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| NIGHT FALLS FAST | |
 December 15 , 1999 
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GWEN IFILL: Kay Redfield Jamieson is a Professor of Psychiatry at Johns Hopkins University School of Medicine. She has written extensively on mood disorders and manic depressive illnesses. Her newest book is "Night Falls Fast: Understanding Suicide." Dr. Jamieson, welcome. KAY JAMIESON, Author, "Night Falls Fast:" Thank you. Thank you. GWEN IFILL: You're an expert on this subject in the most awful possible way. You tried to commit suicide yourself. KAY JAMIESON: That's right. Right. And I am, therefore, a great convert to try and prevent it. I mean, the kind of anguish that goes into a suicide attempt is really hard to describe. And it's pretty terrible. GWEN IFILL: You wrote an earlier book about the subject, "An Unquiet Mind." KAY JAMIESON: Right. GWEN IFILL: And I wonder, since this draws so much on that earlier writing, which was more difficult for you to write? KAY JAMIESON: The book on suicide was much, much more difficult to write. "An Unquiet Mind" was a very personal book. It was a memoir about my own experience with manic depression, but the difficult thing was the decision to write it. It was very hard to make the decision to go public, given my profession and personal concerns. But the writing itself was not hard. In "Night Falls Fast," it was hard because I was confronted everywhere every day with suicide, with stories of suicide, with figures of suicide, the medicine of suicide, the psychology of suicide. It was very ungluing, actually. I had no idea it would be that difficult. GWEN IFILL: One of the figures that struck me the most is you wrote that once every 17 minutes someone commits suicide. How can that be? KAY JAMIESON: In the United States. GWEN IFILL: In just the United States? KAY JAMIESON: Just the United States. Because it's not an uncommon cause of death. I mean, one person in 100 in the United States will die by suicide, and almost two people in 100 will die worldwide. It's not uncommon. GWEN IFILL: A new report that's coming out from the surgeon general's office says that mental illness is the second-leading cause of premature death and disability. KAY JAMIESON: Right. GWEN IFILL: Does that square with your findings, as well? KAY JAMIESON: Very definitely. And it squares with the World Health Organization, the World Bank, and a series of studies at Harvard. GWEN IFILL: Right. Definitely. We know what predisposes someone to suicide, but we don't really know why in the end it happens. KAY JAMIESON: I think it's a hugely complicated act. I mean, we know that mental illness is almost always involved. We know that one of several psychiatric illnesses-- manic depression, depression, schizophrenia, severe anxiety disorders, some of the personality disorders-- are almost always involved. And if you compound those with alcohol or drug use, and if you have a volatile temperament and a tendency toward impulsive behavior, then you're particularly primed to suicide. Obviously, not everyone that does that will commit suicide, but the real risk factors are very severe depression and a genetic component as well. GWEN IFILL: One of the things we imagine about suicide is that it happens in the middle of the night, that people are more likely to commit suicide during the holidays. KAY JAMIESON: Right. GWEN IFILL: But those things aren't necessarily true, are they? KAY JAMIESON: No, they're not. I mean, one of the misconceptions, one of the many, many misconceptions about suicide is that it's much more common around the Christmas holidays, for example. And in fact, suicide is much more common in April, May, and summer months, and it is most in the winter months. It is lowest in the winter months. GWEN IFILL: And it's much more common at 7:00 In the morning than at... KAY JAMIESON: Yeah, in the early morning hours. Right. I mean it's a complicated... It's an elusive sort of thing. GWEN IFILL: Another startling number: One in five high school students seriously considered suicide in the year 1997. KAY JAMIESON: Right. GWEN IFILL: That's a growing number, isn't it? KAY JAMIESON: It's a growing number, and what's even more concerning is that same study, which came out of the CDC, is that one high school student in ten said that he or she had actually attempted suicide. And that's just a horrifying statistic. I mean, when you think about it, and there are more than half a million suicide attempts every year in this country that are serious enough to end up in an emergency room. GWEN IFILL: The Centers for Disease Control, when you say CDC? KAY JAMIESON: Yes, that's right. GWEN IFILL: Why? I guess... I'm not sure you even have the answer to the question, but especially among young people, which this book focuses on, why... Why are the numbers increasing? KAY JAMIESON: Well, I think there are a lot of things. One is that we know depression is increasing in younger people and hitting younger. And also, we also know that when you combine depression with alcohol use, which alcohol and drug abuse seem to also be hitting younger, puberty is hitting younger-- the actual age of puberty-- and the major mental illnesses hit younger, so that you have all sorts of risk factors kicking in to increase the rate. GWEN IFILL: When you take this apart a little bit more, you find it's more likely to be girls than boys, more likely to be Hispanics than African Americans or whites. Why is that? Is there any way of knowing? Is it a cultural influence? KAY JAMIESON: Well, there are more suicide attempts in girls and more completed suicides in men, by a ratio of almost three to four in this country. So there's a very real discrepancy between the sexes. And one of the more concerning statistics, I think from any public health point of view, is it used to be that almost all the suicides were white men. But in the last 15 years or so, 20 years, there has been a doubling of the rates of suicide in young African-American men, which is a very, very concerning statistic if you look at the rate of increase. GWEN IFILL: And where do we begin to get the brunt of it? How do we know why that's... how do you stop it if you can't figure out why it is happening? KAY JAMIESON: Well, I think we know some of the reasons why. I mean, some of it certainly is...you know, I think the abject hopelessness surrounding many people, and particularly when you don't have access to the same kind of health care. I don't think we can pretend that there's equity of health insurance for people of this country. There clearly isn't. That's true for the mentally ill in general. They don't have the same access to health care, and certainly people who are poor or minorities don't begin to have the some kind of access to good care. And we know that a lot of the violence from firearms is self- inflicted. GWEN IFILL: That was my next... 60 percent of the suicides, the weapon of choice is a gun? KAY JAMIESON: That's right, in this country. GWEN IFILL: And so what is it that this country should be doing about these things now that... if it knows those numbers? KAY JAMIESON: I think we should be doing a lot of things. I think we need to be much more proactive. I think the Surgeon General has done a tremendous job by making the recommendations and making suicide a national health priority. I mean, we just haven't even talked about it in this country. We need to start talking about suicide. We need to realize that it's a public health crisis, that it's the second killer of college students. I mean, it's a very dangerous problem. We need to start educating kids not so much about suicide, but about depression. We need to educate parents. What are the symptoms of depression? How do you get people into treatment? The school systems should be become more aware, the churches should become more aware that these are preventable illnesses, I mean, treatable illnesses, that we've got really good treatments out there for depression and manic depression, schizophrenia, and it's a matter of getting people into treatment and being aware. GWEN IFILL: So if someone close to you, your child, your friend, your lover, your spouse, you feel that they are considering suicide or are in some way suicidal, what do you do? KAY JAMIESON: First of all, be direct. Ask them, tell them why you're concerned, what it is that makes you feel like you're concerned about why they might be thinking about suicide. If it's an acute situation, take away anything that could be dangerous like a gun, or a knife, or medications. If necessary, walk the person to an emergency room. Sit with them, talk to them and try to line up care. If there's a question of violence involved, which there not infrequently is, call 911 and get help. You don't want to be alone with them. But for sure you want to talk about it and you want to deal with it in a very direct sort of way. GWEN IFILL: And if there's a question of alcoholism or drug abuse involved? KAY JAMIESON: Same thing, you know. And often it's difficult on a one-to-one basis to talk to somebody, but sometimes it works a little bit better to sit down with a friend or a colleague or somebody from work and a family member as a group and say, "look, we're concerned. We really love you, we really care about you, and we've got a list of people we hope you'll go see," and make those provisions. And if you're a parent and your kid's going off to college, for heaven sakes, sit down and talk about it. What are the illnesses that are likely to hit in college, you know? It's depression. You know, it's not leukemia, that's for sure. GWEN IFILL: Kay Redfield Jamieson, the author of "night falls fast: Understanding suicide," thank you very much. KAY JAMIESON: Thank you. Thanks. |
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