27 “He had, however, four times”: S. E. Ambrose, Undaunted Courage: Meriwether Lewis, Thomas Jefferson, and the Opening of the American West (New York: Simon & Schuster, 1996), pp. 358, 481–482.
28 He may well have suffered: A. T. W. Forrester, “Malaria and Insanity,” Lancet, 1 (1920): 16–17; W. K. Anderson, Malarial Psychoses and Neuroses (London: Oxford University Press, 1927); C. C. Turner, “The Neurologic and Psychiatric Manifestations of Malaria,” Southern Medical Journal, 29 (1936): 578–586; D. H. Funkenstein, “Tertian Malaria and Anxiety,” Psychosomatic Medicine, 11 (1949): 158–159; R. B. Daroff, J. J. Deller, A. J. Kastl, and W. W. Blocker, “Cerebral Malaria,” Journal of the American Medical Association, 202 (1967): 119–122; D. W. Mulder and A. J. Dale, “Brain Syndromes Associated with Infection,” in A. M. Freedman and H. I. Kaplan, eds., Comprehensive Textbook of Psychiatry (Baltimore: Williams & Wilkins, 1967), pp. 775–786; W. W. Blocker, A. J. Kastl, and R. B. Daroff, “The Psychiatric Manifestations of Cerebral Malaria,” American Journal of Psychiatry, 125 (1968): 192–196; A. J. Kastl, R. B. Daroff, and W. W. Blocker, “Psychological Testing of Cerebral Malaria Patients,” Journal of Nervous and Mental Disease, 147 (1968): 553–561; R. M. Wintrob, “Malaria and the Acute Psychotic Episode,” Journal of Nervous and Mental Disease, 156 (1973): 306–317; P. D. Marsden and L. J. Bruce-Chwatt, “Cerebral Malaria,” in R. W. Hornabrook, ed., Topics on Tropical Neurology (Philadelphia: F. A. Davis, 1975); D. A. Warrell, “Cerebral Malaria,” in R. A. Shakir, P. K. Newman, and C. M. Poser, eds., Tropical Neurology (London: W. B. Saunders, 1996), pp. 213–245.
29 Douglass Adair and Dawson Phelps: Quoted in V. Fisher, Suicide or Murder: The Strange Death of Governor Meriwether Lewis (Chicago: Sage Books, 1962), p. 231.
30 One reader of the Washington Post: E. Foxwell, letter to the editor, Washington Post, June 29, 1996; K. R. Jamison, letter to the editor, Washington Post, July 6, 1996.
31 “He was a man of high energy”: Ambrose, Undaunted Courage, p. 482.
32 “The breaking of so great a thing”: William Shakespeare, Antony and Cleopatra, Act V, sc. i, ll. 13–16 (London: J. M. Dent, The Temple Shakespeare, 1896), p. 146.
8 • MODEST MAGICAL QUALITIES
1 “For melancholy”: Robert Burton, The Anatomy of Melancholy, vol. 2. Robert Burton’s (1577–1640) Anatomy of Melancholy was first published in 1621 and remains to this day one of the most important books on the subject. In it, the author acknowledged that he himself suffered from melancholy; it is reported by others that his mother’s brother “died of melancholy.” When Burton died in 1640, several of the students at Oxford whispered among themselves that he had “sent up his soul to heaven thro’ a slip about his neck.” Another Oxford contemporary concurred, stating that Burton had “ended his dayes in that chamber by hinging him selfe.” Whatever the truth of the rumors—and those arguing against suicide point out that Burton would not have been allowed the Christian burial he received had there been definitive evidence that he had killed himself—the epitaph he wrote for his tombstone is provocative: “To whom Melancholy gave life and death.” Michael O’Connell, Robert Burton (Boston: Twayne Publishers, 1986), pp. 31–33; see also Lawrence Babb, Sanity in Bedlam: A Study of Robert Burton’s Anatomy of Melancholy (East Lansing: Michigan State University Press, 1959); Bergen Evans, in consultation with George J. Mohr, The Psychiatry of Robert Burton (New York: Octagon Books, 1972); Ruth A. Fox, The Tangled Chain: The Structure of Disorder in The Anatomy of Melancholy (Berkeley: University of California Press, 1976).
2 “much approved against melancholy”: Robert Burton, The Anatomy of Melancholy, vol. 2, Pt. 2, Sec. 5 (London: J. M. Dent, 1961; first published 1621), pp. 248–251.
3 communicate their intentions: E. S. Shneidman and N. L. Farberow, “The Logic of Suicide,” in E. S. Shneidman and N. L. Farberow, eds., Clues to Suicide (New York: McGraw-Hill, 1957); E. Robins, S. Gassner, J. Kayes, R. H. Wilkinson, and G. E. Murphy, “The Communication of Suicidal Intent: A Study of 134 Consecutive Cases of Successful (Completed) Suicide,” American Journal of Psychiatry, 115 (1959): 724–733; T. L. Dorpat and H. S. Ripley, “A Study of Suicide in the Seattle Area,” Comprehensive Psychiatry, 1 (1960): 349–359; P. G. Yessler, J. J. Gibbs, and H. A. Becker, “On the Communication of Suicidal Ideas: I. Some Sociological and Behavioral Considerations,” Archives of General Psychiatry, 3 (1960): 612–631; K. E. Rudestam, “Stockholm and Los Angeles: A Cross-Cultural Study of the Communication of Suicidal Intent,” Journal of Consulting and Clinical Psychology, 36 (1971): 82–90; 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; J. Beskow, “Suicide and Mental Disorder in Swedish Men,” Acta Psychiatrica Scandinavica, 277 (Suppl.) (1979): 1–138; C. L. Rich, R. C. Fowler, L. A. Fogarty, and D. Young, “San Diego Suicide Study: III. Relationships Between Diagnoses and Stressors,” Archives of General Psychiatry, 45 (1988): 589–594; E. T. Isometsä, M. M. Henriksson, H. M. Aro, M. E. Heikkinen, K. I. Kuoppasalmi, and J. K. Lönnqvist, “Suicide in Major Depression,” American Journal of Psychiatry, 151 (1994): 530–536; E. T. Isometsä, M. M. Henriksson, H. M. Aro, and J. K. Lönnqvist, “Suicide in Bipolar Disorder in Finland,” American Journal of Psychiatry, 151 (1994): 1020–1024.
4 “If we had found that suicide”: E. 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, p. 897.
5 severe anxiety, agitation, or perturbance: E. S. Shneidman and N. L. Farberow, eds., Clues to Suicide (New York: McGraw-Hill, 1957); J. Fawcett, K. A. Busch, D. Jacobs, H. M. Kravitz, and L. Fogg, “Suicide: A Four-Pathway Clinical-Biochemical Model,” Annals of the New York Academy of Sciences, 836 (1997): 288–301.
6 “Many psychiatrists”: W. Styron, Darkness Visible: A Memoir of Madness (New York: Random House, 1990), pp. 68–69.
7 its putative capacity: M. H. Sheard, J. L. Marini, and C. I. Bridges, “The Effect of Lithium on Impulsive Aggressive Behavior in Man,” American Journal of Psychiatry, 133 (1976): 1409–1416; E. A. Wickam and F. V. Reed, “Lithium for the Control of Aggressive and Self-Mutilating Behavior,” International Clinical Psychopharmacology, 2 (1977): 181–190; A. J. Mandell and S. Knapp, “Asymmetry and Mood, Emergent Properties of Serotonin Regulation,” Archives of General Psychiatry, 36 (1979): 909–916; S. L. Treiser, C. S. Cascio, T. L. O’Donohue, et al., “Lithium Increases Serotonin Release and Decreases Serotonin Receptors in the Hippocampus,” Science, 213 (1981): 1529–1531; F. N. Johnson, ed., The Psychopharmacology of Lithium (London: Macmillan, 1984); M. H. Sheard, “Clinical Pharmacology of Aggressive Behavior,” Clinical Neuropharmacology, 11 (1988): 483–492; L. H. D. S. Price, P. L. Charney, P. L. Delgado, and G. R. Heninger, “Lithium and Serotonin Function: Implications for the Serotonin Hypothesis of Depression,” Psychopharmacology, 100 (1990): 3–12; H. K. Lee, T. B. Reddy, S. Travin, and H. Bluestone, “A Trial of Lithium Citrate for the Management of Acute Agitation of Psychiatric Inpatients: A Pilot Study,” Journal of Clinical Psychopharmacology, 12 (1992): 361–362; J. F. Dixon and L. E. Hokin, “Lithium Acutely Inhibits and Chronically Up-Regulates and Stabilizes Glutamate Uptake by Presynaptic Nerve Endings in Mouse Cerebral Cortex,” Proceedings of the National Academy of Sciences USA, 95 (1998): 8363–8368; P. E. Harrison-Read, “Lithium Withdrawal Mania Supports Lithium’s Antimanic Action and Suggests an Animal Model Involving Serotonin,” British Journal of Psychiatry, 172 (1998): 96–97.
8 decrease aggression, agitation: R. W. Cowdry and D. L. Gardner, “Pharmacotherapy of Borderline Personality Disorder,” Archives of General Psychiatry, 45 (1988): 111–119; T. Kastner, R. Finesmith, and K. Walsh, “Long-Term Administration of Valproic Acid in the Treatment of Affective Symptoms in People with Mental Retardation,” Journal of Clinical Psychopharmacology, 13 (1993): 448–451; C. L. Bowden, A. M. Brugger, A. C. Swann, J. R.
Calabrese, P. G. Janicak, F. Petty, S. D. Dilsaver, J. M. Davis, A. J. Rush, J. G. Small, E. S. Garza-Trevino, S. C. Risch, P. J. Goodnick, and D. D. Morris, “Efficacy of Divalproex vs. Lithium and Placebo in the Treatment of Mania,” Journal of the American Medical Association, 271 (1994): 918–924; M. Horne and S. E. Lindley, “Divalproex Sodium in the Treatment of Aggressive Behavior and Dysphoria in Patients with Organic Brain Syndromes,” Journal of Clinical Psychiatry, 56 (1995): 430–431; E. M. Zayas and G. T. Grossberg, “Treating the Agitated Alzheimer Patient,” Journal of Clinical Psychiatry, 57 (Suppl. 7) (1996): 46–51; D. L. Fogelson and H. Sternbach, “Lamotrigine Treatment of Refractory Biploar Disorder,” Journal of Clinical Psychiatry, 58 (1997): 271–273; S. L. McElroy, C. A. Soutullo, P. E. Keck, and G. F. Kmetz, “A Pilot Trial of Adjunctive Gabapentin in the Treatment of Bipolar Disorder,” Annals of Clinical Psychiatry, 9 (1997): 99–103; R. S. Ryback, L. Brodsky, and F. Munasifi, “Gabapentin in Bipolar Disorder,” Journal of Neuropsychiatry and Clinical Neuroscience, 9 (1997): 301; C. B. Schaffer and L. C. Schaffer, “Gabapentin in the Treatment of Bipolar Disorder,” American Journal of Psychiatry, 154 (1997): 291–292; J. Sporn and G. Sachs, “The Anticonvulsant Lamotrigine in Treatment-Resistant Manic-Depressive Illness,” Journal of Clinical Psychopharmacology, 17 (1997): 185–189.
9 Patients who had not been treated with lithium: L. Tondo, K. R. Jamison, and R. J. Baldessarini, “Effect of Lithium Maintenance on Suicidal Behavior in Major Mood Disorders,” Annals of the New York Academy of Sciences, 836 (1997): 339–351.
10 Tondo and his colleagues: L. Tondo, R. J. Baldessarini, G. Floris, F. Silvetti, and N. Rudas, “Lithium Maintenance Treatment Reduces Risk of Suicidal Behavior in Bipolar Disorder Patients,” in V. S. Gallicchio and N. J. Birch, eds., Lithium Biochemical and Clinical Advances (Cheshire, Conn.: Weidner Publishing Group, 1996), pp. 161–171. See also R. J. Baldessarini, L. Tondo, G. Floris, and N. Rudas, “Reduced Morbidity After Gradually Discontinuing Lithium in Bipolar I and II Disorders: A Replication Study,” American Journal of Psychiatry, 154 (1997): 548–550; R. J. Baldessarini, L. Tondo, and J. Hennen, “Effects of Lithium Treatment and Its Discontinuation on Suicidal Behavior in Bipolar Manic-Depressive Disorders,” Journal of Clinical Psychiatry, 60 (Suppl. 2) (1999): 77–84.
11 A 1999 study from Sweden: A. Nilsson, “Lithium Therapy and Suicide Risk,” Journal of Clinical Psychiatry, 60 (Suppl. 2) (1999): 85–88; B. Ahrens, B. Müller-Oerlinghausen, and P. Grof, “Length of Lithium Treatment Needed to Eliminate the High Mortality of Affective Disorders,” British Journal of Psychiatry, 163 (Suppl. 21) (1993): 27–29.
12 “Psychiatrists and other practitioners”: N. J. Birch and D. P. Srinivasan, “Prevention of Suicide,” Lancet, 340 (1992): 1233; R. Colgate, “Ranking of Therapeutic and Toxic Side-Effects of Lithium Carbonate,” Psychiatric Bulletin, 16 (1992): 473–475.
13 to prevent suicide is unproven: F. K. Goodwin, “Anticonvulsant Therapy and Suicide Risk in Affective Disorders,” Journal of Clinical Psychiatry, 60 (Suppl. 2) (1999): 89–93.
14 “antisuicidal effects”: K. Thies-Flechtner, B. Müller-Oerlinghausen, W. Seibert, A. Walther, and W. Greil, “Effect of Prophylactic Treatment on Suicide Risk in Patients with Major Affective Disorders: Data from a Randomized Prospective Trial,” Pharmacopsychiatry 29 (1996): 103–107, p. 106; B. Müller-Oerlinghausen, B. Ahrens, and A. Berghoefer, “Arguments for a Specific Antisuicidal Effect of Lithium,” paper presented at the International Society for Lithium Research, Lexington, Ky., May 1999.
15 “Discontinuing lithium”: B. Müller-Oerlinghausen, cited in M. J. Friedrich, “Lithium: Proving Its Mettle for 50 Years,” Journal of the American Medical Association, 281 (1999): 2271–2273.
16 Sources for graph: D. H. Myers and C. D. Neal, “Suicide in Psychiatric Patients,” British Journal of Psychiatry, 133 (1978): 38–44; S. W. Gale, A. Mesnikoff, J. Fine, and J. A. Talbot, “A Study of Suicide in State Mental Hospitals in New York City,” Psychiatric Quarterly, 52 (1980): 201–213; J. Modestin, “Antidepressive Therapy in Depressed Clinical Studies,” Acta Psychiatrica Scandinavica, 71 (1985): 111–116; Z. Rihmer, J. Barsi, M. Arató, and E. Demeter, “Suicide in Subtypes of Primary Major Depression,” Journal of Affective Disorders, 18 (1990): 221–225; G. Isacsson, U. Bergman, and C. L. Rich, “Antidepressants, Depression and Suicide: An Analysis of the San Diego Study,” Journal of Affective Disorders, 32 (1994): 277–286; E. T. Isometsä, M. M. Henriksson, H. M. Aro, M. E. Heikkinen, K. I. Kuoppasalmi, and J. K. Lönnqvist, “Suicide in Major Depression,” American Journal of Psychiatry, 151 (1994): 530–536; C. L. Rich and G. Isacsson, “Suicide and Antidepressants in South Alabama: Evidence for Improved Treatment of Depression,” Journal of Affective Disorders, 45 (1997): 135–142.
17 are almost always excluded: C. M. Beasley, B. E. Dornsief, J. C. Bottomsworth, M. E. Sayler, A. H. Rampey, J. H. Heiligenstein, V. L. Thompson, D. J. Murphy, and D. N. Masica, “Fluoxetine and Suicide: A Meta-Analysis of Controlled Trials of Treatment for Depression,” British Medical Journal, 303 (1991): 685–692.
18 decrease angry, aggressive, and impulsive behaviors, C. Salzman, A. N. Wolfson, A. Schatzberg, J. Looper, R. Henke, M. Albanese, J. Swartz, and E. Miyawaki, “Effect of Fluoxetine on Anger in Symptomatic Volunteers with Borderline Personality Disorder,” Journal of Clinical Psychopharmacology, 15 (1995): 23–29; E. F. Coccaro and R. J. Kavoussi, “Fluoxetine and Impulsive Aggressive Behavior in Personality-Disordered Subjects,” Archives of General Psychiatry, 54 (1997): 1081–1088.
19 a decrease in the number: S. A. Montgomery, D. L. Dunner, and G. C. Dunbar, “Reduction of Suicidal Thoughts with Paroxetine and Comparison with Reference Antidepressants and Placebo,” European Neuropsychopharmacology, 5 (1995): 5–13; G. Isacsson, U. Bergman, and C. L. Rich, “Epidemiological Data Suggest Antidepressants Reduce Suicide Risk Among Depressives,” Journal of Affective Disorders, 41 (1996): 1–8; A. Ohberg, E. Vuori, T. Klaukka, and J. Lonnqvist, “Antidepressants and Suicide Mortality,” Journal of Affective Disorders, 50 (1998): 225–233; R. J. Verkes, R. C. Van der Mast, M. W. Hengeveld, J. P. Tuyl, A. H. Zwinderman, and G. M. J. Van Kempen, “Reduction by Paroxetine of Suicidal Behavior in Patients with Repeated Suicide Attempts but Not Major Depression,” American Journal of Psychiatry, 155 (1998): 543–547; B. Müller-Oerlinghausen and A. Berghöfer, “Antidepressants and Suicidal Risk,” Journal of Clinical Psychiatry, 60 (Suppl. 2) (1999): 94–99.
20 woefully underprescribe: 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; P. Tyrer, “Drug Treatment of Psychiatric Patients in General Practice,” British Medical Journal, 2 (1978): 1008–1010; M. G. Keller, G. L. Klerman, P. W. Lavori, J. Fawcett, W. Coryell, and J. Endicott, “Treatment Received by Depressed Patients,” Journal of the American Medical Association, 248 (1982): 1848–1855; P. K. Bridges, “And a Small Dose of an Antidepressant Might Help,” British Journal of Psychiatry, 142 (1983): 626–628; L. F. Prescott and M. S. Highley, “Drugs Prescribed for Self Poisoners” British Medical Journal, 290 (1985): 1633–1636; G. Isacsson, G. Boëthius, and U. Bergman, “Low Level of Antidepressant Prescription for People Who Later Commit Suicide: 15 Years of Experience from a Population-Based Drug Database in Sweden,” Acta Psychiatrica Scandinavica, 85 (1992): 444–448; E. Isometsä, M. Henriksson, and J. Lönnqvist, “Completed Suicide and Recent Lithium Treatment,” Journal of Affective Disorders, 26 (1992): 101–104; J. Modestin and F. Schwarzenbach, “Effect of Psychopharmacotherapy on Suicide Risk in Discharged Psychiatric Inpatients,” Acta Psychiatrica Scandinavica, 85 (1992): 173–175; E. T. Isometsä, M. M. Henriksson, H. M. Aro, and J. K. Lönnqvist, “Suicide in Bipolar Disorder in Finland,” American Journal of Psychiatry, 15 (1994): 1020–1024; P. M. Marzuk, K. Tardiff, A. C. Leon, C. S. Hirsch, M. Stajic, N. Hartwell, and L. Portera, “Use of Prescription Psychotropic Drugs Among Suicide Victims in New York City,” American Journal of Psychiatry, 152 (1995): 1520–1522; S.
Henriksson, G. Boëthius, and G. Isacsson, “The Prescription of Drugs to Suicide Cases in a Swedish County, Jämtland, from 1985 Through 1995,” data presented to the Annual Meeting of the American Association of Suicidology, Bethesda, Md., April 1998; K. Rost, M. Zhang, J. Fortney, J. Smith, J. Coyne, and G. R. Smith, “Persistently Poor Outcomes of Undetected Major Depression in Primary Care,” General Hospital Psychiatry, 20 (1998): 12–20; K. H. Suominen, E. T. Isometsä, M. M. Henriksson, A. I. Ostamo, and J. K. Lönnqvist, “Inadequate Treatment for Major Depression Both Before and After Attempted Suicide,” American Journal of Psychiatry, 155 (1998): 1778–1780; G. Isacsson, P. Holmgren, H. Druid, and U. Bergman, “Psychotropics and Suicide Prevention: Implications from Toxicological Screening of 5281 Suicides in Sweden 1992–1994,” British Journal of Psychiatry, 174 (1999): 259–265; M. A. Oquendo, K. M. Malone, S. P. Ellis, H. A. Sackeim, and J. J. Mann, “Inadequacy of Antidepressant Treatment for Patients with Major Depression Who Are at Risk for Suicidal Behavior,” American Journal of Psychiatry, 156 (1999): 190–194.
21 a high rate of suicide: This is reviewed in F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990); see also Z. Rihmer, J. Barsi, M. Arató, and E. Demeter, “Suicide in Subtypes of Primary Major Depression,” Journal of Affective Disorders, 18 (1990); 221–225.
22 perhaps one-third of patients: S. N. Ghaemi, E. E. Boiman, and F. K. Goodwin, “Bipolar Disorder and Antidepressants: A Diagnostic and Treatment Study,” paper presented at the American Psychiatric Association Meeting, Toronto, May 1998.
23 survey of pediatricians: This was a survey investigation headed by Jerry Rushton, a pediatrician at the University of North Carolina at Chapel Hill. The results were presented at the Pediatrics Academic Societies Annual Conference in San Francisco in May 1999 and summarized in the Journal of the American Medical Association, 281 (1999): 1882.
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