A Critique of the book: "Night Falls Fast"

The author, Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins University School of Medicine and an honorary professor of English at the University of St. Andrews in Scotland, was herself a sufferer of manic-depression, and has attempted suicide. Her knowledge of the subject, both professionally and personally, has made her book popular and authoritative.

With this authority, the author claims that suicide is always bad, irrational, and a result of mental illness: the standard position of modern psychology. However, is this authority justified?

Suicide as an Irrational Event

Jamison describes suicide as an impersonal enemy: it comes like a flood or a hurricane. Suicide is also described as irrational: "When people are suicidal, their thinking is paralyzed, their options appear spare or non-existent, their mood is despairing and hopelessness permeates their entire mental domain" (p. 93).

Are suicidal people subject to an event, which is accompanied by irrational thought, or is it possible that at least some suicidal people are making rational decisions?

To answer this we first have to consider what "rational" means. Intuitively, rational thought is just "good thinking". A rational decision is one which was carefully considered, in such a way that the outcome of the decision improves the chances of attaining one's goals. The process of making a rational decision can be broken down into three stages:

1. Determining possible options
2. Evaluating the options
3. Choosing among these options

Restricted Thinking

Jamison supports her conclusion of the suicidal's restricted thinking by noting that actively suicidal people seem to be concerned only with options regarding suicide, such as which method to use, and unconcerned by other options where one would continue to live. This would seem to violate the first stage of rational decisions, i.e. not determining what the possible options are.

However, exploring suicide methods can be viewed as rational in two ways. First, the person may have already decided to commit suicide. Note that de-cide and sui-cide have the same suffix. The suffix "cide" implies killing. Suicide is self-killing. Homocide is murder. To de-cide among several options is to kill the options which were not chosen.

Consider the problem of buying a new car. In choosing between cars A and B, you may use a rational decision process which takes into consideration important criteria (the car's price, safety, etc). But the decisions do not stop there. After choosing car A, you still have to decide what color car you want. It would seem silly at this stage to be interested in what colors car B is available. If you have decided on car A, you have eliminated the option of car B, in any color. The focus should be on the colors in which car A is available.

In the problem of deciding whether to commit suicide, a person could have considered life as an option, and used a rational decision process, however, once the decision is made, the options not chosen are eliminated from further consideration.

The difficult problem of deciding on a suicide method is a separate problem. Resolving it is required in order implement a former (possibly rational) decision to commit suicide. In resolving the second problem, one does not have to reconsider options which were eliminated by the first decision.

The options which were eliminated are no longer actively considered, however, they are still in the background. If you are dismayed that car A does not come in "Shocking Red", then you can revise your decision on car A, and resurrect car B as an option. This would bring you back to the rational decision process between cars A and B, taking an additional feature into consideration: the colors the car is available in. Similarly, the option of life, even when one decided to commit suicide, is always in the background. It is just not actively under consideration, and this is why it may appear to Jamison that it was never considered as an option.

Another way exploring suicide methods can be viewed as part of a rational decision process is that it is simply part of the second stage of rational decisions: evaluating options. If one is considering the option of suicide, then one must realistically evaluate the difficulties and risks involved.

Ironically, it is Jamison's thinking which seems paralyzed and irrational, by the refusal to think of suicide as a valid option.

Rationality

According to the "suicide intent scale" (p. 41-44), an instrument designed to measure the seriousness of suicidal ideation in attempters, the attempters who have greater suicidal intent have:

• taken more careful steps to avoid intervention,
• had more attempts in the past,
• used more effective methods (not notifying potential helpers, taking active precautions against being rescued, etc)

It seems that when people are seriously suicidal, they act and make decisions in such a way as to maximize the chance of success of their attempt. This is typical of rational thought. Jamison assumes that suicide is irrational, but the criteria for evaluating suicidal intention clearly contradicts this assumption.

This is not the only time where Jamison betrays her project of proving the irrationality of suicide. For example, she claims that "Those patients with schizophrenia who are more intelligent and better educated, for example, who performed better on measures of abstract reasoning, and who demonstrate greater insight into the nature of their illness, are more likely to kill themselves". (p. 84).

The Mystery of Suicide

Jamison conforms to the current psychiatric dogma in assuming that suicide is not freely chosen. That is why the problem of predicting, explaining and preventing suicide is a serious one for her. She considers suicide a mystery, for the time being, but one that will be solved with the advance of science. The general framework of her book is a search for a science of suicide, which could solve this problem. But perhaps the problems stem from the assumption Jamison starts with.

Jamison writes that "there are no simple theories for suicide, nor are there invariable algorithms with which to predict it" (p. 19), and that "Death by one's own hand is far too much a final gathering of unknown motives, complex psychologies and uncertain circumstances" (p. 26).

Prediction or explanation of why some people choose a certain profession or embrace a certain political option rather than another, is difficult since free choice is involved. It is obvious that prediction or explanation of suicide is not a matter of exact science. The fact that predicting suicide is nearly impossible, seems more easily explained if we regard suicide as a freely chosen act.

Suicide is bound to be a mystery precisely when a scientific, impersonal explanation is looked for. It is not a mystery if it is understood as a rational act, that happens because of reasons and arguments, rather than because of unconscious causes. Suicide appears to be a mystery because society inhibits the understanding of suicidal people as rational and responsible agents.

Suicide is no more of a mystery than "why do some people write original novels?" or "why are some people ambitious?".

Selective Interpretation

Throughout the book, Jamison observes numerous phenomena, always selectively interpreting them to match her theories. However, opposing interpretations to the same phenomena are possible, and are so obvious, that it is hard to believe that Jamison was not aware of them.

Statistics

The book contains many statistics, charts and tables. However, considering that suicide is a complex phenomenon, the author offers rather trivial interpretations. For example, Jamison writes that 20 to 65 percent of college students had at least once in their lifetime suicidal thoughts (p. 36), which is a high rate compared to that of the general population (5 to 15 %). Jamison could have wondered why this is so. One explanation may be that college students are readier to confess having had suicidal thoughts than the general population - since the latter are more subjected to norms which regard suicide as taboo subject. Another, common-sense explanation is that college students are better educated, smarter and more critical about received opinions, and cultural norms. A refined interpretation of Jamison's statistics should have included such explanations.

Famous Suicides

Jamison presents several accounts of "famous suicides", but she often does so dishonestly, only using the evidence which supports her theories.

Seneca is quoted without attention being paid to the fact that he was a champion of the right to commit suicide. Of suicide as a choice, and not an illness.

Jamison quotes from the letters sent by Virginia Woolf shortly before her death, where she "blamed her madness for her death" (p. 84). Virginia Woolf is portrayed as a feeble and incapacitated person. The author omits, however, Virginia Woolf's rational exploration of suicide: Woolf recorded her views on suicide, while in good health, in the thirties, in correspondence with the composer Ethel Smyth, one of the few friends in whom she confided about her past illnesses. On 30.10.30 she wrote: "Now what are the arguments against that sense - Oh it would be better to end it? I need not say that I have no sort of intention of taking any steps: I simply want to know.....what are the arguments against it?"

The Grief of Survivors

Jamison frequently notes that suicide causes suffering for those left behind. However Jamison acknowledges that suicide might bring peace to the one who contemplates it. She even quotes an Anglican prayer book that mentions the suicidal desire as striving for the "peace of mind the world cannot give".

Any rational person should ask why a thing that brings peace to one should be so dreadful for the others?

To ease the pain of survivors, Jamison suggests that ultimately, the suicide made his or her choice. This reduces the responsibility of the family, and puts more responsibility and the person who committed suicide. However, note that this contradicts other parts of the book which view suicide as an event, and not a choice.

Implicitly, Jamison acknowledges that the way we interpret a suicide has an impact on how we feel about it. The interpretations which are promoted by psychology are harmful for survivors, and cause much grief.

Conclusion

A person who has both personal and professional knowledge about suicide is definitely of interest. But what authority does such a person have relative to a non-suicidal psychologist?

We can refer to similar cases, where homosexual counselors have undergone treatment to "convert" to heterosexuality. Such incidents have occurred even after being homosexual was removed from the list of mental illnesses. Gay psychologists willingly participated in such treatments, which were generally unsuccessful and even harmful.

Jeffry G. Ford, a Licensed Psychologist, grew up as a Christian. His first attempts to rid homosexual thoughts involved psychotherapy, electric shock therapy, belief in god, and exorcism. He joined the ex-gay movement, and began preaching and helping others convert to heterosexuality. For almost 10 years Jeff claimed to be a "former homosexual", but in 1985, Jeff embraced a homosexual identity, and now claims that converting sexual preference is a pseudo science [1].

What we can learn from Jeff's case is that cultural norms and values take precedence over psychological inquiry. Religious teachings, and peer and family pressure kept Jeff in-line with strict Christian norms. The reason Jeff finally accepted being gay is that by 1985, being gay had been de-stigmatized in wide circles of the population. Political activism was the cause of this change.

The norms against suicide are just as strong as past norms against homosexuality. We are at a stage where the political struggle for the right to die is at its infancy: currently only focusing on the terminally ill. Jamison's focus on suicide prevention is not so much indicative of deep psychological insight, but rather of the degree to which the arbitrary norms against suicide are still entrenched in current society.

[1] Jeffry G. Ford, "Reparative Therapy: A Psuedo Science", http://jgford.homestead.com/