Posts tagged Suicide
Posts tagged Suicide
Is it melancholy to think that a world that Robin Williams can’t live in must be broken? To tie this sad event to the overarching misery of our times?
– Russell Brand, comedian/actor
Like millions, I am sitting with the fact that one of the funniest people to grace the planet has died by his own hand. Robin Williams’ death has hit people of my generation, Generation X, especially hard. After all, his face flashed often across our childhood screens. Mork and Mindy episodes were a source of solace for me as a little girl, as I bounced around between foster homes and family members’ homes, while my single mother cycled in and out of the state mental hospital, fighting to survive. I could laugh and say “nanu, nanu – shazbot” and “KO” and do the silly hand sign and forget for just a little while about living a life I didn’t ask for.
“You’re only given one little spark of madness. You mustn’t lose it,” may become one of Robin Williams’ most famous quotes. I was always struck by how he moved so seamlessly between wacky comedy and the most intense dramas. He was so magnificently able to capture the human experience in all its extremes. He threw all that intensity right into our faces, undeniable, raw, frenetic. He showed us our own naked vulnerability and sparks of madness and gave us permission to laugh in the face of all that is wrong in this world.
In the wake of his death, many people are understandably jumping to identify causes. Depending on who you talk to, Robin Williams’ suicide was caused by depression, it was caused by bipolar disorder, it was caused by the drugs, prescription or otherwise. We just don’t know.
As a suicide attempt survivor myself, I can attest that it’s not that easy to find any single cause for the urge to die. It’s true that along with street drugs, SSRI antidepressants and other psych drugs can certainly increase suicide risk in some people. A decade ago, I was one of many who fought and won to get to the FDA to put a black box warning on SSRIs to warn the public of these very real risks. While a drug, legal or illegal, may give us the impetus we wouldn’t otherwise have had to act on suicidal thoughts, for some of us it’s more complex than that.
Our reasons for wanting to die are as varied as our reasons for wanting to live. That, I believe, is the great mystery of suicide.
But I invite us all not to fear the mystery; not to be struck hopeless by it. We can save each other’s lives; better yet, we can find and share reasons to keep on living. If we have 20 seconds, we can share information about a hotline or a warmline. But if we want to really see this horrific epidemic end, we all have to get more involved.
As someone who has looked into the void and longed for it more than once, I can attest that anyone who reaches out in those darkest of times is truly remarkable. It is, tragically, when I am most distressed and most in need of love and acceptance, that I have the hardest time reaching out. This is not an absolution of personal responsibility, because we all must accept some measure of that; rather a recognition that we shouldn’t put the full onus on a suicidal person to “reach out” and “ask for help.” We need to reach out and help. I have written about the problems with the master narrative of suicide prevention, and how punitive and dehumanizing much of the “help” out there currently is. This blog isn’t about that. I’m talking about help that heals.
My point is that we must change the way we relate to ourselves and one another. In revolutionary ways. We must wake up to the fact that we have been socialized since birth to hide the fullness of who we really are. Robin Williams got to act it all out and the world loved him for it. He expressed the madness, the wildness, that we have been conditioned to hide. We are generally chastised for laughing too hard or crying too loud or being too sensitive. We have been trained to put on a proper face and act like all is well. If for some reason we can’t naturally do that (and most of us can’t), we devise ways to cope with the awful unbearableness of it all. They may be fairly innocuous, like binge watching Orange is the New Black in bed all weekend long. Or we may seek to stop the pain in innumerable ways that we know will kill us in the end — from binge eating to chain smoking to staring down a bottle of whiskey or pills.
If we only realized just how many people walked around carrying heavy burdens that are invisible to the world, and were doing every fucking thing possible to keep from cracking under the weight, we would stop feeling so alone and isolated carrying our own. We could put down our burdens and rest, in the all-encompassing field of our human vulnerability and strength.
“Be kind, for everyone you know is fighting a hard battle,” said theologian Ian MacLaren. I am struck by the imperative need for us all to take up the challenge to be kinder to ourselves and others. There is so much suffering in the world. How often do we ask ourselves, in the midst of responding to Facebook posts, Tweets, and emails: how can I relieve suffering? At the very least, how do I not add to it?
No one person can fix this mess we have gotten ourselves into as a species, but we can each be a part of bringing more compassion and acceptance into the world. First, we have to learn to practice it with ourselves. We can be the antidote to the fear and sorrow that exists within us, in other people, and in the world “out there.” Kindness is dismissed as bullshit in a world that values power over others. But as mindfulness teacher Sharon Salzberg reminds us, kindness is a “force.” If unleashed in vast quantities, it could literally reverse the cycle of misery on this planet.
When will we stop walking around in these miraculous, vulnerable human bodies seeing ourselves as separate? What will it take for us to realize our interconnectedness; to act from a deep understanding that suicidal people are not to be feared and judged, but to be embraced and held in the light of understanding and true empathy? Empathy sees that we are all connected, and thus demands well-being for all.
I think of the people who report walking to the bridge and said to themselves, “if one person smiles at me or talks to me, I won’t jump.” Lately I try to go out of my way to smile at people, to talk to people, even if they look at me funny because they aren’t used to random strangers smiling at them or talking to them. Come to think of it, I think talking to strangers is definitely a symptom of some severe mental disorder in the DSM-V.
But seriously, folks. It strikes me that breaking down our collective walls of isolation, of chiseling away our carefully constructed masks, of taking care of ourselves and each other, of judging less and loving more, may be among the most important things we can do with our lives. We can simply value people, not for what they do or what they achieve in the world, but because they are alive on this planet with us, right now, sharing these troubled, turbulent and painfully beautiful times.
In the end, we are stunningly diverse, yet there are basic human needs that we all have in common. The ancient practice of lovingkindness exhorts us to wish for ourselves and all beings to be safe, to be healthy, to be free, to live with ease. How can we create a world where these universal human needs are met? I think this is one of the primary questions we should all be asking ourselves right now, and figuring out the answers together.
I don’t claim that smiling at the person who makes your coffee or talking to a stranger on the metro will save the planet. What I do believe is that if we all made human connection, safety, and a sense of shared belonging among our top priorities, if we all tried in ways large and small to end our collective isolation and suffering, this world would be a safer place to be human. And a lot of people might not be eager to leave so soon.
Nanu, nanu, Robin Williams. Rest in peace.
To Know Suicide: Depression Can Be Treated, but It Takes Competence
By Kay Redfield Jamison, The New York Times Opinion Pages
BALTIMORE — WHEN the American artist Ralph Barton killed himself in 1931 he left behind a suicide note explaining why, in the midst of a seemingly good and full life, he had chosen to die.
“Everyone who has known me and who hears of this,” he wrote, “will have a different hypothesis to offer to explain why I did it.”
Most of the explanations, about problems in his life, would be completely wrong, he predicted. “I have had few real difficulties,” he said, and “more than my share of affection and appreciation.” Yet his work had become torture, and he had become, he felt, a cause of unhappiness to others. “I have run from wife to wife, from house to house, and from country to country, in a ridiculous effort to escape from myself,” he wrote. The reason he gave for his suicide was a lifelong “melancholia” worsening into “definite symptoms of manic-depressive insanity.”
Barton was correct about the reactions of others. It is often easier to account for a suicide by external causes like marital or work problems, physical illness, financial stress or trouble with the law than it is to attribute it to mental illness.
Certainly, stress is important and often interacts dangerously with depression. But the most important risk factor for suicide is mental illness, especially depression or bipolar disorder (also known as manic-depressive illness). When depression is accompanied by alcohol or drug abuse, which it commonly is, the risk of suicide increases perilously.
Suicidal depression involves a kind of pain and hopelessness that is impossible to describe — and I have tried. I teach in psychiatry and have written about my bipolar illness, but words struggle to do justice to it. How can you say what it feels like to go from being someone who loves life to wishing only to die?
Suicidal depression is a state of cold, agitated horror and relentless despair. The things that you most love in life leach away. Everything is an effort, all day and throughout the night. There is no hope, no point, no nothing.
The burden you know yourself to be to others is intolerable. So, too, is the agitation from the mania that may simmer within a depression. There is no way out and an endless road ahead. When someone is in this state, suicide can seem a bad choice but the only one.
It has been a long time since I have known suicidal depression. I am one of millions who have been treated for depression and gotten well; I was lucky enough to have a psychiatrist well versed in using lithium and knowledgeable about my illness, and who was also an excellent psychotherapist.
This is not, unfortunately, everyone’s experience. Many different professionals treat depression, including family practitioners, internists and gynecologists, as well as psychiatrists, psychologists, nurses and social workers. This results in wildly different levels of competence. Many who treat depression are not well trained in the distinction among types of depression. There is no common standard for education about diagnosis.
Distinguishing between bipolar depression and major depressive disorder, for example, can be difficult, and mistakes are common. Misdiagnosis can be lethal. Medications that work well for some forms of depression induce agitation in others. We expect well-informed treatment for cancer or heart disease; it matters no less for depression.
We know, for instance, that lithium greatly decreases the risk of suicide in patients with mood disorders like bipolar illness, yet it is too often a drug of last resort. We know, too, that medication combined with psychotherapy is generally more effective for moderate to severe depression than either treatment alone. Yet many clinicians continue to pitch their tents exclusively in either the psychopharmacology or the psychotherapy camp. And we know that many people who have suicidal depression will respond well to electroconvulsive therapy (ECT), yet prejudice against the treatment, rather than science, holds sway in many hospitals and clinical practices.
Severely depressed patients, and their family members when possible, should be involved in discussions about suicide. Depression usually dulls the ability to think and remember, so patients should be given written information about their illness and treatment, and about symptoms of particular concern for suicide risk — like agitation, sleeplessness and impulsiveness. Once a suicidally depressed patient has recovered, it is valuable for the doctor, patient and family members to discuss what was helpful in the treatment and what should be done if the person becomes suicidal again.
People who are depressed are not always easy to be with, or to communicate with — depression, irritability and hopelessness can be contagious — so making plans when a patient is well is best. An advance directive that specifies wishes for future treatment and legal arrangements can be helpful. I have one, which specifies, for instance, that I consent to ECT if my doctor and my husband, who is also a physician, think that is the best course of treatment.
Because I teach and write about depression and bipolar illness, I am often asked what is the most important factor in treating bipolar disorder. My answer is competence. Empathy is important, but competence is essential.
I was fortunate that my psychiatrist had both. It was a long trip back to life after nearly dying from a suicide attempt, but he was with me, indeed ahead of me, every slow step of the way.
Kay Redfield Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine, is the author of “An Unquiet Mind: A Memoir of Moods and Madness” and “Night Falls Fast: Understanding Suicide.”
Alice Fischer, at home in Cincinnati, displaying one of her paintings. Ms. Fischer has schizoaffective disorder, a variant of schizophrenia. She was one of the first narrators to tell her story to the Schizophrenia Oral History Project.
CINCINNATI — The psychologist Lynda Crane found that of the many injuries inflicted by schizophrenia, the greatest could be the pain of being forgotten. Just naming the illness somehow erased the person, something she learned when her 18-year-old son’s doctors said he had schizophrenia. Six years later, he committed suicide.
“It took me a long time to come to terms with it,” Dr. Crane says. “Even I had a hard time understanding it, how this bright man, with a brilliant future, could suffer like this. One thing I learned was that as soon as you mentioned the word, people stopped seeing the person. They just saw the diagnosis and a collection of symptoms. Doug, my son, was forgotten.”
For years Dr. Crane, a professor at the College of Mount St. Joseph in the western hills of Cincinnati, sought a way to enlighten her students and others about the ordinary people who live withschizophrenia despite its extraordinary burdens – the confused thinking, the delusions, the hallucinations, the anxiety and fear. Then she discovered a tool more commonly used among sociologists and anthropologists: oral history. Employing the device to examine schizophrenia has shifted her own perspective about a disease she thought she knew well.
“People with schizophrenia do not lose their individuality, even when the illness is very severe,” Dr. Crane says. “What I discovered through oral history is that it’s not about schizophrenia. It’s about a complexity of life that is very hard to get at any other way.”
For the past three years, on their own time and with no outside money, Dr. Crane and a fellow Mount St. Joseph psychologist, Tracy McDonough, have built the Schizophrenia Oral History Project. Other oral history collections have focused on diseases like AIDS or leprosy, but this is the first to focus on schizophrenia, they say.
So far they have recruited two dozen people to sit down with them and a voice recorder, asking their “narrators” simply: What’s it like to be you?
“The real beauty of this project,” says Dr. McDonough, “comes out of the fact that Lynda and I really try not to ask a lot of questions. The narrators want to tell their stories. They have something to say. Many of them have told us that no one has ever asked them about their lives before.”
The psychologists began the project by alerting local mental-health organizations that they were looking for participants willing to volunteer directly. “We didn’t want the providers to make the call because that can create a sense of, ‘I have to do this because my therapist wants me to,’” Dr. Crane says. “So each of the narrators had to take the initiative.”
One participant, Shirley Austin, 47, lives by herself on the west side of Cincinnati with her terrier, Fluffy. After a nightmarish childhood of violence and sexual abuse, Ms. Austin learned as a teenager that she had schizophrenia, and she says that even though she takes her medication, has relatives nearby and attends a church, she wrestles with loneliness. When her therapist told her about the oral history project, she was curious.
“Not even my therapists have ever asked me about my life that much,” Ms. Austin says. “I felt like I got strength and courage talking about what happened to me. I want to tell all the teenaged girls to be strong, that I’m a survivor, and they can be, too.”
Dr. Crane and Dr. McDonough have delivered more than 30 talks about the project in the Cincinnati area, visiting schools and local groups and collecting responses.
“I like to think of myself as open-minded, but the Schizophrenia Oral History Project helped me see that I was stigmatizing patients,” said Vicki Cheng, a nursing student at Miami University who heard one of the talks. “I would not have been surprised to learn that a patient with cancer or heart disease loved organic gardening or painting. Why in the world should I be surprised that someone with schizophrenia has hobbies, too?”
The project has benefited participants, too, like Alice Fischer, 43, who has schizoaffective disorder, a variant of schizophrenia, and lives with her mother and brother in her childhood home in Cincinnati’s Price Hill neighborhood. Ms. Fischer said she had been teased since grade school well into adulthood. “Even right now, sometimes on the bus, people say mean things to me,” she said.
She jumped at the chance to join the oral history project as one of its first narrators because she says newspapers and television too often communicate the wrong idea about people with mental illness. Ms. Fischer also prodded her brother, who has schizophrenia, to participate in the oral history project, but he resisted, fearful of repercussions from going public with his illness.
The project’s website features Ms. Fischer’s vivid paintings of owls or hearts or handprints with upbeat messages for world peace. “I want people to know I’m not dangerous,” she says. “They don’t know what a nice person I am.”
One of the narrators most gravely affected by schizophrenia is Paul Drake, 49, who for 14 years has lived with a tabby cat named Tiger in a small cluttered apartment on Cincinnati’s west side. Through his reading, he learned organic gardening to supplement his meager food budget. He starts tomatoes and other vegetables on his windowsill and grows them on a small plot behind his building. He has taught his neighbors how to garden.
Dr. Crane and Dr. McDonough have shared with the narrators some of the written responses they’ve received from listeners to the oral history project; one comment for Mr. Drake said, “I respect Paul’s insights and appreciate his straightforward sharing of how he copes.”
Mr. Drake says the positive reactions “make me feel good.” Amid the disorder of his mind, he frames a sentence to describe the impact that his participation has had on him.
“It gives me,” he says, “some immortality.”
Dr. Crane is retiring from teaching this spring and turning over leadership of the Schizophrenia Oral History Project to Dr. McDonough, who has been applying for grants to support the work and searching for more narrators.
A few weeks ago, they got a call from Alice Fischer’s brother. He said he was ready now to tell his story.
Anne Saker is a writer in Maineville, Ohio.
Image source: alert.psychiatricnews.org
Adults with schizophrenia who threaten or attempt suicide have sharply increased risks of becoming violent, according to a recently published analysis.
Katrina Witt, a doctoral candidate affiliated with the University of Oxford (England), and her associates analyzed longitudinal data from the National Institute of Mental Health’s CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness), a randomized controlled trial of antipsychotic medication in 1,460 adults with schizophrenia of generally moderate severity who were receiving usual care.
During a median follow-up of 15.7 months, 33.7% of the patients experienced suicidal ideation, 11.1% threatened suicide, and 5.8% attempted suicide, Ms. Witt and her associates reported (Schizophr. Res. 2014;154:61-7). About 8.3% of the patients showed violent behavior at some time as ascertained from interviews with family members.
In univariate analyses, suicidal threats and suicide attempts were significantly associated with violent behavior in both sexes, whereas suicidal ideation was not significantly associated for either sex.
In multivariate analyses that adjusted for a variety of comorbidities (alcohol misuse, drug misuse, diagnosed major depressive disorder, or diagnosed antisocial personality disorder), men and women had significantly elevated risks of violence if they made suicidal threats (hazard ratios, 3.8 and 9.4) or attempted suicide (hazard ratios, 2.8 and 4.4).
Additionally, for both sexes, the risks were elevated by roughly the same extent after adjustment for age or baseline scores for depression, hostility, positive symptoms, or poor impulse control. In women, adjustment for 6-month scores on these measures also made little difference; however, in men, adjustment abolished the significant association between suicide attempts and subsequent violence.
Of the three suicidality measures, suicidal threats yielded the greatest improvement in the prediction of violence for both sexes when added to a baseline risk model consisting of age, comorbid substance use disorder, and previous violence.
Ms. Witt and her associates cited several limitations. First, randomized controlled trials of antipsychotic effectiveness are “less likely to recruit individuals reporting thoughts of suicidality and self-harm.” In light of that fact, it might not be possible to generalize the results of this study to all patients with schizophrenia.
Also, the CATIE data were not collected to meet the aims of this study, and as a result, it was not possible to include relevant confounding factors such as intelligence scores and “neighborhood socioeconomic deprivation.”
Nevertheless, they said, their findings have implications for clinical care and for possible explanatory mechanisms.
"First, as part of the clinical risk assessment of violence in schizophrenia, as recommended by clinical guidelines in both the [United States] and [United Kingdom], a careful examination of history of suicidality should be included," they wrote.
"Second, the association between suicidal attempts and violence may be modified by 6-month depression, hostility, positive symptomatology, and poor impulse control scores in males. Given that medication adherence was monitored during the CATIE trial, this finding may suggest that acute symptomatology, perhaps exacerbated by medication nonadherence, may account for some of the association between suicidality and violence in males," they maintained. Thus efforts to ensure adherence might improve outcomes.
For more mental health news, Click Here to access the Serious Mental Illness Blog
By Josh Rivedal, professional actor, author, playwright, speaker on suicide prevention
Posted on The Huffington Post Healthy Living
Men are willing to talk about the size of their prostate glands, or how much Viagra they’re allowed to take, but they’re still not willing to be open about their mental health.
If men want to live long, healthy and productive lives it’s absolutely crucial that the dialogue surrounding men’s mental health has to change.
I lost my father Douglas to suicide in 2009. Douglas lost his father Haakon to suicide in 1966. Each suffered from undiagnosed mental disorders and each suffered in silence because of the stigma surrounding men talking about and getting help for mental illness.
Haakon was dealing with post-traumatic stress disorder after having been shot down in Hamburg, Germany, in 1941. Douglas may have been clinically depressed for a very long time, but my mother filing for divorce was a catalyst (not the cause) for his action in taking his own life.
There’s a relatively new case study in The Journal of Men’s Health that says that men are affected tremendously by divorce. They have higher rates of alcohol and drug abuse, depression and detach themselves from personal relationships and social support.
In 2011, I had several catalysts for my own near-suicide attempt: the dissolution of a relationship with a long-term girlfriend (similar to a divorce), a lack of work, and fallout from my mother’s betrayal. I was in terrible emotional pain and unknowingly suffering from clinical depression.
Standing at the ledge of a fourth floor window, I realized I didn’t want to die. I just wanted to end my inner torment. And I needed to break the familial cycle. So I came back inside, took a risk and asked for help by calling my mother.
Over the next few months I continued to take more risks. I called old friends to tell them I needed their support. I got into therapy. And no one ever told me I was crazy, stupid or a bad person. They told me they loved me and wanted to help me.
While recovering from clinical depression, I wanted to help youth and other men like me. So I used a biographical one-man play, The Gospel According to Josh, about my foray into show business along with my father’s suicide and took it to high schools, colleges and community centers all across the U.S. and Canada. With it, I talk about the importance of mental health and suicide prevention. Most of my audiences were and still continue to be women. One of the things I’ve found is that men have a difficult time talking about and getting help for their mental health or if they’re feeling suicidal. There seems to be some societal pressure that says “You’re not a true man if you don’t have it all together, all the time.”
But I have a message for men everywhere that’s simple yet profound. There’s always hope and help out there for you. As a man who has suffered from clinical depression, I can say from personal experience that this is not a character flaw or a weakness. It doesn’t make you any less of a man. In fact, by asking for help it makes you a stronger man. It gives you a fighting chance to improve your life and become the person you want to be. Reach out to your family and friends and ask for help. Nip it in the bud before it can turn into a crisis.
And while I’m not a mental-health professional, here are several resources to where you can ask for additional help from a professional if you need it: ManTherapy.org — an interactive tool to learn about men’s mental health; MentalHealthAmerica.net — find your local chapter of Mental Health America, a place where you can find information to help you live mentally well; SuicidePreventionLifeline.org — a general crisis line where you can reach out 24/7 to speak with someone if you’re feeling suicidal.
For more mental health news, Click Here to access the Serious Mental Illness Blog