Book Review: Night Falls Fast: Understanding Suicide
Review by David Yarian, Ph.D.
Dr. Jamison has written a literate, compassionate and scientifically rigorous account of what we currently know about suicide -- its causes, predictability, and the possibilities for prevention.
She is clear from the beginning that she has a personal stake in her scholarship: "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."
Kay Jamison has bipolar disorder (manic-depressive illness), which manifested itself first as a major depression at age seventeen. She received good treatment including proper medications, but thoughts of suicide were never far from her mind.
Still, she went on with her life, completing graduate school in psychology and taking academic and research positions at prestigious institutions. Following her suicide attempt and successful recovery she turned her scholarly skills to understanding what had happened to her.
"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. "
Out of her newfound scholarly orientation has come an outpouring of best-selling books on bipolar disorder: An Unquiet Mind: A Memoir of Moods and Madness; this book on suicide; and Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. She is currently Professor of Psychiatry at the Johns Hopkins University School of Medicine.
In this book Jamison focuses on the phenomenon of suicide, which she believes most often occurs when the victim is suffering from severe mental illness. She states: "Difficulties in life merely precipitate a suicide; they do not cause it." A loss or disappoint may serve as catalyst for suicide, but the great majority of persons who experience similar losses do not commit suicide. She believes bipolar disorder with its extreme highs and lows of mania and depression often plays a central role in the psychopathology underlying suicide.
She notes the co-occurence of alcohol and chemical dependency as frequent concomitants of suicidality, as the sufferer attempts to medicate the unbearable psychic pain. She cites research showing risk factors for prediction of suicide. The person who has made a previous suicide attempt, for example, is 39 times more likely to commit suicide than the general population. Other potent risk factors are mood disorders (15 to 21 times more likely); substance abuse (7 to 14 times more likely); schizophrenia and personality disorders (7 to 8 times more likely). Interestingly, chronic illnesses such as Huntington's disease, multiple sclerosis and cancer increase the risk only slightly (2 to 3 times more likely).
Jamison excels at communicating the desperate pain of the person contemplating suicide; his irrationality and inability to think his way out of it. She offers comfort to family members of suicides through clearly describing the mental illnesses underlying suicidal behavior.
This book is, perhaps oddly, a pleasure to read. Jamison weaves together poetry, diaries and journals of suicides, summaries of research studies, her own experience and the stories of many others who have struggled with suicide. The result is this very informative book which reads like good literature and tells a profound human story.
I recommend this book to everyone touched by suicide. For those who are struggling with thoughts and desires of suicide, Jamison offers information that can help you find a better way. To those who have lost a loved one to suicide, her compassionate yet scientific presentation can provide comfort and understanding. To those who are trying to help those who are struggling, whether as friend, family member or professional, this book will help you understand suicide better -- the experience, the painful struggle, and how to help.