Anna H.
For Scott Wiessman, 6/27/09
Mental Health Practice
In the book Night Falls Fast are Kay Redfield Jamison’s personal attempts, shared with the world, to understand the nature of, reasonings behind, and struggles leading up to a person’s choice to end his or her own life, and the subsequent devastation, horror, and confusion experienced those left to behind. In exploring her own ruminations, fear, and sadness about the prevalence of suicide—Jamison herself has bipolar disorder, and has been suicidal several times throughout her life, nearly completing once— and our western society’s intense discomfort with it as a world-wide mental health crisis, Night Falls Fast is aimed at filling in our lack of understanding about and empathy for those who suffer from and sometimes succumb to the lead contributors to suicidal acts: depression, manic-depressive [bipolar] disorder, schizophrenia, and substance abuse. In reading the book, however, it was my experience that Jamison seemed to get lost in gory details and terrible stories of bright lives consumed, focusing instead on the same sensationalism and voyeurism which she condemns in the general public treatment of this terrible phenomenon. Jamison, in setting out to dispel the stigma of suicide, insomuch as she can persuade her readers to recognize the struggles with mental illness most often behind it, falls frequently into the same culturally-bound showcasing treatment of suicide-as-spectacle that she criticizes. In this paper, therefore, I will examine the ways in which Jamison— despite her goals of addressing the dearth of knowledge about why and how people come to a decision of suicide and its underlying causes in such a way as to remove its stigma, that it may be more swiftly and easily addressed for public health— nonetheless struggles in her writing to escape the ways in which suicide is often treated in America: as morbidly fascinating, but largely incomprehensible.
Jamison’s book is not strictly a memoir in that, while she does include small personal narratives as a woman with an intimate history of suicidal ideation and attempt, she largely treats it as a collection of discourses, studies, and essays, all trying to make sense of how and why so many have and continue to take their own lives, and what do we who are left, or who survived, do to try to curtail its prevalence. Her own experiences with major bouts of depression, as the result of having bipolar disorder, seem to have a major impact in the way in which she writes the book, both in the loving and admiring prose with which she describes the multiplicity of brilliant and inspiring historical figures, known and unknown to the general reader, who eventually took their own lives, and in the brutally vivid details she embeds in our minds of their decent into a personal hell only escapable through suicide. I have no doubt that she identifies with her subjects, and in doing so takes her readers on the same terrible journey that she and they felt for the first two thirds of the book.
This book actually came highly recommended for me prior to taking 698 Practice in Mental Health by a friend who himself has struggled for years with bipolar disorder, as a window into the downward spiral of hopelessness one experiences in feeling suicidal, written by someone who had “been there” herself. I had sought out and spoken with Jim about depression and suicidal thoughts, in response to my own most recent experience of both— the third such in my lifetime— looking for someone who would understand how dark my vision had become, and in the course of dinner he brought up identifying with Jamison’s depictions and writings. I purchased the book, but could not bring myself to read it until it became absolutely necessary to choose a mental health memoir for class and I found Night Falls Fast already in my possession; ultimately, given my personal mental states over the course of 2009, I wish I had chosen a different book to use for this assignment, but I did finish it, albeit with reluctance, after much discomfort and some with secondary trauma. Unlike Jim, I would never recommend this book to a person currently battling the personal demons of depression, hopelessness, or suicidal thoughts: rather than feeling like I could empathize and relate from a healthy distance, Jamison’s style of storytelling is so terribly detailed, and her depictions so graphic, that I found myself frequently only able to read a handful of pages at a time before becoming profoundly disturbed. There is no wall that one can construct to protect themselves from these stories of real-life, unbearable suffering and often violent, grisly endings sought when they have felt the pain described in the pages before them. I struggled mightily with this book, and ultimately finished it, but was unsatisfied by the treatment it gave to both its subject, and its prognosis for the future.
Jamison, perhaps in exorcizing her own feelings at coming so close to becoming another casualty of her book, repeats over and over stories of young lives lost and great minds destroying themselves, multiplicities of statistics which numb the heart at their prevalence and methods of terrible sought-after release which felt physically harmful to read over and over again. Given the pain I felt in reading the repetition of stories with wrenching, early endings, the amount of loss experienced and the enumeration about ways people have sought their own demise, I can only hope their purpose serves to drive home the point of suicide’s terrible reality, and the need to intervene in seemingly senseless self-destruction. I fear, however, that it may serve the opposite end of further cutting off communications, either through desensitization, making these tales like a macabre depiction from a crime novel, or overwhelming the reader to the point where they do not know how they might deal with such pain in their own lives, and therefore shut down the possibility of open communication. I can imagine how powerful these depictions would be for someone who had not had firsthand knowledge of these feelings, that now they might really begin to recognize the crushing weight of these feelings, and how such an otherwise awful end might seem like relief, but for anyone recovering or still battling with depression themselves, reliving it within these pages is traumatizing and can threaten to suck you back in. In the book’s first two thirds’ unrelenting reiteration of violence and despairing, Jamison seems to be searching for answers to why people must suffer so, on behalf of those left behind, those who have survived their own attempts, and those who still consider suicide to be an option worth considering; there does not, sadly, seem to be a good enough answer to justify the inclusion of so much pain which assaults the reader. However, repeating again and again the same pattern of promising lives full of accomplishments already, devoured by mental health problems incomprehensible to those who have not felt their oppression, and ended for lack of hope that life will ever get better, Jamison’s ruminations, though disturbing as intrusive thoughts or flashbacks, do serve a significant purpose: suicide is de-romanticized in the extreme and laid bare and raw for the horror that it is, that the concerned reader might address it in his or her life and community with urgency and a somewhat better understanding.
I struggle with Jamison’s conflicting viewpoints, as she writes this book both as one who has fought continuously against depression in her own life—and thus far, won—and an upper class psychiatrist who uses the terminology of mental illness to describe not only schizophrenia and manic-depression, but also substance abuse and major depression. Hers is not a strengths-based model of study, and perhaps due to that, she focuses greatly on the pathology of suicide, particularly as it relates to genetics and is compounded by drug and alcohol abuse, leading up to the terrible details that go into the deaths of so many of her discussed examples. In effect, due to her major focus being the horrors of depression as it leads up to suicide, Jamison seems to largely ignore the positives of biopsychosocial input, tempered with protective factors, personal strengths, and multiplicity of treatment options— now more than ever used together to help prevent depression from growing so unmanageable— and she approaches the majority of her book with little hope and less optimism. Coping with bipolar disorder, Jamison gives her whole-hearted support to lithium, the classic mood-stabilizing drug; I have concerns, however, with her terming it the “antisuicide medication”, as it is a dangerous tendency, among Americans in particular, to assume or expect that one can oversimplify treatment of something with as complex a set of contributing factors as suicide. Despite her warning to readers that it may not work for everyone, terming anything with a cure-all designation is dangerous in a book so desperately lacking in hope for its readers, and I fear too many would latch on to one such buoy as their only possible salvation from suicidal ideation and eventual completion. My greatest criticism of Night Falls Fast, however, is that despite her seeming understanding of the dangers inherent in a culture-bound search for a magic bullet to “cure” these mental health issues and the expectations for a true “antisuicide medication”, as she discusses in the “As a Society” chapter on the how the media ought not to treat suicide, Jamison herself persists in using language and storytelling techniques which undermine her otherwise sound understanding of how to address suicide. Jamison quotes the CDC’s recommended guidelines to the media regarding suicide treatment as a paradigm for how suicide ought not to be portrayed: by presenting simplistic explanations for suicide, engaging in repetitive, ongoing or excessive reporting of suicide in the news, providing sensational coverage of suicide, reporting “how-to” descriptions of suicide [acts], presenting suicide as a tool for accomplishing certain ends, glorifying suicide or persons who commit suicide, or focusing on the suicide completer’s positive characteristics, (Jamison, 280-282). While she does not ignore all of these guidelines, despite including them in her book, Jamison herself still falls into these same habits during the first two thirds of Night Falls Fast, recounting multiple times the specific details of horrible deaths with morbid fascination, including as examples wonderful and famous minds in literature and art, and getting caught by her own condemnation.
What Jamison does do well is give factual evidence of the terrible impact that depression and its too-often-successor suicide do to individuals, regardless of gender or ethnicity, and their survivors. Using comprehensive statistical information and examples from all eras, nationalities, races and gender groups, Jamison poignantly illustrates that depression and suicide are great equalizers: they spare no population. That she is a well-educated white woman does show through in her more elaborate case examples and stories, in that most are about white men and women of prominence or potential (though with a few notable exceptions). Jamison does try to point out explicitly the troublingly ignored populations of homeless mentally ill, many of whom suffer from bipolar disorder or schizophrenia and for whom suicide is perhaps a more common option that with the general public, but recognizing that the greatest impact will be made on her audience with examples from more prominent—and therefore, theoretically better off— spheres of life, she spends the majority of her ink tracing more well known or well off figures from history who have succumb to suicide. Despite her best efforts to show the devastatingly vast scope of life suicide touches, non-white, non-educated populations remain largely unrepresented in this book, reflecting our cultural concern which only becomes actively alarmed when those who somehow should not be so desperate are taking their own lives.
The last third of the book is far less overwhelming, as it offers some light at the end of the tunnel in the form of treatment discussions and the usefulness of medication and public health awareness work, both of which are promising steps. It includes a discussion of most effective treatment methods—“Modest Magical Qualities”, with a discussion of both medicinal and therapeutic interventions—a discourse on the positive efforts public health workers have been making towards suicide awareness and prevention, and a sober conclusion discussing the impact of suicide on surviving family, spouses, and friends. Given the book’s publication in 1999, I think it would behoove Jamison to update for her audience, to add in the hopeful advancements of psychopharmacology in the past 10 years beyond what she discusses regarding the older generations of mood stabilizer, MAOIs, and tri-cyclic antidepressants, including the now common usage of most SSRIs and the new class of antidepressant medication, SNRIs. Similarly, while Jamison creates a depiction at once poignant and resilient of the family and friends left to rebuild themselves after the suicide of a loved one, she gives very little of herself, either as a survivor who managed to cope with the suicide of her dear friend (though we know not how), or how her own family coped with the darkness she lived in on and off throughout her life. Neither does she offer anywhere near as detailed accounts from the lives of others as she does for the deaths of those whose stories she does tell: this imbalance of perspective deprives us from taking away anything therapeutic, and keeps us perpetually sapped of emotional vitality all the way through to the book’s end.
As a student of social work, I was very pleased to read Jamison’s endorsement of combining psychopharmacology with therapy (psychiatry, in her case) as both her personal salvation and the best means of combating suicidal action. I truly wish that she had spent more time using herself as an example of those who can and do recover; despite having personally lost a number of friends and acquaintances to suicide, in addition to almost succeeding in taking her own life, Jamison is an emblem of hope for those who fear they cannot make it, yet she does not use her status as a model for others. We do not get to hear what worked for her, beyond sticking with her lithium and psychiatry regimen, we do not get to experience her headway made out of the depths of despair and into normal, even stellar functioning. Other than her dedication to her husband and brother, we know nothing about her support systems, which are not at all addressed elsewhere in the book’s tally of losses either. It is a significant failing on Jamison’s part that she leaves us without her own example of recovery from depression, or at least a discussion of its remission, as hope, to counteract the overwhelming burden left by the other stories in this book. We are left feeling unmoored and helpless after an onslaught of depressive stories, and instead of stressing those people and actions which did reach her through the darkness, we are left with only the smallest glimmers and told merely to keep holding on.
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