by Kay Redfield Jamison
Vintage Books, 1999
Review by Christian Perring, Ph.D. on Sep 30th 1999
Jamison is a professor of psychiatry at the prestigious Johns Hopkins School of Medicine, and is co-author of Manic Depressive Illness, an authoritative tome on bipolar mood disorder. She is best known for her thoughtful and moving memoir An Unquiet Mind, in which she describes her personal experience of manic depression. She has also written Touched With Fire, a discussion of the relation between mania and creativity. In her new book on suicide, she maintains her focus on depression and manic depression. The great majority of people (in the west at least) who commit suicide suffer from a major mental illness.
The blurb accompanying Night Falls Fast says it is "the first major book in a quarter century on suicide." This exaggerates: Jamisons book is largely a summary of readily available information. She does not attempt to give a new account of the causes or the effects of suicide, and she does not have any new proposals for how to reduce the numbers of suicides and suicide attempts. Furthermore, there has been a number of books published in the last ten years on the same topic, such as David Lester's Making Sense of Suicide (reviewed in Metapsychology September 1998), Mark William's Cry of Pain: Understanding Suicide and Self-Harm, and Geo Stone's Suicide and Attempted Suicide: Methods and Consequences.
The strength of this new book is not in new research or proposals, but in the quality of Jamison's writing and her ability to bring together existing research. She intersperses discussion of scientific research with stories of individuals. Her knowledge of the research is impressive: there are 96 pages of notes and references in small print at the end of the book. She explains the facts of suicide in clear straightforward prose, structuring the book with definitions at the start, then discussing psychology and psychopathology, methods of suicide, biology and evolution, and finally suicide prevention. Her tone is even and reassuring; in the face of such a painful topic, Jamison retains an authoritative calm. She explains the facts with compassion and concern, dispelling myths and preconceptions as she goes along.
For instance, on Christmas Day my mother usually tells me that more people commit suicide on that day than on any other day of the year. But this turns out to be untrue, since holidays do not bring more suicides than other days, although Valentines day does bring more suicide attempts. Jamison emphasizes that the mood stabilizer lithium is clearly the best drug we have to fight suicide. Antidepressants and newer mood stabilizers may have fewer side effects, but they turn out to be less successful at preventing suicide. Drug manufacturers may not want to emphasize this finding, because they dont have a patent on lithium, it being a naturally occurring chemical, and so they cannot make much profit from it.
Of course, it is the personal stories that carry the most emotional impact. This is especially true of her telling of the life and death of Drew Sopirak, who joined the United States Air Force Academy with high hopes. But he had manic depression, and his condition declined until he killed himself. Jamison talks about the effects on his family and friends, and how they remember him. There are moments of grim humor, such as when she quotes Dorothy Parkers writings on her suicide attempts. She quotes suicide notes of the famous and the unknown. She briefly mentions her own suicide attempt, and she alludes to the profound effect that suicide has had on her own family.
Night Falls Fast is not a self-help book, nor is it a textbook. Yet it may be useful to many people who want to better understand suicide. Ultimately Jamison aims to raise awareness about suicide, and to draw attention to how serious a problem it is for our society. Many other problems that cause less grief get more attention from the public. The stigma over suicide overlaps with the stigma of mental illness, and often people dont even know how to bring up the topic. Across the world, suicide accounts for 1.8% of all deaths. In women aged between 15 and 44 years, it is the second leading cause of death after tuberculosis. For men in this age range, it is the fourth leading cause of death, after road traffic accidents, tuberculosis, and violence.
When I explain such facts to students in my undergraduate classes on death and dying, they say they previously had no idea that suicide is so prevalent. This reflects how little attention suicide gets in popular culture, as well as how many misconceptions regarding it persist. High profile suicides (especially of rock stars and celebrities) are generally given uninformed and slanted coverage in the news media. Even if Jamison only partially succeeds in bringing more awareness of the growing epidemic of suicide in western society, she will have accomplished a great deal.