Night Falls Fast

by Kay Redfield Jamison

  ALSO BY KAY REDFIELD JAMISON

  An Unquiet Mind: A Memoir of Moods and Madness

  Touched with Fire: Manic-Depressive Illness and the Artistic Temperament

  Manic-Depressive Illness (with F. Goodwin)

  THIS IS A BORZOI BOOK

  PUBLISHED BY ALFRED A. KNOPF

  Copyright © 1999 by Kay Redfield Jamison

  All rights reserved under International and Pan-American

  Copyright Conventions. Published in the United States

  by Alfred A. Knopf, a division of Random House, Inc.,

  New York, and simultaneously in Canada by

  Random House of Canada Limited, Toronto.

  Distributed by Random House, Inc., New York.

  www.randomhouse.com

  Knopf, Borzoi Books, and the colophon are registered

  trademarks of Random House, Inc.

  Owing to limitations of space, acknowledgments for

  permission to reprint previously published material

  may be found following the index.

  Library of Congress Cataloging-in-Publication Data

  Jamison, Kay R.

  Night falls fast : understanding suicide / by Kay Redfield

  Jamison. — 1st ed.

  p. cm.

  eISBN: 978-0-307-77989-2

  1. Suicide—United States. 2. Children—Suicidal behavior—

  United States. 3. Youth—Suicidal behavior—United States.

  I. Title.

  RC569.J36 1999

  616.85′8445′00973—dc21 99-311227

  v3.1_r1

  For my husband,

  Richard Jed Wyatt

  With deep love

  and

  For my brother,

  Dean T. Jamison

  Who kept the night at bay

  Night falls fast.

  Today is in the past.

  Blown from the dark hill hither to my door

  Three flakes, then four

  Arrive, then many more.

  —EDNA ST. VINCENT MILLAY

  Contents

  Cover

  Other Books by This Author

  Title Page

  Copyright

  Dedication

  Epigraph

  Prologue

  I BURIED ABOVE GROUND

  An Introduction to Suicide

  1 Death Lies Near at Hand

  History and Overview

  2 To Measure the Heart’s Turbulence

  Definitions and Magnitudes

  Essay: THIS LIFE, THIS DEATH

  II JUST HOPE HAS GONE

  Psychology and Psychopathology

  3 Take Off the Amber, Put Out the Lamp

  The Psychology of Suicide

  4 The Burden of Despair

  Psychopathology and Suicide

  5 What Matters It, If Rope or Garter

  Methods and Places

  Essay: THE LION ENCLOSURE

  III PANGS OF NATURE, TAINTS OF BLOOD

  The Biology of Suicide

  6 A Plunge into Deep Waters

  Genetic and Evolutionary Perspectives

  7 Death-Blood

  Neurobiology and Neuropathology

  Essay: THE COLOURING TO EVENTS: THE DEATH OF MERIWETHER LEWIS

  IV BUILDING AGAINST DEATH

  Prevention of Suicide

  8 Modest Magical Qualities

  Treatment and Prevention

  9 As a Society

  The Public Health

  10 A Half-Stitched Scar

  Those Left Behind

  Epilogue

  Appendix: Resources for Information About Suicide, Mental Illness, and Alcohol and Drug Abuse

  Notes

  Acknowledgments

  A Note About the Author

  PROLOGUE

  Summer evenings at the Bistro Gardens in Beverly Hills tended toward the long and languorous. My friend Jack Ryan and I went there often when I lived in Los Angeles, and I invariably ordered the Dungeness crab and a scotch on the rocks. Not so invariably, but from time to time, Jack would use the occasion to suggest we get married. It was an idea with such patent potential for catastrophe that neither of us had much of an inclination to take the recurring proposal with too much gravity. But our friendship we took seriously.

  This particular evening, having hooked and tugged out the last bits of crab, I found myself edgily knocking the ice cubes around in my whisky glass. The conversation was making me restless and uneasy. We were talking about suicide and making a blood oath: if either of us again became deeply suicidal, we agreed, we would meet at Jack’s home on Cape Cod. Once there, the nonsuicidal one of us would have a week to persuade the other not to commit suicide; a week to present all the reasons we could come up with for why the other should go back on lithium, assuming that having stopped it was the most likely reason for the danger of suicide (we both had manic-depressive illness and, despite the better and often expressed judgment of others, had a tendency to stop taking our lithium); a week to cajole the other into a hospital; to invoke conscience; to impress upon the other the pain and damage to our families that suicide would inevitably bring.

  We would, we said, during this hostage week, walk along the beach and remind the other of all of the times we had felt at the end of hope and, somehow, had come back. Who, if not someone who had actually been there, could better bring the other back from the edge? We both, in our own ways and in our own intimate dealings with it, knew suicide well. We thought we knew how we could keep it from being the cause of death on our death certificates.

  We decided that a week was long enough to argue for life. If it didn’t work, at least we would have tried. And, because we had years of cumulative experience with lifestyles of snap impetuousness and knew how quick and final a suicidal impulse could be, we further agreed that neither of us would ever buy a gun. Nor, we swore, would we under any circumstances allow anyone else to keep a gun in a house in which we lived.

  “Cheers,” we said in synchrony, ice and glass clinking. We sealed our foray into the planned and rational world. Still, I had my doubts. I listened to the details, helped clarify a few, drank the rest of my scotch, and stared at the tiny white lights in the gardens around us. Who were we kidding? Never once, during any of my sustained bouts of suicidal depression, had I been inclined or able to pick up a telephone and ask a friend for help. Not once. It wasn’t in me. How could I seriously imagine that I would call Jack, make an airline reservation, get to an airport, rent a car, and find my way out to his house on the Cape? It seemed only slightly less absurd that Jack would go along with the plan, although he, at least, was rich and could get others to handle the practicalities. The more I thought about the arrangement, the more skeptical I became.

  It is a tribute to the persuasiveness, reverberating energies and enthusiasms, and infinite capacity for self-deception of two manic temperaments that by the time the dessert soufflés arrived we were utterly convinced that our pact would hold. He would call me; I would call him; we would outmaneuver the black knight and force him from the board.

  If it has ever been taken up as an option, however, the black knight has a tendency to remain in play. And so it did. Many years later—Jack had long since married and I had moved to Washington—I received a telephone call from California: Jack had put a gun to his head, said a member of his family. Jack had killed himself.

  No week in Cape Cod, no chance to dissuade. A man who had been inventive enough to earn a thousand patents for such wildly diverse creations as the Hawk and Sparrow missile systems used by the U.S. Department of Defense, toys played with by millions of children around the world, and devices used in virtually every household in America; a Yale graduate and lover of life; a successful businessman—this
remarkably imaginative man had not been inventive enough to find an alternative solution to a violent, self-inflicted death.

  Although shaken by Jack’s suicide, I was not surprised by it. Nor was I surprised that he had not called me. I, after all, had been dangerously suicidal myself on several occasions since our Bistro Gardens compact and certainly had not called him. Nor had I even thought of calling. Suicide is not beholden to an evening’s promises, nor does it always hearken to plans drawn up in lucid moments and banked in good intentions.

  I know this for an unfortunate fact. Suicide has been a professional interest of mine for more than twenty years, and a very personal one for considerably longer. I have a hard-earned respect for suicide’s ability to undermine, overwhelm, outwit, devastate, and destroy. As a clinician, researcher, and teacher I have known or consulted on patients who hanged, shot, or asphyxiated themselves; jumped to their deaths from stairwells, buildings, or overpasses; died from poisons, fumes, prescription drugs; or slashed their wrists or cut their throats. Close friends, fellow students from graduate school, colleagues, and children of colleagues have done similar or the same. Most were young and suffered from mental illness; all left behind a wake of unimaginable pain and unresolvable guilt.

  Like many who have manic-depressive illness, I have also known suicide in a more private, awful way, and I trace the loss of a fundamental innocence to the day that I first considered suicide as the only solution possible to an unendurable level of mental pain. Until that time I had taken for granted, and loved more than I knew, a temperamental lightness of mood and a fabulous expectation of life. I knew death only in the most abstract of senses; I never imagined it would be something to arrange or seek.

  I was seventeen when, in the midst of my first depression, I became knowledgeable about suicide in something other than an existential, adolescent way. For much of each day during several months of my senior year in high school, I thought about when, whether, where, and how to kill myself. I learned to present to others a face at variance with my mind; ferreted out the location of two or three nearby tall buildings with unprotected stairwells; discovered the fastest flows of morning traffic; and learned how to load my father’s gun.

  The rest of my life at the time—sports, classes, writing, friends, planning for college—fell fast into a black night. Everything seemed a ridiculous charade to endure; a hollow existence to fake one’s way through as best one could. But, gradually, layer by layer, the depression lifted, and by the time my senior prom and graduation came around, I had been well for months. Suicide had withdrawn to the back squares of the board and become, once again, unthinkable.

  Because the privacy of my nightmare had been of my own designing, no one close to me had any real idea of the psychological company I had been keeping. The gap between private experience and its public expression was absolute; my persuasiveness to others was unimaginably frightening.

  Over the years, my manic-depressive illness became much worse, and the reality of dying young from suicide became a dangerous undertow in my dealings with life. Then, when I was twenty-eight years old, after a damaging and psychotic mania, followed by a particularly prolonged and violent siege of depression, I took a massive overdose of lithium. I unambivalently wanted to die and nearly did. Death from suicide had become a possibility, if not a probability, in my life.

  Under the circumstances—I was, during this, a young faculty member in a department of academic psychiatry—it was not a very long walk from personal experience to clinical and scientific investigation. I studied everything I could about my disease and read all I could find about the psychological and biological determinants of suicide. As a tiger tamer learns about the minds and moves of his cats, and a pilot about the dynamics of the wind and air, I learned about the illness I had and its possible end point. I learned as best I could, and as much as I could, about the moods of death.

  I

  Buried Above Ground

  —AN INTRODUCTION TO SUICIDE—

  Encompass’d with a thousand dangers,

  Weary, faint, trembling with a thousand terrors.…

  I … in a fleshly tomb, am

  Buried above ground.

  —WILLIAM COWPER

  English poet William Cowper (1731–1800) on several occasions tried to poison, stab, or hang himself. The self-described “lines written during a period of insanity” were composed after one of his suicide attempts.

  CHAPTER 1

  Death Lies Near at Hand

  —HISTORY AND OVERVIEW—

  A tiny blade will sever the sutures of the neck, and when that joint, which binds together head and neck, is cut, the body’s mighty mass crumples in a heap. No deep retreat conceals the soul, you need no knife at all to root it out, no deeply driven wound to find the vital parts; death lies near at hand.… Whether the throat is strangled by a knot, or water stops the breathing, or the hard ground crushes in the skull of one falling headlong to its surface, or flame inhaled cuts off the course of respiration—be it what it may; the end is swift.

  —SENECA

  NO ONE KNOWS who the first was to slash his throat with a piece of flint, take a handful of poison berries, or intentionally drop his spear to the ground in battle. Nor do we know who first jumped impulsively, or after thought, from a great cliff; walked without food into an ice storm; or stepped into the sea with no intention of coming back. Death, as Seneca states, has always lain close at hand; yet it is a mystery why the first to kill himself did: Was it a sudden impulse, or prolonged disease? An inner voice, commanding death? Perhaps shame or the threat of capture by an enemy tribe? Despair? Exhaustion? Pressure from others to spare common resources of food and land? No one knows.

  It is unlikely that Homo sapiens was the first to think of suicide or act on the thought of it; indeed, from an evolutionary perspective this would seem rather arbitrary, given the sophistication of the hominids before us. The Cro-Magnons, we believe, were skilled hunters, makers of blades and spears, plaiters of rope, users of fire, and reflective, ingenious inventors of remarkable art forms and elaborate burial rituals. And, there was Homo neanderthalensis before them, and the hunting apes, such as chimpanzees, known to be aggressive, social, and cognitively complex toolmakers. At what point did self-awareness enter into the life of the brain? When did a conscious, deliberate intent to die veer off from the borderlands of extreme recklessness and impetuous, life-threatening taking of risks? Violence and recklessness, profound social withdrawal, and self-mutilation are not, as we shall see, unique to our species. But perhaps suicide is.

  We will never know who or why or how the first to kill himself did (or herself; we will never know that either). But it is very likely that once suicide occurred and others were cognizant of it, the act was repeated—in part because the reasons and means would remain integral to the psychological and physical environment, and in part because animals and humans learn, to considerable extent, through imitation. Suicide, dangerously, has a contagious aspect; it has, as well, for the vulnerable, an indisputable appeal as the solution of last resort.

  Recorded observations about suicide are, of necessity, far more recent than its first occurrences. Society’s attitudes, as captured in its literature, laws, and religious sanctions, provide one window into our collective reactions to self-murder. They give a historical perspective to the evolution of our perceptions about suicide, perceptions that have varied from our seeing it as an accepted and valued event to treating it as a sin or a crime, or conceptualizing it as the consequence of adverse circumstances or pathological mental states.

  Certainly, cultures have varied in their notions of self-inflicted death. Several—for example, the Eskimo, Norse, Samoan, and Crow Indian—accepted, and even encouraged, “altruistic” self-sacrifice among the elderly and sick. Among the Yuit Eskimos of St. Lawrence Island, if an individual requested suicide three times, relatives were obligated to assist in the killing. The person seeking suicide dressed in ritual death garb and then was killed
in a “destroying place” set aside specifically for that purpose. To save commonly held resources of food or to allow a nomadic society to move on unhindered by the physically ill or elderly, some societies gave tacit if not explicit approval to suicide.

  No early cultural or religious sanctions were attached to the suicides recorded in the Old Testament or to the only one, that of Judas Iscariot, described in the New (attitudes toward suicide hardened during the early years of Christianity). Most of these deaths, like those of the ancient Greeks portrayed by Homer, were seen as matters of honor, actions taken to avoid falling into the hands of a military enemy, to atone for wrongdoing, or to uphold a religious or philosophical principle. Hannibal, for example, took poison rather than be captured or dishonored, as did Demosthenes, Cassius, Brutus, Cato, and scores of others. Socrates, who refused to renounce his teachings and beliefs, drank hemlock. Gladiators thrust wooden sticks or spears down their throats or forced their heads into the spokes of moving carts in order that they might choose their own, rather than another’s, time and way of dying.

  Beliefs about suicide varied considerably in ancient Greece. The Stoics and Epicureans believed strongly in the individual’s right to choose the means and time of his death. Others were less accepting of the idea. In Thebes and Athens, suicide was not against the law, but those who killed themselves were denied funeral rites and the hand that had been used for the act was severed from the arm. Aristotle regarded suicide as an act of cowardice, as well as an act against the state; so, too, did Pythagoras. (Although, according to Heracleitus, Pythagoras starved himself to death.) Roman law actively prohibited suicide and further prohibited the passing on to heirs of the suicide’s possessions and estates. The Catholic Church from its earliest days opposed suicide and, during the sixth and seventh centuries, codified its opposition by excommunicating and denying funeral rites to those who died by their own hand. Suicide was never justifiable, wrote St. Augustine in an authoritative argument for the Church, because it violated the sixth commandment of God, “Thou shalt not kill.”