Night Falls Fast

Sometime in the summer of 2006, before EMSAM really started permeating the tissues of my brain, I became keenly interested in the biology of suicide. I wondered what could possibly go so wrong in an otherwise functioning head as to allow the body's self-defense systems to short-circuit that way.

I bought a copy of Night Falls Fast: Understanding Suicide by Kay Redfield Jamison. I read it in a weekend, and then I went back and read it again, painstakingly highlighting the points that resonated with me most at that moment. Some of them even have Post-It flags sticking out from between the pages. The book is full of interesting facts and statistics, case studies and medical insights. My therapist wanted to read the book anyway, and she asked to borrow my copy because she wanted to see where my focus was in that wash of information. Here are the things I highlighted:

Page 38: Most instances of suicidal thought, although often frightening and of concern, lead to neither a suicide attempt nor suicide, but some do.

Page 39: Often, people want both to live and to die; ambivalence saturates the suicidal act. Some wish to escape, but only for a while.

Page 84: The awareness of the damage done by severe mental illness--to the individual himself and to others--and fears that it may return again play a decisive role in many suicides...Patients who do well socially and academically when young and then are hit with devastating illnesses such as...manic depression seem particularly vulnerable to the spectre of their own mental disintegration and the terror of becoming a chronic patient.

Page 91: Psychological pain of stress alone...is rarely sufficient cause for suicide. Stress and pain are relative, highly subjective in their experiencing and evaluation.

Many individuals at a fairly high risk for suicide--for example, those with depression or manic-depressive illness--function extremely well between episodes of their illness, even when in situations of great pressure, uncertainty, or repeated emotional or financial setbacks.

Depression shatters that capacity. When the mind's flexibility and ability to adapt are undermined by mental illness, alcohol, or drug abuse, or other psychiatric disorders, its defenses are put in jeopardy. Much as a compromised immune system is vulnerable to opportunistic infection, so too, a diseased brain is made assailable by the eventualities of life. The quickness and flexibility of a well mind, a belief or hope that things will eventually sort themselves out--these are the resources that are lost to a person when the brain is ill.

Page 93: In short, when people are suicidal, their thinking is paralyzed, their opinions appear spare or nonexistent, their mood is despairing, and hopelessness permeates their entire mental domain. The future cannot be separated from the present, and the present is painful beyond solace.

Page 40: This sense of the unmanageable, of hopelessness, of invasive negativity about the future is, in fact, one of the most consistent warning signs of suicide...People seem to be able to bear or tolerate depression as long as there is the belief that things will improve. If that belief cracks or disappears, suicide becomes the option of choice.

Page 110: (nearly two-thirds of those with depression have a serious drinking or drug problem, compared with one-fourth of those with depression alone). May is pleased to report that she has no substance abuse issues. She tries to be a responsible adult in control of some aspect of her behavior.

Here's the biggie:
At least one person in five with major depression will attempt suicide, and nearly one-half of those with bipolar disorder will try to kill themselves at least once.

Page 114: Getting the correct treatment is a gamble and, even with the best of doctors, it often takes a long time to take effect. People often wait until they are most ill before seeking care and may be unable to stay the treatment course long enough to make them feel sufficiently well to continue living.

Page 125: All the psychiatric disorders we have been discussing...are not only painful and terrible illnesses to have, they also have profound, usually alienating and destabilizing, effects on the ability of the affected person to have meaningful relationships, to engage in satisfying and economically viable work, and to believe in the point of living.

Page 149: Far more people actually kill themselves in psychiatric hospitals than they do in highly publicized or exotic places. Five to 10 percent of all suicides, in fact, take place in mental hospitals.

Page 150: The line between civil liberties and preservation of life is a controversial one.