Cover image for Night falls fast : understanding suicide
Night falls fast : understanding suicide
Jamison, Kay R.
Personal Author:
First edition.
Publication Information:
New York : Knopf : Distributed by Random House, 1999.
Physical Description:
x, 432 pages : illustrations ; 23 cm
Format :


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RC569 .J36 1999 Adult Non-Fiction Open Shelf
RC569 .J36 1999 Adult Non-Fiction Central Closed Stacks
RC569 .J36 1999 Adult Non-Fiction Open Shelf
RC569 .J36 1999 Adult Non-Fiction Open Shelf

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From the best-selling author ofAn Unquiet Mind: the first major book in a quarter century on suicide, with a particular focus on its terrible pull on the young.Night Falls Fastis both compelling and timely: in the United States and across the world there has been a frightening surge in suicides committed by children, adolescents and young adults.  It is the third major cause of death in 19- to 24-year-olds, and the second in college students. Dr. Kay Redfield Jamison, an internationally recognized authority on depressive illnesses and their treatment, knows this subject firsthand.  At the age of 28, after years of struggling with manic-depression, she attempted to kill herself. Her survival marked the beginning of a life's work to investigate both mental illness and self-inflicted death.          Weaving together a psychological and scientific exploration of the subject with personal essays about individual suicides, Dr. Jamison in this book brings not only her compassion and literary skill, but all of her knowledge, research and clinical experience to bear on this devastating problem. In tracing the network of reasons that underlie suicide, Dr. Jamison gives us astonishing examples of the methods and places people have chosen to kill themselves, and a startling look at their journals, drawings and farewell notes. She also brings us vivid insight into the most recent findings from hospitals and laboratories across the world; the critical biological and psychological factors that interact to cause suicide; the new strategies being evolved to combat them; and the powerful, but insufficiently used treatments from modern medicine. Night Falls Fastdispels the silence and shame that too often surround suicide; it helps us to understand the suicidal mind, to better recognize the person at risk, and to comprehend the profound and disturbing loss created in those left behind.

Author Notes

Clinical psychologist Kay Redfield Jamison was born on June 22, 1946. She received a B.A., M.A., and Ph.D. from the University of California, Los Angeles. She is considered one of the foremost experts on bipolar disorder, which she has had since her early adulthood. She is Professor of Psychiatry at the Johns Hopkins University School of Medicine and a Honorary Professor of English at the University of St. Andrews in Scotland. She is the author of numerous books including An Unquiet Mind: A Memoir of Moods and Madness; Night Falls Fast: Understanding Suicide; and Touched with Fire: Manic-Depressive Illness and the Artistic Temperament.

(Bowker Author Biography)

Reviews 4

Publisher's Weekly Review

Providing historical, scientific and other helpful material on suicide, Jamison (An Unquiet Mind), a Johns Hopkins psychiatry professor, makes an excellent contribution to public understanding with this accessible and objective book. There is, she asserts, a suicide every 17 minutes in this country. Identifying suicide as an often preventable medical and social problem, Jamison focuses attention on those under 40 (suicides by those who are older often have different motivations or causes). Citing research that suicide is most common in individuals with mental illness (diagnosed or not), particularly depression and manic depression, she clearly describes the role of hormones and neurotransmitters as well as potential therapies, including lithium and other antidepressants. Jamison presents fascinating facts about suicide in families and in twins, gender disparities, and the impact of the seasons and times of day. She also provides poignant portraits of those who have committed suicideÄfrom the explorer Meriwether Lewis to a high-achieving Air Force Academy graduateÄas well as stories from her own experience. Historical perspective on how different societies have viewed suicide gives context, especially on methods and common locales (in the U.S., San Francisco's Golden Gate bridge is the most popular spot). Critical of her profession for not recognizing suicidal tendencies more readily, Jamison scolds the media and firearms industry as well. The book effectively brings suicide out of the closet, gives general readers insight into symptoms and should increase national awareness of the problem. (Oct.) (c) Copyright PWxyz, LLC. All rights reserved

Choice Review

Jamison (Johns Hopkins Univ.) focuses on understanding why young people kill themselves, what mental suffering precipitates suicide, and how professionals and society can prevent this tragedy. The author weaves a tapestry of scientific evidence with personal accounts and clinical material. Fascinating poetry and essays illuminate the turmoil of the suicidal mind, showing how creative individuals seek to escape their intolerable stress. Jamison divides the discussion into four parts: a history, overview, definitions, and measurement of suicide; the psychology, psychopathology, and methods of suicide; the role of biology, neurobiology, and immunology; and new horizons in treatment, prevention, public health, and bereavement. The stories of individuals and the discussion of controversies and unanswered questions about suicide will engage the reader, who will come to see that treatment must address multiple causes: individual vulnerabilities, severe psychiatric illness, and acute psychological stress. Despite the body of knowledge about prevention, application of this knowledge has not been broad or effective. This discussion of individuals whose productive lives were threatened by the demons of mental illness and compelling desires for suicide will challenge those who wish to understand and slow down this epidemic. All collections. S. M. Valente; University of Southern California

Booklist Review

In An Unquiet Mind (1995), Jamison took personal and professional risks in revealing that she, a professor of psychiatry at Johns Hopkins, suffered from manic-depressive illness and in detailing her symptoms and her travails with medication. And she indeed set off a storm of controversy within and beyond the mental health community. Her new book is a scholarly piece of work whose appeal nevertheless extends far beyond a professional readership. It is a study of the possible relationship between manic-depressive illness and the artistic temperament, especially as it affects suicide. Besides the psychology and psychopathology of suicide, Jamison discusses her own suicide attempt years ago, and she concludes that mood disorders, alone or combined with substance abuse, are the complex of conditions most commonly associated with suicide. Jamison also studies the methods of suicide and their relative popularity; in America, firearms are used in more than 60 percent of all suicides. Jamison presents information on genetic factors predisposing one to suicide and inspects the all-important role of serotonin levels in the brain in some detail. Her discussion of suicide prevention considers hospitalization and such medications as lithium, anticonvulsants, and antidepressants. She puts a human face on the statistics she presents with quotations from the works of writers including Anne Sexton, Sylvia Plath, William Styron, and Dylan Thomas as well as excerpts from case studies. --Whitney Scott

Library Journal Review

The grim topic of suicide has been the subject of several major works, including Emile Durkheim's Suicide: A Study in Sociology (Free Pr., 1997. reprint), A. Alvarez's literary study The Savage God (1972), and a wealth of poetry. Now Jamison, the author of the best-selling autobiography An Unquiet Mind: A Memoir of Moods and Madness, brings her unique combination of scientific analysis, personal revelation, and poetic expression to the study of suicide. (Jamison, a manic depressive, attempted suicide at age 28 and is now a professor of psychiatry at Johns Hopkins University School of Medicine). Chapters explore the history of suicide, psychopathology as a leading cause, the influence of genetic factors, and prevention on both an individual and a societal level. Jamison explicitly limits her study to people under 40 and emphasizes major psychiatric illness as the main causative factor for suicide in this population. This title is worthy of its forebears while adding a modern scientific perspective. Essential for both public and academic libraries. [Previewed in Prepub Alert, LJ 6/1/99.]ÄMary Ann Hughes, Neill P.L., Pullman, WA (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.



Prologue Summer 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 Jack's 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 didn't 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 wasn't 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 soufflés 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 later -- Jack had long since married and I had moved to Washington -- I received a telephone call from California: Jack had put a gun to his head, said a member of his family, and "put a bullet through his brain." 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 by the 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 businessman -- this remarkably imaginative man had not been inventive enough to find an alternative solution to a violent, self-inflicted death. Although shaken by Jack's 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 pact and certainly had not called him. Nor had I even thought of calling. Suicide is not beholden to an evening's promises, nor does it always hearken to plans drawn up in lucid moments and banked in good intentions. I know this for an unfortunate fact. Suicide has been a professional interest of mine for more than twenty years, and a very personal one for considerably longer. I have a hard-earned respect for suicide's ability to undermine, overwhelm, outwit, devastate, and destroy. As a clinician, researcher, and teacher I have known or consulted on patients who hanged, shot, or asphyxiated themselves; jumped to their deaths from stairwells, buildings, or overpasses; died from poisons, fumes, prescription drugs; or slashed their wrists or cut their throats. Close friends, fellow students from graduate school, colleagues, and children of colleagues have done similar or the same. Most were young and suffered from severe illness; all left behind a wake of unimaginable pain and unresolvable guilt. Like many who have manic-depressive illness, I have also known suicide in a more private, awful way, and I trace the loss of a fundamental innocence to the day that I first considered suicide as the only solution possible to an unendurable level of mental pain. Until that time I had taken for granted, and loved more than I knew, a temperamental lightness of mood and a fabulous expectation of life. I knew death only in the most abstract of senses; I never imagined it would be something to arrange or seek. I was seventeen when, in the midst of my first depression, I became knowledgeable about suicide in something other than an existential, adolescent way. For much of each day during several months of my senior year in high school, I thought about when, whether, where, and how to kill myself. I learned to present to others a face at variance with my mind; ferreted out the location of two or three nearby tall buildings with unprotected stairwells; discovered the fastest flows of morning traffic; and learned how to load my father's gun. It was not the kind of education one expected to receive in high school. The rest of my life at the time -- sports, classes, writing, friends, planning for college -- fell fast into a black night. Everything seemed a ridiculous charade to endure; a hollow existence to fake one's way through as best one could. But, gradually, layer by layer, the depression lifted, and by the time my senior prom and graduation came around, I had been well for months. Suicide had withdrawn to the back squares of the board and become, once again, unthinkable. Chillingly, although the privacy of my nightmare had been of my own designing, no one close to me had any real idea of the psychological company I had been keeping. The gap between private experience and its public expression was absolute; my persuasiveness to others was unimaginably frightening. Over the years, my manic-depressive illness became much worse, and the reality of dying young from suicide became a dangerous undertow in my dealings with life. Then, when I was twenty-eight years old, after a damaging and psychotic mania, followed by a particularly prolonged and violent siege of depression, I took a massive overdose of lithium. I unambivalently wanted to die and nearly did. Death from suicide had become a possibility, if not a probability, in my life. Under the circumstances -- I was, during this, a young faculty member in a department of academic psychiatry -- it was not a very long walk from personal experience to clinical and scientific investigation. I studied everything I could about my disease and read all I could find about the psychological and biological determinants of suicide. As a tiger tamer learns about the minds and moves of his cats, and a pilot about the dynamics of the wind and air, I learned about the illness I had and its possible end point. I learned as best I could, and as much as I could, about the moods of death. Excerpted from Night Falls Fast: Understanding Suicide by Kay Redfield Jamison All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

Table of Contents

Prologuep. 3
I Buried Above Ground: An Introduction to Suicidep. 9
1 Death Lies Near at Hand: History and Overviewp. 11
2 To Measure the Heart's Turbulence: Definitions and Magnitudesp. 26
Essay: This Life, This Deathp. 52
II Just Hope Has Gone: Psychology and Psychopathologyp. 71
3 Take Off the Amber, Put Out the Lamp: The Psychology of Suicidep. 73
4 The Burden of Despair: Psychopathology and Suicidep. 98
5 What Matters It, If Rope or Garter: Methods and Placesp. 130
Essay: The Lion Enclosurep. 154
III Pangs of Nature, Taints of Blood: The Biology of Suicidep. 161
6 A Plunge into Deep Waters: Genetic and Evolutionary Perspectivesp. 163
7 Death-Blood: Neurobiology and Neuropathologyp. 182
Essay: The Colouring to Events: The Death of Meriwether Lewisp. 213
IV Building Against Death: Prevention of Suicidep. 233
8 Modest Magical Qualities: Treatment and Preventionp. 235
9 As a Society: The Public Healthp. 264
10 A Half-Stitched Scar: Those Left Behindp. 290
Epiloguep. 309
Appendix Resources for Information About Suicide, Mental Illness, and Alcohol and Drug Abusep. 315
Notesp. 319
Acknowledgmentsp. 415
Indexp. 419