Book Review: Night Falls Fast: Understanding Suicide by Kay Redfield Jamison

Kay Redfield Jamison’s Night Falls Fast (N.Y.: Vintage Books, 1999) is a must-read for understanding suicide. A professor of Psychology at Johns Hopkins University and an advocate for those, like her, who suffer from manic depression (bipolar disorder), Jamison speaks about suicide with clinical authority and personal experience.

She argues that suicide, an unthinkable act when one is healthy, can arrive at the doorsteps of the depressed as a seductive and compelling solution to unbearable mental anguish. Suicidal ideation has the capacity to outwit even those highly attuned to its deception and trick the most resilient among us. For this, it is worthy of serious study.

She begins with a history of suicidal ideation first described in antiquity and traces it to contemporary times, when damning attitudes about self-inflicted death have finally begun to receive a fuller understanding of its root causes. Jamison is a researcher, and she delves into global studies on suicide rates among all age groups while she also writes beautifully, from the heart, about her own experience with attempting suicide.

She wants us to understand the suicidal mind at the center of a range of psychiatric illnesses that can rob a person of a satisfying life, where drugs and alcohol can tamp down the persistent voices, the daily dread, but can also ultimately hasten the trajectory of illness. She examines its biological predisposition, nutritional deficits, and neurological features, because not all people faced with a difficult life choose suicide, so who does? She notes that highly successful artists, writers, mathematicians, and scientists with a great imagination and creativity are more predisposed to suicide.

Captain Meriwether Lewis committed suicide, seemingly at odds with the notion of him as a hero, but William Clark was not entirely surprised: “I fear O! I fear the weight of his mind has overcome him” (p. 225). Jamison also explores methods and places of suicide and shows how these different settings are governed by personality traits, access, and cultural norms. Suicide is not, as commonly considered, a selfish act, but is done by people who think they are sparing their loved ones, and “would hurt them less dead than alive” (p. 292).

Jamison also dissects the intensity of suffering, guilt, and even the feelings of relief that can plague family members, and finally, she ends with an overview of recent advances in treatment and prevention guidelines. Her book should be required reading for all health professionals.