Kay Redfield Jamison is Professor of Psychiatry at the Johns
Hopkins University School of Medicine. She lives in
Washington, D.C.
1. Jamison writes, "My hope was to maintain an individual
perspective-through an emphasis on the psychology of suicide and an
extensive use of the words and experiences of those who seriously
attempted to, or eventually did, kill themselves" [p. 20]. In other
words, she attempts to write about her subject with an intimacy and
immediacy that will engage the reader, despite the painful nature
of her topic. How well does she succeed in what she sets out to do?
How does this book change your thinking about those who kill
themselves?
2. Jamison reports that the rate of suicide has
tripled among young people in the past forty years, and that
suicide is now the second leading cause of death among American
college students. What are some of the forces in our society,
according to studies Jamison cites, that might be causing this
alarming trend? What point is Jamison making about the variety of
styles and feelings expressed in suicide notes? Only one in four
people who kill themselves, she says, is likely to leave a note.
What in the state of a suicidal mind would account for this
unwillingness to communicate their intentions?
3. In his suicide note, British painter Benjamin Haydon left a
quote from Shakespeare''s King Lear: "Stretch me no longer on this
rough world" [p. 83]. If this is a feeling shared by most people
who commit suicide, doesn''t it seem entirely understandable, and
forgivable, that they should end their lives? Why then have most
societies been so insistent that suicide be considered a crime and
a grave sin, involving forfeiture of property, exclusion from
hallowed graveyards, etc.?
4. What is the cumulative effect upon you, as a
reader, of the use of statistics throughout the book? Are you
surprised, for instance, that while 30,000 Americans die from
suicide each year, 500,000 make suicide attempts? How does Jamison
bridge the gap between scientific studies and the emotion
surrounding the issue of suicide?
5. Jamison tells with care and great empathy the tragic stories
of Dawn Befano, Drew Sopirak, and Meriwether Lewis, among others.
Do these stories successfully provide a window into the tumultuous
and shattered minds of those who suffer from mood disorders? What
makes them so compelling? Do you believe that these deaths were
avoidable?
6. Jamison uses the story of the unknown woman
who climbed into the lions'' enclosure at the Washington Zoo to
point out the urgent problems of the homeless mentally ill. She
writes, "They make us uncomfortable, but not so uncomfortable that
we protect or house, insure or tend or heal them" [p. 158]. Do you
agree with Jamison that American society is irresponsible and cruel
in its policies regarding the homeless mentally ill?
7. Jamison uses the examples of the Japanese
volcano Mount Mihara, San Francisco''s Golden Gate Bridge, and
other popular sites for those who choose to end their lives, to
illustrate the odd fact that suicide sometimes has a dramatic
allure that can be contagious. Why do you suppose this is so? Do
you think that young people are especially vulnerable to a
"copycat" phenomenon in suicide?
8. How do you feel about the poem on pages 90-91, written by a
fifteen-year-old boy who killed himself two years later? Does it
seem predictive of his fate? Do you think this was a masked cry for
help?
9. The story of Washington political figure
John Wilson shows that the social stigma surrounding mental illness
is still strong enough to put an end to political hopes. Is this
bias justified? Should the public demand that those who hold public
office be free of mental instability? Or is this a lingering
prejudice that will eventually be outgrown?
10. Surgeon General David Sacher has said, "As a society, we do
not like to talk about suicide" [p. 264]. Why, in a society which
is so permissive and so open, should suicide, depression and
related forms of mental illness be hard to talk about? To what
degree does a sense of shame prevent the suicidal individual from
seeking help? Do you agree with Jamison when she argues that
educating the public about mental illness will bring about a change
in thinking, treatment, and public policy regarding suicide?
11. Until the publication of An Unquiet Mind,
Jamison had kept her own illness a secret. Had it been known, do
you think she could have had a successful career as a professor of
psychiatry, or that she would have been chosen to write an
important standard textbook on the subject of manic depression?
Would you consider the sacrifice of Jamison''s own privacy
ultimately worth the exposure, considering that she wants to save
lives? Do you think that her books will have a definite effect in
reducing the suffering of the mentally ill and the toll of suicide
in this country?
12. Jamison points out that the field of psychiatry is turning
ever more strongly towards pharmacological management and away from
psychotherapy, and that "there remains a pervasive belief in many
psychiatric and research quarters that medication by itself is
sufficient to deal with serious mental illness" [p. 252]. What is
the danger of trying to manage mood disorders solely through
medication? What does Jamison suggest is the ideal approach to the
treatment of these illnesses?
13. What do you think of psychiatrist Thomas Szasz''s views on
mental illness and suicide [pp. 253-54]? Was the court correct in
making him pay damages to the wife of a patient of his who killed
himself after Szasz instructed him to stop taking lithium? Should
someone who holds such views be made to stop practicing
medicine?
14. Jamison quotes the writer Joseph Conrad, who suffered from
major depression and survived a suicide attempt, as saying:
"Suicide, I suspect, is very often the outcome of mere mental
weariness-not an act of savage energy but the final symptom of
complete collapse" [p. 198]. Yet, as she points out, most people
are able to survive the stresses of life without "complete
collapse," and others are not. Why is this so? How important a role
does the biochemistry of the brain play in our response to life''s
troubles?
15. Josephine Pesaresi''s description [pp. 301-302] of the
response to her husband''s suicide underscores the lack of real
empathy that people often have for the survivors of people who kill
themselves. Do you think that her family''s sense of isolation was
unusual? Do the immediate survivors of a person who kills himself
or herself need a different kind of concern and care from the
people around them than, say, the survivors of a death by
cancer?
16. What does Jamison mean when she writes, in
her epilogue: "I am by temperament an optimist, and I thought from
the beginning that there was much to be written about suicide that
was strangely heartening" [p. 309]?
17. Reflecting on the emotional toll it took to
write this book, Jamison writes ruefully, "Mostly, I have been
impressed by how little value our society puts on saving the lives
of those who are in such despair as to want to end them. It is a
societal illusion that suicide is rare. It is not" [p. 310]. The
staggering fact is that "every seventeen minutes in America,
someone commits suicide" [p. 309]. Does this book leave you with a
new sense of what an urgent and tragic public health issue suicide
is? Do you come away with some ideas about what can be done to save
the lives of potential suicides?