Paul L. Wachtel, is a CUNY distinguished professor and author, most recently, of "Race in the Mind of America."


Understanding Suicide

By Kay Redfield Jamison

Knopf. 432 pp. $26

Tragedy, sin, existential self-affirmation, despairing self-annihilation, impulsive reaction to a loss or shame, product of a deeply rooted mental illness: Suicide has been viewed as all of these and more, and through the ages it has been a matter of fascination, horror, dangerous temptation and, at times, mute incomprehension. In "Night Falls Fast," Kay Redfield Jamison brings us face to face with the suicidal mind in a manner so intense and penetrating that, paradoxically, the immersion in despair she offers is a source of great pleasure.

Jamison moves comfortably from history to literature to psychology to biology. We learn, in fascinating detail, how different societies have viewed suicide and attempted to deal with its sometimes seductive pull. We discover the contents of the earliest known suicide note, a 4,000-year-old Egyptian papyrus, written in verse, which includes lines such as, "Lo, my name is abhorred; Lo, more than the odour of crocodiles." Above all, we encounter a beguiling dialectic between Jamison's considerable narrative skills, which offer us a novelistic portrayal of suicidal people from the standpoint of lived experience, and her perspective as a clinical scientist, which stresses the genetic and biochemical sources of suicidal tendencies.

Even when she emphasizes genetics and biology--Jamison contends that suicide, at least among the young and physically healthy, is almost always a product of a "diseased" brain--her literary skills are quite evident. Those whose eyes glaze over at such terms as "neurotransmitter" or "serotonin reuptake" are likely to be surprised at how lucid and absorbing she makes these topics. Serotonin and even "5-hydroxyindoleacetic acid" become characters in a drama as narratively compelling as any one might see on the stage.

A key source of the book's strengths is Jamison's unique vantage point. She is at once a leading researcher on suicide and mood disorders and herself a sufferer from manic depression, which she controls by daily doses of lithium. This dual perspective, as both observer and experiencer, give the book a noteworthy depth and gravity. But her special interest in manic depression, both personal and professional, also skews her account in ways that can contravene her obvious aim not just to write a fascinating account (which she has) but also to save lives. Although Jamison covers the range of psychological disorders and social and cultural influences that can increase the risk of suicide, the suicidal individual who is also manic-depressive or suffering from major depression is clearly front and center in this book. Consequently, some readers may be led to take less seriously the danger of suicide (for themselves or those they love) if they do not see the signs of major affective disorder that Jamison describes so vividly.

Consider, for example, a 1997 survey of high school students, cited by Jamison, which indicated that fully 1 in 5 seriously considered suicide in just the past year and that most of those had actually made a plan--a study whose chilling validity is attested to by the fact that nearly 1 in 10 actually attempted suicide during the one-year period. Though, fortunately, most of those attempts did not result in death and a goodly number were surely ambivalent or intended as dramatic communication, the risk of death is real in almost every instance. Clearly, concern about suicide cannot be limited to those with major psychiatric disorders. A biologically encoded disorder may increase the danger, but the turmoil of adolescence, and indeed sometimes the highly initiative culture of adolescence, can pose risks in themselves.

Overall, however, Jamison's emphasis on the role of diagnosable--and treatable--mental illness in generating suicidal states of mind is well justified on empirical grounds. She cites considerable research to support her conclusion that "psychological pain or stress alone--however great the loss or disappointment, however profound the shame or rejection--is rarely sufficient cause for suicide." The bulk of the evidence, she argues, suggests instead that "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."

Notwithstanding its emphasis on brain dysfunction and diagnosable mental illness, "Night Falls Fast" never succumbs to a reductionistic, medicalized view of human behavior. Jamison puts us--sometimes frighteningly well--inside the experiential world of the suicidally despairing individual, and her aim is anything but dismissively pathologizing. In essence, her account of the illness that impels the suicide conveys not the message that deep down these people are simply "sick" but precisely the opposite--that what makes the sickness so tragic is that it attacks human beings whose talents, loves and aspirations she makes so palpably evident.