Real Suicide Prevention or Self-Satisfied Nonsense?

It's Suicide Prevention Month/Week/Whatever again. Those of us who are or have been suicidal know suicide prevention as a year-round, full time job. Those of us who are or have been suicidal have a whole lot of experience at preventing suicide. Is anyone interested to hear from us? Some of the following came from an earlier post. It bears repeating, 'cuz evidently even some bright people have some strange ideas. Like:





Suicide is not a choice

The way people talk, you'd think we sit down and make a list, pros and cons of suicide. Then based on our calculations, we make some kind of decision. She chose to end her life. Or, How could he have been so selfish.

This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.

You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.

Resisting COVID Depression, One Song at a Time

Who knew COVID would last this long? Did you, like me, feel a bit of hope last spring? We had the tools; we got the jab; the numbers started falling.

But . . . not everybody got the jab.

Then . . .


Now? Children are thrown into a virus laden cauldron while state legislatures pass laws prohibiting measures that would reduce the spread of a pandemic. Nurses are dropping like flies. A guy died in an emergency waiting room this week because there was no room for him in ICU.

And people with a high school diploma and an internet connection know better than the medical community. Instead of heeding the pleas of their doctors, they are taking horse-deworming medicine. Our local feed store has run out of it.

I guess next up--the horses start dying.

So, it looks like this thing is going to be with us for a while.

Okay, it's time for those of us with treatment-resistant depression, unresponsive bipolar, and longterm suicidality to step up to the plate. We have a bit of experience about surviving lunacy that does not let up.

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How to resist the forces that are dragging us down into a black hole with no end in sight? After we have given up hope as a liar and we have to figure out how to exist anyway?

The answer: Do every tiny little thing that offers the tiniest littlest bit of relief you can.

Hear me out. This week's tiny little thing, which actually is a tested and successful tool of resistance is - SING.

That's what I said. Sing.

In 2013 I reported on research about the physiological and social action benefits of singing. Here is an abbreviated version of that original post:

Hearts Beat as One

Prejudice, Not Stigma: How People with Mental Illness Get Crap Health Care

Eight years ago I published an article titled Doctors' Prejudice Against Mental Illness. It lays out the reasons why it is so damn hard for doctors to learn. Here is a paragraph from that original rant:

Similarly, people with other mental illnesses as well often do not receive routine standard of care for a whole host of conditions, including screens for infections, dental care, metabolic syndrome, even blood pressure checks, even while receiving medications that put them at risk for all of these health complications. As a consequence, the death rate gap between people with mental illness and the rest of the population is growing.

The link in the second paragraph is to a World Psychology article, a review of the literature documenting the crap health care that people with serious mental illness receive, with the consequence that we die an average of ten years sooner than people without mental illness.

The difference in lifespan is only slightly due to suicide. For the most part we die of the same things everybody else dies of, heart disease, cancer, that sort of thing. We just die sooner because our heart disease and cancers are not detected as early, nor treated as aggressively, as everybody else's.

Statistics are sterile things. People with severe mental illness in the US have the same lifespan as people in Somalia. Well, I don't know people in Somalia and I'm not dead yet, right? So what does that mean?

How about one person to make it real? How about one story to explain how doctors' prejudice works and what the consequences are?

Here is my story.

A month ago, after a few years of telling my therapist, I think they're missing something, I had had it. I called the doctor's office and said, I have a lump in my vagina. Nobody has ever looked at the damn thing, and I don't believe anymore that it is a hemorrhoid, (which is what the diagnosis was.)

The scheduler took lump in vagina seriously, and I got an appointment that afternoon. They finally looked at the damn thing.

Who told you that was a hemorrhoid? Actually, I had referred to it as such originally, because I do have a hemorrhoid, and because I am not the damn doctor!

She didn't look at it?

I described the symptoms I had reported, that it was pushing into my vagina.

Hemorrhoids don't do that. She didn't look at it?

The new doctor and the student who was shadowing him were so nonplussed, I began to doubt my own memory of the appointment two and a half years ago.

So I went home and looked up the case notes in my chart.

Sure enough, the provider had faithfully recorded what I had told her. Sure enough, what I had told her clearly indicated the diagnosis I finally received, a prolapsed bladder.

Only back then, it would have been grade one, the least serious. (I also Googled prolapsed bladder, with which I was not familiar because I am not the damn doctor!

But today, I have a grade three prolapse. My bladder is hanging outside my body. Plus, now there's a bulge on the other side of the vagina wall. The nonsurgical intervention is off the table. The required surgery is now more complicated.

Just like how people with schizophrenia whose cancers are not diagnosed until the most serious stage four, my prolapse was not diagnosed until the most serious grade three.

She didn't look at it?

Ah, but the chart told the rest of the story and contained the explanation. While I had requested a full physical to discuss this discomfort in my nether regions, the nurse who did the Medicare wellness check a few days earlier had alerted the provider about my depressive episode. They and the social worker had a consultation and decided, We are concerned that we are not doing enough to help you with your bipolar.

I would hear that exact line from two different people on that day when she didn't look at the damn thing. They had considered carefully how to work around my presumed stigma about seeing a psychiatrist. (Why would I be reluctant to see a fifth psychiatrist? Except for her lack of qualifications in bipolar, that is...)

Actually, both the provider and the social worker seemed pretty nervous. How were they expecting this insufficiently medicated bipolar to behave? In anticipation of the conversation, I can imagine that the provider's HPA axis was in high gear and interfering with her diagnostic capabilities.

Now, the wellness check had run long, because nobody had recorded the extensive family and psych history I had provided ahead of time. The nurse was inputting a lot of data, and reduced it to highlights that will be of no help if I am ever hospitalized. She didn't really have a full picture of how much time I spent with a nationally esteemed expert on bipolar. She hadn't ever heard of him--because she doesn't treat bipolar; she does Medicare wellness checks.

Nor did she have a full understanding of the range of treatments that this bipolar expert and I had already tried, and my full compliance with his recommendations, and, following his recommendations, my relative stability for the past few years, with a recent blip of a depressive episode, for which I had a treatment plan.

Nope, a nurse, a nurse practitioner, and a social worker decided they weren't doing enough to help me with my bipolar.

Translation:

Red alert! Bipolar not taking antipsychotics in aisle three!

via GIPHY

So the provider didn't have time to look at the damn thing. She had to get me to agree to talk with the social worker whose assignment was to convince me to try the practice's consulting psychiatrist, a generalist (I use the term cookie-cutter psychiatrist) fresh out of residency.

The upshot of the cookie-cutter psychiatrist's chart review was a recommendation for a medication I indeed had not tried, a medication that the expert, another also much more experienced psychiatrist, and a better family practitioner had all specifically told me not to take. Plus some other stuff that is not best practice.

The other upshot was that I spent a few weeks traumatized and frantic about the quality of care I was likely to get if I ever did have a psychiatric emergency. The expert has retired, and I still don't have a replacement, because I am not willing to put my life in the hands of people who have read less research about bipolar than I have.

But anyway, I have bipolar disorder. Whatever is wrong with me must be related to that. So nobody needs to look at anything.

via GIPHY

Since that diagnostic fiasco from two years and a half years ago, I have frequently complained of fatigue. No luck getting that dealt with either. In fact, reviewing my case notes, now knowing why this thing is hanging out of my body, I wonder whether along the way I have had a few UTIs, also not diagnosed, because I said fatigue instead of lethargy. Because I am not the damn doctor!

And fatigue, clearly, is a symptom of depression...

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...for which I had already refused their efforts to help me when they wanted to prescribe medications that I knew would make the course of my bipolar worse.

That is the mechanism, the process that delivers crap health care to people with mental illness. That is how we die on average ten years sooner than the rest of you.

Look on the bright side, Goodfellow. It's just a bladder handing outside your body. It's not stage four cancer. 

This time.

via GIPHY

Yeah, well, Dame Maggie, I guess I'm feeling like my bladder, kind of low about the whole thing.

Surviving Heat Waves with Bipolar Disorder

Did you know that more people are murdered at 92 degrees Fahrenheit than any other temperature? I read an article once. Lower temperatures, people are easy-going, over 92 and it's too hot to move, but just 92, people get irritable.

That's what the sheriff said in an opening scene of It Came from Outer Space. Set in Arizona -- even in black and white, you could feel the heat rolling off the sand. And throughout the movie, they attributed people's reports of strange sightings to heat-induced lunacy.

As I read that quote from 1953, I think -- 92, if only!

Everybody is irritable right now in -- how shall we put this? -- the coolest summer we will experience for the rest of our lives. Everybody is exhausted. But some of us more than others.

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The health department reminds us to check in on the old folks, to remember the pets. The newspaper reports on the location of cooling stations for the homeless. But it falls to us loonies to remind each other to watch out for fellow loonies.

The DSM doesn't mention it, no doctor ever responded with a simple acknowledgment when I brought it up, but part of bipolar is difficulty with temperature regulation.

Makes sense, doesn't it? There's more to bipolar disorder than up and down, more than happy and sad. It's about balance, or rather, lack thereof. Our brains are not good at maintaining homeostasis. Translation: they can't adjust to changing conditions for a whole range of normally fluctuating levels (hormones, blood pressure, appetite, energy, and yes, temperature).

Natasha Tracy's article in HealthyPlace.com reports on meta-analyses of studies on the effects of heat on people with mental illness. More people are murdered, the sheriff said? It turns out that suicides go up in high heat. Wow. 

Here is one such study that showed a link between the temperature outside and hospitalizations for bipolar.

Let's layer on, like an ugly sweater, the effect of medications that many of us loonies take. Anticholinergic drugs, tricyclic antidepressants and antipsychotics among them, decrease the production of sweat. There goes our number one cooling mechanism offline.

What about lithium? Anyone who takes it has been warned about the dangers of lithium in hot weather. Lithium is a salt, with a narrow range of acceptable blood levels. So if you do sweat and become dehydrated, you risk becoming toxic.

Well, weigh lithium's toxicity against its protection against suicide. It may still be your best choice.

What to do? What to do?

First: PAY ATTENTION!

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Catch heat exhaustion in its earliest stages, with light-headedness, fatigue, dizziness, nausea, muscle cramping. Move to an air conditioned place, remove extra clothing, take a shower or cover yourself with a wet towel, lie down, drink fluids -- the kind that do not have alcohol in them!

Heat stroke, what you get when you don't pay attention, is a life threatening condition. Once you get there, with headache, confusion, no sweating, rapid heart rate, hot red dry skin, nausea or vomiting, loss of consciousness, you are likely unable to notice the problem, let alone get yourself the help you need. But if you notice somebody else with heat stroke, call 911 -- yes, this is a medical emergency -- use the shower or wet towel trick, and do NOT give fluids.

Even better, try PREVENTION!

With the outside temp at 104 and still rising today, as I write this, I am sitting inside my house, which is well-insulated and holding at 84, but has no air conditioning. I have a wet towel around my neck. I have another wet towel under my bare feet, doubled over, with ice cubes between the layers. I have a glass of water next to me, with no ice, because tepid water is better at cooling than iced, for some reason. I will be leaving shortly to spend the night with my in laws. They do have AC.

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Public libraries, movies, grocery stores -- a few more ideas. If you don't have AC, now would also be a good time to avoid alcohol, which is dehydrating.

Take care, dear readers, and check up on your loonie neighbors!

One Exciting Thing and One Ironic Thing About Prozac Monologues and Psychology Today

Last week Psychology Today posted Bipolar Disorder: How to Get Correctly Diagnosed, my interview with Monica Starkman, M.D. about Prozac Monologues: A Voice from the Edge. Its tag says, The average of seven years to receive accurate diagnosis is unacceptably high.

Damn straight it is! The article is about how to improve that rate, or at least to improve the odds for the people who follow its suggestions.

This popular journal chose to place the article in its Essential Reads section on its bipolar resource page. The article's key points include:

  • Bipolar disorder, particularly Type II, is often misdiagnosed.
  • People tend to spend much more time in a depressive state and often do not recognize mild or hypomanic symptoms.
  • The chance of getting properly diagnosed is increased by using online screening tools and bringing family/friends to doctor visits.

I spent a mere (!) five years misdiagnosed with major depression, two of them taking the antidepressants that threw me into mixed episodes and made me suicidal. A random conversation on an airplane led me to the Mood Disorder Questionnaire referenced in the Psychology Today article. Taking the MDQ was the first step to discovering my bipolar and, more importantly, getting on the road to recovery.

So the exciting thing is that this information will be accessible to a larger audience than those of us who go poking around medical journals. That is my mission. Contact me on my website if I can speak to your book club, church group, or fraternal organization about mental illness and recovery.

The ironic thing? -- The photo the magazine chose to accompany the article.

This photo ticked all the boxes in the memo I sent to the cover design people for Prozac Monologues, saying,
Don't even.

In fact, this photo showed up in my Facebook feed twice last week, once illustrating my own article, the other to go with a HealthiNation post, Four Myths about Bipolar Disorder. The photo suggests the following myths:

MYTH: Bipolar disorder means having mood swings.

MYTH: The mood shifts are rapid and constant.

MYTH: The highs are extremely high, and the lows are extremely low.

MYTH: Mania is a euphoric mood.


I mean, doesn't she look like she's on a wild whipsaw of emotion? Check out the article to learn more about why these myths distort the reality of bipolar disorder.

In a nutshell, bipolar exists across a range, and shows up in many cognitive and energetic systems, not just mood. It's not just up and down. I took too much trouble to demonstrate that in Prozac Monologues to have the cover undo my labors.

I also told the cover design people that I didn't want a white woman on the cover. I didn't want anything that suggested to people of other races that this book was not about them. Because mental illness does not discriminate by race or gender. Neither should information, treatment, nor recovery.

On a personal note, the Independent Book Publishers Association recently awarded Prozac Monologues a Benjamin Franklin Award in the highly competitive category of autobiography and memoir. Of the f
ront cover design, one judge wrote: Outstanding. So creative and effective. One of the best this judge has seen among this year’s contest entries. The cover design is powerful and impactful. It will make a reader/browser/ shopper want to learn more about the book’s content. Fantastic.

I concur, and want to give credit to Leah Lococo of She Writes Press for her work. Not only did her design dodge the pitfalls of bipolar myths, but she managed to capture the story itself, the hypomanic episode that kicked off by writing the first seven monologues in eight days on a yellow notepad, filling every line, every margin, and every space between with energy and urgency.

(The judge liked the back cover even more.)

So. Yay! A good month with an expanded reach for information that is vital to people whose depression is not getting better:

It might be depression plus something more.
And you might be able to get better after all.

Plus a little bit of weirdness about misunderstandings of bipolar disorder. But that part isn't really news, is it.

On the Road Again for NAMI: No Cougars Encountered

NAMI and I go way back. I don't even know when or how I heard of this organization, the nation's largest grass roots organization dedicated to building better lives for the millions of Americans affected by mental illness. But it has walked beside me for thirteen years now, as I have tried to build my own better life.

NAMI began in 1979, when some Wisconsin parents of people with schizophrenia pushed back against the prevailing theory of the day, that they had caused this terrible disease in their children. They aligned their new organization with the view that schizophrenia is an illness of the brain, and a commitment to support research into medical approaches to alleviate this and other mental illnesses.

NAMI provides advocacy, education, support and public awareness. My own life has been touched by NAMI through their Peer to Peer classes and support groups. My wife attended Family to Family classes. In the last ten years, these core programs have expanded to address other needs.

So most years, I have participated in their annual fund raiser, the NAMIWalk. For the first few years, I walked with NAMI Johnson County in Iowa City, with Team Prozac Monologues. It was a party affair, kicked off with balloons and Middle Eastern dancers and roller derby demonstrations. And t-shirts, always t-shirts.

This year we did it DIY. COVID cancelled the big events. We all walked our own routes.

My route was the Peterson Ridge Trail in Deschutes National Forest, south of Sisters, Oregon.

Some different scenery this year:



And some novel challenges:


But this was not the first DIY NAMIWalk for me. In 2012 we were in Costa Rica when the date came. Not to be deterred, heck - why don't we make a movie!


Seriously, in the days before IPhones, we carried a laptop to the beach!

Anyway, if you are inclined to support my fund-raising efforts this year, the pledge page is still active. Here it is. Many thanks to those who have already contributed, this year and in years past.

In 2009, the local NAMI chair asked me to participate in Mental Illness Awareness Week, a vigil remembering people who had died from their mental illness. On October 4th, I stood in front of a hundred people or so. I was struggling myself to survive when I said for the time, Hello, my name is Willa Goodfellow, and I have a mental illness.

That seems an age ago. An admission that seemed so daring then has become my brand. NAMI has been part of my getting to a much healthier place about acknowledging my reality.

I stated an intention that night. I am proud to say that I am fulfilling it. So I close this post the way I closed those remarks twelve years ago:

...To that end, I am going to live with this disease the way Don lived with his. Openly -- I have a mental illness. Actively -- I will answer ignorance with education. Politically-- I will meet discrimination with change. And in community -- I will support and be supported by others who share this illness with me, so that we can survive it together.

Does Music Therapy Help People with Bipolar Disorder? Maybe Not

Non-pharmaceutical approaches to mental illnesses are great. I mean, who wouldn't like to pop a pill without the side effects?

I eagerly clicked on the link: Music therapy for bipolar disorder: Can it help? from the newsletter, Medical News Today, hoping to find the playlist that would soothe the savage beast. The article reported on two studies, both pretty small, N<30. I guess music therapy doesn't attract the big bucks in research land. Spoiler alert: I did not find the magic playlist.

The first study compared people with bipolar in a euthymic state (stable, not depressed, not manic) with healthy controls. They listened to music that typically produces wonder and joy. The healthy controls felt wonder and joy. The bipolar participants felt... tense. The researchers surmised that the negative emotions in bipolar participants has to do with difficulties in emotional regulation, part of the executive dysfunction.

The music disrupted an equilibrium, perhaps, which healthy controls found exhilarating, but bipolar people found simply disruptive? -- That's my conjecture.

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