A Mission Against Suicide
Throughout her life, Dr. Kay Redfield Jamison has struggled with a mental illness that sent her plummeting into depressions and soaring into wild, dizzy manias. When she was just 28, she attempted suicide by taking a massive overdose of the drug lithium. She nearly died.
A professor of psychiatry at Johns Hopkins University School of Medicine, an author and a person living with manic-depressive illness, Jamison described her experiences in a bestselling book, âAn Unquiet Mindâ (Alfred A. Knopf, 1995). Her latest book, âNight Falls Fastâ (Alfred A. Knopf, 1999), tells the story of many other troubled people. In it, she explores the act of suicide in the young.
Suicide is the third-leading cause of death in young people; its rates are even higher in the elderly. It takes the lives of 30,000 Americans every year. Last week we talked with Jamison about the reasons people kill themselves and what can be done to stop the scourge.
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Question: Many people find it hard to understand why someone would take their own life. As someone who has been there both professionally and personally, can you describe the feelings that lead someone to suicide?
Answer: If you havenât experienced it, itâs very hard to describe the level of pain that goes into suicidal thinking: the hopelessness and despair. Severe depression brings with it a tremendous loss of energy--a lack of ability to do the things you ordinarily do. Life becomes meaningless and flat. You see no point to anything, no point to living, you are acutely aware of how taxing you are to other people. All of a sudden you canât reach out to friends. With that, comes a level of mental agony and agitation that is just very difficult to portray. Severe mental illness also affects your capacity to reason. So itâs not like youâre deciding whether to live or die when youâre at the top of your game.
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Q: What are the main causes of suicide?
A: Ninety to 95% of suicides are associated with major mental illnesses. Depression, manic depression and schizophrenia are the main ones. Alcohol and drug abuse are also risk factors. And certain personality types--impulsive and volatile--are also at higher risk for suicide. One person will be devastated by a breakup but not consider or attempt suicide. Another person will pick up the gun, and thatâs that.
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Q: Is everyone who contemplates suicide at high risk?
A: Thinking about it is not uncommon. Maybe 15% to 20% of people have thought about it, and seriously enough that theyâre concerned. Most are not going to attempt suicide. But any time you think about killing yourself youâd be foolish to ignore it. It is a warning sign. If the feelings get worse, or continue over time, you should get help.
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Q: Your book describes some of the actions toward suicides in centuries past: stakes through the heart, bodies dragged through streets then hanged on gallows or buried at night at the crossroads. Why such viciousness?
A: Suicide is such an incomprehensible, frightening thing. Itâs so contrary to the human desire to live. When youâre frightened, you have to put as much distance between yourself and that which is frightening. You do that by burying it as quick as you can and as deep as you can. Itâs understandable that in the 14th century you would do that, even though it was barbaric, cruel and brutal. How many ways did people have back then to understand strange behavior?
What I canât understand is why in 1999--with what we know about how to treat these illnesses, and what causes them--that weâre sitting around still not talking about a major public health problem.
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Q: Why have rates of suicide in the young risen sharply since the 1950s?
A: Partly, itâs because today suicide is less likely to be reported as accidental death. But depression seems to be genuinely increasing in the young, and hitting younger. That may be because puberty--when mental illnesses tend to take off--comes earlier today.
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Q: How can society lower the death toll from suicide?
A: We should talk to our kids, just as we talk to them about drugs. This isnât easy. We arenât born knowing how to have these conversations.
Instead of urging kids to talk about their feelings--kids probably arenât going to talk to parents this way past a certain point--I think parents should talk to them as they would about any illness. Tell them what the symptoms of depression are, and explain that these are signs of a common, very treatable illness.
I think itâs particularly important to do this before kids go off to college with its stresses, sleep disturbances and access to drugs and alcohol. Especially if there is mental illness in the family. Suicide is the second leading cause of death in college students. I also think that universities should be much more proactive. Many student health services are ineffectual. Parents should scope out the mental health facilities just as they would any other facility at the school.
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Q: What about the medical profession and health care system?
A: I think doctors are not asking patients enough questions about suicide and arenât aware enough of which medications are most effective or of some of the side effects--such as agitation--that can be problematic. Doctors should be available and aggressive in their treatment and inform patients of possible side effects as well as the fact that there will probably be setbacks during recovery, and that the risk for suicide goes up as people begin to get well.
Most physicians donât have enough time with patients to ask all the questions that they should. Health coverage for mental illnesses is often inadequate. The tendency in HMOs has been to cover--reluctantly and inadequately--medications, but not psychotherapy. But study after study has shown that itâs more effective to treat severe depression and manic depression with both psychotherapy and medication than either one alone.
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Q: Many people today use the herbal supplement St. Johnâs wort to self-medicate for depression. What are your views on that?
A: I think itâs potentially harmful. Thereâs quite a bit of evidence that St. Johnâs wort works in mild to moderate depressions. The problem is that itâs not regulated by the Food and Drug Administration in this country, so you donât know how much youâre getting or how pure it is. And youâre not under a doctorâs care. It can also give people the illusion of treatment and, if it doesnât work, people can tend to think that thatâs the end of the line. Iâm very conservative. I think people should use standard treatments--the ones that have been studied, where you know the problems and you know the efficacy.
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Q: Why are people more prone to commit suicide when they are recovering from a depression?
A: People in the throes of a depression lack energy. As they recover, they can act on suicidal thoughts they already had. Also, when people get depressed they become acutely indecisive. Top CEOs of Fortune 500 companies, used to making a thousand decisions a day, when they get depressed, cannot decide which pair of socks to wear. That indecisiveness dwindles as someone starts to get well. Also, people think theyâre just going to get steadily better and better. But recovery usually has a zigzag path. So they may get better for a day or two and think, âWow, Iâm well again,â and then plummet. That can be devastating.
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Q: I had often heard that rates for suicide peak around Christmas. But you point out that this is a myth.
A: Suicide rates are at their absolute lowest in December. Suicide peaks in the spring and early summer. There is probably a biological cause.
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Q: What should I do if I suspect that a friend or family member is at risk for suicide?
A: Reach out to them. Tell them youâre concerned because they seem really depressed. Ask what you can do to help. Ask them if they are thinking of taking their life. You should certainly be concerned if someone is talking about death a lot. People considering suicide tend to talk about it.
I think, more broadly, we have to set up a society thatâs more compassionate. That recognizes depression is really common and if you donât get it one of your friends is likely to. We donât really want to destigmatize suicide, but we do want to destigmatize the illnesses that lead up to suicide. Itâs a matter of ratcheting up public and parental awareness, bit by bit. No one thing is going to solve all this.
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For more information about mental illness and suicide, contact the National Alliance for the Mentally Ill at 200 N. Glebe Road, Suite 1015, Arlington, VA 22203-3754; call (800) 950-6264; or visit https://www.nami.org. You can also contact the American Foundation for Suicide Prevention, 120 Wall St., 22nd floor, New York, NY 10005; (888) 333-2377; https://www.afsp.org.
