Life is tough, then you die. This is true for everyone but zillionaires like Donald Trump. We all know how bad it can get. Cancer. Bankruptcy. Divorce. Incarceration. The kids die. Then the dog. The house burns down. Feeling suicidal yet? If you are, Kay Redfield Jamison, professor of psychiatry at Johns Hopkins and author of a new book on the subject, would claim you're suffering from a mental illness.
"Most who encounter the ordinary, if awful stresses and losses handed out by life handle them well or reasonably well," Jamison assures us in "Night Falls Fast." "In fact, very few people commit suicide under even the most terrible and prolonged situations of physical or mental suffering."
The ones who break are "biologically vulnerable," suffering from "depression, schizophrenia, alcoholism, or crippling anxiety." Jamison herself is "a biologically vulnerable" woman who tried to kill herself when she was 28 with an overdose of Lithium. She failed, of course. Picked herself up. And began a lifelong study of her malady. The result is "Night Falls Fast."
Jamison's treatise on suicide takes a serious tone, and is neither an easy nor a cheerful read. The book's characters eat the gun. Drink Drano. Leap into volcanoes. One woman climbs into a lions' den. A little girl tries to jump from a speeding car because "I am very hungry. I bite people and try to eat them up." The only intentionally "light" moment is the presentation of the joke/poem "Risumi" by Dorothy Parker:
Razors pain you;
Rivers are damp;
Acids stain you;
And drugs cause cramp.
Guns aren't lawful;
Nooses give;
Gas smells awful;
You might as well live.
Although we may chuckle at Parker's gallows humor, let's not forget that the poet tried to off herself three times. What about us? When I was 15 I tried to kill myself ` la Romeo and Juliet. Not to go into the gory details too deeply, but my girlfriend and I were kicked out of our respective suburban households. We'd made a death pact, but my love sensibly backed out of the deal, leaving me on my own to attempt to kill myself. I was lucky that I didn't succeed, and now attribute the whole thing to a passing adolescent phase. At the time, I did not suffer the highs and lows of manic depression. I was not schizophrenic and I am pretty sure I was not clinically depressed.
Although my situation was just bad suburban melodrama, I was sure Jamison would say my take was wrong. Sure, teenagers are in hormonal overdrive, but that alone never leads to suicide. Jamison attributes the 120 percent rise in children's killing themselves to a changing age of puberty, and the age in which depression first occurs.
I couldn't understand how Jamison could exclude unfortunate events in a person's life -- which would change the way anyone looks at the world -- and attribute all suicides to psychotic illness. So I went to her for some answers, to find out if suicide is truly only the domain of the mentally ill.
Do people at book signings start telling you their suicide stories?
Sometimes.
Are you a repository for suicide stories?
I wouldn't put it that way, but yes.
[Bowman tells her his story.]
Were you really depressed?
Not clinically. And I think that there are others like me who aren't manic depressives and still try to kill themselves. But most of the suicide victims that you included in your book have brain-chemistry problems.
Most people go through a lot of difficult things and don't commit suicide. There is generally a depressive component in addition to everything else that is going on.
You write that suicide is never a result of a single factor or event. So back during the Depression, bankruptcy was just the final straw that made brokers leap from their windows?
Yeah. Because you have to look at all the people who went bankrupt and lost their families and lost everything and didn't kill themselves.
And people who are terminally sick generally don't kill themselves?
Overwhelming they do not.
I hope I have the courage and opportunity to kill myself if I get a terminal illness. I know a certain building in New York City without guards in the lobby. You can take an elevator to the 31st floor where the hallway is lined with unlocked windows. Down below -- just an empty alley. It seems smart to know about such buildings. Is this kind of consideration abnormal?
It is and it isn't. It's concerning that you think about it that much. It's just something I would put in the back of my head -- it's something to deal with. I mean, how old are you?
Forty.
I would say it's premature to be going into that much planning.
Doesn't everybody have such thoughts?
A lot of people think about suicide, but the difference between thinking about it and attempting it is huge.
Is suicide the first thing you think of when you're clinically depressed?
No. If you have a clinical depression, you're just more vulnerable to suicide. Most people who are clinically depressed don't kill themselves. But of people who kill themselves, most were clinically depressed.
What are the exceptions to this rule -- those who killed themselves and weren't clinically depressed?
Drugs can lead to suicide. Alcohol. A financial crisis. Again, a single risk factor only slightly increases the odds that someone will kill themselves. As I say in my book, "Acute psychiatric illness is the single most common trigger of suicide."
Do people who are suicidal know it?
I don't think a child who's 8 years old and puts a rope around his neck is completely aware of being suicidal. I think it involves a level of cognitive thinking that is perhaps not available to that 8-year-old child. But is the child desperate and unhappy? Yes. I think by definition suicide requires some conscious, motivational component.
Do you think kids are more prone to look at suicide as "I'm gonna do this because things are really bad"?
One of the reasons suicide begins to occur more frequently in adolescence is because puberty is associated with the onslaught of major psychiatric illnesses. The average age of onset for manic depression is at age 17 or 18; for schizophrenia, it's 19. Kids are at a time when their control of impulses is not as well-established as when they're older. They're getting ill for the first time and it's particularly devastating.
Is there a difference between those who try to kill themselves and those who succeed?
It's estimated that there are 10 to 25 suicide attempts for every completed suicide. Women are more likely to attempt suicide than men, while men are more likely to succeed.
Why the difference?
Females are twice as likely to suffer from depression, which is why they make more attempts. They are also less violent and impulsive than men, so they use relatively safer means like self-poisoning.
And men are more likely to use guns?
Yes. Also, the stigma to admit to a failed suicide attempt is greater for men than for women.
But in the end, men, women and children never commit suicide just because of stress? It still doesn't make sense to me. Is it nuts to think that way?
I don't think it's "nuts." It's not clear to me what you're really asking me in this interview, actually. The subject of my book is why people kill themselves. Not thoughts that people may have across the distribution of population. I'm actually talking about people who go out and kill themselves. And how do we keep them from doing that; and why do they do it.
But before most people kill themselves, they think about it. So you have to be concerned with people's thoughts. When I read your book, I considered whether or not I was at risk of suicide. It was only later that I thought about people I know who may be potentially at risk. What do most readers pick up on first?
People read it for various reasons. A lot of people who have a family member who killed themselves read it to understand why a child or brother or sister or husband or wife killed themselves. Some people just want to know about suicide. As a human being, the great ongoing question is trying to figure out why people kill themselves.
Do you feel that we're living in the age of suicide?
I think there are way too many people killing themselves unnecessarily. I think there is a huge suicide problem in the United States. I think people are very aware that suicide is not uncommon. For example, it's the second killer of college students.
I'm just curious, what did you think of the recent review of your book in New York Times?
I thought it was great.
But he said that after you read this book, you feel like killing yourself ...
[Silence.]
It must have been a hard book to write.
Yes. It was a very hard book to write.
What are you doing next?
I'm writing a book about medicine in the National Zoo.
Do animals commit suicide?
There's no evidence that they do. They certainly engage in high-risk and self-destructive behavior at times. They chew their tails off; chew their hands off in conditions of great stress. The issue of whether or not it's intentional or not is hard to prove in animals that can't communicate. For example, lemmings -- people think of lemmings committing suicide, but there's no evidence that that's what they're doing.
OK, since we don't know about animals, what about people -- are they ashamed to be committing suicide or feel that it's their right?
It's hard to know. Family members are often ashamed that someone killed themselves in their family. Unfortunately, that's not an unusual reaction. I think that's one of the problems of suicide -- people don't feel like they can talk to other people enough about it.
How can suicide be prevented?
By identifying those at risk and helping them get treatment; by not romanticizing suicides in the news, and limiting access to instruments of suicide, such as guns. We need to also get rid of the stigma against suicide.
How will your book help?
In several ways: I would like people to become aware of how much of a major health problem suicide is, especially among the young; and to understand the level of absolute desperation and anguish that goes into it. And however tempting it is to think about suicide in existential terms, the fact that clinical research and scientific research are quite consistent with showing that an overwhelming majority of suicides are related to treatable psychotic illness. Parents ought to talk to their kids about it -- not necessarily suicide, but surely about depression.
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