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June 19, 2011
I miss Iris Chang. Though I never met her, her life, her presence, her words, deeply affected me and many others around the world. When she committed suicide in November, 2004, I felt like I'd lost a sister, and the world had lost an important leader. Now, we all have the opportunity to know Iris through the eyes of her mother and best friend, Ying-Ying Chang, in the outstanding memoir The Woman Who Could Not Forget: Iris Chang Before and Beyond "The Rape of Nanking".
Iris Chang first burst into international prominence in November, 1998, with the publication of her second book, The Rape of Nanking. It was the 60th anniversary of the horrendous events that reverberated around the world at the time but then were largely forgotten in the West in the wake of the war and subsequent rise of Japan and Japan-U.S. relations. Over the course of six weeks from December, 1937 to January, 1938, an invading Japanese army murdered over 200,000 Chinese civilians, and raped tens of thousands of women. The stories are brutal and shocking: living people used for bayonet practice; forced acts of incest; mass shootings. A memorable picture I once saw in a profile of Iris (and which is reproduced in her mother's memoir) shows her standing next to photos of crying elderly victims at the exhibit that first sparked her determination to write about the events. She is sad, haunted, her eyes meeting the viewer as if calling upon our very conscience to help soothe the pain.
Her book did just that. She not only chronicled the awful pain, but also the stories of individuals like John Rabe (A Nazi who was horrified by what he saw), Minnie Vautrin (an American) and others who did much to save lives despite overwhelming odds. Iris also became an outspoken activist and strong debater when faced with vigorous Massacre denials by the ultra-right in Japan, and even extending to the Japanese Ambassador at the time. She rightly pointed out Holocaust denial is not tolerated - why should we expect less than full apologies, contrition and reparations from Japanese officials for atrocities committed during wartime? For her strength, vision and clarity, she won many admirers and unfortunately, some detractors.
I really didn't know too much about Iris Chang apart from this topic. I wish she had lived a long life, one that would have certainly been even more influential in Asian American, American and world consciousness. Instead we have another human tragedy. After her death, some called her "the last casualty of the Rape of Nanking", and it was widely reported that she had become overwhelmed by the horrors she recorded; she was at work on another book about the American tank battalion tortured during the Bataan Death March. Her mother's book paints a very different story, though, and one that should be required reading for every parent, every mother and daughter, anyone who's ever loved a woman, every psychiatrist and psychotherapist, and anyone interested in the power of a human life - the "power of one" as Iris called it.
I have never read such a finely detailed account of a child's life from a parent's perspective, from early years to untimely death. This is a mother who was deeply involved in her daughter's life at all stages. Reading it, I felt as close as a reader could to being in the minds of two extraordinary women. Iris is a self-starter from the get-go, extremely talented, driven, dedicated and ambitious, yet very likeable and human at the same time. Her parents' care is evident at every turn, as they encourage their children to do their best, yet emphasize their children's happiness. Letters, emails and conversations form a fine record of loving exchanges about each other and concerns for broader social issues, as well as Iris's burning desire to excel. This is a closely observed life, a closely held life, which touches us with its reach from the personal to the global. There are some minor conflicts and disagreements, as must be expected in any relationship, but I'm left with a sense of abiding respect and affection for the Chang family.
Reading of Iris's rise was more gripping than any of the ROCKY movies for me - I just kept cheering for her and hoping it would never end. But suddenly, about 8 months before she committed suicide, she seems to hit a brick wall. She goes on a grueling book tour for her third book, The Chinese In America, a 500-page tome, which takes her to over 20 cities in a month. She returns exhausted and depressed. Moreover, apparently something happens which makes her fearful. She'd had threats against her since the publication of The Rape of Nanking, but she'd largely ignored these. She tells her mother that someone approached her at a book-signing and said something which she took as intimidation.
Despite advice, she decides to go to Kentucky to interview survivors of the tortured tank battalion for her fourth book. When she arrives, her paranoia worsens dramatically and she ends up in a psychiatric unit. Her parents fly out and bring her home. The next months are filled with appointments with various psychiatrists, and trials of several antipsychotic and antidepressant medications, which don't seem to lift her dark mood or paranoid suspicions. She is even seen in twice-weekly psychotherapy at this time. She has one suicidal gesture (a plan to drink vodka and take sleeping pills) which she doesn't carry out, and then she goes to a gun shop. Finally, she drives a car to a secluded location, and ends her life with the pull of a trigger.
Faced with her unspeakable loss, Ying-Ying Chang, a scholar with a Ph.D in Biochemistry and a career in Microbiology, searches for answers. The Iris Chang of 2004 was markedly different than the Iris who existed before. Dr. Chang reports her daughter had expressed an aversion to the idea of suicide earlier in her life, as well as no clear episodes of any depressive, psychotic, or anxiety disorders. There is no known family history of psychiatric illness. The family engages with the help offered by psychiatrists, even attending support groups and staying in close touch with Iris's doctors. (She is critical, though, of a few failures of attention by the psychiatrists - for example, one insists on collecting the co-pay at the time of the visit, and requires Dr. Chang to cc Iris on emails sent to the doctor. Those psychiatrists who practice this way might think twice after reading these critiques.)
Finally, though, Dr. Chang cannot explain Iris's suicide. She concludes, with the backing of at least one expert from Harvard, that Iris was the victim of the side effects of the antidepressant and antipsychotic she was taking.
There has been a well-publicized "black box" warning on antidepressants since 2004, that they may elevate thoughts of suicide in children with Major Depressive Disorder. Other reports extend this to adults. However, all the research I've seen indicates that there isn't any evidence that antidepressants actually increase suicides (as opposed to thoughts or behaviors). Moreover, there is evidence that the overall benefit of antidepressants outweigh their risks - for example, the suicide rate in children increased after a drop in antidepressant prescriptions occurred in 2004 (http://www.psychiatrictimes.com/display/article/10168/1345423). Also, I have heard anecdotally that the suicide rate in Japan has fallen since a major SSRI was introduced there. But that is not to say that it isn't possible that Iris and other patients could have experienced agitation and suicidality because of medications.
I think the answers are much harder, though. Iris's suicide note offers a clue:
Dear Brett, Mom, Dad and Mike:
For the last few weeks, I have been struggling with my decision as to whether I should live or die. As I mentioned to Brett, when you believe you have a future, you think in terms of generations and years; when you do not, you live not just by the day - but by the minute. You don't want someone who will live out the rest of her days as a mere shell of her former self...I had considered running away, but I will never be able to escape from myself and my thoughts. I am doing this because I am too weak to withstand the years of pain and agony ahead. Each breath is becoming difficult for me to take...The anxiety can be compared to drowning in an open sea. I know that my actions will transfer some of this pain to others, indeed those who love me the most. Please forgive me. Forgive me because I cannot forgive myself.
Love,
Iris
(continued on page 2)
Certainly her family knows her and her situation best, but I can't help but think that these are the words of a woman who feels her life has irrevocably changed. She believes that she has lost her most prized possession, her ability to think clearly. Iris believed that she was doomed to live out her days as "a shell of her former self", and this was unacceptable to her. Was it the paranoid thoughts, the loss of reason? Was it despair at needing to take medications? Certainly, Iris had a well-founded distrust of authority; in her paranoid state, this must have also transferred to a distrust of psychiatrists more generally. This may have further isolated her. Indeed, Dr. Chang mentions that Iris was not fully open with her doctors.
Iris was a brilliant woman. She diagnosed her son with symptoms of autism long before his doctors thought there was anything to be concerned about. I suspect that she came to the conclusion that she was on a downward path, and thus that life wasn't worth living. I wish it weren't so. I wish she had a better connection to doctors and medical support. I wish she had never bought a gun (it shouldn't be possible for someone with a recent psychiatric admission to purchase a gun so easily). I wish that mental illness didn't have such a stigma - people can live productive, useful lives even when burdened so.
Suicide and war are the second and third highest causes of death among females age 15-44 (and they are in the top five for men in that age range). Asian American women have the highest suicide rate of any ethnic group in younger and older age cohorts.
This wonderful life and terrible loss, made resonant by a mother's loving words, is a cause for reflection and re-dedication to saving lives and ending war. In November, 2004, a mother lost the apple of her eye. We lost our Iris. May we never lose another.
Postscript:
After writing much of this, I attended a memorial for victims of the Invasion of Okinawa at the close of World War II. Almost a quarter million people died then, many of them victims of retreating Japanese soldiers who forced civilians to commit suicide. Over a hundred years ago, the King of the Ryukyu Kingdom, precursor of Okinawa, wrote
The time for wars is ending
The time for peace will come soon
Do not despair...
Life itself is our treasure.
I only wished Iris Chang could have experienced those words; she surely would have been an eloquent spokesperson for all oppressed peoples. If only every person thinking of suicide could realize that "life itself is our treasure."
For Further Reading:
Jamison, Kay Redfield. Night Falls Fast: Understanding Suicide. Vintage Books, 1999
http://www.amazon.com/gp/product/0375701478/ref=as_li_ss_tl?ie=UTF8&tag…
Chang, Ying-Ying. The Woman Who Could Not Forget: Iris Chang before and beyond the Rape of Nanking. Pegasus, 2011
http://www.amazon.com/gp/product/1605981729/ref=as_li_ss_tl?ie=UTF8&tag…
UPDATE 6/20/11
New data further supporting antidepressant use:
http://psychiatry.jwatch.org/cgi/content/full/2011/620/1
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