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  Seasonal patterns of suicide

  The peaking of suicide in the spring and summer can be demonstrated in data collected as long ago as the fifteenth century and as recently as the last few years. The graph on this page shows monthly patterns of suicide in several populations: England, 1485–1715; Europe (France, Italy, Belgium), 1840–1876; England, 1865–1884; fifteen World Health Organization countries, 1951–1959; and the United States, 1980–1995. Across all time periods and all countries the spring-to-summer peak and the winter trough were found.

  It is clear, as well, from looking at the graph, that the seasonal effect was more pronounced in earlier centuries—for example, in England (1485–1715) and Europe (1840–1876)—than it has been in later ones, such as the fifteen World Health Organization countries (1951–1959) and the United States (1980–1995). This lessening in amplitude over time was also apparent in a major Danish study that examined seasonal patterns in Denmark between 1835 and 1955 and in subsequent investigations carried out in Australia and New Zealand, Canada, Finland, Hungary, Sweden, and the United States. The explanations for this “deseasonalization,” as Jürgen Aschoff of Germany’s Max Planck Institute has described it, center on the idea that there has been a decrease in our biological responsiveness to the natural environment and that this decrease has been brought about by artificial lighting, central heating and air-conditioning, industrialization, and urbanization. It is also possible that some of the recent deseasonalization has taken place because antidepressant medications may be more effective in preventing suicides that have a strong seasonal component than those that do not.

  Emile Durkheim observed last century that there was greater seasonality in suicides in rural areas than in urban ones, a finding replicated earlier this century in the United States and within the past few years in South Africa. Urbanization has brought with it more distance from the rhythms of light and heat in the natural world. Electricity, artificial lighting, interrupted sleep patterns (including less total sleep time), and central heating all have decreased the impact of the natural seasons on the brain and body. Yet the seasonal impact remains strong.

  Why should suicide ebb and flow with the seasons? And why should suicide occur more often in the months of sunlight, instead of during the bleak, drizzly months of winter? We know, of course, that the daily rest-activity cycles are deeply affected by changes in daylight and temperature. Hibernation of animals is the most obvious example of this relatedness. Profound behavioral, endocrine, and other physiological changes are common in response to seasonal changes in light. In humans, variations in mood, energy, sleep, and behavior are also strongly affected by the seasons, but they are far more pronounced in patients with mood disorders. In fact, many neurobiological systems of relevance to mood disorders, and presumably to suicide as well, show pronounced seasonal patterns; these include levels of neurotransmitters, sleep and temperature regulators, melatonin, testosterone, estrogen, thyroid, and other hormones. During the winter, for example, which has the lowest rate of suicide, plasma L-tryptophan (a precursor of serotonin) is at its peak, as are melatonin and thyroid hormones and possibly cholesterol as well. All are thought to be deeply involved in the regulation of mood, activation, or the sleep-wake cycle. The effect of seasonal changes on serotonin and other transmitters remains unclear.

  Of particular relevance in discussing seasonal patterns in suicide, however, is the strong seasonal variability in the occurrence of the major psychiatric disorders, depression, mania, and schizophrenia. More than two thousand years ago, Hippocrates observed that melancholia was more likely to occur in the spring and autumn, and other ancients noted a strong tendency for attacks of mania to occur during the summer months. These observations have been replicated by the more systematic work of recent scientists. Hospital admissions for mania, it has been shown by many investigators, are far more common in the late spring and summer. Schizophrenia, likewise, appears to be likely to occur or recur during the summer months.

  Depressive episodes show a more diverse seasonal pattern. There are generally two broad peaks for hospital admissions for depression: during the spring and during the autumn. Hospitalizations for depression are more likely to reflect the severity of the depression—including suicidality—than the beginning of the episode per se. In fact, many depressive episodes begin in winter but reach their maximum severity or dangerousness in the early spring. Hospital admission dates for mania, on the other hand, are more immediately tied to the actual onset of manic episodes than they are for depressive ones because of the more quickly emergent nature of mania.

  Several things are likely to contribute to the seasonality of both the severe mental illnesses and suicide. The biological changes brought about by alterations in temperature and the length of daylight are likely to underlie both phenomena. Seasonal fluctuations in the brain’s chemicals, importantly serotonin, may have a forceful effect not only on an underlying predisposition to suicide but also on psychopathological states such as mania, violence, depression, and psychosis. This is also true of their effect on suicide. Violent suicides show a far stronger seasonal pattern than do nonviolent ones; they, like homicide and other violent behaviors, are much more likely to occur in the late spring and summer months. A seasonal effect on factors likely to change levels of omega-3 essential fatty acids—such as fluctuating availabilities of foods and vegetables and an increased intake of fat-rich foods during winter solstice holidays—has been suggested by scientist Joseph Hibbeln.

  Manic and schizophrenic episodes during the summer months precipitate highly volatile, agitated, and paranoid states that may in turn lead to impulsive and violent acts such as suicide. Too, because most individuals who become manic also go through a depression before or after their mania, they are at increased risk of suicide during those times as well. Mixed states, that is, coexisting depression and mania, are also likely to increase during this time and are among the most deadly of psychopathological conditions. These may occur independently, as part of the transition between depression and mania, or in the transition between mania and normal psychological functioning. There is an overlap in depression and mania peaks in the spring and fall that in turn correlates with the peaks in suicide.

  Depression carries with it a greatly increased risk of suicide not only during its acute phase but also during its slow and often tempestuous period of recovery. Suicide is not at all uncommon at the end of the worst part of the depression, when mood seems to be improving and energy has returned. Nor is it rare during the early stages of the descent into despair. Depression is often subtly mixed with perturbing manic symptoms, and many patients initially diagnosed as depressed turn out, on closer clinical evaluation, to experience mixed states as well.

  Severe depression, manic-depression, and schizophrenia may additionally act as a “second hit” for those genetically vulnerable to suicide; that is, the pain and agitation of psychosis, the biological events it sets into play, or the anguish and frustration at again becoming ill may interact lethally with a susceptible constitution. Spring and summer are deceptive notions and contain a capacity for self-murder that winter less often has. Or, as Edward Thomas believed, winter lingers far past its season:

  But these things also are Spring’s—

  On banks by the roadside the grass

  Long-dead that is greyer now

  Than all the Winter it was;

  The shell of a little snail bleached

  In the grass; chip of flint, and mite

  Of chalk; and the small birds’ dung

  In splashes of purest white:

  All the white things a man mistakes

  For earliest violets

  Who seeks through Winter’s ruins

  Something to pay Winter’s debts,

  While the North blows, and starling flocks

  By chattering on and on

  Keep their spirits up in the mist,

  And Spring’s here, Winter’s not gone.

  THE COLOURING TO EVENT
S:

  THE DEATH OF MERIWETHER LEWIS

  We were now about to penetrate a country at least two thousand miles in width, on which the foot of civilized man had never trodden; the good or evil it had in store for us was for experiment yet to determine.… However, as the state of mind in which we are, generally gives the colouring to events.… I could but esteem this moment of my departure as among the most happy of my life.

  —MERIWETHER LEWIS, APRIL 7, 1805

  THE YOUNG red-haired Virginian had thought hard and well about the provisions his men should take with them, but the planning cannot have been easy. A few dozen men were about to set out on an eight-thousand-mile journey across the unmapped American wilderness. There was little they could draw upon to predict the quick variability of the land or to grasp its vastness. The expedition would be far afield from usual calculation and experience, but because of this it would in the end be unmatched for what it discovered about the country, its inhabitants, and its resources.

  The trip would be dangerous, it would be arduous, and it would take more than two years to complete, but the expedition’s leader was anything but bowed or intimidated. He had the confidence of the president who had chosen him, as well as a firm, well-placed belief in his own ability to command men and to carry out the scientific work at the heart of the expedition’s mission. He had prepared for the trip with care and intelligence, and he was exhilarated to have the chance to explore and chart the unknown lands.

  His country had just, overnight, doubled in size. On July 4, 1803, the U.S. Congress had purchased the Louisiana Territory from Napoleon. For three cents an acre, the government had acquired the vast, murkily bordered lands stretching from the Mississippi River to the Rocky Mountains. It was clear to some that it was only a matter of time until America pushed past the western mountain ranges and took the nation’s expanding borders to the Pacific Ocean. In the meantime, the country needed knowing.

  Captain Meriwether Lewis, the young Virginian who had drawn up the plans for the westward expedition, was a U.S. Army officer who had lived in the wilderness frontier and was well acquainted with Indian cultures. He was six feet tall, restless, intrepid, and profoundly and wide-rangingly curious; he knew life not only from the frontier but, more recently, from the inside of the president’s house as well. Thomas Jefferson, two weeks before taking office in February 1801, had written to Lewis asking that he help with the “private concerns of the household” and, more intriguingly, “to contribute to the mass of information which it is interesting for the administration to acquire.” Lewis’s “knoledge of the Western country, of the army and of all of it’s interests & relations has rendered it desirable” that he join Jefferson as the president’s private secretary.

  Meriwether Lewis accepted the position with speed and delight, and for two years the fellow Virginians, separated in age by nearly thirty years, shared meals, confidences, and several hours of most days together. Both men were singularly inquisitive by nature, and both were passionate for the exploration of the country’s vast lands—the young officer for the exploration itself, the president for what could be learned from it. In 1802, Jefferson decided that Lewis should command an expedition to the Pacific Ocean; he then set out for the young officer a remarkable course of tutelage in subjects ranging from geography and natural history to medicine, botany, and astronomy.

  Jefferson had high expectations for the westward journey, and he had a thousand questions and requests: “The object of your mission,” the president wrote Lewis in June 1803, “is to explore the Missouri river, & such principal stream of it, as, by it’s course & communication with the waters of the Pacific Ocean, may offer the most direct and practicable water communication across this continent, for the purposes of commerce.” Lewis was to “take observations of latitude & longitude … with great pains and accuracy,” and he was to make several copies of all notes and observations—one to be written “on the paper of the birch, as less liable to injury from damp than common paper”—in order to guard against damage or loss. Lewis was to determine the names of the Indian nations, “& their numbers; the extent & limits of their possessions … their language, traditions, monuments; their ordinary occupations in agriculture, fishing, hunting, war, arts … the diseases prevalent among them, & the remedies they use … peculiarities in their laws, customs and dispositions.”

  Lewis and his men were also to record the “soil and face of the country, it’s growth & vegetable productions … the animals of the country generally … the mineral productions of every kind … Volcanic appearances.” Climate was to be carefully noted “by the proportion of rainy, cloudy & clear days, by lightening, hail, snow, ice, by the access & recess of frost, by the winds prevailing at different seasons, the dates at which particular plants put forth or lose their flowers, or leaf, times of appearance of particular birds, reptiles or insects.”

  Jefferson’s instructions to Lewis could not have been written by anyone else. As Donald Jackson, the editor of the correspondence and documents of the Lewis and Clark expedition, has put it: “They embrace years of study and wonder, the collected wisdom of his government colleagues and Philadelphia friends; they barely conceal his excitement at realizing that at last he would have facts, not vague guesses, about the Stony Mountains, the river courses, the wild Indian tribes, the flora and fauna of untrodden places.”

  The president had no doubt that if anyone could be trusted to carry out his requests, it would be Meriwether Lewis. “Capt. Lewis is brave, prudent, habituated to the woods, & familiar with Indian manners & character,” Jefferson wrote to Benjamin Rush, the eminent Philadelphia physician from whom Lewis was to learn medicine in order to look after his men on the expedition. “He is not regularly educated, but he possesses a great mass of accurate observation on all the subjects of nature which present themselves here, & will therefore readily select those only in his new route which shall be new.” After Lewis died, Jefferson elaborated further upon his friend’s temperament and character: “No season or circumstance could obstruct his purpose,” Jefferson wrote. He possessed a passion for “dazzling pursuits”; had “enterprise, boldness, and discretion,” “courage undaunted,” and a “firmness and perseverance of purpose which no thing but impossibilities could divert from its direction.” His fidelity to truth was “scrupulous.”

  In the final paragraph of the president’s extraordinary and detailed instructions to Lewis, Jefferson requested that he designate a second in command who could take over Lewis’s responsibilities should he die on the expedition. Lewis decided to appoint a co-leader instead and chose for the position William Clark, an officer he greatly admired and liked and under whom he had previously served.

  By the late summer of 1803 the expedition was under way. The leaders and their men set out with fishing hooks and tents; mosquito netting, whiskey, and salt pork; Pennsylvania rifles and axes; sextants and telescopes; lamps and kettles and saws. They left with provisions for most imaginable contingencies, and they took, as well, items of exchange for the Indians they would encounter: boxes of fabrics and bright things—500 brooches, 72 rings, 12 dozen looking glasses, 3 pounds of beads—tomahawks and knives; striped silk ribbons and calico shirts; and 130 rolls of tobacco. There were, for the inevitable fevers and injuries along the way, tourniquets, lancets, and medicinal teas. Laudanum, an ease for almost any ailment, was boxed up as well, as were cloves and nutmegs to disguise the acrid taste of improvised brews and tonics. Peruvian bark, containing quinine, was included to fight malaria.

  With what they had and knew, the men could cross rivers and plains, build boats, and survive in the mountains. They could barter for goods, and they could defend themselves. But two of the men, Lewis and Clark, could also measure, describe, and write down what they had observed and where their journey had taken them. They had provisions for history—100 quills, 1 pound of sealing wax, 6 papers of ink powder, and 6 brass inkstands—and with their quills and ink they filled red morocco-bound journals and an e
lk-skin field book with precise and captivating scientific records of their twenty-eight-month journey across the American continent.

  The Corps of Discovery—Lewis and Clark and their small contingent of soldiers, hunters, woodsmen, blacksmith, cook, and carpenters—went into the country’s unmapped territories and mapped them; explored its rivers and mountains; dug canoes out of cottonwood trees; did commerce with the Indians; and at times stayed among them. They caught fish and shot game. They walked forever, took the measure of the lands and rivers they crossed, and then, after extracting from the stars what they needed for their bearings, the leaders of the expedition would start to write. They filled their journals with detailed descriptions of the plants and trees they had discovered, new animals encountered, the flowings of waters and the structure of the mountains, and the medicines or the discipline they had doled out to their men.

  The journals of Lewis and Clark are vivid and immediate; they pull the reader into the unexplored continent and wildlife of wilderness America. Here, for example, is Lewis writing about weather, the taste of a beaver tail, and the gait of porcupines. It is May 1805, and the expedition is making its way upstream on the Missouri River: