225 Work on decreased oxygenation of the blood of smokers is reviewed in Marc Galanter and Herbert Kleber’s Textbook of Substance Abuse Treatment, page 216.
225 Work on smoking and serotonin may be found in David Gilbert’s Smoking, pages 49–59.
226 For a fuller account of my life with Russian artists, see The Irony Tower: Soviet Artists in a Time of Glasnost.
227 That the rationale behind alcohol taxes in Scandinavia includes the benefits of reduced suicide was discussed with Håkan Leifman and Mats Ramstedt of the Swedish Institute of Social Research on Alcohol and Drugs (SoRAD). Statistical information is provided in a study to be published in a forthcoming supplement of Addiction entitled “Alcohol and Suicide in 14 European Countries,” by Mats Ramstedt. For more information on the relationship between alcohol consumption and suicide, see George Murphy, Suicide in Alcoholism, and I. Rossow, “Alcohol and suicide—beyond the link at the individual level,” Addiction 91 (1996).
228 On serious alcoholism and cognitive impairment, see David McDowell and Henry Spitz’s Substance Abuse, pages 45–46.
228 For alcohol’s toxic effects on the liver, the stomach, and the immune system, see Ibid., 46–47.
228 That the mortality rate is higher among alcoholics than among nonalcoholics is stated in Donald Goodwin’s Alcoholism, the Facts, page 52.
228 The statistic that 90 percent of Americans have had alcohol and the figures on physiological addiction to alcohol in the United States are from David McDowell and Henry Spitz’s Substance Abuse, pages 41–42.
228 The role of serotonin and cortisol in resisting alcohol consumption is discussed in Marc Galanter and Herbert Kleber’s Textbook of Substance Abuse Treatment, pages 6–7 and 130–31.
228 Information on the GABA receptors I take from personal correspondence with Steven Hyman and David McDowell. For an in-depth discussion on alcohol, GABA, and other brain neurotransmitters, see Marc Galanter and Herbert Kleber’s Textbook of Substance Abuse Treatment, pages 3–8. Work on serotonin’s reinforcing alcohol consumption is in R. J. M. Niesink et al.’s Drugs of Abuse and Addiction, pages 134–37.
228 The superiority of psychodynamic therapies for dual-diagnosis patients seems more a clinical reality than a well-studied fact. Most of the clinicians I’ve spoken with have espoused a belief that for real recovery a dual-diagnosis patient must understand how the abuse affects the depression and vice versa. Marc Galanter and Herbert Kleber write in their Textbook of Substance Abuse Treatment that for “patients for whom affect regulation is an issue, psychodynamic psychotherapy may be especially valuable.” Page 312.
228 The Columbia practice is in the S.T.A.R.S. (Substance Treatment and Research Service) Program.
229 A great deal has been published on Antabuse. For a detailed description of its mode of action, see David McDowell and Henry Spitz’s Substance Abuse, pages 217–19.
229 On use of Naltrexone for withdrawal from alcohol and heroin, see Ibid., 48–51.
229 For information on the history of marijuana, see Ibid., 68.
230 Marijuana’s lung toxicity is discussed in Marc Galanter and Herbert Kleber’s Textbook of Substance Abuse Treatment, pages172–73.
230 The work on depression in the families of stimulant abusers is from Mark Gold and Andrew Slaby’s Dual Diagnosis in Substance Abuse, page 18.
230 The percentage of cocaine users who become addicted is in David McDowell and Henry Spitz’s Substance Abuse, page 93.
230 Work on lab rats choosing stimulants over food and sex is in R. A. Yokel et al., “Amphetamine-type reinforcement by dopaminergic agonists in the rat,” Psychopharmacology 58 (1978). There have also been numerous studies involving rhesus monkeys, with the same results. See, for example, T. G. Aigner et al, “Choice behavior in rhesus monkeys: Cocaine versus food,” Science 201 (1978).
230 The neurophysiology of the cocaine crash is expounded in Mark Gold and Andrew Slaby’s Dual Diagnosis in Substance Abuse, pages 109–10.
230 The general effects of amphetamines and cocaine on the neurotransmitters are described in R. J. M. Niesink et al.’s Drugs of Abuse and Addiction, pages 159–165.
230 That acute craving can last for decades is indicated in Mark Gold and Andrew Slaby’s Dual Diagnosis in Substance Abuse, page 110.
230 The use of a ten-week course of antidepressants to endure the drug crash is described in Bruce Rounsaville et al., “Psychiatric Diagnoses of Treatment-Seeking Cocaine Abusers,” Archives of General Psychiatry 48 (1991).
231 The permanent effect of amphetamines and cocaine on the dopamine system is described in Mark Gold and Andrew Slaby’s Dual Diagnosis in Substance Abuse, page 110. They write, “Animal studies have documented occasional dopaminergic neuronal degeneration with chronic stimulant administration.”
231 The work on cocaine and CRF is in Thomas Kosten et al., “Depression and Stimulant Dependence,” Journal of Nervous and Mental Disease 186, no. 12 (1998).
231 The figures on depression among opiate abusers comes from Ghadirian and Lehmann’s Environment and Psychopathology, pages 110–11.
232 The high rate of depression among people on methadone is described in Mark Gold and Andrew Slaby’s Dual Diagnosis in Substance Abuse, page 110.
232 The statistics on Vietnam veterans and heroin addiction are in Craig Lambert, “Deep Cravings,” Harvard Magazine 102, no. 4 (2000): 67.
233 The work on ecstasy and serotonin axons is summarized in R. J. M. Niesink et al., Drugs of Abuse and Addiction, pages 164–65. That ecstasy reduces serotonin levels 30 to 35 percent may be found in U. McCann et al., “Serotonin Neurotoxicity after 3,4-Methylenedioxymethamphetamine: A Controlled Study in Humans,” Neuropsychopharmacology 10 (1994). For more on ecstasy and the monoamines, see S. R. White et al., “The Effects of Methylenedioxymethamphetamine on Monoaminergic Neurotransmission in the Central Nervous System,” Progress in Neurobiology 49 (1996). For a lively and varied discussion of ecstasy and neurotoxicity, see J. J. D. Turner and A. C. Parrott, “ ‘Is MDMA a Human Neurotoxin?’: Diverse Views from the Discussants,” Neuropsychobiology 42 (2000).
234 For my discussion of the benzodiazepines, I have relied on the work of Dr. Richard A. Friedman of Cornell, and in particular on oral interviews conducted with him in the spring of 2000.
234 The dangers of excessive benzos are discussed in Mark Gold and Andrew Slaby’s Dual Diagnosis in Substance Abuse, pages 20–21.
234 For a fuller description of roofies, see David McDowell and Henry Spitz’s Substance Abuse, pages 65–66.
235 The origins of heroin with Bayer are discussed in Craig Lambert, “Deep Cravings,” Harvard Magazine 102, no. 4 (2000): 60.
235 David McDowell and Henry Spitz’s Substance Abuse provides a short history of ecstasy, pages 59–60.
235 Michael Pollan’s piece appeared under the title “A Very Fine Line,” New York Times Magazine, September 12, 1999.
238 Keith Richards’s remark was discovered in Dave Hickey’s brilliant book Air Guitar, before the title page. I thank the very hip Stephen Bitterolf for sharing it with me.
CHAPTER VII: SUICIDE
243 The idea that there is often no clear causal link between depression and suicidality is taken from a number of authors intimate with both phenomena. As George Colt writes on page 43 in The Enigma of Suicide, suicide is no longer thought of as “depression’s last stop.”
243 The quotation from George Colt is from Ibid., 312.
243 That over 40 percent of the people in the general public who committed suicide had had psychiatric in-patient care is taken from Jane Pirkis and Philip Burgess, “Suicide and recency of health care contacts: A systematic review,” British Journal of Psychiatry 173 (1998): 463.
244 A. Alvarez’s remark on attempts at exorcism is from his The Savage God, page 96. His words about suicide and ambition appear on page 75.
245 These famous lines from Hamlet are in act 3, scene 1, lines 79–80; the second quotation is from act 3, scene 1, lines 83–85. There
is of course no single and clear interpretation for this speech from Hamlet. I would point readers toward C. S. Lewis’s Studies in Words, for example, which devotes a whole chapter to the relationship between “conscience” and “conscious.” I would also emphasize the brilliantly lucid interpretation provided by Harold Bloom in Shakespeare: The Invention of the Human.
245 Albert Camus’s notion that suicide is the one philosophical problem is in The Myth of Sisyphus and Other Essays, page 3.
245 Schopenhauer’s remarks are from his essay “On Suicide” in The Works of Schopenhauer, page 437.
246 Santayana’s statement comes from Glen Evans’s The Encyclopedia of Suicide, page ii.
246 Freud’s remark on having no way to approach suicide is taken from a speech he gave at a gathering of the Vienna Psychoanalytical Society on the subject of suicide, April 20 and 27, 1910. I have taken it as quoted in Litman’s essay “Sigmund Freud on Suicide,” in Essays in Self-Destruction, edited by Edwin Shneidman, page 330.
246 Albert Camus speaks of the illogic of postponing death in The Myth of Sisyphus and Other Essays, page 3.
247 Pliny’s quotation is taken from The Works of Schopenhauer, page 433.
247 These lines are to be found in John Donne’s Biathanatos, page 39.
247 The quotation from Schopenhauer is in the book Essays and Aphorisms, page 78.
247 The quotations from Thomas Szasz come from his book The Second Sin, page 67.
247 The Harvard study is described in Herbert Hendin’s Suicide in America, page 216.
248 Edwin Shneidman’s quotation about the split is from his book The Suicidal Mind, pages 58–59.
248 Edwin Shneidman’s statement about the right to belch is quoted from George Colt’s The Enigma of Suicide, page 341.
248 The assertion that someone commits suicide every seventeen minutes was calculated using statistics for total number of suicides per year, provided by the NIMH (31,000 for year 1996). The calculation: 524,160 minutes per year divided by 31,000 suicides per year equals one suicide every 16.9 minutes.
248 That suicide ranks number three among causes of death for young people is taken from NIMH Suicide Facts Web sites (statistics are for year 1996). That suicide ranks number two among college students is taken from Kay Jamison’s Night Falls Fast, page 21. The comparative statistics on suicide and AIDS and the figure for suicide-attempt-related hospitalizations are both taken from Kay Jamison’s Night Falls Fast, pages 23 and 24 respectively.
248 The World Health Organization (WHO) statistic on suicide comes from The World Health Report, 1999. The study that found suicide to have increased 260 percent within a geographic area is U. Åsgård et al., “Birth Cohort Analysis of Changing Suicide Risk by Sex and Age in Sweden 1952 to 1981,” Acta Psychiatrica Scandinavica 76 (1987).
248 The statistics on suicide and manic-depression, and suicide and major depression, are taken from Kay Jamison’s Night Falls Fast, page 110.
248 The connection between suicidality and first episode is in M. Oquendo et al., “Suicide: Risk Factors and Prevention in Refractory Major Depression,” Depression and Anxiety 5 (1997): 203.
248 The figures on suicide attempts and completed suicides are in George Colt’s The Enigma of Suicide, page 311.
248 The document containing the apparently conflicting statistics is Aaron Beck’s Depression. On page 57, in a survey of suicide research, Beck cites two studies that claim radically different findings. The first study’s findings “suggest that the risk of suicide in a patient hospitalized for depression is about five hundred times the national average.” The second study, presented in the next paragraph, states, “The suicide rate for depressed patients, therefore, was twenty-five times the expected rate. . . .”
249 The NIMH position that “research has shown that 90 percent of people who kill themselves have depression or another diagnosable mental or substance abuse disorder” is on their Web site at www.nimh.nih.gov/publicat/harmaway.cfm.
249 That Monday and Friday have the highest rate of suicide is reported in Eric Marcus’s Why Suicide? page 23.
249 The rate of suicide by hour of the day is in M. Gallerani et al., “The Time for suicide,” Psychological Medicine 26 (1996).
249 The increase of suicide during spring is reported in David Lester’s Making Sense of Suicide, page 153.
249 That women have a higher rate of suicide during the first week (menstrual phase) of their menstrual cycle is discussed in Richard Wetzel and James McClure Jr., “Suicide and the Menstrual Cycle: A Review,” Comprehensive Psychiatry 13, no. 4 (1972). They also review studies that point to elevated rates of suicide attempts during the last week (luteal phase) of the menstrual cycle. There is, however, controversy regarding the methodological validity of many of these studies. For a critical review of the literature, see Enrique Baca-García et al., “The Relationship Between Menstrual Cycle Phases and Suicide Attempts,” Psychosomatic Medicine 62 (2000). The effect of pregnancy and childbirth on maternal suicidality is reported by E. C. Harris and Brian Barraclough, “Suicide as an Outcome for Medical Disorders,” Medicine 73 (1994).
249 Émile Durkheim’s watershed book was published in 1897 as Le Suicide. My discussion of Durkheim’s classifications is taken from Steve Taylor’s rigorous book Durkheim and the Study of Suicide.
250 The quotation from Charles Bukowski I got from a billboard on Sunset Boulevard. I have not been able to find its precise location within his work. I do not recommend driving on Sunset Boulevard during rush hour to locate this reference.
250 The quotation from Alexis de Tocqueville comes from his justly famous Democracy in America, page 296.
250 Émile Durkheim’s extemporization on the social origins of suicide is discussed in Steve Taylor’s Durkheim and the Study of Suicide, page 21.
250 The notion that adults, children, and people with psychiatric illnesses who commit suicide are at least two to three times as likely to have a family history of suicide as those who do not is compiled from over thirty studies and reported in Kay Jamison’s Night Falls Fast, page 169.
250 Paul Wender et al., “Psychiatric disorders in the biological and adoptive families of adopted individuals with affective disorder,” Archives of General Psychiatry 43 (1986), report higher rates of suicide among biological families than among adoptive families. For a review of studies on identical twins and suicide, see Alec Roy et al., “Genetics of Suicide in Depression,” Journal of Clinical Psychiatry, suppl. 2 (1999).
250 The information on suicide clusters is in Kay Jamison’s Night Falls Fast, pages 144–53 for locations, and pages 276–80 for recent epidemics.
251 The suicide epidemic following the publication of The Sorrows of Young Werther is described by Paolo Bernardini in his unpublished manuscript “Melancholia gravis: Robert Burton’s Anatomy (1621) and the Links between Suicide and Melancholy.”
251 The report that suicide rates go up when suicide stories occur in the media, and the report of a jump in suicides following the death of Marilyn Monroe, are in George Colt’s The Enigma of Suicide, pages 90–91.
251 A discussion of how suicide-prevention programs may in fact inspire suicides occurs in Kay Jamison’s Night Falls Fast, pages 273–75.
251 That suicide attempts predict suicide is reported in Rise Goldstein et al., “The Prediction of Suicide,” Archives of General Psychiatry 48 (1991). They write, “We were able to demonstrate that not only a history of prior suicide attempts but also the number of attempts is critical, as the risk of suicide increases with each subsequent suicide attempt.” Page 421.
251 The quotation from Maria Oquendo et al. is from “Inadequacy of Antidepressant Treatment for Patients with Major Depression Who Are at Risk for Suicidal Behavior,” American Journal of Psychiatry 156, no. 2 (1999): 193.
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