Serious Mental Illness Blog

Official blog for LIU Post's Clinical Psychology Doctorate SMI Specialty Concentration

Posts tagged mental

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Missy Douglas: Visualizing bipolar disorder through artBy David Keller, BBC News
Fed up with keeping her mental health a secret, bipolar disorder sufferer Missy Douglas spent a year creating a painting each day to express her feelings. Controversially, she decided not to take her medication during this time, in the hope that paintings demonstrating her highs and lows would raise awareness of her condition.
Waking up each morning, Missy Douglas has no idea how the day will go. She may feel invincible, or she may be hit by a bout of depression.
Battling the emotional extremes in life has become second nature to the 37-year-old artist, who has lived with bipolar disorder for most of her adult life.
Last year she chose to do what she does best. Every day, for a year, she picked up her paintbrushes and painted exactly how she felt.
She decided to give up her medication while she carried out the project.
"I wanted it to be as pure a view of the disorder as possible," she said.
"Painting every day didn’t make me feel more stable or increase my sense of wellbeing," she said Douglas. "In fact, trying to look inside and express raw emotion or psychological distress everyday was very difficult.
"It sometimes exacerbated the depression or mania I was experiencing at the time. However, when I look back I can recognize the patterns and rhythms of my own ‘brand’ of the disorder."
Bipolar disorder brings about strong mood swings that can last for several weeks.
It can leave people unable to form relationships or cope with the day-to-day routine of work and - in extreme circumstances - lead to a feeling of worthlessness.
Douglas, who is originally from Northampton but now lives in New York, said living with the condition could be “extremely exhausting”.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Missy Douglas: Visualizing bipolar disorder through art
By David Keller, BBC News

Fed up with keeping her mental health a secret, bipolar disorder sufferer Missy Douglas spent a year creating a painting each day to express her feelings. Controversially, she decided not to take her medication during this time, in the hope that paintings demonstrating her highs and lows would raise awareness of her condition.

Waking up each morning, Missy Douglas has no idea how the day will go. She may feel invincible, or she may be hit by a bout of depression.

Battling the emotional extremes in life has become second nature to the 37-year-old artist, who has lived with bipolar disorder for most of her adult life.

Last year she chose to do what she does best. Every day, for a year, she picked up her paintbrushes and painted exactly how she felt.

She decided to give up her medication while she carried out the project.

"I wanted it to be as pure a view of the disorder as possible," she said.

"Painting every day didn’t make me feel more stable or increase my sense of wellbeing," she said Douglas. "In fact, trying to look inside and express raw emotion or psychological distress everyday was very difficult.

"It sometimes exacerbated the depression or mania I was experiencing at the time. However, when I look back I can recognize the patterns and rhythms of my own ‘brand’ of the disorder."

Bipolar disorder brings about strong mood swings that can last for several weeks.

It can leave people unable to form relationships or cope with the day-to-day routine of work and - in extreme circumstances - lead to a feeling of worthlessness.

Douglas, who is originally from Northampton but now lives in New York, said living with the condition could be “extremely exhausting”.

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

Filed under art artist artistic creative creativity fine artist paint painting painter bipolar bipolar disorder mind body brain wellness health healthy mental health mental mental illness recovery treatment hope psychology psychiatry counseling life life story feelings feeling

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TEDxMaastricht Clarissa Silva: Expert from experience

Video description: Live with your strength, not with your weaknesses. "Bizarre how fast your life can change," that’s how Clarissa started her talk. She worked as a caregiver when she got mentally ill.

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

Filed under experience experiences story stories life life changing mental health mental illness mental health illness mind body brain wellness healthy recovery hope hopeful caregiver psychology psychiatry counseling therapy treatment feeling feelings emotion emotions emotional

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Patient No. 9413By Roger Cohen, The New York Times
My mother was a woman hollowed out like a tree struck by lightning. I wanted to know why.
Ever since her first suicide attempt, in 1978, when I was 22, I had been trying to fill in gaps. She was gone much of the time in my early childhood, and when she returned nobody spoke about the absence.
I learned much later that she had suffered acute depression after my younger sister’s birth in 1957. She was in hospitals and sanitariums being shot full of insulin — a treatment then in vogue for severe mental disorder — and electricity. The resulting spasms, seizures, convulsions and comas were supposed to jar her from her “puerperal psychosis,” the term then used in England for postpartum depression.
In 1958, my mother was admitted to the Holloway Sanatorium, the sprawling Victorian Gothic fantasy of a 19th-century tycoon, Thomas Holloway, who amassed a fortune through the sale of dubious medicinal concoctions. The sanitarium, opened in 1885, was a great heap of gabled redbrick buildings, topped by a tower rising 145 feet into the damp air of Surrey.
Run initially as a private institution, the Holloway Sanatorium became a mental hospital within Britain’s National Health Service after World War II. It was not closed until 1981. Many of its records and casebooks were burned. The gutted building became a setting for horror movies. Directors could not believe their luck. It is now a gated community of luxury homes.
Some records were preserved at the Surrey History Center. In the faint hope that a trace remained of my mother, I wrote to inquire. My parents had never spoken in any detail of her first depression. A letter came back a few weeks later. References to June Bernice Cohen had been located in the admissions register and in ward reports from July 1958.
These showed that “she was patient number 9413, was admitted on 25th July 1958 and discharged on 12th September 1958.” The ward reports for most of August and September had vanished. I applied under Britain’s Freedom of Information Act to see the records.
My re-encounter with my mother involved painstaking negotiation with an archivist. At last I was presented with the weighty register for female patients. Entries are written with fountain pen in cursive script. In columns across the page my mother is identified. “Name: June Bernice COHEN. Ref Number: 9413. Age: 29. Marital Status: Married. Religion: JEW.”
I stared at her age — so young — and at the capitalized entry under religion: “JEW.” The noun form has a weight the adjective, Jewish, lacks. It seems loaded with a monosyllabic distaste, which was redoubled by the strange use of the uppercase. June was not religious. She is the youngest on the page. She is also the only non-Christian.
The first ward notes on my mother read, “History of depression in varying degrees since birth of second child, now fourteen months old. Husband is engaged in medical research. Patient has some private psychotherapy and also modified insulin treatment at St. Mary’s last month, being discharged July 8th. On admission she was depressed, tearful and withdrawn.”
The doctor examining my mother was struck by how “her tension increased remarkably on mention of latest child.” I ran my fingers over the page and paused at “JEW.” I wanted to take a soothing poultice to her face.
On July 28, 1958, my mother was visited by a Dr. Storey. He “confirms diagnosis of post-puerperal depression and advises Electro-Convulsive Therapy (ECT), which patient and husband are now willing to accept.”
She first underwent electroshock treatment on July 30, 1958. I see my slight young mother with metal plates on either side of her head, flattening her dark curls, her heart racing as her skull is enclosed in a high-voltage carapace. I can almost taste the material wedged in her over-salivating mouth for her to bite on as the current passes.
The treatment was repeated a second time, on Aug. 1, 1958. That was one day before my third birthday. So, at last, that is where she was.
I now have some facts to anchor memory, fragments to fill absence. My mother, who recovered sufficiently to be stable, if fragile, for about 15 years through my childhood and adolescence, would suffer from manic depression, or bipolar disorder, through the latter third of her life. She died in 1999 at the age of 69. The ravages of this condition I observed; the onset of her mental instability I only felt.
The hidden hurts most. Mental illness is still too clouded in taboo. It took me a long time to find where my mother disappeared to. Knowledge in itself resolves nothing, but it helps.
Acceptance — it comes down to that. This is how I came to this point, and to this place, by this looping road, from such anguish, and I am still alive and full of hope.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Patient No. 9413
By Roger Cohen, The New York Times

My mother was a woman hollowed out like a tree struck by lightning. I wanted to know why.

Ever since her first suicide attempt, in 1978, when I was 22, I had been trying to fill in gaps. She was gone much of the time in my early childhood, and when she returned nobody spoke about the absence.

I learned much later that she had suffered acute depression after my younger sister’s birth in 1957. She was in hospitals and sanitariums being shot full of insulin — a treatment then in vogue for severe mental disorder — and electricity. The resulting spasms, seizures, convulsions and comas were supposed to jar her from her “puerperal psychosis,” the term then used in England for postpartum depression.

In 1958, my mother was admitted to the Holloway Sanatorium, the sprawling Victorian Gothic fantasy of a 19th-century tycoon, Thomas Holloway, who amassed a fortune through the sale of dubious medicinal concoctions. The sanitarium, opened in 1885, was a great heap of gabled redbrick buildings, topped by a tower rising 145 feet into the damp air of Surrey.

Run initially as a private institution, the Holloway Sanatorium became a mental hospital within Britain’s National Health Service after World War II. It was not closed until 1981. Many of its records and casebooks were burned. The gutted building became a setting for horror movies. Directors could not believe their luck. It is now a gated community of luxury homes.

Some records were preserved at the Surrey History Center. In the faint hope that a trace remained of my mother, I wrote to inquire. My parents had never spoken in any detail of her first depression. A letter came back a few weeks later. References to June Bernice Cohen had been located in the admissions register and in ward reports from July 1958.

These showed that “she was patient number 9413, was admitted on 25th July 1958 and discharged on 12th September 1958.” The ward reports for most of August and September had vanished. I applied under Britain’s Freedom of Information Act to see the records.

My re-encounter with my mother involved painstaking negotiation with an archivist. At last I was presented with the weighty register for female patients. Entries are written with fountain pen in cursive script. In columns across the page my mother is identified. “Name: June Bernice COHEN. Ref Number: 9413. Age: 29. Marital Status: Married. Religion: JEW.”

I stared at her age — so young — and at the capitalized entry under religion: “JEW.” The noun form has a weight the adjective, Jewish, lacks. It seems loaded with a monosyllabic distaste, which was redoubled by the strange use of the uppercase. June was not religious. She is the youngest on the page. She is also the only non-Christian.

The first ward notes on my mother read, “History of depression in varying degrees since birth of second child, now fourteen months old. Husband is engaged in medical research. Patient has some private psychotherapy and also modified insulin treatment at St. Mary’s last month, being discharged July 8th. On admission she was depressed, tearful and withdrawn.”

The doctor examining my mother was struck by how “her tension increased remarkably on mention of latest child.” I ran my fingers over the page and paused at “JEW.” I wanted to take a soothing poultice to her face.

On July 28, 1958, my mother was visited by a Dr. Storey. He “confirms diagnosis of post-puerperal depression and advises Electro-Convulsive Therapy (ECT), which patient and husband are now willing to accept.”

She first underwent electroshock treatment on July 30, 1958. I see my slight young mother with metal plates on either side of her head, flattening her dark curls, her heart racing as her skull is enclosed in a high-voltage carapace. I can almost taste the material wedged in her over-salivating mouth for her to bite on as the current passes.

The treatment was repeated a second time, on Aug. 1, 1958. That was one day before my third birthday. So, at last, that is where she was.

I now have some facts to anchor memory, fragments to fill absence. My mother, who recovered sufficiently to be stable, if fragile, for about 15 years through my childhood and adolescence, would suffer from manic depression, or bipolar disorder, through the latter third of her life. She died in 1999 at the age of 69. The ravages of this condition I observed; the onset of her mental instability I only felt.

The hidden hurts most. Mental illness is still too clouded in taboo. It took me a long time to find where my mother disappeared to. Knowledge in itself resolves nothing, but it helps.

Acceptance — it comes down to that. This is how I came to this point, and to this place, by this looping road, from such anguish, and I am still alive and full of hope.

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

Filed under patient psychiatry psychology counseling hospital med meds medication mental health mental illness mental health illness mind body brain wellness healthy treatment recovery hope suicide suicidal inpatient depression depressed depressing history therapy therapist

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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

57 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.”

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