Night Falls Fast

by Kay Redfield Jamison

  • • •

  THE RELATION between suicide attempts and suicide is murky. There are an estimated ten to twenty-five suicide attempts for every completed suicide. And many, if not most, people who attempt to kill themselves do so more than once.

  Gender certainly plays a role in both suicide attempts and suicide. Women in the United States are two to three times more likely to attempt suicide than men. American men, on the other hand, are four times as likely actually to kill themselves. The reasons for this are complicated and will be dealt with at different points throughout this book, but part of the discrepancy may be due to differences in the rates and types of the psychiatric illnesses associated with suicide and attempted suicide. Women and girls, for example, are at least twice as likely as men to suffer from depression, which may account for some of the increase in the rate of suicide attempts. This higher rate of depression in women has been extensively documented in many studies, including the major international investigation led by Myrna Weissman. In each of the ten countries she and her colleagues studied—the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand—depressive illness was far more common in women than men. Rates for manic-depression, on the other hand, were the same for both sexes.

  Although depression is more common in women, their depressive illnesses may be less impulsive and violent than those of men; this in turn may make women less likely to use violent methods and more likely to use relatively safer means such as self-poisoning. There is also evidence that men are more likely than women to feel there is a stigma attached to a “failed” suicide attempt. Women also may remember and report the attempts they do make more accurately.

  Men, who may have a more aggressive and volatile component to their depression, are also less likely to seek medical help for psychiatric problems. They further add to their suicide risk by using alcohol and drugs and keeping firearms. (This is not a recent phenomenon, as we shall see later when discussing suicide methods in more detail. The first edition of the American Journal of Insanity, published in 1845, reported that more than two-thirds of men who committed suicide used violent and highly lethal means—firearms, throat slashing, or hanging—whereas only one-third of the women used such methods.)

  The method used in a suicide attempt clearly has a determining power in whether an individual lives or dies. China, whose citizens accounted for more than 40 percent of the world’s suicide deaths in 1990, is the only major country where a comparable number of women and men die by suicide. Although other social factors certainly play a role, the percentage of the population still living on the land and the widespread availability of highly lethal pesticides, coupled with little or no access to emergency medical care, make death from self-poisoning more likely in China than in the Western nations.

  There is a crucial overlap between those who attempt suicide and those who commit it: long-term (ten- to forty-year) follow-up studies, for example, show that of those who attempt suicide, 10 to 15 percent will eventually kill themselves. Predicting who will go on to complete suicide is one of the most difficult, frustrating, and essential clinical problems that there is. The borders between thinking, acting, and fatal action are more tenuous, uncertain, and dangerous than any of us would like to believe; this Robert Lowell captured well in his final verses from “Suicide”:

  Do I deserve credit

  for not having tried suicide—

  or am I afraid

  the exotic act

  will make me blunder,

  not knowing error

  is remedied by practice,

  as our first home-photographs,

  headless, half-headed, tilting

  extinguished by a flashbulb?

  Suicide, which kills approximately 30,000 Americans a year, takes a terrible toll across all continents. A recent World Health Organization report estimates that suicide was the cause of 1.8 percent of the world’s 54 million deaths in 1998. Suicide figures even more prominently as a cause of death in the young. The ten leading causes of death for males and females between the ages of fifteen and forty-four are shown in the graph on the opposite page. Suicide, it can be seen, is the second major killer of women in this age group and the fourth major killer of men. By any standards, suicide is a critical public health problem.

  During the past half century, rates of suicide in the young have been increasing throughout the world. The rapid rise, especially in those below the age of twenty-five, has been a major concern to clinicians, scientists, and public health officials. British researchers, for instance, surveyed the change in youth suicide rates in eighteen countries from the early 1960s to the 1970s. There were significant increases in virtually all of the countries. Researchers at the Karolinska Institute in Stockholm tracked suicide patterns over a thirty-year period, from 1952 to 1981, and found that the risk of a twenty-year-old man committing suicide before the age of twenty-five had increased by 260 percent.

  In the United States, between 1980 and 1992, the rate of suicide in children aged ten to fourteen increased by 120 percent. In 1995, more teenagers and young adults died from suicide than died from cancer, heart disease, AIDS, pneumonia, influenza, birth defects, and stroke combined. There are, as Maryland’s chief medical examiner has put it, “too many, too young.” The strong trend toward higher suicide rates at earlier ages, a trend found by many other groups of scientists, has provoked a great deal of speculation and research about why this should be so.

  Leading causes of death in females and males, worldwide, ages 15–44

  Some of the increase may be due simply to more accurate reporting of suicide; that is, coroners and medical examiners are now more correctly attributing some violent teen deaths to suicide rather than classifying them as accidents or equivocal deaths. Easier and earlier access to firearms, alcohol, and drugs almost certainly contribute to the higher rates, making those who are vulnerable to suicide yet more so. There is, as well, some suggestion that neurological damage to the fetus from nutritional deficiencies or alcohol, nicotine, or cocaine use in pregnant mothers may result in more children with the mood and behavior patterns that are associated with suicide. (American and Finnish studies published in 1999 found, for example, that mothers who smoke during pregnancy increase the chances of violence, impulsivity, and addictive disorders in their children.) Likewise, premature babies who once would have died are now surviving longer, and it is possible that their nervous systems may have been made more vulnerable as a result of their very low birth weight. Yet another possible reason for the increase in the number of suicides is that the success of psychiatric medications has allowed many individuals who have mental illness to marry and have children who would not have done so in earlier times, and this may have contributed to an increase in the kinds of psychiatric illnesses (depression, manic-depression, and schizophrenia) that carry with them an increased rate of suicide.

  One of the most commonly proposed explanations for the increasing rate of youth suicide, however, is the observation that the average age of puberty has decreased sharply over the last several decades; perhaps related to this is the fact that the age at which depression first occurs has also decreased. There is additional evidence that the actual rates of depression may have increased over time.

  Because depression and other forms of mental illness are at the heart of many suicides, it is to these disorders of terrible despair, confusion, hopelessness, and reckless impulse that we now turn.

  THIS LIFE, THIS DEATH

  A lonely impulse of delight

  Drove to this tumult in the clouds;

  I balanced all, brought all to mind,

  The years to come seemed waste of breath,

  A waste of breath the years behind

  In balance with this life, this death.

  —WILLIAM BUTLER YEATS,

  “An Irish Airman Foresees His Death”

  THERE IS a moment as you watch that your heart stops and you wish you could return t
he videotape to its owners and forget what you have seen. You know the end of the story; you know that what is done is done; and still there is a terrible sadness in it, more even than you had reckoned on. The tape is difficult to watch, impossible not to, and dreadful in its foretelling.

  The home video, no doubt like a hundred others taken that same day, scopes across the Rampart mountain range of the Colorado Rockies, which in turn sets the stage for the manmade jags and triangulars of the buildings of the U.S. Air Force Academy. Lurching, the camera continues to record landscape and people and the day’s events, settling at last on the parade ground covered with squadrons of marching cadets in their dress blue jackets, white pants, white gloves, and golden sashes. A thousand, or nearly, graduating seniors; all of them, but one, newly commissioned officers.

  The marching ends, and one by one the cadets receive their diplomas, salute, and return to their seats. Each name, a moment; each brisk salute, an exercise in pent enthusiasm. Slowly, the camera’s field becomes more focused, more personal, and a name is called out. It is clear from the crowd’s response—a roar of appreciation goes up from his classmates—that the young man is immensely popular; indeed, a fellow cadet has described him as the most respected senior at the Academy, and his squadron has given him its outstanding leadership award.

  The young man takes his diploma, raises gloved hand to hat, and salutes sharply, quickly. He smiles gloriously, graciously, contagiously, and you begin to understand the warmth and extent of his classmates’ response.

  But it is not at this moment that your heart stops, although a certain melancholy seeps in. Rather, it is later, after all the names have been called, all the salutes given and received. For the moment, the martial measures of the Air Force song pound out across the parade field and stadium, and then, suddenly, a thousand freshly minted second lieutenants snap their heads back and watch six F-16s streak overhead in tight formation, the traditional flyover tribute to the Academy’s new officers. Before the jet contrails begin to fade, total pandemonium breaks out and hundreds of white hats are flung high into the air, sailing every which way into the sky, creating a higgledypiggledy of bobbing specks of white. Cheers and embraces obliterate the remaining shreds of order.

  The home video focuses once again on the young man whose slowly spreading smile had so captivated, whose appearance had evoked such spontaneous warmth and cheers from his classmates. He, like them, had watched the jets overhead and flung his hat into the air. But this is the moment that causes your heart to stop—his face displays a subtle but chilling confusion. He seems unmoored, not quite sure of what to do next, slightly glassed off from the swirl around him. It is painful to watch because you know the end of the story, and almost unbearable because you know that this is in some way the beginning of that end.

  The young man, Drew Sopirak, did not return to the Air Force Academy the night of his graduation, nor did he receive his officer’s commission. Although he had dreamed for years of becoming a pilot and had won a highly competitive slot in flight school, he never received his pilot’s wings. That evening, instead, he left the celebrations to return to a place in which no one could have imagined him, the psychiatric ward of a nearby military hospital. There he tried to sort out the most recent hand he had been dealt. Unlike all previous hands, which had been flush with love and luck and ability, this one was a nightmare of all things lost. It was unexpected and, ultimately, unplayable.

  Success, it would seem, was not a sufficient teacher. Nor, would it seem, were remarkably caring friends and family. Drew Sopirak had all these in full measure. He was, by every account of his friends and instructors, warm, vivacious, and hugely popular with his peers; a natural leader; “drop-dead gorgeous”; and a person for whom no one was a stranger. “There was just something about him,” said one of his friends. “I don’t think anyone could quite pin it down as to why he was so wonderful—he just was.” He had been valedictorian of his Wilmington, Delaware, high school; president of both his junior and senior classes; Homecoming King; captain of his sports teams; and an engaging “Mole” in a community production of The Wind in the Willows. It was of little surprise to anyone that Drew was offered appointments to both West Point and the Air Force Academy. He had been expected to succeed, and he had.

  Drew chose the Air Force Academy, an easy decision for an eighteen-year-old with a passion for all things that fly and a dream and a determination to become a pilot. Yet within eighteen months of graduating from the Academy, Drew Sopirak somehow found his life so painful and his future so bleak that he went to a gun store, bought a .38-caliber revolver, and pulled the trigger. When it misfired, he pulled the trigger again.

  He was twenty-three years old: the way down had been long, and it had been fast.

  Minds of men fashioned a crate of thunder,

  Sent it high into the blue;

  Hands of men blasted the world asunder;

  How they lived God only knew!

  Souls of men, dreaming of skies to conquer

  Gave us wings, ever to soar!

  . . . . . . . . . . . . . .

  Keep the wings level and true.

  —“United States Air Force Song”

  The Air Force had prepared Drew for many of the things he might expect in life, but it did not, nor could it, prepare him for madness. So when his mind snapped, just a few weeks shy of graduation, he had no equivalent of his earlier survival training to see him through the splintering mania and subsequent, inevitable flameout. His mind pelted first out of bounds and then out of commission; it took along with it his dreams and his life. Manic-depressive illness proved to be an enemy out of range and beyond the usual rules of engagement.

  Drew was to mention later that he had experienced occasional problems with racing thoughts and periods of depression prior to his first manic episode. But these he had kept to himself. He was the last person any of his friends would have expected to become psychotic or to have to be confined to a psychiatric hospital. The very unexpectedness and the seeming incongruity, however, were themselves not entirely unexpected, given the nature of the illness that was to kill Drew. Manic-depressive illness usually strikes young, not uncommonly during the college years, and not uncommonly in the apparently invincible—the outgoing, the energetic, the academically successful.

  Drew’s own academic work, which had been excellent, began to decline significantly during his last months at the Air Force Academy. His roommate noted that at about the same time Drew was making statements “that did not make a lot of sense,” and his mother became increasingly concerned that he “sounded paranoid” when she talked to him on the telephone. He was, by his own report, intensely euphoric, sleeping little, and some nights sleeping not at all.

  In the midst of his sleeplessness, increasingly manic, Drew became convinced that he had the answers to many or most of the world’s problems and that he was a messenger of God. He designed a super spacecraft, based less on his background in aeronautical engineering than on his newly, and delusionally, acquired understanding of UFOs. The spacecraft, as he drew and described it, had spinning lights, a mysteriously increasing energy source, “a new kind of synergy” derived from dry-ice packs and plasma, and a strange force field that created a flow pulse that would somehow “push” the aircraft. The concepts are difficult to follow—indeed incoherent, as manic thinking tends to be—but the notes and drawing clearly had signal importance to Drew as he sketched them out late in April 1994, in his acutely grandiose and delusional state. Painfully, there is also a more personal and prophetic sentence, buried and almost lost in his frenzied notes and sketches: “You will not be happy,” Drew had written to himself. “You’ll be stressed—about something important.” There is no clue as to what the source of the stress would be.

  Early in June, while in the mountains, he heard the voice of God telling him to “purify” himself; in response to this commandment, he removed all his clothes and ran naked through the woods. Later, frightened, confused, and cover
ed with cuts and bruises, terrified that the world might be ending, he made his way to his chaplain’s house. The chaplain’s wife put a blanket around him; then, shaken and very psychotic, he was taken to the Air Force Academy Hospital. Still paranoid the next morning and agitated that Russian spies at the Academy, having heard about his superplane, were “out to get him,” he was transferred to Fitzsimons Army Medical Hospital.

  The military physicians who evaluated Drew were psychiatrically thorough, medically rigorous, and compassionate. His brain was scanned to rule out tumors or vascular disease that might cause a mania-like syndrome; his urine was checked for drugs that might cause paranoid, agitated, or manic states; consultations were obtained from both the departments of neurology and medicine. The doctors concluded that Drew had an extensive family history of manic-depressive (bipolar) illness and that he himself had a classic textbook case of the same disease. They also noted in his medical record that he had many friends, was a very good student, and had been an excellent cadet. “His past history,” wrote one of his doctors, “is significant for excelling in any activity that he became involved in.”

  Drew was started on lithium and within two or three days was decidedly better. By the ninth day of his hospitalization he no longer was delusional, although at one point he became frightened that the hospital might try to do surgery on him to “remove important information from his head.” He was able to attend the graduation ceremonies at the academy but within a few days’ time had to be air-evacuated for continued treatment at Andrews Air Force Base, near Washington, D.C.