We all move uneasily within our restraints.

Once a restless or frayed mood has turned to anger, or violence, or psychosis, Richard, like most, finds it very difficult to see it as illness, rather than being willful, angry, irrational or simply tiresome.

But then back on lithium and rotating on the planet at the same pace as everyone else, you find your credit is decimated, your mortification complete: mania is not a luxury one can easily afford. It is devastating to have the illness and aggravating to have to pay for medications, blood tests, and psychotherapy. They, at least, are partially deductible. But money spent while manic doesn't fit into the Internal Revenue Service concept of medical expense or business loss. So after mania, when most depressed, you're given excellent reason to be even more so.

I think wanting to write is a fundamental sign of disease and discomfort. I don't think people who are comfortable want to write.

In depression, your capacity to feel just flattens and disappears and what you feel is pain and a kind of pain that you can't describe to anybody. So it's an isolating pain, a completely isolating pain.

Each way to suicide is its own: intensely private, unknowable, and terrible. Suicide will have seemed to its perpetrator the last and best of bad possibilities, and any attempt by the living to chart this final terrain of life can be only a sketch, maddeningly incomplete

It is tempting when looking at the life of anyone who has committed suicide to read into the decision to die a vastly complex web of reasons; and, of course, such complexity is warranted. No one illness or event causes suicide; and certainly no one knows all, or perhaps even most, of the motivations behind the killing of the self. But psychopathology is almost always there, and its deadliness is fierce. Love, success, and friendship are not always enough to counter the pain and destructiveness of severe mental illness