crowyhead, October 11, 2007 (view all comments by crowyhead)
Jamison begins this excellent book by describing suicide in the same terms that one might describe a particularly awful disease: "Suicide is a particularly awful way to die: the mental suffering leading up to it is usually prolonged, intense, and unpalliated," she writes. "There is no morphine equivalent to ease the acute pain, and death not uncommonly is violent and grisly." This sets the tone for the book, which is unflinching and frequently painful to read, yet the author also infuses the information and narratives with a deep sense of compassion and understanding.
After reading William Styron's excellent Darkness Visible, I was struck with the way that many memoirs and other books on depression dance around the subject of suicide. Just about every depressive's memoir describes the author's bout of suicidal ideation or his or her suicide attempt, yet at the same time many books on depression seem to go out of their way to divorce suicide from depression and manic-depressive illness. There is a strong desire, it seems, to stress that not everyone who is depressive will attempt or commit suicide, and that not everyone who commits suicide is depressive or otherwise mentally ill. While this is true, it also muddies the very strong connection between mental illness and suicide, perhaps to the detriment of many.
Jamison seeks to remedy this by very strongly stating that suicide is indeed most common in people with mental illness, diagnosed or not, and backs up this claim with a great deal of research. She also explores research into when people are at their most vulnerable, which is sometimes surprising. For example, one of the most dangerous times in terms of suicide is the period directly after a patient has been released from the hospital. At first this seems counterintuitive, but it actually makes sense -- if someone has been hospitalized for depression or another mental illness, they have been in a fairly sheltered and safe environment. Upon release, however, not only is the patient suddenly confronted with the problem of picking up their life where they left off and dealing with practicalities like returning to work and daily life, but there is also an increased risk of medication noncompliance. Jamison also elaborates on one theory as to why some suicides seem to be provoked by the use of antidepressants: in many cases, when a person is deep in the throes of depression, they lack the energy and wherewithal to carry out suicide plans. Perversely, once the antidepressants begin to work, the patient starts to feel just well enough to carry out plans they had only considered before.
Jamison is also not afraid to bring a human element to the book. Interspersed with her clear reportage of scientific research into suicide are specific accounts of individuals who committed or attempted suicide -- including Jamison herself.
Overall, I feel like this is a cruicially important book. It's especially useful to those who have come into contact in some way with mental illness and suicide, but I think pretty much everyone could benefit from reading it and achieving greater understanding of this issue.
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