To Know Suicide

By Jamison, Kay Redfield | International New York Times, August 18, 2014 | Go to article overview

To Know Suicide


Jamison, Kay Redfield, International New York Times


Depression is a grave illness, but we can help people back to life.

When the American artist Ralph Barton killed himself in 1931, he left behind a suicide note explaining why, in the midst of a seemingly good and full life, he had chosen to die. Everyone, he wrote, "will have a different hypothesis" to explain why he did it, and most would be wrong. "I have had few real difficulties," he said, and "more than my share of affection and appreciation."

Yet his life had sunk into misery. "I have run from wife to wife, from house to house, and from country to country, in a ridiculous effort to escape from myself," he wrote. The reason he gave for his suicide was a lifelong "melancholia" worsening into "definite symptoms of manic-depressive insanity."

Barton was correct that people often account for suicide by external causes like marital or work problems, physical illness, financial stress or trouble with the law, rather than attribute it to mental illness. Stress can interact dangerously with depression, but the most important risk factor for suicide is mental illness, especially depression or bipolar disorder (also known as manic- depressive illness). When depression is accompanied by alcohol or drug abuse, which it commonly is, the risk of suicide increases perilously.

Suicidal depression involves a kind of pain and hopelessness that is impossible to describe -- and I have tried. I teach in psychiatry and have written about my bipolar illness, but words struggle to do justice to the experience.

Suicidal depression is a state of cold, agitated horror and relentless despair. The things that you most love in life leach away. There is no hope, no point, no nothing.

The burden you know yourself to be to others is intolerable. So, too, is the agitation from the mania that may simmer within a depression. There is no way out and an endless road ahead. When someone is in this state, suicide can seem a bad choice but the only one.

It has been a long time since I have known suicidal depression. I am one of millions who have been treated for depression and gotten well; I was lucky enough to have a psychiatrist well versed in using lithium and knowledgeable about my illness, and who was also an excellent psychotherapist.

This is not everyone's experience. Many different professionals treat depression, including family practitioners, internists, psychiatrists, nurses and social workers. This results in wildly different levels of competence. Many who treat depression are not well trained in the distinction among types of depression. There is no common standard for education about diagnosis. …

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