Night Falls Fast

by Kay Redfield Jamison

  49 It is malevolent: A. Roy, “Suicide in Schizophrenia,” in A. Roy, ed., Suicide (Baltimore: Williams & Wilkins, 1986), pp. 97–112; C. B. Caldwell and I. I. Gottesman, “Schizophrenia—A High-Risk Factor for Suicide: Clues to Risk Reduction,” Suicide and Life-Threatening Behavior, 22 (1992): 479–493.

  50 death’s heads: Emil Kraepelin, Dementia Praecox and Paraphrenia, trans. R. M. Barclay, ed. G. M. Robertson (Huntington, N.Y.: Robert E. Krieger, 1971; first published in English 1919), p. 14.

  51 “I lay motionless”: Carol S. North, Welcome, Silence: My Triumph over Schizophrenia (New York: Simon and Schuster, 1987), p. 116.

  52 “The reality for myself”: R. Bayley, “First Person Account: Schizophrenia,” Schizophrenia Bulletin, 22 (1996): 727–729.

  53 For many, mood is also affected: S. G. Siris, “Depression and Schizophrenia,” in S. R. Hirsch and D. R. Weinberger, Schizophrenia (Oxford: Blackwell Science, 1995), pp. 128–145.

  54 at least one in four: R. E. Drake and P. G. Cotton, “Depression, Hopelessness and Suicide in Chronic Schizophrenia,” British Journal of Psychiatry, 148 (1986): 554–559; A. A. Salama, “Depression and Suicide in Schizophrenic Patients,” Suicide and Life-Threatening Behavior, 18 (1988): 379–384; K. K. Cheng, C. M. Leung, W. H. Lo, and T. H. Lam, “Risk Factors of Suicide Among Schizophrenics,” Acta Psychiatrica Scandinavica, 81 (1990): 220–224; A. M. Dassori, J. E. Mezzich, and M. Keshavan, “Suicidal Indicators in Schizophrenia,” Acta Psychiatrica Scandinavica, 81 (1990): 409–413; J. S. Jones, D. J. Stein, B. Stanley, J. R. Guido, R. Winchel, and M. Stanley, “Negative and Depressive Symptoms in Suicidal Schizophrenics,” Acta Psychiatrica Scandinavica, 89 (1994): 81–87; H. Heilä, E. Isometsä, M. M. Henriksson, M. E. Heikkinen, M. J. Marttunen, and J. K. Lönnqvist, “Suicide and Schizophrenia: A Nationwide Psychological Autopsy Study on Age- and Sex-Specific Clinical Characteristics of 92 Suicide Victims with Schizophrenia,” American Journal of Psychiatry, 154 (1997): 1235–1242; C. D. Rossau and P. B. Mortensen, “Risk Factors for Suicide in Patients with Schizophrenia: Nested Case-Control Study,” British Journal of Psychiatry, 171 (1997): 355–359.

  55 intensely irritable, and restless: P. E. Yarden, “Observations on Suicide in Chronic Schizophrenia,” Comprehensive Psychiatry, 15 (1974): 325–333; C. W. Dingman and T. H. McGlashan, “Discriminating Characteristics of Suicide,” Acta Psychiatrica Scandinavica, 74 (1986): 91–97; D. G. Wilkinson, “The Suicide Rate in Schizophrenia,” British Journal of Psychiatry, 140 (1982): 138–141; P. Allebeck, A. Varla, E. Kristjansson, and B. Wistedt, “Risk Factors for Suicide Among Patients with Schizophrenia,” Acta Psychiatrica Scandinavica, 76 (1987): 414–419; A. M. Dassori, J. E. Mezzich, and M. Keshavan, “Suicidal Indicators in Schizophrenia,” Acta Psychiatrica Scandinavica, 81 (1990): 409–413.

  56 30 to 40 percent: A. Roy, “Suicide in Schizophrenia,” in A. Roy, ed., Suicide (Baltimore: Williams & Wilkins, 1986), pp. 97–112; L. N. Robins and D. A. Regier, eds., Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (New York: Free Press, 1991); C. B. Caldwell and I. I. Gottesman, “Schizophrenia—A High-Risk Factor for Suicide: Clues to Risk Reduction,” Suicide and Life-Threatening Behavior, 22 (1992): 479–493; R. Chatterton, “Parasuicide in People with Schizophrenia,” Australian and New Zealand Journal of Mental Health Nursing, 4 (1995): 83–86; G. L. Haas, “Suicidal Behavior in Schizophrenia,” in R. W. Maris, M. M. Silverman, and S. S. Canetto, eds., Review of Suicidology, 1997 (New York: Guilford, 1997), pp. 202–236

  57 the single best predictor: J. W. Shaffer, S. Perlin, C. W. Schmidt, and J. H. Stephens, “The Prediction of Suicide in Schizophrenia,” Journal of Nervous and Mental Disease, 159 (1974): 349–355; G. Wilkinson and N. A. Bacon, “A Clinical and Epidemiological Survey of Parasuicide and Suicide in Edinburgh Schizophrenics,” Psychological Medicine, 14 (1984): 899–912; P. Allebeck, A. Varla, E. Kristjansson, and B. Wistedt, “Risk Factors for Suicide Among Patients with Schizophrenia,” Acta Psychiatrica Scandinavica, 76 (1987): 414–419; G. L. Haas, “Suicidal Behavior in Schizophrenia,” in R. W. Maris, M. M. Silverman, and S. S. Canetto, eds. Review of Suicidology (New York: Guilford, 1997), pp. 202–236. Roy, “Suicide in Schizophrenia.”

  58 in the early stages: M. T. Tsuang and R. F. Woolson, “Excess Mortality in Schizophrenia and Affective Disorders,” Archives of General Psychiatry, 35 (1978): 1181–1185; D. W. Black and G. Winokur, “Prospective Studies of Suicide and Mortality in Psychiatric Patients,” Annals of the New York Academy of Sciences, 487 (1986): 106–113; C. A. Johns, M. Stanley, and B. Stanley, “Suicide in Schizophrenia,” Annals of the New York Academy of Sciences, 487 (1986): 294–300; D. Wiersma, F. J. Nienhuis, C. J. Slooff, and R. Giel, “Natural Course of Schizophrenic Disorders: A 15-Year Followup of a Dutch Incidence Cohort,” Schizophrenia Bulletin, 24 (1998): 75–85.

  59 recently released: G. S. Stein, “Dangerous Episodes Occurring Around the Time of Discharge of Four Chronic Schizophrenics,” British Journal of Psychiatry, 141 (1982): 586–589; Roy, “Suicide in Schizophrenia”; D. W. Black and R. Fisher, “Mortality in DSM-III-R Schizophrenia,” Schizophrenia Research, 7 (1992): 109–116; C. D. Rossau and P. B. Mortensen, “Risk Factors for Suicide in Patients with Schizophrenia: Nested Case-Control Study,” British Journal of Psychiatry, 171 (1997): 355–359.

  60 Although hallucinations and delusions: A. Breier and B. M. Astrachan, “Characterization of Schizophrenic Patients Who Commit Suicide,” American Journal of Psychiatry, 141 (1984): 206–209; G. Wilkinson and N. A. Bacon, “A Clinical and Epidemiological Survey of Parasuicide and Suicide in Edinburgh Schizophrenics,” Psychological Medicine, 14 (1984): 899–912; Roy, “Suicide in Schizophrenia”; D. Hellerstein, W. Frosch, and H. W. Koenigsberg, “The Clinical Significance of Command Hallucinations,” American Journal of Psychiatry, 144 (1987): 219–221; K. J. Kaplan and M. Harrow, “Positive and Negative Symptoms as Risk Factors for Later Suicidal Activity in Schizophrenics Versus Depressives,” Suicide and Life-Threatening Behavior, 26 (1996): 105–121; W. S. Fenton, T. H. McGlashan, B. J. Victor, and C. R. Blyler, “Symptoms, Subtype, and Suicidality in Patients with Schizophrenia Spectrum Disorders,” American Journal of Psychiatry, 154 (1997): 199–204.

  61 Although the eating disorders: D. B. Herzog, M. B. Keller, and P. W. Lavori, “Outcome in Anorexia Nervosa and Bulimia Nervosa: A Review of the Literature,” Journal of Nervous and Mental Disease, 176 (1988): 131–143; E. D. Eckert, K. A. Halmi, P. Marchi, et al., “Ten-Year Follow-up of Anorexia Nervosa: Clinical Course and Outcome,” Psychological Medicine, 25 (1995): 143–156.

  62 A review of more than thirty studies: A. Gardner and C. Rich, “Eating Disorders and Suicide,” in R. Yufit, ed., Proceedings of the 21st Annual Meeting of the American Association of Suicidology (Denver: American Association of Suicidology, 1988), pp. 171–172; P. K. Keel, J. E. Mitchell, K. B. Miller, T. L. Davis, and S. J. Crow, “Long-Term Outcome of Bulimia Nervosa,” Archives of General Psychiatry, 56 (1999): 63–69.

  63 Anxiety disorders, on the other hand: J. Fawcett, W. A. S. Scheftner, L. Fogg, D. C. Clark, M. A. Young, D. Hedeker, and R. Gibbons, “Time-Related Predictors of Suicide in Major Affective Disorder,” American Journal of Psychiatry, 147 (1990): 1189–1194; E. C. Harris and B. Barraclough, “Suicide as an Outcome for Mental Disorders: A Meta-Analysis,” British Journal of Psychiatry, 170 (1997): 205–228.

  64 The defining symptoms: P. J. Clayton, W. M. Grove, W. Coryell, et al., “Follow-up and Family Study of Anxious Depression,” American Journal of Psychiatry, 148 (1991): 1512–1517.

  65 Panic attacks are also: M. M. Weissman, G. L. Klerman, J. S. Markowitz, and R. Ouellette, “Suicidal Ideation and Suicide Attempts in Panic Disorder and Attacks,” New England Journal of Medicine, 321 (1989): 1209–1214; M. G. Warshaw, A. O. Massion, L. G. Peterson, L. A. Pratt, and M. B. Keller, “Suicidal Behavior in Patients with Panic Disorder: Retrospective and Prospective Data,” Journal of Affective Disorders, 34 (1994): 235–247; C. D. Horning and R. J. McNally, “Panic Disorder a
nd Suicide Attempt: A Reanalysis of Data from the Epidemiologic Catchment Area Study,” British Journal of Psychiatry, 167 (1995): 76–79; M. M. Weissman, “Comorbidity and Suicide Risk,” British Journal of Psychiatry, 167 (1995): 819–820; E. C. Harris and B. Barraclough, “Suicide as an Outcome for Mental Disorders: A Meta-Analysis,” British Journal of Psychiatry, 170 (1997): 205–228.

  66 Severe anxiety: J. Fawcett, W. A. S. Scheftner, L. Fogg, D. C. Clark, M. A. Young, D. Hedeker, and R. Gibbons, “Time-Related Predictors of Suicide in Major Affective Disorder,” American Journal of Psychiatry, 147 (1990): 1189–1194.

  67 suicide is rare: N. L. Gittleson, “The Relationship Between Obsessions and Suicidal Attempts in Depressive Psychosis,” British Journal of Psychiatry, 112 (1966): 889–890; C. M. Rosenberg, “Complications of Obsessional Neurosis,” British Journal of Psychiatry, 114 (1968): 477–478; R. A. Woodruff, P. J. Clayton, and S. B. Guze, “Suicide Attempts and Psychiatric Diagnosis,” Diseases of the Nervous System, 33 (1972): 617–621; C. E. Hollingsworth, P. E. Tanguay, L. Grossman, and P. Pabst, “Long-Term Outcome of Obsessive-Compulsive Disorder in Childhood,” Journal of the American Academy of Child Psychiatry, 19 (1980): 134–144; W. Coryell, R. Noyes, and D. House, “Mortality Among Outpatients with Anxiety Disorders,” American Journal of Psychiatry, 143 (1986): 508–510.

  68 unless it is extremely severe: E. Kringlen, “Obsessional Neurotics: A Long-Term Follow-Up,” British Journal of Psychiatry, 111 (1965): 709–722; P. Hay, P. Sachdev, S. Cumming, et al., “Treatment of Obsessive-Compulsive Disorder by Psychosurgery,” Acta Psychiatrica Scandinavica, 87 (1993): 197–207.

  69 Impulsivity and violence: M. R. Fryer, A. J. Frances, T. Sullivan, S. W. Hurt, and J. Clarkin, “Suicide Attempts in Patients with Borderline Personality Disorder,” American Journal of Psychiatry, 145 (1988): 737–739; B.-A. Armelius and G. Kullgren, “Pc-Modelling as an Instrument to Identify Patterns of Traits and Behaviors Associated with Completed Suicide in Borderline Personality Disorder,” in G. Kullgren, ed., Clinical Studies on the Borderline Concept with Special Reference to Suicidal Behavior (Umeå, Sweden: Umeå University Medical Dissertations, 1987), p. 204, cited in B. Runeson and J. Beskow, “Borderline Personality Disorder in Young Swedish Suicides,” Journal of Nervous and Mental Disease, 179 (1991): 153–156; D. A. Brent, B. Johnson, S. Bartle, et al., “Personality Disorder, Tendency to Impulsive Violence, and Suicidal Behavior in Adolescents,” Journal of the American Academy of Child and Adolescent Psychiatry, 32 (1993): 69–75; B. S. Brodsky, K. M. Malone, S. P. Ellis, R. A. Dulit, and J. J. Mann, “Characteristics of Borderline Personality Disorder Associated with Suicidal Behavior,” American Journal of Psychiatry, 154 (1997): 1715–1719; A. T. A. Cheng, A. H. Mann, and K. A. Chan, “Personality Disorder and Suicide: A Case-Control Study,” British Journal of Psychiatry, 170 (1997): 441–446.

  70 When the unstable elements: M. R. Fryer, A. J. Frances, T. Sullivan, S. W. Hurt, and J. Clarkin, “Suicide Attempts in Patients with Borderline Personality Disorder,” American Journal of Psychiatry, 145 (1988): 737–739; E. M. Corbitt, K. M. Malone, G. L. Haas, and J. J. Mann, “Suicidal Behavior with Minor Depression and Comorbid Personality Disorders,” Journal of Affective Disorders, 39 (1996): 61–72; E. T. Isometsä, M. M. Henriksson, M. E. Heikkinen, H. M. Aro, M. J. Marttunen, K. I. Kuoppasalmi, and J. K. Lönnqvist, “Suicide Among Subjects with Personality Disorders,” American Journal of Psychiatry, 153 (1996): 667–673; M. H. Stone, “Paradoxes in the Management of Suicidality in Borderline Patients,” American Journal of Psychotherapy, 47 (1993): 255–272; P. H. Soloff, “Risk Factors for Suicidal Behavior in Borderline Personality Disorder,” American Journal of Psychiatry, 151 (1994): 1316–1323; J. Davis, P. Janicak, and F. Ayd, “Psychopharmacotherapy of the Personality-Disordered Patient,” Psychiatric Annals, 25 (1995): 614–620.

  71 Nearly three-quarters: T. H. McGlashan. “The Chesnut Lodge Follow-up Study: III. Long-Term Outcome of Borderline Personalities,” Archives of General Psychiatry, 43 (1986): 2–30; J. Paris, R. Brown, and D. Nowlis, “Long-Term Follow-up of Borderline Patients in a General Hospital,” Comprehensive Psychiatry, 28 (1987): 530–535; M. H. Stone, D. K. Stone, and S. Hurt, “The Natural History of Borderline Patients Treated by Intensive Hospitalization,” Psychiatric Clinics of North America, 10 (1987): 185–206.

  72 more than 40 percent: B. S. Runeson, J. Beskow, and M. Waern, “The Suicidal Process in Suicides Among Young People,” Acta Psychiatrica Scandinavica, 93 (1996): 35–42.

  73 “During the first hours”: H. A. Wishnie, “Inpatient Therapy with Borderline Patients,” in J. E. Mack, ed., Borderline States in Psychiatry (New York: Grune & Straton, 1975), pp. 47–48.

  74 The reasons for this: P. M. Marzuk and J. J. Mann, “Suicide and Substance Abuse,” Psychiatric Annals, 18 (1988): 639–646.

  75 Alcohol and drugs, used: T. W. Estroff and M. S. Gold, “Medical and Psychiatric Complications of Cocaine Abuse with Possible Points of Pharmacological Treatment,” Advances in Alcohol and Substance Abuse, 5 (1986): 61–76; J. M. Himmelhoch and M. E. Garfinkel, “Sources of Lithium Resistance in Mixed Mania,” Psychopharmacology Bulletin, 22 (1986): 613–620; F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990).

  76 mental illness usually precedes: D. B. Kandel and M. Davies, “Adult Sequelae of Adolescent Depressive Syndromes,” Archives of General Psychiatry, 43 (1986): 255–262; K. A. Christie, J. D. Burke, D. A. Regier, D. S. Rae, J. H. Boyd, and B. Z. Locke, “Epidemiologic Evidence for Early Onset of Mental Disorders and Higher Risk of Drug Abuse in Young Adults,” American Journal of Psychiatry, 145 (1988): 971–75; R. C. Kessler, “The National Comorbidity Survey: Preliminary Results and Future Directions,” International Journal of Methods in Psychiatric Research, 5 (1995): 139–151; R. C. Kessler, C. B. Nelson, K. A. McGonagle, M. J. Edlund, R. G. Frank, and P. J. Leaf, “The Epidemiology of Co-Occurring Addictive and Mental Disorders: Implications for Prevention and Service Utilization,” American Journal of Orthopsychiatry, 50 (1996): 36–43.

  77 “I am constitutionally sensitive”: J. W. Robertson, Edgar A. Poe: A Psychopathic Study (New York: G. P. Putnam, 1923), p. 82.

  78 Two of every three: L. N. Robins and D. A. Regier, eds., Psychiatric Disorders in America (New York: Free Press, 1991).

  79 those who are both: P. Nicholls, G. Edwards, and E. Kyle, “Alcoholics Admitted to Four Hospitals in England: General and Cause-Specific Mortality,” Quarterly Journal Studies of Alcohol, 35 (1974): 841–855; M. Berglund, “Suicide in Alcoholism,” Archives of General Psychiatry, 41 (1984): 888–891; A. C. Whitters, R. J. Cadoret, and R. B. Widmer, “Factors Associated with Suicide Attempts in Alcohol Abusers,” Journal of Affective Disorders, 9 (1985): 19–23; D. W. Black, W. Yates, F. Potty, R. Noyes, and K. Brown, “Suicidal Behavior in Alcoholic Males,” Comprehensive Psychiatry, 27 (1986): 227–233; A. Roy and M. Linnoila, “Alcoholism and Suicide,” Suicide and Life-Threatening Behavior, 16 (1986): 244–273; M. A. Schuckit, “Primary Men Alcoholics with Histories of Suicide Attempts,” Journal of Studies on Alcohol, 47 (1986): 78–81; G. Winokur and D. W. Black, “Psychiatric and Medical Diagnoses as Risk Factors for Mortality in Psychiatric Patients: A Case-Control Study,” American Journal of Psychiatry, 144 (1987): 208–211; D. Hasin, B. Grant, and J. Endicott, “Treated and Untreated Suicide Attempts in Substance Abuse Patients,” Journal of Nervous and Mental Disease, 176 (1988): 289–294; M. Hesselbrock, V. Hesselbrock, K. Syzmanski, and M. Weidenman, “Suicide Attempts and Alcoholism,” Journal of Studies on Alcohol, 49 (1988): 436–442; M. M. Henriksson, H. M. Aro, M. J. Marttunen, M. E. Heikkinen, E. T. Isometsä, K. I. Kuoppasalmi, and J. K. Lönnqvist, “Mental Disorders and Comorbidity in Suicide,” American Journal of Psychiatry, 150 (1993): 935–940; M. D. Rudd, P. F. Dahm, and M. H. Rajals, “Diagnostic Comorbidity in Persons with Suicidal Ideation and Behavior,” American Journal of Psychiatry, 150 (1993): 928–934; E. Johnsson and M. Fridell, “Suicide Attempts in a Cohort of Drug Abusers: A 5-Year Follow
-Up Study,” Acta Psychiatrica Scandinavica, 96 (1997): 362–366; L. Tondo, R. J. Baldessarini, J. Hennen, G. P. Minnai, P. Salis, L. Scamonatti, M. Masia, C. Ghiani, and P. Mannu, “Suicide Attempts in Major Affective Disorder Patients with Comorbid Substance Use Disorders,” Journal of Clinical Psychiatry (Suppl. 2) (1999): 63–69.

  80 “He knew he was standing”: John Berryman, cited in Paul Mariani, Dream Song: The Life of John Berryman (New York: William Morrow, 1990), pp. 466–467.

  5 • WHAT MATTERS IT, IF ROPE OR GARTER

  1 “Since we can die”: Thomas Chatterton, “Suicide.” Chatterton (1752–1770), an English poet, wrote “Suicide” a few months before he swallowed a fatal dose of arsenic. “Cease my anguish’d soul,” he wrote not long before he died, “And this last act of wretchedness forgive.” He was seventeen.

  2 “In whatever direction”: Seneca, “To Norvatus on Anger” (III. xv. 3–xvi.), p. 295.

  3 “He plunged a dagger”: S. B. Nuland, How We Die: Reflections on Life’s Final Chapter (New York: Alfred A. Knopf, 1994), p. 158.

  4 “Razors pain you”: D. Parker, The Poetry and Short Stories of Dorothy Parker (New York: Modern Library, 1994), p. 62.

  5 “When Dorothy was sufficiently recovered”: M. Meade, Dorothy Parker: What Fresh Hell Is This? (New York: Penguin USA, 1989), p. 107.