From Library Journal
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.
Copyright 2000 Reed Business Information, Inc.
In An Unquiet Mind (1995), Jamison took personal and professional risks in revealing that she, a professor of psychiatry at Johns Hopkins, suffered from manic-depressive illness and in detailing her symptoms and her travails with medication. And she indeed set off a storm of controversy within and beyond the mental health community. Her new book is a scholarly piece of work whose appeal nevertheless extends far beyond a professional readership. It is a study of the possible relationship between manic-depressive illness and the artistic temperament, especially as it affects suicide. Besides the psychology and psychopathology of suicide, Jamison discusses her own suicide attempt years ago, and she concludes that mood disorders, alone or combined with substance abuse, are the complex of conditions most commonly associated with suicide. Jamison also studies the methods of suicide and their relative popularity; in America, firearms are used in more than 60 percent of all suicides. Jamison presents information on genetic factors predisposing one to suicide and inspects the all-important role of serotonin levels in the brain in some detail. Her discussion of suicide prevention considers hospitalization and such medications as lithium, anticonvulsants, and antidepressants. She puts a human face on the statistics she presents with quotations from the works of writers including Anne Sexton, Sylvia Plath, William Styron, and Dylan Thomas as well as excerpts from case studies. Whitney Scott
From Kirkus Reviews
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) -- Copyright ©1999, Kirkus Associates, LP. All rights reserved.
Review
"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 lives--and, doubtless, save a few."--Newsday
"A profound and impassioned book--it 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
From the Inside Flap
From the author of the best-selling memoir An Unquiet Mind, comes the first major book in a quarter century on suicide, and its terrible pull on the young in particular. Night Falls Fast is tragically timely: suicide has become one of the most common killers of Americans between the ages of fifteen and forty-five.
An internationally acknowledged authority on depressive illnesses, Dr. Jamison has also known suicide firsthand: after years of struggling with manic-depression, she tried at age twenty-eight to kill herself. Weaving together a historical and scientific exploration of the subject with personal essays on individual suicides, she brings not only her remarkable compassion and literary skill but also all of her knowledge and research to bear on this devastating problem. This is a book that helps us to understand the suicidal mind, to recognize and come to the aid of those at risk, and to comprehend the profound effects on those left behind. It is critical reading for parents, educators, and anyone wanting to understand this tragic epidemic.
From the Back Cover
From the author of the best-selling memoir An Unquiet Mind, comes the first major book in a quarter century on suicide, and its terrible pull on the young in particular. Night Falls Fast is tragically timely: suicide has become one of the most common killers of Americans between the ages of fifteen and forty-five.
An internationally acknowledged authority on depressive illnesses, Dr. Jamison has also known suicide firsthand: after years of struggling with manic-depression, she tried at age twenty-eight to kill herself. Weaving together a historical and scientific exploration of the subject with personal essays on individual suicides, she brings not only her remarkable compassion and literary skill but also all of her knowledge and research to bear on this devastating problem. This is a book that helps us to understand the suicidal mind, to recognize and come to the aid of those at risk, and to comprehend the profound effects on those left behind. It is critical reading for parents, educators, and anyone wanting to understand this tragic epidemic.
About the Author
Kay Redfield Jamison is 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.
Excerpt. © Reprinted by permission. All rights reserved.
Prologue
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.
