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

by

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.

 

It’s World Suicide Prevention Day: Do You Know Where Your Mental Health Is?

by

JC Schildbach, LMHC

Just before I sat down to write this, around 8 p.m. my time, I lit some candles and placed them in the windows of my home–as was requested by the organizers of World Suicide Prevention Day–a small gesture that maybe nobody will notice–but a sign of solidarity nonetheless.

One might ask, ‘Solidarity with whom?’

With those who have died by suicide?

With those who have lived through a suicide attempt?

With those who have been impacted by the suicide of an important person in their lives?

How about just plain everybody?

None of us are immune to suicide, or the impacts of suicide.

A great many of us like to believe we’re immune.

But our mental health is not made up of absolutes.  It is not a simple either/or option: mentally healthy or mentally ill.

Suicidality itself exists on a scale of ‘definitely not going to happen today’ to ‘working on it right now.’

And perhaps the more we think we’re immune to issues with our mental health, the more we fail to recognize when we might be tilting toward trouble.

2015_wspd_banner_english

Take a big enough hit to your self image–loss of your job, loss of a spouse or signficant other; maybe add on a string of other bad occurrences–financial troubles, illness, the death of a loved one; mix in a few too many drinks and easy access to means, and who knows what might happen?

More than half of the 40,000+ deaths by suicide in the United States each year involve a gun.  How many of those do you suppose were the result of, say, long-term depression, versus a fairly quick unravelling of the deceased’s sense of self, and a lack of knowledge about how to identify and utilize available support systems?  How many of those were a booze-fueled ‘screw it’ to a really bad month, or week, or day?

Of course, when one believes one is immune to such problems, when those problems arise, one will be that much less likely to seek out help.

I don’t want to give the wrong impression.  Many people who die by suicide have been struggling with mental illness for the bulk of their lives.  Many of them have made multiple attempts before they finally die by suicide.

But there are also plenty who die by suicide because they are overwhelmed by circumstances, and have no real idea what to do.  They have never given thought to what to do, or who to turn to.  They do not want others to think of them negatively–perhaps the same way they have thought of others in similar circumstances.

So we need to recognize that we’re all travelling on the same continuum, that we’re all forever in flux, rather than believing we are in two separate camps that will forever remain apart: the mentally healthy and the mentally ill.  Otherwise, we potentially block ourselves off from the need for compassion.  It’s much easier to look away when we can say, “Not me.”

candle

So maybe those candles will go unnoticed, or maybe not.

And at least they’re flickering away against the darkness of “Not me.”

Another Round: American Roulette

by

JC Schildbach, LMHC

Pour another round.

Put another round in the chamber.

And let’s play another round of American Roulette.

Dizzy?  Go ahead and get off.

Dizzy? Go ahead and get off.

I’m not talking about felt and chips and all that. I’m talking about American Roulette—where we add more and more rounds, to more and more chambers, in more and more guns, point them all at our own collective head, squeeze the collective trigger, then act all surprised when anybody dies.

Then as the bodies are cooling, we start in on a round of all our favorite follow-up games.

Of course it starts with a round of “America’s Next Top Mass Murderer.” This is where media outlets decide what becomes a national story. It’s a complex formula, involving body count, victim age/status, and location. We have so many shots fired so often, in so many places, that we just can’t let any old killings grab hold of the public imagination.

Hell, the public doesn’t have enough imagination to keep up.

Adult males getting gunned down in the “bad part” of town—doesn’t rate unless there’s an insanely high body count. Okay, that’s pretty much true of any killings in the “bad part” of town.

Nightclubs—the same.

Men wiping out their families? Pffbbt! We’ve grown surprisingly numb to the idea of an “estranged husband” gunning down his wife, kids, and maybe a few additional members of his extended family. But moms gunning down their families? That just might work.

Schools—you can maybe get some traction there, although college shootings are getting pretty passé, as are high schools. Elementary schools—still pretty damn shocking.

Churches—those rate pretty high.

Movie theaters—those practically ARE churches.

So, how about grocery stores? public parks? malls? restaurants? Maybe a library or a museum? How about a nursing home? But, really, I have to defer to the experts for how to rank all of those.

Then, once we’ve determined that a mass-shooting is heinous enough to warrant a spot in the public imagination, we move to a round of “Wheel of Blame,” sponsored by the good, pro-murder folks at the National Rifle Association.

Really, it’s just another form of rigged roulette—38 spaces on the spinning wheel, at least 30 marked “mental health” or “mental illness.” When we get lucky, the wheel stops on one of the random spots marked with something we can really get mad at—like racism, or pop culture, or some “foreign” religion.

Because when the wheel lands on something we can get mad at, then we can do something symbolic in lieu of doing something that might actually lower the body count—like take down a flag that hasn’t had any business being associated with any part of ‘the government’ in the 150 years since that cluster of slavery-supporting traitors failed in their effort to destroy the Union. Or we can blame some movie, or some TV show, or some rock star for inspiring a murder spree. Or we can yell at the President to bomb ISIS, or to stop talking to Iran—because that will fix problems right here at home, where we like to kill our own.

Of course, the Wheel mostly lands on “mental health” or “mental illness” and we don’t have to do anything except say “fix the mental health system”—as if there is some magical way to grant psychotherapists the ability to pluck out those who are going to commit mass murder, plop them into a treatment program, and prevent them from ever getting their hands on all the readily-available guns and ammo out there.

But remember that when you spin that Wheel of Blame, you absolutely must avoid the spaces marked “guns”—those spots just go to the house—instant bankruptcy. Go ahead and say guns and lax laws that allow easy access to guns had a role in gun violence. You’ll get nowhere. Our gracious NRA sponsors, the politicians and media they own, and the screaming devotees of the Cult of the Shiny Metal Bang Bang will all see to that.

And even though it’s gotten pretty tired and unnecessary, we’ll run another round of “Not the Time”—wherein such insightful luminaries as draft-dodging, teen-loving, rock-n-roll has-been Ted Nugent, along with other NRA pets, can tell us that now is not the time to talk about gun control—not in the wake of such a tragedy—as they question the patriotism of anyone who would politicize the deaths of people killed by guns—oops, I mean killed by people with guns—oops, I mean killed by bad people with guns.

What’s so great about “Not the Time”—even though it’s getting really tired—is that we’re almost never more than a few days away from a mass murder, even if we are more than a few days away from a mass murder that really caught the public’s attention.

Oh, hey!  Now give it up for a round of our newest game show: “Open Carry Chucklehead Brigade”—y’know, that trending ritual where gun enthusiasts decide to go stand outside recruitment centers, or in malls, or near schools, or wherever the latest killing took place, brandishing their big, long weapons out of some bizarre sense that such behavior is supportive of those who are suffering the aftermath of gun violence. Hey…uh…guys…we’ve all been talking, and…uh…nobody feels safer because of your presence. For most people, a group of sweaty guys standing around with big guns does not look like safety. It looks like a meeting of the local chapter of the Future Mass Murderers of America.

I know there are plenty of rounds of plenty of other games I’ve left out—like the obligatory round of “False Equivalencies” (people die from using cars, and knives, and dental floss, and ice cream, and…), and the round of “Enforce The Laws That Already Exist” (as if the NRA hasn’t already made sure that most of those laws have no teeth), and the round of “There Are Already Too Many Guns Out There to Fix the Problem” (got it–too tough, don’t try!). But, damn! Those games are getting so dreadfully boring.

So, where were we?

Oh, yeah—pour another round.

Somebody else is picking up the tab.

Or maybe you are.

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

by

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’

by

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.

Sylvia Frumkin’s Place

by JC Schildbach, LMHC

I’d venture a guess that many who enter the mental health field, as with any potentially dramatic profession all the way from police to executives, do so with visions informed by Hollywood. One of the main Hollywood portrayals of the mental health worker is is that of the therapist/psychiatrist as a well-compensated genius, ensconced in a plush office, treating the worried well or other “eccentric” or “neurotic” types, while constantly being admired by clients for one’s observational skill and ability to call forth ‘breakthrough’ moments. The other end of the spectrum is the heroic social worker who, through sheer tenacity, overcomes all the problems an impoverished neighborhood can throw at her, overcoming multi-generational patterns, and very recent traumas, to really, really make a difference in the lives of an entire community.

Many in the field are drawn to books by Yalom, or Rogers, or perhaps even some acolytes of Oprah, who tell us that just by listening and accepting our clients, or by throwing the right bit of tough-love advice a client’s way, true transformation will take place, and clients will make huge leaps forward, forever changing their lives for the better.

Susan Sheehan’s “Is There No Place on Earth for Me?” is perhaps the perfect antidote to the pie-in-the-sky visions of one’s brilliance and dedication making all the clinical difference in the world. It balances out the ideas about the wondrous gift of therapy with the reality of chronic and severe mental illness, and its resistance to ‘ah-ha moments’ and dramatic progress. It pushes past that “we don’t need no medications” mantra, which can, in fairness, apply to a lot of mental health issues.

“Is There No Place on Earth for Me?” was first published as a four part series in The New Yorker in 1981, then published as a book in 1982. For it, Sheehan won the Pulitzer Prize for General Non-Fiction in 1983. A new edition of the book was released roughly a year ago, including a new afterword by Sheehan. On reading about the re-issue in the online version of the New York Times in January of 2014, and having never read it before, I put it on my ‘to read’ list, and eventually checked out an old edition from the library.

Frumkin cover

The book, written from the perspective of a journalist, and not of a therapist trying to convince the readers of the efficacy of particular approaches to treatment, is involved in ways that few case studies can be. Sheehan spent over two years with Sylvia Frumkin (not her real name), a woman diagnosed with schizophrenia. Sheehan had a great deal of access not only to the information on Frumkin’s treatment and behavior during the period when Sheehan shadowed Frumkin, but also to family members and others, getting a great deal of background on Frumkin’s life prior to her diagnosis, and the progress and setbacks that took place before Sheehan had ever met her.

Having had numerous contacts with clients diagnosed with schizophrenia, or suffering from other forms of psychosis, most often from a distance, it took me a while to get through the book. That is, the kinds of delusions, rants, and flights from treatment that plague Frumkin and those trying to help her, and which Sheehan documents in detail, were familiar to me—of course, with Frumkin’s behaviors being particular to her own case. Still, it was like trying to read about many of the most frustrating aspects of work during one’s down time.

For the uninitiated, I imagine the book is much more compelling, rather than overly familiar, and thus, somewhat draining. In discussing “Is There No Place on Earth for Me?” with colleagues, I’ve most often likened it to Kafka’s “The Trial”—a book that is deliberately tedious in its depiction of a bureaucracy more intent on sustaining itself than serving any clear purpose—although, that comparison probably has much more to do with what I bring to the reading of Sheehan’s book than to what she has documented in such depth of detail. Also, I don’t think the mental health system—either now or at the time—is deliberately set up to be frustrating…it just frequently is, particularly for those most in need of help.

In addition to capturing the daily details of the behavior of a (this) client with schizophrenia, Sheehan also does a masterful job of explaining, simply and concisely, some fairly complicated legal, medical, and treatment-related concepts. For instance, Sheehan outlines the concept of “least restrictive” forms of treatment, both the bane and the beauty of our mental health system, which has been around since well before the current lack of options made it so completely mandatory.  In doing so, she answers that most familiar of questions about why we can’t “just lock up” people suffering from chronic forms of mental illness who can become rather taxing to a variety of public and private resources.

The most fascinating elements of Frumkin’s story to me, though, were the ‘side treatments’—pointless, and sometimes dangerous, programs that Sylvia was subjected to. Without going into a great deal of detail, the treatments ranged from moving in with a relative and his family who believed that all Frumkin needed was a good dose of Jesus and discipline to overcome her laziness and wicked ways, to a doctor who felt that manipulating the insulin levels of patients to extreme degrees could cure them of schizophrenia.

Ultimately, what works for Frumkin (or worked back around 1980) is what still works for clients today: a small number of medications that prove effective in treating schizophrenia, as well as (to greatly simplify things) a structured environment and supportive professionals. Unfortunately, said medications can lose their effectiveness over time, or the side effects can become increasingly detrimental to the clients. It is also quite common for clients to simply quit taking their medications, feeling them unnecessary or viewing them as the root cause of various forms of discomfort or other troubles in their lives. In addition, the structured environments can only be maintained for as long as clients are compliant with treatment, and as long as the treatment remains effective, and as long as funding and various programs allow. On top of that, anything from the restructuring of institutions, to changes in law and other policy, to the career changes of providers, to differences of opinion between providers and family members, can lead to new doctors and other providers making changes, sometimes rather arbitrarily, to a client’s medication regimen or support systems. In Frumkin’s case, alterations to her treatment and medications were made numerous times, in the most haphazard of fashions, often by doctors and other providers who seemed ignorant of her case history, or of how the medications work.

One might also note that this book was written back before the U.S., under President Ronald Reagan, decided that people with chronic mental illness enjoy the freedom that homelessness brings. So, Frumkin’s movements within the system are relatively easy in terms of her various forays into decompensation leading to fairly quick, and relatively long-term inpatient placements, with step-downs to semi-independent housing, and other supports that are much rarer today (and for most of the last three decades).

Ideally, Sheehan’s book would be taught in graduate schools, or maybe at earlier levels, by instructors who are familiar with the clinical aspects of schizophrenia; the current and historical treatments for it; and the current and historical state of affairs with regard to mental health facilities, available inpatient beds for clients with mental health issues, and legal and systemic complications to accessing those beds or other program options.

To be clear, it is necessary, as therapists, or in other capacities in the mental health field, to come equipped with a belief that we can make a difference. Without a bit of the dreamer in us, we would never head down this path to begin with.

But it is also necessary for providers at all levels to understand just what they are up against, particularly given that almost all providers in the mental health field will end up doing at least a round or two in the public mental health system–from practicums/internships to early jobs to entire careers–where the most challenging of clients often end up by default—frequently after being abandoned by families and other support systems, including insurance companies.

Frumkin’s family, as dysfunctional as they are, and as frequently detrimental to her treatment as they can be, at least hang in there to the extent that they can—which I imagine was at least somewhat less difficult when hospital beds and supported living options weren’t at such a premium as they are today. In the end, though, this isn’t a story of a family hanging together and triumphing over a terrible disease. It’s the story of a debilitating mental illness, and the toll it takes on the client, as well as those around her, and the wildly inconsistent efforts by a variety of people and systems to help her cope.

Welcome to Sylvia’s Place.

Dropping Keys, Dropping Letters

by Jonathan C. Schildbach, LMHC, waning ASOTP, reforming soul-eater

An eighth-season episode of The X-Files was built around a “soul-eater”—a person who could draw the disease out from others into his own body, eventually vomiting it out. The concept of the soul eater is based in various forms of folklore involving a range of ideas about curses and cures, and the ability of some to take away those things that most harm or most sustain a person. Unfortunately for this particular soul eater, the demands of those who knew of his powers began to overwhelm his ability to process and expel the disease. He existed in a perpetual state of deformity and misery.

I like the soul eater as a metaphor for the work done by many people in “the healing professions.” In this field, many of us work at building a skill set that allows us to help extract the mental and spiritual toxins in others. Ideally, those receiving help will find a way to vomit out the toxins themselves. Yet, such toxins are in no short supply, and many who are most in need of help thrive on a constant diet of disease coupled with a willingness to let others take on the burdens of that disease. It becomes far too easy for helpers to end up like the suffocating soul eater, awash in the illness of others.

In the professional parlance, we call all that business of being overwhelmed by the problems of others “secondary trauma.” There’s a tendency to assume that, as trained professionals, we are able to recognize and address our own forms of distress. But, like many people in positions of suffering, particularly those who are considered high-functioning, it is entirely too easy to soldier on without addressing our own needs. We know how to address all this, and yet we often don’t, or we often address it in an unhealthy fashion, assuming it will pass in time. We take on more than we can handle, and think nothing of it. Whatever doesn’t kill me makes me more convinced I’m strong enough to take it.

Hey--eat any good diseases lately?

Hey–eat any good diseases lately?  The X-Files’ soul eater.

I bring this all up by way of saying that I’m in the midst of a career shift—not out of the helping professions, but into some different channels in the same field.

In particular, last night I dropped off the keys to the office where I’ve been serving as an ASOTP for the last year-and-a-half, at least temporarily distancing myself from a particular portion of the field that I have been involved with for over seven-and-a-half years—the treatment of sex offenders.

The change was forced by way of making a shift in my full-time employment in crisis services. As I write this, I am deliberately allowing myself only some small bit of awareness of the insanity of my professional life over the past several years. Yes, I have been working full time in crisis services, while also working anywhere from zero to ten hours per week with sex offenders. Such arrangements are not unusual in the helping professions—where we are pushed to learn our craft in rigorous, unpaid positions, while also attending school and working a paid job just to stay afloat. The habits of overextension established while in graduate school can extend out into professional life, and feel totally normal, even as we are pushed toward deformity and misery.

Currently in a break from a years-long pattern of toxic soul-eating, and ready engagement with secondary trauma, I realize I’ve become numb to plenty of very bizarre things. Running plethysmography assessments, I can sit through audio scenarios of sexually violent behaviors, paying them as little attention as if they were overplayed Top 40 hits from yesteryear piped over a grocery store or dentist office sound system. I’ve become entirely too comfortable asking people about their masturbation habits, and pressing them when I think they’re lying (only in the course of assessments, of course—well, mostly). Fortunately, I haven’t become so numb that I’ve lost all awareness of the twists and turns of my mind, although I frequently find myself stumbling in otherwise polite conversations when frighteningly dark and vulgar jokes spring to mind—an entirely appropriate coping mechanism in certain circumstances and with particular people—but definitely nothing you want to spring on friends of friends who don’t even have the most limited of contexts for understanding where such thoughts could come from.

And all of that was on top of 40-plus hours per week of run-of-the-mill crisis intervention, suicide prevention, utilization management…

So, if I want to mix in some metaphors, I can say I’m now a ronin—a samurai without a master—an ASOTP without a CSOTP—which, really just makes me a guy with an expensive piece of paper that says I’m an ASOTP until next September, but which conveys no real ability to treat any offenders unless and until I take on another master/CSOTP. Weighing the massive number of hours I still have to accrue across assessment, face-to-face treatment, and supervision, in order to get the full credential myself, I think this may be it for my involvement in offender-land.

I’ve dropped off the keys; and, with no further action, the letters, too, will drop—as will the level of…expulsion required of me on a regular basis. Sure, I’ll still do what I can to draw out various forms of mental/spiritual disease when that is required of m—but hopefully now in more manageable, fun-sized portions.

 

 

Dad’s Grave

by J.C. Schildbach, MA, LMHC, ASOTP, Preacher’s Kid

The Summer of 1977 is forever burned into my brain as a collection of hallowed moments experienced while on a cross-country, family car trip in a Pine-Green Chevy Impala Station Wagon: Seeing a lightning storm roll toward St. Louis from the top of the Gateway Arch, enjoying a traditional Chinese wedding banquet in San Francisco, swimming in Lake Michigan, watching “Star Wars” at a theater in Chicago when we were unable to procure tickets to the King Tut exhibit. (As a decades-long fan of the movie, it pains me to note that I nodded off sometime after the scene of R2-D2’s capture, later jarring awake to the battle cry of a Tusken Raider).

There were days-long visits to farms in communities we had lived in before I was old enough to remember, where I got to ride a horse for the first time, play in a rubber raft in a flooded cornfield, and experience the frightening speed of an angry mother pig as a newfound friend and I were made to race it to the fence of its pen after said friend pelted the sow with a dried-out corn cob. There was the morning I inadvertently released the inmates of a henhouse as I made a rather misguided effort to helpfully gather the eggs before breakfast, and the wonder of first experiencing the Beach Boys’ “Endless Summer” surf anthems from a landlocked farm community in the midwest.

Somewhat more mundane moments have stuck with me as well—attending a Saturday night church service in Sheboygan; staying up late to watch “Sssssss” on TV on a rainy night in Independence, Missouri; settling into the perfect stereo situation in the back seat of the Impala as my brothers played Blue Oyster Cult’s “Agents of Fortune” on the car’s cassette deck—“This ain’t the Garden of Eden,” indeed.

But there was one great disappointment in the whole epic adventure: the trip to my father’s grave in a small town in Nebraska. The victim of a stop-sign-running driver, and the shoddy engineering of the late-60s AMC vehicle he was driving, my father, the local Missouri Synod Lutheran minister, lost his life in the late summer of 1971. I am writing and posting this on the 43rd anniversary of that unhappy day—a day I was too young to remember or properly process—a day that gave birth to the attachment issues referenced in the subtitle of this blog.

Pops at 21...on his way to change the world.

Pops at 21…on his way to change the world.

The occasion, for me, was already lacking the appropriate sense of solemnity, with the shouting from a baseball game just across the road filling the bright, evening air. Things seemed even further amiss as we headed in the direction of…well, what seemed to be nothing.

Where was the towering monument? The magnificent marble Pieta? Or at least a moderately ornate cross?

Being a big fan of horror movies, and fascinated with the ornamentation and mythology of the church, I had built up the idea in my mind that my father’s grave would be marked by something appropriate to his stature as an important religious leader. My ideas were perhaps weirdly informed by my recent reading of Scott Corbett’s “Here Lies the Body”—a story set in a graveyard, and involving a massive grave marker with a statue of a pointing, judgmental angel—not to mention occult symbols scrawled in blood, and a murder mystery. On top of that, to pass the time on the drive from state to state, I had also read and re-read a book of “real life monsters,” which included stories of Vlad Dracula, and Haitian zombification procedures.

So when I saw the flat, drab grave marker, I wouldn’t say my heart exactly sunk, but my 8-year-old mind certainly underwent some shifts in its understanding of the world–shifts I filed away for later examination.

A little over a decade later, when I bought a copy of Tom Waits’ “Blue Valentine” album, and heard the song “A Sweet Little Bullet from a Pretty Blue Gun” (about the 1977 suicide of a 15-year-old girl who jumped from the 17th story of a Hollywood hotel with her guitar) which contains the line, “Nebraska never lets you come back home,” that scene of my father’s grave came back to me, despite not having given it much thought at all in the interim.

The passage of time, and hopefully the acquisition of some tiny bit of maturity, led me to reassess the precise meaning of my father’s grave. I realized that that grave marker wasn’t about his importance in the world, or his stature in a small Nebraska town. It was just some sign, marking the place where the material–or perhaps more preciseley, the matter-bound–part of his existence was left. His influence, his importance, extends way beyond that little concrete or stone marker.

My father’s influence in the communities he served extends to this day, in part through the connections my family made in those communities.  His impact, which, combined with the hard work and diligence of my mother, who raised five sons and a daughter in the years after my father’s passing, extends out into the world in myriad ways, through the hard work and community involvement of all of my siblings and their children—all in their own ways striving to make the world a more humane place.

For my own part, struggling to understand my father’s path in life before it was cut short, and trying to find my connection to it, has been a lifelong endeavor. And while I may have, at times, viewed my father and his life in weirdly iconic terms—iconic in the sense of symbols, signs, and signals to the outside world—I now view it as iconic in the sense of legitimate meaning and influence, the ability to impact the world positively by being a decent person…the same sort of influence I can only hope to emulate.

Happy death day, pops!

Suicide?!? Shazbot!

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.

THE Mental Health System Fix to Curb Gun Violence

The National Rifle Association (NRA), having confused “the mental health system” with the Pre-cog arm of the FBI’s Future Crimes Division, has endorsed the idea that mass shootings, as well as shootings of the non-mass-variety, are the responsibility of said mental health system. It is with the NRA’s assigning of responsibility for gun-related violence, and the attendant assignation of authority to resolve the problem, that I present the following mental health assessment tool: the Gun Violence Prediction and Prevention Mental Health Assessment Protocol, version 1 (GVPPMHAP-I)

The following assessment tool is to be administered any time a person wishes to purchase a firearm of any kind, regardless of how many firearms those people may already own. In addition, all current firearm owners are required to submit to the assessment by, oh, say next week. Scoring and outcomes of scores are presented at the end of the assessment.

Overcompensation?  What overcompensation?

Overcompensation? What overcompensation?

THE GUN VIOLENCE PREDICTION AND PREVENTION MENTAL HEALTH ASSESSMENT PROTOCOL, VERSION 1 (GVPPMHAP-I)

Instructions: Complete each of the following statements with the response that most closely resembles your own thoughts.

1. When you hear the phrase “assault weapon,” you think of…
a) a culturally accepted and understood term for certain kinds of weapons.
b) how you are so angry at peoples’ ignorance of gun specifics that you want to shoot somebody.
c) a pepper spray, a cumin pistol, a thyme bomb, a rosemary clooney, a mickey rooney.

2. Entering a fast food restaurant carrying an assault rifle…
a) causes other people to instantly perceive you as a threat, as it is a very irrational thing to do.
b) is my God-given right—you got a problem with that?
c) is a good idea given that a dimensional rift could open up at any time, leading to enormous, human-eating insects storming into our plane of existence, and it would really suck if you didn’t have your assault rifle with you when that happened.

3. The greatest American president of the 20th century is…
a) FDR, because the only thing we have to fear is fear itself.
b) Ronald Reagan, who in one fell swoop proved he could take a bullet, and that mentally ill people are the real problem…not guns
c) Thomas Whitmore because he gave those aliens what-for.

4. Despite all evidence showing that women are much more likely to be the victims of gun violence when they have guns in their homes or on their persons than when they don’t…
a) women should be allowed to buy guns under the law just like men, much the same way women should be treated equally under the law in all ways.
b) the real problem is that women just don’t have ENOUGH guns.
c) women are the last, best hope for defeating the impending robot insurrection, so need to keep guns at all times, whatever the cost.

5. Guns don’t…
a) have any purpose being brandished at peaceful political rallies other than to intimidate people who disagree with those showing off their guns in public.
b) kill people; people with mental illness kill people!
c) get to tell me what to do. I tell them what to do.

6. Of the roughly 19,000 suicides in the United States each year, half of them are completed with firearms, suggesting that…
a) guns allow for impulsive, violent suicide attempts that are far more likely to be lethal than any other method.
b) See, I told you the problem is with the mental health system.
c) if I’m really serious about killing myself, I should probably get a gun.

7. We don’t need new gun laws, we just need…
a) to reinstate the old ones that were made unenforceable through the lobbying efforts of the NRA.
b) to get rid of all gun laws.
c) more mystery-flavor Doritos so that we may learn to thrive on the toxins in our environment and become one with cancer.

8. School shootings could best be stopped…
a) with a combination of measures, including reasonable gun control policies; working to get school staff, parents, and students engaged in the school community; and educating parents about the potential dangers of keeping weapons in the home when children/teens might access those weapons.
b) by displaying the Ten Commandments in the classroom.
c) by attractive teens who are able to resolve society’s ills through the power of dance.

9. Smart gun technology…
a) is a reasonable way to limit who can and can’t use a particular weapon.
b) is just another tool of the fascist government to prevent me from shooting any gun I can get my hands on.
c) is a bad step in the direction of weapons gaining full consciousness and realizing the threat posed by their human masters.

10. Each year in the U.S. there are roughly as many deaths by automobile as there are by guns, leading to the conclusion that…
a) guns should be regulated at least as heavily as automobiles and subject to similar controls, such as training in appropriate usage and safety prior to licensing, gun registration, and requirements for gun owners to purchase insurance to pay for any damages resulting from the use of said weapons.
b) automobiles are just as deadly as guns (false equivalencies and misunderstandings of statistics be damned).
c) Pixar should make a “Guns” movie, similar to their “Cars” movie, which tells the tale of waning small-town America through the eyes of a cocky AR-15, Blasty McRatatat, who becomes stranded in a sleepy, little community on the way to a gun show. Through their obvious goodheartedness, the quirky, adorable townsweapons teach the AR-15 to slow down and appreciate life one short burst at a time.

11. Banding together with other assault-rifle owners in order to intimidate government employees who are attempting to enforce a penalty against a racist rancher who has been stealing from the commons for decades…
a) makes you one of those outlaws with a gun, who needs to be stopped by law-abiding citizens with guns.
b) makes you a patriot who believes in the true values of America.
c) Cows are pretty cool. I could hang out with cows all day. It’s only good manners to always say, “Hi, cow!” every time you see a cow, although most of them would prefer if you called them by their proper names. I once knew a cow named Sister Maria Theresa Fortenzia. Isn’t that a funny name for a cow?

12. People who live in fear that the government is coming to take all their guns away…
a) are paranoid and creepy and should probably have their guns taken away.
b) are the only real Americans who are truly awake to the reality of the one-world-government dystopian hell soon to be visited on us all.
c) should know that the loss of their guns is the last thing they should be worrying about in the face of the one-world-government dystopian hell soon to be visited on us all.

13. The only thing that stops a bad guy with a gun is…
a) another bad guy with a gun, a cop, a good guy with pepper spray, a good guy who knows how to tackle a bad guy with a gun, reasonable gun control measures making it much more difficult for bad guys to get guns, enabling law enforcement to track suspicious purchases of guns and ammo, a good guy with a crossbow, a good guy with a knife, a good guy with an apple…sorry, that was several things that potentially have the power to stop a bad guy with a gun…but, y’know, if people are gonna kill somebody or stop somebody, they’re going to find a way to do it, and guns aren’t really necessary, right?
b) Wayne LaPierre’s fiery delivery of nonsensical rhetoric.
c) a well-aimed garbage truck.

14. This assessment involves a fourteenth question because…
a) paranoid conspiracy theorists would probably view an assessment with thirteen questions as being somehow satanic or otherwise involving the occult.
b) because it was probably crafted by liberal pussies who want to make sure it doesn’t reference anything patriotic or pro-America like the original thirteen colonies.
c) test subjects engaging in speculation about the number of questions on an assessment is a sure-fire way to identify people who have an unnatural obsession with the arbitrary connections they make, which seem irrational to anyone not sharing in their delusions.

Scoring is as Follows:
For every “a” answer, score one point.
For every “b” answer, score two points.
For every “c” answer…what the hell, two points seems reasonable.

Once the score is added up, engage the following procedures:

For anyone scoring a 14 or above:
• Prior to any gun purchase, a license for gun ownership must be obtained, which will include training in, and demonstrated proficiency in, use of the weapon, safe storage of the weapon, and proper maintenance of the weapon.
• Prior to licensing, the person desiring to purchase a firearm must pass a comprehensive background check.
• Prior to licensing, the person desiring to purchase a firearm must undergo a three-month waiting period.
• Prior to licensing, the person desiring to purchase a firearm must pass a rudimentary course in statistics/risk assessment so that they understand that they are much more likely to experience the death of a family member by gunshot wound due to having a gun in the home, than by not having a gun in the home, and that cars really are not more dangerous than guns unless a lot more people deliberately start using cars to kill people.
• Purchases of assault weapons, assault rifles, automatic weapons, and semi-automatic weapons will be disallowed.
• Any guns owned must be registered in a national database accessible by local government/police agencies for the basic purpose of making sure any law enforcement officers responding to a situation at a particular residence will have some idea of the level of danger they are facing there.
• At time of acquisition of any gun, owners must purchase firearm insurance at whatever going rates insurance companies deem reasonable for covering expenses related to use of firearms, including, but not limited to, costs for destruction of property, medical care, mental health care, and loss of life stemming from use of firearms.

In an ongoing effort to ensure the public safety, the “mental health system” reserves the right to impose further restrictions/sanctions on the ownership of guns.  Currently under consideration: a proposal by one Dr. Rock to increase the cost of bullets to $5,000 apiece.

The “mental health system” would like to thank the NRA and the American people for their trust and support in the design and implementation of the GVPPMHAP-I and its attendant requirements.