The Noonday Demon (49 page)

But there is nothing to say, nothing that can assuage the loneliness of self-annihilation. Kay Jamison tells the painful story of her own suicide attempt at a time when her thought was as disrupted as her mood: “No amount of love from other people—and there was a lot—could help. No advantage of a caring family and fabulous job could be enough to overcome the pain and hopelessness I felt; no passionate or romantic love, however strong, could make a difference. Nothing alive and warm could make its way in through my carapace. I knew my life to be a shambles and I believed—incontestably—that my family, friends, and patients would be better off without me. There wasn’t much of me left anymore, anyway, and I thought my death would free up the wasted energies and well-meant efforts that were being sent on a fool’s errand.” It is not unusual to believe that one is a burden to others. One man who committed suicide wrote in his final note, “I have pondered it and have decided I would hurt friends and relatives less dead than alive.”

Great misery does not make me suicidal, but occasionally in a depression
something small will overwhelm me and I get a ridiculous feeling. There are too many dirty dishes in this kitchen, and I don’t have the stamina to clean them. Perhaps I will just kill myself. Or—look, the train is coming and I could just jump. Should I? But it’s in the station before I make up my mind. These thoughts are like waking dreams and I can see their absurdity, but I know that they are there. I do not want to die in these thoughts, and I do not want violence, but in some ludicrous fashion, suicide seems to simplify things. If I killed myself, I wouldn’t have to fix the roof or mow the lawn or take another shower. Oh, imagine that luxury of never having to comb my hair again. My conversations with the acutely suicidal have led me to believe that this feeling is closer to the one that most often leads to a suicide attempt than is the feeling of total despair that I had during darkest depression. It is a sudden perception of a way out. It is not exactly a melancholy feeling, though it may occur in an unhappy context. I also know the feeling of wanting to kill the depression and of being unable to do so except by killing the self it afflicts. The poet Edna St. Vincent Millay wrote:

Nourishing your own misery can grow too wearisome to bear, and that tedium of helplessness, that failure of detachment, can lead you to the point at which killing the pain matters more than saving yourself.

I talked to a large number of suicide survivors while I was working on this book, and one particularly frightened me. I met him in a hospital the day after his attempt. He was successful and attractive and fairly happily married, living in a nice suburb of an American coastal city, and working as a chef in a popular restaurant. He had suffered from periodic depression but had gone off his medication about two months earlier, believing that he would be fine without it. He had not told anyone that he was going to stop the medication, but he had appropriately lowered his dose over a few weeks before entirely discontinuing treatment. He had felt fine for a few days but had then begun to develop repetitive and explicit suicidal thoughts that were independent of other depression symptoms. He continued to go to work, but his mind drifted regularly to the idea of self-extermination. Eventually he had decided, with what he believed to be good reason, that the world would be better off without him. He tidied up a few loose ends in his life and made arrangements for things to continue after he was gone. Then one afternoon when he had decided it
was time, he swallowed two bottles of Tylenol. About halfway through, he called his wife at her office to say good-bye, quite certain that she would see his logic and would not oppose his decision. She was not sure at first whether this was some kind of joke, but she soon realized that he was serious. Unbeknownst to her, he was taking pills by the handful even as they spoke on the telephone. Eventually, he got annoyed with her for arguing against his plan, said good-bye, and hung up the phone. He took the rest of the pills.

Within a half hour, the police arrived. The man, who realized his plans were going to be foiled, stepped outside to chat with them. He explained that his wife was a bit nutty, that she did this sort of thing to cause him grief, and that there was really no reason for them to be there. He knew that if he could stall them for a further hour or so, the Tylenol would destroy his liver function (he’d done some careful research), and he hoped that if he couldn’t make them leave, he could at least distract them. He invited them in for a cup of tea and set the water to boil. He was so calm and convincing that the policemen believed his story. He did get some delay out of them; but they said that they really had to follow up a possible suicide attempt and would regretfully have to compel him to accompany them to the emergency room. His stomach was pumped in the nick of time.

When I talked to him, he described the whole thing the way that I sometimes describe dreams, events in which I appear to have played a bewilderingly active role whose meaning I cannot distinguish. He was recovering from the stomach pumping and was very shaken, but he was quite coherent. “I don’t know why I wanted to die,” he said to me, “but I can tell you that yesterday it made perfect sense to me.” We went over the details. “I decided the world would be a better place with me not in it,” he said. “I thought it all through and I saw how it would free my wife, how it would be better for the restaurant, how it would be a relief to me. That’s what’s so strange, that it seemed like such an obviously good idea, so sensible.”

He was enormously relieved to have been saved from that good idea. I would not describe him as happy that day in the hospital; he was as terrified by his brush with death as the survivor of a plane crash might be. His wife had been with him most of the day. He said that he loved her and that he knew she loved him. He enjoyed his work. Perhaps something unconscious in him led him to the telephone when he was ready to kill himself, causing him to call his wife rather than to write a note. If there was, it was little comfort to him because it had so entirely failed to register with his conscious mind. I asked his doctor how long the patient would remain hospitalized, and the doctor said it would make sense to
keep him until his flawed logic could be better explored and his blood levels of medication could be set. “He seems healthy enough to go home today,” said the doctor, “but he would have seemed healthy enough not to be here the day before yesterday.” I asked the man whether he thought he would make another suicide attempt. It was as though I had asked him to predict someone else’s future. He shook his head and looked at me with a pale, bewildered expression. “How can I know?” he asked me.

His bewilderment, his emotional defeat, are commonplaces of the suicidal mind. Joel P. Smith, a man in Wisconsin who has survived multiple suicide attempts, wrote to me, “I am alone. A large proportion of depressed people I know are more or less alone, having lost their jobs and used up their families and friends. I become suicidal. My ultimate guardian—namely myself—has not just gone off duty, but, so much more dangerously, has become the advocate, the agent of destruction.”

On the day it took place, when I was twenty-seven, I understood and believed in the reasons for my mother’s suicide. She was in the late stages of terminal cancer. In fact, with my father and brother, I helped my mother kill herself and, in doing so, experienced a great intimacy with her. We all believed in what she did. Unfortunately, many who believe in rational decision making—including Derek Humphry, author of
Final Exit,
and Jack Kevorkian—seem to think that
rational
means “straightforward.” It was not easy to arrive at this rational decision. It was a slow, tangled, peculiar process whose convolutions were as madly individual as those experiences of love that can lead to marriage. My mother’s suicide is the cataclysm of my life, though I admire her for it and believe in it. It so distresses me that I mostly draw up shy of thinking and talking about its details. The simple fact of it is now a fact of my life and I will gamely share that with anyone who asks. The reality of what happened, however, is like something sharp that is embedded in me, that cuts whenever I move.

Activists draw an obsessively careful distinction between “rational” and all other suicides. In fact a suicide is a suicide—overdetermined, sad, toxic in some measure to everyone it touches. The worst and the best kind lie at either end of a continuum; they differ more in degree than in essential quality. Rational suicide has always been a popular and frightening idea. The narrator of Dostoyevsky’s
The Possessed
asks whether people kill themselves from reason. “Lots,” Kirilov replies. “But for prejudice there would be more; many more; all.” When we speak of a rational suicide and distinguish it from an irrational one, we are sketching out the details of our own or our society’s prejudices. Someone who killed himself because he didn’t like his arthritis would seem suicidal;
someone who killed herself because she couldn’t bear the prospect of a painful and undignified death from cancer seems perhaps quite rational. A British court recently awarded a hospital permission to force-feed a diabetic anorexic and to inject her with insulin against her will. She was extremely wily and had contrived to substitute a mix of milk and water for the insulin that she was supposed to be injecting, and she soon reached a nearly comatose state. “Well, is that anorexia?” asked the therapist who was treating her. “Is that suicidal behavior? Is that para-suicidal? I think it’s obviously a very depressed and very angry thing to do.” What about people with miserable but not immediately fatal illnesses? Is it reasonable to kill oneself in the face of Alzheimer’s or Lou Gehrig’s disease? Is there such a thing as a terminal mental state, in which someone who has received lots of treatment and remains unhappy may commit rational suicide even if he is not ill? What is rational for one person is irrational for another, and all suicide is calamitous.

In a hospital in Pennsylvania, I met a man in his late teens whose wish to die I would be particularly inclined to honor. He was born in Korea and abandoned as an infant; when he was found, half-starved, he was put into a Seoul orphanage from which he was adopted when he was six by an American alcoholic couple who abused him. By the time he was twelve, he had been made a ward of the state and sent to live in the mental hospital where I encountered him. He suffers from cerebral palsy, which has crippled his lower body into uselessness, and speech is painful and laborious for him. In the five years he has lived full-time at the hospital, he has received every medication and treatment known to mankind, including a full spectrum of antidepressant treatment and electroconvulsive therapy, but he has remained bitter and anguished. He has made innumerable suicide attempts since late childhood, but because he is in a care facility, he has always been saved; and since he is confined to a wheelchair on a locked ward, he can seldom make his way to a situation private enough for his attempts to stand a chance. Desperate, he tried to starve himself to death; when he hit unconsciousness, he was fed intravenously.

Though his physical disability makes speech a struggle for him, he is perfectly capable of rational conversation. “I’m sorry to be alive,” he said to me. “I didn’t want to be here in this form. I just don’t want to be here on earth. I have had no life. There are no things I like or that give me joy. This is my life: upstairs in building number nine of this hospital and then back here to building number one, which is no better than building number nine. My legs are painful. My body hurts me. I try not to talk to the people in here. They basically all talk to themselves anyway. I’ve taken a lot of medication for my depression. I don’t think the medicine works for me. I lift weights upstairs with my arms, and I use the computer. That
keeps my mind occupied and it distracts from what I have. But it is not enough. This will never change. I will never not feel like killing myself. It feels good to cut my wrists. I like seeing my own blood. Then I fall asleep. When I wake up, I say to myself, ‘Damn it, I woke up.’ ” Plenty of people with cerebral palsy lead rich and satisfying lives. This young man, however, is so psychologically bruised and so violently hostile that he will probably not encounter much love and would perhaps be unable to appreciate it if it were offered to him. He is moving to me and to some of the people who help to take care of him, but no heroic person who wants to give up a life to helping him has materialized; there are not enough selfless people on earth to devote themselves to all the people like him who fight against their own life every minute on this planet. His life is physical pain and mental pain and physical incompetence and mental shadows. To me, his depression and his wish to die seem untreatable, and I am glad that I do not have responsibility for ensuring that he wakes up every time he manages to cut his wrists, that I am not the one who inserts the feeding tube when he has deliberately stopped eating.

In another hospital, I encountered an eighty-five-year-old man in good health who, with his wife, took mortal doses of barbiturates when she began to develop liver cancer. They had been married sixty-one years and had a suicide pact. She died. He was revived. “I was sent in to cure this guy’s depression,” a young psychiatrist said to me. “Give him some pills and therapy so he won’t be depressed because he’s old, sick, in constant pain, his wife dead, suicide didn’t work. It’s been six months, he’s still in the same state, he could live ten years. I treat depression. What he’s got, it’s not that kind of depression.”

Tennyson’s poem “Tithonus” tells the story of such late-life despair. Tithonus was the lover of Eos, the dawn; she asked Zeus to give him eternal life. Zeus granted her request; but she had forgotten to ask for eternal youth. Unable to kill himself, Tithonus lives forever growing infinitely old and infinitely more old. He longs to die, saying to his former lover: