Kay Redfield Jamison - Night Falls Fast: Understanding Suicide

I B URIED A BOVE G ROUND
An Introduction to Suicide

1 Death Lies Near at Hand
History and Overview

2 To Measure the Hearts Turbulence
Definitions and Magnitudes

II J UST H OPE H AS G ONE
Psychology and Psychopathology

3 Take Off the Amber, Put Out the Lamp
The Psychology of Suicide

4 The Burden of Despair
Psychopathology and Suicide

5 What Matters It, If Rope or Garter
Methods and Places

III P ANGS OF N ATURE , T AINTS OF B LOOD
The Biology of Suicide

6 A Plunge into Deep Waters
Genetic and Evolutionary Perspectives

7 Death-Blood
Neurobiology and Neuropathology

IV B UILDING A GAINST D EATH
Prevention of Suicide

8 Modest Magical Qualities
Treatment and Prevention

9 As a Society
The Public Health

10 A Half-Stitched Scar
Those Left Behind

S ummer evenings at the Bistro Gardens in Beverly Hills tended toward the long and languorous. My friend Jack Ryan and I went there often when I lived in Los Angeles, and I invariably ordered the Dungeness crab and a scotch on the rocks. Not so invariably, but from time to time, Jack would use the occasion to suggest we get married. It was an idea with such patent potential for catastrophe that neither of us had much of an inclination to take the recurring proposal with too much gravity. But our friendship we took seriously.

This particular evening, having hooked and tugged out the last bits of crab, I found myself edgily knocking the ice cubes around in my whisky glass. The conversation was making me restless and uneasy. We were talking about suicide and making a blood oath: if either of us again became deeply suicidal, we agreed, we would meet at Jacks home on Cape Cod. Once there, the nonsuicidal one of us would have a week to persuade the other not to commit suicide; a week to present all the reasons we could come up with for why the other should go back on lithium, assuming that having stopped it was the most likely reason for the danger of suicide (we both had manic-depressive illness and, despite the better and often expressed judgment of others, had a tendency to stop taking our lithium); a week to cajole the other into a hospital; to invoke conscience; to impress upon the other the pain and damage to our families that suicide would inevitably bring.

We would, we said, during this hostage week, walk along the beach and remind the other of all of the times we had felt at the end of hope and, somehow, had come back. Who, if not someone who had actually been there, could better bring the other back from the edge? We both, in our own ways and in our own intimate dealings with it, knew suicide well. We thought we knew how we could keep it from being the cause of death on our death certificates.

We decided that a week was long enough to argue for life. If it didnt work, at least we would have tried. And, because we had years of cumulative experience with lifestyles of snap impetuousness and knew how quick and final a suicidal impulse could be, we further agreed that neither of us would ever buy a gun. Nor, we swore, would we under any circumstances allow anyone else to keep a gun in a house in which we lived.

Cheers, we said in synchrony, ice and glass clinking. We sealed our foray into the planned and rational world. Still, I had my doubts. I listened to the details, helped clarify a few, drank the rest of my scotch, and stared at the tiny white lights in the gardens around us. Who were we kidding? Never once, during any of my sustained bouts of suicidal depression, had I been inclined or able to pick up a telephone and ask a friend for help. Not once. It wasnt in me. How could I seriously imagine that I would call Jack, make an airline reservation, get to an airport, rent a car, and find my way out to his house on the Cape? It seemed only slightly less absurd that Jack would go along with the plan, although he, at least, was rich and could get others to handle the practicalities. The more I thought about the arrangement, the more skeptical I became.

It is a tribute to the persuasiveness, reverberating energies and enthusiasms, and infinite capacity for self-deception of two manic temperaments that by the time the dessert souffls arrived we were utterly convinced that our pact would hold. He would call me; I would call him; we would outmaneuver the black knight and force him from the board.

If it has ever been taken up as an option, however, the black knight has a tendency to remain in play. And so it did. Many years laterJack had long since married and I had moved to WashingtonI received a telephone call from California: Jack had put a gun to his head, said a member of his family. Jack had killed himself.

No week in Cape Cod, no chance to dissuade. A man who had been inventive enough to earn a thousand patents for such wildly diverse creations as the Hawk and Sparrow missile systems used bythe U.S. Department of Defense, toys played with by millions of children around the world, and devices used in virtually every household in America; a Yale graduate and lover of life; a successful businessmanthis remarkably imaginative man had not been inventive enough to find an alternative solution to a violent, self-inflicted death.

Although shaken by Jacks suicide, I was not surprised by it. Nor was I surprised that he had not called me. I, after all, had been dangerously suicidal myself on several occasions since our Bistro Gardens compact and certainly had not called him. Nor had I even thought of calling. Suicide is not beholden to an evenings promises, nor does it always hearken to plans drawn up in lucid moments and banked in good intentions