Franklin James Cook

Archive for the ‘Mental Illness’ Category

Antidepressants Aren’t the Problem, Marketing Them Is

In Advocacy, Mental Illness, Opinion on February 26, 2010 at 1:02 pm

Pills with Dollar Signs

By Franklin Cook, SPNAC Editor

I’ve been reading a lot lately about antidepressant medications, with the idea that I was going to summarize some of the recent debate about whether they are part of the problem or part of the solution regarding suicide. But I have abandoned the idea of writing a summary such as that in this small forum because, for one thing, some of the “debate” about antidepressants and suicide is very polarized, with one camp applauding them as a miraculous intervention to alleviate the suffering of suicidal people and the other decrying them as part of a murderous conspiracy being perpetrated against us all by Big Pharma. Instead, I’ve decided for now that I need to merely try to articulate my conclusions from my reading without elaborating upon them or pointing to supporting documents (in other words, to offer my unadorned opinion, which I don’t often do in the pages of SPNAC, but which seemed an important starting place for me on this topic, while I’m waiting for the New Yorker or the Atlantic or Harper’s to commission me to write a full-fledged essay on the topic).

Here is what I think can accurately be said about antidepressant medications, depression, and suicide:

  • Depression is an illness with its source in the biological structure, content, and processes of people’s brains (internally driven phenomena) AND in the structure, content, and processes of people’s “ways of thinking” about ideas and experiences (externally driven phenomena).
  • There is a clear and direct link between depression and suicide.
  • Medicines (antidepressants) have been developed that — for some people — alleviate the biological symptoms of depression, including their tendency to attempt suicide.
  • In some people, the medicines don’t work or don’t work very well, and in others they cause negative side effects, including increasing in some cases people’s tendency to attempt suicide.
  • The effects of antidepressant medication on the brain are not understood as well as they ought to be understood relative to how widely the medicines are used.
  • The scientific inquiry about antidepressants is a dynamically evolving endeavor, and there is insufficient consensus about some of the most important questions at hand.
  • The clinical usefulness of these medicines has been negatively affected by their marketing and distribution, which has overreached the science supporting their use.

And here is what a list of remedies for the current situation might look like:

  • The use of antidepressant medication must be supported as a treatment option.
  • Clinical guidelines for safe administration of antidepressants must be strengthened, and clinicians must be trained and otherwise equipped to administer them safely.
  • Strict safeguards must be put in place — not via a “warning label” but via an improved standard of practice or even a legal mandate — to keep people who are prescribed antidepressants safe from suicide.
  • Effective patient and public education about depression and its treatment — including the role of antidepressant medication — must be instituted.
  • Effective treatments must be developed, implemented, and supported that address not only the biological sources of depression but also people’s “ways of thinking” that contribute to depression.
  • Research on depression — as well as on both biological and other interventions and treatments — must be done much more strategically, ambitiously, and independently.
  • All marketing of antidepressant medications ought to be suspended while a thorough, independent review of the scientific knowledge about and marketing practices for them is undertaken and recommendations for implementing the remedies above (or better ones) are instituted.

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Man and His Basset Hound Cycling To Boost Awareness

In Mental Illness, Prevention, Take Action on February 13, 2010 at 12:18 pm
Bassett in bike sidecar

Antigone is ready for the next stretch of the bicycle trek from Chicago to San Francisco. (Marci Stenberg, Merced Sun-Star)

In “Man and Dog Peddling a Message: Against Suicide and for Basset Hound Rescue,” Merced Sun-Star reporter Carol Reiter writes about Marshall Lee’s and his dog Antigone’s cross-country journey to promote sucide prevention (and Bassett Hound rescue, as well).

The pair will cross the Golden Gate Bridge in San Francisco early this week to conclude a 3,500-plus mile journey that began in Chicago last October. In the video accompanying the story, Marshall Lee describes the insidiousness of depression and suicide:

Depression eats at you nibble by nibble … It doesn’t … just attack full on. [At first] it had been an occasional thought, “Maybe you should kill yourself.” Then … when unemployments was running out, I was losing my apartment, and I had no place to go, and didn’t know waht to do, that’s when the depression really hit hard, and that’s when the suicidal thoughts came every day …

However, according to the Sun-Star report,

Worries about what would happen to his dog after his death stopped Lee numerous times from carrying through with his suicide plans.

“This cute, sweet dog gave me the ability to say no to suicide,” Lee said.

Lee is asking people to take part in the annual American Foundation for Suicide Prevention Out of the Darkness Overnight Walk, which is in Boston this year on the night of June 26-27. According to AFSP,

The Out of the Darkness Overnight is an 18-mile journey through the night, from dusk until dawn. It’s a unique opportunity to bring the issues of depression and suicide into the light as we walk together to turn heartbreak into hope for tomorrow.

Walker registration is open and general donations to the walk are being accepted.

For updates to this story, see “Antigone Goes West: A Basset Blog.”

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Primary Care Depression Screening Would Save Lives

In Mental Illness, Opinion, Prevention on February 8, 2010 at 2:46 pm

By Franklin Cook, SPNAC Editor

In a Huffington Post item today, titled “Let’s Not Get Too Depressed about Depression,” Dr. Lloyd Sederer, a psychiatrist and public health advocate, argues for a mandate that would do as much to prevent suicide as any other single action might accomplish:

One hundred percent of primary care practices .. should be screening for depression and using standardized treatment guidelines.

Dr. Sederer has a fairly straightforward plan to accomplish the nationwide screening he recommends.

Mental health has been losing in the competition for fair time and proper management without a numerical measure of a disease. How about starting with its poster child disease — depression — to remedy that?

The good news is that there is a simple, nine-item questionnaire called the PHQ-9 that someone can fill out in the waiting room, before seeing the doctor or nurse, that provides a highly reliable number that tells the doctor the likelihood (almost 90 percent sensitive) that you have a depression.

Of course, screening every visitor to a doctor’s office and then further assessing and effectively treating those who have depressive illness is a vast undertaking that would not be simple nor easy nor without cost. [Editor’s note: Please see Dr. DeQuincy Lezine’s comprehensive and insightful comment on this point.]

But we know that about 33,000 people a year die by suicide in the United States and that about half of them have a mood disorder (which implicates some type of depression in 16,000 suicides annually). So if depression is mental health’s “poster child disease” and it plays a role in 16,000 deaths every year, might not universal screening for depression in primary care be, as Dr. Sederer argues, a good starting place for prevention?

There are several models already available to move such an initiative forward. Here are two examples:

(1) The Three Component Model developed by the Macarthur Initiative on Depression and Primary Care is “a systematic approach” involving the “primary care clinician and practice, care management, and collaborating mental health specialist.”

The three components include elements shown to improve depression outcomes in recent randomized controlled trials. Telephone support for the depressed patient from a care manager is one central element as is periodic quantitative feedback about the patient’s response to treatment from the care manager to the clinician. The feedback is provided through depression severity scores based on PHQ-9. Another element is closer relationships between the primary care clinician and mental health specialists …

(2) The Suicide Prevention Toolkit for Rural Primary Care is an Internet-based resource containing “information and tools to implement state-of-the-art suicide prevention practices and overcome the significant hurdles this life-saving work faces in primary care practices.”

The Toolkit offers the support necessary to establish the primary care provider as one member of a team, fully equipped to reduce suicide risk among their patients. For instance, the tools will help you engage your patients and those around them in managing their own suicide risk. You’ll find tools for developing partnerships with mental health providers — regardless of how far away they may be — and a guide to developing telemental health services, a promising solution for many rural areas. There are also posters for display in your office, schools, and churches, and wallet cards listing warning signs for suicide and the number of the national crisis line.

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Beliefnet Blogger’s Mission Is Healing Depression

In Grief, Mental Illness, Stigma on November 13, 2009 at 5:54 am

Borchard-BookTherese J. Borchard, founder of the blog “Beyond Blue” offers an explanation in Huffington Post for why she is on a personal mission to help people who have depression.

After trying 23 medication combinations, working with 7 psychiatrists, participating in two inpatient hospital psychiatric programs, and attempting every alternative therapy out there, I made a bargain with God.

“I will dedicate the rest of my life to helping people who suffer from mood disorders,” I promised, “if I ever wake up and want to be alive.”

Miraculously that day did come … the morning I woke up and thought about coffee.

So here I am. With my mission: to educate folks about mental illness and to offer support to those who, like myself, suffer from mood disorders.

Borchard is the survivor of her aunt’s suicide and a tireless crusader for better treatment and understanding for people with mood disorders and for the cause of suicide prevention. She has a book coming out in January, Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes, which she says was written

So that others might find a seed of hope in my story, and be able to hang on for one day longer. So that anyone who struggles with anxiety or depression–even in the slightest way–might find a companion in me, some consolation in the incredibly personal details of my story, and a bit of hope to lighten an often dark and lonely place.

It’s about my end of the bargain.

[Editor’s note: I can’t recommend the book without having read it, but over the past year I have read her blog and do recommend it, especially but not exclusively for people who are religious, which is the point of view from which she writes. FJC]

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In Wake of Fort Hood, Focus Is on Mental-Health Readiness

In Mental Illness, Prevention on November 8, 2009 at 10:12 am

In “At Walter Reed, a Palpable Strain on Mental-Health System,” Washington Post reporters Anne Hull and Dana Priest use the deadly shooting rampage last week by an army psychiatrist at Fort Hood, Texas, as a backdrop to starkly criticize what could be called the military’s lack of mental-health readiness.

More than two years after the nation’s political and military leaders pledged to improve mental-health care, their promises have fallen short at military hospitals around the country, according to mental-health professionals, Army officials, and wounded soldiers and their families … It isn’t only Walter Reed that is under fresh scrutiny [after the shootings]: Evidence of an undermanned, overworked health-care system stretches all the way to the Pentagon, where all of the top health-policy positions remain unfilled, leaving a void on an issue long fraught with inefficiencies and entrenched bureaucracies.

The report notes that the top civilian position in the Department of Defense focused on healthcare is vacant (Assistant Secretary of Defense for Health Affairs), along with “three other top positions — the principal deputy, the deputy for clinical programs and policy, and the chief financial officer post.”

The vacancies occur as the Army in particular struggles with a soaring suicide rate. In 2009 so far, 117 active-duty Army soldiers were reported to have committed suicide, with 81 of those cases confirmed — up from 103 suicides a year earlier.

Quoted in the report is PFC Sophia Taylor, who is receiving treatment at Walter Reed while the Army prepares to give her a dishonorable discharge, which she plans to oppose.

“The amputees get the great treatment,” Taylor said. “Purple Hearts, money for losing their limbs. I have a lot of respect for them. But I lost my mind, and I couldn’t even get a simple ‘thank you for your service.'”

Related SPNAC post: “Culture of Stigma Is a Key Cause of Military, Veteran Suicides” at .

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Prison Program Teaches Self-Care for Mental Health

In Mental Illness, Prevention on September 9, 2009 at 9:40 am

In “Inmates Learn How To Better Manage Their Mental Illness,” Gannett News reporter Cara Matthews covers the Wellness Self-Management program at New York’s Fishkill Correctional Facility.

“Traditionally mental-health treatment was … that I’m the doctor, you take this medication, you’ll get better,” said Howard Holanchock, assistant mental-health commissioner for the state Department of Correctional Services. “But Wellness Self-Management puts it on the patient, to help the patient develop their kind of individual, kind of personalized goals and relapse-prevention plans.”

The report states that “about 15 percent of the approximately 59,000 state prisoners, some 8,000 people, are being treated for mental illness.” One of those 8,000 is Scott Collins, who has been in the Wellness Self-Management program for five months.

“It’s helped me get out of my shell a lot. I usually isolate,” Collins said as he sat in a circle with seven other inmates and three staff members in a basement classroom at the medium-security prison. “Being here has helped me a lot.”

The program is small (it can serve up to 160 inmates), but it is being evaluated for how prisoners who complete it “fare in terms of disciplinary actions in prison and relapse, recidivism and hospitalization after they are released.”

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Anti-Depressant Use Doubles; Joint Psychotherapy Decreases

In Mental Illness, Research on August 3, 2009 at 11:16 pm

According to an article in USA Today by reporter Liz Szabo, “the number of Americans using antidepressants doubled in only a decade, while the number seeing psychiatrists continued to fall.” The article is based on a “study of nearly 50,000 children and adults,” which appears in the current issue of Archives of General Psychiatry.

According to the USA Today report,

About 10% of Americans — or 27 million people — were taking antidepressants in 2005, the last year for which data were available at the time the study was written. That’s about twice the number in 1996 … Yet the majority weren’t being treated for depression. Half of those taking antidepressants used them for back pain, nerve pain, fatigue, sleep difficulties, or other problems, the study says.

Among users of antidepressants, the percentage receiving psychotherapy fell from 31.5% to less than 20%, the study says. About 80% of patients were treated by doctors other than psychiatrists …

Olfson says his study shows that doctors need more training in mental health. And he says he’s concerned about the decline in patients receiving psychotherapy. Patients who receive only medication may not get the help they need, he says.

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Suicides in Farm Country Covered in “Weekly Spark”

In Mental Illness, Prevention on July 31, 2009 at 8:08 am

“Farmer suicides spotlight lack of mental health care in rural America” appears in the July 30 editon of The Weekly Spark, the Suicide Prevention Resource Center’s (SPRC) newsletter:

Crisis help lines for agricultural workers are serving an important support role for farmers in economic distress. However, accessing mental health care can be a challenge in rural farming areas, with some residents having to travel long distances to access a mental health service provider. According to Mike Rosmann (executive director of the nonprofit corporation AgriWellness), other challenges to achieving rural mental health parity include uneven training for behavioral health professionals who intend to work in rural communities, and the reimbursement structure for mental health services.

See the original story in the Iowa Independent, by freelance writer Lynda Waddington, a New Journalist Fellow with the Center for Independent Media.

Story Indicts Lack of Help for Co-Occurring Disorders

In Grief, Mental Illness on July 29, 2009 at 9:02 pm

In a remarkable story in the Washington Post, reporter Tom Jackman chronicles the life and death of Danny Watt, who “was a walking symbol of a phenomenon called co-occurring disorders, or dual diagnosis, which is estimated to affect 7 million adults in the United States.”

These people are both seriously mentally ill and abusing drugs or alcohol. About half of all adults who are seriously mentally ill are also thought to be addicted. The mental health community calls this “self-medication.” The federal government estimates that 90 percent of people with co-occurring disorders do not get the treatment they need.

Danny’s death shows how hard it can be to treat people with co-occurring disorders and why so many die young.

Danny died by suicide in April 2008 when he was 21 years old. Jackman’s in-depth report, which is “gleaned from his mental health records, extensive interviews with his family and Fairfax County mental health officials, and from [Danny’s] own notes,” describes in poignant detail his downward spiral and years and years of decisions that did not take into account the nature of Danny’s illness and of intervention after intervention that were, at best, unhelpful and, at worst, harmful to Danny.

In the end, the article is an unequivocal indictment of the mental health care system’s failure to adequately treat dual diagnosis patients.

E. Fuller Torrey, a psychiatrist with the Treatment Advocacy Center in Arlington and a prominent critic of the widespread deinstitutionalization of psychiatric patients, says forced treatment is essential when people are too mentally ill to realize they need help.

Saying that Danny had responsibility for his care is “fine for someone with substance abuse, but if you’re dealing with psychosis, then there’s no way you’re going to treat someone like that in an unlocked facility,” Torrey said. “What you’re looking at is the system is not set up to treat the difficult patients.”

Danny’s parents came to that belief repeatedly.

“It was always, ‘Get him stable, get him out,'” said Bobby Watt [Danny’s father]. “No long-term plans. . . . We wanted him in a place where he was locked up with proper medical attention until he became stable. I begged them to put him in a mental hospital. I told them, ‘If you put him out on the streets, he’ll be dead in a week.'”

That was April 3, 2008. Eleven days later, Danny was dead.

Jackman’s story is accompanied by an unforgettable video interview with Danny’s parents.

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Columnist’s Story of Depression and Suicide Hits Home

In Mental Illness, Prevention on July 23, 2009 at 9:04 am

Marc Hansen

In a column in the Des Moines Register, Marc Hansen tells the story of a 46-year-old man who died by suicide and, in doing so, clearly describes how clinical depression can be both insidious and undetected — and fatal.

The suicide of Matt Duncan garnered the columnist’s attention because he is the son of Randy Duncan, a University of Iowa football standout who played in two Rose Bowl championships. Hansen describes Matt Duncan as “big, strong, smart, compassionate” and as a person who appeared healthy and exuberant:

After turning 40, he decided he’d train for a Toughman competition. Why not? He had a blue belt in tae kwon do. At 6 feet, 3 inches and 225 pounds, he was in great shape.

When people asked Duncan how he was doing, he’d say, good, great, couldn’t be better, when nothing could be further from the truth.

But Matt’s case is one in which “depression … wears a mask,” writes Hansen. “There’s no pool of blood, no broken bones, no scar tissue.” He tells the story of Matt’s depression through the reflections of Matt’s father:

“Growing up, he was a normal, great, happy kid,” Randy Duncan says. “There were no signs at all.”

But then Matt took a high-pressure job with a big law firm in Washington, D.C. All he did was work. He had no social life.

“It kind of started then. He became more of a recluse. He wasn’t going out with friends or answering phone calls. We got him to a psychiatrist. Doctors made the diagnosis in 1998.”

Matt moved home and took a job with his father’s firm and tried to stay on top of it.

“He did everything you’re supposed to do,” his father says. “It was a chemical imbalance.”

Hansen notes that this same type of “chemical imbalance” is present in “millions of Americans [who] suffer from clinical depression,” and he goes on to summarize the malady’s symptoms.

According to guidelines set forth by the American Psychiatric Association, depression is diagnosed when at least five symptoms are present for most of the day, nearly every day, for at least two weeks: Constant sadness, irritability, hopelessness, trouble sleeping, low energy or fatigue, feeling worthless or guilty for no reason, significant weight change, difficulty concentrating, loss of interest in favorite activities. At least one of the symptoms must be persistent sad or empty feelings or loss of interest in activities.

He closes his column by recommending that anyone who experiences those symptoms should seek medical help “immediately, if not sooner.”

By making the direct link between clincial depression and suicide using the example of a man who is the son of someone who is known and admired by people across the state, who is truly a “son of Iowa,” Hansen renders a valuable service to his readership. There are too many men like Matt Duncan — men in their middle years who are known for showing up and taking care of business in every aspect of their lives, but who are struggling with depression and suicidal thoughts — and hopefully his story will encourage them to seek the help they need.

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Attempt Survivor Finds Self-Help Support in DBSA

In Mental Illness, Postvention on July 18, 2009 at 7:41 am

Reporter Paula Rhoden of the Prescott Daily Courier tells the story of Joel Kobren, whose bipolar disorder drove him to a suicide attempt and whose recovery connected him with the Depression and Bipolar Support Alliance (DBSA), where he is now a leader in the self-help movement for people with depression in Arizona.

Kobren encountered DBSA after his nearly-lethal attempt led to discovering the nature of his mental and emotional challenges:

Finally, after 58 years, doctors diagnosed him with bipolar disease, a diagnosis that truly changed his life. Kobren said he was no longer an “underachiever” who could not keep a job or maintain a relationship; there was a real reason for his “mood swings.”

As part of his therapy, Kobren started looking for a self-help group. He said “suicide survivor” groups were really grief groups for families and friends of people who committed suicide … Kobren said he could not find what he really needed — a depression group. Kobren’s search led him to the national Depression and Bipolar Support Alliance.

Kobren is now involved, along with Henry Willey, president of the DBSA Yavapai County Chapter and others, in developing a statewide DBSA organization that they hope, in turn, will develop chapters throughout Arizona, each with its own peer-led support group.

Peer groups allow people to talk to others dealing with depression or bipolar disease, and learn what may or may not work, Willey said.

“DBSA is not a 12-step program and it is not a therapy group. It is just peers helping peers … Personally, I have been bipolar since elementary school but was not diagnosed until I was 35 years old. I have been through everything.”

Kobren said, “DBSA gave me the avenues to fulfill the goals I set as part of my recovery. As an organization, it has opened doors and been very welcoming. At the same time, there is no pressure. DBSA does not expect anything from me. It just opened the next door for me to go through when I am ready.”

SPNAC readers can search for a DBSA support group near them at this site.

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“Weekly Spark” Shares News One Might Otherwise Miss

In Advocacy, Media, Mental Illness on July 9, 2009 at 3:04 pm

Today’s “Weekly Spark,” a newsletter from the Suicide Prevention Resource Center (SPRC), pointed to an article that I missed in my review of suicide-related news last week: “Chasse case helps spur creation of mental health crisis center.” The story is important both because of the value of mental health crisis services such as the one established in Portland and because of the role of advocacy in bringing about change in society’s response to mental illness. Here’s the story summary, from the “Weekly Spark”:

A new 16-bed mental health crisis center in Northeast Portland will accept people who are suffering a mental health crisis such as suicidal or violent thoughts, hallucinations or severe anxiety. The center will serve as an alternative to jail or the emergency room for people who are in danger of harming themselves or others, and will provide up to 10 days of assessment and treatment. The center was created to improve the county’s response to people in mental health crisis. The issue was brought to the forefront by the 2006 death, in the back of a patrol car, of a man with schizophrenia.

Kudos to SPRC staff for its newsletter, which has led the way in bringing authoritative news to both the specialist and the general reader on a wide range of topics related to suicide prevention. If you’re interested, please sign up for SPRC’s mailing list.


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CBT Shown To Be Preventative with Teen Depression

In Mental Illness, Prevention, Research on July 7, 2009 at 6:52 am

A post by Nancy Shute last month in her U.S. News & World Report “On Parenting” blog covers a study showing that “cognitive behavioral therapy can prevent teenagers from becoming clinically depressed.”

That’s great news, because serious depression afflicts 2 million teenagers each year and puts them at greater risk of suicide and depression throughout life.

The findings of the study were published in the Journal of the American Medical Association.

Half of the 316 teenagers in the study, led by Vanderbilt University psychology professor Judy Garber, took part in eight weekly, 90-minute group sessions, in which they were taught problem-solving skills and practiced them. Cognitive behavioral therapy isn’t traditional, long-term “talk therapy”; it’s a short-term treatment, usually lasting no more than 20 sessions, based on the idea that people’s thoughts cause their feelings and behaviors. Thus if people change how they think about a situation and how they respond to it, they can feel better, even if the situation hasn’t changed.

Shute notes that “finding cognitive behavioral therapy can be tricky, because it’s advertised more than it’s actually delivered” and gives a description of CBT, from the Association for Behavioral and Cognitive Therapies, which she points out, “also has a decent online therapist finder”:

In cognitive therapy, a person learns to:

  • Distinguish between thoughts and feelings.
  • Become aware of how thoughts can influence feelings in ways that sometimes are not helpful.
  • Learn about thoughts that seem to occur automatically and how they can affect emotions.
  • Evaluate critically whether these “automatic” thoughts and assumptions are accurate or perhaps biased.
  • Develop the skills to notice, interrupt, and correct these biased thoughts.

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Canada’s Prime Minister Eulogizes MP Lost to Suicide

In Grief, Mental Illness, Stigma on July 6, 2009 at 9:10 am

A momentous occasion unfolded on Saturday when a head of state spoke both insightfully and eloquently about depression and suicide. The occasion, sadly, was the funeral of Dave Batters, a Member of Parliament who died by suicide the end of June, and the speaker the Prime Minister of Canada, Stephen Harper, who told Batters’ family and the other mourners gathered in Regina, Saskatchewan,

We need to know that mental illness like Dave’s is shockingly common in our society. It affects the great and the small alike despite the stigma that still too often surrounds it.

Other politicians have carried the same burden. In fact, perhaps the two greatest English-speaking politicians in history, Abraham Lincoln and Winston Churchill, struggled with depression.

Harper also spoke of Batters with an emphasis on how he lived not just on how he died, a point many survivors of suicide suicide feel is missed by society as they grieve the loss of their loved ones.

This we know: in his struggle, Dave achieved a life worth living, a simple but profound truth, a goal we all aspire to, and he reached it. Dave’s family can take great pride in this.

For Dave made a significant contribution to the lives of others. Another great goal in life, and one he achieved so ably.

When he ran for public office, Dave did not do so for selfish reasons. He responded to the tragedy of another, the murder of his friend Michelle. He heard, and answered a call to service and he did so with conviction, distinction and success.

Depression didn’t stop that. It was his decency that drove him forward, that defined him in life, that will define him in death.

The Prime Minister also reached out to everyone who suffers from depression or who has been touched by suicide, declaring that “Dave is not alone” and recognizing the thousands of others who die by suicide every year.

The science has progressed, but we still don’t know enough about depression, and less about suicide.

But we know this much: depression can strike the sturdiest of souls. It cares not how much you have achieved nor how much you have to live for …

Unlike its myth, depression is not a function of character except that to fight it summons a strength of character, and a great strength of character like Dave’s to fight it as long as he did. Dave dealt with his illness head-on. That takes courage.

To Dave’s family, we mourn and share your loss. But so too do we share your pride in Dave’s life and in the greater good he served through elected office and through his public battle with depression from which we can all learn.

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Christian Writers Push Back against Suicide Stigma

In Grief, Mental Illness, Stigma on April 30, 2009 at 7:00 am

[Editor’s note: Two recently published articles written by Christian authors give perspectives that push back against the stigma about suicide to which Christianity has historically contributed. The ideas they touch upon reflect a trend over the past century–and increasingly in recent decades–for Christian churches to be more understanding about mental illness and suicide and less judgmental and prescriptive about related behavior.]

In a story in Christianity Today, journalist Christine Scheller writes candidly about her religious faith in relation to the death of her son by suicide.

For nearly two decades, love gave rein to Gabriel, his brother, my husband, and me as we galloped prettily through life. Then we hit a rough patch … Our church experiences alone had left my husband and me limping and our sons jaded … Just about the time I thought we might regain our family stride, Gabriel died by suicide. He was 23 …

Early on, the suicide felt like a cruel cosmic joke. It was as if God, or the Devil, or some Job-like combination thereof, was mocking and toying with us.

The family received comfort from a psychiatrist Scheller had recently met, Aaron Kheriaty of the Psychiatry and Spirituality Forum, who assured them that their son’s death was not their fault and “firmly insisted that the death would never make sense: suicide is inherently an irrational act.”

Kheriaty was a safe person to invite into our moment of horror, unlike some pastors who later described the suicide as an “unwise choice” and simple spiritual failure.

Kheriaty delivered the homily at Gabriel’s funeral, explaining that

“For reasons that are quite beyond our comprehension, God allowed Gabriel to suffer a terrible illness … Gabriel’s death issued from an unsound mind that was afflicted by a devastating disorder.”

In the end, Scheller writes as a survivor who needs “time and space to come to a realistic self-assessment”:

I trust that for me, the crucible will forge a better person, and lead to peace … When I think of all that Gabriel suffered in this life, I do not understand. I find it difficult to trust God or engage him with the intimacy I once enjoyed. And yet every day, I inhale moments of grace. I am immeasurably grateful for the privilege of being Gabriel’s mother.

As Gabriel was walking out the door of this life, I called out after him, “I love you.” Love is as strong as death, wrote Solomon. The love of God is stronger.

The latest column in The Citizen (Fayette County, Georgia) by Pastor Justin Kollmeyer of Prince of Peace Lutheran Church in Fayetteville is titled “Suicide and Heaven.” According to Kollmeyer, not merely “the truth” but “the truth with power and conviction” is that

[Suicide is] wrong. It’s horrible. It’s cruel. It’s regrettable. It’s not the answer. It’s not God’s will. It is never an acceptable solution. It’s an atrocious wounding of all those who love the one making this decision, especially the family …

But I believe there is more to committing suicide than just making one bad and damnable decision for all time …

Kollmeyer first accounts for those who die by suicide because of clinical depression, which he says “is a disease, just as a heart attack is a disease, and cancer is a disease, and diabetes is a disease.”

Health care professionals remind us that suicide is not an inevitable or acceptable outcome of depression. None of us “accepts” suicide as a result of depression, but in hindsight we can see the disease at its most destructive when we see suicide. Death by disease? Unfortunately yes.

Then he goes on to answer the question of suicide being an “unforgivable sin” from a Christian point of view:

Fortunately no! God declares in His word through scripture that He loves His creation, especially His human creation despite the “fallen-ness” and “brokenness” of human sin … God can disagree totally with the decision of one of His dear children, who commits suicide. But at the same time, He keeps His promise to grant salvation and receive sinners into eternal life. Ultimately, we all get into heaven the exact same way. Not earning it, not deserving it, but by trusting in and believing in the sheer grace of God. Can someone who commits suicide go to heaven? Simply, yes. By the grace of God.

Kollmeyer tosses suicide on the pile with all sin (including the Christian concept of “original sin”)–which is contradictory, for one must ask, Is being sick a sin?–but nonetheless, he asserts the belief that Christian doctrine does not condemn those who die by suicide to hell.

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Essay Offers Clear Insight into Coping with Mental Illness

In Mental Illness on April 28, 2009 at 2:37 pm

By Franklin Cook, SPNAC Editor

In 1999, 21 years after my father died by suicide, I experienced the most serious bout of depression I’ve ever had, including frighteningly clear insight into what it’s like to feel grossly suicidal. I lost 25 pounds and woke up daily, usually somewhere between 2 a.m. and 4 a.m., with anxiety that constricted my chest as I watched–in my mind’s eye–depictions of worst-case scenarios unfolding in my life.

I calmed myself by offering what I later came to call “furnace prayers.” I was living with my girlfriend-at-the-time on temporary assignment in an apartment in Oakland, where Broadway meets College Avenue. It was February and very cold every night, and the only source of heat in the apartment was a narrow, vented metal contraption attached to a wall in the living room. The furnace was almost from-floor-to-ceiling tall and lit itself with a flaming whoosh whenever the black knob on the bottom of it was twisted to the right. Each time I awakened, I would get out of bed and go sit cross-legged in front of the furnace to be as meditative as I could be as I suffered the night away. I would always wind up in one version or another of prostrate on the ground, praying that I would not totally freak out (and that my chest would not explode) before it was time for me to shower and get dressed and walk to the Rockridge BART station. That was furnace prayers.

I don’t think I ever would have killed myself (or ever will) even though suicide was in my mind all the time–torturing me, it seemed–and the best I could do was (speaking directly to the force that constantly compelled me to ponder enacting as soon as possible my own death) tell it again and again, “No.” I did not make a plan to kill myself nor come close to doing anything that would lead to my suicide, but when my girlfriend and I went on our day off as tourists to visit the Golden Gate Bridge (which I had never seen up close), I couldn’t get across it. She and I started walking toward the bridge from the parking lot on the Marin County side, and as we walked out to where the bridge’s narrowness and height above the water began to take shape in my visual field, I had to stop and turn around because it felt to me–viscerally–as if I might get sucked over the railing by the destructive force that had been beckoning me for weeks.

The article I’m posting today–Ian Grey’s “The Perfect Prescription: A musician explores the role music has played in treating his mental illness,” from Baltimore City Paper–made me think of that decade-old depressive episode of mine. More precisely, Grey’s memoir made me think of how much I later appreciated the insight I gained into how my father must have felt in the months leading up to his suicide, for “Perfect Prescription” offers the reader an eyewitness view of what it feels like to live with mental illness and, in the end, not only to survive but also to rise above whatever disturbances befall a person as he tries to cope with it.

Grey begins with his initial experience of psychosis …

I was about 14 when I first went crazy. Sitting in the bedroom of my parents’ G.I. Bill house, a bolt of noxious energy exploded around me and the air turned grainy, like reality was suddenly an ugly, 16-mm film. Terrified, I saw the universe beyond my small room as endless and black, occupied only by a malign Presence.

… which was relieved by repeated doses of “Electric Light Orchestra’s ‘Ma-Ma-Ma Belle,’ a silly pop rocker but with an essential difference–a huge, super-distorted guitar,” and before it ends, covers the gamut, from Grey’s experiences in therapy and with medication to his musings and research on the nature of mental illness and the curative powers (at least for him) of music.

Grey concludes with an email he received from Petr Janata, an associate professor at UC Davis’s Center for Mind and Brain:

“Music,” he writes, “is free to impact some evolutionary deep networks (limbic system: anterior cingulate and amygdala), while the cortex can appraise the situation and render it safe, thereby giving it overall positive valence.”

I choose to read this as validation. But it doesn’t explain why music has helped me so much, while failing so spectacularly, so tragically with others … who struggled hard with MI in their own ways and lost, and how totally out there I’ve been at various junctures and still survived. For that, I think [musician Tiffany Lee] Brown has the ultimate answer. It’s no good and it isn’t fair but it sounds about right. “We’re very lucky,” she says.

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Teen Depression Screening Is Endorsed, if Therapy Is Available

In Mental Illness, Prevention on March 30, 2009 at 9:25 pm

ORIGINAL REPORT — Medical Writer Lindsey Tanner, reporting for the Associated Press, writes that “an influential government-appointed medical panel is urging doctors to routinely screen all American teens for depression.”

An estimated 6 percent [nearly 2 million] of U.S. teenagers are clinically depressed. Evidence shows that detailed but simple questionnaires can accurately diagnose depression in primary-care settings such as a pediatrician’s office.

The task force said that when followed by treatment, including psychotherapy, screening can help improve symptoms and help kids cope. Because depression can lead to persistent sadness, social isolation, school problems and even suicide, screening to treat it early is crucial, the panel said.

The recommendation from the U.S. Preventive Services Task Force appears in April’s issue of the journal Pediatrics.

Because depression is so common, “you will miss a lot if you only screen high-risk groups,” said Dr. Ned Calonge, task force chairman and chief medical officer for Colorado’s Department of Public Health and Environment.

Calonge stressed that the panel does not want its advice to lead to drug treatment alone, particularly antidepressants that have been linked with increased risks for suicidal thoughts. Routine depression testing should only occur if psychotherapy is also readily available, the panel said. Calonge said screening once yearly likely would be enough.

The recommendation follows the passage of a mental health parity law in the United States, which “is expected to prompt many more adults and children to seek mental health care.”

A separate report, also released Monday in the Pediatrics journal, says primary care doctors including pediatricians and family physicians will need to get more involved in mental health care.

Dr. Alan Axelson, a Pittsburgh psychiatrist who co-authored the second report [said that] because children’s families often get to know their pediatricians, having those doctors offer mental health screening can help make it seem less stigmatizing.

Most pediatricians aren’t trained to do psychotherapy, but they can prescribe depression medication and monitor patients they’ve referred to others for therapy, he said.

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Town’s Website Reacts to Economy with Mental Health Tips

In Mental Illness on March 24, 2009 at 7:45 pm

Wise words about the economy and mental health recently came from the website of a town in eastern Massachusetts, where a humble public servant — Jon Mattleman, Director of the Needham Youth Commission, to be precise — wrote this:

If you are experiencing stress about the economy and/or your finances, below are a few tips that you might want to consider:

If you are in a relationship — Money can be a significant source of stress in relationships. If one partner feels overwhelmed or panics, it is important that the other person provide stability and support so that both don’t spiral downward together.

If you have kids — Be honest with your children as well as age-appropriate in explaining how the financial crunch is impacting the family. Be positive, reassuring, and ask them if they have any fears. Children look to parents for information and guidance, and parents need to model behavior which illustrates that they are coping appropriately also.

If you are retired, single, and/or alone — Clearly this is a time of unprecedented concern for our economy…but the reality is that we have faced difficult times in the past and ultimately triumphed. Make certain to share your feelings with others and keep connected with friends.

Generally speaking, for all people it is important to:

  • Try to keep a positive attitude
  • Exercise and stay active
  • Learn to accept what you cannot control
  • Learn relaxation techniques such as deep breathing
  • Get plenty of sleep/rest
  • Limit or eliminate alcohol/drug use
  • Seek out social supports
  • Laugh – this is one of the most effective stress reducers
  • Get help from friends or a professional if you feel overwhelmed, depressed, or at risk for self injury.

We don’t know if Mr. Mattleman’s composition was entirely original of if he compiled his suggestions from other sources, but we applaud him for sharing them with his constituents … and, now, with all of us.

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SPNAC: APA Principles Are a Guide for Mental Health Advocates

In Advocacy, Mental Illness on March 22, 2009 at 3:18 pm

Former Oregon Sen. Gordon Smith, left, talks with Dr. John Wernert, board chairman of the American Psychiatric Association Political Action Committee, during the 2009 Advocacy Day. (Photo for APA by Maureen Keating)

Former Oregon Sen. Gordon Smith, left, talks with Dr. John Wernert, board chairman of the APA Political Action Committee, during Advocacy Day. (Photo for APA by Maureen Keating)

ORIGINAL STORY — In a story for Psychiatric News, reporter Rich Daly explains one of the goals of members of the American Psychiatric Association when they met with members of Congress last month during the APA’s 2009 Advocacy Day.

The enactment of mental health parity and the reduction of the Medicare copay for outpatient mental health services to 20 percent were major accomplishments this past year, and APA leaders are urging Congress and the Obama administration to ensure that psychiatric care is covered on an equal basis with other types of care under any proposals to reform health care.

The article references the APA’s “Principles for Health Care Reform for Psychiatry — Position Statement,” which is an excellent guideline for all mental health advocates to use as we watch over the reshaping of America’s health care system and make sure that creating a sound mental health care system in the nation is a priority. Here are the APA principles:

1. Every American with psychiatric symptoms has the right to a comprehensive evaluation and an accurate diagnosis which leads to an appropriate, individualized plan of treatment.

2. Psychiatric treatment should be based on continuous healing relationships and engagement with the whole person rather than the narrow symptom-focused perspective.

3. Timely access to psychiatric care and continuity of care are the cornerstones for quality, even as a continuum of medical and non-medical services becomes available that would encourage maximum independence and quality of life for psychiatric patients.

4. There must be full parity of psychiatric treatment with the rest of medicine and utilization management must be the same for people with mental illness and well as for other medical illnesses. Payment and utilization should be on the basis of treatment and services and not on diagnosis.

5. Psychiatric care should be patient and family centered, community based, culturally sensitive, readily available for patients of all ages, with particular attention to the specialized needs of children, adolescents, and the elderly. Disparities in the access to care for ethnic and racial minorities must be addressed.

6. Access to psychiatric care should be provided in numerous settings, including private offices, community mental health centers, specialty clinics, and hospitals as well as in the workplace, schools, and correctional facilities. Psychiatric care should be fully integrated with the rest of medicine in primary care settings and in hospitals.

7. Patients deserve to be treated with dignity and respect. When they are clinically able, they are entitled to choose their physician and other providers and make other decisions regarding their care. When they are incapable of doing so, they should receive the treatment they need and when able, they should choose future care.

8. As medical information enters the electronic age, leading to increased efficiency and ease of access to health data on all individuals, the confidentiality of this data must have the highest priority.

9. Patients should receive care in the least restrictive setting possible that encourages maximum
independence and access to a continuum of clinical services.

10. Psychiatric care should be fully integrated with the treatment of substance use disorders.

11. Psychiatric care should have an emphasis on early recognition and treatment as well as prevention. Research into the etiology and prevention of mental illness and into the ongoing development of safe and effective treatment interventions must be supported.

12. Efforts must be intensified to combat and overcome the stigma historically associated with mental illness and its treatments through enhanced public understanding and awareness of mental disorders and the effectiveness of psychiatric treatment.

13. More resources should be devoted to the training for an adequate supply of psychiatrists, especially child psychiatrists, to meet the current and future needs of the population.

* Prepared by the Board AD HOC Work Group on a Mental Health Care System. Approved by the Assembly, November 2008. Approved by the Board of Trustees, December 2008. “Policy documents are approved by the APA Assembly and Board of Trustees … These are … position statements that define APA official policy on specific subjects” (APA Operations Manual).

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Innovative Home for the Mentally Ill Named for Suicide Victim

In Mental Illness on February 19, 2009 at 9:56 am

ORIGINAL STORY — In a story in the Chicago Tribune, reporter Ted Gregory tells about Joanna’s Lodge in Winfield, Ill., “a place that takes a somewhat unconventional but promising approach to empowering and improving the lives of people with mental illness.”

“To me, there’s such a pride in the people who live there,” said Mary Lou Lowry, executive director of NAMI DuPage. Joanna’s Lodge is named for Lowry’s daughter, who committed suicide after a psychotic break in 2003. “They’re always so warm and welcoming. They’re so happy to be there, and when they move on, there’s a huge celebration.”

Joanna’s Lodge was started in 2007 and is the only facility of its kind in Illinois. It follows the Fairweather Lodge model, now being used in 10 states, which “is based on research done in the early 1960s by psychologist George Fairweather.”

Conducting research among people with mental illness at Veterans Administration hospitals across the country, Fairweather found that leadership and problem-solving could be developed in small groups. That work led to the Fairweather Lodge model …

Activity is fundamental to Joanna’s Lodge, a “training campus” where four to eight residents with chronic mental illness receive intensive training in life skills and team building for up to six months and then graduate to a home where they live together in groups of four. During their campus stay, residents learn, among other skills, meal planning, budgeting, medication and stress management, employment and social skills, conflict resolution and problem solving. Lodge residents select a captain, treasurer, secretary and meal captain every week. Every day they hold member council meetings to discuss household issues of the day. By the time they graduate, they also must have a job.

“It empowers them to feel much better about themselves,” said Susan Simonsen, executive director of New Beginnings Community Services, Inc., the organization running Joanna’s Lodge. “Now, they have a purpose. They have a lot of self-esteem. They feel like an active member of society, and they deserve that.”

Esther Onaga of Michigan State University says that the approach instituted through the Fairweather Lodge model causes small groups of residents to become “an intentional community of support.”

[She] said people who graduate from Fairweather lodges return to mental health institutions much less frequently than those discharged from conventional institutions. Lodge graduates also hold jobs, a rarity for residents of more conventional homes, she said. In addition, Fairweather Lodges and the homes affiliated with them cost less to run than conventional homes for the mentally ill.

Those measurable outcomes suggest that investing in the empowerment of the mentally ill pays off. Even more than that, the approach used at Joanna’s Lodge meets basic human needs that often are neglected in other institutional settings.

“So many times people with mental illness have been limited in not being able to follow their dreams,” Lowry said. “So many have forgotten their dreams. We hope this will encourage them to get back their dreams and get back their lives.”

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