Falls Fast: Understanding Suicide
I am a dry tree" (Isaiah)
When Kay Redfield Jamison uses this quote from a suicide to explain
the degree of hopelessness that the successful execution of this
act embodies, it is hard for the reader not to feel just as overwhelmed
by those feelings of despair.
As Jamison explains in this thorough, beautifully written and
oddly compelling book, suicide is one of those acts that mocks
those who survive, whether they are family members, health professionals,
compassionate friends, or simply bewildered bystanders. She writes
that we now know almost everything about suicide except the ‘why’,
and to a large extent, this book is her attempt to bring us closer
to some comprehension of this tragic mystery. Be careful, though.
It’s not a book to attempt in one sitting; that would be almost
too much to bear.
suicides, although by no means all, can be prevented," says
Jamison. "The breach between what we know and do is lethal."
The statistics that Jamison, a professor of psychiatry at Johns
Hopkins University School of Medicine and an honorary professor
of English at the University of St. Andrews in Scotland, cites
are sobering: 30,000 Americans kill themselves every year; half
a million make an attempt that is serious enough to land them
in a hospital emergency room. Jamison – herself a sufferer of
manic-depression, and a failed suicide– knows her subject all
The risk of suicide is especially great among teenagers and young
adults. Suicide is the third leading cause of young people, and
the second among college students. She writes, "College-age
children are at particular risk for mental illness or suicide
because first episodes of depressive illness or schizophrenia
are most likely to occur at this time."
And according to a 1997 Youth Risk Behavior Surveillance Study
that the author mentions, 20 percent of high school students have
seriously considered suicide. Another study, based on New York
high school students, suggests that 50 percent of them have thought
about killing themselves.
Jamison is particularly stringent in her condemnation of diagnosis
and treatment of mentally ill children and adolescents, who are
at risk for suicide. One problem is that bipolar disorder and
manic-depression are often misdiagnosed as attention deficit disorder.
Another is that too many school-based programs aren't effective
in their interventions. Jamison believes that some do harm, by
students with inaccurate or misleading information.
One program she does like, based on the work of David Shaffer
at Columbia, is effective in part because there is no responsibility
for teachers or students to assume the role of mental health professionals.
In one of the more disheartening narratives, following the fallen
trajectory of a successful Air Force cadet who succumbs to mental
illness and ultimately suicide, Jamison writes, "Each way
to suicide is its own: intensely private, unknowable and terrible."
To be sure, there are some definite risk factors that contribute
to the likelihood of suicide. Having a bipolar disorder, manic
depression, schizophrenia, especially when combined with alcohol
or drug abuse, clearly contribute to
successful suicides. In general, according to Jamison, suicide
is more likely to be linked to a psychiatric, rather than a major
condition. Still, she cautions, "Psychological pain or stress
alonehowever great the loss
or disappointment, however profound the shame or rejection—is
rarely sufficient cause for suicide."
It's hardly coincidence that suicides often appear to run in families.
In one of the more provocative chapters, Jamison suggests that
perhaps there is an evolutionary, or even biological basis for
suicide. She asks, "Is suicide a price to pay for diversity?",
wondering whether manic-depressives,
for example, benefit society by conserving resources when they
are depressed, and contributing disproportionately to a culture’s
academic and creative endeavors during the manic cycles.
Ultimately, however, Jamison concludes that “suicide usually requires
multiple "hits"a biological pre-disposition, a
major psychiatric illness, and an acute life stressbut only
some of these "hits" are amenable to change."
And perhaps that is the ultimate value, and lesson, of this book:
that those left behind, struggling to understand the unfathomable
and find a peace that eluded the one who left, cannot carry the
burden of responsibility forever. Ultimately, suggests Jamison,
the suicide made his or her choice.#
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