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		Kay Redfield Jamison Understanding & Preventing Suicide Kay Redfield Jamison, Ph.D., a professor of psychiatry at the Johns Hopkins University School of Medicine, is the
co-author of the standard medical text on manic-depressive illness (bipolar disorder) along with numerous scientific publications about mood disorders, suicide, psychotherapy, and lithium. In addition, she is the best-selling author of Touched with Fire: Manic-Depressive Illness and the Artistic Temperament; An Unquiet Mind (about her own manic-depression); and Night Falls Fast: Understanding Suicide. Read more about Kay Jamison. Kay Redfield Jamison was a live event chat guest on PlanetRx.com on November 30, 1999. This is an edited transcript of the chat.

PRx Host :	We are honored tonight to have as our chat guest Kay Redfield Jamison, Ph.D., a professor of psychiatry at Johns Hopkins School of Medicine and the author of Night Falls Fast: Understanding Suicide, referred to by The New York Times* as the most important book on suicide in the last 25 years. Welcome to PlanetRx.com, Dr. Jamison.*
Kay Jamison :	Thank you.
PRx Host :	I'd like to start by looking at the dimensions of suicide worldwide. Our surgeon general has declared suicide a crisis in this country. More than 30,000 Americans die by suicide each year. Is this true in other countries, too?
Kay Jamison :	Yes, that's right. And, worldwide, nearly one million people die each year by suicide. There's a huge public health problem around the world. In fact, in the age range of 15-44, suicide is the second killer of women worldwide, and the fourth killer of men.
PRx Host :	Your book focuses on young people who die by suicide. Is the rate [in that age group] increasing?
Kay Jamison :	The rate of suicide in young people has tripled since 1950 but has begun to level off recently. But, in the age group 10-14, there has been a dramatic increase over the last several years. Likewise, there has been a very disturbing increase in suicide among African-American men.
PRx Host :	In children so young! Do we know why?
Kay Jamison :	We know a lot of the reasons for suicide. The most consistent thing that is associated with suicide is mental illness. More than 90% of all suicides are associated with one of several psychiatric disorders, predominantly depression, manic-depression, schizophrenia, drug and alcohol abuse, and certain personality disorders.
PRx Host :	Are these illnesses genetic?
Kay Jamison :	There is a very, very strong genetic component to bipolar/manic-depressive illness, a genetic component to schizophrenia, a genetic component to alcoholism, and a genetic component to the severe recurrent depressions.
PRx Host :	We see more and more teens and young people becoming depressed. Why does this illness come in the late teens and 20s so often? What happens?
Kay Jamison :	There are many reasons for both depression and suicide occurring more often in young age groups. The severe mental illnesses have their age of onset quite young. For example, the average age of onset of manic-depression is 17 or 18 years old; for schizophrenia, it's about 19; for depression, the late 20s. The increase in depression seems to correlate with the onset of puberty, and we know that the age of puberty has been going down over the last several decades.
PRx Host :	Can depression then be predicted?
Kay Jamison :	I think, not at the moment, but certainly it can be relatively straightforwardly diagnosed.
PRx Host :	What are the major symptoms of depression? I think parents may think a child is depressed because of school or a work situation, when the depression is far more serious.
Kay Jamison :	The main symptoms of depression are: mood, thinking, sleep, energy, and behavior. When people are depressed, their mood tends to be apathetic or hopeless or irritable. They tend to lose interest in things that they ordinarily find interesting and meaningful in their lives. Their thinking becomes constricted, ruminative, indecisive, occasionally suicidal. They find it difficult to concentrate on conversations or when reading. They are often consumed with guilt and self-loathing. They very often have problems with sleep; i.e., they either sleep too much or they are unable to sleep or stay asleep. Their appetite can increase or decrease, and their weight can increase or decrease. They tend to withdraw from other people, to lose interest in people. In severe cases of depression, they can become delusional and have hallucinations. The diagnosis is made on the basis of the pattern of the symptoms, how long the symptoms have lasted, and the severity of the symptoms.
PRx Host :	Thank you. The horror of depression is apparent in your words. Would you speak to the difference between depression and manic-depression, please? And how treatable each is?
Kay Jamison :	Yes. Fortunately, depression is one of the more treatable illnesses that exists. Depression is a part of manic-depression, so that people can have depression alone, or they can have depression with episodes of mania or very mild mania. And mania is characterized by many of the symptoms that are seemingly opposite to those of depression. For example, when people are depressed, they experience lethargy, tiredness, a lack of energy. Whereas in mania, energy levels are boundless; in mania, you need far less sleep than normal. Your mood is irritable or exuberant, your thinking and speech are very rapid. Instead of withdrawing, people who are manic tend to become very involved with other people. They are very active. They are often very irritable and volatile. Manic-depressive illness tends to be recurrent, occurs more often [than depression] and there are more episodes. The suicide rate is relatively high in depression and manic-depression, and slightly higher in manic-depression. Both illnesses are quite treatable, though it may take some time to figure out the best treatment.
PRx Host :	Can a physical trauma bring on depression or manic-depression?
Kay Jamison :	Yes, it can in different ways. Some physical trauma, such as stroke, can cause symptoms of mania or depression. Particularly after some heart surgeries, some people have severe depression. There are certain medications that can bring on depression and mania. Sometimes physical traumas can have an impact on sleep patterns. Sleep loss can result in mania in people who have a vulnerability to mania.
PRx Host :	We are in the midst of the holiday season. Does this have an effect on depression and/or on suicide rates and attempts?
Kay Jamison :	Most people think that the holiday season is associated with an increased rate of suicide, but it is not. In fact, by far the highest rate of suicide occurs in the late spring and summer. And, by far the lowest rate occurs in December and January. There are seasonal mood disorders where people have more depression in the winter months, and there are certainly some people who have psychological reactions to the holidays, to being around family and unpleasant memories and so forth. But that's different from severe depressive illness and certainly different from suicide.
PRx Host :	I'd like now to turn to some questions from our audience.
nrhine :	I'd like to bring up a different slant. My daughter, who is 21, is part of a Peace Corps project on youth development in Micronesia. Yap Island, where she is stationed, has the highest youth suicide rate in the world due to the clash of Western culture with an aboriginal lifestyle. She is working hard to try and help these kids find some hope. They are depressed and part of a fatalistic culture. Suicide is how they escape their lives. Have you studied other cultures such as this, and do you have any recommendations for a 21-year-old Peace Corps worker trying to make a difference in a highly suicidal situation?
Kay Jamison :	First of all, I think it's great that she's in Micronesia and in the Peace Corps. I think it's a very complex situation in Micronesia. There is a high suicide rate among men. Some of it is cultural. We don't know their genetics or the biological side of it. In general, I think reading and learning as much as possible about the subject when dealing with depression is the best thing to do. I'm a great believer in education. Again, the evidence from the clinical and scientific literature says that the strongest relationship is still mental illness. And social and cultural factors and stress tend to interact with biological vulnerabilities to increase the chances of suicide. Because, whatever the culture or stress is, the majority of people do not commit suicide.
jola12 :	I see that children as young as 8 or 9 are being diagnosed with manic-depression. Do these diagnoses hold up?
Kay Jamison :	Some diagnoses do hold up and some do not. The question is: Can a child 8 or 9 have bipolar illness? The answer is yes. And, indeed, younger.
col858 :	Advice experts often give is to watch for certain signs in people who may be suicidal. But I know of a few cases where the person in question was so good at hiding behind a mask that their families and friends had no idea, and these were educated, aware people, I believe. How do you really know if someone is suicidal?
Kay Jamison :	I think that it can be extremely difficult to know if someone is very suicidal. And you can't always know. I think what we need to do, as a society, is to make people aware of several things so that it makes it easier for people to recognize and to talk about those feelings if they have them. I think that society needs to be more aware of the fact that suicide is common, that one person in 100 will die by suicide, that suicide is the second killer of college-aged children, and the third killer of people in general. One of the first things that we need to be aware of is how common suicide is, so that we are more aware of how often it can occur. As a society, we need to be more aware of the symptoms of depression and more compassionate towards people who have mental illness, so that people who feel so desperate and such anguish as to wish to die, feel that they can seek and receive help. One of the worst things about being suicidal is the belief that nobody can help, and that there is no hope, that there is no treatment that can help. In fact, we have good treatment. People need to be made aware from a very young age that depression is very common, that mental illness is common. If they have symptoms of depression, if they are drinking to relieve depression, it is important that they know that there is treatment that can work and help them. I think parents need to be straightforward with their children about the symptoms of depression and mania, particularly if they have depression or other mental illness in their families. They need to talk about it openly, to encourage their children to be open and to talk about it with their parents and, again, to be aware that treatment exists that can work. I think, also, that there are certain symptoms of suicidal behavior that can be problematic, particularly people who are severely depressed, who have a history of being suicidal, who are volatile, inclined to angry outbursts in addition to being depressed, who are impulsive.
PRx Host :	How should I respond to someone who tells me she is having suicidal urges?
Kay Jamison :	Listen, ask questions about how long it's been going on, the nature of the suicidal thoughts, whether there are specific plans. If the person is in treatment, take the expression seriously. If the person is acutely suicidal or you are concerned that they may be, try to not leave them alone, try and get them help, walk them to an emergency room. Remove guns from the house, remove knives, remove medications that can be used to commit suicide. If the person seems very suicidal and won't get help, call 911. Reassure the person that help is available and that treatment is possible and very likely to work.
PRx Host :	There is a new move among many suicide survivors to use the term "died by" or "died of" suicide, rather than "committed suicide." The changed language is to help decrease the stigma of suicide and its previous classification as a crime ("committed") and to reclassify it as an illness, like cancer, etc. What is your opinion of changing the language?
Kay Jamison :	I know people have strong feelings, and I think it's very understandable. It's a good point. "Commit" doesn't have just the connotation of crime; it has many connotations. But it's always important to pay attention to language. There are many ways of working on the issue of stigma; language is one important way. Law is another. Discrimination in healthcare is another. Mental health is discriminated against in terms of research. I think the single best way of getting rid of the stigma is public education and research and new treatments. But, all of these things are important, and I think it's important that people make their feelings known.
MaryVegh :	Are people with manic-depression, once diagnosed and treated, able to carry on a "normal" life? What kind of problems might arise?
Kay Jamison :	Most people who have manic-depressive illness do go on to have normal or reasonably normal lives. It is a treatable illness. It often takes quite a while for the illness to get better, to figure out the right kind of treatment. It can be frustrating and upsetting to have to wait for that. But there are many people who compete in the workplace, and in every aspect of American society at every level, who have this illness. And, unfortunately, it's not always easy to know that because the stigma of the illness makes it difficult for people to be open to expressing it.
dogbert42 :	What encouragement is there for people who have recurring symptoms and have had them for years, who are being treated, but unsuccessfully? I spend a lot of time in support groups on the Internet, and sometimes I don't know what else to say to encourage people to keep trying.
Kay Jamison :	It can be very discouraging. It does take time. I'm a great believer in getting a second opinion if you're not getting well as quickly as you think you should be. Not everyone can afford to get a second opinion, but I would encourage it if it is possible. There are excellent support groups available. The National Alliance for the Mentally Ill, which is based in Arlington, Va. (phone 800-950-6264; website www.nami.org); The National Depressive and Manic Depressive Association, which is based in Chicago, Ill. (phone 800-826-3632; website www.ndmda.org); The Depression and Related Affective Disorders Association, based at Johns Hopkins Medical School (their phone number is 410-955-4647; website www.med.jhu.edu/drada). Other organizations are listed in my book.
jenroz :	I would like your opinion on genetic engineering to eliminate manic-depressive illness. As a controlled manic-depressive and the parent of a very creative and wonderful controlled manic-depressive son, I would be very interested in your thoughts. And I must tell you that your books and your work have been a blessing for us. Thank you.
Kay Jamison :	Thank you very much. I think that this is a very important issue. Overwhelmingly, what we will learn from the genetics of manic-depression will be a godsend, because we will be able to diagnose the illness earlier, more accurately, understand exactly what's causing it, and develop treatments that are more specific and with fewer side effects. All of those are life-saving things. But I think the issue of genetic engineering is one that raises concerns. I, for one, am prejudiced, because I have this illness myself. We always want to keep diversity in our gene pool, a diversity of temperament and thinking styles and energy levels, risk-taking levels, the capacity to feel things extremely. And we want to protect that. There is a lot of evidence that there is an association with an increased rate of mood disorders in highly creative people. Most people who are creative obviously don't have mental illness, but there is a disproportionate number of creative people who do. What we want to be able to do is provide people options about what to do and to let them make their own decisions, but we want to respect their individuality.
PRx Host :	Do cluster suicides, where a group of young people in the same geographical area die by suicide within a close time frame, also relate to depression and manic-depression?
Kay Jamison :	There isn't much evidence for that. There are some genetic groups that have an increase in certain kinds of mood disorders, but there doesn't seem to be that kind of "clustering" that you occasionally see with young suicides.
PRx Host :	There is often deep guilt for family members who have had a child, sibling, or spouse die by suicide. What can you say to the survivors to help them?
Kay Jamison :	I think that one of the most awful things that happens is that not only does the parent or brother or sister lose someone through death, but in the case of suicide, they make themselves responsible, or let others imply that, "If only they loved them more or had been more sensitive," then things would have been okay. We never say that to somebody who's lost somebody to leukemia. Suicide is a death that is related to illness. I think, again, that people need to learn about the nature of suicide to alleviate that sense of guilt. There are support groups out there for people. The American Foundation for Suicide Prevention (phone 888-333-2377; website www.afsp.org) and the American Association of Suicidology (phone 202-237-2280; website www.suicidology.org) have support groups. There are advocacy groups set up by members who have been instrumental in changing public perception of suicide. [U.S. Surgeon General] Dr. David Satcher, who has made suicide a public health priority, has it right. It is a problem. It is not a parent's responsibility. People don't have to feel horrible. I think it's important that we do something about the illnesses that lead up to this and that we change public opinion and the policy of public health practices.
mtgrosskopf :	Your book was wonderful, and I think you covered every aspect of the tragedy of suicide except one. There was essentially no mention of the gay, lesbian, and transgender population as high risk for suicide. Could you speak to this, please?
Kay Jamison :	Yes, I didn't cover that and a lot of groups because the focus was on the psychological and biological understanding of suicide. The research on suicide and suicide attempts in gay and lesbian groups is controversial. The evidence seems to suggest that suicide attempts are more common in these groups, but that suicide itself does not seem to be increased. I think that there are many groups that are more at risk. The most common pattern, however, is those individuals who suffer from severe mental illness, have drinking or drug problems, and access to drugs or firearms [are more prone to die by suicide]. I think the issue of compassion is one that needs to be raised in the context of compassion for any kind of group that expresses itself differently from "the norm." There is no excuse for even one child in the United States who is gay or is struggling with their sexual identity to feel so desperate as to consider suicide. Our society has to raise its level of compassion to not allow that kind of stigma against any group. I think that the major issue of suicide is mental illness.
PRx Host :	Thank you for a strong statement that is so important. Now, another question from the audience.
dogbert42 :	How do you judge when you, yourself, are in danger of suicide? Both of the incidents my doctor calls suicide attempts were attempts on my part to escape the pain for a few days. I never intended anything more serious than that.
Kay Jamison :	It can be difficult to figure out what and how severe a thought is about suicide. You should always take it seriously, and you should always do everything to treat it and aggressively. Even though the desire may be to escape it for a few days, an attempt can end up being lethal. The potential is there for a tragedy. So, again, there are certain treatments; for example, lithium, which actually has the best record for preventing suicidal behaviors. There are combinations that can be used in treatment. There are support groups.
KatieF76 :	My husband killed himself in August 1997, five weeks after our second son was born. The boys are now 5 and 2, and I worry that there may be a genetic predisposition toward suicide. Is there any truth to that, and what are the signs of depression in kids?
Kay Jamison :	There is a genetic component to suicide. And there is a far stronger genetic component to the psychiatric illnesses that are associated with suicide. But, that certainly does not mean that a child is destined to suicide. The odds are very much against it. There are many things that can be done. Be sure to talk about it with your doctor and find what the best course of treatment is. However, as with any genetic illness or condition, it's a good idea to be extra careful and aware of the early symptoms of depression and get treatment early. Some of the early symptoms in children are the ones that I described earlier for depression in general. Other symptoms include unexplained headaches, avoiding school, irritability, temper tantrums, sadness, emotional withdrawal. Those are non-specific, and they may or may not be indicative of a serious problem, but they should be taken seriously and be treated.
PRx Host :	If an identical twin dies by suicide, is the surviving twin at risk, even if he has shown no signs of depression? Are other family members at risk?
Kay Jamison :	They are statistically at an increased risk for suicide. But, again, the odds are overwhelming that they will not commit suicide. Just be careful to ask directly, straightforwardly, about any concerns you may have as a parent about signs of depression. To just ask and make the statement, "If you ever feel so desperate, if you think about harming yourself, please talk to me about it." There are so many things that can be done about it. We just need to have an environment where you feel comfortable about doing something about it. Create an open environment for family and friends to discuss this, just as you would with any other illness.
ponchogirl :	Can you speculate on the advances in the treatment of depression and mania that we will have in the next few years and beyond?
Kay Jamison :	There are, in the short term, many drugs and antidepressant, anticonvulsive medications that can be used with manic-depression, there are new classes and types of antidepressants that work in many different ways biologically that are being developed that have fewer side effects. That's in the short term. In the long term, the research is going very rapidly in the direction of understanding exactly where in the brain the genetic material and the causes of the illnesses reside. And, once it is known what the abnormalities are, drugs will be developed and diagnostic tests will be developed that will be much more specific to the underlying causes. There are now very general treatments.
PRx Host :	We have come to the end of our chat, and on behalf of everyone who is dealing with depression and manic-depression and suicide and its aftermath in families, I thank you. Your book is so important, as are all your efforts to educate our society.
Kay Jamison :	Thank you, thanks very much.

For more information on suicide and mental illness, visit:

More About Kay Redfield Jamison

Kay Redfield Jamison, Ph.D., a professor of psychiatry at the Johns Hopkins University School of Medicine, is the co-author of the standard medical text on manic-depressive illness (bipolar disorder) along with numerous scientific publications about mood disorders, suicide, psychotherapy, and lithium. In addition, she is the best-selling author of Touched with Fire: Manic-Depressive Illness and the Artistic Temperament; An Unquiet Mind (about her own manic-depression); and Night Falls Fast: Understanding Suicide. Jamison's work is unique for her open use of her own life and manic-depressive illness to illustrate the connection between depression, manic-depression, and suicide.

Educated at the University of California-Los Angeles, and the University of St. Andrews, Scotland, Jamison was formerly the director of the UCLA Affective Disorders Clinic. She has received major awards for her work from the American Suicide Foundation, the National Depressive and Manic-Depressive Association, and the National Mental Health Association, among others. Jamison is currently both the clinical director for the Dana Consortium on the Genetic Basis of Manic-Depression and the chair of the Genome Action Coalition, a coalition of more than 100 patient groups and pharmaceutical and biotechnology companies. She also serves on the National Committee for Basic Sciences at UCLA and is the executive producer and writer for a series of award-winning public television specials about manic-depressive illness and the arts.

Heralded as the most important book on suicide in 25 years, Night Falls Fast reveals the frightening statistics about suicide. Among them, Jamison notes that every 17 minutes someone in the United States dies by suicide and that, since 1987, suicide has killed 18,000 more young men in the United States than has AIDS. Her book is a wake-up call to suicide as a major national health problem and a call to the nation to take preventive action. Night Falls Fast, published in September 1999, has put Jamison in the national spotlight again, with coverage in all the major media, including "60 Minutes II," National Public Radio, "Larry King Live," and "The Today Show."

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