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

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?

God

@TheTweetOfGod

· 18h

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

Making Music to Build Your Brain

Manic episodes burn up brain cells. So do depressive episodes. So do panic attacks. Cortisol run amuck leaves you with potholes in your head. Not to worry -- the brain has a built-in repair system, Brain Derived Neurotrophic Factor, BDNF.

They've been trying forever to reverse engineer antidepressants. If they can figure out how they work, they figure they will know what causes depression in the first place. At first they thought it was low serotonin levels, the proverbial "chemical imbalance." A more recent thought is that a low serotonin level is not the cause, after all; it's the effect. Fix the problem farther upstream by stimulating BDNF to repair the brain damage, and the serotonin level sorts itself out.

But the natural thing that gets this hormone humming to patch your potholes is learning! There's this big deal about seniors doing Sudoku to ward off dementia. But it only works until you get good at it. You have to keep doing new stuff that you don't already know how to do.

And what better than learning to play a musical instrument? You have no talent? You tried it as a kid and you were lousy? Hear me out. If you were good at it, it wouldn't build your brain. Seriously, it's like exercise. If you don't feel the struggle, you're not building the muscle. Making music turns out to be a full body/brain workout.

So go get yourself a ukelele! Your brain will be glad you did.

photo of pothole in public doman

photo of road repair taken by US Air Force and in public domain

It's Friday Afternoon...