Review
>Excerpts

Night Falls Fast

          This is a compelling book written in poetic prose on the topic of suicide: Jamison's insights are as alive as her previous book, An Unquiet Mind. Her own stories of a struggling with manic-depression arise in the pages of this, as well as those of countless others who have been lost in madness. Her descriptions are valuable for the elegant way that they are presented, and I find them more lucid than the DSMIV. For sufferers of the disorders from schizophrenia and manic-depression to the array of personality disorders, it is deep reading. The hundreds of ways to die are discussed elegantly, and poets and artists cross the work through their suicidal urges. It is the third leading cause of death in nineteen- to twenty-four-year olds, and the second in college students. Attempts toward prevention of this phenomenon and the insufficiency of resources as modern medicine are offered as well. She studies implicitly the biololigical and psychological factors which lead to suicide and with compassion individual cases are described within the text. Jamison, a trained specialist and sufferer of manic-depression, writes with only her own depth, knowledge and compassion. Its elaborate details on the suffering of manic-depressive and schizophrenic illnesses are profound. Jamison's resources for this book are diverse. The depth of the experience of sorrow for those left behind is discussed very appropriately. Night Falls Fast is a melancholy, and often fascinating book which remains as a brave and poetic marvel.

Excerpts

For some, suicide is a sudden act. For others, it is a long-considered decision based on cumulative despair and circumstance. And for many, it is both: a brash moment of action taken during a span of settled and suicidal hopelessness. Sudden death often waits in the wings for those whose family histories or brain chemistries predispose them to impulsive suicide; they are like dry and brittle pyres, unshielded by the inevitable sparks thrown off by the living. If by temperament they are impetuous and volatile, their cast to take risk taking will become instigators of brawls; participants in and perpetuators of tumultuous affairs; gamers and gamblers; high-wire acts; and dealers in discord. They are like the Australian aborigines who, as Stephen Pyne describes them in his book World Fire, "on this, the hottest and driest of the vegetated continents. . . habitually walked around with falming firebrands that dribbled embers everywhere." They are the ones vulnerable to impulsive suicide: those who are volatile and fractious by nature, those who are subject to the Catherine wheel instability of mania or who live the tossed-and-turning lives associated with personality disorders or alchoholism.

Mania provides a violent contrast to the melancholic states. "The blood," as Austrian composer Hugo Wolf said, "becomes changed into streams of fire"; thoughts cascadea nd ideas leapfrog from topic to topic. Mood is exultant but often laced with a savage and agitated irritability. One is, said Robert Lowell, "tireless, madly sanguine, menaced and menacing." Thought is expansive, frictionless, and astonishingly quick; talk is fast and unstoppable; and the senses are acute, engaged and sharply responsive to the world about them.

The fluidity of thinking in mania is matched by the seductive, often psychotic sense of cosmic relatedness of ideas and events. (The dazzle and rush of euphoric mania make it hard for many patients to give it up.) Russian poet Velimir Khlebnikov - who was highly eccentric, wildly moody, for a time institutionalized in a mental hospital, and who was described by Mayakovsky as the 'Columbus of new poetical continents. . . one of our masters" - believed that he posessed thoughts, equations of birth and death." The artist of numbers, he was certain, could draw the universe.

With mania, there is vast, restless energy and little desire or need for sleep. Behavior is erratic, impetuous and frequently violent; drinking, sex, and the spending of money are excessive. When mania is severe, visual and auditory hallucinations, as well as delusions of grandeur and persecution, may occur. Paranoia, explosive rage, and despair not uncommonly lie beneath the expansive mania interior.

To be frightened of the world; to be walled off from it and harangued by voices; to see life as distorted faces and shapes and colors; to lose constancy and trust in one's brain: for the most pain is beyond conveying. Robert Bayley, a patient with schizophrenia, a patient with schizophrenia, put into words some of the awfulness of his day-to-day struggles:

The reality for myself is almost constant pain and torment. The voices and visions, which are so commonly experienced, intrude and so disturb my every day life. The voices are predominantly destructive, either rambling in alien tongues or screaming orders to carry out violent acts. They also persecute me by way of unwavering commentary and ridicule to deceive, derange, and force me into a world of crippling paranoia. Their commands are abrasive and all-encompassing and have resulted in periods of suicidal behavior and self-mutilation. I have run in front of speeding cars adn severed arteries while feeding this compulsion to destroy my life. As their tendency gains momentum, there is often no element of choice, which leaves me feeling both tortured and drained. I hear distorted sounds that modulate and contort from the very core of my brain. There are times when these sounds can erupt from nowhere as the voices continue to propel me into a crazed inner world.

The visions are extremely vivid, provoking fear and consternation. For example, during periods of acute bombardment, paving stones transform into demonic faces, shattering in front of my petrified eyes. When I am in contact with people, they can become grotesquely deformed, their skin peeling away to reveal decomposing inner muscles and organs.

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