In The Noonday Demon, the definitive book on depression, Andrew Solomon points out that:

Many depressives never become suicidal. Many suicides are committed by people who are not depressed. The two subjects are not parts of a single lucid equation, one occasioning the other. They are separate entities that frequently coexist, each influencing the other.

Given that, defining and understanding "suicidality" can be difficult. It's a tricky subject. When first I became aware of the notion of suicide, I wondered about it (in much the same way that Paulapalooza's son and other inquisitive children will pursue a new concept). Why would a person do that? What would it feel like? If I deemed it necessary, how would I do it? Because death was the singular focus of all of my unhappiness as a child and young adult, I couldn't imagine why anyone would ever commit suicide. I figured that if I ever found myself in a situation in which people typically contemplate suicide (barring irremedial situations like terminal pain or illness), I would see it as an occasion to do whatever I pleased--I would just release myself from all responsibilities and burdens and start over again.

A year or so into my therapy, when the clonazepam began to significantly reduce my anxiety, I became depressed. I suffered through a handful of actual depressive episodes, and discovered pain that I couldn't manage because I felt it in my will and my understanding rather than in my body. I also became aware of what are most accurately described as emotional flinches, but which are, I think, officially referred to as suicidal images, a step short of suicidal ideation. They're the combination of a spasm of not wanting to be the person who felt and experienced what I felt and experienced and a split-second visual image of suicide. They're the combination of yelling or punching the wall and shame, embarrassment, or a similar painful feeling, and the expression of long-repressed (and fermented) pain and anger.

My therapist and psychopharmacologist were alarmed by this turn of events, but I wasn't. I don't know if that can be attributed to the anhedonia that's often a central component of depression (and can allow someone who would never commit suicide to slide into it) or to my core certainty that I'll never commit suicide. My caretakers weren't going to wait to find out which it was. As far as they were concerned, this was suicidality (though I'm not convinced). They switched my medication to Celexa, which addresses both depression and anxiety, and the images have passed.

I've been reviewing my experience as I've been reading Ben Kerschberg's Piercing the Veil. Ben contacted me through this Weblog after reading my descriptions of myself, and asked me to mention his book, the profits from the sale of which will go to the Marshall Pickens Hospital, where he recovered from his unsuccessful suicide attempt last year. Before mentioning it, I thought I'd buy a copy and read it. It's not The Noonday Demon, Darkness Visible, or An Unquiet Mind, as Ben readily admits:

Unlike the artists who have come before me, I cannot adequately describe that Darkness. I cannot find the correct words to paint that Hell. But if my own tale allows even one person to avoid ever having to search for those words him- or herself, then I would relive it all one thousand times...

A very noble sentiment, and I wish him luck. As the book itself makes clear, publicly acknowledging his struggles didn't come naturally to him. His doing so will be helpful to both him (as being vulnerable is the surest means of gaining emotional strength) and others. To that end, he is currently a Fellow in Mental Health and the Law at Yale Law School, where he is likely to do far more good for those he wants to help than he's likely to do through this book. That is important work, and I'm glad that someone so capable and passionate is undertaking it.

The book clearly demonstrates that even relatively privileged and very successful people can be suicidal--that, in fact, success can be driven by the same emptiness that can lead to suicide. But beyond those central points (which are significant), I don't know that the book will help anyone to better understand suicidality, and that's frustrating. Ben describes the onset of his affliction, the night before his seventh birthday, after seeing his parents argue, quite simply:

For the first time in my life, I knew I didn't want to exist. I did not yearn to be at a friend's house or at the movies or playing catch with my friends. I wanted to disappear without a trace. On that evening, seven, cowering, I knew there was another place. And I knew, even then, that there was a trail that would get me there, for its trailhead had just found me. An obsession had begun. My resolve was unflappable.

The trail reappears throughout the book, but we never hear another word about his parents' relationship or how it affected Ben, about his emotional state beyond his certainty that he would one day commit suicide, about the emotional impact of school-age alienation and bullying that's mentioned only in passing, or about many other details that would greatly enhance the reader's understanding of the emotional basis of suicidality. Most children see their parents argue, but most don't become suicidal. Why did he? He mentions seeing therapists at different times prior to his suicide attempt, but never describes their discussions. He doesn't suggest any potential diagnoses (depression, anxiety, etc.), yet toward the end, as he's listing the medications that he now takes (Prozac, lithium, and clonazepam), he describes how they address symptoms of depression and anxiety that he seems to have suffered all along. Thus, it's very difficult to place his suicidality in the context of his life or to determine how it might appear in the context of the lives of those around us.

The one thing that I've personally taken from this book is that I'm not suicidal. Ben describes an almost gnostic certainty (which proved accurate) that he would attempt suicide. I have the same certainty that I won't. That's comforting.