The Noonday Demon
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252 That lithium is the drug most tested for its effects on suicidality is recorded in Kay Jamison’s Night Falls Fast, pages 239–41.
252 That the rate of suicide among bipolar patients who discontinue use of lithium rises sixteenfold is indicated in Leonardo Tondo et al., “Lithium maintenance treatment reduces risk of suicidal behavior in Bipolar Disorder patients,” in Lithium: Biochemical and Clinical Advances, edited by Vincent Gallicchio and Nicholas Birch, pages 161–71.
252 That patients treated with ECT have lower suicide rates than those treated with medications is outlined in Jerome Motto’s essay “Clinical Considerations of Biological Correlates of Suicide,” in The Biology of Suicide, edited by Ronald Maris.
252 Freud’s formulation of suicide as a murderous impulse toward the self is discussed in a number of his writings. In “Mourning and Melancholia,” he writes, “We have long known, it is true, that no neurotic harbors thoughts of suicide which he has not turned back on himself from murderous impulses against others.” See The Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 14, page 252.
252 Edwin Shneidman’s description of suicide as murder in the 180th degree is reproduced in George Colt’s The Enigma of Suicide, page 196.
252 Freud’s formulation of the death instinct is described in Robert Litman’s essay “Sigmund Freud on Suicide,” in Essays in Self-Destruction, Edwin Shneidman, editor, page 336.
252 Karl Menninger’s formulation is cited in George Colt’s The Enigma of Suicide, page 201.
252 Chesterton’s lines are in Glen Evans amd Norman L. Farberow’s The Encyclopedia of Suicide, page ii.
252 The effects of chronic stress in depleting neurotransmitters have been researched by many people. An excellent summary of these ideas is provided by Kay Jamison’s Night Falls Fast, pages 192–93. For more information on the brain’s response to stress, see Robert Sapolsky et al., “Hippocampal damage associated with prolonged glucocorticoid exposure in primates,” Journal of Neuroscience 10, no. 9 (1990).
253 The work on suicidality and cholesterol is summarized nicely in Kay Jamison’s Night Falls Fast, pages 194–95.
253 The work on low levels of serotonin, high numbers of serotonin receptors, inhibition, and suicidality is summarized by John Mann, one of the pioneers in the area, in his “The Neurobiology of Suicide,” Lifesavers 10, no. 4 (1998). Hermann van Praag’s essay “Affective Disorders and Aggression Disorders: Evidence for a Common Biological Mechanism,” in The Biology of Suicide, edited by Ronald Maris, is also an excellent review of the findings to date. For further reading, see Alec Roy’s “Possible Biologic Determinants of Suicide,” in Current Concepts of Suicide, edited by David Lester.
253 The information regarding low levels of serotonin in murderers and arsonists may be found in M. Virkkunen et al., “Personality Profiles and State Aggressiveness in Finnish Alcoholics, Violent Offenders, Fire Setters, and Healthy Volunteers,” Archives of General Psychiatry 51 (1994).
253 There are countless studies of the relationship between low serotonin and animal risk-taking. One particularly strong essay is P. T. Mehlman et al., “Low CSF 5-HIAA Concentrations and Severe Aggression and Impaired Impulse Control in Nonhuman Primates,” American Journal of Psychiatry 151 (1994). I have also drawn material from a number of articles published in the Across Species Comparison and Psychopathology ASCAP newsletters.
253 Levels of norepinephrine and noradrenaline in postsuicide brains have been studied by many researchers. Kay Jamison provides an excellent summary in Night Falls Fast, pages 192–93.
253 For more on low levels of essential neurotransmitters, see John Mann, “The Neurobiology of Suicide,” Lifesavers 10, no. 4 (1998).
253 For an excellent report on Marie Åsberg’s findings, see her “Neurotransmitters and Suicidal Behavior: The Evidence from Cerebrospinal Fluid Studies,” Annals of the New York Academy of Sciences 836 (1997).
254 The work on tryptophan hydroxylase is in D. Nielsen et al., “Suicidality and 5-Hydroxindoleacetic Acid Concentration Associated with Tryptophan Hydroxylase Polymorphism,” Archives of General Psychiatry 51 (1994).
254 Monkeys brought up without mothers have been studied by Gary Kraemer. I have looked specifically at his study “The Behavioral Neurobiology of Self-Injurious Behavior in Rhesus Monkeys: Current Concepts and Relations to Impulsive Behavior in Humans,” Annals of the New York Academy of Sciences 836, no. 363 (1997), presented at the NIMH’s Suicide Research Workshop, November 14–15, 1996.
254 Work on early abuse and lowered serotonin is in Joan Kaufman et al., “Serotonergic Functioning in Depressed Abused Children: Clinical and Familial Correlates,” Biological Psychiatry 44, no. 10 (1998).
254 For more on the link between fetal neurological damage and suicidality, see Kay Jamison’s Night Falls Fast, page 183.
254 Comparative male-to-female serotonin levels are described in Simeon Margolis and Karen L. Swartz, “Sex Differences in Brain Serotonin Production,” The Johns Hopkins White Papers: Depression and Anxiety, 1998, page 14. For in-depth information regarding gender and brain monoamine systems, see Uriel Halbreich and Lucille Lumley, “The multiple interactional biological processes that might lead to depression and gender differences in its appearance,” Journal of Affective Disorders 29, no. 2–3 (1993).
254 The quotation from Kay Jamison is from her book Night Falls Fast, page 184.
254 The link between availability of guns and suicide is published in a variety of studies. I have specifically looked at M. Boor et al., “Suicide Rates, Handgun Control Laws, and Sociodemographic Variables,” Psychological Reports 66 (1990).
254 The information on gas-related suicide in England is in George Colt’s The Enigma of Suicide, page 335.
255 That more Americans kill themselves with guns than are murdered with them every year is in Kay Jamison’s Night Falls Fast, page 284. The suicide rates for states according to strictness of gun control laws, as well as the quotation by David Oppenheim, are from George Colt’s The Enigma of Suicide, page 336.
255 The statistic for the number of Americans who kill themselves every year with guns was taken from the Centers for Disease Control. An on-line journal offered the following total, the source of which I could not find on the CDC’s Web site: “Figures released on November 18 by the CDC show that the number of suicides using firearms [was] 17,767 in 1997.” See www.stats.org/statswork/gunsuicide.htm. A rough estimate can also be calculated using information readily available on the CDC’s Web site. Of the 30,535 people who committed suicide in 1997, the CDC estimates that “nearly 3 out of every 5” of these suicides was committed with a firearm. Calculations using this formula find the total number of firearm suicides to be 18,321. I have chosen 18,000 as an approximate average of these two figures. See the CDC’s Web site at www.cdc.gov/ncipc/factsheets/suifacts.htm.
255 The information on modes of suicide in China is in Kay Jamison’s Night Falls Fast, page 140.
255 The information on modes of suicide in Punjab is in Ibid., 137.
255 For the rates of suicide among artists, scientists, businessmen, poets, and composers, see ibid., 181.
255 The rate of suicide among alcoholics is taken from George Colt’s The Enigma of Suicide, page 266.
255 Karl Menninger’s quotation is from Man Against Himself, page 184.
257 The experiments on rats crowded together have been carried out by Juan López, Delia Vásquez, Derek Chalmers, and Stanley Watson and were presented at the NIMH’s Suicide Research Workshop, November 14–15, 1996.
257 The work on rhesus monkeys reared without mothers has been carried out by Gary Kraemer. I have specifically looked at his study “The Behavioral Neurobiology of Self-Injurious Behavior in Rhesus Monkeys,” presented at the NIMH’s Suicide Research Workshop, November 14–15, 1996.
257 The story of the suicidal octopus I take from Marie Åsberg.
257 The work on suicide and trauma of early parental death comes from L. Moss and
D. Hamilton, “The Psychotherapy of the Suicidal Patient,” American Journal of Psychiatry 122 (1956).
257 The numbers on suicide attempts and those showing suicide to be the third leading killer among people fifteen to twenty-four in the United States are taken from D. L. Hoyert et al., “Deaths: Final data for 1997. National Vital Statistics Report,” published for the National Center for Health Statistics. It is available on the Web at www.cdc.gov/ncipc/osp/states/10lc97.htm. Attempted suicide was estimated by using the NIMH’s statistic that “there are an estimated eight to twenty-five attempted suicides to one completion.” The figure of eighty thousand attempts is therefore, unfortunately, a modest estimate. The NIMH report may be found at www.nimh.nih.gov/publicat/harmaway.cfm.
257 The catalog of reasons for increased suicidality is taken from George Colt’s The Enigma of Suicide, page 49.
258 The work on high-achieving adolescents and suicide is presented in Herbert Hendin’s Suicide in America, page 55.
258 The notion that a protected view of death may lead to some young suicides is discussed in Philip Patros and Tonia Shamoo’s Depression and Suicide in Children and Adolescents, page 41.
258 For information about suicide rates among men over sixty-five, see Diego de Leo and René F. W. Diekstra’s Depression and Suicide in Late Life, page 188.
258 The notion that the elderly use particularly lethal technologies for suicide and are particularly secretive about it is from Ibid.
259 Higher suicide rates among divorced or widowed men are discussed in Ibid.
259 On the development of motor problems, hypochondria, and paranoia among the elderly as a consequence of depression, see Ibid., 24.
259 On the elderly depressed and somaticization, see Laura Musetti et al., “Depression Before and After Age 65: A Reexamination,” British Journal of Psychiatry 155 (1989): 330.
259 The comparative international suicide rates, which place Hungary at the top of the list with a suicide rate of 40 per 100,000 and Jamaica at the bottom with a rate of 0.4 per 100,000 can be found in Eric Marcus’s Why Suicide? pages 25–26.
259 Kay Jamison’s catalog of suicide techniques is in her book Night Falls Fast, pages 133–34.
263 The WHO position on suicide as a “suicidal act with a fatal outcome” is detailed in their report, Prevention of Suicide.
263 Kay Jamison’s quotation is in Night Falls Fast, page 39.
263 A. Alvarez’s quotation is in The Savage God, page 89.
263 Albert Camus’s quotation is in The Myth of Sisyphus and Other Essays, page 5.
263 Julia Kristeva’s quotation is in Black Sun, page 4.
263 Edwin Shneidman’s formulation of the five causes of suicide is taken from his book The Suicidal Mind. The direct quotation is from pages 58–59.
264 The Kay Jamison quotation occurs in Night Falls Fast, page 74.
265 On Kay Jamison’s description of her state of mind during her own suicide attempt, see Ibid., 291. She has also published a memoir of her battles with manic-depressive illness, entitled An Unquiet Mind.
265 The suicide note is taken from Kay Jamison’s Night Falls Fast, page 292.
266 The quotation from Edna St. Vincent Millay is from her “Sonnet in Dialectic,” in Collected Sonnets, page 159.
268 I have written about my mother’s death at some length in the past. I described it in a New Yorker story on euthanasia, and it was the basis for the eleventh chapter of my novel, A Stone Boat. I have chosen to write about it for what I hope will be the last time because it is part of my story as it exists in this book. I beg the indulgence of readers familiar with my earlier work.
268 The quotation from Fyodor Dostoyevsky’s The Possessed is on page 96.
269 The British court finding on the diabetic anorexic was brought up in an oral interview with Dr. Deborah Christie, who worked on the case. See Deborah Christie and Russell Viner, “Eating disorders and self-harm in adolescent diabetes,” Journal of Adolescent Health 27 (2000).
270 The quotation from Alfred Lord Tennyson’s “Tithonus” is lines 66–71, in Tennyson’s Poetry, page 72.
270 The lines from Eliot are in the epigraph to his poem “The Waste Land.” The Complete Poems and Plays presents the Latin: “Nam Sibyllam quidem Cumis ego ipse oculis meis vidi in ampulla pendere, et cum illi pueri dicerent: Σíβμλλα τí θέλɛιS; respondebat illa: απoθανɛιν θέλω,” page 37.
271 This poem by Emily Dickinson is in The Complete Poems of Emily Dickinson, page 262.
273 The quotation from E. M. Cioran is in his A Short History of Decay, page 36.
273 Virginia Woolf’s suicide note is quoted from The Letters of Virginia Woolf, vol. 6, pages 486–87.
274 The quotations from Virginia Woolf’s diaries come from The Diary of Virginia Woolf, pages 110–11.
278 Ronald Dworkin’s remarks are in Life’s Dominion, page 93.
278 The quotation from Rilke is from “Requiem for a Friend,” in The Selected Poetry of Rainer Maria Rilke, page 85.
280 The quotation from A. Alvarez is from The Savage God, page 75.
281 The quotation from Nadezhda Mandelstam is in Ibid., 151–52.
281 The quotation from Primo Levi is from the U.S. edition of The Drowned and the Saved, pages 70–71.
282 That medications may have been to blame for the suicide of Primo Levi is suggested in Peter Bailey’s introduction to the British edition of The Drowned and the Saved.
283 Nietzsche writes in Beyond Good and Evil, maxim 157, page 103: “The thought of suicide is a powerful solace: by means of it one gets through many a bad night.”
CHAPTER VIII: HISTORY
285 Though I was not able to find any secondary source that plumbed the history of depression in a fully convincing way, I wish to acknowledge my considerable debt to Stanley Jackson’s Melancholia and Depression.
285 Etymology of the word depression is from The Oxford English Dictionary, vol. 3, page 220.
285 The Beckett quotation is from Waiting for Godot. I have taken it from The Complete Dramatic Works of Samuel Beckett, page 31.
286 For a general description of humoral theory as it existed among the Greeks, including the views of Empedocles on melancholy, see Stanley Jackson’s Melancholia and Depression, pages 7–12.
286 The quotations from the Hippocratic Corpus, which, for the sake of simplicity, I have referenced as from Hippocrates, may be found in Hippocrates, W. H. S. Jones and E. T. Withington, trans. and eds., book 2, page 175. The information on his cure of King Perdiccas II is in Giuseppe Roccatagliata’s rigorous A History of Ancient Psychiatry, page 164.
287 The suggestion that chole was conflated with cholos comes from Bennett Simon’s Mind and Madness in Ancient Greece, page 235.
287 The use of black moods in Homer is from Ibid.
287 The quotation of Homer from The Iliad is in book 6, lines 236–40, page 202.
287 Hippocrates’ attacks on the practitioners of sacred medicine is in Giuseppe Roccatagliata’s A History of Ancient Psychiatry, page 162. That “all that philosophers have written on natural science no more pertains to medicine than to painting” is quoted in Iago Galdston’s Historic Derivations of Modern Psychiatry, page 12.
287 Socrates’ and Plato’s opposition to Hippocrates, as well as Plato’s model of the human psyche, are described in Bennett Simon’s Mind and Madness in Ancient Greece, pages 224–27. A good comparison between Plato’s and Freud’s ideas exists in Iago Galdston’s Historic Derivations of Modern Psychiatry, pages 14–16. Plato’s ideas concerning the importance of childhood and family in the development of the child are discussed in Simon’s Mind and Madness in Ancient Greece, pages 171–72.