Suicide is Not Painless

Originally published in the Austin Chronicle on December 3, 1999.

Orthodox opinion will hold that Kay Redfield Jamison’s Night Falls Fast: Understanding Suicide is the most compelling discussion of suicide in many years—though not because of the book’s more obvious virtues. One can hardly fail to notice that Jamison possesses a talent for synthesis as well as a gift for prose that appeals to a broad readership. Nor can one doubt that the book addresses an urgent issue, for suicide is threatening to acquire epidemic dimensions. More than 30,000 Americans die by their own hand every year. Another 500,000 make an attempt serious enough to require hospitalization, Jamison reports. No one knows how many additional lives are shadowed by the ambivalence that characterizes the psychology of would-be victims.

For its lucidity and relevance Night Falls Fast promises to gather luxurious praise indeed. (The book has already received an advertisement cloaked as a review in the New York Times, and its author has appeared on Larry King Live and other programs.) Yet the promulgators of current “mental health” orthodoxies will find an even more satisfying reason to embrace the book. For Jamison, a prominent professor of psychiatry at Johns Hopkins University and the author of An Unquiet Mind—a bestselling memoir of her manic depression—flatters the increasingly prevalent view that biology determines human behavior in general and “mental health” in particular.

She argues, relentlessly, that “the most common element in suicide is psychopathology, or mental illness,” and fingers depression and manic depression as the two most insidious culprits. She insists that these maladies, in turn, have biological and perhaps even genetic origins. Accordingly, Jamison’s vigorous program for suicide prevention centers on prescription drugs that modulate levels of serotonin and related “neurotransmitters.” Don’t American psychiatrists already make a fetish of antidepressant medications? Not according to her. She complains that “doctors in general woefully under-prescribe antidepressants and lithium for patients who could benefit from them.” She thinks, too, that “shock therapy” is “underutilized,” and predicts a happier future when “there will almost certainly be biological tests to assess suicide risk.”

Much of Jamison’s analysis is sufficiently agile so as to dodge the label of dogmatism. She allows, for example, that psychological and sociological factors often precipitate the final decision to act. But she brooks no dissent concerning the underlying biology of suicidal depression. The result is an intelligent book, yet one that is both unreflective and frequently immodest.

Those readers disinclined to place all their faith in biological explanations of human behavior—or, for that matter, in the collective judgment of the psychiatric establishment—are permitted a measure of skepticism before being drugged senseless. Jamison too often conflates causes with treatments, for example. Even if suicide does result from some deficit in brain chemistry, why not try to remedy the imbalance through psychological mechanisms that are known to have the desired neurological effects? She likewise endows clinical research into prescription drugs with far too much authority. Consider, in this respect, the November 10 issue of the Journal of the American Medical Association, wherein an editorial lambastes researchers for a longstanding pattern of “deliberate” duplicity. Authors who publish the results of drug trials habitually exaggerate their efficacy in an effort to please “commercial interests,” i.e., profit-hungry pharmaceutical companies.

Unlike Howard Kushner’s American Suicide (1989) or Ian Hacking’s fascinating Mad Travelers (1998), Jamison’s programmatic analysis of mental illness does not leave much room for historical or philosophical reflection. Indeed, she seems only to imagine benign therapists and researchers pursuing objectively scientific solutions in the most noble, disinterested manner. No surprise, then, that she regards the civil liberties of patients as little more than a nuisance.