Posts tagged mental illness
Posts tagged mental illness
Is it melancholy to think that a world that Robin Williams can’t live in must be broken? To tie this sad event to the overarching misery of our times?
– Russell Brand, comedian/actor
Like millions, I am sitting with the fact that one of the funniest people to grace the planet has died by his own hand. Robin Williams’ death has hit people of my generation, Generation X, especially hard. After all, his face flashed often across our childhood screens. Mork and Mindy episodes were a source of solace for me as a little girl, as I bounced around between foster homes and family members’ homes, while my single mother cycled in and out of the state mental hospital, fighting to survive. I could laugh and say “nanu, nanu – shazbot” and “KO” and do the silly hand sign and forget for just a little while about living a life I didn’t ask for.
“You’re only given one little spark of madness. You mustn’t lose it,” may become one of Robin Williams’ most famous quotes. I was always struck by how he moved so seamlessly between wacky comedy and the most intense dramas. He was so magnificently able to capture the human experience in all its extremes. He threw all that intensity right into our faces, undeniable, raw, frenetic. He showed us our own naked vulnerability and sparks of madness and gave us permission to laugh in the face of all that is wrong in this world.
In the wake of his death, many people are understandably jumping to identify causes. Depending on who you talk to, Robin Williams’ suicide was caused by depression, it was caused by bipolar disorder, it was caused by the drugs, prescription or otherwise. We just don’t know.
As a suicide attempt survivor myself, I can attest that it’s not that easy to find any single cause for the urge to die. It’s true that along with street drugs, SSRI antidepressants and other psych drugs can certainly increase suicide risk in some people. A decade ago, I was one of many who fought and won to get to the FDA to put a black box warning on SSRIs to warn the public of these very real risks. While a drug, legal or illegal, may give us the impetus we wouldn’t otherwise have had to act on suicidal thoughts, for some of us it’s more complex than that.
Our reasons for wanting to die are as varied as our reasons for wanting to live. That, I believe, is the great mystery of suicide.
But I invite us all not to fear the mystery; not to be struck hopeless by it. We can save each other’s lives; better yet, we can find and share reasons to keep on living. If we have 20 seconds, we can share information about a hotline or a warmline. But if we want to really see this horrific epidemic end, we all have to get more involved.
As someone who has looked into the void and longed for it more than once, I can attest that anyone who reaches out in those darkest of times is truly remarkable. It is, tragically, when I am most distressed and most in need of love and acceptance, that I have the hardest time reaching out. This is not an absolution of personal responsibility, because we all must accept some measure of that; rather a recognition that we shouldn’t put the full onus on a suicidal person to “reach out” and “ask for help.” We need to reach out and help. I have written about the problems with the master narrative of suicide prevention, and how punitive and dehumanizing much of the “help” out there currently is. This blog isn’t about that. I’m talking about help that heals.
My point is that we must change the way we relate to ourselves and one another. In revolutionary ways. We must wake up to the fact that we have been socialized since birth to hide the fullness of who we really are. Robin Williams got to act it all out and the world loved him for it. He expressed the madness, the wildness, that we have been conditioned to hide. We are generally chastised for laughing too hard or crying too loud or being too sensitive. We have been trained to put on a proper face and act like all is well. If for some reason we can’t naturally do that (and most of us can’t), we devise ways to cope with the awful unbearableness of it all. They may be fairly innocuous, like binge watching Orange is the New Black in bed all weekend long. Or we may seek to stop the pain in innumerable ways that we know will kill us in the end — from binge eating to chain smoking to staring down a bottle of whiskey or pills.
If we only realized just how many people walked around carrying heavy burdens that are invisible to the world, and were doing every fucking thing possible to keep from cracking under the weight, we would stop feeling so alone and isolated carrying our own. We could put down our burdens and rest, in the all-encompassing field of our human vulnerability and strength.
“Be kind, for everyone you know is fighting a hard battle,” said theologian Ian MacLaren. I am struck by the imperative need for us all to take up the challenge to be kinder to ourselves and others. There is so much suffering in the world. How often do we ask ourselves, in the midst of responding to Facebook posts, Tweets, and emails: how can I relieve suffering? At the very least, how do I not add to it?
No one person can fix this mess we have gotten ourselves into as a species, but we can each be a part of bringing more compassion and acceptance into the world. First, we have to learn to practice it with ourselves. We can be the antidote to the fear and sorrow that exists within us, in other people, and in the world “out there.” Kindness is dismissed as bullshit in a world that values power over others. But as mindfulness teacher Sharon Salzberg reminds us, kindness is a “force.” If unleashed in vast quantities, it could literally reverse the cycle of misery on this planet.
When will we stop walking around in these miraculous, vulnerable human bodies seeing ourselves as separate? What will it take for us to realize our interconnectedness; to act from a deep understanding that suicidal people are not to be feared and judged, but to be embraced and held in the light of understanding and true empathy? Empathy sees that we are all connected, and thus demands well-being for all.
I think of the people who report walking to the bridge and said to themselves, “if one person smiles at me or talks to me, I won’t jump.” Lately I try to go out of my way to smile at people, to talk to people, even if they look at me funny because they aren’t used to random strangers smiling at them or talking to them. Come to think of it, I think talking to strangers is definitely a symptom of some severe mental disorder in the DSM-V.
But seriously, folks. It strikes me that breaking down our collective walls of isolation, of chiseling away our carefully constructed masks, of taking care of ourselves and each other, of judging less and loving more, may be among the most important things we can do with our lives. We can simply value people, not for what they do or what they achieve in the world, but because they are alive on this planet with us, right now, sharing these troubled, turbulent and painfully beautiful times.
In the end, we are stunningly diverse, yet there are basic human needs that we all have in common. The ancient practice of lovingkindness exhorts us to wish for ourselves and all beings to be safe, to be healthy, to be free, to live with ease. How can we create a world where these universal human needs are met? I think this is one of the primary questions we should all be asking ourselves right now, and figuring out the answers together.
I don’t claim that smiling at the person who makes your coffee or talking to a stranger on the metro will save the planet. What I do believe is that if we all made human connection, safety, and a sense of shared belonging among our top priorities, if we all tried in ways large and small to end our collective isolation and suffering, this world would be a safer place to be human. And a lot of people might not be eager to leave so soon.
Nanu, nanu, Robin Williams. Rest in peace.
Even though schizophrenia is one of the most severe forms of mental illness, nearly 40 percent of people with the disorder say they’re happy, new research contends.
Researchers at the University of California, San Diego, surveyed 72 schizophrenia patients, ranging in age from 23 to 70, living in the San Diego area, and found that 37 percent said they were happy all or most of the time.
Their happiness wasn’t related to the length or severity of their mental illness, to their mental or physical status, or to factors such as age and education. Instead, their happiness was associated with positive mental and social characteristics such as optimism, resilience and lower stress levels, the researchers said.
The findings are valuable because these positive traits can be taught to many people, said the authors of the study, which was published online Aug. 18 in the journal Schizophrenia Research.
"People tend to think that happiness in schizophrenia is an oxymoron," senior author Dr. Dilip Jeste, a professor of psychiatry and neurosciences, said in a university news release.
"Without discounting the suffering this disease inflicts on people, our study shows that happiness is an attainable goal for at least some schizophrenia patients. This means we can help make these individuals’ lives happier," Jeste added.
By way of comparison, about 83 percent of people without schizophrenia said they were happy most or all of the time. And none of the people without schizophrenia said they were never or rarely happy, compared with about 15 percent of those with the mental disorder.
"People with schizophrenia are clearly less happy than those in the general population at large, but this is not surprising," study lead author Barton Palmer, a professor in the university’s department of psychiatry, said in the news release.
"What is impressive is that almost 40 percent of these patients are reporting happiness and that their happiness is associated with positive psychosocial attributes that can be potentially enhanced," Palmer added.
The study was funded, in part, by the U.S. National Institute of Mental Health (NIMH).
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.”
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.
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”