8 Work done by Clare Harris: E. C. Harris and B. Barraclough, “Suicide as an Outcome for Mental Disorders: A Meta-Analysis,” British Journal of Psychiatry, 170 (1997): 205–228.

  9 one-third of the patients: A. Stenbeck, K. A. Achté, and R. N. Rimón, “Physical Disease, Hypochondria and Alcohol Addiction in Suicides Committed by Mental Hospital Patients,” British Journal of Psychiatry, 111 (1965): 933–937.

  10 Two things seem to be true: T. L. Dorpat, W. F. Anderson, and H. S. Ripley, “The Relationship of Physical Illness to Suicide,” In H. L. P. Resnick, ed., Suicidal Behaviors: Diagnosis and Management (Boston: Little, Brown, 1968), pp. 209–219.

  11 most of the medical conditions: F. A. Whitlock, “Suicide and Physical Illness,” in A. Roy, ed., Suicide (Baltimore: Williams & Wilkins, 1986), pp. 151–170; E. C. Harris and B. M. Barraclough, “Suicide as an Outcome for Medical Disorders,” Medicine 73 (1994): 281–296; P. R. McHugh, “Suicide and Medical Afflictions,” Medicine, 73 (1994): 297–298.

  12 a three- to eightfold decrease: E. C. Harris and B. Barraclough, “Suicide as an Outcome for Medical Disorder,” Medicine, 73 (1994): 281–296.

  13 “airless and without exits”: A. Alvarez, The Savage God (New York: W. W. Norton, 1990; first published 1971), p. 293.

  14 “I have been and am”: Sylvia Plath, The Journals of Sylvia Plath, T. Hughes and F. McCullough, eds. (New York: Dial Press, 1982), p. 240.

  15 “The next thing”: Alan Garner, The Voice That Thunders: Essays and Lectures (London: Harvill Press, 1997), pp. 208–209.

  16 “What I had begun”: William Styron, Darkness Visible: A Memoir of Madness (New York: Random House, 1990), p. 50.

  17 “becomes changed”: Hugo Wolf, quoted in F. Walker, Hugo Wolf: A Biography (London: J. M. Dent & Sons, 1968), p. 359.

  18 “tireless, madly sanguine”: Robert Lowell, “Near the Unbalanced Aquarium,” in R. Giroux, ed., Robert Lowell: Collected Prose (New York: Farrar, Straus and Giroux, 1987), p. 353.

  19 the “Columbus”: V. Mayakovsky, quoted in V. Markov, The Longer Poems of Velimir Khlebnikov (Westport: Conn.: Greenwood Press, 1975), p. 23.

  20 “Working with number”: Ibid., pp. 362–363.

  21 “The condition of my mind”: E. Reiss, Konstitutionelle Verstimmung und Alanisch-Depressive Irresein: Klinische Untersuchungen über den Zusammenhang von Veranlagung und Psychose (Berlin: J. Springer, 1910).

  22 One person in a hundred: F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990); L. N. Robins and D. A. Regier, Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (New York: Free Press, 1991); R. C. Kessler, D. R. Rubinow, C. Holmes, J. M. Abelson, and S. Zhao, “The Epidemiology of DSM-III-R Bipolar I Disorder in a General Population Survey,” Psychological Medicine, 27 (1997): 1079–1089.

  23 at least twice as common: M. M. Weissman, R. C. Bland, G. J. Canino, C. Faravelli, S. Greenwald, H.-G. Hwu, P. R. Joyce, E. G. Karam, C.-K. Lee, J. Lellouch, J.-P. Lépine, S. C. Newman, M. Rubio-Stipec, E. Wells, P. J. Wickramaratne, H.-U. Wittchen, and E.-K. Yeh, “Cross-National Epidemiology of Major Depression and Bipolar Disorder,” Journal of the American Medical Association, 276 (1996): 293–299; J. Angst, “The Prevalence of Depression,” in M. Briley and S. A. Montgomery, eds., Antidepressant Therapy: At the Dawn of the Third Millennium (St. Louis: Mosby, 1998), pp. 191–212.

  24 Bipolar illness is generally: F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990); D. A. Regier, M. E. Farmer, D. S. Raye, B. Z. Locke, S. J. Keith, L. L. Judd, and F. K. Goodwin, “Co-Morbidity of Mental Disorders with Drug and Alcohol Abuse: Results from the Epidemiologic Catchment Area (ECA) Study,” Journal of the American Medical Association, 264 (1990): 2511–2518; D. F. MacKinnon, K. R. Jamison, and J. R. DePaulo, “Genetics of Manic-Depressive Illness,” Annual Review of Neuroscience, 20 (1997): 355–373.

  25 Suicide attempts are disproportionately high: G. F. Johnson and G. Hunt, “Suicidal Behavior in Bipolar Manic-Depressive Patients and Their Families,” Comprehensive Psychiatry, 20 (1979): 159–164; K. R. Jamison, “Suicide and Bipolar Disorders,” Annals of the New York Academy of Sciences, 487 (1986): 301–315; Y. W. Chen and S. C. Dilsaver, “Lifetime Rates of Suicide Attempts Among Subjects with Bipolar and Unipolar Disorders Relative to Subjects with Other Axis I Disorders,” Biological Psychiatry, 39 (1996): 896–899; F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990); S.-Y. Tsai, C.-C. Chen, and E.-K. Yeh, “Alcohol Problems and Long-Term Psychosocial Outcome in Chinese Patients with Bipolar Disorder,” Journal of Affective Disorders, 46 (1997): 143–150; R. C. Kessler and E. E. Walters, “Epidemiology of DSM-III-R Major Depression and Minor Depression Among Adolescents and Young Adults in the National Comorbidity Survey,” Depression and Anxiety, 7 (1998): 3–14. S. G. Simpson and K. R. Jamison, “The Risk of Suicide in Patients with Bipolar Disorders,” Journal of Clinical Psychiatry, 60 (Suppl. 2) (1999): 53–56.

  26 Individuals with mood disorders: E. Vieta, E. Nieto, C. Gastó, and E. Cirera, “Serious Suicide Attempts in Affective Patients,” Journal of Affective Disorders, 24 (1992): 147–152.

  27 For those with mood disorders: A. R. Beisser and J. E. Blanchette, “A Study of Suicides in a Mental Hospital,” Diseases of the Nervous System, 22 (1961): 365–369; K. A. Achté, A. Stenback, and H. Teravainen, “On Suicides Committed During Treatment in Psychiatric Hospitals,” Acta Psychiatrica Scandinavica, 42 (1966): 272–284.

  28 Mild or moderate depressions: J. R. Morrison, “Suicide in a Psychiatric Practice Population,” Journal of Clinical Psychiatry, 43 (1982): 348–352; R. L. Martin, C. R. Cloninger, and S. B. Guze, “Mortality in a Follow-up of 500 Psychiatric Outpatients: I. Total Mortality,” Archives of General Psychiatry, 42 (1985): 47–54; G. W. Blair-West, G. W. Mellsop, and M. L. Eyeson-Annan, “Down-Rating Lifetime Suicide Risk in Major Depression,” Acta Psychiatrica Scandinavica, 95 (1997): 259–263.

  29 Swedish researchers: O. Hagnell, J. Lanke, and B. Rorsman, “Suicide Rates in the Lundby Study: Mental Illness as a Risk Factor for Suicide,” Neuropsychobiology; 7 (1981): 248–253.

  30 The severity of depression: T. L. Dorpat and H. S. Ripley, “A Study of Suicide in the Seattle Area,” Comprehensive Psychiatry, 1 (1960): 349–359; M. Arato, E. Demeter, Z. Rihmer, and E. Somogyi, “Retrospective Psychiatric Assessment of 200 Suicides in Budapest,” Acta Psychiatrica Scandinavica, 77 (1988): 454–456; M. M. Henriksson, H. M. Aro, M. J. Marttunen, et al., “Mental Disorders and Comorbidity in Suicide,” American Journal of Psychiatry, 150 (1993): 935–940; E. T. Isometsä, M. M. Henriksson, H. M. Aro, M. E. Heikkinen, K. I. Kuoppasalmi, and J. K. Lönnqvist, “Suicide in Major Depression,” American Journal of Psychiatry, 151 (1994): 530–536; S. C. Dilsaver, Y.-W. Chen, A. C. Swann, A. M. Shoaib, and K. J. Krajewski, “Suicidality in Patients with Pure and Depressive Mania,” American Journal of Psychiatry, 151 (1994): 1312–1315.

  31 Suicide appears to be: D. L. Dunner, E. S. Gershon, and F. K. Goodwin, “Heritable Factors in the Severity of Affective Illness,” Biological Psychiatry, 11 (1976): 31–42; M. T. Tsuang, “Suicide in Schizophrenics, Manics, Depressives, and Surgical Controls,” Archives of General Psychiatry, 35 (1978): 153–155; T. H. McGlashan, “Chestnut Lodge Follow-up Study: III. Long-Term Outcome of Schizophrenia and Affective Disorders,” Archives of General Psychiatry, 41 (1984): 586–601; J. Endicott, J. Nee, N. Andreasen, P. Clayton, M. Keller and W. Coryell, “Bipolar II: Combine or Keep Separate?” Journal of Affective Disorders, 8 (1985): 17–28; R. L. Martin, C. R. Cloninger, S. B. Guze, and P. Clayton, “Mortality in a Follow-up of 500 Psychiatric Outpatients,” Archives of General Psychiatry, 42 (1985): 58–66; A. Weeke and M. Vaeth, “Excessive Mortality of Bipolar and Unipolar (Manic-Depressive) Patients,” Journal of Affective Disorders, 11 (1986): 227–234; Z. Rihmer, J. Barsi, M. Arató, and E. Demeter, “Suicide in Subtypes of Primary Major Depression,” Journal of Affective Disorders, 18 (1990): 221–225; S. C. Newman and R. C. Bland, “Suicide Risk Varies by Subtype of Affective Disorder,” Acta Psychiatrica Scandinavica, 83 (1991): 420–426.

  32 more common in major depression: S. B. Guze and E. Robins, “Suicide and Primary Affective Disorders,” British Journal of Psychiatry, 117 (1970): 437–438; G. Winokur and M. Tsuang, “The Iowa 500: Suicide in Mania, Depression, and Schizophrenia,” American Journal of Psychiatry, 132 (1975): 650–651; W. Coryell, R. Noyes, and J. Clancy, “Excess Mortality in Panic Disorder: A Comparison with Primary Unipolar Depression,” Archives of General Psychiatry, 39 (1982): 701–703; M. Berglund and K. Nilsson, “Mortality in Severe Depression,” Acta Psychiatrica Scandinavica, 76 (1987): 372–380; D. W. Black, G. Winokur, and A. Nasrallah, “Suicide in Subtypes of Major Affective Disorder: A Comparison with General Population Suicide Mortality,” Archives of General Psychiatry, 44 (1987): 878–880; F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990).

  33 “The patients, therefore”: E. Kraepelin, Manic-Depressive Insanity and Paranoia, trans. R. M. Barclay, ed. G. M. Robertson (New York: Arno Press, 1976; first published 1921), p. 25.

  34 Paranoia, extreme irascibility: J. Himmelhoch, D. Mulla, J. F. Neil, T. P. Detre, and D. J. Kupfer, “Incidence and Significance of Mixed Affective States in a Bipolar Population,” Archives of General Psychiatry, 33 (1976): 1062–1066; F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990); S. L. McElroy, P. E. Keck, H. G. Pope, J. I. Hudson, G. L. Faedda, and A. C. Swann, “Clinical and Research Implications of the Diagnosis of Dysphoric or Mixed Mania or Hypomania,” American Journal of Psychiatry, 149 (1992): 1633–1644.

  35 “I walk from room to room”: Anne Sexton, handwritten notes dated “February 16th or so [probably 1957],” Dr. Orne file, restricted collection; quoted in Diane Wood Middlebrook, Anne Sexton: A Biography (Boston: Houghton Mifflin, 1991), p. 36.

  36 “I went to bed & wept”: Edgar Allan Poe, letter to Annie L. Richmond, November 16, 1848, in John Wand Ostrom, ed., The Letters of Edgar Allan Poe, vol. 2 (Cambridge, Mass.: Harvard University Press, 1948), pp. 401–403.

  37 Mixed states: G. R. Jameison, “Suicide and Mental Disease: A Clinical Analysis of One Hundred Cases,” Archives of Neurology and Psychiatry, 36 (1936): 1–12; K. R. Jamison, “Suicide and Bipolar Disorders,” Annals of New York Academy of Sciences, 487 (1986): 301–315; S. C. Silsaver, Y.-W. Chen, A. C. Swann, A. M. Shoaib, and K. J. Krajewski, “Suicidality in Patients with Pure and Depressive Mania,” American Journal of Psychiatry, 151 (1994): 1312–1315; S. M. Strakowski, S. L. McElroy, P. E. Keck, and S. A. West, American Journal of Psychiatry, 153 (1996): 674–676; J. F. Goldberg, J. L. Garno, A. C. Leon, J. H. Kocsis, and L. Portera, “Association of Recurrent Suicidal Ideation with Nonremission from Acute Mixed Mania,” American Journal of Psychiatry, 155 (1998): 1753–1755.

  38 “The patient cannot”: Kraepelin, Manic-Depressive Insanity and Paranoia, pp. 64–65, 164.

  39 Psychosis, the presence: D. W. Goodwin, P. Alderson, and R. Rosenthal, “Clinical Significance of Hallucinations in Psychiatric Disorders,” Archives of General Psychiatry, 24 (1971): 76–80; W. Coryell and M. T. Tsuang, “Primary Unipolar Depression and the Prognostic Importance of Delusions,” Archives of General Psychiatry, 39 (1982): 1181–1184; D. E. Frangos, G. Athanassenas, S. Tsitourides, P. Psilolignos, and N. Katsanou, “Psychotic Depressive Disorder: A Separate Entity?” Journal of Affective Disorders, 5 (1983): 259–265; S. P. Roose, A. H. Glassman, B. T. Walsh, S. Woodring, and J. Vital-Herne, “Depression, Delusions, and Suicide,” American Journal of Psychiatry, 140 (1983): 1159–1162; M. Wolfersdorf, F. Keller, B. Steiner, and G. Hole, “Delusional Depression and Suicide,” Acta Psychiatrica Scandinavica, 76 (1987): 359–363; D. W. Black, G. Winokur, and A. Nasrallah, “Effect of Psychosis on Suicide Risk in 1,593 Patients with Unipolar and Bipolar Affective Disorders,” American Journal of Psychiatry, 145 (1988): 849–852; C. L. Rich, M. S. Motooka, R. C. Fowler, and D. Young, “Suicide by Psychotics,” Biological Psychiatry, 23 (1988): 595–601; J. F. Westermeyer, M. Harrow, and J. T. Marengo, “Risk for Suicide in Schizophrenia and Other Psychotic and Nonpsychotic Disorders,” Journal of Nervous and Mental Disease, 179 (1991): 259–266; K. J. Kaplan and M. Harrow, “Positive and Negative Symptoms as Risk Factors for Later Suicidal Activity in Schizophrenics Versus Depressives,” Suicide and Life-Threatening Behavior, 26 (1996): 105–121; P. E. Quinlan, C. A. King, G. L. Hanna, and N. Ghaziuddin, “Psychotic Versus Nonpsychotic Depression in Hospitalized Adolescents,” Depression and Anxiety, 6 (1997): 40–42.

  40 depressed patients with auditory hallucinations: D. Hellerstein, W. Frosch, and H. W. Koenigsberg, “The Clinical Significance of Command Hallucinations,” American Journal of Psychiatry, 144 (1987): 219–221.

  41 Psychotic patients do, however: E. Isometsä, M. Henriksson, H. Aro, M. Heikkinen, K. Kuoppasalmi, and J. Lönnqvist, “Suicide in Psychotic Major Depression,” Journal of Affective Disorders, 3 (1994): 187–191.

  42 People with depression or manic-depression: G. R. Jameison, “Suicide and Mental Disease: A Clinical Analysis of One Hundred Cases,” Archives of Neurology and Psychiatry, 36 (1936): 1–12; S. Guze and E. Robins, “Suicide and Primary Affective Disorders,” British Journal of Psychiatry, 117 (1970): 437–438; J. B. Copas, D. L. Freeman-Browne, and A. A. Robin, “Danger Periods for Suicide in Patients Under Treatment,” Psychological Medicine, 1 (1971): 400–404; M. T. Tsuang and R. F. Woolson, “Excess Mortality in Schizophrenia and Affective Disorders,” Archives of General Psychiatry, 35 (1978): 1181–1185; G. F. Johnson and G. Hunt, “Suicidal Behavior in Bipolar Manic-Depressive Patients and Their Families,” Comprehensive Psychiatry, 20 (1979): 159–164; A. Weeke, “Causes of Death in Manic-Depressives,” in M. Schou and E. Strömgren, eds., Origin, Prevention and Treatment of Affective Disorders (London: Academic Press, 1979), pp. 289–299; A. Roy, “Risk Factors for Suicide in Psychiatric Patients,” Archives of General Psychiatry, 39 (1982): 1089–1095; D. W. Black, G. Winokur, and A. Nasrallah, “Mortality in Patients with Primary Unipolar Depression, Secondary Unipolar Depression, and Bipolar Affective Disorder: A Comparison with General Population Mortality,” International Journal of Psychiatry and Medicine, 17 (1987): 351–360; J. Fawcett, W. Scheftner, D. Clark, D. Hedeker, R. Gibbons, and W. Coryell, “Clinical Predictors of Suicide in Patients with Major Affective Disorders: A Controlled Prospective Study,” American Journal of Psychiatry, 144 (1987): 35–40; D. W. Black, “The Iowa Record-Linkage Experience,” Suicide and Life-Threatening Behavior, 19 (1989): 78–89; A. Roy, “Features Associated with Suicide Attempts in Depression: A Partial Replication,” Journal of Affective Disorders, 27 (1993): 35–38; B. Ahrens, A. Berghöfer, T. Wolf, and B. Müller-Oerlinghausen, “Suicide Attempts, Age and Duration of Illness in Recurrent Affective Disorders,” Journal of Affective Disorders, 36 (1995): 43–49; H. Brodaty, C. M. MacCuspie-Moore, L. Tickle, and G. Lusocombe, “Depression, Diagnostic Sub-Type and Death: A 25-Year Followup Study,” Journal of Affective Disorders, 46 (1997): 233–242.

  43 one of the highest-risk periods: Sir T. S. Clouston, Clinical Lectures on Mental Disease, 5th ed. (London: Churchill, 1898); J. Barfield Adams, “Suicide—From a General Practitioner’s Point of View,” The Practitioner, 44 (1915): 470–478; D. K. Henderson and R. D. Gillespie, A Textbook of Psychiatry (London: Oxford University Press, 1927); E. Stengel, “The Risk of Suicide in States of Depression,” Medical Press, 234 (1955): 182–184; J. B. Copes, D. L. Freeman-Browne, and A. A. Robin, “Danger Periods for Suicide in Patients Under Treatment,” Psychological Medicine, 1 (1971): 400–404; J. B. Copas and M. J. Fryer, “Density Estimation and Suicide Risk in Psychiatric Treatment,” Statistical Society, 143 (1980): 167–176; P. Barner-Rasmussen, “Suicide in Psychiatric Patients in Denmark, 1971–1981: II. Hospitalization Utilization and Risk Groups,” Acta Psychiatrica Scandinavica, 73 (1986): 449–455; E. Schweizer, A. Dever, and C. Clary, “Suicide upon Recovery from Depression: A Clinical Note,” Journal of Nervous and Mental Disease, 176 (1988): 633–636.

  44 “We should be careful”: Benjamin Rush, Medical Inquiries and Observations upon the Diseases of the Mind (Philadelphia: Kimber & Richardson, 1812), pp. 239–240.

  45 “The electricity manifests itself”: Michael Hurd, The Ordeal of Ivor Gurney (Oxford: Oxford University Press, 1984), p. 158.

  46 “There is a dreadful hell”: “To God,” ll. 8–9, 12, in P. J. Kavanagh, ed., Collected Poems of Ivor Gurney (Oxford: Oxford University Press, 1984), p. 156.

  47 “There is one who all day”: from “An Appeal for Death,” ll. 1, 22, in Kavanagh, ed., Collected Poems of Ivor Gurney, pp. 181–182.

  48 Schizophrenia is the most severe: R. J. Wyatt, R. C. Alexander, M. F. Egan, and D. G. Kirch, “Schizophrenia: Just the Facts. What Do We Know? How Well Do We Know It? Schizophrenia Research, 1 (1988): 3–18; L. N. Robins and D. A. Regier, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (New York: Free Press, 1991); American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (Washington, D.C.: American Psychiatric Association, 1994); I. I. Gottesman, “Complications to the Complex Inheritance of Schizophrenia,” Clinical Genetics, 46 (1994): 116–123; P. Asherson, R. Mant, and P. McGuffin, “Genetics and Schizophrenia,” in S. R. Hirsch and D. R. Weinberger, Schizophrenia (Oxford: Blackwell Science, 1995), pp. 253–274.

 

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