Night Falls Fast

by Kay Redfield Jamison

  An epidemic of suicides by burning occurred in England and Wales in 1978 to 1979 after a twenty-four-year-old Australian heiress, deported from England the week before after having threatened to kill herself in Parliament Square, set fire to herself in front of the Palais des Nations in Geneva. Three days later, a director of Fortnum and Mason committed suicide in a similar manner on the banks of the Thames at Windsor. By month’s end, there had been ten immolations, and within a year eighty-two people had killed themselves by burning. This was in stark contrast to an annual average of twenty-three such suicides in the years 1963 to 1978 (in no year had there been more than thirty-five). The tremendous media coverage of the self-immolations led the researchers who wrote up these findings to conclude that there was a need for some form of voluntary restraint on the part of the press. “In a free society,” they wrote, “there is a conflict between the need for a free press and the use of the press of reports of horrifying deaths as spectacles for entertainment purposes.” They also stressed the need to deromanticize death by burning. Far from being quick and painless, they pointed out, only one-third of those who set fire to themselves died immediately. Another one-third lived longer than twenty-four hours, and all the victims experienced great pain and suffering.

  AT THE FOOT of Mount Fuji, Japan’s highest mountain and a sacred site, there is a dense forest called Jukai, the “sea of trees.” The forest, which grew over a lava plateau, is unpopulated and essentially without roads. The first recorded suicide in Jukai was in the fourteenth century; since that time, the thick “black forest” has enticed hundreds to their deaths. Yoshitomo Takahaski, of Yamanashi Medical College, contends that there is an almost mythic belief that once in the forest there is no coming out: the magnetic composition of the igneous lava plateau renders a compass virtually useless, and because visibility is nil, it is next to impossible to navigate by sun or stars.

  In the early 1960s, a popular Japanese writer wrote a bestselling novel that described the heroine’s attempt to kill herself by entering the forest. Streams of people followed her example. Television, films, newspapers, and magazines added to the attraction by calling further attention to Jukai as a suicide site. Regular police patrols had to be put in place in order to rescue potential suicides, and wide-scale searches for bodies are now conducted in the spring and fall. At least thirty still die in the forest each year, most by hanging or overdoses; a few kill themselves with carbon monoxide poisoning or die from exposure.

  Of all the suicide sites romanticized in literature, however, of all of those given ink and airtime by the media, two stand out for their hold on both the popular and suicidal imaginations: Mount Mihara, on the Japanese island of Oshima, and the Golden Gate Bridge in San Francisco.

  Mount Mihara, an active volcano in Japan, was almost entirely unknown until January 1933, when two classmates from an upper-crust Tokyo school climbed to the top of its crater. Meiko Ukei, at twenty-four the older of the two, announced to her friend that she intended to throw herself into the volcano. She would, she explained, be cremated instantly and sent heavenward in smoke and beauty. After extracting a vow of secrecy from her friend, she jumped.

  Masako Tomita was only twenty-one, and understandably unable to keep the promise she had made. She confided in another friend, who then insisted that Masako take her to Mount Mihara so that she, too, could “follow Meiko to paradise through Mihara’s gateway.” Masako was unable to persuade her friend otherwise, and in early February the two young women climbed to the top of the volcano. The friend jumped alone, Masako returned alone, and soon the story was a major force in the cultural life of Japan. People swarmed to Mihara, first by steamer and then by a larger boat that was required to handle the curious. On an April Sunday not long after the deaths of the two young women, six people leaped into the volcano; twenty-five others had to be physically restrained from doing so. Tourists lined up to watch the suicides, which were now occurring several times a week. By year’s end, at least 140 people had committed suicide.

  The following year, 1934, more than 160 plunged to their deaths and another 1,200 had to be restrained by the police from following suit. In January 1935, three young men jumped to their deaths within ten minutes of one another. The police maintained a twenty-four-hour watch at the crater, and a high barbed-wire fence was erected; yet in 1936, at least 600 people killed themselves in Mihara. The crater and its surrounding area and local commerce took on a ghoulish, surreal quality, as Edward Ellis and George Allen recount in Traitor Within:

  The suicide epidemic brought to Oshima a boom comparable to the Florida land craze of 1925–26. From a barren, desolate place, it blossomed into a combination national shrine, Coney Island, Atlantic City, and Niagara Falls. The island’s population increased greatly. Fourteen hotels and 20 restaurants opened within two years. Horses were imported to carry tourists to Mihara’s summit. Five taxicab companies opened for business. By 1935 the island’s photographers had increased from two to 47. A post office was opened at the crater’s edge. A strictly amusement-park touch was added with the construction of a 1,200-foot chute-the-chute down Mihara’s slope to provide the visitors a final thrill.…

  The Tokyo Bay Steamship Company replaced the Kiku Maru with two new large ships, declared a 6 percent dividend on stock which had paid no dividends for the previous three and a half years, and reported that its net profit was now running to $280,000 a year. Part of this income was provided by a spectacular addition which the steamship company made to Mihara’s attractions. The company had imported three camels to carry tourists across the mile-wide strip of volcanic desert which surrounds Mihara’s crater. The first of these animals most Japanese had ever seen, they were an instant, money-making success.

  In an effort to escape the onus of profiting on suicide, the steamship company refused to sell one-way tickets to Oshima. The government backed the company with a law making it a criminal offense to attempt to purchase a one-way passage. Plain-clothes men were assigned to mingle with the passengers on the ships, with instructions to arrest anyone who appeared to them to be bent on suicide.

  Access to the mountain was eventually closed, but not before at least a thousand people had thrown themselves into the crater.

  A year or so later, on the other side of the Pacific Ocean, the Golden Gate Bridge was opened. A graceful structure in San Francisco Bay in a staggeringly beautiful part of the world, it soon took on the siren call of Mount Mihara. Three months after the bridge opened in May 1937, the first of more than a thousand, and some estimate nearly twice that number, committed suicide by jumping over the side. Leaping to death from the Golden Gate Bridge soon entered into American folklore, much as Mihara had seeped into Japanese cultural awareness. Psychologists Richard Seiden and Mary Spence, of the University of California at Berkeley, observe that a language and mythology soon grew up around the bridge: if the stress gets too great, they quote city residents as saying, “one can always go off the bridge.” In San Francisco, Gray Line Tour bus drivers cited Golden Gate Bridge suicides as a part of their tours, and jokes on the subject ended up in greeting cards. The San Francisco Chronicle reported a lottery whose players bet on the date of the next suicide from the bridge.

  The jump from the Golden Gate Bridge is 250 feet and almost invariably fatal. Trauma from water impact is extreme, ripping apart the great blood vessels, demolishing the central nervous system, and transecting the spinal cord. A few have died from drowning and one from a shark attack, but mostly death is caused by the crushing impact of body on water. In the word of one of the doctors who investigated the causes of death in the suicide victims, the trauma rips the internal organs “asunder.”

  In fact, only 1 percent of those who jump from the Golden Gate Bridge survive. David Rosen, a psychiatrist at the University of California, San Francisco Medical School, interviewed six of those survivors, and all said that for them it was only the Golden Gate Bridge that they considered as a suicide site; as one put it, “It was the Golden Gate Brid
ge or nothing.” Another remarked, “There is a kind of form to it, a certain grace and beauty. The Golden Gate Bridge is readily available and it is connected with suicide.” One man, suffering from depression, also emphasized the bridge’s accessibility. In the suicide note he left before jumping off the bridge, he asked, “Why do you make it so easy?”

  All the survivors favored the construction of a suicide barrier, an idea resisted by bridge officials until very recently. Most of the survivors also stressed the importance of somehow deromanticizing suicide from the bridge. One survivor, understandably, if naively, said, “Newspaper editors should voluntarily stop all press coverage of the Golden Gate Bridge suicides—extensive press coverage put the idea into my mind.” This is debatable, but it is an important and complicated debate to which we will return.

  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. It may seem strange that such high rates should exist in places specifically designed to protect patients from harming or killing themselves. But in many ways, it is no more strange than the fact that there are high death rates in intensive care units or on oncology wards. Psychiatric hospitals exist to take care of the most severely ill and those most at risk for suicide. A common reason for admission to a mental hospital is having attempted suicide, and attempted suicide is, as we have seen, the single best predictor of subsequent suicide. A substantial risk of suicide is also one of the few reasons people can be held in hospitals involuntarily.

  Although many precautions can be taken by medical staff to protect patients, there is no way, short of intolerable violations of privacy and freedom, to protect everyone. The line between civil liberties and preservation of life is a controversial one. Acutely suicidal patients are kept under close observation, often on a locked ward. Windows on such wards are usually unbreakable and unopenable, electrical cords are kept as short as possible, and “breakaway” hooks and shower rods, designed to break off at low weights, are used. Patients are searched for sharp objects and drugs, and matches, lighters, nail polish remover, mirrors, bottles, scissors, belts, and shoelaces are removed from their possession.

  Physical observation of suicidal patients is intense, with levels varying according to the assessment of the suicide risk. In one-to-one observation, the patient is continuously watched and accompanied by a staff member even when the patient is showering or using the toilet. The physical proximity is kept close, sometimes no further than arm’s length, in order to allow a quick response in case of a sudden or impulsive move. Occasionally, a single nurse may observe two or three suicidal patients at the same time; if the suicide risk appears to lessen, a patient will then be put on five-, fifteen-, or thirty-minute “checks.” These checks consist of staff members monitoring the whereabouts and well-being of the patient on a frequent but not continuous basis.

  Were suicidal patients able or willing to articulate the severity of their suicidal thoughts and plans, little risk would exist. But this is not the case. Patients determined to die may present a clinical picture greatly at variance with how they actually feel or what they intend to do. They may move quickly and with desperate ingenuity. As nineteenth-century psychiatrist Emil Kraepelin wrote in his classic text, Manic-Depressive Insanity:

  Only too often the patients know how to conceal their suicidal intentions behind an apparently cheerful behaviour, and then carefully prepare for the execution of their intention at a suitable moment. The possibilities at their command are numerous. They may, while deceiving the vigilance of the people round them, drown themselves in the bath, hang themselves on the latch of the door, or on any projecting corner in the watercloset, indeed even strangle themselves in bed under the cover with a handkerchief or strips of linen. They may swallow needles, nails, bits of broken glass, even spoons, drink up any medicine, save up sleeping-powder and take it all at one time, throw themselves downstairs, smash their skull with a heavy object and so on. A female patient by sticking in pieces of paper managed to prevent the upper part of a window, where there was no grating, being properly shut, and then threw herself down from the second storey in an unwatched moment. Another who was shortly to have been discharged, was alone for a few minutes in the scullery; she took a little bottle of spirit and a match from the cupboard, which had been left open through negligence, and having poured the spirit over herself set herself on fire.

  In the 1930s, Gerald Jameison and James Wall, at Bloomingdale Hospital in New York State, described the varieties of suicide methods used by patients in their hospital: twisted cords round the neck; two neckties attached to plumbing fixtures in the toilet; three handkerchiefs attached to the hinge of a closet door; a curtain tied around the throat and then attached to a window sash; cut throats from razors or window glass; and a cut femoral and radial artery with a piece of glass from a tumbler. (Sylvia Plath, who had been hospitalized after a nearly lethal suicide attempt, described in her autobiographical novel, The Bell Jar, the guile attendant to suicidal thought: “A maid in a green uniform was setting the tables for supper,” she wrote. “There were white linen tablecloths and glasses and paper napkins. I stored the fact that they were real glasses in the corner of my mind the way a squirrel stores a nut. At the city hospital we had drunk out of paper cups and had no knives to cut our meat.”)

  Hanging and jumping are by far the most common methods of suicide used by psychiatric inpatients, and being under staff supervision is no guarantee against self-inflicted injuries and death. Psychiatrists Jan Fawcett and Katie Busch, in a Chicago-based study of patients who had committed suicide while in the hospital, found that more than 40 percent had been on fifteen-minute checks at the time they killed themselves. Fully 70 percent of those who killed themselves had denied, prior to the act, any suicidal thinking or plans.

  The reality of treating seriously ill and potentially suicidal patients is that difficult clinical decisions have to be made each step of the way. When should a patient first be taken off constant nursing observation and placed on fifteen- or thirty-minute checks? At what point can a patient first be allowed off the ward unaccompanied or given a pass to go home for the weekend? Prediction is imperfect, and patients who are desirous of dying dissemble.

  Research indicates that more than half the patients who kill themselves in psychiatric hospitals had been described by nursing or medical staff, just before their suicides, as “clinically improved” or “improving.” Indeed, nearly 50 percent of those who commit suicide while on a ward, or immediately after discharge from the hospital, had been assessed as nonsuicidal at the time of admission. The days early in hospitalization and those leading up to discharge are particularly high-risk periods for suicide. The time prior to leaving the hospital is often laden with concerns about rejection by family and friends, loneliness, a still turbulent clinical course (often characterized by volatile mood cycling and an exceedingly uncomfortable restlessness, agitation, and irritability), concerns about job problems or unemployment, and fears about being able to manage outside the hospital. Often caught in the dilemma of being too well to be in the hospital but not well enough to deal with the realities and stresses of life outside, as well as having to contend with the personal and economic consequences of having a serious mental illness, patients sometimes feel utterly hopeless and overwhelmed, and kill themselves. Hospitals can provide sanctuary and medical care; they can save the lives of many who are suicidal. But they cannot save everyone.

  THE LION ENCLOSURE

  The world goes by my cage and never sees me.

  —RANDALL JARRELL,

  “The Woman at the Washington Zoo”

  THE CAUSE of death, said the medical examiner, was suicide: the dead woman had died from sharp- and blunt-force injury associated with massive blood and soft-tissue loss. No doubt this was true. More to the point, however, the thirty-six-year-old woman with long dark hair had been mangled, shredded, and partially e
aten by one or both of the lions in their outdoor enclosure at the National Zoo in Washington. Mauling was the reality. Mauling, with all of its attendant visual horrors, was what people conjured. Not blunt-force injury. Not soft-tissue loss. A woman was violently dead, in a manner handpicked and appalling.

  Her body, still wet from swimming across a twenty-six-foot moat—only one of several barriers separating the public from the four-hundred-pound cats—was discovered by a zoo worker on a cold March morning in 1995. Face up, mutilated beyond recognition, the body was dressed lightly for the winter day. It lay on a grassy terrace near the place where the lions went for their usual feeding; the arms and hands had been chewed off. Bite marks covered the corpse. Certainly, as the medical examiner put it—certainly and terribly—“this was not an instantaneous death.”

  No one doubted the immediate cause of death. The lions, a young male and older female, would have responded predictably to an intruder in their territory. Out of curiosity or a sense of threat, instinct would dictate a deadly or near-deadly outcome. No one questioned that the powerful and dangerous carnivores had killed the young woman. The questions that, for a day or two, kept the nation’s capital spellbound were, instead: Who was she? And why?

  Intense public interest in the macabre circumstances of the woman’s death provoked an inevitable round of speculation: Was it suicide? Murder? Had she fallen into the lion enclosure by accident? The bizarreness of the circumstances, the savagery of her death caught everyone’s imagination in the darkest, most primitive of ways.

  The Washington Post, in one of five stories it ran on the subject, captured the city’s shock at the act: “Suddenly,” wrote journalist Phil McCombs, “this city of smooth diplomacy with its false beaming smiles and barely sheathed fangs, this town where Arafat and Rabin could shake hands and lobbyists blandly testify under oath that their deadly products won’t harm you, this place of careful spins and cloaked motives and paper death, was mesmerized by the sudden fierce savagery of real slaughter.… It was, in a way, a death too simple for Washington to swallow. By yesterday afternoon [two days after her death had been reported], at least one caller to talk radio was speculating that the sad event at the zoo must be related to the Whitewater investigation.”