Serious Mental Illness Blog

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To Know Suicide: Depression Can Be Treated, but It Takes CompetenceBy Kay Redfield Jamison, The New York Times,
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.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

To Know Suicide: Depression Can Be Treated, but It Takes Competence
By Kay Redfield Jamison, The New York Times,

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.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under recovery hope depressed depression sad sadness emotion emotions feeling feelings thought thoughts mind body brain wellness healthy mental mental health illness mental illness diagnosis disorder treatment psychology psychiatry counseling psychologist psychiatrist counselor

51 notes

To Know Suicide: Depression Can Be Treated, but It Takes CompetenceBy 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.”
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

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.”

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under suicide suicidal death dead depressed depression sad sadness emotion emotions feeling feelings mind body brain wellness mental health mental illness mental health illness psychology psychiatry counseling recovery treatment hope disorder diagnosis bipolar

275 notes

How schizophrenia is shaped by our culture: Americans hear voices as threatening while Indians and Africans claim they are helpfulBy Ellie Zolfagharifard, DailyMail
Scientists came to the conclusion after speaking with 60 schizophrenics 20 came from California, 20 from Accra, Ghana and 20 from Chennai, India In America, voices were intrusion and a threat to patient’s private world In India and Africa, the study subjects were not as troubled by the voices. The difference may be down to the fact that Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity. Whereas outside the West, people imagine the mind and self as interwoven with others and defined through relationships.
People suffering from schizophrenia can often hear imaginary voices so terrifying that they are left traumatized.
One American patient described the voices as ‘like torturing people, to take their eye out with a fork, or cut someone’s head and drink their blood.’
A study has now found that these voices can be shaped by culture, with Western cultures experiencing far more disturbing psychotic episodes.
Schizophrenia is a severe brain disorder that can cause people to hear ‘voices’ that other people don’t hear. It affects about one per cent of the global population over the age of 18.
Many people in Western cultures have reported hearing voices claiming other people are reading their minds, controlling their thoughts or plotting to kill them.
In Africa and India, however, these hallucinatory voices appear as harmless and even playful, according to the study by Stanford University in California. 
While there’s no cure for schizophrenia, this study suggests that therapies urging patients to develop relationships with their imaginary voices could prove useful.
As part of the study, Professor Tanya Luhrmann interviewed 60 adults diagnosed with schizophrenia; 20 each in San Mateo, California; Accra, Ghana; and Chennai, India.
Overall, there were 31 women and 29 men with an average age of 34, who were asked about their relationship with the imaginary voices.
While many of the African and Indian subjects registered largely positive experiences with their voices, not one American did.
Instead, the U.S. subjects were more likely to report experiences as violent and hateful.
For instance, they spoke of their voices as a call to battle or war – ‘the warfare of everyone just yelling.’
The Americans mostly did not know who spoke to them and they seemed to have less personal relationships with their voices, according to Professor Luhrmann.
But among the Indians in Chennai, more than half heard voices of kin or family members commanding them to do tasks.
'They talk as if elder people advising younger people,' one subject said. That contrasts to the Americans, only two of whom heard family members.
The Indians also heard fewer threatening voices than the Americans – several heard the voices as playful, as manifesting spirits or magic, and even as entertaining.
Finally, not as many of them described the voices in terms of a medical or psychiatric problem, as all of the Americans did.
In Accra, Ghana, where the culture accepts that disembodied spirits can talk, few subjects described voices in brain disease terms.
When people talked about their voices, 10 of them called the experience predominantly positive; 16 of them reported hearing God audibly. ‘Mostly, the voices are good,’ one participant remarked.
The difference may be down to the fact that Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity, said Professor Luhrmann.
Whereas outside the West, people imagine the mind and self as interwoven with others and defined through relationships.
In America, the voices were an intrusion and a threat to one’s private world – the voices could not be controlled.
However, in India and Africa, the subjects were not as troubled by the voices – they seemed on one level to make sense in a more relational world.
Still, differences existed between the participants in India and Africa; the former’s voice-hearing experience emphasized playfulness and sex, whereas the latter more often involved the voice of God.
'The difference seems to be that the Chennai and Accra participants were more comfortable interpreting their voices as relationships and not as the sign of a violated mind,' the researchers wrote.
The research, Professor Luhrmann observed, suggests that the ‘harsh, violent voices so common in the West may not be an inevitable feature of schizophrenia.’
The findings may be clinically significant, according to the researchers and adds to research that shows specific therapies may alter what patients hear their voices say.
'Our hunch is that the way people think about thinking changes the way they pay attention to the unusual experiences associated with sleep and awareness, and that as a result, people will have different spiritual experiences, as well as different patterns of psychiatric experience,' Professor Luhrmann said.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

How schizophrenia is shaped by our culture: Americans hear voices as threatening while Indians and Africans claim they are helpful
By Ellie Zolfagharifard, DailyMail

Scientists came to the conclusion after speaking with 60 schizophrenics 20 came from California, 20 from Accra, Ghana and 20 from Chennai, India In America, voices were intrusion and a threat to patient’s private world In India and Africa, the study subjects were not as troubled by the voices. The difference may be down to the fact that Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity. Whereas outside the West, people imagine the mind and self as interwoven with others and defined through relationships.

People suffering from schizophrenia can often hear imaginary voices so terrifying that they are left traumatized.

One American patient described the voices as ‘like torturing people, to take their eye out with a fork, or cut someone’s head and drink their blood.’

A study has now found that these voices can be shaped by culture, with Western cultures experiencing far more disturbing psychotic episodes.

Schizophrenia is a severe brain disorder that can cause people to hear ‘voices’ that other people don’t hear. It affects about one per cent of the global population over the age of 18.

Many people in Western cultures have reported hearing voices claiming other people are reading their minds, controlling their thoughts or plotting to kill them.

In Africa and India, however, these hallucinatory voices appear as harmless and even playful, according to the study by Stanford University in California. 

While there’s no cure for schizophrenia, this study suggests that therapies urging patients to develop relationships with their imaginary voices could prove useful.

As part of the study, Professor Tanya Luhrmann interviewed 60 adults diagnosed with schizophrenia; 20 each in San Mateo, California; Accra, Ghana; and Chennai, India.

Overall, there were 31 women and 29 men with an average age of 34, who were asked about their relationship with the imaginary voices.

While many of the African and Indian subjects registered largely positive experiences with their voices, not one American did.

Instead, the U.S. subjects were more likely to report experiences as violent and hateful.

For instance, they spoke of their voices as a call to battle or war – ‘the warfare of everyone just yelling.’

The Americans mostly did not know who spoke to them and they seemed to have less personal relationships with their voices, according to Professor Luhrmann.

But among the Indians in Chennai, more than half heard voices of kin or family members commanding them to do tasks.

'They talk as if elder people advising younger people,' one subject said. That contrasts to the Americans, only two of whom heard family members.

The Indians also heard fewer threatening voices than the Americans – several heard the voices as playful, as manifesting spirits or magic, and even as entertaining.

Finally, not as many of them described the voices in terms of a medical or psychiatric problem, as all of the Americans did.

In Accra, Ghana, where the culture accepts that disembodied spirits can talk, few subjects described voices in brain disease terms.

When people talked about their voices, 10 of them called the experience predominantly positive; 16 of them reported hearing God audibly. ‘Mostly, the voices are good,’ one participant remarked.

The difference may be down to the fact that Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity, said Professor Luhrmann.

Whereas outside the West, people imagine the mind and self as interwoven with others and defined through relationships.

In America, the voices were an intrusion and a threat to one’s private world – the voices could not be controlled.

However, in India and Africa, the subjects were not as troubled by the voices – they seemed on one level to make sense in a more relational world.

Still, differences existed between the participants in India and Africa; the former’s voice-hearing experience emphasized playfulness and sex, whereas the latter more often involved the voice of God.

'The difference seems to be that the Chennai and Accra participants were more comfortable interpreting their voices as relationships and not as the sign of a violated mind,' the researchers wrote.

The research, Professor Luhrmann observed, suggests that the ‘harsh, violent voices so common in the West may not be an inevitable feature of schizophrenia.’

The findings may be clinically significant, according to the researchers and adds to research that shows specific therapies may alter what patients hear their voices say.

'Our hunch is that the way people think about thinking changes the way they pay attention to the unusual experiences associated with sleep and awareness, and that as a result, people will have different spiritual experiences, as well as different patterns of psychiatric experience,' Professor Luhrmann said.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under schizophrenia schizophrenic psychosis psychotic america american americans india african mental health mental illness mental illness health psychology psychiatry counseling mind body brain wellness healthy recovery therapy therapist bipolar voices hearing voices hallucination hallucinations

83 notes

Robin Williams: Depression Alone Rarely Causes SuicideBy Roni Jacobson, Scientific American
Several factors, such as severity of symptoms, family history, substance abuse and a “mixed” depressive and manic state may combine to increase the risk for suicide
In his stand-up and best-loved comedies, including Aladdin and Mrs. Doubtfire, Robin Williams was known for his rapid-fire impersonations and intensely playful energy. His most critically acclaimed work, however, including his Oscar-winning turn in Good Will Hunting, married humor with sharp introspection and appreciation for melancholy. Reports of his death from apparent suicide on August 11 at the age of 63 have prompted much speculation about the actor’s personality and mental health. Williams had been seeking treatment for severe depression, and many commenters have labeled that as the reason for his death. Whereas the majority of people who commit suicide suffer from depression, less than 4 percent of those eventually take their lives. Clearly, more factors are at work as causes of suicide than depression alone. The severity of mood disorders, past suicide attempts and substance abuse are all thought to increase the risk. Recent evidence also suggests that the mixed-depressive form of bipolar disorder can be a particularly dangerous time that can often go undetected or masquerade as general depression and irritability. In 2006 Williams told interviewer Terry Gross on the radio show Fresh Air that he had experienced depressive episodes, but said that he had not been diagnosed with clinical depression or bipolar disorder—an illness typified by extreme emotional highs and lows, where people alternate between states of manic energy and deep depression. He also discussed his struggles with addiction and substance abuse—cocaine in the 1970s, and later, alcohol, for which he entered treatment in 2006. ”Do I perform sometimes in a manic style? Yes,” Williams said. “Am I manic all the time? No. Do I get sad? Oh yeah. Does it hit me hard? Oh yeah,” he said at the time.Depression, which affects about 16 million people in the U.S. according to the National Institutes of Mental Health, and more than 350 million globally according to the World Health Organization, is thought to be the result of interacting social, biological and environmental factors. The word “depression” is tossed around casually, but in reality the condition can be quite debilitating. People with major depressive disorder (also known as clinical, major or unipolar depression) exist beyond the realm of sadness. In fact, they can feel numb to the world and often become lethargic and lose interest in people and activities that formerly brought them joy. When the disorder is at its most severe, people with depression may even experience psychosis—seeing or hearing things that aren’t there. Unsurprisingly, the more severe the depression symptoms the more likely the person is at risk for suicide. Mild to moderate depression or dysthymia—chronic gloominess that is less serious than major depression—is not considered a risk factor for suicide. When left untreated, however, moderate depression can turn severe over time as the episodes build on one another. Although women attempt suicide more often, men are more likely to complete the act. That morbid fact is frequently attributed to the method: Men use firearms or hanging—much harder to recover from than overdosing on pills, women’s method of choice. Yet men are also more likely to be depressed for a longer period of time and to have their depression go undetected than are women. The longstanding biological explanation of depression—that people with the disorder have low levels of the neurotransmitter serotonin—is now considered overly simplistic. But serotonin, which facilitates learning and memory, is thought to be involved in some capacity; people with depression struggle to break negative, recursive thought patterns that inhibit their ability to learn from new information. In a 2014 study, John Keilp, a neuropsychologist at Columbia University, and colleagues found that people with depression who attempt suicide tend to have shorter attention spans and worse memory capacity than those with the disorder who do not attempt suicide. Cognitive behavioral therapy and medication can work together to correct those counterproductive thought patterns, but that type of recovery becomes more difficult when mind-altering recreational substances are added to the equation. This challenge is particularly true with the introduction of sedatives, or “downers,” such as benzodiazepines and alcohol. Alcohol depresses the brain’s reward centers even further, making it harder bounce back. Approximately 60 percent of people who commit suicide have consumed alcohol at the time of death. Another condition that may appear as depression but is actually a facet of bipolar disorder, called a mixed-depressive episode, can also elevate the risk for suicide. This condition is characterized by a depressive episode with three or more “hypomanic” symptoms—which can include irritability, distractibility and agitation. Mixed episodes combine the racing thoughts of a manic episode, but with a distinctly negative instead of euphoric tinge Mixed states in turn may deepen depression and make it more resistant to treatment. A 2013 review in The American Journal of Psychiatrysuggests that suicidal ideation and past suicide attempts are more frequent in people during mixed-depressive episodes compared with those experiencing depression alone. This summer Williams reportedly entered Hazelden, an addiction treatment center in Minnesota. He had not fallen off the wagon, but was taking the opportunity to “fine-tune and focus on his continued commitment to [sobriety].” Although it was not enough in the end—the effects of addiction can linger for years after substance abuse has stopped, and depression is a supremely intractable disorder— hopefully the bravery he displayed in addressing his problems head-on will encourage more people seek help before it’s too late. A number of other factors can contribute to suicide risk—poverty, for one, family history of suicide, for another. But the tragedy of Williams’s death should remind us that the most debilitating and life-threatening mood disorders can strike anyone, and once they do, it can be awfully hard to find release. For more on suicide, read our special report: ”Suicide: Genius, Suicide and Mental Illness: Insights into a Deep Connection”
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Robin Williams: Depression Alone Rarely Causes Suicide
By Roni Jacobson, Scientific American

Several factors, such as severity of symptoms, family history, substance abuse and a “mixed” depressive and manic state may combine to increase the risk for suicide

In his stand-up and best-loved comedies, including Aladdin and Mrs. Doubtfire, Robin Williams was known for his rapid-fire impersonations and intensely playful energy. His most critically acclaimed work, however, including his Oscar-winning turn in Good Will Hunting, married humor with sharp introspection and appreciation for melancholy.
 
Reports of his death from apparent suicide on August 11 at the age of 63 have prompted much speculation about the actor’s personality and mental health. Williams had been seeking treatment for severe depression, and many commenters have labeled that as the reason for his death. Whereas the majority of people who commit suicide suffer from depression, less than 4 percent of those eventually take their lives.
 
Clearly, more factors are at work as causes of suicide than depression alone. The severity of mood disorders, past suicide attempts and substance abuse are all thought to increase the risk. Recent evidence also suggests that the mixed-depressive form of bipolar disorder can be a particularly dangerous time that can often go undetected or masquerade as general depression and irritability.
 
In 2006 Williams told interviewer Terry Gross on the radio show Fresh Air that he had experienced depressive episodes, but said that he had not been diagnosed with clinical depression or bipolar disorder—an illness typified by extreme emotional highs and lows, where people alternate between states of manic energy and deep depression. He also discussed his struggles with addiction and substance abuse—cocaine in the 1970s, and later, alcohol, for which he entered treatment in 2006. ”Do I perform sometimes in a manic style? Yes,” Williams said. “Am I manic all the time? No. Do I get sad? Oh yeah. Does it hit me hard? Oh yeah,” he said at the time.

Depression, which affects about 16 million people in the U.S. according to the National Institutes of Mental Health, and more than 350 million globally according to the World Health Organization, is thought to be the result of interacting social, biological and environmental factors. The word “depression” is tossed around casually, but in reality the condition can be quite debilitating. People with major depressive disorder (also known as clinical, major or unipolar depression) exist beyond the realm of sadness. In fact, they can feel numb to the world and often become lethargic and lose interest in people and activities that formerly brought them joy. When the disorder is at its most severe, people with depression may even experience psychosis—seeing or hearing things that aren’t there.
 
Unsurprisingly, the more severe the depression symptoms the more likely the person is at risk for suicide. Mild to moderate depression or dysthymia—chronic gloominess that is less serious than major depression—is not considered a risk factor for suicide. When left untreated, however, moderate depression can turn severe over time as the episodes build on one another.
 
Although women attempt suicide more often, men are more likely to complete the act. That morbid fact is frequently attributed to the method: Men use firearms or hanging—much harder to recover from than overdosing on pills, women’s method of choice. Yet men are also more likely to be depressed for a longer period of time and to have their depression go undetected than are women.
 
The longstanding biological explanation of depression—that people with the disorder have low levels of the neurotransmitter serotonin—is now considered overly simplistic. But serotonin, which facilitates learning and memory, is thought to be involved in some capacity; people with depression struggle to break negative, recursive thought patterns that inhibit their ability to learn from new information. In a 2014 study, John Keilp, a neuropsychologist at Columbia University, and colleagues found that people with depression who attempt suicide tend to have shorter attention spans and worse memory capacity than those with the disorder who do not attempt suicide.
 
Cognitive behavioral therapy and medication can work together to correct those counterproductive thought patterns, but that type of recovery becomes more difficult when mind-altering recreational substances are added to the equation. This challenge is particularly true with the introduction of sedatives, or “downers,” such as benzodiazepines and alcohol. Alcohol depresses the brain’s reward centers even further, making it harder bounce back. Approximately 60 percent of people who commit suicide have consumed alcohol at the time of death.
 
Another condition that may appear as depression but is actually a facet of bipolar disorder, called a mixed-depressive episode, can also elevate the risk for suicide. This condition is characterized by a depressive episode with three or more “hypomanic” symptoms—which can include irritability, distractibility and agitation. Mixed episodes combine the racing thoughts of a manic episode, but with a distinctly negative instead of euphoric tinge Mixed states in turn may deepen depression and make it more resistant to treatment. A 2013 review in The American Journal of Psychiatrysuggests that suicidal ideation and past suicide attempts are more frequent in people during mixed-depressive episodes compared with those experiencing depression alone.
 
This summer Williams reportedly entered Hazelden, an addiction treatment center in Minnesota. He had not fallen off the wagon, but was taking the opportunity to “fine-tune and focus on his continued commitment to [sobriety].” Although it was not enough in the end—the effects of addiction can linger for years after substance abuse has stopped, and depression is a supremely intractable disorder— hopefully the bravery he displayed in addressing his problems head-on will encourage more people seek help before it’s too late.
 
A number of other factors can contribute to suicide risk—poverty, for one, family history of suicide, for another. But the tragedy of Williams’s death should remind us that the most debilitating and life-threatening mood disorders can strike anyone, and once they do, it can be awfully hard to find release.
 
For more on suicide, read our special report: ”Suicide: Genius, Suicide and Mental Illness: Insights into a Deep Connection

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under robin williams robin williams mental health mental illness mental health illness mind body brain wellness healthy depressed depression symptoms family drug drugs alcohol suicide suicidal feelings emotions aladdin mrs doubtfire comic comedian death dead

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Mental health: The largest unmet health need in Ireland todayBy Dr Jim Lucey, Irish Examiner
Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society, writes Dr Jim Lucey.
The topic of the Merriman Summer School this year is the emotional life of our country.
It is a timely agenda as our nation approaches its 100th birthday. Much of our national dialogue appears to be about economic and political agendas as though these existed in a vacuum.
But what is the emotional state of Ireland today? More speculatively let me ask this: what is it about a nation or a culture that nurtures and sustains emotional wellbeing? The answer to this second question could inform us as we try rebuild our country following its financial collapse.
Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society.
Unfortunately the typical response to mental distress in Ireland is neglect, or postponement at best. It has been said that if your car breaks down today, you could probably have it repaired within an hour, but if you or I have a mental breakdown today, it is unlikely that we will get help for at least 18 months. The delay is largely in our inability to have the mental health conversation.
However, there is a pressing need to widen our discussion because of the importance of our mental health. It is necessary for us all to enter the mental health debate.
There is much said about our vision for change in mental health services in Ireland, but for many this vision is an Ashling rather than a reality. There is still no national strategy to tackle the problems of suicide in Ireland. The problems and the costs of alcohol and substance abuse are still given insufficient priority, since in Ireland today, the drinks industry has disproportionate influence.
So what is it about our mental and emotional health which makes it such a taboo subject? The answer is complicated. It has not have been helped by the poverty of our language around mental wellbeing or by our asylum history of shame, fear and guilt. The problem is also with our mental and emotional consciousness, and this is political and social and cultural.
Modern Ireland is very different from the nation imagined by its founders. It is still, as St Colmcille called it, “a small island on the edge of the world”, but today, Ireland is struggling to become “the best little country in the world… to do business in”. We might question whether this vision is sufficient for the real challenges we face.
The first one 100 years of Irish freedom has been as traumatic as the century before it was tragic, and these memories are persistent. Memories of trauma are not usually lost even if they do not remain in the forefront of our consciousness.
Our independence emerged on the background of the great famine and of the Great War. The “peace process” which brought to an end 30 years of bloody civil war, a conflict we euphemistically called “The Troubles” has left many questions still unanswered. Since then, nearly every institution in the State has been discredited to a greater or lesser extent. With each shameful disclosure, denial has been followed by incremental half truths seemingly extracted in dental fashion. This establishment response to distress, a game of cat and mouse with the truth, was well rehearsed long before the banks collapsed.
In psychological terms, this process of denial is damaging, not just because it postpones understanding and prolongs the struggle to find recovery, but because like Pavlov’s dogs, we may have become conditioned to non-disclosure.
Recent historians have described how to some extent in the early independent Ireland, we believed “we were a chosen people… a people set apart”. It was against this background of national self-deception that the earliest whistleblowers, as well as artists and reformers, must have struggled, since our processes seemed incapable of getting to insight.
On the other hand, our stated beliefs about Ireland have changed and “changed utterly”. Now we are given to question everything, and now we know at least some of the truths.
Our “states of fear” have been exposed so we now we know that in our asylums, 2% of our population was incarcerated against its will. We know that many of our young people and vulnerable adults were physically and sexually abused in church/state institutions and industrial schools, in the laundries, in the mother and baby homes, and all the rest.
These revelations have been so shocking that the sadness of it is too much to bear, too hard to hear, and yet we must hear it in order to understand and recover. We have only begun this work.
Despite these positives, the reality is that social and economic inequality is the biggest risk factor for poor health in Ireland. The mental and emotional health of nearly one quarter of our population is in jeopardy. The most common disorders are depression and anxiety.
So what does the description of mental disorder in Ireland tell us about the emotional health of our country today? The truth is there is no evidence that we are a depressed or an anxious nation. The measurable hallmarks of low mood and all the rest are not endemic in Ireland today. We do not lack energy and certainly we possess the drive and concentration to meet most challenges and succeed.
Equally, the features of anxiety disorder are not evident in our nation. If anything, it is impulsivity that is more typical. Experience shows that in Ireland, we are in distress and this is in response to the traumas of recent times.
In our next century, we could learn from our experience to create a culture that promotes and celebrates our mental health. We could prioritise the wellbeing of our people and build a concept beyond our current ideas of wealth. The mental capital of our country is our economic capital, and our economy can thrive again only if we include all those currently in distress within our recovery plan.
Surely a renewed conversation about values would be restorative. Perhaps then, the emotional and economic value of our homeless and unemployed would be acknowledged. Just as the emotional consequences of excluding the mentally ill needs to be recognised, the right to more effective means of recovery for all our people and our society needs to be endorsed.
So is there hope? Absolutely.
Our tendency to denial, dissociation, and non-disclosure, may not have helped us resolve our conflicts to date, but ultimately, we must re-engage if we are to recover.
How then can we move on from the distress of our past? This question is surely important for any nation which truly wishes to make progress, but only one nation that I know of has a specific word for the process. In Germany they call it “Vergangenheitsbewailtigung” or “wrestling with the past so as to come to terms with it”.
The meaning of this process for the German nation has been profound and the benefits are measurable. Denial is no more tolerable there than is dissociation. The result has been a cultural rebirth. Now as our 100th birthday approaches, is it possible that we would begin a cultural renewal based on a genuine dealing with our past? A cultural wrestling with our past could lead to the rebuilding of our country on universal principles of human rights. Into our second century, we could emphasise priorities that would make our young people and our old people strong and emotionally resilient. We could begin to include our homeless and our mortgaged, our emigrants and our immigrants, our believers and our unbelievers in a journey towards an Ireland that would be well and not only well-off. An emotionally healthy Irish life is not something that will happen by chance.
Certain resilience factors contribute to the development of a mentally healthy, emotionally resilient populations. They include a secure base, education, social competence and friendships, talents, interests and positive values. A renewed Irish society dedicated to building these resilience factors might prioritize them as much as finance or foreign affairs, and so future political and cultural decisions could be made congruent with these goals. A renaissance of our culture, of life and work and spirit, balanced with our sport, music and arts and respect for beliefs could emerge.
This working towards positive values would sustain growth; and with resilience the next generation could grow together to better withstand its traumas and rebuild itself.
Out of a sincere re-engagement with our history, we could make peace with ourselves and rediscover what it is to be truly mentally and emotionally well; so that more people could live independently, work productively and most of all, love each other with a whole heart.
Edited version of the keynote speech delivered by Dr Jim Lucey, clinical professor of psychiatry at TCD and medical director at St Patrick’s mental-health services, to mark the opening of the Merriman Summer School in Glór, Ennis, Co Clare.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Mental health: The largest unmet health need in Ireland today
By Dr Jim Lucey, Irish Examiner

Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society, writes Dr Jim Lucey.

The topic of the Merriman Summer School this year is the emotional life of our country.

It is a timely agenda as our nation approaches its 100th birthday. Much of our national dialogue appears to be about economic and political agendas as though these existed in a vacuum.

But what is the emotional state of Ireland today? More speculatively let me ask this: what is it about a nation or a culture that nurtures and sustains emotional wellbeing? The answer to this second question could inform us as we try rebuild our country following its financial collapse.

Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society.

Unfortunately the typical response to mental distress in Ireland is neglect, or postponement at best. It has been said that if your car breaks down today, you could probably have it repaired within an hour, but if you or I have a mental breakdown today, it is unlikely that we will get help for at least 18 months. The delay is largely in our inability to have the mental health conversation.

However, there is a pressing need to widen our discussion because of the importance of our mental health. It is necessary for us all to enter the mental health debate.

There is much said about our vision for change in mental health services in Ireland, but for many this vision is an Ashling rather than a reality. There is still no national strategy to tackle the problems of suicide in Ireland. The problems and the costs of alcohol and substance abuse are still given insufficient priority, since in Ireland today, the drinks industry has disproportionate influence.

So what is it about our mental and emotional health which makes it such a taboo subject? The answer is complicated. It has not have been helped by the poverty of our language around mental wellbeing or by our asylum history of shame, fear and guilt. The problem is also with our mental and emotional consciousness, and this is political and social and cultural.

Modern Ireland is very different from the nation imagined by its founders. It is still, as St Colmcille called it, “a small island on the edge of the world”, but today, Ireland is struggling to become “the best little country in the world… to do business in”. We might question whether this vision is sufficient for the real challenges we face.

The first one 100 years of Irish freedom has been as traumatic as the century before it was tragic, and these memories are persistent. Memories of trauma are not usually lost even if they do not remain in the forefront of our consciousness.

Our independence emerged on the background of the great famine and of the Great War. The “peace process” which brought to an end 30 years of bloody civil war, a conflict we euphemistically called “The Troubles” has left many questions still unanswered. Since then, nearly every institution in the State has been discredited to a greater or lesser extent. With each shameful disclosure, denial has been followed by incremental half truths seemingly extracted in dental fashion. This establishment response to distress, a game of cat and mouse with the truth, was well rehearsed long before the banks collapsed.

In psychological terms, this process of denial is damaging, not just because it postpones understanding and prolongs the struggle to find recovery, but because like Pavlov’s dogs, we may have become conditioned to non-disclosure.

Recent historians have described how to some extent in the early independent Ireland, we believed “we were a chosen people… a people set apart”. It was against this background of national self-deception that the earliest whistleblowers, as well as artists and reformers, must have struggled, since our processes seemed incapable of getting to insight.

On the other hand, our stated beliefs about Ireland have changed and “changed utterly”. Now we are given to question everything, and now we know at least some of the truths.

Our “states of fear” have been exposed so we now we know that in our asylums, 2% of our population was incarcerated against its will. We know that many of our young people and vulnerable adults were physically and sexually abused in church/state institutions and industrial schools, in the laundries, in the mother and baby homes, and all the rest.

These revelations have been so shocking that the sadness of it is too much to bear, too hard to hear, and yet we must hear it in order to understand and recover. We have only begun this work.

Despite these positives, the reality is that social and economic inequality is the biggest risk factor for poor health in Ireland. The mental and emotional health of nearly one quarter of our population is in jeopardy. The most common disorders are depression and anxiety.

So what does the description of mental disorder in Ireland tell us about the emotional health of our country today? The truth is there is no evidence that we are a depressed or an anxious nation. The measurable hallmarks of low mood and all the rest are not endemic in Ireland today. We do not lack energy and certainly we possess the drive and concentration to meet most challenges and succeed.

Equally, the features of anxiety disorder are not evident in our nation. If anything, it is impulsivity that is more typical. Experience shows that in Ireland, we are in distress and this is in response to the traumas of recent times.

In our next century, we could learn from our experience to create a culture that promotes and celebrates our mental health. We could prioritise the wellbeing of our people and build a concept beyond our current ideas of wealth. The mental capital of our country is our economic capital, and our economy can thrive again only if we include all those currently in distress within our recovery plan.

Surely a renewed conversation about values would be restorative. Perhaps then, the emotional and economic value of our homeless and unemployed would be acknowledged. Just as the emotional consequences of excluding the mentally ill needs to be recognised, the right to more effective means of recovery for all our people and our society needs to be endorsed.

So is there hope? Absolutely.

Our tendency to denial, dissociation, and non-disclosure, may not have helped us resolve our conflicts to date, but ultimately, we must re-engage if we are to recover.

How then can we move on from the distress of our past? This question is surely important for any nation which truly wishes to make progress, but only one nation that I know of has a specific word for the process. In Germany they call it “Vergangenheitsbewailtigung” or “wrestling with the past so as to come to terms with it”.

The meaning of this process for the German nation has been profound and the benefits are measurable. Denial is no more tolerable there than is dissociation. The result has been a cultural rebirth. Now as our 100th birthday approaches, is it possible that we would begin a cultural renewal based on a genuine dealing with our past? A cultural wrestling with our past could lead to the rebuilding of our country on universal principles of human rights. Into our second century, we could emphasise priorities that would make our young people and our old people strong and emotionally resilient. We could begin to include our homeless and our mortgaged, our emigrants and our immigrants, our believers and our unbelievers in a journey towards an Ireland that would be well and not only well-off. An emotionally healthy Irish life is not something that will happen by chance.

Certain resilience factors contribute to the development of a mentally healthy, emotionally resilient populations. They include a secure base, education, social competence and friendships, talents, interests and positive values. A renewed Irish society dedicated to building these resilience factors might prioritize them as much as finance or foreign affairs, and so future political and cultural decisions could be made congruent with these goals. A renaissance of our culture, of life and work and spirit, balanced with our sport, music and arts and respect for beliefs could emerge.

This working towards positive values would sustain growth; and with resilience the next generation could grow together to better withstand its traumas and rebuild itself.

Out of a sincere re-engagement with our history, we could make peace with ourselves and rediscover what it is to be truly mentally and emotionally well; so that more people could live independently, work productively and most of all, love each other with a whole heart.

Edited version of the keynote speech delivered by Dr Jim Lucey, clinical professor of psychiatry at TCD and medical director at St Patrick’s mental-health services, to mark the opening of the Merriman Summer School in Glór, Ennis, Co Clare.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

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