Cover Essay
Cover essay. TEN. 2001;3(8):8
T.E.N
Th e Ec o n o m i c s o f Ne u ro s c i e n c e
INTEGRATED HEALTH IN CNS MEDICINE
End Game
Dr. Jan Fawcett
Chicago, IL
P a r a d o x i c a l l y, it was Jan Fawcett’s
“determination to be happy in what I did”
that led him to the study of suicide. Determined to follow his own lights, he spent
2 years at the Anapolis Naval Academy,
which convinced him that he wasn’t cut
out for life in the military. Exchanging his
navy blues for a white coat, he attended
Yale University Medical School, and later
did his psychiatry training at Langley
Porter Neuropsychiatric Institute and the
University of Rochester Medical Center.
As a young researcher at the National
Institute of Mental Health, he started
work that would chart his future course: he
began analyzing data on steroid levels in
suicides, searching for the biochemical
underpinnings of the urge to self-destruct.
In 1972, Dr. Fawcett was named
professor of psychiatry at RushPresbyterian-St. Luke’s Medical Center in
Chicago. He happily admits that he
had found his calling as both a caregiver
directly involved in helping patients,
and as an academic, allowed to be a
“student for life.” In 1992, Dr. Fawcett
was appointed director of the Rush
Institute for Mental Well-Being at RushPresbyterian-St. Luke’s Medical Center,
where he continues his work tod a y. Over
the span of his career, he has become one
of the nation’s preeminent authorities on
suicide prevention.
Suicide is the 8th overall cause of
death in the United States. Suicide
attempts are responsible for over
500,000 emergency room visits annually.
The enormity of these numbers masks the
fact that each suicide is an individual
t r a g e d y, and its effects ripple outward
into an individual’s family, friends, and
community. Each one leaves behind the
sorrow of a life ended unnecessarily,
August
2001
and the haunting question: Could it have
been prevented?
Clinicians are charged with—and
indeed can be held legally responsible
for—determining whether a person is at
risk of suicide, and if so, whether they are
at acute risk. But how do you measure
despair? There is no blood test or marker
yet devised that shows suicidal intent.
Caregivers find themselves in a “Catch22”: their suspicions of suicidal intent
cannot be proven until the patient tries to
commit suicide.
Dr. Fawcett has addressed the enigma
of suicide from both its clinical and
biochemical aspects. He has devoted a
substantial portion of his career to
painstaking analysis of the conditions
of patients who do and do not commit
suicide, in hopes of uncovering clear
signposts that will alert clinicians to taking
timely preventive action. His research on
the biochemical basis of depression has
helped provide the hard science underpinning current views of depression as a
chronic and highly treatable illness.
D r. Fawcett became one of the
principal investigators of the NIMH
Psychobiology of Depression Collaborative
Study, a 22-year project that began in
1978 studying the diagnosis and outcome
of depressive illness. The Collaborative
Study marked an important watershed in
the study of suicidality because it followed
a high-risk group of depressed patients
over time. Previous studies had only
looked back at the state of patients who
had committed suicide. In this way, Dr.
Fawcett and his collaborators were able to
compare those who committed suicide
with those who did not, and to ask about
what factors differentiated them.
Dr. Fawcett’s findings contradicted the
current wisdom at the time, determining
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that severe anxiety states and panic
attacks should be treated as acute predictors of suicidal risk. Since anxiety states
are readily treatable, this is indeed an
encouraging finding with important implications for clinical practice. In every
forum he can find, he argues eloquently for
the careful assessment of anxiety in
depressed patients.
In addition to his work on depression,
Dr. Fawcett has done research on alcoholism, a key comorbidity in depression, as
well as bipolar disorder. Recently, he has
investigated the use of drugs to control
alcohol cravings, and has written a book
titled New Hope for People With Bipolar
Disorder: A Guide for Patients and Those
Who Journey With Them. He plans to turn
his focus to the exciting potentials of new
treatments that use learning to reshape the
brain, and possibly to alleviate depression
and the urge to commit suicide.
A rare combination of compassionate
clinician and first-rate empirical scientist,
Dr. Fawcett is routinely named one of the
country’s top doctors in national magazines. In 1989, he was awarded the first
D r. Jan Fawcett Humanitarian Award
from the National Depressive and ManicDepressive Association (NDMDA),
named in his honor. Widely recognized for
his contributions to mental health
research, he received the 2000 Life
Achievement Award for career research
from the American Foundation for Suicide
Prevention (AFSP).
Biochemistry may one day yield an
assay of suicidality, but until then,
Dr. Fawcett is one of the few willing to
explore the corners of the dark nights of
the soul, in the hope of helping more live
to see the dawn.
—Natasha Waxman, MFA
T•E•N