Once considered a thorny question for theology, philosophy, and sociology, suicide is being recast—like much else in our society—as a medical problem. Self-harm—as it’s now commonly termed— is understood to be latent in some bodies, similar to the gene for cancer, indeed as a sort of cancerous mutation of our characters, and therefore—in a more hopeful way—also subject to treatment—unless the patient self-terminates first. What seemed, until recently, the most intimate and possibly important of philosophical questions—does a person have the right, or, even, under special circumstances and in certain cultures and epochs, the duty to end one’s earthly existence—has been classified as a medical disease, and no more the distinctive product of an individual consciousness than, say, liver failure.

At the time when he was “pacing the roof of [his] apartment building in Brooklyn, climbing down the fire-escape ladder and hanging by [his] hands from the railing, then climbing back up with sore palms and lying on the roof, in a ball,” Antrim was among the best—if not the best—of a group of writers that includes George Saunders, Ben Marcus, and Sam Lipsyte who from one angle or another can be seen as the literary inheritors of the pioneering “experimental” writer, Donald Barthelme. In different ways, each of these writers combined a surreal, comic sense of the absurd with a formalist/minimalist aesthetic and the male pathos of John Cheever and Richard Yates into a particularly American poetics of befuddlement, if never quite despair. Life is mostly awful, because we are so ourselves; we sell ourselves short, but we also overreach; in both cases because we are trapped. Yet there’s often a horizon of hope, located in the family, or the promise of decency. It’s contemporary literature’s version of the sensibility that produced The Simpsons and movies like Groundhog Day.

Elect Mr. Robinson for a Better World, Antrim’s 1993 début, tapped a vein of unconscious cruelty amid civic righteousness that wouldn’t manifest in real life until the 2000s; The Verificationist remains the best recent novel about the American psychotherapeutic establishment, even as it stages one therapist’s midlife and marital crisis over the course of a single pancake supper at a fictionalized IHOP, during which the narrator literally floats. In “An Actor Prepares” (1999) the tone-setting opening piece of the short story collection The Emerald Light in the Air—Antrim’s most recently published work before the present one—the middle-age narrator directs and fatefully miscasts himself in a liberal arts college’s avant-garde student production of A Midsummer Night’s Dream—with the result that everyone, not least the institution itself, is exposed. Throughout his work, but especially in the short stories, Antrim displays a physical comedian’s gift for gesture, rhythm, and timing. He doesn’t just write about the feeling of floating or stumbling drunk at a dinner party; he makes the reader feel it.

In brief, Antrim had mastered the knack of grabbing readers by their shortening attention spans and then carrying them to a reckoning with various forms of deep psychic distress. Often told in the first person, these novels and stories perform the psyche’s intricate evasions and half-recognitions, even as they show them; they are chronicles of irrational behavior and cries for help that only the reader can answer.

The Donald Antrim we initially encounter in One Friday in April often sounds a lot like the characters in his fiction: manic, brilliant, at the mercy of forces over his head but also in his head. The opening section is dominated by cycling repetitions and rhetorical questions: “The itch in my temple, the need for a bullet was constant. The itch wasn’t topical. It wasn’t itchy skin. If I scratched it, if I could somehow dig into my brain and scratch the itch, then I could feel clarity and peace. Without the bullet I would never have either. But when had I ever felt clear? When had I ever been peaceful? How long until it was time for another Ativan?”

Antrim captures the rhythm of a certain very lucid kind of disordered thinking. It’s remarkable, after everything that follows—including years of electroshock therapy—that Antrim can reproduce the twists of his thoughts as they then were, with such forensic accuracy. It’s as if years of writing these unreliable narrative voices had prepared him to write himself, equally unreliably.

What’s new, for Antrim, is that there is now a solid and unambiguous center. That location of meaning, stability, and what he often calls “safety,” is the hospital, full of kindly nurses and caring, if sometimes terrifying doctors. This is also new for American literature. Readers raised on One Flew Over the Cuckoo’s Nest or Girl, Interrupted, or, God forbid, versed in the work of Michel Foucault, would expect a more countercultural or at least more skeptical view of organized psychiatry. At one moment, Antrim narrates what appears to be a classic scene of “psych ward” literature: He describes his conviction that he’s been placed “in the wrong hospital” and that he’s been confined against his will. He rushes the nurses station, where he’s confronted by his attending physician and a team of aides. But here the expected outcome is turned on its head: Instead of being straightjacketed, injected, and locked up, Antrim is firmly and directly talked down. So much so that he eventually realizes that once again he was not in control of his actions. Trust your doctor!

And support your doctors and nurses and hospital workers, too: “We have the hospital. I was there,” Antrim writes at the end of what he sometimes calls “this letter, this report,” “The hospital’s floors and white walls, and the bedrooms and the bathrooms were clean. The patients were not beaten, humiliated, or shoved aside. Medication was never forced. Solitude was possible but no one was kept in isolation … There was soap on the bathroom sink ledge, and coffee with breakfast and the comfort of other patients. We need our hospitals.”

Two years after their conversation, Wallace would commit suicide. Antrim comments that “he felt like he lost a comrade in survival.” Then, in a brief paragraph, he proceeds to invoke the age-old clichés about art and madness only to set them aside, “What is genius? Might fame be linked with suicide? These are old questions.” Instead, Antrim asks a different question that brings us a little too close to the simplistic conclusion that Dave, like Donald, and probably also like Vincent, Virginia, Sylvia, and Kurt weren’t quite in their right minds when they decided to kill themselves, “Is it logical to imagine that psychotic self-evaluations are cogent? The notion that we choose death over pain, fundamental to our current thinking on suicide, suggests that we choose at all, as if some part of us exists outside the illness, unaffected, taking in the situation and making rational decisions.”

Moments like these, however, are where Antrim’s memoir begins to reveal the limitations of medicalized culture. Antrim surrenders any claim to a part of himself outside the illness. He did this in order to survive, and no one can fault him for wanting that. This is a large part of the book’s power: As an account of disease and mental illness, it’s designed also as a kind of “stations on life’s way” for anyone who has crossed over into suicidality and yet retains, somewhere, a wish to find a path out of it.

Describing his ECT treatments, Antrim switches to the second person, putting the reader in the position of the helpless patient. “You tell the doctors that you want to get better. You’ve only ever wanted to get better. There’s a bite plate on the metal table beside the anesthesiologist.” The pronoun switch and the physical details aren’t there to, um, shock the reader, but to enlighten.

Like all good testifiers, Antrim wants to reduce the terror of anyone who might find themselves where he was and is lucky enough, as Antrim was not, to have this book. His purpose, much like Elizabeth Wurtzel’s embrace of the wonders of Prozac three decades earlier, is missionary. At the end, he calls for “a paradigm shift in our understanding of suicide: neither will nor agency, only dying.” Instead of insight or personal truth, he calls for “a great commitment to the hospital, to our community, and our health. What is the hospital if not all of us? What is medicine if not touch?”

One doesn’t need to be a fully paid-up member of the anti-psychiatry movement in its various recent historical forms (whether Thomas Szasz, R.D. Laing, Felix Guattari, or Scientology) to see that certain very important elements of human meaningfulness are lost by fully accepting the “patient-disease” model of the would-be suicide along with “the world as hospital” and “intimacy as a form of medicine.” The French schizophrenic poet and mystic Antonin Artaud—who did not kill himself despite (Antrim might say because of) years of brutal hospitalization and enforced insulin injection therapy, a proto-form of ECT—wrote that “even to become suicidal, I have to wait for the return of my ego … Before I commit suicide I have to be certain that I exist and that I can die.” While interned at the Rodez asylum, Artaud theorized that Van Gogh’s suicide was neither choice nor illness but the inevitable result of the conflict between Van Gogh’s creative consciousness and the consciousness of the doctors and social forces that wanted to help him but also domesticate him; to make him and his work “safe.” (“For it was not because of himself, because of the disease of his own madness that Van Gogh abandoned his life. It was under pressure of the evil influence of Dr. Gachet, a so-called psychiatrist.”)  So Van Gogh became, for Artaud, “The Man Suicided by Society.”

In Artaud’s way of seeing and feeling, as elucidated most recently from the imagined perspective of his mother by French author Justine Levy, suicide is the outcome of an assault by one mode of consciousness against another. That both modes might exist inside the same body does not make one kind of consciousness any less external or social. The other essence (“what and who he was”) that Van Gogh had discovered in himself was transcendental and trans-human and enabled him to see into the life of things. Geniuses are little messiahs. For these individuals, “to be or not to be” is not the question, rather it’s “how to be,” amid the pressures of contradictions. If the pressure becomes intolerable, then the suicidal impulse presents itself.

This way of thinking about suicide isn’t really that far from the contemporary medical view, given voice in Antrim’s book. Both men understand suicide as something that happens to someone in a gray zone between action and reaction—an accident that might as well be a murder. The conditions in which a suicide could take place, however, are always around us. The difference between Antrim’s and Artaud’s way of thinking, however—let’s call it “psycho-social”—is in the emphasis that Artaud puts on creative consciousness. He posits certain kinds of suicide as a violence against creativity—directed from without but carried out from within by a corrupted deep state lodged in the soul.

By contrast, One Friday in April has very little to say about Antrim’s own creative work, or his own peculiar consciousness and beliefs, prior to his bout with suicide. He enters his most intense period of hospitalization just as his nonfiction memoir about his alcoholic, abused and abusive mother, prophetically but also ironically titled Afterlife, is about to be published. He feels painfully guilty. He tells us that he’s convinced he’ll never write again. He had cheated on his girlfriend and felt bad about it. He enters a period of intense mourning in which he both regrets his decision to have become a writer, regrets the unavoidable traducing of his mother in prose, and also regrets not being able to write. But he says nothing about the kind of writing he was doing, or the kind of writing he hoped to do.

Part of this reticence must stem from the author’s socially laudable desire to appear as a type of Everyman, as well as a palpable sweetness of character. The book’s frequent recourse to the second person establishes Antrim’s desire to connect with an ideal readership of potential fellow would-be suicides, which is a lot of us, myself included. At the same time, Antrim’s experience of suicide and survival is—if not unique—influenced by his own experiences with top-quality mental health care unavailable to most of the population, a solid supportive group of friends, lovers, and ex-lovers—all acknowledged—and probably buttressed by prior validating experiences of personal success. Antrim had already survived his dysfunctional, abusive family more than once, even as they reached out to claim him one last time, in midlife. At no point, even as Antrim closes his memoir with the happy ending of his late marriage, does he choose to reflect on what might set him apart from so many of those who are drawn—or pushed—to contemplate or bring about the end of their lives.

I don’t mention these things to diminish Antrim’s personal suffering, which was tremendous, but to point to another limitation of the pathologization-plus-empathy model in handling the problem of suicide. For all of its Forsterian “only connect-ness,” One Friday in April is proof that not every suicide starts at the same place or ends up with the same kind of acceptance. At one point, Antrim wisely observes that “The suicide cannot feel or live on hope. Our hope is gone.” Yet the image he finally presents of himself—happily settled down with a loving wife and the family connection he craves, still with a job, once again a published author, able to write—seems like the kind of ending that can be vouchsafed to very few.

What would he, or the doctors, have to say to those who have lost a child, who have witnessed atrocities or committed them, who have lost not just homes and a sense of belonging but entire life-worlds, languages, and ways of being that can never be recaptured or replaced? Contrary to the hopeful view that Americans are still inclined to take as normal, there are things that no hospital, no medical regime, however good, can cure. For certain events, in certain lives, there’s still only religion, philosophy, and the madness of art.