Category Archives: Suicide

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.

THE Mental Health System Fix to Curb Gun Violence

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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.

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.

 

 

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 Two: Psych Beds and Psych Meds–Faster Than a Speeding Bullet?

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As we pass the 13.5-month anniversary of the Newtown school shooting, and approach the 15-year anniversary of the Columbine school shooting (or, hell, pick a school shooting and do the chrono-math) we find ourselves struggling with the idea of stigmatizing people with mental illness in order to support easy access to guns and ammo—okay, not so much struggling as having to have a really stupid argument with people who love guns and people who know better than to engage in such a dangerous form of Objektophilie at the expense of fellow citizens, and while demeaning a particular group of citizens.

In an opinion piece that was posted on the Fox News web site just before the one-year anniversary of the Newtown school shooting, “Medical A-Team Member” Dr. Keith Ablow once again lends his severely-compromised credibility to the issue of gun control versus mental-health-system-blaming in order to craft an argument where fewer people would die if only there was increased access to psych beds and other psych services, and just as much, if not more, access to guns.

You can read the piece (all puns intended) here… http://www.foxnews.com/opinion/2013/12/12/on-newtown-anniversary-america-mental-health-system-still-mess/

Dr. Ablow fires out a random assortment of gun- and mental-health-related ideas with the precision and deadly accuracy of a single blast of #9 shot, aimed to take down the elephant in the room—that no meaningful action has been taken to reduce access to unnecessarily powerful weapons and massive amounts of ammunition.  Of course, as with trying to take down an elephant with a single blast of #9 shot, all that Ablow does is irritate the elephant—or exacerbate the problem—by claiming that it is mental illness that is the real problem.

Ablow starts off by listing five mass shooters from recent years, and remarks that we “now know” that they were all severely mentally ill.  Ablow then abruptly shifts to talk about Virginia State Senator Creigh Deeds, whose adult son, Austin (aka Gus), slashed/stabbed the Senator (with a knife) and then committed suicide (with a gun) in November.  (Note: this crime did not involve mass killing).

Prior to the stabbing and suicide, Austin was under an emergency custody order for a psychiatric evaluation, which expired before a psychiatric bed was secured for him.  Multiple hospital officials in Virginia later stated that they had open psychiatric beds at the time Austin was turned away.  It’s unclear exactly how things fell apart in this case, but it wouldn’t be impossible for a six-hour hold to expire while an overwhelmed staff at one facility needed to present the case for, and secure a bed for, hospitalization at another facility.  It is also possible that Austin did not meet grounds for (mental health) detention.

Dr. Ablow states that Austin was “discharged from an emergency room where he complained of severe psychiatric symptoms.”  But there are a number of problems with this statement.  For one, it comes in the context of one of Dr. Ablow’s “We know” statements—and “we” do NOT “know” what Austin may or may not have said or “complained” about.  Also, given that Austin was under an emergency custody order, chances are that he wasn’t voluntarily seeking help.  If Austin was willingly seeking help, and considered competent to do so, then the order wouldn’t have been necessary.

Unfortunately, if a client is not a clear threat to self or others, or in danger of harm due to being incapable of caring for him/herself, the client (generally speaking) cannot be detained.  Senator Deeds stated, after the incident, that while he expected conflict with his son, he did not expect his son to turn violent.  And in Virginia (mental health evaluation and detention procedures differ from state to state) a person cannot be detained if the emergency custody order expires before a psychiatric “bed” is found.  By contrast, in a number of other states, if a person is viewed as detainable for mental health reasons, they can be held (for example, in an emergency room) until a psychiatric bed becomes available or the client is stabilized.

At any rate, Dr. Ablow devotes a one-sentence paragraph to greatly simplifying what happened in the Deeds case, and ensuring that nobody who reads his column would understand anything about how laws related to mental health treatment operate, or what is required of patients and evaluators in detaining a person for mental health reasons.

As a bit of an aside, I routinely speak with people who think that all it takes for the state to send out an ambulance with a couple of guys and a straitjacket to cart away a loved one is three people who will pinky-swear that a relative or close friend needs to be “locked up.”  This is the kind of information that comes from old movies involving a group of people conspiring to get a relative “committed,” so they can usurp the family fortune.  As another bit of an aside, think of how much you agree with the idea that it should be legal for the state to lock a person up based on a consensus among three people that the person is “crazy.”

But Ablow’s interest is not in creating greater understanding, or making any kind of appeal to anybody based on, say, critical thinking skills.  It’s in telling us how guns are not a problem when it comes to people being shot.

Strangely enough, to make his pro-gun argument, Ablow then discusses Adam Lanza, the Newtown, Connecticut mass-shooter, in deeper detail.  Lanza, Ablow explains, was “allowed” to “learn how to shoot a firearm” by his mother, Nancy, who was the first victim of Adam’s shooting spree.  Dr. Ablow apparently hopes that readers don’t remember/can’t do an Internet search to find out that Lanza’s mother had numerous guns and a great deal of ammunition in her home (where Adam also lived), all purchased legally, and, shortly before the killings, had even written a check to Adam so he could go buy his own gun.

Also, as with the Deeds case, Lanza’s mother indicated that she did not fear violence from Adam, despite his statements and behavior to the contrary, and despite the large number of weapons she kept in her home.  Nancy Lanza’s sense of safety in opposition to all signs to the contrary is not unusual.  Most gun-rights advocates seem to suffer from some sort of collective delusion that they cannot be harmed with their own guns, although statistically speaking, gun owners and their family members are much more likely to be shot with those guns (accidentally, self-inflicted, or otherwise) than any bad-guys.

While ignoring Nancy Lanza’s love of guns, Dr. Ablow notes Adam’s obsession with mass murder, his playing of “violent video games (including one about school shootings)” and that Adam lived in the basement of his mother’s home, where he had covered the windows with trash bags and only communicated with his mother via e-mail during the three months before the shootings took place.  Dr. Ablow mentions Lanza’s Asperger’s Disorder diagnosis, and posits that he “may well have merited other diagnoses.”

Well, given that most people with Asperger’s Disorder don’t take up arms against grade-school children, I’d guess Dr. Ablow might be right about that diagnosis piece.  Lanza had also been diagnosed with an anxiety disorder, and with Obsessive Compulsive Disorder (neither of which tend to lead to mass killing), and had been prescribed medications related to his various diagnoses, but there was little follow-up by Lanza or his mother with regard to the psychiatric care.

This leads to another point regarding how pointless it is to claim that the “mental health system” is to blame for the problem of gun violence.  If the family members of someone like Adam Lanza did little or nothing to get him help, and actively encouraged his access to guns, it seems rather ridiculous to think a psychiatrist would be able to correct that situation with a few days in the hospital and some medications.

Strangely enough…whoops, I mean, “of course,” Dr. Ablow doesn’t mention where Lanza got any of the weapons and ammunition, but instead highlights just how weird (he assumes his readers will believe) it is that Lanza lived in his mother’s basement, and spent time on computers.  Remember, kids, video games kill.  Living in your mother’s basement kills.  Having a massive arsenal of weapons in the home is NOT the problem.

Getting all compassionate, Dr. Ablow goes on to say that “untreated or poorly treated mental illness is” a problem.  He even italicizes it.  Oh, wait, let me back up off of that statement a bit, so that we can see that what he actually says is that (and let this soak in), an “anti-gun agenda misses the point: Firearms aren’t the responsible variable in mass killings: untreated or poorly treated mental illness is.”  (His italics)

Well, I don’t know, Dr. Ablow…I’ve got a weird feeling that there are a lot of people out there with untreated or poorly treated mental illness who don’t commit mass killings, at least in part because they don’t have access to a bunch of guns and ammunition.  (My italics)

After his impassioned, italicized plea that guns don’t kill people, people with mental illness kill people, Dr. Ablow awkwardly segues to a brief mention of the 1927 Bath School disaster as the example of the “worst episode of school violence ever” and notes (italicized and underlined) that it “involved no gun.”  (Yes, his underlining and italicizing).

The Bath School disaster is one of those weird things that pro-gun folk like to cite as a reason why school shootings really aren’t all that bad.   Unfortunately, it kind of undermines their argument if you actually look at it—because the Bath School disaster was committed using dynamite and incendiary pyrotol—substances that are not generally sold in your local Walmart.  Those explosives in particular aren’t actually available much anymore, pyrotol having been banned for sale to farmers in 1928 (the year after the Bath School disaster—committed by a guy who owned a farm), and dynamite having largely gone off the market due to the availability of more stable explosives.

Another fun fact is that explosives tend to be rather heavily regulated by the government.  After that whole episode of Timothy McVeigh blowing up the Oklahoma City Federal Building, a whole lot of regulations got slapped on the seemingly innocuous components of his fertilizer-truck-bomb.  So, if you want to make a connection about the appropriate action to take after somebody uses a certain kind of “tool” to kill a lot of people, bringing up explosives isn’t really helping your case.  After all, we don’t encourage people to go buy more explosives to make sure the good exploders can explode the bad exploders.

Ablow also forgets to make any relevant connection between Andrew Kehoe, the man responsible for the Bath School disaster, and mental illness.  Certainly, given that Kehoe was homicidal and suicidal, he could have been detained by today’s standards if his intentions were at all known.  But from all accounts, he was a rather angry, vindictive individual, like a lot of people who commit gun crimes.  Ablow fails to delve into the possibility that Kehoe was constantly playing Grand Theft Auto XIV, eating Cheeto-and-kale sandwiches (on Dave’s Killer Bread), and drinking Baja-Blast Mountain Dew, while masturbating to animated monster porn.

In another odd turn that undermines his argument, Ablow then chooses to discuss untreated mental illness, saying (in relation to suicide of all things) that, “shooting victims don’t come close to the body count from untreated mental illness in the United States.”  Apparently, Dr. Ablow,  thinks that “shooting victims” who shoot themselves don’t count.  Because suicides make up about two-thirds of all gun-related deaths in the U.S.  And suicide by firearm makes up about half of all suicides.

To give some nice, round numbers, there are over 30,000 firearm deaths per year in the United States, with about 19,000 of those due to suicide.  There are about 38,000 suicides total.  The next-highest category of suicides is suffocation, which accounts for around 9,500 deaths.  But “suffocation” includes a variety of things such as hanging, cutting off one’s air with plastic bags over one’s head, and using one’s car exhaust to deprive an enclosed space (and, hence, oneself) of oxygen.

Along with failing to mention that suicides by gun account for the lion’s share (sorry lions) of suicides, Ablow also neglects to mention that a big piece in risk assessment and suicide prevention involves removing firearms from the homes of suicidal (and homicidal) people.  After all, why would anyone take the guns away from people who are suicidal or homicidal (or who are so paranoid as to think that the government is coming to take their guns away)?  Why would anyone take guns away as part of “fixing” the mental health system?

Dr. Ablow then makes the tragi-comedic statement that he wishes that in the year since the Newtown shootings the Surgeon General would have, “declared war on mental illness.”  I suppose Dr. Ablow means a declaration of war on mental illness—like where a lot of resources are committed to treating mental illness and maybe to getting rid of the stigma associated with mental illness—as opposed to declaring war on those with mental illness.  Because, in effect, blaming mental illness and the failures of the “mental health system” for mass shootings, instead of viewing easy access to the tools for killing (guns and ammo) is a rather shaky position to take.   As a general rule, “untreated mental illness,” which covers a huge range of possibilities, is not the vehicle by which metal projectiles end up penetrating children’s skulls.

Ablow goes on to compliment the Obama administration for providing additional funding for mental health care through the Mental Health Parity and Addiction Equity Act. No, really, a guy on Fox news said the Obama administration kinda-sorta did something good.  But he then condemns the Obama administration for undermining mental health care by trying to ensure access to mental health care via “Obamacare.”  He says that insurance companies do nothing but try to block access to mental health care, and because Obamacare tries to bring down costs, it sucks that people are going to have access to mental health care and the insurance companies that want to deny them care.

So, I think Ablow’s point is that Obama tried to do some good, but failed because he didn’t devote enough resources to it.  Increased access to mental healthcare is good, but failure to provide enough money for the highest levels of mental healthcare is bad?  What’s the remedy for that?  Dr. Ablow apparently thinks the remedy is mental health spending in whatever amount is necessary to put all people dealing with mental illness of any kind into the ongoing care of a psychiatrist…because we all know that what helps people diagnosed with a mental illness…any mental illness…is somebody who prescribes them the right medications.  Right?

Let’s do it, then, Dr. Ablow: provide unlimited funding for unfettered access to psychiatrists for all people who are diagnosed with a mental illness.  What does that entail?  Monthly check-ins with a psychiatrist?  Weekly check-ins?  Daily check-ins?  It’s hard to know what Dr. Ablow is talking about, because he states that MDs need to be in charge of the care of any person who needs mental health care.  But unless we increase spending on mental health care by billions, and find a gusher of a grad school, spewing psychiatrists, his ill-defined proposal isn’t going to work.

What Dr. Ablow (very vaguely) proposes is sheer fantasy.  And the reason he proposes fantasy to deal with a real world problem is that if a real world problem has a fantastical answer, then that real world problem never has to be solved.  We can keep saying, “Fix the mental health system,” or, “Make sure the mentally ill can’t get guns” all while we ignore the fact that we have no intention or way to fix the mental health system in the fashion proposed.

Maybe a better solution is to allow mental health professionals to evaluate people who want to buy guns.  If you meet certain diagnostic criteria, you are not allowed to own a gun.  If you own a gun, everybody in your house must undergo annual psychiatric testing.  But, then, wouldn’t the desire to own a gun be an indication of mental illness, since the intent to own a gun to protect oneself from bad guys would indicate an intention to shoot somebody?  Well, nevermind, it would all be rather expensive anyway.

Dr. Albow leans toward closing his piece out by claiming that “We haven’t done anything to meaningfully coordinate police departments and the courts with the gutted community mental health system.”  Aside from the idea that the mental health system has been “gutted,” I think those involved in dealing with the “mental health system” might find Dr. Ablow’s statements false and offensive.  Because, despite massive budget cuts, and childish blame-cops-judges-and-mental-health-providers arguments like Dr. Ablow’s, numerous police agencies, court systems, and mental health agencies have been doing their damnedest to coordinate care, and provide community education into how to navigate the complicated legal knots of the system. They’ve also been doing what they can to get guns out of the hands of people who are potentially suicidal and/or homicidal, despite the best efforts of the NRA to make sure that everyone, regardless of mental health status, has access to guns.

Dr. Ablow actually closes out his piece by claiming that the Newtown school massacre was “entirely preventable”—which I guess it was, but not by anything that would happen in Dr. Ablow’s fantasy world where psych beds and psych meds negate bullets.  He states that the real surprise in the year since the Newtown school massacre is that there wasn’t “another” Newtown massacre.  But I’m guessing that the parents of the children who were the victims of the 27 school-shooting deaths and 35 gunshot injuries committed in schools in the year following Newtown might disagree with the idea that there was not “another” Newtown.   Sure, there wasn’t a single incident where the same number of people were killed and injured. But what kind of world is Ablow living in where he is willing to excuse even one person being shot at a school in a given year, and to blame mass shootings on mental health providers and people with mental illness, while choosing to support the right of gun manufacturers to continue to provide just about anyone with access to firearms and ammunition designed specifically for killing people?

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 →