Category Archives: Crisis Intervention

“Suicide by Cop”—Mental Illness and Law Enforcement Response

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JC Schildbach, LMHC

Georgia Tech engineering student and Pride Alliance president Scout Schultz phoned 911 at 11:17 p.m. Eastern last Saturday night to report a dangerous, armed individual—Scout Shultz. All indications are that the call was a suicide attempt, which the police, lamentably, completed.

In the world of crisis intervention and suicide prevention, we routinely assess for plan, means, and intent. In other words, we ask if someone expressing suicidal ideation has a plan to harm themself; if so, we ask if they have the means to carry out the plan; and we also seek to determine how determined the suicidal person is to actually go through with the plan.

For instance, if an adult male says he is suicidal and has a plan to shoot himself, but he has no access to a gun, there is a plan but no means. If that same person has a plan to shoot himself, and access to a gun, but says he is not going to do it because he would never do that to his family or has religious reasons for avoiding suicide, then he has a plan and means, but the intent is absent or lacking. If that same person has a plan to shoot himself as soon as he finishes his drink, access to a gun, and no reasons he identifies for not shooting himself, then plan, means and intent have all come together in a rather urgent fashion.

In the case of Schultz, the plan, means, and intent might be characterized in the following way.

Plan: suicide by cop; means: a call to 911 to anonymously report self (in the third person) as an armed danger to the community; intent: plenty enough to make the call and brandish a weapon at the police.

Scout and the cops

Crisis intervention or crisis escalation?

Schultz apparently knew enough to indicate the possible presence of a gun, rather than just reporting the knife (which turned out to be a “multipurpose tool”—something that is generally less fatal than a gun, or even, say, a hunting knife or kitchen knife). The threat of a firearm is likely to put officers in a different frame of mind prior to even arriving on scene, even if protocols are still essentially the same.

Even so, it is puzzling that an officer, with a second officer nearby who was also aiming a gun at the allegedly dangerous individual, would choose to stop said multipurpose-tool-wielding individual with a bullet to the chest. Granted, even with the best training available, professionals can panic in novel situations, or situations where they feel threatened. And, generally speaking, the sense of feeling threatened is the main criteria for police officers to be excused for fatally shooting anybody, regardless of what that anybody may be armed with, or why they may be engaging in some form of threatening behavior.

For those not familiar with the dynamic, I suppose there could be questions about how being shot by the police is a form of suicide. But for people in crisis intervention and suicide prevention, and, I suspect, for a majority of law enforcement officers out there, it’s far more common than one might imagine. Deliberately provoking an armed person into killing you is, arguably, less difficult than taking the steps yourself. For instance, if you don’t have access to a gun, shooting yourself is rather difficult. Getting shot by someone else is, perhaps, more within reach.

Beyond that, any method of suicide where you have to push yourself into that final, fatal act forces you to overcome eons of ingrained animal behavior that drives you to keep yourself alive. With the right threats, a suicidal person can turn that same instinct in someone else into a means for suicide completion.

When it comes to crisis intervention, and 911 dispatch, suicide by cop is also a bit of a conundrum. If a person calls to report suicidal ideation and refuses to ‘contract for safety’ (essentially, agree to do something other than killing him/herself), the person can report any of a number of intended means of suicide, including “suicide by cop”, knowing that the standard protocol in any report of intent to complete suicide is to send police out for a ‘welfare check’. Whether or not the person reports “suicide by cop” as the intended means, he/she is likely to know that the right provocation can lead to the use of deadly force. The police will get almost always get dispatched one way or another, because of the threat of suicide, and the directives to get suicidal people to an Emergency Room for a mental health assessment.

Schultz found a way to bypass some of the usual protocols by going straight to 911 and exaggerating the threat. No crisis counselors engaging in a clinical assessment. Deliberately misleading information provided to 911 dispatchers, which was, in turn, relayed to police.

But the entire situation begs plenty of questions about how Schultz’s plan, assuming Schultz was fully intending to die, could have been brought to fruition with what was essentially a minor manipulation of information.

Why was a shot to the chest the means the officer chose as self-preservation and to subdue the threat? If a gun needed to be the tool of choice, why wasn’t a debilitating, but non-fatal shot attempted instead? Why did the officers not use a taser or pepper spray to disable Schultz?

But, perhaps most of all, we need to ask if there are there police officers who aren’t trained to recognize and address attempts at suicide by cop? Police officers, so divorced from knowledge of mental health issues and basic human behavior that all threats are considered deadly? Police officers who are not trained to reasonably assess the threat level any given individual represents and to respond with non-lethal force in every instance possible?

Granted, when they are sent out on a call, law enforcement officers never know what they are walking into, or how any particular situation may unfold, and only have whatever information has been provided dispatchers, and then been filtered down to them. Such an information chain most certainly adds to the stress of police officers’ jobs, and the potential for error.

This post isn’t intended as an anti-police rant. In crisis intervention, mental health professionals have to work closely with the police in coordinating appropriate responses to potentially dangerous situations—which are most often about clients putting themselves at risk more than anyone else. That said, Police are the ones who put themselves in harm’s way as first responders, to ensure that nurses, doctors, social workers, and counselors can then step in to engage in assessments and treatment.

But we need to make sure that police aren’t bringing guns to a multipurpose-tool fight as part of a routine and accepted response, especially when that fight is against people struggling with mental illness—lest the need for mental health assessment and treatment is removed by a fatal, law-enforcement-administered gunshot.

See You in Hell, My Friend

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J.C. Schildbach

An impulse buy one morning, exhausted and mildly intoxicated. I worked nights, and so did she—back when we worked at the same place. Whiskey in the morning isn’t all that unusual when morning is your evening…and drinking a lifestyle choice.

I didn’t make the connection until I got it in the mail and thought, ‘Why the hell did I buy this?’

It was a screen-printed sweatshirt, a mock-Christmas sweater, featuring a modified version of the “Sigil of Baphomet”—an inverted pentagram, with the head of “The Goat of Mendes” inside, and the Hebrew for “Leviathan” spelled out, one character between each point of the star.

a-baphomet-xmas

But where was I going to wear this? I wasn’t going to any Christmas parties, and haven’t been in the mood to wear any sort of provocative T-shirts since, maybe, my Dead Kennedy’s “Too Drunk to F*ck” shirt back when I was in college.

Wait…there was also “Thanks a lot, God”…which I printed and sold…a friend’s design.   And a few more are springing up now, including some fart jokes and worse. Let’s just say that within the last decade…wait…I thought of something else. Ok…moving on.

Eventually the fog lifted…Winnie the Pooh worshipping Baphomet…that’s the post she messaged me not four days before she died in her sleep. It came across as a still image, although it was supposed to be a .gif—an altered version of Pooh exercising in front of a mirror.

pooh-baphomet

Her death wasn’t expected at all. She’d had health problems—but not of the terminal kind, as far as I knew—and apparently, as far as she knew.

It wasn’t until roughly two months after she died (and at least 5 months before I ordered that sweatshirt) that the memorial service was held, on her birthday, in the early evening sun of Golden Gardens Park in Seattle.

I was reminded that night that we all know people in different ways. People remembered her as intense and potentially off-putting, while also supportive, nurturing, and teaching. There were tales of wild, dumpster-diving/reach-for-the-brass-ring adventures; and stories of sage advice, a kind word, a wisely snide comment.

Some minor celebrities were there…people whose work I knew, and admired.

I kept quiet…mostly.

The last time I saw her—in real life/face to face—was when we went out to breakfast at a dive up the road from where we worked. She had taken a new position, and was moving off the grave shifts we shared. We were celebrating her new position, and the end of our overnight shifts together.   We enjoyed Bloody Marys, Biscuits and Gravy, and hash browns.

(A few months later, I would move on, too, to another organization entirely).

On that morning I picked up the tab…but only because 1) I have a limited capacity for showing affection/appreciation otherwise, 2) I was essentially her supervisor on those shifts, so it only seemed right, and 3) we had a vague plan for a future gathering where she would get me back.

That final night, while slapping together a playlist on my laptop, I inadvertently started playing a song by Ghost…or Ghost B.C. if that’s how you want to be…”Year Zero”…which our other shift-mate instantly recognized (the chants of ‘demon’ names are hard to miss if you’re familiar with them—Belial, anyone?).

It didn’t take long for her to fall in love with the band. She messaged me later in the day, saying she couldn’t believe she had never heard of them before.

Yes, ours was a soft Satanism, a casual Satanism…something difficult to fathom for those who take matters of eternal life all too seriously. And out of fear of…or concern for…those very same people, I hesitated in completing this post all those months ago…shelved it, sat on it, failed to put it together once and for all.

I neglected to process the grief in a way that made sense to me…or that made sense to the friendship I had with her. I just added it to the list of other head-kicks and gut-punches I was enduring, ignoring, and stuffing…waiting for a time when I assumed the blows would stop landing, and I might be able to crawl off to a dark corner and heal.

For her part, she was Buddhist…or something like it, I suppose. We enjoyed our dark humor more than we ever engaged in any deeply spiritual or religious discussions. I’ve got no legitimate religious/spiritual label for myself. Raised Lutheran, self-converted to agnosticism. My wife accuses me of believing in ghosts, but denying they (or any other spiritual beings or energy) exist.

True enough…but also false enough.

My co-worker and I shared a penchant for self-destruction, and self-sabotage, largely tamed by age to a kind of resignation that we weren’t really capable of being bad people…although we still kept trying to prove to ourselves, and a few select others, in small, stupid ways, that maybe we were.

She was only seven years my senior…so her death still brings shock…even after the steadily-increasing numbers of deaths I experience each year, many involving people right around her age. But most of those are prefaced with diagnoses and attempts at treatment, along with the actual spectre of specific forms of death…usually cancer of one kind or another…not the vague idea of ‘health problems,’ or a good night’s sleep unexpectedly becoming an eternal sleep.

Her picture…the one distributed on postcards at the memorial service, the lyrics to Patti Smith’s “Memorial Song” (“It is true I heard/God is where you are”) printed on the other side, is propped up on my desk at home…a reminder of…what? Not to blow off life? A reminder of the idea that we’re all gonna die sometime…maybe soon?

desk-cyndee

I don’t know

It’s there.

It makes me smile.

Sometimes it scares me into thinking I better get off my ass…but not necessarily acting on that scare.

But, always, it brings me back to that same, old, silly idea…born of tauntaun rides, and sub-par 80s metal…

(Then) I’ll see you in hell, (my friend).

Imagine Han Solo fronting Grim Reaper, or Steve Grimmet, clad in a red, pleather jumpsuit, heading out into the rapidly-dropping temperature of Hoth…or don’t. I really need to learn how to work with Photoshop to get these images out into the world…or not.

At any rate, “See you in hell” isn’t an insult or a threat, but a badge of honor among those who carry themselves as…well, I suppose ‘antiheroes’ is as close as I’m going to get…the people plugging along, trying to do good in spite of themselves…not bucking to be perfect—because who the hell cares about that?—but struggling to be human in a way that supports all other humans, or as many of them as we can tolerate, and…well…all those other damned living things.

So, yeah…

I’ll see you in hell, my friend.

 

 

 

 

 

Yes, Breitbart, 33,000 People ARE Killed with Guns Each Year

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J.C. Schildbach, LMHC

There is absolutely nothing controversial about Hillary Clinton’s claim that, in the United States, “We have 33,000 people a year who die from guns”–except maybe to those who don’t understand how words and numbers work.

Yet, AWR Hawkins, breitbart.com’s “Second Amendment Columnist,” posted a “Fact-Check” column, titled “No, 33,000 Not Killed with Guns Each Year” following the third presidential debate, claiming that Clinton deliberately inflated the CDC numbers of firearm deaths by adding in suicides. This is not the first time Hawkins has posted similar complaints.

What Hawkins fails to do is explain how suicides by firearm somehow fall outside of the “33,000 people a year who die from guns.” Certainly, Hawkins must understand that somebody who uses a gun to kill him/herself is dead, and did use a gun in order to die—making that person someone who ‘died from a gun.’

Using Hawkins’ preferred language of people “killed with guns each year” still doesn’t change anything. A person who commits suicide with a firearm still was, in fact, killed with a gun.

suicide-gun-mouth

Hawkins also strikes out by putting the phrase “gun violence” in quotation marks, saying that the use of that phrase (which Clinton did not use in the quote he complains about) somehow plays into Clinton’s strategy of fooling the public. But, again, killing oneself with a firearm does qualify as “gun violence”–first of all, because it involves an act of violence; and secondly, because it involves a gun. Or you can reverse that so the gun is first and the violence is second—still doesn’t change anything.

I don’t want to get into speculation about things that Clinton didn’t say, but perhaps if she had used the phrase “gun crimes” or had referred to murders using guns, then Hawkins would have a better argument. But Clinton didn’t. So Hawkins doesn’t.

And, in case you’re wondering, the 33,000 figure is dead-on. Here’s a chart, showing the CDC numbers of gun deaths for the years 2010 to 2014 (2014 being the most recent year statistics are available) clearly showing that gun deaths have reached well above 33,000 per year for 2012, 2013, and 2014, and averaged 32,964 per year for the five-year period.

avg-gun-deaths-2010-to-2014

A handy chart of CDC statistics on gun deaths, lifted from Everytown for Gun Safety at  https://everytownresearch.org/gun-violence-by-the-numbers/

Now, I get that gun-loving Americans, including the Breitbart crowd, don’t like to believe anything negative about guns. They also don’t like to believe that they may, at some point, end up so distraught, or so deep in the throes of mental illness, that they might use their guns on themselves, and/or their family members or other loved ones—or perhaps even neighbors or random strangers.

By pushing the suicide statistics aside, or pretending they ‘don’t count’, Hawkins ignores a harsh reality here: that people who own guns tend to kill themselves with those guns far more than they kill an intruder in their home, or otherwise defend themselves from the big, bad, scary world out there. People who own guns kill themselves with those guns more often than criminals use guns to kill innocent citizens; and more frequently than ‘gang violence’ leads to gun deaths.

There is also considerable overlap in the “murder/suicide” category—where gun owners kill their significant others, family members, co-workers, or random strangers, prior to turning their guns on themselves. And because guns are such a quick and effective killing tool, the decision to use them in an act of violence on loved ones or oneself is often impulsive—a few too many bad days in a row, a bad argument following a few too many beers, or even a partner deciding they want out of a relationship, and the gun comes out as the ultimate way to put a stop to whatever is so aggravating.

As for mental illness, Hawkins’ argument becomes even less convincing in the face of all the clamoring about how we don’t have a gun problem in the U.S., but we have a mental health problem. Of course, people who make such an argument are usually talking about the mental health issues of mass shooters. Yet, if we (properly) view suicide as a mental health issue, then the numbers of firearm suicides become that much more disturbing. Gun owners kill themselves at a rate roughly twice as high as the rate of gun murders. That’s a vast mental health issue that’s not being addressed, and that is being exacerbated by guns.

Yes, I know that many of the people who want to argue in favor of guns like to point out that people who commit suicide will find the means to do so, even if you take their guns away–an argument which is demonstrably false in terms of overall lethality. There are many ways to map out the evidence showing this falsehood, including the high rate of suicide by firearm–roughly 50% of all suicides in the U.S. are completed using guns. Another way to conceptualize the difference in suicide methods is to compare suicide completion rates using firearms relative to suicide completion rates using other methods. For instance, plenty more people survive suicide attempts by overdosing on pills than survive suicide attempts using guns.

Those who are willing to brush off the connection between firearms and suicide also sometimes argue that suicide is a matter of personal freedom—of being allowed to end one’s life when one chooses. I will say that I’m not completely opposed to people being able to end their own lives on terms they choose. However, I’ve learned enough to know that people are least equipped to make that decision quickly, impulsively, or while in a deep depression (among many other factors). Very few people attempt suicide while they are thinking in the clearest of terms, or making a rational decision based on a comprehensive review of the facts.

Depression and many other forms of mental illness are notorious for their association with cognitive distortions, aka, “thinking errors”—misinterpreting the world around one, the impact one’s actions have on others, and the view other people have of one (again, among many other factors). As I’ve pointed out before, the idea that a gun keeps one safe is, itself, a cognitive distortion. The suicide-by-firearm statistics make that clear.

There is also, perhaps, a great irony here, in that Hawkins believes he is advocating for gun ownership, when the “mental health” approach to suicide prevention involves removing the means for suicide. That is, safety planning for suicide prevention involves taking away those means most likely to be used in a suicide attempt, while the person at risk for suicide gets treatment.

So, how do we address the mental health problems associated with guns and suicide? Take the guns away, at least until the person moves beyond risk for suicide. Of course, mental health treatment is not predictive. Risk factors can be weighed, and support systems assessed, but given the ease with which a person can use a gun to end her/his own life, a dip back into depression, a few more bad days, a drift away from regular engagement with one’s (positive) coping skills, and the risk can escalate once again.

Hawkins thinks he is supporting gun rights by poo-pooing the statistics on firearm deaths in the United States. But what he is actually doing is pointing out that suicide is twice as big a problem, where guns are concerned, as murder is. His solution is to pretend the people who commit suicide with guns aren’t really people who “die from guns.”

At base, he is arguing that people who commit suicide with guns aren’t really people…or perhaps aren’t really people who deserve the support to go on living.

 

What? Me Network?

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JC Schildbach, LMHC

A few weeks back, as a favor to a friend, I was invited (compelled?) to speak with a small group of victim advocates—county employees who serve as a kind of official support system for those people directly impacted by a crime. The topic: sex offenders and sex offender treatment.

I agreed to the meeting several months prior, when I was still working directly in the field of sex offender treatment. Having moved away from that field, I hadn’t exactly been immersed in relevant information. As ‘luck’ would have it, though, the Josh Duggar situation provided plenty of focus on issues of law and treatment regarding sex offenses, and an easy access point to discuss much of the involved information.

I had not prepared an actual presentation–the kind with Powerpoint slides, and handouts. Rather, the victim advocates sent me a number of questions via email, and I spent the allotted hour attempting to provide straightforward answers. As with any specialized field, though, nuanced and complex answers are far more the norm.

A quick sampling of some of the (paraphrased) questions and the (overly simplified/incomplete) answers:

Q: What are recidivism rates for adult offenders versus juvenile offenders?

A: Much lower than most people think, in both cases.

Q: Is treatment for offenders a “one size fits all” program, or is it tailored to the specifics of the offender and the offense?

A: There are standardized “assignments” and program requirements, but, as with any form of therapy, it works best when the particulars of the people involved are taken into consideration.

Q: Do you see a lot of commonalities among offenders?

A: As with any ‘diagnosis’ or behavioral category, there are going to be a great many similarities—or those points where behaviors, and justifications for those behaviors, share many similarities—for example…

The lunch hour actually went by pretty quickly. And, despite feeling a bit nervous about providing accurate information without delving into boring details, nobody fell asleep. (Which reminds me, I promised to email some information about various psych tests, which I never did—and I also meant to ask about doing a quick once-over of my friend’s notes to make sure I hadn’t misspoke or inadvertently conveyed any muddled or inaccurate information).

At any rate, the lunchtime meeting was a good refresher about how necessary, and how difficult, it can be to properly ‘network’ within one’s chosen field. It’s quite easy to sit back and complain that people know so little about the specialization you’ve devoted a great deal of your working life to, without doing anything to address that lack of knowledge.

Happy face mad

Of course, it can be extremely difficult breaking through all the noise and confusion to relay one’s own specialized understanding of specific issues, or to have the patience to let the specialized knowledge of others in.

After all, we can all get bogged down in our day-to-day life. And going to trainings or other networking opportunities can feel like just another professional obligation—more about checking a box on a form, than about gaining knowledge and understanding that can truly help in one’s ability to help others—not to mention, the opportunity to meet and connect with other people who are potentially valuable allies and resources.

Still, I suppose we all have our fair share of networking disaster stories.

Take, for example, the time that I went to a breakfast fundraising event for the King County Sexual Assault Resource Center as a special guest of the Seattle Archdiocese (damn, that sounds important, doesn’t it? But, truth be told, I was actually the ‘plus one’ to my boss’ invitation as a special guest of the Seattle Archdiocese). Anyway, after the program of speakers, ranging from local media luminaries, to elected officials, to experts in the field of sexual assault treatment, to the families of sexual assault victims, as the time arrived for everyone to mingle and/or make a quick getaway to avoid mingling, I managed to upend a glass of water, which drained directly into the chair where I was sitting. Mingling in wet pants—not really a comfortable experience, or a good way to convey anything you want other professionals to remember about you.

Beyond various faux pas, I think many professionals go to trainings and seminars with those colleagues we already know—potentially insulating and isolating ourselves from other attendees. Whatever your impressions of people in the mental health field, plenty of us are actually introverts who find crowds and forced socialization to be extremely draining. For some, the same skills that make us effective in a one-on-one or group session, or even a phone-based intervention—such as being able to focus not only on a person’s words, but the whole of what people are communicating non-verbally—can make it very difficult to just mingle in a large crowd.

There is also the potential for fumbling when you’re on the ‘turf’ of some other specialization. I mean, imagine how potentially uncomfortable it can be when you work in the field of sex offender treatment, and are attending a conference for providers who treat the victims of such offenders. Ultimately, the goals are the same—to reduce the impact of such trauma, and combat the underlying causes of such offenses—but you’re definitely working different sides of the same street.

There are also several forms of specialization that can reach into most other areas of treatment—substance abuse, personality disorders, suicidality, and on and on. No practitioner has the ability to become truly well-versed in every possible situation they encounter. Ideally, though, they will learn enough to recognize when they need to refer out, and how to recognize the signs of those areas with which they aren’t particularly familiar.

I suppose this is all weighing on me a bit heavily, as I have my licensure renewal coming up, and need to make sure I have all of my trainings in order. I’ve done plenty of trainings, and perhaps a whole lot more personal study, over the past few years, but not all of that counts for official training credits.

On top of just staying abreast of one’s own field, and finding trainings of interest that fit one’s schedule and budget, the state instituted a requirement that all counselors have to have training in how to deal with suicidal clients at regular intervals. I’m trying to approach this positively. I get the reason for its necessity (although the real reason for the change in requirements had to do with previous problems in the state’s credentialing process that allowed people with little-to-no education in mental health to call themselves “counselors”—which led to multiple tragedies and other less-than-ideal outcomes).

Still, having worked in suicide prevention for years makes the requirement a bit redundant for me. I know and respect many of the people conducting the trainings, and certainly learn from them each time I have occasion to encounter them. But as a general topic area, I could be brushing up on or exploring other areas where I haven’t already spent years of professional focus, particularly given that the trainings are aimed at practitioners who aren’t particularly sturdy in their suicide prevention/intervention skills.

Mental Health practitioners are also required to take regular ethics trainings—I suppose for those therapists who can’t remember not to force their own views on people, not to run around blabbing about their clients, and not to sleep with their clients.

That said, I will look to make the most of my remaining trainings, try to be pleasant and sociable, and pay attention so that I might actually gain some new insight. And I vow not to be one of those terrible bores who offers up one’s own experiences during question-and-answer periods, just to show how knowledgeable one is, rather than actually seeking information from the experts providing it.

And perhaps I should just schedule one of those suicide prevention trainings ASAP—or maybe after I cast about a bit to see if any of my friends in the field have been blowing off that training too, and want to go along.

Self-Infantilization or Supportive Compromise? On the Controversy over Safe Spaces

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JC Schildbach, LMHC

In her March 21 piece for the New York Times, “In College and Hiding From Scary Ideas” Judith Shulevitz mocks, among other people and things, Brown University student Katherine Byron for setting up a “safe space” for students who might be “triggered” during a debate between Jessica Valenti and Wendy McElroy that was likely to include a discussion of rape culture.

Shulevitz reported that the safe space “room was equipped with cookies, coloring books, bubbles, Play-Doh, calming music, pillows, blankets and a video of frolicking puppies, as well as students and staff members trained to deal with trauma.” Nothing is said about why such items and personnel might have been present, or what the theory behind such a ‘safe room’ might be, other than Shulevitz’s own assumptions about how college students of today are over-parented and overly-sensitive.

Shulevitz goes on to say that, “Safe spaces are an expression of the conviction, increasingly prevalent among college students, that their schools should keep them from being ‘bombarded’ by discomfiting or distressing viewpoints.” Shulevitz does not provide anything other than anecdotal evidence about the alleged increasing prevalence of such a conviction.

On top of that, one major thing that gets lost in Shulevitz’s piece is that the debate between Valenti and McElroy went on. The ideas were not silenced. No speaker was banned.

Instead, Byron, and those who assisted her, offered a place where audience members could go if they became uncomfortable, not necessarily with the ideas being expressed, but with the content of the discussion, which presumably included descriptions of how rape is depicted in popular culture, as well as how rape and rape victims are treated in the news media, by law enforcement, and in other areas of their lives.  The safe room was established by the Sexual Assault Task Force, first and foremost, to afford a safe space for trauma victims–not a refuge from ideas.

All the comfort of the joys of childhood...

All the comfort of the joys of childhood…

Perhaps Shulevitz’ mocking of the “safe spaces” is particularly disappointing because she has written other pieces on trauma and its impacts, most notably, a November piece in The New Republic, called “The Science of Suffering” which explored research into how PTSD can potentially be transmitted from generation to generation.  In it, Shulevitz includes this succinct and powerful description of PTSD:

Provoke a person with PTSD, and her heart pounds faster, her startle reflex is exaggerated, she sweats, her mind races. The amygdala, which detects threats and releases the emotions associated with memories, whirs in overdrive. Meanwhile, hormones and neurotransmitters don’t always flow as they should, leaving the immune system underregulated. The result can be the kind of over-inflammation associated with chronic disease, including arthritis, diabetes, and cardiovascular disease. Moreover, agitated nervous systems release adrenaline and catecholamines, both involved in the fight or flight response, unleashing a cascade of events that reinforces the effects of traumatic memories on the brain.

Shulevitz’s New Republic article describes research into, among others, Cambodian refugees who suffered through brutal conditions of war. And maybe this is where Shulevitz’ disconnect arises: her inability to see how a sexual assault in the modern-day USA could lead to similar forms of psychological and physical response as living through a years-long period of war somewhere else in the world.

But PTSD just as powerful as that experienced by those who have been through war can arise out of a sexual assault or rape. PTSD is not measured and assigned on some scale where those who experienced the longest, and arguably worst, trauma have the ‘most’ or most severe PTSD.

Complaining of the “self-infantilization” (a term Shulevitz credits to Judith Shapiro) demonstrated by things like the Brown University safe room, Shulevitz also neglects to explore other potential psychological issues stemming from sexual assault, particularly for those who were assaulted repeatedly at a young age. To be clear, I am not assigning a specific causal relationship here (i.e., if this happens, then that is the result, and/or, because a person exhibits this behavior, this particular thing has happened to them) but issues such as Borderline Personality Disorder are often tied to a history of having been sexually traumatized.

Strangely enough, complications associated with Borderline Personality Disorder can include shortcomings in one’s ability to develop into an emotionally mature adult.  Along with the repeated hospitalizations, there are frequently tendencies toward anxiety and overreaction to stimuli, impulsivity, fear of abandonment, hostility and perceptions that one is being personally attacked, and difficulties in forming long-term, stable relationships—issues which might, along with PTSD symptoms, be addressed (at least in the immediate sense of a perceived threat) by the “safe room” tactics that Byron deployed.

Rather than exploring the potentially positive effects of the safe room, though, Shulevitz instead uses it, and other alleged examples of “hypersensitivity” at universities, as evidence that today’s college students aren’t tough enough to handle the real world, and that today’s parents are coddling their children too much. But ongoing PTSD, personality disorders, and other psychological manifestations of trauma are not the result of overly-attentive parenting—and are more likely to be exacerbated by the opposite—a lack of attentiveness and support by those who should be providing it.

Still, Shulevitz pats herself and her peer group on the back for being much “hardier souls” than today’s college students–which includes an explanation that, in her day, college students only censored speakers for the right reasons. She writes, “I’m old enough to remember a time when college students objected to providing a platform to certain speakers because they were deemed politically unacceptable.” Shulevitz isn’t particularly clear on how “politically unacceptable” is markedly different from ‘ideas that make some people uncomfortable.’

Perhaps this is a good time to reiterate that Byron and her Sexual Assault Task Force didn’t actually stop anybody from speaking at Brown, but set up a space, off to the side, out of concern for those who might be interested in hearing the debate, but weren’t too confident that they would respond well to it. If anything, it represents a form of compromise much more than a form of censorship.

So maybe the safe room isn’t the perfect answer. Maybe it seems funny and easy to mock as a form of “self-infantilization,” particularly to those who aren’t all that interested in finding out what it’s supposed to mean or accomplish—those people who, as Shulevitz puts it, haven’t learned “the discipline of seeing the world as other people see it.”

Then again, maybe today’s college students aren’t really that different from past generations of college students—and are just exploring different ways of addressing concerns that didn’t exist in the past—or, rather, were ignored in the past.

Because heaven knows, none of us from older generations ever did anything questionable while we were in college, or came up with ideas that older generations might mock, as we tried, in an atmosphere of rapidly evolving technology, culture, and scientific understanding, to navigate a complicated passage into adulthood.

Suicide at the Oscars, part two: ‘The Phone Call’

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JC Schildbach, LMHC

It was a great year for crisis lines at the Oscars—or, rather, for films involving crisis lines. Not only did the documentary, Crisis Line: Veterans Press 1 take home a statue, but so did the short, live-action film The Phone Call. And, while Crisis Line: Veterans Press 1 tried (perhaps a little too enthusiastically) to convey a sense of the actual drama that can occur at a crisis line, The Phone Call comes across as a disturbingly simplistic endorsement of suicide-on-demand and irresponsible behavior by crisis line workers, all while portraying a dangerously inaccurate view of the function of crisis lines.

I will begin with the same bit of disclosure I placed at the beginning of my piece on Crisis Line: Veterans Press 1: Having spent more than five years working full-time for a crisis line, and continuing to work in a position sideways from, and occasionally overlapping with, such work, I can’t help but come to these films with something of a bias. And I will also offer up a spoiler alert for The Phone Call: if you haven’t seen it, and you don’t want to know exactly what happens, stop reading now.

The Phone Call seems to have generated most of its praise based on the acting of Sally Hawkins (as Heather) and Jim Broadbent (as Stanley/John)—which is undoubtedly solid, even given the ludicrous material. But most reactions seem to ignore any other critical angle—like the crass manipulations taking place in order to make The Phone Call happen at all.

To begin with, the call center where the story takes place seems to be lost in time. Despite the opening shot of the movie panning by a sign that reads “City WiFi Zone,” the crisis center apparently has no computers and no Internet hookup.

Now, I don’t know the current state of crisis line call centers in the UK, or really the state of any such call centers aside from the ones I’ve worked in, visited, or seen in documentaries—all in the United States. But I will say that if a call center in this day and age equips workers only with a pad of paper, a pen, a phone, and a lamp—they are verging on worker abuse. Absent the most dire of funding situations, failing to provide crisis line workers with computers and Internet access is simply unacceptable, given the relatively low cost of such amenities—and the necessity of such items in making it possible for workers to track down lifesaving information—or even to assist callers who are simply trying to access other services.

At one point in the movie, we see Sally Hawkins’ character, Heather, get up from her desk—thankfully she sat at the front of the room near the bookshelves—to try and look up the “mystery caller” in the notebooks where past call records are kept—handwritten on paper.

Add to that the script manipulation of having absolutely minimal staffing. Despite there being numerous desks in the call center, when Heather arrives, there is only one other worker there–Daniel.  At the only time Heather even considers enlisting Daniel’s help with Stanley/John, Daniel is talking with another caller, back turned to Heather, and flipping through a phone book, or some other reference material. She immediately (and completely irresponsibly) determines she can’t get Daniel’s attention—as if muting her phone and calling across the room would have been too much trouble to stop somebody from dying.

'Would you look at that? Daniel's busy. Guess you really are going to die today, Stanley.'

‘Would you look at that? Daniel’s busy. Guess you really are going to die today, Stanley.’

Stanley/John is also supposed to be a sympathetic character, the main reason being that his wife, Joan, died two years ago after a long struggle with cancer. As Heather questions Stanley/John about other family members he may have, we also find out that he and Joan tried to start a family, but had only one stillborn child, 25 years ago, and then were unable to have any children after that. Certainly, it’s a sad tale. Certainly, we can understand Stanley/John’s despair.

But just imagine being in the same situation as Heather—or really any crisis line worker—being treated the way Stanley/John is treating her. Stanley/John has decided he is going to die, and has decided that whatever random worker answers the phone is going to have to listen as it happens.

John/Stanley sobs, makes vague statements indicating he has taken actions to kill himself, and refuses to provide information under threat that he will hang up to prevent anyone from tracing the call and sending an ambulance. The audience has to accept that either the call center does not utilize caller id—further putting workers in a terrible situation—or that John/Stanley blocked his information, in order for the whole ‘hanging up’ thing to really work as a threat.

Stanley/John eventually reveals that he’s taken “Antidepressants” that he got “from the doctor.” But killing oneself with pills tends to be a lot trickier than most people realize—at least to do it in the calm, and apparently quick way that Stanley/John manages, all while allowing for a conversation and a quick death before the ambulance crew can arrive and try to revive him—and without his body doing its damnedest to try and expel the deadly pills he’s ingested. Then again, perhaps Heather waited a good long while before calling for the ambulance, as she was looking through notebook after notebook to find the right person named John who lived around the corner from the Boston.

The big moment of connection for Heather, where she (mostly) accepts Stanley/John’s decision to die, is when Stanley/John asks in a pressured tone, “Can you just stay there and talk to me? Are you allowed to do that? Can’t you just stay there and talk to me and hold my hand? Isn’t that alright?”

Heather’s answer: “Of course, I can. I’m not going anywhere.”

There are an infinite number of much better answers Heather could have given at that time. For instance: “No, that’s not allowed, Stanley/John. I’m not here to make you feel better about killing yourself. And, to be honest, if I was really doing my job, my co-worker, Daniel, here would know everything that was going on, and probably already have an ambulance heading your way.”

Instead, in the course of the short conversation, Heather passes up numerous chances to make more than just a conversational connection with Stanley/John. For instance, Heather and Stanley/John discuss jazz, including Stanley/John telling Heather he could teach her how to play tenor saxophone properly. Yet, rather than latch onto that, and suggest that Stanley/John maybe teach music, or otherwise get back into music, Heather doesn’t push on that point of Stanley/John’s ambivalence at all.

In fact, beyond asking about immediate family, Heather does nothing to find out if Stanley/John was involved in anything else in his entire life beyond his relationship with Joan. Work? Friends? Family? Hobbies? Pets?

Heather also does nothing to explore what Stanley/John has done to deal with his grief over the loss of his wife. All we know is that he got antidepressant pills from his doctor. Apparently, Heather takes this as evidence that Stanley/John really has made a valiant effort to deal with the kinds of normal struggles anybody feels at the loss of a long-time companion. ‘Oh? You got a prescription? Wow—that was very brave of you. I’m sorry you still ended up feeling something.’

And perhaps the most obvious thing Heather leaves out is asking how Stanley/John’s wife, Joan, might react to Stanley/John’s decision to kill himself. Or maybe we are meant to accept that Joan is the kind of person who would want her husband to die—that she’s something of a monster, and Stanley/John is really stressed out because he’s two years late on following through with their suicide pact.

Throughout the conversation, Heather lets Stanley/John bully her into not talking about the things she should be talking about, all with the threat that he’ll hang up, and the assertion of his ‘needs’—how he just can’t go on without Joan, but really needs someone to ‘hold his hand’ at the end.

We are supposed to find it comforting that once Stanley/John insists that it is, in fact, too late for a rescue, he compliments Heather, saying, “you’ve been wonderful. You’ve been a wonderful friend to me.”

But Heather is not Stanley/John’s friend, and isn’t supposed to be acting in that capacity. And really, if Heather was either doing her job right, or actually acting in a capacity as Stanley/John’s friend, she would have done more to try and help him.

And then we get the most maudlin endorsement of suicide ever committed to film—we see the ambulance arriving outside Stanley/John’s home. The camera switches to an interior shot of the home’s front door. We see someone arrive, and…it’s Joan! We never actually see Stanley/John, only hear him talking to Joan for a while.  She talks about how she’s “been looking for” him, and they both agree that they’ve missed each other. So, we get this reunited-in-death sap that makes this suicide seem cute, since it helped an old couple get back together.

'What, John? You've gone and killed yourself? You go to hell for that, don't you know?'

‘What, John? You’ve gone and killed yourself? You go to hell for that, don’t you know?’

It’s no surprise that director and co-writer Max Kirby comes out of the world of commercials and music videos. The Phone Call is practically a commercial for suicide, with all the depth of the average music video. It’s a concept piece that tries to press emotional buttons, while keeping the audience from engaging in too much thought.

As we watch The Phone Call, we are not meant to think about the value in going on with life, and finding meaning after loss. We don’t even get a serious look at suicide, depression, or mental illness, because we are given only the most surface reasons for Stanley/John to kill himself. We are supposed to take this all as somehow romantic—the sad, old man who just can’t go on without his wife. Isn’t it sweet that he’s killing himself?

And perhaps even more aggravating is the summation of the movie from its official website: “Heather works in a helpline call centre. When she receives a phone call from a mystery man, she has no idea that the encounter will change her life forever.”

I’m not sure exactly what we are supposed to take away from this tagline—that the big change in her life is that she is now carrying the burden of having sat through this man’s death, while being derelict about trying to help him? The big scene we are supposed to take as evidence of change is one in which we see Heather following through on part of the conversation she had with Stanley/John—to go back and visit a jazz club she used to frequent. We see her getting cozy with call center co-worker, Daniel, a potential relationship that was hinted at early in the movie. ‘Gee whiz, isn’t it nice that all it took was the suicide of an old man to make me get out and live a little? Isn’t this rosé delightful?’

To clarify, my reaction to the movie is not meant as some discussion about the right to die, but about the way crisis lines operate, and the absolutely awful way this is portrayed in the movie. It is simply not the job of crisis line workers—paid or volunteer—to just “hold a caller’s hand” while that caller dies by his/her own hand.

It is a hazard of working at a crisis line that one may end up on the phone with somebody as that person dies. But this is much different than such an occasion being the purpose of that work. A police officer has the potential hazard of being shot on the job—but it is not the police officer’s work to be shot on the job. A teacher may be subject to the hazard of being verbally abused or even hit by an angry child—but it is not the teacher’s job to be verbally abused or hit.

And what kind of horrible people would you be attracting to work at the crisis line if you told them that part of their job was just to listen as people die? What would be considered an appropriate level of intervention if just letting people die was considered an acceptable or even desired outcome?

Heather, like any crisis line worker, when confronted by questions of listening versus intervening, should make it clear that, as much as crisis line workers are there to offer support, they are required to intervene in order to prevent callers from completing suicide. And with experience and training, one will gain a better idea of just when that intervention needs to take place.

In the case of The Phone Call, there was an admission that a suicide attempt was already underway; and for all intents and purposes, Heather did nothing. We are supposed to see that as somehow touching, and even life-affirming.

Don’t just feel about that. Think about that.

 

And now for the obligatory ending: If you or someone you know is having thoughts of suicide, call the national (U.S.) suicide prevention hotline 1-800-273-TALK.

 

Suicide at the Oscars, part one: ‘Crisis Hotline: Veterans Press 1’

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J.C. Schildbach, LMHC

The topic of suicide came up in at least three acceptance speeches at the latest edition of the Academy Awards on February 22, 2015. (Okay, yeah, I’m late to the party again). And perhaps even more astonishingly, two of those acceptance speeches were actually related to films about suicide prevention hotlines. First up is the documentary, Crisis Hotline: Veterans Press 1. (A post about the short film, The Phone Call will follow soon).

Having spent more than five years working full time for a crisis line, and continuing to work in a position sideways from, and occasionally overlapping with, such work, I can’t help but come to these films with something of a bias.

As a matter of fact, I first saw a portion of Crisis Hotline: Veterans Press 1 on a Sunday morning after coming home from an overnight shift at a call center where the crisis line calls represent only one of many mental health functions with which the staff is tasked. Having spent the bulk of my work week on understaffed shifts, I was perhaps a bit resentful at flipping on the TV to see a scene what Bob Hosk, one of the Veterans Crisis Line supervisors who features prominently in the documentary, described as “five hours here at the hotline” utilizing “about four personnel to help one guy.”

Now, don’t get me wrong. I think it’s great that the resources were available and the effort was made, with (spoiler alert) a positive outcome for an active duty service member in Hawaii.

In the time since I first saw that segment of the documentary, I’ve become more familiar with the workings of the military in addressing the epidemic of suicide among veterans and service members, and will say it is truly impressive to see the complete change that has taken place over roughly the last two decades—from an approach to suicide and mental health issues that could be described as ‘don’t ask don’t tell’ to one of increasing and highly-promoted access to counseling services, to working with suicide prevention specialists and investing in the crisis line depicted in the documentary, among many other avenues.

But, back on that summer morning, knowing that in similar situations (an unknown caller making a vaguely suicidal statement, then hanging up) rather than having a specific staff member on shift to call a special “law enforcement” phone number at cell phone company to get information on the caller’s location by pinging cell phone towers, and then being able to devote ‘five hours and four personnel’ to find the caller, whichever one of us took the call would typically end up trying to call back, and, failing any respone from that, doing a quick Internet search on the phone number (like they show in the documentary) and then making a call to 911 dispatch in whatever location the phone number (probably) originated, to report that somebody had called and threatened suicide—‘no, we don’t have a name; we don’t have an address; we don’t know how they might do it or if they tried anything yet; we don’t know if there are weapons involved; no, we don’t know much of anything about anything—we’re following our protocol, sorry to bother you.’ Then on to the next call—which could range from a hospital social worker inquiring about a client’s mental health history, to a client with chronic mental illness telling us about his dinner, to someone struggling to get help for a family member with a mental illness, to…

In the case of Crisis Hotline: Veterans Press 1, my sense is that the caller from Hawaii was truly coming from a place of desperation, and, perhaps, wasn’t aware of other options available to him, or just what sort of response might kick in as the result of the call he made. He may have thought that by hanging up, he could just drop the whole matter. He may have scared himself simply by voicing the thoughts he was having about ending his life, and so tried to walk away from that.

But beyond my initial reaction to the portion of the film I saw back on that sunny Sunday morning, and my somewhat-tempered-by-time-and-new-information response now, I have mixed reactions to the film.

I’ll say that, overall, I think it’s an excellent depiction of some of the most challenging types of work that happen at crisis lines, and at the Veteran’s Crisis Line Center in particular, which the film notes “is the only call center in the U.S. serving veterans in crisis.” (A more accurate description would be that it is the only call center in the U.S. specifically established to serve veterans, and specifically engaging the particular protocols of that call center in order to assist veterans. Any crisis line in the U.S. will take calls from veterans, and do what they can to help. Call centers affiliated with Lifeline routinely take calls from veterans and their families, in part because the callers don’t always ‘press 1’ when prompted to get transferred specifically to the Veterans Crisis Line Center. And, while Lifeline workers typically will explain to such callers that they have not reached the veteran’s line, they always offer to help.)

Semantics aside, not all calls to a crisis line are life and death—or even crises. Each time the phone rings, it’s not a given that the caller is a someone on the verge of taking her/his life, or a family member of such a person. But you wouldn’t know that from watching this film. You only get the slightest whiff of the lighter calls, when, early on, the camera moves through the call center, the sound of constantly ringing phones and poignant snippets of dialog, reaching the microphones at just the right time: “really proud of you…Where were you stationed?..So twice you tried to hang yourself before?…Do you want me to send someone there for you?…Did you get injured while you were out on active duty?…diagnosed with PTSD?…If there’s anything we can do for you…”

Okay, so those don’t come across as all that light. That particular scene is one of many subtle manipulations used by the filmmakers—layering audio to create a particular impression of an “always on” call center. For the sake of drama, the filmmakers leave out audio involving callers who are just seeking information or non-emergency services. They leave out the repeat callers who are really just touching base and giving a brief synopsis of their day. They leave out those calls having any of a number of angles that aren’t even remotely related to suicide.

The filmmakers also choose to escalate the drama in a completely unnecessary way. For instance, the music, most often quiet, involves drawn-out, high-pitched tones that add to the tension viewers are meant to feel—as if trying to talk a stranger out of suicide isn’t drama enough.

I love this woman: Maureen--Crisis Line Responder, Extraordinaire

I love this woman: Maureen–Crisis Line Responder, Extraordinaire

On top of that, the final segment of the film takes place on Christmas Eve. The scene opens with outside shots of the call center at night, American flag flying, trees wrapped in colorful, twinkling lights, as a soft jazz version of “Have Yourself a Merry Little Christmas” plays–the song adding a sting of dark humor with it’s ‘all our troubles will be miles away’ and ‘let your heart be light’ emotions. The timing of the scene was undoubtedly selected because of the heightened emotions many viewers are likely to have around the idea of a “Christmas miracle” or notions of family togetherness at the holidays. But it also serves to reinforce the popular, but ill-informed, notion that ‘the holidays’—Christmas in particular—are a time of heightened depression and increased suicide, an impression reinforced by a shot of the notepad where the crisis responder has written a quote from a suicidal veteran: “Holidays are depressing.”

There are other things that could be taken as manipulation, but which I think were not only clinically sound decisions, but also place the focus where the documentarians wanted it: on the people working at the crisis line. Not hearing the callers, for instance–while likely done just as much for clinical reasons, as for legal and artistic reasons–provides for greater control over how the information will be presented to the audience, and also removes any impressions viewers might have of the callers based on their voices, or the tones they are using.  While I obviously don’t know the specifics of how any of the callers in the documentary spoke or sounded, anybody who has spent time working on a crisis line knows that many of the callers can come across in a way that, shall we say, challenges empathy. Responders need to be aware of the potential biases they bring to calls, and need to develop skills for de-escalating and connecting with difficult callers. At any rate, difficult or not, hearing the callers’ voices would create a completely different film.

Still, one of the most valuable aspects of the film is in giving voice to the crisis line responders, not only in their moments of calm where they appear to be completely in control, but when they are giving voice to frustrations as well. During one call, Robert, a veteran himself, complains that the response time from police is “ridiculous.” In a separate interview segment, Robert expresses the anger that crisis line responders can feel toward callers: “How dare you take your own life?” But part of the reason Robert’s rawness comes across in a potentially endearing fashion is that the filmmakers also let him speak about his struggles with questions of his own abilities, whether or not he has made the right decisions, or whether he made them in time—questions born of situations where the interventions failed.

There are other responders in the film with whom I had a harder time connecting—feeling a sense of kinship, or understanding their particular reactions, or the ways they tried to connect with callers. I don’t want to dwell too much on my snotty, hypercritical reactions, though—or even mention them in any specificity. For one thing, I know only a very limited amount about what was happening in those particular situations. And I don’t know how those people move about in daily life, or in their routine work at the crisis line.

But why I will most back away from potentially harsh or nitpicky-sounding criticism of any of the responders is because I can’t imagine having to work a crisis call with the knowledge that cameras are on me, and that whatever I do could end up on HBO.

That said, there is one responder in particular, Maureen, who comes across as the undoubted ‘star’ of the film. Little is explained about Maureen or her background, except, perhaps, that she reveals that she has sons, as she is complimenting a caller on her handling of a difficult situation.

Beyond that, Maureen demonstrates the perfectly complicated balance of compassion and detachment that is rare in crisis line workers. She is able to connect to the callers, but does not get visibly drawn into the drama, despite mentioning calls that ‘stay with you.’ Early on, we hear her say, “It’s ultimately the veteran’s decision if they are going to live or die…and as a responder, you have to have a really good grasp of that.” Truer words have never been spoken.

Maureen is able to deliver lines of perfect connection to callers–lines that may seem odd to those unfamiliar with such situations. After asking a caller about how his friend (who died in combat) would react to news of the veteran’s suicidal intent, she listens for a bit, then says, “He’d kick your ass? So he’s a good friend.” Maureen is able to drably ‘contract for safety’ with callers, getting them to promise that they at least won’t kill themselves while they are on the line with her, and then works to expand on that promise.

Maureen is the responder featured in the final scene of the movie—the one that takes place on Christmas Eve. Against this backdrop of heightened emotion, she is tasked with drawing a soldier with a gun out of the desert, and back to his parents, despite much of his life unraveling. She is further challenged by limitations on her involvement—having to direct the veteran’s mother on how to bring him home, and then sitting silently, listening, and hoping it all works out.

In the end, Crisis Line: Veterans Press 1 leaves much to contemplate—whether from a clinical or technical perspective—or any of the other myriad perspectives that could be brought to the film. It is incredibly effective in that it is able to provoke a range of emotions, and could, potentially, be used as a tool for training crisis line workers and volunteers, service members and their families, or really anyone who wants a better understanding of how crisis lines work, how the mental health system can be accessed, or how the military is responding to concerns of suicide among its ranks.

It remains to be seen if the film will help draw more workers and volunteers to crisis services, or perhaps scare more of them off. And this is where I have the most difficulty with the film. How much is too much when trying to convey the intenstity of real-life situations? What level of manipulation and film-making technique serves to create understanding, and what level serves to drive only emotional response?

Granted, the vast majority of people who see Crisis Line: Veterans Press 1 will never work in a crisis line call center. But, there’s always a chance they might need one.

So (obligatory ending)…

If you are concerned that somebody you know may be struggling with thoughts of suicide, call (or get them to call) the National Suicide Prevention Lifeline at 1-800-273-8255—Veterans Press 1.