Suicide, the disease .

“I believe that suicide is a natural history, a disease process,” Donald Antrim writes in One Friday in April, his recently-published book on his struggles with suicide and depression. Suicide is, in Donald’s words, “not an act or a choice, a decision or a wish.” This, in fact, is the central interrogation of the book: the question of free will for the suicidal man.

The trouble, of course, is that suicide is generally defined as willful self-killing. But this is not the view Antrim takes, at least in his case. Rather, he sees suicide as an illness “with origins in trauma and isolation, in deprivation of touch, in violence and neglect, in the loss of home and belonging.” To introduce his illness, Antrim brings the reader into the titular Friday in April, where he alternates between pacing on the roof of his apartment and hanging from the fire escape. While Donald came to the roof to jump and die, dying was not his life’s plan; this was the culmination of his disease’s progression, beginning years earlier, much like the loss of ambulation in someone with ALS.

Fortunately, Antrim ultimately climbed down from the roof, where he was promptly hospitalized. Like other works in the canon of mental illness, we see a glimpse into the world of psychiatric treatment: involuntary confinements; voluntary confinements; medications like Klonopin, Ativan, and Nortriptyline; the side effects of those medications like weight gain; hypochondria; psychotherapy; electroconvulsive therapy; no therapy; being pushed in a wheelchair as if your legs were broken; being handcuffed by the police as if you were a criminal.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not recognize suicide as a disease — but rather the consequence of other psychiatric conditions — though the latest edition of the DSM introduced suicidal behavior disorder as a “condition for further study,” alongside conditions like Attenuated Psychosis Syndrome and Caffeine Use Disorder.

If suicide is a disease, then Donald Antrim is not the only accomplish writer to have suffered from it. In the book, Donald recounts hearing the devastating news that the preeminent novelist David Foster Wallace had taken his own life. In this tragic act, Wallace joined Ernest Hemingway, Virginia Woolf, and F. Scott Fitzgerald, a fact that most English courses politely omit. (The association between prose and mental illness may not be a coincidence; in one study, it was found that authors were more likely to have psychiatric conditions such as schizophrenia, bipolar disorder, and depression.)

The great tragedy of our time, though, is that suicide does not solely afflict the artisians, but people from all walks, particularly those between the ages of 10 and 34, where suicide is the second leading cause of death. Regardless of its place in the DSM, this is a public health crisis, recently recognized by a special Surgeon General report.

I will not editorialize Antrim’s thesis on suicide as a disease. But this is crucial to understand: Antrim’s account is not a plea for pity nor a cry for help — it is a history of suffering and survival. There are many people, though, who struggle with suicide and in fact commit suicide who were unable to tell their story. The people left behind may be consumed with guilt, anger, and an inability to understand why their loved one died from this disease. Thus, I will end this morbid discussion with my favorite quote by David Foster Wallace, who captured the aphasia of mental illness better than anyone else in The Depressed Person:

“The depressed person was in terrible and unceasing emotional pain, and the impossibility of sharing or articulating this pain was itself a component of the pain and a contributing factor in its essential horror.”