I know a hundred ways to die.
I’ve often thought I’d try one;
Lie down beneath a motor truck
Some day when standing by one.

Or throw myself from off a bridge--
Except such things must be
So hard upon the scavengers
And men that clean the sea.

I know some poison I could drink.
I’ve often thought I’d taste it.
But mother bought it for the sink
And drinking it would waste it.

--Edna St. Vincent Millay, “I Know A Hundred Ways to Die”

Inside this snarl of wet, gray tissue, a monster hides.

In a microscopic darkness, where impulses are dictated and memories locked away,

the monster contaminates the brain with confusion, imbalance, misconception, apathy, terror and mania. It
breeds lethargy, psychosis, vengeance, self-hatred and anxiety.

This is the monster of mental illness, the monster of disorders. Sleeping in the cracks of the mind, cold and dangerous. Individuals burdened with diseases of the mind are often victims of circumstance, heredity and coincidence, and for some, medication and therapy are insufficient to ease the pain.

For some, the only escape is death.

Suicide is the second most prolific killer after heart and lung disease in the United States. Studies in 2006 show that suicide is more common than murder. The statistical gap between homicide and suicide widens exponentially in urban cities like San Francisco and New York.

The explanation for the prevalence of suicide in large cities is vague. Researchers speculate that the myriad of artistic communities in these cities affects the statistics, because individuals with interests in the arts are at a greater risk for suicide.

In a gray, twisted hallway at the Academy of Art in San Francisco, a girl with copper hair and haunted blue eyes struts towards a partially open door. She pushes it with a pale hand, and indistinguishable clatter can be heard. It is a cavernous loft of a room, with large, smudged windows and traces of chemicals permeating the air.

Artists are everywhere, creating. The girl walks to her own work in the corner. She touches it with affection—a miniature chest of drawers within the gutted cover of a large book. The drawers are filled with notes and pictures inspired by her experience with a love unrequited—her most recent stalker.
This is the Book Arts class offered at the Academy, and Janelle Bishop,** a 24-year-old printmaking major, would not be standing in this room exhibiting her “Stalker Book” if her suicide attempt almost five years ago had succeeded.

“I have no idea why I’m still here,” she says with a smirk. It appears that she wants to say more, but she closes her lips into a thin line and walks away.

Janelle is a diagnosed Bipolar and Manic Depressive patient, who swallows three different types of medication—including lithium— every morning to control extreme intervals in temperament and depression. Manic depression and bipolarity causes common activities to become impossibly difficult.

“This disease,” she says with a heavy breath, “makes every teeny fleck of flesh on your body weigh a hundred pounds.”

In a deserted alcove where type-settings are kept, Janelle articulates her failed attempt to end her life five years ago.

In an ill-lighted dorm, a 19-year old Janelle is confused and sick. It has been days since she’s slept or eaten, months since she’s cared about anything. She thinks of her classes, which she is failing, her friends, who are sick of her strange and constant apathy, her family, detached and acres away, and this unrelenting, rootless pain that she cannot understand. The mood swings and tantrums, insomnia and exhaustion are driving her mad.

The rooms are breathing and faceless things are trying to stab her through the walls. She sees ghosts in the mirrors and confuses them with her own reflection. There is a pressure, like being packed in cotton, surrounding her body.

An oversized bottle of Tylenol sits seductively on her night table. She thinks, I’m done. She thinks, No one will notice. She thinks this will make it stop.

The pills go down her throat in handfuls. She swallows them with gulps of alcohol—rum, in a clear bottle—and is done with two-thirds of it before the nausea arrives. She can’t vomit and doesn’t really want to. She wants to sleep. She wants to write and paint.

But mostly, she just wants freedom.

Bishop watches, with her stomach in knots, as the dim room spins and spins. The objects surrounding her are buzzing and the room is shrinking. Suddenly she has her journal and she’s writing nonsense, and the buzzing is overwhelmingly loud, and then she’s in bed, and she’s dying.

Two days pass and Janelle Bishop wakes up, alive. She is surprised by her pulse.

Two months later, she tries again with barbiturates, and fails again. She cuts her wrists, but in the wrong direction and not deep enough to die. She is unsure now if suicide will destroy the pain, but she knows exactly how to do it—quickly and almost painlessly—if she changes her mind.

And this is the part that scares her, because now she doesn’t want to die, but now she knows how. In a fit of mania or depression, the overwhelming impulse could lead Bishop to an irreversible fate.

“People who really want to die, die,” she says, fixing her round eyes on her hands. “I think I wanted to, but I didn’t want to choose it. Now I don’t want to die, but I don’t want to go on this way, either. Day to day it’s really hard. I’m always second guessing my emotions. I have to embrace this disease, because it’s who I am.”

Bishop’s family is incredibly accepting and supportive of her condition, which is uncommon; studies show that less than half of family members of the mentally disordered are even aware of the condition, and even fewer are willing to cater to it. For now, Bishop focuses on the positive aspects of manic depression.

“Everything is more intense, because all of my receptors are on,” she says, chuckling. “My emotions are more colorful, colors more beautiful. My favorite color is yellow. Did you know that yellow is the preferred color of the criminally insane?”

While countless methods of suicide exist, some statistics regarding suicide are vague. It is believed that many suicides go totally unreported, or are reported officially under another cause of death to preserve reputation of the deceased or by family request.

The official Medical Examiner’s report, submitted by Chief Medical Examiner of San Francisco Dr. Amy Hart, ascertains that suicide accounts for only 7.3 percent of the city’s deaths of 2006, not including inconclusive results pertaining to vehicular deaths.

Of this 7.3 percent, hanging is the most common method used, followed by barbiturate overdose, death by firearm, leaping from a building, asphyxiation, leaping from the Golden Gate Bridge, drowning, and finally, sharp force injuries (the most commonly romanticized method in media). On average, males in this city are three times more likely to commit suicide than females, and White Non-Hispanics are the racial group at the highest risk for suicide.

Psychologist and internationally acclaimed expert on mood disorders, Dr. Kay Redfield Jamison, is the author of many books on the subject of mental illness and suicide. In her book Night Falls Fast: Understanding Suicide, statistics show that suicide in the United States has reached epidemic proportions, being the cause of death for more people than HIV/AIDS. On average, 30,000 Americans die by self-murder each year, and another 500,000 make a suicide attempt serious enough to require emergency medical attention.

“Suicide is a particularly awful way to die,” she writes. “The suffering of the suicidal is private and inexpressible. Suicide carries in its aftermath a level of confusion and devastation that is beyond description.”

And she would know. Jamison is a diagnosed manic-depressive, and at age 28, attempted to take her own life. She wrote Night Falls Fast after the anticipated suicide of her friend Jack Ryan, who, against advisement, had ceased taking his lithium prescription.

Lithium carbonate is the pharmacological compound used in mood-stabilizing drugs. Although prescribed at controlled levels, lithium is toxic and can cause nausea, vomiting, ataxia (failure of muscle control) and diarrhea. Patients prescribed lithium often experience the greatest positive results in mood stabilization, but must be acutely monitored.

Lithium efficiently catalyzes serotonin production in the brain. Serotonin is a neurotransmitter, active in controlling pain perception, mood and memory. If serotonin levels are low in a person’s brain, signals are incapable of jumping across the synapses—tiny gaps between cells that allow information to travel from the brain to the nervous system. Low serotonin incapacitates mood, causing depression and violent mood cycles.

Side effects for any psychological drug are usually unpleasant, including nausea, weight gain, acne, unstable appetite and insomnia. Unfortunately, this can often trap a patient in a vicious cycle of treatment, battling increased depression caused by an emotional reaction to side effects. Autopsy reports show that nearly 15 percent of suicides in the United States occur while the victim is taking prescription medication.

The winter months bring a deep risk of suicide to the vulnerable. For a 19-year-old girl of Aptos, California, the morning of October 22, 2003, would bring devastation.

It is cold in her quiet house, and the pale-blonde girl with the perfect teeth is gathering her things for school. Her life, from the outside, is filled with wealth and love. Her father is a successful dentist, her mother pretty and petite. She and her younger brother are popular, talented and brilliant students.

She grabs her backpack, flashing one quick, photo-ready smile for the hallway mirror—her father’s a dentist, after all, and she’s proud of her grin—and walks around the sharp corner of the kitchen into the garage.

She hears it before she flicks on the light. The purr of a running motor. In the darkness, she feels an icy stab of uncertainty, wondering if there is a stranger in her home or a robber.

With great velocity, the light is on, and what meets Denise Caine’s** frightened eyes is more terrible than any thief or transient. In the driver’s side of her white Camry is the lifeless body of her father, his skin a pallid gray, his mouth hung open.

This cold October morning, Caine’s father, a successful dentist, well-loved father and husband, loses the battle against depression, poisoning himself with carbon-monoxide in his daughter‘s front seat.

The last thing Caine remembers is screaming.

Carbon-monoxide is a silent, invisible and deadly gas emitted from car engines and other machinery. It is an extremely common method of suicide. The death is supposedly painless and non-violent. In the wake of her father’s suicide, Caine, now a 23-year-old graduate of the University of Los Angeles, must struggle with the notion that, technically, her father is a criminal.

“How can we keep destroying someone after this? I love him. We all do.”

Killing yourself is no more a crime against society than throwing away the photographs of someone you used to love.” Her emotion is tangible, but the law is indifferent to sentiment.

Suicide is a serious crime in many cities. If someone attempts suicide and fails, and is caught, standard law requires that they be confined to a psychiatric hospital for no less than 72 hours. They are examined, and unless dementia is observed or treatment is requested by the patient, they will be released.

The idea of preventing suicide by making it illegal is noble. The question is whether or not a completed suicide is a crime. Historically, suicide is socially unacceptable—the corpses of suicides in archaic European cultures were dragged through the streets, mangled, drawn and quartered, beaten and forbidden a proper burial.

Of the 15,000 articles, journals and other pieces of literature written on suicide, not one truly defines it. The act of taking your own life is simply too personal. It must be remembered that nothing will make a clear mind comprehend a mind that wants to die.

Without empathy for the suffering, these disorders and their catastrophic results will continue to destroy. By romanticizing suicide, the monster will win.

October 28th, 1995
I live in Hell, day in, day out. Every day, I break down a little bit more. I am eroding, bit by bit, cell by cell, pearl by pearl. I am a hopeless case. I have lost my angel. I have lost my mind. The days are too long, too heavy; my bones are crushing under the weight of these days.

I will not go back into a hospital. I will simply take a walk into the
water. The pain has become excruciating, constant and endless. It exists beyond time, beyond reality, beyond endurance. Tonight I would take an overdose, but I don’t want to be sick, I just want to be dead.

—From the journal of Dawn Renee Befano, a Maryland journalist, whose body was found months after the date of this entry, floating in a lake.