Inner Darkness. - Review - book review

Night Falls Fast: Understanding Suicide, by Kay Redfield Jamison (Knopf, 432 pp., $26)

WE have lately been deluged with words about mental illness: essays in The New Yorker on the experience of recovering from depression; books on causes, symptoms, cures; memoirs of madness by literary giants and dwarves alike. The topic seems to fascinate most people. Most, but not all. Confronted by this tremendous, confused, heartfelt outpouring, conservative intellectuals have mostly responded: Get over it!

Conservatives are not listening to Prozac. The literature of self- revelation strikes them as a failure of reticence on the part of writers, and an invitation to hypochondria for readers. This literature is, for many conservatives, itself symptomatic of a social disease: a "thera peutic culture" that, step by insidious step, is replacing the criteria of morality with those of health.

There is truth in this critique, but it is not the whole truth; and to the extent that conservatives act as though it is, the culture will be deaf to their critique. Con servatives will not get a hearing, that is, until they face up to the reality of mental illness. Reading Kay Redfield Jamison's Night Falls Fast would be a good way to start.

Jamison, a professor of psychiatry at the Johns Hopkins University School of Medicine, is an expert on mental illness. Her book Touched with Fire dealt with the peculiar susceptibility of writers, artists, and musicians to manic- depression. Her knowledge of the subject is rooted not only in research and reading but bitter experience: As detailed in her subsequent memoir An Unquiet Mind, she herself has suffered from manic-depression and has attempted suicide. In her latest book, she surveys what we know about suicide among the young and middle-aged.

One thing we know, or ought to know, is that it is not rare. Perhaps one in ten fatal shootings by police officers is deliberately provoked by the victim in what has been called "suicide by cop." Jamison writes, "In 1995, more teenagers and young adults died from suicide than died from cancer, heart disease, AIDS, pneumonia, influenza, birth defects, and stroke combined." A survey from the same year found that one in ten college students had seriously considered suicide in the previous year, most having drawn up a plan. Only accidents kill more of them; yet most families don't look at mental-health services at all when picking a college.

Arming a teenager to withstand stress, setbacks, and heartache is not enough. Jamison insists that it is mental illness that causes most suicides: depression, manic-depression, and schizo phrenia, all of which often find their victims in young adulthood.

Healthy people, for the most part, can handle the occasional disappointments of life; mental illness can make it difficult to cope with the sunrise. Poets and doctors, like creative and successful people generally, are more prone to mental illness and suicide than most people. It must be especially maddening for people who live by their wits to appear to be losing them; to see their minds, capable of such wonders, turning on themselves. Jamison writes, "Patients who do well socially and academically when young and who then are hit by devastating illnesses such as schizophrenia and manic- de pression seem particularly vulnerable to the spectre of their own mental disintegration and the terror of becoming a chronic patient."

That terror may be at its worst when the disintegration is not. Suicide takes too much work when you're curled up in a ball. A little more energy, a little more clarity, makes it possible (and sometimes, a little more cunning, to fool the doctors). Then, too, "the jagged pattern of recovery" often raises hopes and cruel ly dashes them. The chronic dread that the illness will return-Poe's "long periods of horrible sanity"- plays "a decisive role in many suicides." So it is not surprising that the smarter and better informed a schizophrenic is, the more likely he is to commit suicide; or that doctors' assessments of hospitalized patients soon to kill themselves are often more upbeat than their assessments of patients who live.

The case studies presented by Jamison are hideous and harrowing. There is Drew Sopirak, who had just graduated from the Air Force Academy when manic-depression struck him down; the explorer Meriwether Lewis, whose suicide is still not squarely faced in all the history books; Margaret Davis King, a Navy veteran and homeless paranoid schizophrenic who broke into the National Zoo a few years ago to be mauled and eaten by lions.

Along the way we learn that, contrary to widespread belief, suicide rates do not increase over holidays, or during the night. That winter is, in every country studied, the sparsest season for suicide (and less remarkably, that Mondays are the peak day for it). That the chief advantage of the new medications that have become so prominent in the '90s is not their greater efficacy but their lower toxicity, making it hard to overdose on them. We read in one chapter about the matter-of- factness often characteristic of suicide notes, in another about the evolutionary psychologists' speculations about the origins of mental illness. And we read briefly about Jamison's intimate familiarity with her subject, which, she confirms, made writing the book emotionally wrenching.