Violence is an expression of aggression.
Kay Redfield Jamison, Ph. Few readers may realize how heavy a Essay of women violence is taken by suicide during the years of high school, college, and young adulthood.
When the person who dies is young, the devastation is even more profound. The public, however—including most parents— remains disturbingly unaware of the prevalence of suicide among young people.
This is in part because, until recently, there was virtually no public health policy on the subject; in part because society is reluctant to discuss both suicide and the mental illnesses most directly responsible for it; and in part because there is a pervasive belief that suicide is highly idiosyncratic in nature and therefore neither predictable nor preventable.
Unlike oncologists and cardiologists, who know that certain types of tumors or heart disease radically increase the likelihood of death, psychiatrists and psychologists tend not to think of mortality rates in the context of psychiatric illnesses.
In fact, we know a great deal. In the United States, suicide is the third major cause of death in toyear-olds and the second leading cause of death in college-age students.
Inmore teenagers and young adults died from suicide than from cancer, heart disease, AIDS, stroke, and lung disease combined. Suicide kills the young dreadfully and disproportionately. And, across the world, in those between the ages of 15 and 44, suicide is the second leading killer of women and the fourth of men.
Nearly one million people die by suicide each year, 30, of them in the United States. Nearly one high school student in ten admits to having actually attempted it. Each year in the United States, more thansuicide attempts are made that are serious enough to warrant medical attention in an emergency room.
We understand—up to a point—the mental states of those who kill themselves: We have compelling evidence from a large number of studies that the single most important factor in suicide is psychopathology: More than 90 percent of all people who kill themselves suffered from a major psychiatric or addictive illness depression, manic-depression, schizophrenia, or alcohol and drug abusea severe anxiety disorder, or borderline or antisocial personality disorder.
Those who are victims of both depression and alcohol or drug abuse are especially at risk. Most people who were depressed will not kill themselves. But of those who do, the majority were profoundly depressed. I could kill a woman, or wound a man. I think I could.
I gritted to control my hands, but had a flash of bloody stars in my head as I stared that sassy girl down, and a blood-longing to rush at her and tear her to bloody beating bits.
We know that neurotransmitters such as serotonin, norepinephrine, and dopamine are deeply enmeshed in the volatility, impetuousness, and violence that go along with the moody and explosive temperaments most closely associated with self-murder.
Violence is, unquestionably, an integral part of many suicides. Poet Sylvia Plath, who was treated for depression and later killed herself, described a terrible violence within her: We are fortunate today to have effective ways to treat the psychiatric illnesses most commonly associated with suicide: Of all these, lithium is the most persuasively tied to the actual prevention of suicide.
But not everyone will respond to lithium, and not everyone who needs it will take it as prescribed. Other medications—such as the antipsychotic clozapine, and the antidepressants—can also help prevent suicidal behavior.
Most of these medications have troublesome side effects, but the research literature is consistent in showing that patients at high risk for suicide are in great danger if undertreated—as many still are.
We are also fortunate to have a surgeon general, Dr. David Satcher, who is both knowledgeable about suicide and forcefully involved in doing something about it. At last suicide is being recognized as a public health issue. We know many things about suicide, but not enough.
What we do know is not being communicated as well as it should. We need to generate far more public awareness of how prevalent a killer suicide really is and of the symptoms of and treatments for depression and the other psychiatric disorders implicated in suicide.
Families, schools, churches and synagogues, teachers and university administrators all need to learn more and do more. We require a society with its eyes open to this preventable tragedy, a society that does not tolerate the intolerable. And his mother hung it on the kitchen door, and read it to all his auntsViolence is an expression of aggression.
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