World Suicide Prevention Day from a Different Perspective

Many people who are suicidal hate suicide prevention campaigns. We notice that they are not directed at us, but at would be heroes. They publish lists of risk factors, things to watch out for in those of us who would thwart their efforts. But we fail to see listed what drives us to suicide: poverty, bills, homelessness, rape, child abuse, bullying. Nor do we hear anything about addressing these issues that might actually reduce suicide rates.

What about helping parents understand their children's sexuality so that LBGTQ children don't end up on the streets? What about bully intervention programs in schools (designed to prevent bullying, not treat the victim)? What about universal health care and food security? What about a health care reimbursement structure that encourages doctors to go into psychiatry? What about treatment that isn't demeaning? What about...

Instead, we get posters of "head clutchers." Get a grip.

Diagnosing Bipolar - Doing Better to Prevent Suicide

How can I be a better psychiatrist for you?

Frankly, I was gobsmacked by that question. It came in response to reading my book, Prozac Monologues: A View from the Edge. The book is a comedic memoir of misdiagnosis and a self-help book for bipolar. It is both uproariously funny and brutally frank about my suicidal episodes, usually at the same time.

There are two directions to go with that question. This particular psychiatrist cares about both.

What kind of behaviors and qualities could he display that would make the relationship more helpful? Honestly, not all psychiatrists are interested in this question. I don't do relationships; I use psychopharmacology to treat psychiatric disorders, a psychiatrist once told me. Well, that had the benefit of clarifying things.

How can I improve my diagnostic skills? Nevertheless just about any psychiatrist wants to get the answer to the puzzle right, even the ones who treat patients as no more than a puzzle.

Gratitude - The Prozac Monologues Publication Edition

Fifteen years! From the hypomanic first draft of Prozac Monologues on a yellow legal notepad to a published book, and the nail file that inspired it all.

The book was officially released into the wild this week and will be celebrated in two launches, one sponsored by Paulina Springs Books in Sisters, OR, and the other sponsored by Prairie Lights in Iowa City, IA.

It's a good time to talk about gratitude. Forgive my self-indulgence. It is a day to reflect.

First, people have asked whether it was hard to write about such dark times in my life, if it retriggered some of those emotions. Occasionally, it did. Occasionally I would have a sleepless night remembering, in particular, difficult encounters in treatment. One can forgive sincerely. One can forgive over and over. Still, the brain remembers. I don't harbor resentments, but I can't always hop off the time travel machine that is my brain, how it repeats the tracks laid down by past traumas.

A Better Suicide Prevention Month

CW: Cynical Warning.

Anybody else cringe all through Suicide Prevention Day/Week/Month? Anybody else roll their eyes at the "Ask for Help" messages? Or search the lists of "Warning Signs" to make sure you're covering your tracks?

Are you a potential helper and confused by that paragraph? Did you design this poster? Let me explain it to you. The psychiatrist doesn't accept your insurance. The psychiatrist who does accept your insurance doesn't treat your issue. There isn't a psychiatrist. The therapist is available six weeks from now. Or later. What's the point of therapy anyway, the therapist isn't going to pay your rent, if you could make rent you could manage your mental illness just fine, thank you very much.

If you call a help line, what if the cops arrive to handcuff you in front of your neighbors to help you enjoy your free trip to the ER? That's the only thing that will be free. If you go to the ER, you may or may not be admitted. Either way, the bill will leave you homeless.

Circadian Rhythms and Fixing Bipolar's Wonky Clock

When nothing else worked, Social Rhythms Therapy got my bipolar under control. That's why Ellen Frank is my mental health hero. She invented it.

A few years ago, I spent four weeks summarizing Frank's book, Treating Bipolar Disorder: A Clinician's Guide to Interpersonal Social Rhythms Therapy. My goal was to create a patient's guide. Here is the link to Part Four. It includes links to the earlier posts.

Frank describes Interpersonal Social Rhythms Therapy like this: IPSRT [is] a treatment that seeks to improve outcomes that are usually obtained with pharmacotherapy alone for patients suffering from bipolar I disorder by integrating efforts to regularize their social rhythms (in the hope of protecting their circadian rhythms from disruption) with efforts to improve the quality of their interpersonal relationships and social role functioning.

Circadian rhythms are at the core of IPSRT. People with bipolar have difficulty maintaining the stability of our circadian rhythms, because our internal clocks, governing everything from sleep cycles to blood sugar levels to body temperature are, well, wonky.

Will This Trauma Never End?

I found this video while trying to survive the cluster f*ck of misdiagnosis, antidepressants, mixed episodes, and a psychiatrist and therapist who didn't know what they didn't know, so it must be me and maybe I had borderline personality disorder - the go to diagnosis for patients that the professionals are tired of.

OK Go - This Too Shall Pass. And in fact, it did. I survived to... today? I offer it to everybody who is trying to survive the current COVID cluster f*ck in the US.

To Write Love - Hope for Depression, Addiction, Self-Harm, and Suicide

There is power in a story. You tell me your story. You are seen, heard, affirmed. I tell you my story. You know that I am for real. We are not alone.

To Write Love on Her Arms (TWLOHA) harnesses the power of story to offer hope to people struggling with depression, addiction, self-harm, and suicide.

The organization itself began with a story, a young woman who was suicidal but could not be admitted into a treatment program because she was also addicted and they couldn't bear the liability of her detox.

Yes, if you think you're done after you tell your suicidal friend or family member to get help, read that sentence again. Trying to get treatment can be enough of a nightmare to push us over the edge.

But that was just the beginning. A group of friends took it upon themselves to create a safe place and treatment program for this young woman for the five days it took to detox. The treatment program was admittedly unorthodox. She stayed with friends. In rotating teams they supported her, kept her safe. They also took her to concerts, Starbucks, and church. They prayed. They smoked cigarettes. They were her hospital.

Mostly, they listened.