Posts tagged Suicide
Posts tagged 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
[In the News] Inside the National Suicide Hotline: Preventing the Next Tragedy
By Josh Sanburn
As U.S. suicide rates rise, experts are divided over which strategies save more lives
Kevin Hines paced along the Golden Gate Bridge, trying to figure out whether to obey the voices in his head urging him to jump. Anyone paying the slightest attention to Hines should’ve seen that something was horribly wrong. Sure enough, after about a half-hour, a woman approached him. Hines thought she was there to save his life.
Instead, she was a tourist wanting Hines to take her picture. The look of desperation on his face apparently didn’t register. Elation crumpled into despair. “Nobody cares,” he thought. “Absolutely nobody cares.”
Hines soon hurdled a railing, stepped out onto a ledge 25 stories above San Francisco Bay and jumped. He immediately regretted it. Falling 75 miles an hour headfirst toward the water, Hines realized that if he was going to save himself, he had to hit feet first. So he threw his head back right before he plunged 80 feet into the cold waters, shattering two of his lower vertebrae. He eventually surfaced and was rescued by the Coast Guard. Only one out of 50 who jump survive.
Thirteen years removed from his attempt, Hines is now an author and lecturer, and doing quite well considering his experience. Hines frequently travels around the country talking about what happened on September 25, 2000. Diagnosed with bipolar disorder, he still has auditory and visual hallucinations as well as paranoid delusions. But today, he has a support network of family and friends that check up on him and identify early warning signs that could lead to Hines harming himself again. He logs his symptoms into an online document he shares with others so they can keep an eye on him. Hines says that’s what separates him from so many others who have suicidal thoughts.
“When you learn to be self-aware with mental illness, you can save your own life,” Hines says.
In May, the Centers for Disease Control released data showing that in 2010, 38,364 people weren’t able to save themselves. For the first time, the number of suicides surpassed deaths from motor vehicle accidents and most researchers believe that number is low, if anything, because many suicides go unreported. The suicide rate for Americans aged 35 to 64 rose 28.4 percent from 1999 to 2010. According to the CDC, $35 billion is lost due to medical bills and work loss costs related to suicide each year. And while suicide rates are not as high as they were in the early 1990s, they’ve climbed steadily upward since 2005.
As more Americans commit suicide, some in the field question the effectiveness of current prevention programs. Over the last 15 years, public policy and federal funding have shifted toward a broader mental wellness movement aimed at helping people deal with anxiety and depression that could eventually lead to suicidality. But that shift may have left those most at-risk of suicide, like Hines, without the support they need.
One program sits at the intersection of those two approaches. The National Suicide Prevention Lifeline, which expects 1.1 million to 1.2 million calls this year and receives about 15 percent more callers each year, is broadly marketed to the general public through billboards and ads that reach those suffering from anxiety, depression and loneliness but are often not actively suicidal. At the same time, it’s an emergency resource for those who are at immediate risk of killing themselves and who struggle with chronic mental illness. But some in the field question its effectiveness, along with the effectiveness of many other services and programs funded and promoted on a national scale. Those in the field often use the metaphor of a river to illustrate the divide: Is it worth getting to more people upstream or narrowly targeting those like Hines downstream?
At the Waterfall
The bridge phone inside New York City’s suicide prevention call center only rings about once a month. But when it does, often in the middle of the night, it emits distinct, deep chirps – as if the phone itself is in distress. The operators manning the 24/7 LifeNet hotline recognize the ring immediately. It means someone’s calling from one of the area’s 11 bridges, and they’re likely thinking about jumping.
LifeNet, a suicide prevention hotline servicing New York’s metropolitan area, also serves as one of 161 call centers that make up the National Suicide Prevention Lifeline network, headquartered in the same building. During its busiest hours from 9 a.m. to 7 p.m., the hotline has roughly 20 operators working the phones inside their unassuming L-shaped office space in lower Manhattan. The operators could easily be mistaken for a collection of telemarketers. The large computer screen at the head of the call center showing the number of lines being processed could easily reside inside QVC’s customer service center.
You don’t get a sense of what truly happens in this room until you run across the bridge phone, which is a direct line to the call center. It’s LifeNet’s equivalent of the Oval Office’s mythical red phone. On the wall above it, black Ikea picture frames display detailed information for each bridge and the locations of its call boxes: “Northbound 3rd Avenue Exit,” “Westbound Light Pole 60.” If someone calls, they can use the caller ID, check the information above the phone and immediately locate the caller and send help.
If it were up to those who work at LifeNet, however, they would get rid of the bridge phone altogether. “What we want is to get people upstream,” says John Draper, director of the National Suicide Prevention Lifeline. “We don’t necessarily want to get people who are on the edge of the waterfall. If they are, we can help them. But it’s a huge cost savings for the entire mental health system if you can get people further upstream.”
Draper is the National Suicide Prevention Lifeline’s soft-spoken, goateed, pony-tailed director and a whole-hearted advocate for early treatment. Talk to him and you realize why he’s in this field, something, he says, chose him. Draper speaks calmly but with purpose. He looks you in the eye. He routinely uses your name in conversation.
In the 1980s, Draper was part of a mobile crisis team, a group of clinicians that goes into the homes of people who are psychiatrically ill but unable or unwilling to get help. He says he soon came to the realization that the country’s mental health system operated behind bricks and mortar, “where it waits for people.”
“It says, ‘Ok, you’re mentally ill?’ I’ll see you Tuesday at 9 a.m. Hope you can make it.’ The system is not set up for the convenience of the user,” he says. “And as a result, two-thirds of the people with mental health problems in this country never seek care. So here was this program that goes into people’s homes. I was like, man, this is the way it should be.”
A decade later, the Mental Health Association of New York City established a 24/7 crisis information and referral network and hired Draper. Several years later, the Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services and now partially funds the national lifeline, assessed callers who had contacted crisis centers like New York’s and found that most of them felt less distressed emotionally and were less suicidal after the call. Draper calls it a groundbreaking finding.
LifeNet came into its own in 2001 when it became a central resource for those affected by the Sept. 11 terrorist attacks, which in New York City was just about everybody. People were reporting depression, anxiety and other traumatic responses in massive numbers. LifeNet’s call volume and staff doubled, and it’s never gone down. That time in the spotlight positioned the hotline to administer the national suicide prevention lifeline starting in 2004.
Today, Draper and his staff oversee more than 160 networked call centers around the country. Call 1-800-273-TALK, and you’ll be routed to the call center closest to the phone number from which you’re calling. The staff, funded with $3.7 million a year by SAMHSA, helps develop risk assessment standards for operators around the country so they can consistently and quickly determine the seriousness of a situation over the phone.
Draper expects call volume to increase again this year. About 8 million adults in the U.S. are thinking seriously about suicide, but only 1.1 million actually attempt it. So when Draper sees the volume actually reaching that 1.1 million number, which he expects it to this year, he views it as a good thing.
“If your calls are increasing, does that mean more people are in distress?” he says. “That’s not necessarily true. It means more people may have been in distress all along but didn’t know this resource was there. So the more we promote awareness of this resource, once it gets out, then it stays out there.”
The problem for people like Draper is definitively determining whether suicide prevention efforts are working. The only way you ever know if you’re saving someone’s life is if they come out and say so, and that makes it difficult to truly gauge the effectiveness of the lifeline or any other prevention program or service.
“The lifeline is a valuable addition to our efforts,” says Dr. Lanny Berman, executive director of the American Association of Suicidology (AAS). “It’s indeed a resource for people in suicidal crisis to reach out immediately and get help. Whether it is effective in saving lives remains to be seen.”
But some of the available data seems to indicate that the lifeline is having a positive effect. Studies done by Columbia University’s Dr. Madelyn Gould have found that about 12 percent of suicidal callers reported in a follow-up interview that talking to someone at the lifeline prevented them from harming or killing themselves. Almost half followed through with a counselor’s referral to seek emergency services or contacted mental health services, and about 80 percent of suicidal callers say in follow-up interviews that the lifeline has had something to do with keeping them alive.
“I don’t know if we’ll ever have solid evidence for what saves lives other than people saying they saved my life,” says Draper. “It may be that the suicide rate could be higher if crisis lines weren’t in effect. I don’t know. All I can say is that what we’re hearing from callers is that this is having a real life-saving impact.”
You may think that a suicide prevention office would be a dreadful place to work, but it’s really just like any other around the country: idle chatter near the water cooler, lunch breaks with co-workers, cinnamon rolls in the break room. It’s just that from this room, lives are being profoundly affected every day. And even though the exact number of people who have truly been helped will never be known, the lifeline has very strong advocates, including Kevin Hines.
Hines’ story is not merely dramatic; it’s a test case in how the mental health system broke down. There are essentially three main ways to prevent suicide: treatment; means prevention; and access to prevention resources. At the time, Hines wasn’t properly being treated for bipolar disorder; the Golden Gate Bridge has no physical barriers to prevent suicide attempts; and as for the bridge’s suicide prevention call box, Hines didn’t know it was there.
“Had I known, I’m sure I would’ve called,” he says, “because I desperately wanted to talk to somebody.”
Back in New York City’s suicide prevention call center, I ask Draper if it’s difficult to come in to work each day, to motivate his employees to take another call and assure them that what they’re all doing is actually working.
“When I tell people what I do, they say, ‘Oh, Draper, that must be really depressing,’” he says. “And I say, man, I’m in the suicide prevention business, not the suicide business. What I see every day and what our crisis center staff hears every day is hope. And they know that they’re a part of that.”
He says it’s important to remember that 1.1 million adults are attempting suicide every year, but 38,000 are actually dying by suicide.
“What that is telling us is that by and large, the overwhelming majority of suicides are being prevented,” he says. “And those stories are not being told.”
For more mental health news, Click Here to access the Serious Mental Illness Blog
[Film of Interest] "Running from Crazy"
Mariel Hemingway Tackles Family History of Suicide, Mental Illness in New Doc
The new documentary “Running from Crazy” chronicles the life of actress Mariel Hemingway, the granddaughter of the great novelist Ernest Hemingway. The film focuses on Mariel’s family history of mental illness and the suicides of seven relatives, including her grandfather and her sister, Margaux.
iThe film is directed by the two-time Academy Award-winning filmmaker Barbara Kopple, whose documentary “Harlan County U.S.A.” has become a classic and won an Oscar in 1977.