Jamison: greater public awareness of suicide needed

By Nancy Hurrelbrinck

Kay Redfield Jamison said she hadn't been planning to write a book on suicide, but when she was on a promotional tour for a book she'd written about manic depression, someone approached her at nearly every reading with a photo of a relative who had committed suicide.

"There's a lot of new information out about suicide, but the breach between what we know and what we do is lethal," the Johns Hopkins University professor of psychiatry told a crowd of about 400 in a March 25 talk sponsored by the Virginia Festival of the Book and the Mental Health Association.

Suicide is the second major cause of death of 15- to 19-year-olds and college students in this country, killing more people in that age group than cancer, heart disease, AIDS and strokes combined, she said.

One in 10 college students and one in five high school students state that they seriously considered committing suicide in the previous year, and one in 10 high school students had attempted it, said Jamison, who has written three books on manic-depressive illness and one on suicide.

The most important factor in suicide cases is pyschopathology -- depression, manic-depression, schizophrenia, anti-social personality disorder, anxiety, alcohol and drug abuse are involved in 90 percent of suicides, she said.

"There are effective ways to treat psychiatric illnesses associated with suicide ... but people at high risk often remain dangerously underdiagnosed," she said, adding that there's a great need for more public awareness of how prevalent a killer suicide is.

"Families, schools, churches and especially university administrators need to learn more and to do more to educate others," she said. "We need a society that doesn't tolerate the intolerable, as this society does."

Jamison, who wrote in An Unquiet Mind about her own struggle with manic-depression, read the prologue to her recent book, Night Falls Fast: Understanding Suicide. There, she described making an elaborate pact with a friend who was also manic-depressive that each would offer counsel and comfort if one became suicidal. The person in danger would check into a hospital if the other thought it was necessary. Neither would own a gun.

Two years after they'd made the pact, her friend shot himself. He hadn't called her.

Jamison said during the question-and-answer session that she had felt suicidal numerous times herself and had attempted suicide once by overdosing on lithium. When she woke up and found she was alive, she realized that if she didn't take her lithium regularly she would die.

"I haven't missed a day since then," she said, adding that many manic-depressives resist taking lithium for several reasons.

"I have researched lithium, I know how it works biochemically, yet I have stopped taking it at times," she said. "Lithium causes acne, weight gain and trembling, and it has a stigma attached to it."

Moreover, 50 percent of manic-depressives become euphoric when they're manic; it's a highly addictive state that "leaves cocaine in the dust," she said. "People love mania in the early stages, but then become psychotic in the later ones."

Answering a question about how to spot manic-depression before it becomes serious, Jamison said, "some kids look fine and suddenly get sick. For others, it starts with social withdrawal, mild depression, mood swings, violence and great irritability."

She added that parents should be on the lookout if there's a family history of psychiatric illness.

Every case of suicide isn't preventable, given that many people are volatile and do it on impulse, but, from a public health perspective, most can be prevented, she said.

"When a child commits suicide, there's a lot of guilt, [and] a lot of crisis counselors are brought into the school, but they don't create a prevention program or, what actually works better, a depression awareness program," she said.

Information about manic depression is widely available in schools, but the quality of the materials varies, she said.

"We need an excellent CD-ROM about mental illness that has information presented for children in different grade levels," she said. "It could be included in orientation packets at colleges."

Asked whether involuntary commitment should be made easier, Jamison responded with a definitive "yes."

"It has been misused, but our laws have gone so far in the other direction that it's very hard to commit someone," she said. "We need to educate judges, because a manic person can look calm and rational when he's sitting in front of a judge."

In response to a question about how to help someone who is resistant to get treatment, Jamison cited the intervention model used for alcoholics, where a group that includes family members, co-workers and friends sit down with the person and tell him they're concerned about him.

"But sometimes the level of denial can be so profound that you have to protect yourself and get on with your own life," she said.

Jamison also read the epilogue from her book, in which she notes that she has taped over her desk the closing line from "Disenchantments," a poem by Douglas Dunn: "Look to the living, love them, and hold on."