Suicide is Not a Dirty Word

Isolation is an extremely common symptom of depression and often invoked as a warning sign for suicide. At this point in my life, it’s so intuitive to me that I forget other people don’t understand. Isolation is a positive feedback loop; the more someone isolates the more they feel they need to isolate. Let me unpack some of that logic. Maybe you can see these behaviors in yourself and fight against them. Maybe you see someone you care about, and this can keep you from getting angry or personally hurt. It really isn’t about you. Step 1: Not enough energy So, I have one caveat here. I am an introvert; I lose energy being around (most) other people and gain it by spending time alone. I would guess that extroverts have a very different experience of isolation, and I’d like to hear more about that. I can’t find much information on it, but I’d guess that it takes longer for them to withdraw, but the negative effects ramp up quicker. Anyway, for me the first thing that happens is I j...

I hate every single “Is Donald Trump Mentally Ill?” article. I can’t believe how many “intelligent” people love to call the president mentally ill. It’s stupid and cruel. Stop doing that. We have a group of psychiatrists who think it’s their “duty” to give an armchair diagnosis to the president. Really? If it meets the Enquirer's high ethical standard, why shouldn't trained medical professionals do it? Good news about Cher, though. First, mental illness does not make you a cruel asshole who makes bad decisions. He’s stupid, willfully so. He’s egotistical, he’s selfish, he’s vain. It doesn’t matter if those things are at a level that’s diagnosable as a personality disorder or not. It certainly doesn’t tell us anything about his brain chemistry. He’s a bad person who does bad things. Shut up psychiatrists; if you want to pitch in maybe try helping a real person who can’t afford your services. You better hope I don't run into you in a dark parking lot, page 106....

Mood disorders, including depression and bipolar, are more common than most physical diseases, yet most of us have a poor grasp on what they actually are. Emotional disregulation is the most obvious outward symptom, but that's just one effect of broader neurological dysfunction. Let's explore the exciting world of mood (or affective) disorders! Doesn't this look like fun?! Traditionally, mood disorders are presented on a model with one axis, like the figure below: Image: Mayo Clinic Euthymia is the x-axis, and mood disorders depart from there, either going high (mania) or low (depression). There is a major flaw with this model, especially when we talk about suicide risk. Recent research has found that most of the time bipolar people are actually experiencing mixed episodes, or moods with both manic and depressive features. The model above cannot represent mixed episodes, leading many to believe they are rare. I developed a different 2-axis model to better rep...

I need to get myself back into treatment, but it’s so overwhelming and intimidating. Often, people who don’t have mental illness do not understand why so many of us are resistant. They think it’s like going to the doctor for the flu. It’s nothing like that. I know it can help, but only if I’m lucky enough to find the right people. If it’s your first time seeking help I don't want to discourage you. However, I think it’s important to know that mental health really is still in the dark ages. There are some great things, but the road is covered in mines. Today I want to explore some of these problems, because if we can go searching for help knowing how to spot signs of less-than-stellar care, hopefully we can get ourselves out of bad situations.  1. People or clinics promising to cure you Anyone who promises they can fix you should not be trusted.  Our goal is improvement and management. Some depression will fade over time, but there’s no way to tell who has chronic ...

The most fearsome thing you can say about a warrior is that he has no fear of death. Self-preservation is our strongest instinct; a person who overcomes it is free to do anything. He or she is freed from the prison of consequences society builds to control our behavior. We usually forget this when we are suicidal, but the people around us don’t. When we start demanding reasons to live from the people in our lives, they can’t possibly give us a sufficient answer. Unless you’ve broken your self-preservation instinct you don’t need a reason to live. You live to live. You live to see what the future is. You live because typically we’re programmed to believe the future will be better than the present. That seems to be part of the ruminative apparatus. Society rests on a few unspoken assumptions. The most important assumption is that people want to keep living. Humans are typically driven by self-preservation and self-improvement, and our social systems reflect that. However, i...

Mandatory reporting is an excellent example of how tone-deaf and confusing mental health policy can be. Mandatory reporting laws require health professionals, including therapists and psychologists, to report certain things to higher authorities, even if they were revealed during an otherwise confidential session. Depending on were you live different things are reportable, but “danger to self” is virtually universal. Most people see this as a way to intervene during crisis, and they may be right. There really aren’t numbers about the efficacy of this policy. Like most things in mental health, it just “feels right” to the legislators who passed it. Therapists and other health providers may support mandatory reporting, since it gets them off the hook for difficult patients. But no one ever asks the clients what’s up. I was explaining mandatory reporting to my mom the other evening. Here in Texas, if you are involuntarily hospitalized (a common result of mandatory reporting)...

Picture it: Angers, France, July 4, 2017. I've traveled across the Atlantic Ocean to talk to an international (but mostly European) audience about guns in America. As my presentation wore on, their expressions became more and more distorted, twisting into grimaces of disbelief and confusion. It was both patriotic and deeply embarrassing.  The CDC, NIH, and other government research agencies are prohibited from examining gun violence by the 1996 Dickey Amendment. However, they do make firearm mortality data available through the CDC mortality files . Any epidemiology on guns must be performed by private citizens. So, here we are. The original presentation covered both homicide and suicide. I'm happy to talk about homicide at a different time, but today let's just look at the suicide side of things.  Half of completed suicides are gun suicides. The rest mostly die by suffocation or poison. Cutting, though romantic, is rarely an effective way to complete suici...