Category Archives: Depression

You Are Here

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By J.C. Schildbach, MA, LMHC, ASOTP, Carbon-based being

If any of you pay all that much attention to this blog, then you may have noticed it’s been a little quiet over the last few weeks.

When I look at it objectively, the inactivity here makes plenty of sense. I caught a nasty summer cold at the same time I had a lot of extra work at my second job, along with the usual work at my full-time job, which has been predictably plagued by the summer vacations and seasonal staffing changes, leading to workload strains.

I was also trying to finish some of those summer projects—particularly the pressure-washing and re-coating of the deck. Even in summer, trying to get the weather to cooperate with my days off can be a challenge, not to mention my complete inability to accurately predict how long any project will take me. I’m working on a formula that is something like AT = h x 4 + 36d, where AT = actual time, h = the total number of hours I predict something is going to take, and d = days.

Whatever the equation or excuses, it’s not like I haven’t had plenty to write about. Hell, I’ve even cranked out a thousand-plus words on each of a few posts—a follow-up piece to one I wrote about a conversation I had with my niece; and one on Will Hayden of “Sons of Guns” getting arrested for allegedly raping his daughter repeatedly over the course of two+ years. (Just now, it occurred to me that the way to make those two posts work might be to combine them and dump at least half of what I wrote). When I couldn’t make these newer efforts work out, I tried re-tooling some things I had written earlier that I never liked enough to post. But all of it was turning into disjointed, bland, repetitive…stuff…stuff that I couldn’t quite untangle and reweave to the level I wanted. Trying to make any of it work at all started to feel too much like drudgery and burdensome obligation.

There were other things going on as well—upsetting situations with friends that, although, or perhaps because, I couldn’t do anything about them, were very draining. On top of that I was jumping through hoops to try to get adjustments made to the particulars of a contract, after spending over a month jumping through hoops to get to the point where any contract had been established at all. Expressing an intention to walk away rather than trying to fix anything more turned out to be just the thing to motivate a real resolution. Now why hadn’t I thought of that sooner?

A number of valued co-workers have also been moving on to what I hope are greener pastures for them, pastures that I hope will not become so lush and large that they put us out of contact. Among those who are moving on is a talented, funny, and inspirational artist.  Another who has made the big career shift is an ever-observant thinker who, with a few counselor-ly questions and observations—including pointing out the need to ‘mourn’ or otherwise acknowledge the little losses, such as co-workers moving on—has repeatedly helped me recognize whether I’m actually charting a course, or merely bobbing about in the tides.

Straddling the line of done and undone, looking for the passage to motivation.

Straddling the line of done and undone, looking for the passage to motivation.

I could turn this into a more deliberate post about self-care and minding one’s moods—about paying attention to those signs of situational depression—like pushing too hard and not having enough fun when trying to write one’s blog pieces. But really, getting this out was just about writing something that wasn’t a big struggle to be clever or original or even relevant. It was about scanning the map for that red dot or arrow that says, “You Are Here” so that maybe I could make my way to an exit and head back home.

In truth, none of the points I mentioned above are completely resolved. But at least I decided to go find that big, light-up plexiglass mall-map rather than wandering about looking at things I don’t want or need.  And now that I have some idea of where I’m at, it might be a little easier to get back to where I parked my car…after I hit a restroom.

 

 

 

Suicide?!? Shazbot!

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By J.C. Schildbach, MA, LMHC, ASOTP

Before we get started, let me just mention that I spend the better part of my workweek involved in crisis intervention and suicide prevention. And let me note that anybody’s reaction to the death of another is going to be personal, and related to the kind of connection between them.

Now, let me tell you something horribly, selfishly, insensitively awful about me.

When I first heard of Robin Williams’ death by suicide, my thoughts were, more-or-less in this order…

1)  Damn!

2)  60-something-year-old man…history of mental health issues…history of substance abuse…makes sense.

3)  I wonder what else was going on with him.

4)  I am NOT going to write a blog post about this.

5)  Uggh! There’s gonna be a shitload of extra calls on the crisis line tonight!

Somewhere down the line was, “Shazbot!!” I totally f*cking wish “Shazbot!!” had been my first thought.

Anyway, before you climb all over me for my previously-mentioned insensitivity and selfishness, or whatever you might want to call it (I think I’ll call it “appropriate clinical detachment”), let me explain, in order of those thoughts.

1)  Yes, “damn!” It was shocking and unexpected to hear such a thing, essentially out of the blue. As for the context…I received a text message from my daughter about Williams’ death while running a plethysmography assessment (look it up). What this means is I was sitting in a small, dark, very stuffy and hot room running what I imagine would seem to most people to be a very disturbing clinical assessment to determine what kinds of really terrible things might lead to…ahem…responses for somebody with some admittedly inappropriate arousal patterns.

In such a situation, I didn’t have a lot of options for furthering a conversation or following whatever breaking news may have been happening. I had to shelve whatever thoughts or emotions I was having, and continue on with the assessment.

(You may ask why I wouldn’t have turned my phone completely off during a forensic assessment, but the reality of it is that the trace of the assessment is being recorded for later review, where it’s much easier to spot problem situations, and that turning my phone off only leads to things like my daughter destroying a sliding glass door because she locked herself out of the house on a cold day in early March—long story—well, not really, I think I just told it).

2) Which leads to…”60-something-year-old man…history of mental health issues…history of substance abuse…makes sense.”

Sitting in that dark, stuffy, hot room, staring at a double-lined forensic “trace” on a computer screen, with few responsible options available for furthering my knowledge/understanding of the situation, the defense mechanism of clinical detachment kicked in. Think about it, yelling “Oh my God!,” or sobbing openly, or exclaiming, “Shazbot!” all would have been pretty inappropriate.

At any rate, the quick run-through of Williams’ risk factors is the kind of clinically detached comment that I suppose is hard for a lot of people to take, especially when it has not been filtered at all. I can’t speak for everybody in the field of counseling/therapy, mental health, or even crisis intervention and suicide prevention, but there’s an odd dichotomy that exists in most people who get involved in such fields: we tend to be highly sensitive people; we learn to be very objective about that sensitivity.

If I wanted to get all sci-fi, I could say people in this field are empaths…empaths who have honed their skills away from making them one big, raw nerve, and toward using that sensitivity to discern a deeper sense of what is happening in others without being overwhelmed by it. Most of us have some pretty pronounced defense mechanisms. So, ideally, our training leads to an ability to pick out risk factors and make judgments about how those risk factors affect a situation, so that an appropriate course of action can be taken. Such risk factors are not predictive, but tend to be more actuarial.

Furthermore, the assessment of risk factors tends to weed out irrelevant elements. I’ve heard so many people go off about Williams’ fame and money as if that should have kept him from suicide, but those factors are irrelevant to a suicide assessment…except perhaps in the context of Williams’ available resources for obtaining help. But, and here’s a big generalization (as well as a big but), for somebody who is at the point of committing suicide, the concept of “help,” regardless of one’s resources, has become rather abstract and unreachable. From such a viewpoint, the available “help” appears to have been exhausted and shown to be inadequate. So, pushing past the money and fame, if one looks at Robin Williams from the standpoint of demographics and his personal history, he fits into a high risk category—or, rather, multiple high risk categories, even before other information about his health was revealed.

3)  “I wonder what else was going on with him” was merely a further part of the assessment of risk and what led Williams to his course of action. In suicide risk assessment, this is a huge factor. (Can I get a ‘duh’?). If the demographic factors alone played the deciding role in whether somebody was going to commit suicide, then we’d have near-universal suicide by people who fit into the same demographic categories as Williams.

Hence, one of the things that is always asked of people expressing suicidal thoughts is some variation on “Is there anything in particular that’s leading you to feel this way?”

The big idea behind such a question is to open up a conversation with someone who has, perhaps, not had such an opportunity to discuss what’s going on with them. A lot of people who attempt suicide, or are headed in that direction (here’s another big generalization) have been very closed off about their thoughts, and what they’re going through. Sometimes, broaching this conversation, being able to “normalize” suicidal thoughts (let people know they’re not as rare as they might think), and giving somebody a chance to talk through their immediate experiences, can lead to a person discovering that they have supports and strengths they weren’t considering when they were staying closed off and keeping it all to themselves.

4) The idea that “I am NOT going to write a blog post about this” came from a number of places. As someone who works in suicide prevention, and who writes a (mostly weekly) blog it seemed almost obligatory for me to at least note Mr. Williams’ passing. I shudder at “obligatory.”

Also, following any highly-publicized suicide, a whole slew of TV pieces, articles and blog posts (among other things) commenting on suicide and depression and the lives of those who complete or attempt suicide go flooding out into the world. It makes sense that people want to find out what happened, or understand how it could’ve happened, or share their personal feelings, or pay tribute, or say obnoxious, ignorant things…and there is often plenty of overlap in all of that.

And all of the posts and articles, and TV pieces close out with the phone number for Lifeline, the National Suicide Prevention Hotline, urging people to get help for themselves, or for anybody they know, who is considering suicide or having suicidal thoughts.

As I’ve noted in other posts, I don’t do death too well. And I don’t really like talking about a particular celebrity because they died, or talking about suicide because that’s how someone famous died. I don’t generally shy away from talking about suicide, but I’m not deep into worrying about what celebrities are doing in their private lives. At any rate, when such conversations happen, I find myself slipping too far into the clinical, or just keeping my mouth shut. As for Robin Williams…I’m pretty sure I saw the entire run of “Mork and Mindy” and the “Happy Days” episode that spawned Mork, although I couldn’t really tell you much of anything about any of those storylines…as apparently memorable as they were, what with the rainbow suspenders and flying eggs and all. I’ve seen several, but definitely not all, of Williams’ movies.

Williams, like almost any accomplished artist who is around long enough, and productive enough, is going to put out work that is great, and some that is less great. The last thing I saw him in was “World’s Greatest Dad”—strangely enough, a story about a man who becomes a sort of celebrity after he ghost-writes a suicide note to cover up the fact that his teenage son died from autoerotic asphyxiation. I really enjoyed this movie, like I’ve enjoyed all of Bobcat Goldthwait’s movies (the ones he writes and directs). They tend to involve a kind of dark humor and exploration of at least mildly taboo subjects that are right up my alley. And, as a special bonus, “World’s Greatest Dad” was partly filmed at a bookstore and “mall” about five minutes from my house.

Williams as the most talkative mime ever in "Shakes the Clown"...shattering expectations for better or worse.

Williams as the most talkative mime ever in “Shakes the Clown”…shattering expectations for better or worse.

But then again, I had also written some spotty notes about how “Good Will Hunting” is one of numerous movies that gets the therapeutic relationship all wrong. I could continue on about liking how “Alladin” made good use of Williams’ rapid-fire joking, as did “Good Morning, Vietnam” and how he did some good stuff around mental health issues, like “Awakenings” and even “Patch Adams.”

I could tell of how I once spent half of a 9th-grade biology class trying to stop laughing uncontrollably after attempting to relay part of a Williams comedy routine to my lab partner (who is still my closest friend, not counting my wife). To completely butcher the joke, it involved Williams doing an impersonation of E.T. saying “ouch” because he was standing on his testicles.

5) Which leaves only “Uggh! There’s gonna be a shitload of extra calls on the crisis line tonight!”

I’ll concede that this is a pretty damn selfish thought. But, to provide some context, the call volume on Lifeline, the National Suicide Prevention Hotline on Monday, the day of Williams’ death, was double the call volume of the day before. On Tuesday, August 12, Lifeline had its highest call volume ever in the history of the service.

It’s true that not all of those calls involved people with suicidal thoughts, or suicidal intentions. The calls were not all from people standing on a bridge, or sitting in their living room with a gun in their lap, or lying in bed with several containers of pills and a bottle of gin beside them. Many of the calls were people asking how to get help for people they know. Many were people upset and sad at Williams’ passing, and just trying to process their own thoughts. But many were from people struggling with suicidal thoughts and intentions, several of them consumed with the idea that if Williams, with all he had achieved, was going to kill himself, then why shouldn’t they?

And, of course, people being the way they are, whenever the Lifeline number gets widely published and shared around on social media, there were more than the usual number of prank calls. (Quick note, kids: DO NOT prank the Lifeline—we have to take suicidal threats seriously, which means you might get a visit from the police as the price of your little joke, and as the price to the people of your hometown, who now have police officers responding to a non-emergency situation because you thought it was funny to be the kind of asshole who mocks people suffering from depression).

On top of the massive increase in Lifeline calls, most of the Lifeline call centers also serve as local crisis lines, and there was a huge uptick in the calls to local crisis lines (I don’t have specific numbers on this one yet, but trust me). Several of the Lifeline call centers, including the one I work in, also serve multiple functions within the local mental health system. To say the least, things got a little overwhelming.

I could go on about a number of other factors involved here, like how, while some call centers may be able to call in additional volunteers to address the short-term spike, generally speaking, the staffing, as with any business, is aimed at addressing an ‘average’ workload.  And there isn’t any way to suddenly increase the number of telephone lines and work stations to deal with what is, ultimately, only going to be a short-term (even if massive) increase in call volume.

By Thursday night/Friday morning, things seemed to be calming down a bit, easing back down to normal…at least in terms of call volume.

But we’re all still left with the sadness and the loss of an entertainer who reached people worldwide, and the struggle to understand and accept whatever this means to us personally, or societally, or clinically.

And, oh yeah…

If you or anyone you know is struggling with suicidal thoughts, PLEASE PLEASE PLEASE call LIFELINE, the National Suicide Prevention Hotline, at 1-800-273-TALK.

Suicide Notes from the Cosmic Web of Coincidence

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Back around Christmas, I posted a piece about how, contrary to popular belief, the ‘holiday season’ is not the most suicidal time of the year. I’m gonna let you in on a little secret…spring is.

I wasn’t giving the idea of springtime suicide all that much thought, until the news of a note from Kurt Cobain’s wallet—mock wedding vows that turned out to have been penned by Courtney Love—bounced into the news for a day or two, and I realized I’d been hearing about a lot of recent suicides–well-known and mostly-unknown.

Hearing the specifics of Cobain’s wallet note, on a local radio show as I drove home from work, knocked down a self-imposed wall that had prevented me from engaging with the stories of recently-released information and evidence from Cobain’s death, leading me to think back on my memories from that time.

Back then, my wife and I were making a living designing and printing T-shirts out of our apartment, selling them at the Fremont market, and through ads in a local paper, The Stranger, and in national publications Spin, Vibe, and Rolling Stone, as well as doing custom jobs for businesses, bands, and other organizations. News of Cobain’s death had managed to elude us until I saw it in a Seattle Times headline, there on display by the sales counter at a gas station/convenience store across the road from our apartment, where I had gone on a late-afternoon beer run.

As with most deaths, my reaction was one of stunned silence–an unvoiced, “Wow, that’s weird.”  Back home, I hemmed and hawed and didn’t quite manage to relay the information, instead turning on the TV news and waiting for the story to come on.

We had only recently confirmed my wife’s first and only pregnancy; and it hadn’t been long enough for us to share the news with friends and family. I couldn’t stop thinking of that photo of Kurt, Courtney, and baby Frances from the cover of Spin. Cobain, not even a year-and-a-half older than me, had achieved what we were all supposed to want—right? Money, fame, a family—all while getting to tout his artistic integrity and give a big middle finger to…well, whoever he wanted, I guess. He was just getting started. He could continue on being a vital artist, or get old and boring, or become a recluse, or whatever he wanted. He had the resources now, and…

Kurt and courtney and frances

Well, if I steer clear of the conspiracy theories, he killed himself. How was that even possible?

Looking back through a lens of pop culture references, I think of Tyler Durden confirming that we weren’t all going to become millionaires, and movie stars, and rock gods. But Cobain had become that…or at least two out of three.

Also, prior to Cobain’s death, I’d read interviews with Eddie Vedder where he talked about being depressed and drinking too much wine, and I was worried Vedder was going to kill himself…intentionally, passively, or accidentally. Cobain said plenty of dark things, sure, but he was just kidding…right?  And, yeah, I had all the Nirvana albums, and all the tracks that turned up on compilations, credited and uncredited…No Alternative, Hard to Believe, The Beavis and Butthead Experience…

In my earliest thoughts about this post, I had some germ of an idea about making a connection between Cobain’s death and my current work…like Cobain’s death had some impact on the trajectory of my life, and…oh well, whatever, nevermind. I think we all try to fit various life events into narratives that make everything add up into some kind of “everything happens for a reason” bumper sticker idea…as if the suicide of a celebrity I had never even met was meant to guide me to my purpose.

It was a good 12+ years from the time of Cobain’s death until I bounced back into school with the intention of becoming a therapist, and then a few more before I had gotten involved in suicide prevention, almost more by happenstance than by a powerful drive to do so. I found out I was good at it–able to handle the stress of trying to redirect people in crisis—trying to suss out what it was they were after, and find a way to address that (which often just comes down to listening and validating the underlying emotions of their distress).

Cobain may have been one tiny thread among numerous others leading up to where I landed, just like the other people I knew (mostly peripherally) who had taken their own lives—or tried to—the bulk of them in spring. But Cobain was never some overtly motivating factor. In fact, I think if I cited him as a big reason for my work, it would be kind of ridiculous… “Man, Cobain’s suicide really changed me, and I decided I wanted to help people.” But to be clear, I have no harsh judgment for whatever factors direct people to engage in ‘the helping professions.’

A supervisor of mine, who was instrumental in providing me with the fundamentals for dealing with people struggling with suicidal thoughts, theorized that the increase in suicides in spring might have something to do with the dashing of expectations…that slogging through a cold, dark winter is one thing when everybody has to put up with the cold and the darkness. But when spring starts peeling open, turning itself toward the sun, grasping those opportunities to grow…and you’re still stuck in that winter mindset…cold, despondent, unable to see the sun or feel its warmth, or to even care about dragging yourself out into it…well, that’s when you lose hope.

In thinking about springtime suicide, I’ve had this other little germ of a thought…that when we are constantly exposed to the idea that everything happens for a reason, it can have the inadvertent effect of making people seek out connections for why they feel shitty. And when they can’t find particular reasons…or perhaps the reasons they find are viewed as trite or easily resolved by the people around them…or maybe the reasons they find all land in the arena of self-doubt, shame, or a sense that they are apparently deserving of the bad things that have happened to them and the lack of happiness they feel…well, it can hurt that much more.

Instead, why not embrace the idea that plenty of things in life happen for no reason at all, except, perhaps, for the culmination of random factors and arbitrary decisions…the cosmic web of coincidence…which can end up dropping anyone down a deep dark hole? (Arguably, this is a ‘shit happens’ bumper sticker argument, but I like to think of it as much more involved).  And why not embrace the idea that darkness is an essential part of being human? As much as happiness may be the goal, as much as we may all want to be millionaires and rock stars and movie gods, even the millionaires and rock stars and movie gods among us can’t completely avoid disappointments, disasters, trauma, and loss—hell, a lot of them are born of that negativity (although I don’t want to promote any ‘tortured artist’ stereotypes).

None of us get to insulate ourselves against negative feelings. Those negative feelings–even feelings of suicide–are actually much more common than people think. But when we’re so fixated on happy, and so fixated on the idea that we can ARRIVE at happiness once and for all, with just the right combination of attitude and effort, we set people up to wonder just what is wrong with them when happiness seems so elusive.

So, check in with your friends and family this spring and every spring (and every other season for that matter). That celebration-free, often contact-free, stretch from New Years Day until the world starts warming up in spring can be long and dark as hell…and when spring rolls around, and people are left feeling like they are still disconnected and down in a hole, despite all the blossoms and rays, that darkness can become something much more overwhelming.

 

 

Why Asking “Are You Off Your Meds?” Isn’t Funny

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If somebody were to quit using their insulin, or stop taking their heart medication, would a company use that situation as a humorous way to try and sell soft drinks, power tools, or airline tickets?

In recent months, I’ve repeatedly heard a radio commercial involving a married couple discussing a particular service, which is supposed to be so great, at such an unbelievable price, that on hearing about it, the wife asks the husband, “Are you off your meds?”

Sadly, “off your (his/her/my/their) meds” is one of those expressions that is used so casually and so often that it is treated as a perfectly acceptable phrase to describe someone who is viewed as irrational, or who is behaving in any way that is deemed unacceptable by the person using the expression.  If the saying weren’t so accepted, it wouldn’t be used as a joke in a radio ad, in a way that the advertisers assume will cause no offense to anyone, and will actually draw people to the company that paid for the ad.

At base, when people use the phrase “off your meds” to take a dig at someone, they are indicating that they believe the target of that phrase is delusional, or foolish in some way that is indicative of mental illness.  Stripping that phrase down to its core, using “off your meds” as a joke is essentially saying that mental illness is something to be laughed at, and people who use medications to manage mental illness are appropriate targets of ridicule.  In such a context, the symptoms of mental illness that might lead to a diagnosis or to a prescription for psychiatric medications are symptoms that make a person entertaining, or perhaps annoying, in such a way that it is perfectly acceptable to mock them.

Hey, you know what would be really funny? Debilitating psychiatric symptoms!!

Hey, you know what would be really funny? Debilitating psychiatric symptoms!!

For people working in the mental health field, and for a number of connected disciplines, such as medical practice or law enforcement, it is common to end up in situations where questions about a person’s psychiatric medications must be asked: “Are you prescribed any medications?,”  “Have you been taking your medications?,”  “Is your prescriber aware?,” and so on.  Such questions are not jokes to be taken lightly, but queries to get a read on potentially serious problems.

Mental illness that is being treated with medication is much like any physical condition being treated with medication, in that it is ideally guided by a skilled practitioner with a well-informed client, and with the client’s best interests in mind.  If medication is not being used properly, as directed by the prescriber, it becomes nearly impossible to know if medication is effective for a client, or if adjustments need to be made, or if new strategies altogether need to be employed.

So, what exactly does it mean to be “off one’s meds”?  The answer to that question depends on the nature of a particular mental illness, the severity of the illness, and a huge variety of factors in the life of the person taking the medications, much the same as it is for any physical illness being treated with medications.  Some mental illnesses may require use of medications over extended periods—years, or even decades—just to ensure a client’s ability to engage in daily functions.  Other mental illnesses may be subject to cycles where medications can be used over much shorter periods, when symptoms intensify, rather than as a long-term, critical part of everyday routines.

For some, being “off their meds” is the difference between stabilization and falling into debilitating psychiatric symptoms which are likely to lead to an inability to manage even simple tasks.  Intentional, or unintentional self-harm leading to hospitalization may be consequences of people being “off their meds.”  For people falling into this most severe category, maintaining a medication regimen without both professional and personal supports can be extremely difficult.

People with chronic, severe mental illness are also most likely to repeatedly go off their medications without warning, and without informing their friends, families, or professional supports of their decisions.  They are likely to do this with the thought that they are capable of handling their symptoms regardless of signs to the contrary.  Many who fall into the category of chronically mentally ill are also at risk of pursuing self-medication via alcohol, street drugs, or by tampering with the dosages of prescribed medications.

For people who need medications to manage psychotic symptoms, going “off their meds” can make a return to those medications extremely difficult.  Imagine, for example, trying to convince a client suffering from paranoid delusions that they need to take medications when that client views everyone urging the use of such medications as conspirators in a plot to poison and/or control that client.  In such cases, the unfortunate outcome may be that mental health conditions need to deteriorate to the point where the clients can be involuntarily hospitalized before they can get the help they need.

At the same time, for a number of people struggling with mental illness, being “off their meds” is a perfectly reasonable goal, one which they may achieve after a brief period of using medications, or one which they may find they need to pursue multiple times throughout their lives.  Such people may reach a point where they feel they have learned enough coping skills and health strategies to ease off their medications, as they try to maintain a healthy balance of the various elements in their lives, with the support of family, friends, and professionals.  Such attempts to live medication-free can lead to careful, deliberate lifestyle choices that allow for long-term, medication-free, satisfying relationships and careers.  But such attempts can also lead to disappointments, for example, when stressors become overwhelming, and people find that they need the support of medications to achieve periods of stabilization when things are at their worst.

For the purposes of full disclosure, I will say that I feel that the use of psychiatric medications without the support of counseling is almost always a mistake.  Medications without other professional mental health supports can keep clients from “checking in,” both with themselves, and with professionals who can help clients establish and/or strengthen coping skills.  Since it is becoming less and less common for prescribers to have the time for more than brief check-ins with clients, having mental health supports beyond just medication is crucial.

Let me also say that I know that people who call attention to such language issues are frequently accused of lacking a sense of humor, or of being overly sensitive.  Those who make such accusations are also quite fond of demeaning people for taking offense at something that is “just a joke.”  And, no doubt, there are also those people who fall into the potentially-offended group (people on psychiatric medications) who will say that phrases like “off your meds” do not offend them, because they have a sense of humor.

To such people, I say, go ahead and say what you want to say.  I can’t stop you, and I agree it is your right to do so.  But just know that you have a choice to say, or to not say, things that are potentially offensive.  If you feel that it is more important to make jokes about people being “off their meds” than it is to maybe find a different way of expressing yourself, then just don’t demand that others not get offended by your words.  You don’t have any more a right to expect a particular reaction to your words (especially after the potential offense has been pointed out) than anybody has a right to tell you that you can’t say something.

In the United States, we have a convoluted relationship with psychiatric medications, counseling, and mental illness in general.  We rail against people wanting to take pills to solve their problems, then turn around and rail against people who don’t take medications they need.  We say people need counseling to work out their issues, but then condemn counseling as something for people who are too weak to manage their own problems.  And we simultaneously blame untreated mental illness for heinous events, while laughing at people with untreated mental illness.

So how about if we agree that psychiatric medications, when used appropriately, can have a great many benefits, rather than shaming people who use them?  How about if we agree that counseling, entered into in good faith between practitioners and clients, is something that can be of great help?  And how about if we agree that you don’t get to blame untreated mental illness for gun violence (which is a ridiculous argument) and then turn around and laugh about how funny untreated mental illness is (which is an asinine thing to do)?

 

 

 

 

People Up: Toward ‘Gender Neutral’ Suicide Prevention

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Phone-based crisis intervention and suicide prevention frequently involves guiding a caller toward an (often tenuous) agreement that there’s a reason to get through the next day, or maybe just the next hour.

Toward the end of a recent call, the man I’d been talking to for over 40 minutes summed up the call by saying, “Yeah, I get it…man up.”  He went on to mildly berate me, suggesting that he could have had the same stupid conversation with his dad if his dad hadn’t died.  But I’ll take that as a victory.  He agreed he would stay alive to see his kids on the weekend.

He would not agree to turn his gun over to a friend or family member, which would have helped lessen the likelihood of impulsive, violent suicide.  But, for the time being, he had put it away.  And at least he was calling.

Still, the “man up” comment stuck with me.  I suppose on a greatly reductive level, “man up,” was a component of what I had been saying—especially from the perspective of someone who, based on his interpretation of the world around him, had been getting that message for quite some time–that he needed to just take care of his problems and quit complaining.  But it is not the kind of phrase I would ever use with someone, or the kind of message I would try to convey.

My conversation with him had woven in and out of a number of concerns, with the crux of the conversation coming down to the caller’s children, and his responsibility (like that of all parents) to do whatever possible to ensure their well-being.  It is a conversation I’ve had hundreds of times.

The majority of such calls, involving people who have children but are contemplating suicide, involve the caller expressing that his/her children will be better off without them.  There are a small number of variations on the ‘logic’ behind such a thought—usually involving the children not having to suffer through the heartache of the bad parenting they will certainly continue to experience, the hassles the kids will face by bouncing back and forth between divorced parents, and the notion that the children will “get over it” in time.  If the children are young, callers express that it won’t make that big of an impression.  If the children are older, the parents think the children ‘don’t need me anymore’ or are mature enough to process what happened and move on with their lives.

Never mind the mental twists and turns it takes to imagine that children will have coping skills enough to deal with the suicide of a parent, when that parent doesn’t have the coping skills to deal with loss much less permanent than death—loss of a job, loss of a home, loss of a marriage—or any of numerous variations and combinations of things and people that have gotten away.  Statistical studies show that children of people who commit suicide are at greatly increased risk for attempting/committing suicide themselves.  In an overly-simplistic explanation, the increased risk can relate to genetic factors involved in mental health issues, but it also involves behavior modeling.  Our parents are usually the most significant modelers of behavior in our lives.  And we are all doomed to become our parents.

At any rate, I found myself having the same basic conversation with a woman less than two hours later.  “What messages are you sending your kids if you kill yourself?”  I challenged the cognitive distortions in her justifications for suicide, and explained the threat of her children committing suicide and otherwise potentially being saddled with mental health issues from the suicide of a parent.  Ultimately, we got to a similar end result—the caller agreeing she would put up her pills, and live another day.

But in the conversation with the woman, there was no idea of needing to “woman up”–no need to do what was stereotypically feminine in order to go on living, even though the idea of someone ‘sacrificing’ (in this case, the twist being that sacrificing meant staying alive) for one’s children is something that stereotypically falls more heavily on women.

With the ‘man up’ comment replaying itself in my thoughts repeatedly over the next few days, I realized I was (internally) protesting too much.  The notion that I had a nearly identical conversation with a woman that same night seemed like a defensive position more than a straightforward assessment.

I ran through other ideas, examining the way I deal with men versus the way I deal with women.  For example, any form of counseling involves meeting the client where the client is.  Such meeting includes the client’s perceptions of self in relation to gender.

Still, the client’s perceptions are not the same as my way of interacting with the client.  The client’s perceptions dictate a number of things about how I will approach the client, what thoughts might be challenged and how, for example.  But at base, how I deal with people of different genders is on me.  And I need to be aware of whether those dealings are clinically appropriate or not, whether they are tinged with personal biases about what constitutes being appropriately manly or womanly, or fitting into any other gender identity.

I have no problem acknowledging that I speak to people of different genders differently, and that things such as age, economic status, religious beliefs, education, ethnicity, and a whole host of other concerns can color the interactions I have with them.  An awareness of how clients differ in background falls under a heading of “cultural competence.”  Conducting all sessions or interventions in the exact same fashion would be negligent.

Cultural competence includes the need to avoid approaching clients from any viewpoint of prejudice.  In U.S. culture, with its heavy bias toward the idea of women being nurturing and emotional, and men being stoic and strong, it is easy to fall into a trap of diminishing men who seek support, while being much more accepting of women seeking support.  The underlying concepts of weakness and strength, as relates to seeking support, diminish everyone.  Accepting girls and women who seek support while being less accepting of men and boys who do the same indicates an underlying belief in the weakness of women–the need of women to have support, while believing men don’t–or shouldn’t.

In a context where men are expected to “man up” and take care of their problems, rather than to seek help in processing what is going on with them, it makes sense that many men reaching out for help are, if not hostile, at least pensive and anxious—feeling there is something inherently wrong with seeking help, so taking a position challenging those who might help them.

As a culture, we in the U.S. encourage defensiveness and entrenchment in men—refusal to change—with the exception of encouraging men to become ever harder, ever more willing to engage in aggressive fortifying of their position, with that position often being one of isolation.  The processing men do frequently gets externalized to the point where it is not processing at all.  They, for example, focus on fixing the world, usually by berating the weak, or advocating the destruction of people seen as enemies, rather than addressing the personal in their lives and what such isolation and fortification does to them.

I posit that the gender-stereotyped notion that men need to take action is in large part what leads men to commit suicide most often in a rather violent and impulsive fashion.  When the problem is your whole life, and you’ve been taught that the appropriate response to problems is action, frequently violent action, then ending one’s life can seem like an appropriate reaction when that life has gone off the rails.  Mix in alcohol, drugs and weapons, and suicide can seem a reasonable course of action, and be carried out quickly—a decisive form of action, a manly form of action.

This is not to say that I think men in the U.S. are “victims” of the mental health system or of some pro-suicide/anti-male conspiracy.  Men, whether willingly or unwittingly, participate in, and perpetuate, the stereotypes that trap them…the stereotypes that say seeking help is synonymous with weakness.  And so, long as angry men rail against the “wussification” of the nation, they are advocating for a culture of death before mental health, and ensuring that men will not seek help for mental health issues, or if they do, that it will come with a heaping helping of defensiveness and hostility, potentially putting clinicians in a position of enduring abuse, or having to break down numerous walls, before being able to engage productively with male clients.

So, instead of urging anyone to “man up,” perhaps perhaps there could be a kind of unstated encouragement to “people up”–and not in the reductive way that “man up” is used, but in a way that is expansive.  To “people up” could mean to recognize our responsibilities to one another as human beings, whether that be as parents, clinicians, friends, family members, or citizens.  We need to recognize the harm in gender stereotypes, particularly if seeking help and support is connected to stereotypes of weakness.

GUN CONTROL OR PEOPLE CONTROL? Part One: The NRA’s Build-a-Bogeyman Workshop

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It doesn’t matter how many shots are fired and how many bodies pile up—particularly in those attention-grabbing mass shootings—the cry goes out, crafted by the NRA, that it is something other than guns and ammunition that needs to be addressed. The most recent and prevalent pro-gun meme is that it’s the mental health system that needs to be fixed, while guns are just great. In fact, guns are so great that everybody should have them all of the time, except for criminals and those people with a severe mental illness. But if any criminals or people with mental illness try to shoot any of us good people, then we can all pull out our guns and shoot them back, and definitely shoot them better, harder, faster, and, just for good measure, deader.

Prior to the pro-gun, blame-the-mental-health-system meme, it was the, “We don’t need new laws, we just need to enforce the existing laws” meme. Of course, since the NRA lobbied to make sure that the existing laws wouldn’t be enforced, and, in fact lobbied to have laws enacted that made it illegal to enforce the earlier existing laws, they had to come up with a different cheer for team shoot-em-up. So, hence: guns good; mental health system bad.

There’s this other, less clearly- and less frequently- articulated position underlying the broken-mental-health-system argument, that people working with the mentally ill are incompetent, first of all, for allowing the system to fall into disarray, and second of all, for not being clairvoyant enough to determine which of the people they encounter who express some form of homicidal ideation are just talking nonsense and which really are stockpiling weapons or have access to weapons their family members stockpiled, so that said mental health professionals can then direct law enforcement to stop the future crimes. Okay, in fairness, there are ways to assess for danger—not that the NRA didn’t lobby to try to prevent anybody in the medical and mental health fields from even asking people anything as simple as whether they have access to guns.

But fortunately, the NRA has finally stepped up and has been instrumental in working to address real-life situations and offer up functional ideas for systemic changes, like, “You guys need to fix the mental health system so that people with mental illness stop shooting people, okay?” Except there’s that whole thing about how people with mental illness who actually commit violent crimes (a very tiny portion of them) are not generally compliant with treatment if they’re even in treatment to begin with. So not only do mental health practitioners have to accurately determine which of their clients might commit violence and make sure those clients are stopped from doing so, but they also have to ferret out all of the potentially violent people with mental illness, even if they have never even met them.

Anyway, what I’m saying is that the argument about fixing the mental health system is a nonsensical argument for a WHOLE lot of reasons…most notably that it’s an argument designed for inaction as far as gun laws go, while setting up a bogeyman that can spring out and yell ‘boo!’ anytime there’s a high-profile shooting. For instance, if somebody commits atrocities, such as shooting up a theater or a school, then we can all say, “Wow, this guy was obviously disturbed. Why wasn’t he getting any help?” Or if said shooter was in treatment, we can say, “How come more wasn’t done to make sure he wouldn’t hurt anybody?” Or if there are no clear indications that a shooter was, for example, psychotic or in treatment, we can always fall back on the idea of undiagnosed mental illness. The broken-mental-health-system argument is also convenient for all those 19,000-ish annual suicides by gun.

The argument to fix the mental health system is also nonsensical because it essentially allows the problem of gun violence to go on forever. That is, no set of laws is ever going to solve the problem of murder 100%, but when the argument is that guns aren’t problematic, but the mental health care system is, then as long as there are shootings, we can keep hemming and hawing, failing to enact simple measures like universal background checks, or tracking of Internet-based weapons and ammunition sales, or making certain classes of weapons flat-out illegal.

In addition, the broken mental health system argument allows gun manufacturers to rack up more gun sales. After all, what are a few dead kids if you can rake in some extra dough by letting 24-hour news networks scare everybody into thinking they need to arm themselves against a bunch of crazy people who are going to shoot their kids? (or invade their homes, or shoot them in a theater, a mall, a church…) Just check out how gun sales spike after high-profile shootings, combined with talking heads appearing on news shows to say stupid things about how the crimes would have been avoided if only everybody on scene had been armed. Check out the secondary spike in sales when the same talking heads suggest that gun laws are going to suddenly become so restrictive that nobody is going to be able to buy a gun anymore.

On top of that, the majority of the people who parrot the broken-mental-health-system meme have no idea how the mental health system actually works, or how it interacts with law enforcement, hospitals, and the court system, or what could actually be done to “fix” it. Nor do most of them care, since it conveniently props up their view of things, without them having to actually learn or understand anything. They’re super-familiar with arguments about why killers are going to kill just as many people whether they have clips with 8, 27, 92, or 412 rounds; why it doesn’t make a difference if a person has access to a pop gun, a hunting rifle, an AK-47, or a BFG-9000; and why any gun control measure at all is useless because criminals are going to get guns anyway, and then only law-abiding citizens will be left unarmed.

Don’t bother trying to point out that all kinds of laws exist that, just as the concept of law implies, are followed by law-abiding citizens, and violated by criminals, and that what makes a person a criminal is that the person violates a law. After all, the no-gun-control stance involves absolutist/absurdist arguments where ANY restrictions on guns and ammunition mean all law-abiding citizens lose ALL access to their guns and ammo, and criminals suddenly have unfettered access to all the weapons they could ever want so that they can create the maximum amount of mayhem. It’s an argument that requires a good dose of the paranoia that persons with mental illness who carry out violent crimes sometimes exhibit.

But the logical extension of the no-gun-control kind of argument is that we could get rid of “gun crimes” and “gun criminals” completely if we could just get rid of all laws related to guns, because then there would be no gun laws to violate. Then we only have to enforce the existing laws against murder. Yup, what’s really broken is the anti-murder system in this country. And if we all had more guns, we could solve that, too.

Now, don’t get me wrong. I would absolutely love it if we, as a nation, were going to get serious about “fixing” the mental health system (makes it sound so simple, doesn’t it—kind of like fixing a leaky faucet or fixing your basset hound). But getting that fix all taken care of isn’t happening anytime soon, since it takes a whole lot of money, a whole lot of changes to the legal system, enough well-trained mental health professionals working in tandem with law enforcement and other community resources, a whole lot more places to keep persons with severe mental illness while they get treatment, and a whole lot of money. Oh, I guess I touched on that money one already.

Of course, a big block to getting the mental health system fixed is that a lot of the same people screaming at everybody about prying beloved guns from cold dead hands and fixing the mental health system are the same ones screaming to slash taxes and remove all government funding from everything everywhere. A lot of them are the same ones who worship former President Ronald Reagan, who loved the idea of shutting down psychiatric facilities in favor of “privatizing” the oversight of people with severe mental illness, who need a lot more than a place to stay and a minimum-wage worker to watch over them.

And even with that “privatization” of things like residential homes and intensive outpatient programs, guess who is paying for mental health care for the people with the most severe mental illnesses. Go on, guess. If you said “the government,” then you’re right. And if it’s a puzzle to you why people with chronic, severe mental illness aren’t getting good jobs with great insurance plans to pay for all the medications, therapy, and hospitalizations they require, well, then I obviously can’t make you understand how we’re ever going to “fix” the mental health system.

So, how do you reconcile de-funding everything in the government, including the mental health system—particularly those long-term inpatient facilities where the people with the most severe mental illnesses stay (or, rather, used to stay)—with the idea that we’re going to fix the mental health system to keep all the most dangerous people with mental illnesses off the street so that we don’t have to have any new gun control laws? Well, the real answer is that you don’t, because it’s a nonsensical argument in the first place.

Now, happily—well maybe not happily, since it took multiple mass shootings and the NRA clamoring to prevent any gun control laws from being enacted while simultaneously screaming about the broken mental health system—mental health funding is kinda-sorta being restored to the very limited levels that existed back when G.W. Bush was president. Unfortunately, those levels are still not anywhere close to the level—comparatively speaking—that such funding was at when dear, old Ronald Reagan became President. So, thanks NRA—you are advocating for restoring all 40,000-ish psychiatric ward long-term “beds” for those with chronic, severe mental illness that went away back when Ronald Reagan was in office, right?

Beyond the complete insincerity behind the NRA’s argument that the mental health system needs to be fixed, the NRA is actively doing a disservice to the people of the United States—a disservice that actually serves the NRA well by scaring up gun sales. By creating a bogeyman out of people with mental illness, the NRA promotes the idea that people who are diagnosed with a mental illness are inherently dangerous, unhinged, and likely to kill us all. Never mind that the mental health system deals with a wide array of concerns, from situational depression to anxiety disorders, PTSD to schizophrenia, and that the majority of those people are never going to commit a violent crime. By squawking that gun violence is a problem of the mental health system, as opposed to a problem with multiple facets, most notably of ensuring easy access to guns, while provoking fear of one’s fellow citizens, the NRA sets the country on yet another course to doing nothing about gun violence, while spreading ignorance about what mental illness is or what it means. The NRA provokes more fear of a big portion of the population, perpetuates a culture where people will avoid seeking help for mental health issues for fear of becoming part of that bogeyman group, and provides an excuse for inaction that will see no end. After all, as long as there are shootings by people who can be labeled as having a mental health issue–bam–the mental health system failed. It’s got nothin’ to do with the guns themselves.

If you want to consider whether the NRA has anybody’s best interest at heart, consider that following the Newtown school shootings, more than 85% of the American people supported instituting ‘universal background checks,’ but the NRA managed to ensure no action would be taken through the power of the almighty dollar. The NRA can threaten to withhold money from political campaigns, or worse, to dump massive amounts of money into campaigns to take out politicians who do anything they don’t like.

The NRA, aka the gun manufacturer’s lobby, knows that an occasional scare is good for business—and having a bogeyman is the best thing possible—especially when that bogeyman is easily stigmatized, poorly understood, and getting the problem of the bogeyman “fixed” could take forever. The whole fix-the-mental-health-system argument put forth by the NRA is nonsensical because it posits that it is easier to “fix” a complex system that attempts to address the needs of people with a broad range of conditions that are not set, uniform, or easily managed than it is to restrict access to the things that people—many who avoid contact with the mental health system prior to committing heinous acts—use to kill people.

IT’S (not) THE MOST SUICIDAL TIME OF THE YEAR!

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It’s common knowledge that the holiday season, and more specifically the days around Christmas, sees a spike in suicides.  Right?  Wrong.  Not true at all.  But lazy TV news writers and reporters, and scores of jackasses who can’t think of anything original to say, and can’t be bothered to perform a simple Internet search, repeat this same fallacy year in and year out.

Now, I could lay out a bunch of statistics for you here, but that’s boring and stupid and it will take you roughly six seconds to perform that Internet Search I just mentioned, which will turn up well over a quarter-of-a-million articles, almost all of which start off with the same, basic statistics.  Okay, jeez you lazy jackasses—click the link if you don’t believe me:  https://www.google.com/#q=Christmas+suicide+spike

The myth about Christmas-time suicides was most likely birthed by an episode of “The Brady Bunch” wherein mother Carol loses her voice, and is unceremoniously kicked out of the church choir just before Christmas.  Youngest daughter Cindy prays to a mall Santa, who manages to deliver the Christmas miracle of snow in Southern California on Christmas, but can do nothing for Carol’s voice.  On the afternoon of Christmas Eve, Carol is locked in her bedroom, knocking back snifter after snifter of Brandy, and wrapping presents.  As she finishes using the scissors to curl a ribbon, the song Carol was supposed to sing in the church choir comes on the radio.  Carol begins trembling with anger, then viciously slashes at her wrists with the scissors.  A short time later (after a commercial break) housekeeper Alice, attempting to deliver fresh pillowcases to the bedroom, realizes something is amiss, and kicks in the door.   Alice uses her apron to keep Carol from bleeding out as Marcia, fresh from her driving contest victory over Greg, hilariously pilots the family station wagon through an open-air holiday market to the Emergency Room.  Once mom is medically stable, a doctor, played by a pipe-smoking Paul Lynde, tells the family in a happily sadistic voice, “You’re lucky she lived—Christmas is absolutely the worst time of year for suicides.”

(Notice there was no actual mention of a spike in suicides.)

Following the episode, the network aired a public service announcement that involved the Brady kids singing their hit single “Sunshine Day.”  Mike and Carol step into the foreground as the music softens, and say, “The holiday season can be tough.  Don’t let suicide ruin your sunshine day.  Get help.”  Strangely enough, it was revealed several years later by the Parents Music Resource Center that back-masking on another Brady Bunch hit, “Time to Change” involved the first known use of the suicide instructional phrase, “Down the street, not across the road,” voiced by one Paul Lynde.

Now that your mind is totally blown, let’s get at the heart of the matter in all this.  I don’t really care that people mistakenly think they know something about suicide in terms of just the basic issue of them being wrong.  What is problematic is the idea of normalizing seasonal suicide.  That is to say, when it is repeated over and over again that people kill themselves around Christmas, it can seem to those suffering from depression, or suffering from various other situational or seasonal forms of depression or mood disorders, or even just having normal reactions to aggressively annoying family members, that Christmas isn’t such a bad time to kill oneself.  Join the club.  It’s normal.  No big deal.  Suicidal gestures also get a pass in this form of thinking—‘maybe they’ll realize how much they’re hurting me if I hurt myself.’

Now, I’m all for normalizing suicidal thoughts—suicide not so much.  Bear with me here—I think it’s valuable for people to know that suicidal thoughts are not a rare occurrence.  Suicidal action often follows people believing they are all alone and that nobody understands them.  If people realized that suicidal ideation occurs to a lot of people, and along a scale of ‘Maybe I should talk to somebody’ to ‘Holy shit! Why am I heading out into the woods with a loaded gun and a fifth of Monarch gin?’, then they might recognize that seeking help is a good idea.  Furthermore, if more people were aware that a friend or family member expressing suicidal thoughts is not an occasion to panic or to plug one’s ears and start screaming ‘La la la—I can’t hear you!’ but an opportunity to open up a dialog and seek out help, then we could make some more progress not just on suicide, but on mental health issues in general. 

In the good ol’ U.S. of A. we love our stories of suicide, murder, and mayhem.  We love a good tragedy that we can sum up with a banal, and ill-informed comment like “Well, Christmas is when suicides occur the most.”  What we have a harder time with is actually acknowledging that we have feelings other than ‘happy’ and ‘murderous,’ and that there are plenty of things that make us sad.

A client suffering from depression recently told me that she feels that at this time of year she can’t just back out of obligations other people have placed on her.  If she would rather stay home and sleep, read, or watch a movie than go out to the seventeenth Christmas party she’s been invited to in the last two weeks, or spend Christmas Eve and Christmas day shuttling between various relatives’ houses for hectic feeding-frenzies and gift-giving-orgies, the people around her slip into panic mode—as if any expression of a desire to spend time alone is an indication she wants to go kill herself.  She attributes this insistence that she be happy and perpetually moving to the idea that Christmas is the time people kill themselves.  In short, she ends up feeling exhausted and out of sorts, because she is trying to prove to people that she is not suicidal—which, she jokingly added, just makes her want to kill herself and/or leaves her in fear that she might drop dead from exhaustion.

So…yeah…Christmas doesn’t, as a rule, provoke suicide.  And if we could all embrace the real ‘holiday spirit’ of actually connecting with each other, instead of pushing ourselves through marathon ‘base-touching’ sessions with people we ignore the rest of the year; if we could learn to communicate a range of emotions, and respond with caring, rather than indifference or panic, we might realize that because we are each dealing with our own, personal situations, all times of the year are the most wonderful time of the year (and the most depressing time of the year, and the most mundane time of the year, and…) Continue reading →