God and Suicide

Eight years ago I wrote "I don't believe in God anymore." It was the title of a book chapter, a book reflecting on suicide from a Christian perspective, though probably not the Christian perspective that you think about when I say that. More like what goes through the mind of a Christian who is suicidal and is bringing what is left of her theology to the experience and desperately trying to tell the truth about it. The truth. Not what we want the truth to be. Just the truth. It wasn't exactly a suicide note, though it might have been taken that way if that's the way it turned out.

It didn't turn out that way. I recovered. "I don't believe in God anymore" anticipated that I would recover, but that wouldn't make the problem go away. Relapse was statistically probable. I might be in that darkest of places again. This chapter dealt with the problem of suffering. Oh, how tidily that phrase expresses the chaos of a believer's brain when looking into the abyss. But I wouldn't let the tidy answers stand, and I still won't. While I am not so bitter anymore about this remitting, recurring condition of mine, as far as God goes, well, I just don't know as much about God as I used to.

Here is a piece of that chapter:

Although my own soul is a dry desert, I have deep wells from which to draw. While I do not believe in God, so I cannot say the creed, I cannot set my heart on the One who has broken it, I still believe in the communion of saints. As a Christian, I have a big family, across space and time. For now, I ask the rest of my family to do my believing for me.

The lament psalms persist in worship, and worship is how I persist. I listen to Gospel music. I sing along with those whose music it is. I do not have their faith. But I cannot dispute their testimony, what God has done for them, and the power they find in God to get through. I believe in them. I believe in the Brooklyn Tabernacle Choir.

Those whose ancestors survived the Middle Passage, survived slavery, survived Jim Crow, survived the Klan, who still survive today, I don't know how they survive. But they assure me, and I listen to them tell me over and over:

             Everything He said in His word,
               He will do it for you.
               Every prophecy he gave, every promise He made,
               He will do it for you.

Eight years later, I am in remission, not depressed, not even a shadow for the last six months. An eternity! I have challenges. I manage my condition every single day. And my life is good. I work toward a publication date of September 2020. There will be something that comes out of that old hellhole, a book, a different book that offers help and hope to others who have been misdiagnosed and inappropriately treated as I was. And I am very proud of it, Prozac Monologues, the book.

I am not saying it was worth the price. I am not saying that my God issues have been resolved, that some promise was kept, and it's all okay because there was a happy ending. You can say that if you want. But it's a slippery slope, hanging your faith on the happy ending.

David Conroy wrote, Suicide is not chosen. It happens when pain exceeds resources for coping with pain. There is some truth for you. I have been blessed by enormous resources, and they have kept me alive through enormous pain. One of those resources is an unshakable experience of the communion of saints, those who have been there for me across the centuries, from Jeremiah to John of the Cross to the friend who said my prayers for me when I confessed I couldn't pray anymore to the Brooklyn Tabernacle Choir.

I went to church on Sunday with a CD by The Brooklyn Tabernacle Choir. It reminded me of that chapter. And I thought it was time to say thanks. They carried me through.

photo of candle by anonymous, used under Creative Commons license

Doctors as Priests -- The Look

Several years ago I took Prozac for what was then thought to be Major Depression.  The hypomanic episode it precipitated gave me a book.  But before that, it gave me the runs.  Since my first doctor thought the runs would go away on their own, but I was about to leave for Costa Rica and wanted them to go away faster, I sought a second opinion.  The new patient form asked for my full history, and I told the truth about my depression, as well as the runs.

What follows is an excerpt from Prozac Monologues, the book to be published next year.  It describes that appointment.  I offer it as an example of a doctor functioning as priest.  [See last week's commentary on Ron Pies' article, Priests, Providers, and Protectors: The Three Faces of the Physician.]  Not the Father kind of priest, but the more ancient healer/witch/shaman kind.  It's tricky to handle the power of the priesthood.  But I want doctors to manage that power responsibly, not give it up on account of its ambiguity.  It is the power of relationship.  We need doctors to use every power at their disposal to heal.  Priesthood is one of those powers.

The Look

...When the doctor looked at the piece of paper with all those words circled on it, she didn't smile at my weak attempt at humor.  Oh well.  What she was most concerned about for my trip to Costa Rica was how I would manage my depression as the Prozac was leaving my system -- which I could tell it was, because the dark suffocating cloud was coming back.

World Suicide Prevention Day - Keeping It Simple This Year

Two things I wish everybody knew:

No matter how you package it, shaming suicide does not prevent it, and

Understanding never pushed anybody over the edge.

photo of candles by Nevit Dilmen, used under the GNU license.

On Surviving - I Wish Robin Williams Had

Nearly a week's worth of reporting on Robin Williams' death, some of it heartfelt, some of it educational, some of it ignorant bloviating -- even if you have been living under a rock and not heard any coverage at all, you can name the bloviators, can't you.  By now, my readers surely wonder, What is the Prozac Monologues take on his untimely death?

I have written reams on suicide and suicide prevention.  Click on those two links and take your pick.  But skip the Suicide Monologue, at least for another week.  It is inappropriate for another week.  And if you do go there, then mind the humor alert.  I am serious -- about the humor alert, that is.  Some of you won't find it funny. It wasn't written for you.

But before we abandon the suicide conversation in favor of the next thing, let's expand the frame.  Here's the deal.  Of all the people alive on the planet today, 50,000,000 will, at some point in their lifetimes, struggle with suicide.

I can't say we will think about suicide.  Those of you who think about it in passing seem to think that the seriously suicidal think.  There is lots going on inside our burning brains.  But thinking doesn't really describe it.

Suicide Is Not a Choice

I peered over this very overpass on the Eisenhower Expressway. Years ago, there was no the fence along the top, just a rail. It was pie that brought me there. Yes, pie. It was Thanksgiving night, and the holiday was ending without pie.

Of course, it wasn't a reason to commit suicide. Of course, suicide is a permanent solution to a temporary problem. Don't treat me like an idiot with your clever lines.

No, pie brought me there, but that was not why I would jump. Pie was a match, a tiny little three letter match. My problem was a brain filled with gasoline. And one tiny match, that I should have been able to snuff with my fingers, threatened to ignite it and send me over the edge. The shame of being powerless over one tiny match poured on more gasoline.

Suicide Immoral? WTF?

Guilty pleasure: Eavesdropping on psychiatrists talking with each other about us loonies. Like many guilty pleasures, it is not always good for my well-being. But I am endlessly curious. And it has yielded a number of blogposts in the OMGThat'sWhatTheySaid thread.

My go-to source for blog material is Psychiatric Times. It reports the latest news and research in Loony Land. It reflects on the practice of psychiatry. Sometimes it turns to mud wrestling. Oh, the good ol' DSM days!

A couple months ago, one of the editors, Ron Pies wrote a brave (foolhardy?) editorial inspired by Jennifer Michael Hecht's book, Stay: A History of Suicide and the Philosophies Against It. Intending to provoke, he titled it, Is Suicide Immoral?  Let the rumble begin.

The Suicide Monologue

Suicide Humor

They asked for a trigger alert. This is a humor alert. Oh, well.

I realize some people do not find suicide humor humorous. I get that. I respect this opinion and honor the feelings and experiences behind it.

If you have not read Prozac Monologues before, you need to know that it has always aspired to a bent sort of humor. And in honor of the World Health Organization's World Suicide Prevention Day, today's post, a long time coming, is The Suicide Monologue. Watch me while I attempt humor. You don't have to read it. Just know, it is what it is.

More Guns = More Suicides

Compare states to states.  Compare regions to regions.  Compare states within regions to other states within the same region.  Compare people of the same age group, in any age group, men to men and women to women.  Compare unemployed people to unemployed people, working folk to working folk.  Compare city dwellers to city dwellers, country folk to country folk.

Compare people with depression to other people with depression; people who are suicidal to other people who are suicidal; people who have a plan to other people who have a plan; people who have a past suicidal attempt to other people who have a past suicidal attempt, for God's sake!

More Guns = More Suicides.

Get it?

It Gets Better

I was going to get funny this week.  But this won't wait.

The message below took place at a city council meeting in the center of Iowa.  It means all the more to me, because I live in Iowa, and because I know this small city in a rural and conservative part of the middle of America -- a fly-over state.

Oops -- a reader corrected my confusion.  Joel Burns is a councilman in Fort Worth, Texas.  Maybe that makes the story even more significant.

Joel Burns, elected to that city council, has lived long enough for it to get better.



Educators who want to respond to his challenge can find resources at the Teaching Tolerance arm of the Southern Poverty Law Center.

Their new documentary and classroom resource, Bullied includes lesson plans and is available for free to any school that requests it.

I also want to plug their quarterly magazine, Teaching Tolerance.  It gives teachers specific ideas and lesson plans for K-12 on many diversity issues.  Subscriptions are available for free to any teacher who requests it, any donor, and also online.

Bullying Has To Become A Crime

I have never understood why schools are law-free zones, why students who beat up other students are not prosecuted for assault, why teachers and administrators who do nothing are not prosecuted for accessory after the fact.

It Is Time To Prevent Bullying

I also have never understood why society places the burden of violence on its victims.  We know the names of recent victims who could no longer bear that burden.  We develop therapies to repair damage that is done to other victims.  But as with PTSD, we treat after the fact.  We do not prevent.

All the bullied teenagers who died recently have been "outed."  But we do not know the names of the bullies.  We do not work on fixing them.

Children who are cruel grow up to be adults who are cruel and raise children who are cruel.  I repeat Joel Burns' challenge to stop the violence.  That is when we will stop the suicides.

We also do not know the names of the witnesses, those who remain silent.  All that it takes for evil to triumph is for good men to do nothing -- Edmund Burke.  These students, too, must find their voices.  We all must.

Meanwhile, If You Need Help Now:

In the U. S., call 1-800-273-TALK (8255)
Press 1 for English, 2 for Spanish.
Click here to find a hotline outside the United States.

Use of the SPLC and Teaching Tolerance logos does not imply

that they have endorsed the views expressed in this post. 

OMG!!!That'sWhatTheySaid -- Failed Method/Successful Attempt

OMG!  it has been four months since I last gave an OMG! Award.  It's not that I don't keep finding excellent candidates.  It's just that I have been covering other major topics.  Plus, life just...

I am amazed and disappointed to give this month's award to HealthCentral.com for their July 22nd news release, Failed Suicide Method May Predict Likelihood of Successful Attempt.

First, let me introduce HealthCentral.com.  From their website:

Health Central's mission is to empower millions of people to improve and take control of their health and well-being.

• Our 35+ sites provide clinical resources and real-life support to those with life-changing conditions.

• Our wellness resources and tools help people to live healthier, more fulfilled lives.
  

• We are honored to serve over 12 million visitors each month.

Health Central addresses lots of different health issues, including mental health.  Often their information is excellent.  This time they missed the boat with this OMG Award-winning title to one of their featured articles.  They don't get points for originality.  They have repeated a much too popular -- what shall I call it?

Let me put it this way:

A twenty-seven year old woman is diagnosed with breast cancer.  Young women with breast cancer generally have a poor prognosis.  So she receives the most aggressive treatment available, including procedures that damage her body in ways that can be mended and other ways that cannot.  She undergoes intense pharmacological treatment using harsh chemicals that leave her sick, debilitated and at risk for other health complications.  Willing to try anything, she joins a support group, does mindfulness and visualization and changes her diet.

These measures eventually do work.  Her cancer goes into remission.  Her health is monitored carefully for a long time.  Just when she and her family begin to breathe again, she relapses.  Again, she opts for aggressive treatment, tries new drugs prescribed in off-label use, and again is left too weak to care for her children or leave the house.

This time, everybody's best efforts do not work.  She dies.

Does her doctor call that a success?  Does the preacher say she fought a long hard battle and finally succeeded?

Let me put it another way.

A middle-aged man has heart disease.  He gets regular medical attention, takes all his meds, monitors everything he is supposed to monitor, changes his lifestyle, even his job to reduce stress.

Nevertheless, he has a heart attack, in fact, several heart attacks.  Each time he is rushed to the hospital, where emergency personnel work their butts off to save him.  He is transferred to ICU, then to a regular bed, then to rehab.  His family posts frequent status reports on facebook, and his church prays for him every week.

Does anybody say he failed?  That he wasn't serious about these heart attacks of his?  When he returns to church or the golf course, do they turn their faces, afraid they might say the wrong thing and provoke another attack?  One that might be successful?

Mental illness is physical illness.  It has a mortality rate, just like cancer and heart disease.  We struggle desperately for years and undergo every treatment we can find and tolerate, trying to survive our illnesses.  Death by mental illness is not a success.  It is a tragedy.  Survival is not a failure.  When somebody has to be rushed to the hospital and manages to fight his or her way back to life, it is a hard won victory celebrated in heaven.  It ought to be celebrated on earth.  This person deserves a party.  With balloons.  And a cake.

Now let me pause to discuss the content of the article with this outrageous title, because the article does give important information.

The article reports research into the prognosis of suicidal individuals according to the method of self-harm they originally use.  The numbers are astounding.

Those whose initial act of self-harm takes the form of hanging, suffocation or strangulation have the poorest prognosis.  Of those who survive, 85% of them die at their own hand within a year.  They do not get it out of their system.  They die.  Within the year.  85% of them.

Those who jump, or use a firearm or drowning are at a moderately lower risk of subsequent death (69-78%, as reported in the original research.)  Those who use poisoning, overdose or cutting have the lowest risk of completed suicide with in year (25-36%.)

These figures hold true when controlling for diagnosis and for sociological factors.

That said, the single greatest risk factor for death by suicide is a previously survived episode.  Nobody gets it out of their system.

These findings have implications for aftercare.  Just as the most aggressive treatment is warranted for younger women with breast cancer and out of shape persons with heart disease, those whose original method of self-harm is hanging, strangulation or suffocation need the most intensive follow-up, monitoring and treatment.

Again that said, one potentially harmful consequence of this report is that those who use less lethal means, such as cutting or poison, may be dismissed as not serious, as engaging in attention-seeking behavior.

Yes, cutting and overdose are attention-seeking behaviors.  They are the serious attempts of seriously ill people to get serious attention for their serious condition.

Cutting and overdose have serious health consequences.  They are the methods used most often by Latina and African-American girls, who have less access to health care and mental health care anyway.  The consequences of not receiving the attention that these girls plead for are first, brain and liver damage, and then further deterioration of their lives, including dropping out of school, substance abuse, being continued victims of violence at their own hand or that of family and acquaintances, continued poor health choices and early death on account of all of the above.

If you turn your face from anybody who commits a potentially fatal act of self-harm by any means, you become the Scribe who turned his face from the man who was mugged, beaten and left for dead on the road to Jericho, because you count your agenda more important than that person's life.

As I said, this would be an unintended consequence of this article, and one that the author seek to avoid: However, "although use of more lethal methods of self-harm is an important index of suicide risk, it should not obscure the fact that self-harm in general is a key indicator of an increased risk of suicide," Hawton wrote.

Back to the OMG! Award.  I am on a Mission from God.  It is my mission, in whatever years I have remaining of my own life, permanently to eradicate the use of the word successful in the same sentence as the word suicide, and to eliminate the scandalous naming of survival as failure.

So I plead for your help.  I plead, when you hear a grieving friend or family member say that their loved one who died of mental illness was successful in the attempt, I plead that you tell that person, kindly and gently, Suicide is not a choice; it happens when pain exceeds resources for coping with pain.  I am so sorry for your loss, and so sorry that your loved one has lost the battle.

I plead that you, whenever you hear health care professionals refer to a failed attempt, that you feel and that you express your shock and horror at the words.  I plead that you confront them, and urge then to examine the hostility toward their patients and clients that lie beneath their words.

I don't usually inform people that they are winners of the OMG!!That'sWhatTheySaid Award.  Following what I have urged you to do, I will inform Health Central of their award.  Right now. 

Prozac is Talking -- Anybody Listening?

Anybody know this story?  You get a new prescription.  Responsible consumer that you are, you read carefully the PI [prescribing information] sheet.  It says, "If xx happens, call your doctor immediately."  Sure enough, xx happens.  You call your doctor, who does not call back.  After persistent calling over several days, the doc says, "Really?  We'll keep an eye on it."

The other day, I had a nosebleed that wouldn't stop.  The PI sheet says my new med can interfere with platelets, admittedly not very high on the list of side effects.  But I contacted the doc.  "Really?"  she said, "Where did you hear that was a side effect?"  My answer, "On the PI sheet you gave me."  It turned out, my blood work was fine, and the humidifier took care of the nosebleeds.

No harm done.  Right?

On the other hand, five years ago my GP had me on Prozac.  After a couple months, I couldn't sleep, was irritated, agitated, couldn't concentrate, had thoughts of harming myself and others.  The PI sheet said I should tell my doctor.  My doctor increased the dose.

Thus began a series of antidepressants, and a downward spiral that has ended with disability.

OMGThat'sWhatTheySaid! -- Stigma

On November 26th, the New York Times published an article about the presidential policy not to write letters of condolence to the families of service men and women who commit suicide in a war zone.  These letters of condolence have gone out since Abraham Lincoln started writing them during the Civil War.  Given the upswing of suicides in the Armed Services lately and the attendant publicity, this policy of silence, which began in the Clinton era, is coming under scrutiny and challenge.

In response to this article, psychiatrist Dr. Paul Steinberg wrote an Op-Ed commentary titled "Obama's Condolence Problem," winning him this month's OMG Award for -- oh, it's hard to choose.  There are so many prize-worthy lines.  But let's call it for: Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts. I will deconstruct this sentence after putting it in context.

Dr. Steinberg is concerned that any recognition of suicide, even the reporting of it, glorifies it and makes the taking of one’s life a more viable option. If suicide appears to be a more reasonable way of handling life’s stresses than seeking help, then suicide rates increase.

Dr. Steinberg is clearly in the voluntarist camp, believing that people make a conscious, reasoned choice to kill themselves.  Suicide, in his view, is an option, a way of handling life's stresses.  He is in, if not good, then plentiful company, who believe that even while the thought processes of those who commit suicide are impaired, their will is not. They remain responsible for their choice.

Regular Prozac Monologues readers know that I am not in the same company.  Dr. David L. Conroy gave me the words.  From Out of the Nightmare: Recovery from Depression and Suicidal Pain, "Suicide is not chosen; it happens when pain exceeds resources for coping with pain."

Conroy describes the many ways that people who are suicidal attempt to reduce their pain and save their own lives.  Those who are suicidal sometimes use the language of choice and reason.  Conroy, who speaks from personal experience, says it is terrifying to have such little control over our own emotional state that it can shove us headlong over the abyss.  This lack of control is part of, and adds to suicidal pain.  To claim that we have considered the options and are making a reasoned decision is a grasping for the image of control; it is an effort to relieve pain.

Steinberg asserts that choosing suicide over treatment is deserving of shame.  Now that first-rate treatments for depression and post-traumatic stress have evolved and are readily available, and people with emotional problems do not have to suffer quietly, are we taking away the shame of suicide?  When he decribes depression treatments as first-rate, he parts company with the National Institute of Mental Health and many doing research in the field, who acknowledge the true state of treatment.  At least a third of those who seek treatment are not able to find a medication that is effective and tolerable.  Meanwhile, certain side effects of these first-rate treatments themselves increase the risk of suicide, doubling it in the case of insomnia, a frequent side effect of SSRI's and SNRI's.  Akathesia (called "inner restlessness" on prescribing information sheets) is one of the most under-reported side effects, due to euphemisms, and among the five top risk factors for suicide among hospitalized patients.  [Side note: when you read "inner restlessness" on your prescribing sheet, did you realize that "inner restlessness" could significantly raise your risk of suicide?]

Steinberg believes that letters of condolence to family members could be an inadvertent incentive to suicide.  In light of the condolence-letter controversy, the administration is appropriately reviewing the policy that has been in place for at least 17 years — and may indeed want to consider leaving it as it is. But as a country, let’s focus our energies on doing everything we can to diminish inadvertent incentives that might increase self-inflicted deaths.  And elsewhere: We need to find the right balance between concern for the spouses, children and parents left behind, and any efforts to prevent subsequent suicides in the military.

I feel downright silly answering this argument.  But here it is:

First, the shaming of suicide is indeed one of the resources that we possess against it.  But it is an even more significant reason why people do not acknowledge and seek help for thoughts of doing it.  Shame interferes with willingness to report symptoms.  And failure to report symptoms is a significant factor in failure to recover.  To think that we can shame suicide and prevent it at the same time is fanciful. There is no balance to be found here.

Second, it is well known that surviving family members are themselves at greater risk of suicide.  Shame increases their pain, including their suicidal pain.  It is a barrier that prevents them from seeking support and prevents friends from offering it.  A letter from the President could go some distance in reducing the shame of family members and providing comfort in the midst of their pain.  If prevention of suicide is the goal, here is the most direct intervention the President could make.

Now back to the beginning.  Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts.  Putting to one side the impossibility of de-stigmatizing the second while stigmatizing the first, let's take a closer look at what Dr. Steinberg wants to de-stigmatize -- the help soldiers need.  What help would that be?  Psychiatry, leading the mental health professionals.

Steinberg wants to stigmatize suicide and de-stigmatize himself.  That's natural enough.  Nobody likes to be the object of stigma.  People who experience suicidal pain can identify with him in his desire. But I took a fanciful direction upon reading this op-ed piece.  I imagined Dr. Steinberg as a chaplain taking a course in Clinical Pastoral Education.  Are my clergy readers following me here?  Think back to your CPE experience.  Imagine the conversation in group after Dr. Steinberg says Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts.  Somebody from my CPE group would surely have asked, "How does it feel to be the object of stigma?"  And if he returned the question with a quizzical look, "How do you feel to know that people would rather commit suicide than come to you for help?  What does that mean to you personally?"

To my psychiatrist readers (do I have any?), do you have any training like CPE, where you are asked to examine your personal feelings and consider how they affect your judgments and your treatment of patients?  Does it include your judgments about suicide?  How do you feel about yourself when one of your patients commits suicide?   How do you feel about that patient, and the next patient with suicidal ideation?  Can you acknowledge those feelings?  Is shame part of your own experience?  Where have you put your shame?  Your feelings are just that, feelings.  Can you use them to inform your understanding of your patients?

I posted a facebook status last week with a link to Dr. Steinberg's article, asking, "Do patients with any other disease face such disrespect from their doctors?"  I am going out on a limb here.  But I wonder if many psychiatrists have not yet dealt with their feelings about their patients' dying.  When oncologists did, the treatment of cancer patients changed.  Now, who even remembers that cancer once was shamed?

Suicide Prevention Cake

Okay, I know.  It's supposed to read Suicide Prevention Week.  I had a post all written, an attempt at a thoughtful response to an exerpt from Nancy Rappaport's book, In Her Wake: A Child Psychologist Explores the Mystery of Her Mother's Suicide.  I found it on Knowledge is Necessity, one of my favorite blogs to follow.

But before I ever heard about Suicide Prevention Week, I gave the topic a whole month just last June.  And I do recommend that you look at those posts, especially the ones that refer to David L. Conroy, "Suicide is not a choice.  It happens when pain exceeds resources for coping with pain."  Those two sentences open his book, Out from the Nightmare, help to make sense of a topic that people would rather hold at a distance, and give a simple program for suicide prevention.  Reduce pain and/or increase resources.

So after I did my best at one more profundity, I thought again, really, how should one mark Suicide Prevention Week?  It occurred to me, why not celebrate it?  According to Conroy, "Five million people [in the United States] now alive will die by suicide. Twenty-five million more are, or will become, suicide attempters. Suicide has been, or will be, seriously considered by more than 50 million people." [Out of the Nightmare, p. 280.]

But think about it.  In other words, 45,000,000 people now living in the United States are or will at some point be at risk of suicide, and yet their suicides will be prevented.  For the most part, by the people at risk, themselves.  We will keep asking for help until we find somebody who isn't too freaked out to give it to us.  We will take our problems apart, examine them one piece at a time, fix what can be fixed, and either learn to live with or leave behind what cannot be fixed.  We will interrupt a negative thought.  We will get a dog.  We will volunteer.  We will take our meds.  We will stop taking the meds that are making us worse.  We will find a therapist, join a group, speak out against ignorance.  Oh, it's a long list with more ideas here for how to reduce pain, increase resources and remove barriers between.

I propose one more item for the list. We will celebrate our success.  It has been some years since I went to my favorite sushi restaurant for what I thought would be the last time.  So I will go there this week to celebrate how many times I have gone there since and will again in the future. I will bake a cake for a friend to celebrate the number of times that she has prevented her potential suicide.  I will take another friend to coffee to celebrate the number of times that she checked herself into the hospital instead.

Anybody with me on this one? How will you celebrate?  And how will you give yourself cause to celebrate next year?

Suicide Prevention for All of Us

I end this month's focus on suicide with what we can do. Remember, "Suicide is not chosen; it happens when pain exceeds resources for coping with pain." (David L. Conroy, Out of the Nightmare: Recovery from Depression and Suicidal Pain)

So the way out of the nightmare is laid before us: reduce pain and increase resources.   Somewhere below is something you can do for yourself, for those you love and for those whom you have been commanded to love, if you believe in that sort of thing.   These lists are from Conroy, pp. 300-302.  My remarks are in brackets.

Out of the Nightmare: Recovery from Depression and Suicidal Pain

Suicide is not chosen; it happens when pain exceeds resources for coping with pain. 

David L. Conroy had me at the opening sentence.  I read it first at Metanoia.org and knew it came from somebody who had been there.  I recommend the website for help and insight from the insider's perspective.  If you are thinking about suicide, read this first.