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New York City
July 2002

Night Falls Fast: Understanding Suicide
By Merri Rosenberg

"Behold, 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.

"Most 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 too intimately.

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 presenting
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 medical,
condition. Still, she cautions, "Psychological pain or stress alone—however 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 stress—but 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.#


Education Update, Inc., P.O. Box 20005, New York, NY 10001.
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All material is copyrighted and may not be printed without express consent of the publisher. © 2002.