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Night Falls Fast: Understanding Suicide
By Kay Redfield JamisonNew York: Random House, 1999, 432 pp., $14.00.
It seems, in selecting a book that may be helpful to clients or family members of a client dealing with the issues surrounding suicide, that there are literally hundreds of choices. The bookshelves of libraries and bookstores alike are heavily weighed down with literature about most mental illnesses and other disorders. Although significantly longer than most, Night Falls Fast by psychologist, Kay Redfield Jamison is a particularly valuable addition to these massive collections. "Suicide is a particularly awful way to die: the mental suffering leading up to it is usually prolonged and intense," writes Kay Redfield Jamison. "There is no morphine equivalent to ease the acute pain, and death not uncommonly is violent and grisly." Logical and poetic, vivid and beautiful, Jamison’s descriptions of suicidal ideation and attempts are not easy to read, but whoever said this issue would be an easy one to confront? For people finding themselves as clients in a private practice, patients at an in-patient facility, or family members of an attempter or completer, these words will strike deeply, but bring about a greater understanding of suicide. It is not easy reading, either in subject or style, but you'll understand suicide better and be shocked by the depths of depression that drive people to attempt such an act.
The clarity, sensitivity and understanding Jamison has for suicide stems from the fact that she has studied bipolar disorder and suicide both professionally and personally. At seventeen years of age, she planned her own suicide and at the age of 28 she attempted to carry it out. Currently, she is a professor in the Department of psychiatry at Johns Hopkins School of Medicine in Baltimore, Maryland, where she investigates the intricate psychology of suicide. Her personal experience and her professional research have helped Jamison put into words the pain of depression. To express, in words, the anguish and tribulation that a person planning suicide feels is an invaluable gift to the population of people who simply cannot describe what they think, feel and believe about themselves and the world. A reader from Colorado who commented on Dr. Jamison’s book by way of a internet website that, “Dr. Jamison has broken down the barriers between the science and the humanities, clinical work and research in medicine, sufferer and healer. Perhaps most of all she has helped to break down the division between knowing and caring.” This description could not be more perfect.
Although Jamison’s command of the English language and talent in the realm of creative writing is evident, she has also provided an incredibly scientific look at the facts behind suicide. Her book describes why suicide occurs, how it became one of our most significant health problems and remains as such, and how it can be prevented. Jamison also covers topics such as suicide in different cultures and eras, methods of attempting/completing suicide, and the incomprehensible effects on family and friends. She explores what type of person commits suicide and when they are likely to do so. Throughout the book, Jamison includes essays about people who have attempted (and completed) suicide. Some of these people are young, some old. Some are famous and some are not so famous. In all cases, the reader begins to grasp the mind-set of the mentally ill and learns that this is not a phenomenon for any single type of person, age group, race or religion. Suicide is a worldwide problem, and dealing with the process and the aftermath are universally existent. Both the prose and the science in this text bring survivors and loved ones to a similar plane in understanding suicide.
The structure of Night Falls Fast again reflects Kay Redfield Jamison’s equivalent talent in writing scientifically and creatively. Broken into four parts (followed by an extremely helpful epilogue), she has organized the book into sections covering all aspects of suicide. Part I, entitled “An Introduction to Suicide”, offers an in-depth look at the history and overall statistics surrounding suicide. She depicts these facts using not only narrative writing, but also poetry and well-researched facts. Additionally, Dr. Jamison includes a Suicide Intent Scale (pp. 41-44). This questionnaire asks questions of the attempter regarding the circumstances surrounding the attempt, as well as other aspects of his or her thinking.
In Part II, “Psychology and Psychopathology”, Jamison is clearly writing about the mind-set and psychological aspects of suicide. In this section, she also discusses several mental illnesses, such as Schizophrenia, due to the co-morbidity of such disorders and suicidal ideation, attempt, and/or completion. As was the case with the first section, Part II is also sprinkled with poetry, journal excerpts and both creative and scientific writing. I found this variety in her writing to be a reason I would utilize this book in a psychotherapy setting, as all people learn differently, and her varying styles allow room for people to relate to one of her vehicles for depicting suicide.
Parts III and IV, “The Biology of Suicide” and “Prevention of Suicide”, are loaded with research facts covering historical accounts of suicide, accounts expressed in creative writing and poetry, and quotations from famous figures in history. One particularly fascinating issue Jamison tackles in the ninth chapter is the issue of how we, as a society, deal with suicide. A bulleted list is compiled describing many “aspects of news coverage that can promote suicide contagion” (p.280). This list includes ideas such as providing sensational coverage of suicide, reporting “how-to” descriptions of suicide, and focusing on the completers’ positive characteristics. Simply put, when suicide attempts and completions are unintentionally (or intentionally) described in detail, and indirectly glorified, it is no wonder it is the leading killer of adolescents in this country. This brings about another point in recommending this book or utilizing it in psychotherapy. Although Jamison’s writing is vivid, and she masterfully helps attempters begin to understand they are not alone, as well as the loved-ones involved, the author leaves little, in anything, to the imagination. Her depictions of methodology are intensely lucid, thus a client in the midst of depression or deep in suicidal ideation may not be a candidate for certain sections of her book. I find that this book can and will be helpful to many a client, but it is crucial that the stage and severity of the client’s illness are fully understood before assigning readings. Assigning sections for reading and discussion based on each client’s individual needs will be important as well as closely monitoring each client’s reactions to the sections or passages read.
An additional facet of Jamison’s book that may be found to be particularly helpful is the many visual aids. For those people who learn more visually, these diagrams, graphs and drawings may make a significant difference in understanding suicide. Page 49 in Part I provides a diagram depicting the cause of death (% of all deaths), divided up into male and female. This diagram clearly shows the high prevalence of suicide in this society. In both males and females, suicide ranks in the top four causes of death. Although words can convey the same messages, seeing these data graphically often leave a lasting impression, helping the reader to understand they are far from alone. Knowing there are many other people dealing with similar issues is a key aspect that one can touch on in psychotherapy. Artistic works are also included that help visually describe the suicidal mind (p.93). A final example of Jamison’s use of visuals is a graphical representation of the risk of suicide one may have based upon specific psychiatric and medical conditions. For those clients living with mood disorders, for example, it becomes clear that this population often deals with suicide-related issues. Again, the client may begin to understand (s)he is not alone.
Night Falls Fast ends with a very helpful epilogue that includes over a dozen listings of resources and information about suicide, mental illness, and alcohol and drug abuse. Among this list are organizations such as the American Association of Suicidology and the American Foundation for Suicide Prevention. There are also listings for organizations that focus are specific disorders.
All in all, Kay Redfield Jamison exquisitely educates clients about every aspect of suicide, and eloquently expresses the emotions many experience but that often could not be fully put into words. Night Falls Fast is a challenging book, heavy in science and painfully descriptive. Nevertheless, for anyone considering or coping with the idea of attempting suicide (or for those who are close to a person who talks about attempting or has completed suicide) this book will certainly answer many questions and bring about a more equal awareness to the suicidal realm. For depressed and suicidal clients use of this book in psychotherapy will educate clients and help stimulate needed discussions between client and psychotherapist that may prove valuable, if not lifesaving.