Archive for the ‘Suicide’ Category

A Lifetime of Suicidal Thoughts

Tuesday, December 2nd, 2008

Suicide.

Hear the word. Hear the comments.

They’re almost automatic.

“Such a selfish thing to do.”…”Don’t they realize what they’re doing to their families?”…”It’s the ultimate sin!”…and on…and on…and on…

As the mother of two young adults who have each attempted suicide in times of severe illness, I understand what compelled them, what prompted their actions. In it’s continuing series on mental illness, Canada’s Globe and Mail published a stark and honest account of one man’s struggle with suicidal thoughts that would not go away. An excerpt of the story written by Erin Anderssen appears below. To read the article in it’s entirety, follow the link.

“It is always there, like a song he can’t stop humming. It plays in the background when he graduates from law school. When he hears “not guilty” in court. When he cheers his son William to victory in the big hockey game or hugs his daughter Sarah for winning the Grade 3 spelling bee. He left Toronto because standing on the subway platform cranked the volume. He tried to shock it out of his brain. For a time, Star Trek episodes muffled it. Drugs, at best, only dull it.

In nearly every moment of his life, Peter O’Neill thinks about killing himself. Sometimes, he makes plans. He buys rope. He sets a date. Mostly though, he is trapped between wanting to die and trying to live, while the same scenes run on a loop in his mind: a noose dangling in shadow, or his body hanging from a rope.

It has slowly drowned out nearly everything else - his marriage, his career, his family.”

Read the rest of Peter’s story at globeandmail.com

Read more on the topic of suicide. The more we understand it, the better equipped we are to prevent it.

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Kate on Footnote, Footnote on Kate

Monday, November 24th, 2008

Learn more about bipolar disorder and listen to this informative and candid interview.

Click on either of the above photos to view a 42 minute episode of “Footnote,” a weekly book talk show.

Gray Matter Irregularities in Mental Illness

Thursday, October 30th, 2008

Borderline Personality Disorder, Mood Disorders & Anxiety Linked through Structure and Function

Borderline Personality Disorder , as explained in Wikipedia, “is a psychiatric diagnosis describing a prolonged disturbance of personality function characterized by depth and variability of moods. BPD typically involves unusual levels of instability in mood; “black and white” thinking; chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual’s sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation. These disturbances can have a pervasive negative impact on many or all of the psychosocial facets of life. This includes difficulties maintaining relationships in work, home, and social settings. Attempted suicide and completed suicide are possible outcomes, especially without proper care and effective therapy. Onset of symptoms typically occurs during adolescence or young adulthood. Symptoms may persist for several years, but the majority of symptoms lessen in severity over time, with some individuals fully recovering. The mainstay of treatment is various forms of psychotherapy, although medication and other approaches may also improve symptoms.”

Michael Minzenberg, M.D., of the University of California, Davis, and NIMH grantees Antonia S. New, M.D., and Larry J. Siever, M.D., of Mount Sinai School of Medicine reviewed MRI images of patients diagnosed with Borderline Personality Disorder, and found that they experience differences in the working tissue of the brain, called grey matter.

According to the groups research, people with BPD had more than the average amount of gray matter in a fear hub found deep in the human brain. On images, this area over-activated when the patients viewed scary faces.

Interestingly, these same patients had less gray matter and less activity in the hub’s regulator near the front of the brain. These deficiencies effectively removed the normally built-in controls for a runaway fear response, leading to overreaction.

These imaging studies conducted by Minzenberg, New, and Siever are the first to link structural brain differences with functional impairment in the same sample of BPD patients; and their findings impart significance to millions of other patients since similar changes in the same areas of the brain have been documented in mood and anxiety disorders. As the research evolves, it seems clear that there are numerous shared and common mechanisms with mental illnesses that have traditionally been viewed from a biological perspective.

Click here to view “The Neurobiology and Genetics of Borderline Personality Disorder” written by Antonia S. New, MD & Larry J. Siever MD.

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Hope & Support for Shattered Lives

Tuesday, October 28th, 2008

Five years ago, 26-year old Karla Smith died from a self-inflicted gunshot wound. She was, by all accounts,  a talented young woman, a brilliant writer, much loved by her twin brother Kevin and parents, Tom and Fran…and bipolar.

The Smith’s chronicled their experiences in book and web forms, and created The Karla Smith Foundation to provide “hope for a balanced life to family and friends or anyone with a mental illness or who lost a loved one to suicide.”

Over the next few weeks I will mention the Smith’s, their advocacy efforts, and the resources they’ve created. For today, I share a glimpse of Karla from Kevin’s perspective. You can read this eloquent tribute in it’s entirety at the website “In Memory of Karla Smith”.

In Kevin’s words…

…Karla was officially diagnosed with bipolar disorder, also known as manic-depression…The symptoms fit Karla’s behavior to a T. The mania stage includes excessive energy, delusional thinking, paranoia, often accompanied by financial struggles and a desire for constant movement. The depths of the depression stage lead to suicide for one in five individuals with bipolar disorder. There was disbelief, a fear, and countless questions that struck each one of us in our family. A lot of what we discovered was scary - 2.3 million Americans are diagnosed as bipolar, the cause is unknown and generally manifests itself during the late teenage years, and there is no cure. We had to accept that we would never be able to answer the ‘how’ and the ‘why’ questions. We all became experts on this new thing called bipolar disorder and sadly realized it is a lifelong battle that does not go away. As a family member watching this, the word ‘forever’ was a difficult one for me to grasp.

Throughout the years, Karla explained to me eloquently how her illness felt inside and I’m going to share an example in her words from both the manic side and the depression side. During the mania phase, she explained it like this:

“Imagine your mind as a switchboard and you are looking right at it. And on this switchboard is everything that has ever happened in your life - every past thought, every past event, every past emotion. And one flash appears on the switchboard so you focus on it, but 10 seconds later, another flash appears, and you have to look at it, but then there’s another flash over there, and another one here, and another - and your mind pushes you to see all of them because you have to see them all and experience them all. It’s constant. And I try to explain my thoughts, and what is going on, but it’s so hard to speak that fast because everything is just so confusing.”

And on the reverse-side, an example of her depression came to me in the form of a letter:

“It’s hard for me to talk out loud. There’s a rock that lives in my throat. My mind thinks only of death and escape and I cannot keep up with it. I am afraid of everything, I can’t do things I used to do with ease, and I’m afraid of even people that I’m closest to. I often don’t answer the phone or call anyone back. I’m not afraid of one specific thing, but instead a big general fear - that’s how it’s been inside.”

The extremes of this illness are unbelievable. It is mind-boggling to me how a person can change so drastically in the span of just a few weeks. We did discover one very positive thing about bipolar: even though it did not have a cure; taking daily medication could control it. Bipolar individuals can live long normal lives and most people would not even know the individual has been diagnosed…

Learn more about The Karla Smith Foundation and its work to help those whose lives are affected by mental illness or suicide.

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The Link Between Creativity & Mood Disorders

Monday, October 13th, 2008

Last week, CNN’s Elizabeth Landau wrote an insightful article regarding creativity and mood disorders. It is excerpted below.

The works of David Foster Wallace, who committed suicide September 12, are famous for their obsessively observed detail and emotional nuance.

David Foster Wallace reportedly battled depression for 20 years. Certain characteristics of his prose — hypersensitivity and constant rumination, or persistent contemplation — reflect a pattern of temperament that some psychology researchers say connects mental illness, especially bipolar disorder and depression, with creativity.

There have been more than 20 studies that suggest an increased rate of bipolar and depressive illnesses in highly creative people, says Kay Redfield Jamison, professor of psychiatry at Johns Hopkins University and author of the “An Unquiet Mind,” a memoir of living with bipolar disorder.

Experts say mental illness does not necessarily cause creativity, nor does creativity necessarily contribute to mental illness, but a certain ruminating personality type may contribute to both mental health issues and art.

“Unquestionably, I think a major link is to the underlying temperaments of both bipolar illness and depression, of reflectiveness and so forth,” Jamison said.


This theory could help explain why eminent artists throughout history, from composer Robert Schumann to poet Sylvia Plath to Wallace — suffered mood disorders.

“It’s pretty clear if you read [Wallace's] books that he was a very obsessive, kind of ruminating guy,” said Paul Verhaeghen, associate professor of psychology at Georgia Institute of Technology.

“You can see it in his sentences. … They’re breathless and they need to be annotated, and the annotations need to be annotated again.”

The research of Verhaeghen and colleagues shows when people are in a reflective mode, they may become more creative, depressed, or both. Previous research shows that when people are in a ruminating mode, they are more likely to be depressed, he said.

“If you think about stuff in your life and you start thinking about it again, and again, and again, and you kind of spiral away in this continuous rumination about what’s happening to you and to the world — people who do that are at risk for depression,” he said.

Verhaeghen, who is also a novelist and describes himself as a “somewhat mood disordered person,” had a particular interest in the connection between creativity and this ruminating state of mind.

“One of the things I do is think about something over and over and over again, and that’s when I start writing,” he said.

Sensitivity to one’s surroundings is also associated with both creativity and depression, according to some experts.

Creative people in the arts must develop a deep sensitivity to their surroundings — colors, sounds, and emotions, says Mihaly Csikszentmihalyi, professor of psychology and management at Claremont Graduate University in Claremont, California. Such hypersensitivity can lead people to worry about things that other people don’t worry about as much, he said, and can lead to depression.

“The arts are more dangerous [than other professions] because they require sensitivity to a large extent,” he said. “If you go too far you can pay a price — you can be too sensitive to live in this world.”

Terence Ketter is professor of psychiatry and behavioral science at Stanford University.

Ketter and his colleagues compared a healthy control group with bipolar patients, depression patients, and a control group of graduate students in writing and the arts.

They found that people with bipolar disorder scored better — up to about 50 percent higher — on creativity tests than the healthy control group. The creative control group had about the same increase in score relative to the healthy control group.

But more research is needed, says Ketter. The study does not explain the connection or show a causal relationship, he said.

Some have pointed out that being engaged in creative pursuits makes a person more open to experience, while others say the pressure of being engaged in the arts causes negative emotion, according to Ketter.

Still, the temperamental characteristics in question are thought to be somewhat inherent.

“It’s a little hard to argue that engaging in creative activity could create the temperament, and it may be a little bit more possible that this temperament gives you a creative advantage,” he said.

Verhaeghen’s theory that rumination contributes to negative emotions generally sounds plausible and in some ways consistent with his own views, said Ketter.

Many hope that this type of research will be helpful in developing better strategies to manage and detect mental illness. These strategies can sometimes mean the difference between life and death.
“Tragically, mood disorders can still present a sudden death in people who have been undiagnosed and untreated, and die from the illness,” says Ketter.

More specifically, Ketter says, just as heart disease sometimes presents itself for the first time as a fatal heart attack, mental illness sometimes presents itself for the first time as a suicide.

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National Depression Screening Day

Friday, October 10th, 2008

DEPRESSION…

…is the leading cause of disability in the U.S. for ages 15-44.

…affects approximately 14.8 million American adults, or about 6.7 percent of U.S. adults.

…is more prevalent in women than in men.

…is a state of mind in which the things that used to make you happy no longer do.

…is sometimes called “the blues” or being “down in the dumps.”

…is very common after some of life’s most cruel events, like death, divorce, or disappointment.

… takes the joy out of life.

…steals your energy and makes you feel like there is no hope, no reason to go on.

…makes getting dressed and out of the house feel like climbing a mountain.

…diminishes overall health and exacerbates other problems.

…is not just a rare day of sadness.

HERE ARE SOME COMMON SYMPTOMS OF DEPRESSION:

  • persistently sad or irritable mood
  • pronounced changes in sleep, appetite, and energy
  • difficulty thinking, concentrating, and remembering
  • physical slowing or agitation
  • lack of interest in or pleasure from activities that were once enjoyed
  • feelings of guilt, worthlessness, hopelessness, and emptiness
  • recurrent thoughts of death or suicide
  • persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

DEPRESSION…

can sometimes be prevented, and can always be treated.

If you are depressed, it can be hard to believe that life can get better again - but it can. Getting help for depression can give you your life back. Start with the links below to learn more; and make an appointment with your doctor if you or someone you love is depressed.

Especially for college students:

ULifeline

The Jed Foundation

National Alliance on Mental Illness Depression Fact Sheets

Depression and Bipolar Alliance Fact Sheets

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College Kids–Get Help NOW!

Thursday, October 9th, 2008

ESPECIALLY FOR COLLEGE STUDENTS AND THEIR FAMILIES

You should know that, as a college student, it’s easier to get professional help now than it may be after you leave school. This doesn’t mean you won’t run into any problems, but now is the time to get help. You’ll find confidential on-campus resources at your school’s counseling center, health center and places like a Women’s Center on your campus.

Students sometimes feel embarrassed or scared to seek help. Talking about your problems actually takes an immense amount of strength, and it’s important to move past the stigma surrounding mental health issues and get the help you need.

Often, the best place to start is your school’s counseling center. Visit its website or call its main number to find out what they can offer you.

Most on-campus centers provide two to eight free visits, so you can use their confidential services free of charge.

Counseling centers can offer a range of services, from individual sessions with psychologists or social workers, to group sessions for people who share a common issue (such as body-image issues, grief and loss, or academic anxiety), to sessions with psychiatrists. Since services vary campus to campus, your best bet is to find out exactly what your school offers.

If your school doesn’t have a counseling center, check with the school’s health center; mental health professionals may be able to see you there.

Some counseling centers may disclose information to the school administration if a student is suicidal or has thoughts of hurting him- or herself. You have a right to know if your school’s counseling center has such a policy and if the center plans to do this in regard to your situation.

Some schools have policies that require students who disclose self-injurious thoughts or acts to take an involuntary leave of absence; they may require students who have been hospitalized to be cleared by the counseling center before they can return to classes or live on campus. Check your school’s leave policies, code of conduct and residence hall contracts, or ask the counseling center or dean of students about the school’s policies and practices

You also want to look into what health insurance you have (if you have it) and what it covers. Some plans don’t cover mental health care at all while others have limits on the number of visits. If you don’t want to see a clinician on campus, or if the number of visits your counseling center will allow you isn’t enough, your insurance policy may dictate what outside options are available for you. Be aware that if you are on your parents’ health insurance, they may learn that you are receiving treatment from the insurer. Ask your insurance company about its billing practices.

Even if you have no insurance, there are agencies in most communities that offer services on a sliding scale. You can find them listed under “counseling,” “social service agencies” and similar categories. Many religious groups operate family service agencies that provide a range of counseling services.

If you choose not to seek services on campus, your school’s counseling center can be a resource for referral to practitioners and programs off-campus. You may end up seeing a psychologist, psychiatrist or social worker in a private practice near your campus or in your hometown. You can also go to a family doctor to discuss your symptoms, though it is a good idea that you follow up with a mental health professional since a general practitioner is not the most knowledgeable about mental health issues.

Check out ULifeline, an online resource that provides information about mental health issues and professional resources on and around many campuses, you can get additional information at your school’s counseling and psychological services center.

°Thank you, Bazelon Center for Mental Health Law

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Mental Health Awareness Week

Wednesday, October 8th, 2008

I spent two days on college campuses this week, talking to parents and students about mental health and mental illness. So many questions arose, so many kids suffer unnecessarily.

Here are some of the facts, as published by the Bazelon Center for Mental Health Law:

  • Many college students suffer from anxiety, depression and other mental health concerns.
  • Anxiety is the issue most often mentioned by college students who visited campus mental health services.
  • Students also named depression as one of the top ten impediments to academic performance as well as stress, sleep difficulties, relationship and family difficulties
  • In the 2006 National College Health Assessment, 43.8% of the 94,806 students surveyed reported they “felt so depressed it was difficult to function” during the past year, and 9.3% said that they had “seriously considered suicide” during the year.
  • More than 30% of all college freshmen report feeling overwhelmed a great deal of the time-college women, even more (about 38%).
  • In 2006, more than 13% of college students reported experiencing an anxiety disorder within the previous year.
  • While anxiety disorders are common for both genders, women are five times as likely to have them.
  • Eating disorders affect 5-10 million women and one million men, with the highest rates occurring in college-age women.
  • Thirteen percent of students reported experiencing an emotionally abusive relationship in the last school year.

If you are experiencing depression, anxiety, mood swings, sleep disturbances, delusions or hallucinations, or if you feel overwhelmed, immobilized, hopeless or irritable, there is treatment that can help.

You may also benefit from therapy to address common issues such as body image or low self-esteem, to help with a crisis involving your relationship or family, or if you are in the middle of a transition, such as beginning a new school.

Students who seek treatment are not “weak” or “crazy.”

Therapy is a hopeful and affirming act of caring for yourself.

If you are affected by any of these mental health issues, contact your primary care physician or your campus’ college and psychological services.

You can feel better.

Treatment works.

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Youth + Depression + Social Ills = Bad Mix

Wednesday, October 1st, 2008

Having endured numerous suicide watches with my two oldest children, I’m keenly aware of the sleepness nights, painfully tense shoulders and necks, and tears-ready-to-roll moments that parents experience when their kids are in such turmoil.

Since those same two kids have bipolar disorder with deep depressive phases, I also know the angst of watching a child slip further into the dark abyss and wondering if they will again survive.

Recently, the Agency for Healthcare Research and Quality conducted a study to determine which kids were at greatest risk of suicide.  Depression is obviously linked to suicide attempts, but the fact remains that most depressed youth do not attempt suicide. However, when depression is already a factor and key stressors like a romantic breakup, being assaulted, being involved in a fight, or an arrest take place, a suicide attempt is more likely to occur. Social trauma or drama is usually a tipping point.

Here is the data:

Joan R. Asarnow, Ph.D., and colleagues examined suicide attempts among 451 ethnically diverse depressed youth aged 12 to 21 years in the largest study of adolescent depression in primary care to date. In the past 6 months, 12 percent of these youths had attempted suicide. Those who attempted suicide were significantly more likely to be female (91.1 vs. 77 percent) and to have more severe depression.

After controlling for depression severity, only externalizing behaviors remained a significant predictor of suicide attempts, increasing the risk by 58 percent. After controlling for depression severity and externalizing behaviors, none of the other psychopathology factors (substance use, anxiety, and symptoms of post-traumatic stress disorder) contributed to the prediction of suicide attempts, although youth reporting suicide attempts had elevated substance use and anxiety symptoms, including post-traumatic stress symptoms. Suffering a romantic breakup or physical assault nearly doubled or tripled, respectively, the risk of attempting suicide.

See “Suicide attempts among depressed adolescents in primary care,” by Samantha R. Fordwood, M.A., Dr. Asarnow, Diana P. Huizar, B.A., and Steven P. Reise, Ph.D., in the Journal of Clinical Child and Adolescent Psychology 36(3), pp. 392-204, 2007.

Based on this information, parents and primary care doctors should ask depressed youth about these issues. Knowing a teen’s social situation may save his life.

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Inpatient Treatment for Teens

Tuesday, September 9th, 2008

Parents never want to “put away” their children; but sometimes their situation is so precarious and their health and wellness so compromised, safety can no longer be guaranteed. In the last decade, Mark and I have had to hospitalize two of our children many times. It was never easy, always heart-breaking, gut-wrenching. But it had to be done. We literally feared for their lives.

When this is the case, inpatient treatment may be the only plausible course of action. Unfortunately, many of us are called upon to make these life-and-death decisions; and until now, very few resources were available to assist in the decision-making process. That has changed. For those facing this difficult task, NAMI recently released A Resource for Families Considering Residential Treatment Programs for Their Children. Here are some excerpts from that valuable document:

Steps To Take When Considering Inpatient Treatment

  • Take your time. Resist pressure to make an immediate decision. Residential treatment should not be used in place of local emergency resources in the event that your child is in immediate danger. Beware of programs that push you to “act now” to prevent serious harm.
  • Seek an objective, professional opinion before committing to a program.
  • Ask about pre-admission assessments and admission criteria to determine whether your child qualifies.
  • Request an individualized plan for your child that details the therapies, interventions, and supports that will address your child’s specific needs as well as the transition from treatment back to community-based care.
  • If possible, visit the residential program and take a tour of the facilities before making a decision.
  • Interview staff members.
  • Talk to young people currently in the program.
  • Talk to past students and their families.
  • Verify the program’s licensing and accreditation claims.
  • Verify the credentials of the clinical director and staff.
  • Check with the board of education in the state where the program operates to be sure that the educational program is licensed in that state.
  • Contact the state education board in your state to verify that academic credits will transfer.
  • Obtain copies of publicly available information about the residential program, including complaints or actions filed against the residential program, site visit evaluations, violations, and corrective actions.
  • Ask about the program’s philosophy on medications. Programs should neither over-medicate to sedate or have an anti-medication philosophy, especially if your child is currently relying on medications to cope with their diagnosed disorder.

Additional Questions To Ask

  • Which staff members will be working with your child and what is the experience that qualifies them?
  • What are the program’s disciplinary policies and procedures?
  • How will the program respond to specific behaviors exhibited by your child?
  • How much written and verbal contact do they allow between caregivers and their child?
  • Do caregivers have open access to the facility?
  • How does the program define and measure outcomes and success?
  • What academic curriculum does the program use?
  • What is the ratio of students to teachers?
  • Does the program offer classroom learning or independent study?
  • Are academics ongoing or only offered when the young person reaches a certain point in the recovery process?
  • Have there been any reports of unsanitary or unsafe living conditions, nutritionally compromised diets, exposure to extreme environmental conditions or extreme physical exertion, inadequate staff supervision, medical neglect, physical or sexual abuse of youth, or any violations of youth or family rights?
  • What relationship exists between the residential program and agencies or individuals that have referred the family to the program?
  • What is the average length of stay for youth in the program?
  • How does the program prepare youth to return to their home and community?
  • Does the program provide necessary referrals or connections for after release from the program, including assisted housing, supported employment, vocational rehabilitation, life skills training, and others?
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