Night Falls Fast

by Kay Redfield Jamison

  17 The most important cause: I. M. K. Ovenstone, “A Psychiatric Approach to the Diagnosis of Suicide and Its Effect upon the Edinburgh Statistics,” British Journal of Psychiatry, 123 (1973): 15–21; M. W. Atkinson, N. Kessel, and J. B. Dalgaard, “The Comparability of Suicide Rates,” British Journal of Psychiatry, 127 (1975): 247–256; B. M. Barraclough, “Reliability of Violent Death Certification in One Coroner’s District,” British Journal of Psychiatry, 132 (1978): 39–41; R. E. Litman, “500 Psychological Autopsies,” Journal of Forensic Science, 34 (1989): 638–646; M. Speechley and K. M. Stavraky, “The Adequacy of Suicide Statistics for Use in Epidemiology and Public Health,” Canadian Journal of Public Health, 82 (1991): 38–42; P. N. Cooper and C. M. Milroy, “The Coroner’s System and Under-reporting of Suicide,” Medical Science Law, 35 (1995), 319–326.

  18 Self-poisoning deaths: R. D. T. Farmer, “Assessing the Epidemiology of Suicide and Parasuicide,” British Journal of Psychiatry, 153 (1988): 16–20.

  19 This technique: P. Friedman, “Suicide Among Police: A Study of Ninety-Three Suicides Among New York City Policemen, 1934–1940,” in E. S. Shneidman, ed., Essays in Self-Destruction (New York: Science House, 1967), pp. 414–449.

  20 The study, now a classic: E. R. Robins, G. E. Murphy, R. H. Wilkinson, S. Gassner, and J. Kayes, “Some Clinical Considerations in the Prevention of Suicide Based on a Study of 134 Successful Suicides,” American Journal of Public Health, 49 (1959): 888–899; Eli Robins, The Final Months: A Study of the Lives of 134 Persons Who Committed Suicide (New York: Oxford University Press, 1981).

  21 as a method of clinical: E. S. Shneidman and N. L. Farberow, “Sample Investigations of Equivocal Deaths,” in N. L. Farberow and E. S. Shneidman, eds., The Cry for Help (New York: McGraw-Hill, 1961), pp. 118–128; R. E. Litman, T. J. Curphey, E. S. Shneidman, et al., “Investigations of Equivocal Suicides,” Journal of the American Medical Association, 184 (1963): 924–929; T. J. Curphey, “The Forensic Pathologist and the Multidisciplinary Approach to Death,” in E. S. Shneidman, ed., Essays in Self-Destruction (New York: Science House, 1967), pp. 110–117; E. S. Shneidman, “Suicide, Lethality and the Psychological Autopsy,” E. S. Shneidman and M. Ortega, eds., Aspects of Depression (Boston: Little, Brown, 1969).

  22 Members of the Suicide Team: The list of inquiry topics is from E. S. Shneidman, Deaths of Man (Baltimore: Penguin, 1974), p. 135.

  23 “In practically any coroner’s office”: N. L. Farberow and E. S. Shneidman, eds., The Cry for Help (New York: McGraw-Hill, 1965), p. 121.

  24 The psychological autopsy: J. Beskow, B. Runeson, and U. Asgard, “Psychological Autopsies: Methods and Ethics,” Suicide and Life-Threatening Behavior, 20 (1990): 307–323; D. C. Clark and S. L. Horton-Deutsch, “Assessment in Absentia: The Value of the Psychological Autopsy Method for Studying Antecedents of Suicide and Predicting Future Suicides,” in R. W. Maris, A. L. Berman, J. T. Maltsberger, and R. I. Yufit, eds., Assessment and Prevention of Suicide, (New York: Guilford, 1992, pp. 144–181.

  25 It has proven especially useful: T. L. Dorpat and H. S. Ripley, “A Study of Suicide in the Seattle Area,” Comprehensive Psychiatry, 1 (1960): 349–359; B. M. Barraclough, J. Bunch, B. Nelson, and P. Sainsbury, “A Hundred Cases of Suicide: Clinical Aspects,” British Journal of Psychiatry, 125 (1974): 355–373; C. L. Rich, D. Young, and R. C. Fowler, “San Diego Suicide Study: 1. Young Versus Old Subjects,” Archives of General Psychiatry, 43 (1986): 577–582; D. A. Brent, J. A. Perper, C. E. Goldstein, D. J. Kolko, M. J. Allan, C. J. Allman, and J. P. Zelenak, “Risk Factors for Adolescent Suicide: A Comparison of Adolescent Suicide Victims with Suicidal Inpatients,” Archives of General Psychiatry, 45 (1988): 581–588.

  26 These indirect, or “subintentional,”: Edwin Shneidman, Definition of Suicide (New York: John Wiley, 1985), p. 21.

  27 chronic alcohol or drug abuse: Karl Menninger, Man Against Himself (New York: Harcourt, Brace and Co., 1938); Norman Farberow, ed., The Many Faces of Suicide (New York: McGraw-Hill, 1980).

  28 Twenty-five years ago: E. S. Paykel, J. K. Myers, J. J. Lindenthal, and J. Tanner, “Suicidal Feelings in the General Population: A Prevalence Study,” British Journal of Psychiatry, 124 (1974) 460–469.

  29 National Institute of Mental Health: Lee N. Robins and Darrel A. Regier, eds., Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (New York: Free Press, 1991).

  30 Of the 18,500 individuals: E. K. Moscicki, P. O’Carroll, B. Z. Locke, D. S. Rae, A. G. Roy, and D. A. Regier, “Suicidal Ideation and Attempts: The Epidemiologic Catchment Area,” in U.S. DHHS, Report of the Secretary’s Task Force on Youth Suicide: vol. 4, Strategies for the Prevention of Youth Suicide (Washington, D.C.: U.S. Government Printing Office, 1988); E. K. Moscicki, “Epidemiologic Surveys as Tools for Studying Suicidal Behavior: A Review,” Suicide and Life-Threatening Behavior, 19 (1989): 131–146.

  31 Other investigations conducted: J. J. Schwab, G. J. Warheit, and C. E. Holzer, “Suicidal Ideation and Behaviour in a General Population,” Diseases of the Nervous System, 33 (1972): 745–749; T. Hällstrom, “Life-Weariness, Suicidal Thoughts and Suicidal Attempts Among Women in Gothenburg, Sweden,” Acta Psychiatrica Scandinavica, 56 (1977): 15–20; D. S. Vandivort and B. Z. Locke, “Suicide Ideation: Its Relation to Depression, Suicide, and Suicide Attempt,” Suicide and Life-Threatening Behavior, 9 (1979): 205–218; E. L. Goldberg, “Depression and Suicide Ideation in the Young Adult,” American Journal of Psychiatry, 138 (1981): 35–40; R. Ramsay and C. Bagley, “The Prevalence of Suicidal Behaviors, Attitudes and Associated Social Experiences in an Urban Population,” Suicide and Life-Threatening Behavior, 15 (1985): 151–167.

  32 The most comprehensive study: “Youth Risk Behavior Surveillance: National College Health Risk Behavior Survey—United States, 1995,” Morbidity and Mortality Weekly Report, 46 (1997): No. SS-6.

  33 Other research, conducted in Europe: L. E. Craig and R. J. Senter, “Student Thoughts About Suicide,” Psychological Record, 22 (1972): 355–358; C. V. Leonard and D. E. Flinn, “Suicidal Ideation and Behavior in Youthful Nonpsychiatric Populations,” Journal of Consulting and Clinical Psychology, 38 (1972): 366–371; D. C. Murray, “Suicidal and Depressive Feelings Among College Students,” Psychological Reports, 33 (1973): 175–181; B. L. Mishara, A. H. Baker, and T. T. Mishara, “The Frequency of Suicide Attempts: A Retrospective Approach Applied to College Students,” American Journal of Psychiatry, 133 (1976): 841–844; J. L. Bernard and M. Bernard, “Factors Related to Suicidal Behavior Among College Students and the Impact of Institutional Response,” Journal of College Student Personnel, 23 (1982): 409-413; B. L. Mishara, “College Students’ Experience with Suicide and Reactions to Suicidal Verbalizations: A Model for Prevention.” Journal of Community Psychology, 10 (1982): 142–150; M. D. Rudd, “The Prevalence of Suicidal Ideation Among College Students,” Suicide and Life-Threatening Behavior, 19 (1989): 173–183; P. W. Meilman, J. A. Pattis, and D. Kraus-Zeilmann, “Suicide Attempts and Threats on One College Campus: Policy and Practice,” Journal of American College Health, 42 (1994): 147–154.

  34 High school students also: Youth Risk Behavior Surveillance—United States, 1997, Centers for Disease Control and Prevention, CDC Surveillance Summaries, August 14, 1998. Morbidity and Mortality Weekly Report, 47 (1998): No. SS-3.

  35 more than 50 percent of New York: J. M. Harkavy Friedman, G. M. Asnis, M. Boeck, and J. DiFiore, “Prevalence of Specific Suicidal Behaviors in a High School Sample,” American Journal of Psychiatry, 144 (1987): 1203-1206.

  36 20 percent of Oregon high school: P. M. Lewinsohn, P. Rohde, and J. P. Seeley, “Adolescent Suicidal Ideation and Attempts: Prevalence, Risk Factors, and Clinical Implications,” Clinical Psychology: Science and Practice, 3 (1996): 25–46.

  37 One in twenty French boys: M. Choquet and H. Menke, “Suicidal Thoughts During Early Adolescence: Prevalence, Associated Troubles and Help-Seeking Behavior,” Acta Psychiatrica Scandinavica, 81 (1989): 170–177.

  38 In Canada, one in
ten: M. Choquet, V. Kovess, and N. Poutignat, “Suicidal Thoughts Among Adolescents: An Intercultural Approach,” Adolescence, 28 (1993): 649–659.

  39 Another Canadian study: R. T. Joffe, D. R. Offord, and M. H. Boyle, “Ontario Child Health Study,” American Journal of Psychiatry, 145 (1 988): 1420–1423.

  40 it is of further concern: T. M. Achenbach and C. S. Edelbrock, Manual for the Child Behavior Checklist and Revised Child Behavior Profile (Burlington: University of Vermont Department of Psychiatry, 1983); T. M. Achenbach and C. S. Edelbrock, Manual for the Youth Self-Report and Profile (Burlington: University of Vermont Department of Psychiatry, 1987); J. M. Rey and K. D. Bird, “Sex Differences in Suicidal Behavior of Referred Adolescents,” British Journal of Psychiatry, 158 (1991): 776–781.

  41 Parents also seriously underestimate: D. M. Velting, D. Shaffer, M. S. Gould, R. Garfinkel, P. Fisher, and M. Davies, “Parent-Victim Agreement in Adolescent Suicide Research,” Journal of the American Academy of Child and Adolescent Psychiatry, 37 (1998): 1161–1166.

  42 Cynthia Pfeffer: C. R. Pfeffer, “Suicidal Fantasies in Normal Children,” Journal of Nervous and Mental Disease, 173 (1985): 78–84, p. 80.

  43 “One night”: Evelyn Waugh, A Little Learning. The First Volume of an Autobiography (London: Chapman & Hall, 1964), pp. 229–230.

  44 There is, in fact, no consistent: D. J. Pallis and P. Sainsbury, “The Value of Assessing Intent in Attempted Suicide,” Psychological Medicine, 6 (1976): 487–492; A. S. Henderson, J. Hartigan, J. Davidson, G. N. Lance, P. Duncan-Jones, K. M. Koller, K. Ritchie, H. McAuley, C. L. Williams, and W. Slaghuis, “A Typology of Parasuicide,” British Journal of Psychiatry, 131 (1977): 631–641; E. S. Paykel and E. Rassaby, “Classification of Suicide Attempters by Cluster Analysis,” British Journal of Psychiatry, 133 (1978): 45–52; S. Henderson and G. N. Lance, “Types of Attempted Suicide,” Acta Psychiatrica Scandinavica, 59 (1979): 31–39; K. Hawton, M. Osborn, J. O’Grady, and D. Cole, “Classification of Adolescents Who Take Overdoses,” British Journal of Psychiatry, 140 (1982): 124–131; D. J. Pallis, J. S. Gibbons, and D. W. Pierce, “Estimating Suicide Risk Among Attempted Suicides: II. Efficiency of Predictive Scales After the Attempt,” British Journal of Psychiatry, 144 (1984): 139–148; D. A. Brent, “Correlates of the Medical Lethality of Suicide Attempts in Children and Adolescents,” Journal of the American Academy for Child and Adolescent Psychiatry, 26 (1987): 87–89; A. Kurz, H. J. Möller, G. Baindl, F. Bürk, A Torhorst, C. Wächtler, and H. Lauter, “Classification of Parasuicide by Cluster Analysis: Types of Suicidal Behaviour, Therapeutic and Prognostic Implications,” British Journal of Psychiatry, 150 (1987): 520–525; H. Hjelmeland, “Verbally Expressed Intentions of Parasuicide: 1. Characteristics of Patients with Various Intentions,” Crisis, 16 (1995): 176–180; E. Arensman and J. F. M. Kerkhof, “Classification of Attempted Suicide: A Review of Empirical Studies, 1963–1993,” Suicide and Life-Threatening Behavior, 26 (1996): 46–65.

  45 A Suicide Intent Scale: R. W. Beck, J. B. Morris, and A. T. Beck, “Cross-Validation of a Suicide Intent Scale,” Psychological Reports, 34 (1974): 445–446.

  46 In addition to scales: P. R. McHugh and H. Goodell, “Suicidal Behavior: A Distinction in Patients with Sedative Poisoning Seen in a General Hospital,” Archives of General Psychiatry, 25 (1971): 456–464; A. D. Weisman and J. W. Worden, “Risk-Rescue Rating in Suicide Assessment,” Archives of General Psychiatry, 26 (1972): 553–560; L. B. Potter, M. Kresnow, K. E. Powell, Patrick W. O’Carroll, R. K. Lee, R. F. Frankowski, A. C. Swann, T. L. Bayer, M. H. Bautista, and M. G. Briscoe, “Identification of Nearly Fatal Suicide Attempts: Self-Inflicted Injury Severity Form,” Suicide and Life-Threatening Behavior, 28 (1998): 174–186.

  47 between 1 and 4 percent: J. J. Schwab, G. J. Warheit, and C. E. Holzer, “Suicide Ideation and Behavior in a General Population,” Diseases of the Nervous System, 33 (1972): 745–748; E. S. Paykel, J. K. Myers, J. J. Lindenthal, and J. Tanner, “Suicidal Feelings in the General Population: A Prevalence Study,” British Journal of Psychiatry, 124 (1974): 460–469; R. Ramsay and C. Bagley, “The Prevalence of Suicidal Behaviors, Attitudes and Associated Social Experiences in an Urban Population,” Suicide and Life-Threatening Behavior, 15 (1985): 151–167; E. K. Moscicki, P. O’Carroll, D. S. Rae, B. Z. Locke, A. Roy, and D. A. Regier, “Suicide Attempts in the Epidemiologic Catchment Area Study,” Yale Journal of Biology and Medicine, 61 (1988): 259–268; J. Hintikka, H. Viinamäki, A. Tanskanen, O. Kontula, and K. Koskela, “Suicidal Ideation and Parasuicide in the Finnish General Population,” Acta Psychiatrica Scandinavica, 98 (1998): 23–27; D. J. Statham, A. C. Heath, P. A. F. Madden, K. K. Bucholz, L. Bierut, S. H. Dinwiddie, W. S. Slutske, M. P. Dunne, and N. G. Martin, “Suicidal Behaviour: An Epidemiological and Genetic Study,” Psychological Medicine, 28 (1998): 839–855; M. M. Weissman, R. C. Bland, G. J. Canino, S. Greenwald, H.-G. Hwu, P. R. Joyce, E. G. Karam, C.-K. Lee, J. Lellouch, J.-P. Lepine, S. C. Newman, M. Rubio-Stipec, J. E. Wells, P. J. Wickramartne, H.-U. Wittchen, and E.-K. Yeh, “Prevalence of Suicide Ideation and Suicide Attempts in Nine Countries,” Psychological Medicine, 29 (1999): 9–17.

  48 Adolescents, on the other hand: B. L. Mishara, A. H. Baker, and T. T. Mishara, “The Frequency of Suicide Attempts: A Retrospective Approach Applied to College Students,” American Journal of Psychiatry, 133 (1976): 841–844; J. M. Harkavy Friedman, G. M. Asnis, M. Boeck, and J. Di Fiore, “Prevalence of Specific Suicidal Behaviors in a High School Sample,” American Journal of Psychiatry, 144 (1987): 1203–1206; R. T. Joffe, D. R. Offord, and M. H. Boyle, “Ontario Child Health Study: Suicidal Behavior in Youth Age 12–16 Years,” American Journal of Psychiatry, 145 (1988): 1420–1423; M. D. Rudd, “The Prevalence of Suicidal Ideation Among College Students,” Suicide and Life-Threatening Behavior, 19 (1989): 173–183; C. W. M. Kienhorst, E. J. DeWilde, J. van den Bout, R. F. W. Diekstra, and W. H. G. Wolters, “Characteristics of Suicide Attempters in a Population-Based Sample of Dutch Adolescents,” British Journal of Psychiatry, 156 (1990): 243–248; P. J. Meehan, J. A. Lamb, L. E. Saltzman, and P. W. O’Carroll, “Attempted Suicide Among Young Adults: Progress Toward a Meaningful Estimate of Prevalence,” American Journal of Psychiatry, 149 (1992): 41–44; P. M. Lewinsohn, P. Rohde, and J. R. Seeley, “Adolescent Suicidal Ideation and Attempts: Prevalence, Risk Factors, and Clinical Implications,” Clinical Psychology: Science and Practice, 3 (1996), 25–46; “Youth Risk Behavior Surveillance: National College Health Risk Behavior Survey—United States, 1995,” Morbidity and Mortality Weekly Report, 46 (1997): No. SS-6; C. Rey Gex, F. Narring, C. Ferron, and P. A. Michaud, “Suicide Attempts Among Adolescents in Switzerland: Prevalence, Associated Factors and Comorbidity,” Acta Psychiatrica Scandinavica, 98 (1998): 28–33; “Youth Risk Behavior Surveillance—United States, 1997,” Centers for Disease Control and Prevention, CDC Surveillance Summaries, August 14, 1998, Morbidity and Mortality Weekly Report, 47 (1998): No. SS-3.

  49 Myrna Weissman: M. M. Weissman, “The Epidemiology of Suicide Attempts, 1960 to 1971,” Archives of General Psychiatry, 30 (1974): 737–746.

  50 There may also be a tendency: R. D. Goldney, S. Smith. A. H. Winefield, M. Tiggeman, and H. R. Winefield, “Suicidal Ideation: Its Enduring Nature and Associated Morbidity,” Acta Psychiatrica Scandinavica, 83 (1991): 115–120.

  51 There are an estimated: E. S. Shneidman and N. L. Farberow, “Statistical Comparison Between Attempted and Committed Suicides,” in N. L. Farberow and E. S. Shneidman, eds., The Cry for Help (New York: McGraw-Hill, 1961), pp. 19–47; E. Stengel, Suicide and Attempted Suicide (Baltimore: Penguin, 1964); D. Parkin and E. Stengel, “Incidence of Suicidal Attempts in an Urban Community,” British Medical Journal, 2 (1965): 133–138; I. M. K. Ovenstone, “Spectrum of Suicidal Behaviours in Edinburgh,” British Journal of Preventive and Social Medicine, 27 (1973): 27–35; M. McIntire, C. R. Angle, R. L. Wikoff, and M. L. Schlicht, “Recurrent Adolescent Suicidal Behavior,” Pediatrics, 60 (1977): 605–608; K. R. Petronis, J. F. Samuels, and E. K. Moscicki,
“An Epidemiologic Investigation of Potential Risk Factors for Suicide Attempts,” Social Psychiatry and Psychiatric Epidemiology, 35 (1990): 193–199; R. F. W. Diekstra and W. Gulbinat, “The Epidemiology of Suicidal Behavior: A Review of Three Continents,” World Health Statistical Quarterly, 46 (1993): 52–68; C. M. Pearce and G. Martin, “Predicting Suicide Attempts Among Adolescents,” Acta Psychiatrica Scandinavica, 90 (1994): 324–328; A. Schmidtke, “Perspective: Suicide in Europe,” Suicide and Life-Threatening Behavior, 27 (1997): 127–136.

  52 And many, if not most: R. Siani, N. Garzotto, C. Zimmerman Tansella, and M. Tansella, “Predictive Scales for Parasuicide Repetition: Further Results,” Acta Psychiatrica Scandinavica, 59 (1979): 17–23; N. Kreitman and P. Casey, “Repetition of Parasuicide: An Epidemiological and Clinical Study,” British Journal of Psychiatry, 153 (1988): 792–800; E. D. Myers, “Predicting Repetition of Deliberate Self-Harm: A Review of the Literature in the Light of a Current Study,” Acta Psychiatrica Scandinavica, 77 (1988): 314–319; A. Öjehagen, G. Regnell, and L. Träskman-Bendz, “Deliberate Self-Poisoning: Repeaters and Nonrepeaters Admitted to an Intensive Care Unit,” Acta Psychiatrica Scandinavica, 84 (1991): 266–271; H. Hjelmeland, “Repetition of Parasuicide: A Predictive Study,” Suicide and Life-Threatening Behavior, 26 (1996): 395–404; U. Bille-Brahe, A. Kerkhof, D. De Leo, A Schmidtke, P. Crepet, J. Lönnqvist, K. Michel, E. Salander-Renberg, T. C. Stiles, D. Wasserman, B. Aagaard, H. Egebo, and B. Jensen, “A Repetition-Prediction Study of European Parasuicide Populations: A Summary of the First Report from Part II of the WHO/EURO Multicentre Study on Parasuicide,” Acta Psychiatrica Scandinavica, 95 (1977): 81–86.

  53 Women in the United States: R. N. Anderson, K. D. Kochanek, and S. L. Murphy, “Advance Report of Final Mortality Statistics, 1995,” Monthly Vital Statistics Report, 45 (Hyattsville, Md.: National Center for Health Statistics, 1997), DHHS Publication No. (PHS) 97–1120.