that we are really limited in dealing with suicide only insofar as “the privacy of the mind is an impermeable barrier.” She proposes a reconception of both strategy and care. “Psychiatric commitment laws protect civil liberties but not necessarily lives,” she writes. “We have filled these netherlands past any pretense of civilization; we have swollen their ranks with the psychotic and the incapacitated, taken the hopeless and made them more so, and then we have disregarded what they need to survive. We have released the severely mentally ill onto our streets, and they have come to make up a third to a half of our country’s homeless. They disturb the well who share their streets and perplex city managers. They make us uncomfortable, but not so uncomfortable that we protect or house, insure or tend or heal them.”

The accounts of specific suicides in this text are exquisitely elegiac. Jamison tells the painful story of her own suicide attempt at a time when her thought was as disrupted as her mood: “No amount of love from or for other people — and there was a lot — could help. No advantage of a caring family and fabulous job was enough to overcome the pain and hopelessness I felt; no passionate or romantic love, however strong, could make a difference. Nothing alive and warm could make its way in through my carapace. I knew my life to be a shambles and I believed — incontestably — that my family, friends and patients would be better off without me. There wasn’t much of me left anymore, anyway, and I thought my death would free up the wasted energies and well-meant efforts that were being wasted in my behalf.”

Jamison notes that suicide is catching, and avers that one death often enables many others, as localized suicide epidemics have indicated. If suicide is contagious, is not Jamison’s book itself a potential source of infection? Her evocations of the suicidal mind invite too much empathy at times; her eloquence can be dangerous, and I felt a will to self-destruction rise in me as I read on. If the material is somewhat toxic for the reader, however, it must have been more poisonous for the author. It is something to have lived through the writing of this book; it took at least as much courage to write Night Falls Fast as it does to live through the woe that has afflicted Jamison’s living subjects.

Jamison is scrupulously unsentimental, but the true feelings behind this book — frustration, loss, abomination, love, dignity — are constantly evident despite the constraint her science places on them. It is as though her rational mind were a set of ropes employed to tie down emotional truths that would be unbearable if they were set fully free. At the end of Night Falls Fast, Jamison writes, “I wanted to do something about the untolled epidemic of suicide, and the only thing I knew to do was to write a book about it.”

The doctors who helped her to survive saved not only her own life but also, since she was to create this literate exposition of souls that lose themselves, the lives of others. The essence of this book is an astonishing generosity. Though it will not radicalize society as it would like to, it will doubtless improve the grim statistics it reports. Also, since Jamison speaks with deep compassion of those who are left behind after a suicide, her book will allow survivors more easily to forgive themselves and find a way forward.

She ends Night Falls Fast with a line from the poet Douglas Dunn: “Look to the living, love them, and hold on.” Jamison herself has learned to hold on so that she may remain among the living, and her cry for fellows in that struggle is piercing. She learned something glowing and invaluable from the close brush with self-inflicted death that drives her and that will impel her readers; and so she writes not only in fierce opposition to suicide, but also in passionate vindication of life, no matter how onerous it may sometimes be.