Night Falls Fast: Understanding Suicide, by Kay Redfield Jamison. 448 pgs. Knopf, 1999.

No one has killed me. I wish to die. I have committed suicide, reads an anonymous note by a fourteen-year-old girl in Kay Redfield Jamison’s latest book, Night Falls Fast, Dr. Jamison’s exploration of what she considers a too-often taboo subject. Jamison, a leader in the field of mental illness whose book An Unquiet Mind dealt with her first-hand struggle with manic-depression, approaches in her new book the mystery of the suicidal mind from the perspective of doctor, patient, and prose writer. Combining a psychiatrist’s expertise with the insight of the ill, she delivers her material with an artist’s flourish. This is not a dry scientific treatise; Jamison’s prose is sensitive to her topic even as she proffers statistics. Her love of literature serves her: she tells a story with style.

Her choice of subject matter is not the book’s only novelty—it is also hard to pigeonhole in terms of genre. Is it memoir? Research? Science? Biography? The author’s passion for both medicine and literature is undeniable. The book refuses category, and its refusal is as baffling and intriguing as its subject. The title itself seems paradoxical: understanding suicide? Do we want to? Or does that bring us too close to a topic about which we’d prefer to remain in the dark (safe and comforted against the night of the mentally ill)? How will Jamison bring us close to that mind, and can it even be done? Jamison’s explanation of why she’s attempted this book is at once clinical and compassionate:

I have been impressed by how little value our society puts on saving the lives of those who are in such despair as to want to end them. It is a societal illusion that suicide is rare. It is not. Certainly the mental illnesses most closely tied to suicide are not rare. They are common conditions, and, unlike cancer and heart disease, they disproportionately affect and kill the young.

Her audience is not the mentally ill, the medical profession, the author, the artist, the suicide’s family, the next-door neighbor, or the layman alone, but an amalgamation of all of these. This is a book that forms bridges with thoughtful, learned, provocative, heart-felt prose.

Night Falls Fast is a mixed-genre work; it is a medical book, yet it is equally a book full of portraits of the creative mind. Many artists struggle with the subject of mental illness—and there are endless examples of artists (in the book and elsewhere) who suffer from one form or another. For them, questions arise of where creativity lies; of whether reliance on medication is somehow “tampering with the mechanism”; of whether mental illness enhances or destroys (or is irrelevant to) creative genius; and of why the disease and gift link up so often. Instead of focusing on these questions, Jamison shines a light on suicide itself, examining the approach the artist takes toward the subject in order to enlighten her own experience and research. The well-known writers cited in this book, like the anonymous writer of the suicide note, offer as lucid a response as any to the overwhelming question.

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And yet why not say what happened?—Robert Lowell

Jamison’s marriage of the terms “case history” and “patient” to a series of literary voices from Cowper to Plath makes this book of interest to any lover of literature. Her repertoire of works touching on her theme extends from early history to the present day: from an Egyptian poet’s words scratched on papyrus to the eminently quotable twentieth-century Dorothy Parker. Alfred Lord Tennyson, Edgar Allen Poe, Seneca, Virginia Woolf, Langston Hughes, Marina Tsvetaeva, Euripides, and Edward Thomas are only a few to whom Jamison refers or quotes at length. Night Falls Fast, which takes its title from a line in a poem by Edna St. Vincent Millay, leans as much on literature as on the dissertations of the medical profession. Words that move pain into the sphere of art, including her own prose, counterbalance the observations and objectivity of science. Jamison brings to her reader thoughts on suicide which have transcended time while not wallowing in a contemporary romanticization of the “tortured genius.” In this manner, she, like the work she transcribes, transforms pain into something palpable and human.

The writer is important here—writers of all kinds. Jamison includes excerpts from journals of painters like Benjamin Haydon, who quotes from King Lear before his suicide; there is an article from the Washington Post describing the last days before politician John Wilson (who many hoped might one day be mayor of D. C.) hanged himself; an essay on Meriweather Lewis quotes from his diary in addition to accounts of his death written by many others, including Thomas Jefferson. There is a chapter devoted to what insight may be gleaned from suicide notes. Jamison frames the book with a personal account of her experience with suicidal thoughts. Definitions of suicide abound, from the words of ancient Greeks to today’s World Health Organization.

So why has Jamison taken the trouble to compile the words of so many who contemplate and commit suicide when she could focus solely on findings in biology and genetics, research into anonymous case histories, background on suicides throughout time, descriptions of society’s reaction to suicide, current treatments for mental illness, and extensive tables and graphs on everything from a suicide intent scale to potential risk factors, all of which she interweaves throughout? Jamison writes:

Death by one’s own hand is far too much a final gathering of unknown motives, complex psychologies, and uncertain circumstance—and it insinuates itself far too corrosively into the rights and fears and despairs of the living—for the definition of suicide to stay locked within the crisp categories chipped out by scientists or for it to adhere to the abstruse elaborations spun out by linguists and philosophers. Yet however permeable its edges, it remains important, as Henry Romilly Fedden observed in 1938, “to discover the elusive boundaries of suicide.” The Indian widow dying on her husband’s pyre is not, as he put it, “to be linked with the lonely individual strung up in his garret.”

There is no one suicide, and to be an expert on the subject one must be prepared to hear the cacophony of voices.

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I guess you could say I’ve a call.—Sylvia Plath

In order to gain insight into or empathy for the suicide, those who don’t suffer from mental illness must view the world through the eyes of those who do. Those who have experienced suicidal thoughts may feel on firmer ground by connecting with another’s experience. The poet and writer give metaphor and character to the hopelessness of depression and suicide. Sylvia Plath describes the physical and emotional pain of depression and says it is “as if a great muscular owl were sitting on my chest, its talons clenching and constricting my heart.” In many descriptions captured by Jamison, an animal often figures as an archetypal image. Randall Jarrell writes, “The world goes by my cage and never sees me”; not only does the human lose his or her humanity, but there is the oppressive feeling of isolation, of being locked away. Expressions run the gamut from morbid to agonized to humorous—witnessed in the sardonic poem of Dorothy Parker, depressed and alcoholic:

Razors pain you;
Rivers are damp;
Acids stain you;
And drugs cause cramp.
Guns aren’t lawful
Nooses give;
Gas smells awful;
You might as well live.

So what has made circumstances so dire, one might wonder. Why not just cheer up? Jamison the doctor steps in at times to explain the difference between a depressed brain and the brain of one who doesn’t suffer from depression:

Much as a compromised immune system is vulnerable to opportunistic infection, so too a diseased brain is made assailable by the eventualities of life. The quickness and flexibility of a well mind, a belief or hope that things will eventually sort themselves out—these are the resources lost to a person when the brain is ill.

The balance between art and the scientific model strengthen the work and allow a more complete, fully embraceable comprehension of the problem.

In addition to the extensive commentary by published writers, the section on the suicide note thoroughly probes the suicide’s mind-set. Rage, apology, despair, insanity, desperation, and self-contempt are only some emotions in the spectrum. The notes Jamison chooses run from deeply reflective to deflective to opaque, and all writers are caught up in thoughts of escape. There is a note from artist Jules Pascin, who “slit his wrists, wrote a brief note in blood—‘Lucy, pardonnez-moi’—and then hanged himself.” Another man’s message to an unfaithful wife includes the curse, “May you always remember I loved you once but died hating you.” A mid-nineteenth-century Englishman is convinced of religious reasons for ending his life (and the modern mind springs immediately to catastrophes such as Jonestown): “[O]n the one hand, you will have the solemn assurance that I am the Son of God—the Lamb slain from the foundation of the world—and on the other the oppressive fearful fact, that I died by my own hand.” A mother’s note to her children says simply: “I love you. I’m sorry. Study hard.” A young chemist attempts to explain his decision this way: “This is my last experiment. If there is any eternal torment worse than mine I’ll have to be shown.” Yet another woman expresses remorse: “I wish that I could disappear without hurting anyone. I’m sorry.”

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I have it in me so much nearer home
To scare myself with my own desert places. —Robert Frost

As a backdrop to the notes, Jamison includes a section which catalogues the various methods employed to commit suicide. Her descriptions emphasize the tenacity of intent and illustrate the ferocious need the suicide feels to end his or her suffering, and she writes, “these singular methods of suicide. . .evoke horror, certainly, but they also give us a glimpse into otherwise unimaginable misery and madness.” Aware that suicide is often viewed as the ultimate selfish act, Jamison includes a vignette of her own to counteract that view:

I reminded his friend, who knew it well, that I had tried years earlier to kill myself, and nearly died in the attempt, but did not consider it either a selfish or a not-selfish thing to have done. It was simply the end of what I could bear, the last afternoon of having to imagine waking up the next morning only to start all over again with a thick mind and black imaginings. It was the final outcome of a bad disease, a disease it seemed to me I would never get the better of. No amount of love from or for other people—and there was a lot—could help. . . . Nothing alive and warm could make its way in through my carapace.

While she spends most of her time discussing the suicidal individual, she devotes her last chapter to the survivors whose lives are touched by a suicide. Compassionate to those who are ill, she is also an advocate for the living. A narrative early on focuses on a boy stricken with episodes of manic depression as he prepares to leave the Air Force Academy. While Jamison delves into the boy’s experience and reconstructs his mental state from onset of illness to his suicide, she interlocks his story with accounts of friends and family. The book is left to explain the phenomenon of suicide to its survivors more than anyone, and she acknowledges the incompleteness of her picture:

No matter how much we may wish to reassemble the suicide’s psychological world, any light we gain is indirect and insufficient: the privacy of the mind is an impermeable barrier. Everyone has good cause for suicide, or at least it seems that way to those who search for it. And most will have yet better grounds to stay alive, thus complicating everything.

The idea in the passage is not groundbreaking—it is what we know already, even in the face of the suicide’s despair. Yet Jamison’s approach towards the question of suicide is unusual, careful, and extremely readable.

Despite overwhelming pharmaceutical trends in the treatment of mental illness, she does not turn the book into a plug for the newest pill (and she takes care to note issues of noncompliance in patients on medication). Instead, she acknowledges the frustrations and difficulty of recovery: “Anyone who suggests that coming back from suicidal despair is a straightforward journey has never taken it.” The various options for care, from herbs to drugs, from talk to electroshock therapy, are often useless, she points out, without information about and understanding of mental illness. Ideally, the patient, the family, and the physician, can become proactive in preparation for relapse, in the hope of avoiding future death:

Patients who decide, when rational, that if they again become suicidal they wish to be hospitalized or receive antipsychotic medications or undergo electroconvulsive therapy, but who also know that they are unlikely, when ill, to consent to this, may in some areas of the country draw up “Odysseus” arrangements. Based on the mythic character’s request to be strapped to the mast of his ship so that he might avoid the inevitable call of the Sirens, Odysseus agreements (or advanced instruction directives) allow patients to agree to certain treatments in advance.

Knowledge and preparation hopefully increase the likelihood of a successful intervention. And so, the need for this book. While scientific and investigative, the book is humane right down to the many pages of resources included in the back appendix.