Flip the Script on Suicide Prevention Week

National Suicide Prevention Week starts next week (September 8-14) and I am trying to gear up for it. I can’t remember which I am supposed to watch for, the risk factors or the warning signs. I guess somebody will tell me again.

Not to be snarky – I do appreciate this annual effort to get people to pay attention. You’d think so, given my personal stake in preventing suicide, as in, my own. But I have to confess, these campaigns leave me feeling a bit disconnected from myself. How ironic is that?

I figured it out. The problem is that I pay any attention at all to suicide prevention campaigns. But they are not addressed to me. They are addressed to professionals, friends, and loved ones. They are about me and others who are at risk.

But here’s the thing. Professionals, friends, and loved ones are bit players in the suicide prevention business. The ones who do the heavy lifting are the ones in danger ourselves. So we read the literature, always looking for another trick to try, only to discover that we are eavesdropping on somebody else’s conversation.

Honestly, we don’t need to know the warning signs. Honestly, when we are in late stages of planning, we read those lists to make sure we don’t slip up and give the game away.

The Heavy Lifters for Suicide Prevention

The thing is, we are the ones who do the bulk of suicide prevention.

In 2017, 47,173 people in the US died by suicide, and there were an estimated 1,400,000 near misses. Those numbers are huge and keep increasing. But do you realize that they are the tip of an iceberg? There isn’t even an attempt to calculate how many people consider suicide, from passive thought to active planning, those who live with chronic suicidal ideation, those who think of it reflexively as a response to stress or a triggering exposure to a method, those who teeter at the edge of an abyss and abort just short of action.

David Conroy, author of Out of the Nightmare: Recovery from Depression and Suicidal Pain and a psychologist who has been to the edge himself estimated that there are alive today on the planet 50,000,000 people who will struggle with suicidal pain sometime in our lives. 45,000,000 will survive. Those 45,000,000 are the ones I am talking about, who do the heavy lifting of suicide prevention, preventing our own. The other 5,000,000 – a good number of them tried, and simply couldn’t pull it off.

So I want to turn the conversation to us 45,000,000.

I think we need a party.

That’s what I want to do with National Suicide Prevention Week. I want to celebrate it. I want to celebrate all of us who manage to be alive.

I once threw such a party in the lobby of the University of Iowa Hospital and Clinics. Unauthorized, I called it a guerilla party, complete with cake.

When your loved one got out of the psych ward, did it occur to you to bake a cake?


But I suck at cake decoration, as those who attended that party can attest. This year I have something else in mind. Twitter.

#AfterIDidntKillMyself

Every day during National Suicide Prevention Week, I am going to post a photo from the life I have gotten to lead since I pulled myself back from the abyss. I got married #AfterIDidntKillMyself. I went hiking in the Wicklow Mountains of Ireland #AfterIDidntKillMyself. I saw Michelangelo’s David #AfterIDidntKillMyself. I found a publisher for my book #AfterIDidntKillMyself. In fact, I have enough tweets for the whole month. I think I will tweet every day for a month.

Maybe you are or you have somebody who could contribute to that list with your own stories or photos of what happened #AfterIDidntKillMyself. Please join the party with your own tweets.

Arguments Don’t Work

Now this is not intended as some argument against suicide. [See, if you die, you will miss out on something wonderful.] Arguments are not helpful. If you ever call a suicide prevention line, you will not find anybody trying to argue you out of it. Edwin Schneidman, father of suicide prevention, cautions that persuasion does not prevent suicide. Rather, The most effective way to reduce elevated lethality is by doing so indirectly… Reduce the person's anguish, tension, and pain and his level of lethality will concomitantly come down, for it is the elevated perturbation that fuels the elevated lethality.

In other words, people don't commit suicide because they can't figure out it is a bad idea. They do it because they are in pain. Arguments distance the arguer from the one who is in pain. Arguments may reduce the arguer’s pain, because the arguer is right. But they miss the point of prevention. They miss it by a mile. Reduce the pain and you reduce the risk. Really, it’s as simple as that.

But in any case, 45,000,000 of us triumph over our pain. And that is what I am talking about, celebrating our triumph.

Victory

So join me for my National Suicide Prevention Victory Party #AfterIDidntKillMyself.

Suicide Prevention logo by Inspire Malibu
photo of weightlifter from Bundesarchiv German Federation Archive
flair from Facebook.com



Bipolar, Not So Much - A Review

Recurrent depression, treatment-resistant depression, depression with mixed features, cyclothymic disorder -- if your file at the doctor's office is coded for any of these, my heart goes out to you. Chances are you have taken a number of turns around the antidepressant not-so-merry-go-round. I call it "The Chemistry Experiment," and you are the test tube.


Chris Aiken and James Phelps have written the book for you. Bipolar, Not So Much: Understanding Your Mood Swings and Depression introduces the reader to the Bipolar Spectrum. No, they are not talking about the movie version of bipolar, throwing furniture out the window, driving the car into the river... They mean the vast ground between that and your basic depression. They mean depression - with something more.

The authors use a conversational style, speaking directly to the reader and skipping the jargon. They begin by explaining the spectrum. They don't ask the question the way the DSM frames it, Does this person have bipolar? Rather, their question is, How much bipolar does this person have?

Like this:



You won't find the spectrum in the DSM, the manual of diagnoses. The DSM’s symptom silos are designed to put you in one slot or another. The silos came into existence in the 1960s. The spectrum approach is much preferred by the acknowledged experts in bipolar, starting with Goodwin and Jamison who also prefer the name manic depression. But in the recent revision,there was huge resistance to making the change back to the earlier understanding of the disorder. Symptom lists with their precise cut off points seem so tidy and are easier to code. So they remain in the DSM-5, and people like Aiken and Phelps write books to try to inform people who don't know anything more about bipolar than the damn lists. But I digress...

Aiken and Phelps take the approach that you will get the best recovery if you know what is actually going on. So first they thoroughly ground the reader in the spectrum concept, and include the diagnostic and predictive instruments that all the docs can access, but usually don't take the time to use. Damn, I am digressing again...

Next they spend a lot of time on lifestyle changes and other nonpharmocological treatment measures. The thing is, the meds were all developed and work best for the folk on the far ends of that spectrum. Which you already know if you are somewhere in the middle, because they don’t work so well for you, which is how you became a Chemistry Experiment. 

Actually, even if you are clearly unipolar or clearly bipolar 1, Aiken and Phelps have good advice for you regarding sleep, diet, exercise, supplements, and the rest. You’re just going to do better if you don’t ask the meds to do all the work. Mood disorders are more complicated than that mythological chemical imbalance. 

The book's third section is a thorough listing and discussion of all the meds. They have their favorites which may be different from your doctor’s, because they don’t talk to drug reps nor read the ads. They read (and do) the research. Are you getting the sense that I have an agenda here?

Bipolar, Not So Much is the essential resource for for anybody who has depression and maybe something more. It is backed up by Phelp's excellent website PsychEducation.org. It is a humane book by humane doctors who listen and learn from their patients. What a concept, huh? Their dedication page tells the tale:


To our patients. You showed us what life is like in the mood spectrum, and we hope we got it right, or at least close, in this book.

flair from Facebook.com
book cover from Amazon.com
bipolar spectrum graphic from PsychEducation.com.

The Five Stages of Climate Change - Another View

God just tweeted this.

How did I overlook #5 for last week's post?

·
THE FIVE STAGES OF CLIMATE CHANGE 1. Denial 2. Guilt 3. Depression 4. Acceptance 5. Drowning

Stages of Grief and Climate Change

In 1969 Elizabeth Kubler Ross published On Death and Dying. It described the grief process of dying patients and how family and medical personnel could help them toward a good death.

You probably know what came to be called the stages: denial, anger, depression, bargaining, acceptance. They were never intended to describe a straight line process, more like a series of way stations to be visited on the way. They came from her work with people who were dying, and were part of the foundation of the Hospice movement, to take dying back out of the hospital where the focus is on preventing death, and put it on a more humane basis. We all die. Let's do it without the violence of extreme measures.

Kubler Ross has been on my mind lately, as it becomes clear that the planet is dying. We all are dying. But so are the polar bears, as a species, the black rhinos, the bees... And when Monsanto kills off what remains of the bees... We are facing the sixth mass extinction of the planet. Unlike the earlier five, this one is on us humans. And evidently we have eighteen months to turn it around.

No, that BBC report was written last month. Make that seventeen months. The rest of the planet is addressing that deadline, while the US is set to spend the last months we have to make a difference locked in our own coming storm. We have one last chance to prevent a white nationalist totalitarian regime. The issues are tied, fascism and climate change, since the regime is doubled down on a nineteenth century energy policy. So, there we have it. We are screwed.

I am seeing those stages play out in social media and every day interactions. How about you?

Denial


I don't mean the old white guys who have a financial interest in denying climate change. I mean the determined optimism of those who still believe in the last minute reprieve. "Science will solve it." Science did solve it, years ago. We ignored them.

Do you think maybe Marvel Comics has tapped into the denial zeitgeist? Our obsession with comic book heroes testifies to our continued expectation that just when the game appears lost, somebody else will save us. Maybe that girl from Norway...



Anger

Ouch - right? You don't have to read the nightly body count. Look no further than your Facebook feed.

Somebody started a thread with Birdcage gifs. Here was my contribution:

What I think I sound like on Facebook:



What I really sound like on Facebook:



Do you have people who pre-irritate you? I do. Before they open their mouths, I already feel irritated. Maybe we have eighteen - no, seventeen months on climate change. But have we already passed the tipping point on anger? Angry at all the angry people around us - how do we reverse that one?

Depression

A quarter of us in the US are on psychotropic meds. That doesn't count all the self-medicators out there. This is the golden day for legal marijuana.


Bargaining


I think this is what the straw fetish is about. We sit in our SUVs at the fast food drive-through, motors running, and berate the poor kid who handed us our beverage with a plastic straw. Like, if we give up our plastic straws, we will dodge the bullet.


Acceptance


In Kubler Ross's original idea, with acceptance comes peace. I don't really see any peace about the death of the planet out there, nor in here. The closest I come is acknowledgement. That's the word I substituted years ago in the Serenity Prayer, when acceptance carried just too much baggage. God, grant me the serenity to acknowledge what I cannot change.

But these predictions of demise are not for the short term. The seventeen month deadline is for the tipping point. After that, carbon levels will be so high there's only one direction to go. The melted polar caps don't freeze up again, (90° in Anchorage on the 4th of July this year), the icebergs disintegrate, releasing more carbon into the atmosphere, raising the temperature more rapidly, causing ocean levels to rise. Salt water is already infiltrating fresh water aquifers, destroying arable farm land and causing water shortages...


What with environmental refugees, starvation, and the inevitable military responses, civilization is finished thirty years from now. Some say twenty. The thing about these predictions, the only mistakes the predictors make is to predict we have more time than turns out to be the case.


Even so, in the face of environmental refugees, starvation, water shortages, and military intervention, twenty years is a long time to stand on one foot, pulling off that serenity thing about a good death.

We need another stage.


David Kessler, Kubler Ross's coauthor on a later book provides one in Finding Meaning: The Sixth Stage of Grief.


I walked into my therapist's office last week after a month's absence and caught her up. "The book is going great. If it weren't for my existential despair, my life would be terrific." This was pure gift to her. My issues are usually cognitive therapy issues. But she says she does existential therapy. "Maybe ultimately there is no meaning. Maybe you have to find your own."


Finding Meaning


Well, there's plenty of that going around. From Trump as the Second Coming to 
Paul Ryan's blatant embrace of Ayn I-don't-owe-anybody-anything Rand (he's a Catholic of all things!), to Spiritual-but-not-Religious, to tattoos, to My Family is Everything and the Only Thing, to...


I just took this photo on a walk which included a sample of CBD tincture (self-medicating) and a swing by my favorite shoe store. They're red! They're mine! What does it matter that my portfolio is predicted to carry me to my end-of-retirement date, when my end-of-retirement date is anticipated to be later than the end-of-civilization date? Life is short, buy shoes.

So I choose a meaning. The family of God. As we all go down the tubes, I want to go down together, loving my neighbor as myself, welcoming the stranger, protecting the widows and children. 
Not the new-fangled heretical Christianity. Give me that old-timed religion, the Biblical Judeo-Christian thing that the Muslims embrace, too. It's not about power. It has stood up to Pharaoh, to Caesar, to Hitler. It will stand up to what comes next.

Sounds nice, but it's not about being nice, is it. For at least two thousand years, choosing a meaning that goes deeper than the embrace of power, choosing to stand with the dispossessed, the meek in the language of Jesus, has given people something to die for. Not kill for. Die for. To pull that off is going to take the energy I have left, and more. It will take a community of people to support such a decision - to be willing to die. I don't know what you call it. In my shop we call it the Body of Christ. It will take the Body of Christ to be the Body of Christ, broken together. Together with our nonChristian sisters and brothers, too.

Damn, this ended up a sermon. Well, here's the bottom line. If we're all going to die, I don't want to be an asshole.



Captain Marvel image from pyramidinternational.com
Birdcage gifs from giphy.com and tenor.com
dove icon in the public domain
flair from Facebook.com
photo of shoes by author

Describing Negative Emotions and Depression


Negative emotion differentiation (NED) refers to the ability to identify and label discrete negative emotions.

Are you the mom who says to your tantruming toddler, Use your words? That's good parenting in so many ways. Well actually, I found it quicker to turn the critter over and hold him up by his ankles, so he could ponder his universe from a different perspective. You could call that reframing. But that technique is more difficult to execute on a teenager.

Here is the latest reason why Use your words is good for your kid: the folk who get paid to come up with new things to research have discovered a relationship between teenagers and words. The more words they have to describe precisely their negative emotions, the less risk they have to develop depression in the face of high stress. And conversely:

Results suggest that low NED is primarily depressogenic in the context of high stress exposure.

That's from "The perils of murky emotions: Emotion differentiation moderates the prospective relationship between naturalistic stress exposure and adolescent depression,"  by Star, Hershenberg, Shaw, Li, and Santee.

That's what I'm here for. I find cool stuff in the scientific research world and translate it into English for you, dear reader. The more words you have for negative emotions = the less depression you get when stressed.

I'm all over this. I use words like my sister uses broken bits of tile, to turn loss into beauty. There's a bit of Mama's good china that hit the floor in this photo of the tabletop coming together in my sister's workshop:


So one of the things that pleases me about this research study is that I have discovered a new word, depressogenic: causing or tending to cause depression.

Google doesn't recognize euthymigenic. I made it up: creating or sustaining a normal, tranquil mental state or mood. In a sentence: Turning the broken bits of our lives, turning our losses into beauty is euthymigenic. My sister does this with tile. I do it with words. 

Here's an excerpt from Prozac Monologues: What If It's More Than Depression?

The DSM has its checklists. People with depression have poetry. 

People with diabetes discuss about their diet, their feet, their retinas. They check glucose levels. Put two diabetics at a table, they compare numbers.

People with depression talk in metaphor. We talk about the cloud, the curtain, the weight, the darkness. When it goes away, we say, “It lifted!” That lift is a physical sensation, actually, of lightness or elevation...

If I could just find the right words, maybe I could break the spell...

See, I always knew that increasing my vocabulary would help me. Turns out increasing my kid's will help him, too.

cartoon from memedroid.com
photos from the Pato Loco, Coco, Costa Rica by the author

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