37th National Suicide Prevention Week

September 4th through the 10th is National Suicide Prevention Week. September 10th is National Suicide Prevention Day.

National Suicide Prevention Week seeks to inform the public about symptoms of suicide and useful measures of prevention and treatment.

I am a psychiatric social worker. Mental health practice, mental health awareness and mental health advocacy is of the utmost importance to me. I believe that mental well being is just as important as physical and medical well being.

Two years ago I lost a dear friend of eight years. He ended his life and left behind a son. He left his family, he left his friends, he left me.

Even before I lost my friend and before I entered the field of mental health, I developed an interest in the topic of suicide. It was a concept which I could not grasp. Even as a person who has suffered from depression since childhood (I thank God that I am stable with the assistance of medication and therapy), I have been unable to understand the concept of suicide.

It was during graduate school that a professor passively mentioned a book entitled Night Falls Fast: Understanding Suicide by Kay Jamison (Jamison has written a memoir detailing her own journey with Bipolar disorder. The book is entitled An Unquiet Mind: A Memoir of Moods and Madness). I jotted down the title and author's name immediately and purchased the book the following day.

I read the book for a second time when my friend took his own life. I remember frantically seeking other publications which might assist me in somehow understanding why my friend would do this.

Through my search I realized that Night Falls Fast was the best book I would find on the subject. This is not to suggest that one shouldn't seek other books but for me this was precisely what I was looking for.

The book delves into the history of suicide, easy to follow statistics, stories, and scientific facts about suicide in families and in twins, gender disparities, and the impact of the seasons and times of day. Jamison presents poems, suicide notes and stories of individuals who have committed suicide which offer a personalistic viewpoint of those who are suffering. Jamison also scolds the media for actually promoting and maintaining preoccupation with suicide amongst at risk persons.

Below are two excerpts and a poem from the book.

"Depression in most suicides probably impairs the capacity for rational thought while at the same time inducing suicide impulses."

"We know that suicidal acts are often impulsive; that is they are undertaken without much forethought or regard for consequence. More than half of suicide attempts occur within the context of a premeditation period of less than five minutes, and many researchers and clinicians, as well as patients who survive medically serious suicide attempts occur within the context of premeditation period of less than five minutes, and many researchers and clinicians as ell as patients who survive medically serious suicide attempts, lay stress on the role of impulse in the decision to commit suicide. (Although many suicidal patients have well formulated plans for suicide, the ultimate timing and final decision to act are often determined by impulse.)"

Resume by Dorothy Parker
Razors pain you;

Rivers are damp;

Acids stain you;

And drugs cause cramp.

Guns aren't lawful;

Nooses give;

Gas smells awful;

You might as well live

To purchase Night Falls Fast: Understanding Suicide click here.

There are two other books that I would recommend. Prozac Nation by Elizabeth Wurtzel is a memoir that offers insight into the mind of depression and the second is Girl, Interrupted by Susanna Kaysen.

While Wurtzel speaks of her experience only I was able to resonate with many of her sentiments. Being that the book is a National Best Seller I imagine that others have resonated with it as well.

There is a film adapation of the book but I feel that it is a very poor adaptation. The film in my view does not represpent the book well at all. The film is far too simplistic and lacks sufficient detail.

Prozac Nation was published in 1994 and tells the story of at 26 year old Elizabeth Wurtzel and her experience of breakdowns, suicide attempts, medication and psychotherapy and an eventual point of stability. Wurtzel also adds her two cents about drug companies and the media's influence making depression chic.

Wurtzel details her journey in a wonderfully articulate and poetic manner.

"That's the thing I want to make clear about depression. It's got nothing at all to do with life. In the course of life there is sadness and pain and sorrow, all of which, in their right time and season are normal - unpleasant, but normal. Depression is an altogether different zone because it involves a competed absence: absence of affect, absence of feeling, absence of response, absence of interest." 

"And the scariest part is that if you ask anyone in the throws of depression how he got there, to pin back the turning point, he'll never know. There's a classic moment in 'The Sun Also Rises' when someone asks Mike Campbell how he went bankrupt, and all he can say in response is, 'Gradually and then suddenly.' When someone asks me how I lost my mind, that is all I can say too."

"If I were an alcoholic, I'd  be saying I want a drink, but I'm me I don't know what it is I want. But I want it right now!"

"In a strange way, I had fallen in love with my depression. Dr. Sterling was right about that. I loved it because I thought it was all I had. I thought depression was the part of my character that made me worthwhile. I thought so little of myself, felt that I had such scant offerings to give the world, that the one thing that justified my existence at all was my agony."

"I was so scared to give up depression, fearing that somehow the worst part of me was actually all of me. The idea of throwing away my depression of having to create a whole personality, a whole way of living and being that did not contain misery at its leitmotif, was daunting. Depression had for so long been a convenient and honest explanation of everything that was wrong with me, and it had been a handicap that helped accentuate everything that was right. Now, with the help of a biochemical  cure, it was going to go away. I mean, wild animals in captivity will perish if placed back into their natural habitats because they don't know the laws of prey and predator and they don't know the ways of the jungle, even if that's where they belong. How would I survive as my normal self? And after all these years, who was that person anyway?"

To purchase Prozac Nation click here.

Now on to Girl, Interrupted. Most know it best for the film adaptation staring Winona Ryder and Angelina Jolie. I enjoyed the film and believe that the book was well adapted.

The book itself is actually a short 192 page read but it is very telling.

Girl, Interrupted is a memoir of Kaysen's journey as an 18 year old girl.  Kaysen describes her experiences as a young woman in a Mclean psychiatric hospital in the 1967 after being diagnosed with borderline personality disorder.
Kaysen spent approximately two years on a ward for teen girls inside a hospital known for having treated well known persons such as Sylvia Plath,  James Taylor, and Ray Charles.
  
"People ask, 'How did you get in there?' What they really want to know is if they are likely to end up in there as well. I can't answer the real question. All I can tell them is, it's easy."

"And it is easily to slip into a parallel universe. They are so many of them. Worlds of the insane, the criminal, the crippled, the dying, perhaps the dead as well. These words exist alongside this world and resemble it, but they are not in it."

"Another odd feature of the parallel universe is that although it is visible from this side, once you are in it you can easily see the world you came from. Sometimes the word you came from looks huge and menacing, quivering like a vast pile of jelly; at other times it is miniaturized and alluring, a-spin and shining. Every window on Alcatraz has a view of San Francisco."

To purchase Girl, Interrupted click here.

Lastly, I'd like to talk about the documentary film The Bridge.

The Bridge is a controversial documentary. At this date and time the film is on YouTube.

Most people choose to end their lives at the Golden Gate Bridge than any other place in the world. The director and crew spent all of 2004 running footage of the bridge 24 hours a day. In addition the director captured interviews with family members and friends of the suicides featured in the film. Yes, you will witness various individuals jumping over the bridge.

The film is controversial as many seek answers to the most obvious question. "So, you were just allowing people to die for the sake of the film?"

The director explains on the official website that if an individual was walking alone, appeared sad, lingered too long in one spot, paced back and forth, the police were not immediately phoned as there were too many individuals who fit that description.

Emergency authorities were called from the crew's speed dials if they witnessed someone climb the bridge railing. To read the details of the precaution measures taken for the project, read the Directors Statement at the website here.


The Bridge - Trailer

To purchase The Bridge visit the official website here. Whether you watch the film or not I suggest you take a look at my post Meet Kevin Hines - He Jumped and Survived. Hines is featured in the film. He survived the jump off of the bridge and now is an advocate for those who are suicidal. Hines travels around the world sharing his story attempting to inspire others.

Now, that I've given you all this information let us address a very important question. Is suicide selfish? I think the most immediate answer is "yes". But I can tell you that as someone who has lost a loved one I have had a lot of time to think about this.

I believe that there is a level of selfishness involved as depression is a state of self-absorption. As mentioned earlier I speak from personal experience.

I think when people examine the words "selfish" and "self-absorbed" they view these concepts with a condescending glare. Selfish? Bad. Self-absorbed? Really bad.

If we look at these words in the context of depression or other mental illnesses we might see something different. I hope. As mentioned in Kay Jamison's book, Night Falls Fast, the brain's functioning is altered when depressed and certainly when feeling suicidal. Rationale has a tendency to fly out the window.

My friend who died left a son behind but when he was living he was a good father. How would a rational man leave his son behind? That's just it. He wasn't rational.

When we are angry at those who take their own lives it can be difficult to understand this. When we are confused and in the midst of tireless hurt, it can be difficult to understand this. We want comfort, we want answers, we want our loved ones back. We want them to come back so we can shake them and shout, "Why did you leave me?! Don't you see how much this hurts?!" Ultimately, as we snake through the grieving process it is important to understand that our loved ones were not themselves on that day. They didn't want to leave us. They wanted the shit to stop.

So, what can we do as individuals? We can spread awareness, we can research, we can donate, we can learn, we can listen.

Below I have listed helpful information which can assist in identifying suicide risk. I have also listened a variety of resources which include telephone numbers and websites.

Warning Signs and Guidelines

Below is information from The American Foundation for Suicide Prevention (AFSP)


KNOW THE FACTS

Psychiatric Disorders 
More than 90 percent of people who kill themselves are suffering from one or more psychiatric disorders, in particular:

• Major depression (especially when combined with alcohol and/or drug abuse)
• Bipolar depression
• Alcohol abuse and dependence
• Drug abuse and dependence
• Schizophrenia
• Post Traumatic Stress Disorder (PTSD)
• Eating disorders
• Personality disorders

Depression and the other mental disorders that may lead to suicide are -- in most cases -- both recognizable and treatable. Remember, depression can be lethal.
The core symptoms of major depression are a "down" or depressed mood most of the day or a loss of interest or pleasure in activities that were previously enjoyed for at least two weeks, as well as:

• Changes in sleeping patterns
• Change in appetite or weight
• Intense anxiety, agitation, restlessness or being slowed down
• Fatigue or loss of energy
• Decreased concentration, indecisiveness or poorer memory
• Feelings of hopelessness, worthlessness, self-reproach or excessive or inappropriate guilt
• Recurrent thoughts of death or suicide

PAST SUICIDE ATTEMPTS
Between 25 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made suicide attempts are at higher risk for actually taking their own lives.
Availability of means

• In the presence of depression and other risk factors, ready access to guns and other weapons, medications or other methods of self-harm increases suicide risk.

Recognize the Imminent Dangers

The signs that most directly warn of suicide include:

• Threatening to hurt or kill oneself
• Looking for ways to kill oneself (weapons, pills or other means)
• Talking or writing about death, dying or suicide
• Has made plans or preparations for a potentially serious attempt

Other warning signs include expressions or other indications of certain intense feelings in addition to depression, in particular:

• Insomnia
• Intense anxiety, usually exhibited as psychic
• pain or internal tension, as well as panic attacks
• Feeling desperate or trapped -- like there's no way out
• Feeling hopeless
• Feeling there's no reason or purpose to live
• Rage or anger

Certain behaviors can also serve as warning signs, particularly when they are not characteristic of the person's normal behavior. These include:

• Acting reckless or engaging in risky activities
• Engaging in violent or self-destructive behavior
• Increasing alcohol or drug use
• Withdrawing from friends or family

Take it Seriously

• Fifty to 75 percent of all suicides give some warning of their intentions to a friend or family member.
• Imminent signs must be taken seriously.

Be Willing to Listen

• Start by telling the person you are concerned and give him/her examples.
• If he/she is depressed, don't be afraid to ask whether he/she is considering suicide, or if he/she has a particular plan or method in mind.
• Ask if they have a therapist and are taking medication.
• Do not attempt to argue someone out of suicide. Rather, let the person know you care, that he/she is not alone, that suicidal feelings are temporary and that depression can be treated. Avoid the temptation to say, "You have so much to live for," or "Your suicide will hurt your family."

Seek Professional Help

• Be actively involved in encouraging the person to see a physician or mental health professional immediately.
• Individuals contemplating suicide often don't believe they can be helped, so you may have to do more.
• Help the person find a knowledgeable mental health professional or a reputable treatment facility, and take them to the treatment.

In an Acute Crisis

• If a friend or loved one is threatening, talking about or making plans for suicide, these are signs of an acute crisis.
• Do not leave the person alone.
• Remove from the vicinity any firearms, drugs or sharp objects that could be used for suicide.
• Take the person to an emergency room or walk-in clinic at a psychiatric hospital.
• If a psychiatric facility is unavailable, go to your nearest hospital or clinic.
• If the above options are unavailable, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Follow-up on Treatment

• Suicidal individuals are often hesitant to seek help and may need your continuing support to pursue treatment after an initial contact.
• If medication is prescribed, make sure your friend or loved one is taking it exactly as prescribed. Be aware of possible side effects and be sure to notify the physician if the person seems to be getting worse. Usually, alternative medications can be prescribed.
• Frequently the first medication doesn't work. It takes time and persistence to find the right medication(s) and therapist for the individual person.

Resources:
National Suicide Prevention Lifeline 1-800-273-8255

National Hopeline Network (U.S.A.) -  www.hopeline.com - 1-800-SUICIDE

S.A.F.E. Alternatives -  www.selfinjury.com - Self Abuse Finally Ends

The Trevor Helpline is the only nationwide, around-the-clock crisis and suicide prevention helpline for lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. All calls are confidential and toll-free from anywhere in the United States, 24 hours a day, 7 days a week. 866-4-U-TREVOR (866-488-7386)

To visit the Suicide Prevention Resource Center click here


TREATMENT OR COUNSELING:

American Psychological Association -  locator.apa.org - counseling services locator

AAMFT -  www.therapistlocator.net - counseling services locator

Befrienders Worldwide -  www.befrienders.org - treatment and counseling services locator

SAMHSA -  findtreatment.samhsa.gov - substance abuse treatment center locator

SAMHSA -  mentalhealth.samhsa.gov - mental health services locator

AACC -  www.aacc.net - Christian counseling services locator




FOR HELP WITH SELF INJURY:
S.A.F.E. -  www.selfinjury.com – “S.A.F.E. ALTERNATIVES is a nationally recognized treatment approach, professional network, and educational resource base, which is committed to helping you and others achieve an end to self-injurious behavior.”

Self Mutilators Anonymous - www.selfmutilatorsanonymous.org - "Self Mutilators Anonymous is a fellowship of men and women who share their experience, strength and hope with each other, that they may solve their common problem and help others to recover from physical self-mutilation."




FOR HELP WITH EATING DISORDERS:
National Eating Disorders Association - www.nationaleatingdisorders.org - “non-profit organization dedicated to supporting individuals and families affected by eating disorders.”

FINDINGbalance - www.findingbalance.com – Faith based help for eating and body image issues.




FOR HELP WITH ADDICTION:

HBO - HBO.com/addiction - “The Addiction website brings together many of America’s top addiction experts to demystify this much-misunderstood disease.  To find help now, or to learn more about the latest breakthroughs in treatment, select a link.”

"Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking." Meetings can be found in Australia, the UK and USA.

Al-Anon/Alateen – www.al-anon.org – “Offering hope and help to families and friends of alcoholics.”
"Narcotics Anonymous -  an international, community-based association of recovering drug addicts with more than 33,500 weekly meetings in over 116 countries worldwide." To find a meeting in your area visit www.na.org.