Suicide Prevention: Not for Suicidal People

I have mixed feelings about what they call Suicide Prevention.  As a matter of fact, I have real concerns about the whole Suicide Prevention movement and whom it is geared to.

But I decided I should give it a fair trial.  So I Googled "suicide prevention."  What follows is some of what I found.

The first non-ad link was for the National Suicide Prevention Lifeline.  That sounded promising, so I clicked it and saw that their big deal is their help line.  They want me to call for help.

Well, I don't want to call a damned phone number; one of depression's symptoms is isolation and I don't want to talk to anyone.  Besides, the only time I ever called a hotline (not this particular one) and said I was suicidal, they put me on hold.  I hung up.  I have no intention of ever calling one again.  Can't they just give me something encouraging to read?

Then I saw a tab entitled "Get Help."  When I put my cursor over it, I was excited to see what kind of "Help for Yourself" I might find.

But when I saw the categories, I realized there would be no help for me there.  So the "Lifeline" was lifeless for me.

The second link was for the Web site of the American Foundation for Suicide Prevention (AFSP).  I entered "I am suicidal" in the search field, and on the second page of search results I found "I am struggling."

So I clicked and in big letters it said that if I was "in crisis," I should call a specific phone number.  Remember that one of my symptoms is that I don't want to talk to anyone.  Not helpful.

I tried some of AFSP's other links, and they took me to pages that were suited to professionals.  They offered "testimonials," so I went to that page and saw that most of the testimonials were of people who were suicidal themselves after they lost someone to suicide.  To be frank, if I'm suicidal myself I don't want to hear someone whining about how hurt they were.  I'm looking for someone like me.

And then I found this little AFSP gem:

On experiencing relief after a suicide loss: 

It can be extremely difficult to admit you may feel some relief after a suicide loss, inducing additional feelings of guilt, shame, or anger. It is not uncommon to feel relieved in some ways. Chronic mental illnesses can take a huge emotional and physical toll on families and communities. It is very hard to watch the person you love suffer with severe mental health issues. It can be a relief that their suffering is over, as well as your struggles. . . . 

Well, well, well.  Now I know for sure that I'm a burden.  Thanks a lot, AFSP.  Fail.

The third site was Helpguide.  Here I found the very first thing that appealed to me: "Most people who commit suicide don't want to die—they just want to stop hurting."  Okay, now they had me; they knew how I felt.  Further down the page there was even a link to a page they called "SuicideHelp."

Finally, here was what I needed.  Funny thing, though, this was not even a suicide prevention organization.

And the fourth link was to the National Institute of Mental Health.  Here I found lots of scientific stuff, studies, overviews, facts, and statistics, but nothing to help a currently-suicidal person.  There was a link to the Centers for Disease Control and Prevention that looked promising, but again I just found scientific articles.  After many clicks and links, I located this advice from the Mayo Clinic:

Very hard to find and not the most effective advice, but at least it was aimed at me, not some "survivor."  But again, the Mayo Clinic is not a suicide prevention organization.

Well, you get the idea.  It appears to me that these suicide prevention people are a selfish bunch.  They focus on the harm that suicide does to survivors. They are all about themselves. They want to prevent other people from feeling the loss that they have felt.  But I don't get the feeling that they want to talk to a suicidal person to learn about how the person is feeling.

Too bad, because that's how they can prevent suicide.

"Behavioral Health?" What does that even mean?

That's the term for what I guess I don't have.  At least not right now.

Long ago, the head of a social services agency told me that "behavioral health" was meant to be a kinder, gentler term than "mental health." 

Well, I think it's demeaning.  And I told him so.  To me it sounds like, "If those crazy people would just behave better, they wouldn't have all this trouble."

The term has been around for years, but what does it mean?

Definition of "behavioral"

Definition 1a in the Merriam Webster online dictionary defines "behavior" as "the manner of conducting oneself ."  It also lists synonyms for "behavior" as "actions, address, bearing, comportment, conduct, demeanor, deportment, and geste."  "Behavioral" is listed as an adjective related to behavior..

 

An article in the online Encyclopedia Britannica defines "behavioral science" as "any of various disciplines dealing with the subject of human actions . . ."

Definition of "health"

And definition 1a for "health" in Merriam Webster online is "the condition of being sound in body, mind, or spirit . . . ." 

Britannica calls it "the extent of an individual’s continuing physical, emotional, mental, and social ability to cope with his environment."  

Definition of "behavioral health"

So let's put that together.  "Behavioral" describes human actions and "health" means sound and able to cope.   

As near as I can figure it, then, "behavioral health" would mean that my actions are sound and allow me to cope adequately with my environment.

So what does this have to do with depression, schizophrenia, bipolar disorder, and other so-called "mental illnesses?" 

Nothing!

Does "behavioral health" mean that if my actions were sound I would be able to cope with life without getting a mental illness?  That's sure what it sounds like.  Well, that's incorrect.  And it pisses me off.

If we talk about breast cancer, the absence of the illness is called "breast health."  And for those with diabetes, there is a magazine called "Diabetes Health." 

Since the term for such diseases as major depression and schizophrenia is "mental illness," why not just call the absence of such diseases "mental health?"  Or, since these illnesses are brain disorders, how about "brain health?" 

But, please, I beg you, don't call it "behavioral health."

Bored. To. Death.

One of the symptoms of depression is "anhedonia."  It is defined as "inability to enjoy doing the things that are normally enjoyable," or "Loss of interest or pleasure in normal activities." 

That just kind of sounds like boredom.  It can't be all that bad, can it?

Well yes, yes it can. 

A philosophical Wikipedia editor describes the feeling well in the entry on Boredom  "Without stimulus or focus, the individual is confronted with nothingness, the meaninglessness of existence, and experiences existential anxiety."

I'll give you some examples of things you might enjoy, and how you might feel about them if you were depressed:

You love to watch football.  You have a favorite team and you never miss one of their games. 

But now that you're depressed, you really don't care about it.  You think it would be nice if your team won, but you can't watch more than a few minutes of a game until you're bored with it.

You love to read.  You can read for hours on end when you have the opportunity.

But now that you're sick, you can only read a few pages.  Then it feels too hard, and just not worth it to keep reading.  If you have another book started, you might pick that up for a few minutes and put it down again.  Blah.

You like to work on projects around the house.  It could be a remodeling project or a crafts project and you love to spend time on it. 

But you're depressed now.  It's almost impossible to get up enough motivation to work on a project.  And even if you finally get motivated, you lose interest in the project very quickly.  It's just no fun.

You have several favorite TV shows.  You know what night they're on, you wait excitedly for that night, then you follow the plot closely.

From your place of depression, the shows just don't matter anymore.  You may tune in, but it's an effort to concentrate on the show.  It's hard to believe, but you just don't care about what's going on.

You love to do puzzles.  Crossword, word search, Sudoku, scrambles -- you love the challenges.

Depression makes them feel like a waste of time.  Besides, your brain just can't come up with the answers.

You can surf the Web for hours.  One site directs you to another, then to another, and yet another, until you've used up your spare time.  There's so much cool stuff out there!

You're sick now, and things just aren't as interesting.  For some reason, it feels like a huge effort to type and click, and you close your laptop and put it away after a short time.

You're a napper.  You can always curl up and go to sleep for a short or long nap.

Now that you're depressed, you lie there and think, "I'm so tired, but I don't even feel like doing this.  I can't sleep anyway." 

So.  Now what.  There is just nothing you want to do. 

You are too antsy to sit still and do something quiet, but you are too weary to do anything that requires motion.

 

When you add this to the other challenges of depression, it's like being bored to death. 

Isn't it ironic?

After I have been well for several years, I am so optimistic that I won't ever get sick again.

Then I start writing posts like Put Me On The Crazy List, saying I should never be able to purchase a gun.  I tell my friend that he should never give me the guns he keeps safe for me. 

I look at the pills I have hoarded, and I think, "I'll never want to use these!  And just to be safe, I'll get rid of them."  So down the toilet they go.  (Yes, I do know that's not the proper way to dispose of them, but it's best to just do it while I'm in the mood to flush them.)

Ah, but then I get sick again.

I yearn for a gun; it would be so quick that way.  But I don't even have the energy to go buy one.  And my friend certainly won't give me one.  I don't want to talk to anyone anyway, so I wouldn't even call him.

And I yearn for multiple bottles of pills.  To just go to sleep forever.  Why was I so certain I'd never want them?  And my doctor sure as hell won't prescribe a bunch of them for me now.   

Alanis says it perfectly:

Well life has a funny way of sneaking up on you
When you think everything’s okay and everything’s going right
And life has a funny way of helping you out when
You think everything’s gone wrong and everything blows up
In your face

Yes, Alanis, it is ironic.

Circling the Drain

Today I'm swirling around the black pit. 

I went out to a doctor appointment yesterday.  I sat in my car afterward, recuperating.  I ran an errand, then I sat in my car recuperating.  Ran one more errand, sat in my car some more to rest.  These small efforts at interacting with people were exhausting.  A doctor appointment and two quick errands took me 4.5 hours.

I noticed, too, that everything I did yesterday was slow. 

I am known in my family for my speedy driving habits.  I meticulously keep my speed to nine miles above the speed limit, because someone once told me I wouldn't be pulled over unless I went ten miles over the speed limit.

Dear God, I found myself driving 45 in a 55 mph zone and 50 in a 65 mph zone.  I am surely sick.

I'm even walking slowly.  More like a shuffle.

And today I started New-Medicine-Number-2.

You have no idea how demoralizing this is. 

Starting New-Medicine-Number-2 just means that New-Medicine-Number-1 didn't help.  It took almost a month to decide that New-Medicine-Number-1 hasn't helped.  That's because of the nature of these medications. 

These meds attempt to change brain chemistry.  That can't just be accomplished by taking the pill for a few days.  It can take weeks for the medication to get into the brain and then to build up to therapeutic levels. 

Apparently, New-Medicine-Number-1 has had a sufficient trial of four weeks, so it's time to move on.

Imagine if you were subject to physical pain and had to wait four weeks just to see if a new medicine would help.  Then another four weeks for the second new medicine. 

I have already been off of work for a month.  I feel my new career as a Peer Specialist slipping away.  I hope that's just my illness causing me to think that way, and that I can return to this job.  After all, this job is why I left my high-paying IT job to work in low-paying social services.

Now, I have to wait for New-Medicine-Number-2.  To see if it will work, or not.  In the meantime, my caseload at work waits.  God bless my clients.  I can only hope that this latest episode of depressive disorder will help me to understand my clients' illnesses even better.

But, my God, this sure gets old.

What not to say to a depressed person

 
If you are dealing with a depressed person, you might be pretty frustrated and irritated. 

At least that's how I felt when my mother was depressed.  I was so frustrated that I wanted to just shake some sense into her.  That was before I knew Major Depression myself.

Please realize that the depressed person's brain is not functioning properly.  Let that be your fallback thought when you get frustrated, "He's not trying to frustrate me on purpose, his brain isn't working right."

Here are some things that you should probably not say.  These comments will not help your friend or family member.  In fact, they may make him feel worse.

"What are you depressed about?”

There may be a situation that is depressing him, and maybe he doesn’t really want to talk about it. 

 

Or he may not be able to come up with a reason, and then you have made him feel stupid on top of his depression.  Sometimes brain chemistry changes without a clear reason.

 

Just don't ask this. 

 

“You have so much to live for!   Why would you be depressed ?”

The person likely knows if he has good things in his life. 
 
If you remind him of this, you'll make him feel guilty for being depressed because he "should" be happy.  it will just add guilt to his depression.  
 
Just don't ask this, either.

 

“Just don’t think about it.”

 

People say this when the depressed person is obsessing about something. The person cannot just not think about it.  It’s like if someone says, “Don’t think of a kitchen sink;” then all you can think of is a kitchen sink. 

 

Instead, help the person find something else to put his mind on.  Maybe you can help him place his thoughts on the present, the sights, sounds and sensations affecting him right now; that can be helpful.

 

“Don’t say that.  You don’t mean that.”

 

Yes, he does mean that.  Don’t tell him he doesn’t. 

Maybe you could just say, "I'm sorry to hear that."

 

“I know how you feel.”

 

No, I assure you, you do not. 

 

Even if you have suffered from depression, everyone experiences it differently.

 

 

“C'mon!  Just cheer up!”

He can't.  He would if he could. This is like telling a diabetic, “C'mon!  Just change your blood sugar!”  

 

“Don’t cry.”

He doesn’t want to cry and he would stop if he could.  Tears can be cleansing.  

 

Just offer to get him some tissues. 

 

"Don't feel that way!"

They're his emotions; allow him to own them.  In his mind, his thoughts are perfectly reasonable. 

 

You might say, "I don't agree with that," or "I wish you didn't feel that way."

 

 

"I'm worried about you."

Worry doesn't help anyone.  And it makes it sound like he's responsible for your feelings.  He is not.  You are.
 
Just tell him you care about him.

"You just need to (take this vitamin, eat this fruit, do this exercise, go to this doctor, read this book, think this way, blah, blah, blah.)"

If he is seeing a doctor, let the doctor do her job.  If not, encourage him to go to his primary care provider.  Offer to go with him if he wants you to, but don't insist on it.
 

"You're just doing this to get attention."

If you say this, you are telling him that what he is feeling is unimportant and frivolous.
 
Especially if the person sounds like he wants to kill himself, take him seriously.  Call your local crisis services. 
 
 

The most important thing is that he knows you are there for him.  

 

If you are uncomfortable with the depressed person's behavior, please educate yourself on major depression.  There are lots of agencies and web sites you can learn from.  You could start with National Alliance on Mental Illness or the Depression and Bipolar Support Alliance.

 

 

 

 

What I talk about when I talk about "depression."

"Depressed." That just means "sad," or "down," or "feeling low," maybe "moody," or "unhappy."  Right?

Nope.

In my book, "depressed" means "self-loathing," "paralyzed," "angry," "crying for no reason," "not interested in anything," "unable to function."  Oh, and "suicidal."  Which goes along with "in the hospital." 

I also call depression "the black pit."

When I'm just starting down the slippery slope into that black pit, I can act for a while.  Before I go someplace I tell myself, "Okay, time to put on the happy face."  And I smile and act like everything is okay.  But as soon as I leave, my face drops and I'm right back the way I was.  Or maybe worse, because playing the "happy" role is exhausting.  So I start limiting my interaction with other people.

After a while, the happy face cracks.   I can no longer put it on at all.  Then I just stay home.  It's a huge effort just to get to a doctor appointment.  If I have to go out, I just look down at the ground, pretending to be invisible.

The people I love -- my husband, my daughter, my friends, my co-workers, my family -- I feel . . . I know . . . that I'm a burden to them.  They would be better off without me.  They just won't admit it.

And I am such a disappointment to myself.  I was so smart.  I could have done so much more.  I should still do so much more.  But I can't.  I can barely take care of myself.

I get paralyzed.  I will sit or stand in one spot for half an hour.  Or more.  Like a statue.  With no thought process going on.  Sometimes I try to do something.  I want to take a shower, but I can't do it.  I want to go to work, but I can't do it.  I want to exercise, but I can't do it.  I mean PHYSICALLY I cannot do it.  Really.  Wish I could explain it.

I am angry.  At any big or little thing.  I get ferocious:  so angry that I cry and shake.  It is free-floating anger, ready to erupt at any time.  I feel sorry for the people who have to live or work with me.

I am not interested in eating.  Not even chocolate.  I'm not interested in word puzzles.  I have a stack of terrific books to read, but nothing appeals to me.  There's nothing on TV that I want to watch.  Not even politics.  Dear God, you know I'm sick when I'm not interested in chocolate or politics. 

I cry.  I sob.  For long periods of time.  I am distraught.  And the worst part is that I don't know why.  Even the beautiful things that I normally find joy in -- a blue sky, an adorable dog, a fuzzy caterpillar, God's amazing creation, sunshine (especially sunshine) -- just make me cry.  Why?  Something is screwed up inside my brain, I guess. 

I am in so much emotional pain that I cannot stand it.  So I scream when nobody is around.  No words, just screams.  Somehow it feels like if I scream loud and long enough, the emotional pain will go away.  But it doesn't work. 

Once, when I was in the hospital, I screamed while I was in the shower, thinking the running water would drown out my screams.  But everybody heard me.  After that, I was just the crazy screaming lady.  It's sad when your fellow mental patients look at you like you're the crazy one.

I am in so much pain that I want to die.  I think it's my only way out of the pain.  But it's not a passing thought, like, "I might as well kill myself."

Suicide is my old friend.  It comforts me.  I have been thinking seriously about it for a very long time.  I have read countless books about it.  It is my daily companion, even when I'm well.  I have several well-thought-out plans of how I can kill myself.  I know how to get past the fear of the pain of death itself.  Suicide is my plan B.

I often think that I'm going to die by suicide eventually anyway so I might as well just get it over with. 

But I have promised someone that I won't kill myself.  And I don't break my promises, especially to this person.  So now I am trapped.  There is no way out.  I am down in the black pit, death and pain are churning all around me, dragging me down and down, and there is  No. Way. Out.

Sometimes I have to go to the hospital to keep from killing myself.  And then my insurance company gets to decide if I am sick enough to be admitted to the hospital.  Not my doctor, not my family, not the professional evaluator at the hospital, MY F*CKING INSURANCE COMPANY.  Talk about a death panel.

Now I've been through this drill many times before.  And I have finally learned that I can get better.  I desperately try to hang on to that thought, to keep from being swept further down into the churning black pit.

My doctor will add in a new medicine (already has, actually), and after a few weeks it may help (already hasn't, actually).  So now we'll try a different combination of medicine and give that a few weeks to work.  Patience is one of the unwanted lessons of depression.  But eventually, agonizingly slowly, I will start to feel better.  At least I hope so.


Do you think I'm crazy for writing this, insane for feeling this way?  Frankly, my dear, I don't give a damn.  I only write for those whose minds are open enough to learn.  If you're not one of those people, then you can go straight to hell.  I'll be waiting for you here, because depression truly is hell.


Thanks for reading. 

--------------------------------------------------------------------------------------------------------------------

  

P.S.  Please . . . 

• Do not give me advice.
• Do not tell me you know how I feel.
• Do not tell me why I'm depressed.
• Do not ask me why I'm depressed.  If I knew that, I could work on fixing the problem.
• And do not worry about me. For God's sake, don't worry about me. The last thing I need is people thinking worst-case scenarios about me and flinging those kind of bad vibes about me into the universe.

There but for the grace of God . . .

If you have always lived comfortably, I want to help you understand why people with mental illnesses need so much help. 

These people's brains don't work right.  They need our help to have a place to live, to have food to eat, to feed and clothe their children.  They need our help to get medical care to help their brains function correctly.

I am amazingly lucky.  I don't know how I landed in this place, but I'm so glad I did.  Yes, I have suffered from Major Depression since I was a teen.  But I had all the right supports:

• My husband takes his marriage vows very seriously.  In sickness and in health, this wonderful man has stood by me. 
• I had a home to return to when I got out of the hospital.
• I had a daughter to live for.
• My parents both had experiences with depression.  They were  kind and compassionate.
• My in-laws were also kind and compassionate. 
• My co-workers were mostly nice. 
• I have seen the same psychiatrist for over 25 years. 
• I had jobs with healthcare insurance, plus short- and long-term disability insurance. 
• My job and benefits were still there for me when I came back from sick leaves, thanks to the Family and Medical Leave Act, signed into law by Bill Clinton.

When you are in the throes of a mental illness, your brain is not functioning correctly.  Now, consider the misery some people have to go through at the same time  that they can't think straight:

• Her spouse decides he can't tolerate her lack of motivation/fatigue/crying/sleeping all the time.  He leaves and she has no income.  She has to move to a homeless shelter, where her belongings become infested with bed bugs.
• His parents kick him out of the house because he is acting weird.  Now he is sick and homeless; he couch surfs until his friends cannot cope with his illness anymore.
• She has to be admitted to the hospital.  She has no family supports, so OCY takes her children.
• He takes medicine that helps his brain work correctly, but it has awful side effects -- it makes him drool.  He feels better but no one wants to hire him.
• He is misdiagnosed.  Instead of helping his brain work right, medicine makes him worse.  He becomes lost in a maze of case managers, agencies, therapists, psychiatrists, disability hearings, and hospitalizations.
• He is denied Social Security Disability Income.  He appeals, but they tell him it could take up to a year to get a decision.  A year!  In the meantime, he is homeless because he has no income.
• He has been in and out of psychiatric treatment for years.  Every time he gets sick, he sees a different psychiatrist.  There is no continuity of care; no one knows what treatments have worked or not worked in the past.  Doctors don't trust his own story of his previous medical care.

These examples are all based on people I have met in my various hospitalizations and outpatient experiences.  Please try to imagine living with illness plus these various sad circumstances.  Try to imagine being homeless or losing your children while your brain can't correctly interpret reality.

Sure, they're part of Mitt Romney's 47%, but they are not freeloaders.  They are very sick and they cannot work because of their illnesses.  Or they try to work but can't keep a job because of their illnesses.  Or nobody wants to hire them because of their illnesses.



And there, but for the grace of God, go I.

Can America end gun violence?

Can this country do what it takes to reduce gun violence?  Let's talk about the issues involved.

We'll start with President Obama's proposals.  The President's plan includes four points:

1. Closing background check loopholes to keep guns out of dangerous hands
2. Banning military-style assault weapons and high-capacity magazines, and taking other common-sense steps to reduce gun violence
3. Making schools safer and
4. Increasing access to mental health services.

I like this.  There's some good stuff here.

Closing background check loopholes wouldn't have affected Newtown, granted.  But it might stop suicides and domestic shootings.  And making straw purchases a felony might stop some of the street sales of guns in inner cities. 

I have mixed feelings about banning assault weapons, but I can get behind banning high-capacity magazines that let someone rip off 150 shots in five minutes.  That would definitely help in mass shooting scenarios, like the one in Arizona where the shooting was stopped when the shooter had to stop to change clips.  Some people think that stopping gun violence is a gun control issue.

I also have mixed feelings about "making schools safer."  There is some evidence that school resource officers (SROs), who are supposed to make schools safer, are criminalizing childish behavior and teaching kids to distrust police. But others say this isn't true.  The ACLU has put forth a paper to guide SROs that encourages thinking about "the role of SROs within the context of the educational mission of schools."  Some people believe that gun violence can be addressed as a school safety issue.

Increased access to mental health care is great because mentally ill people have been stigmatized and marginalized forever.  They need care.  Some people think that gun violence is a mental health issue.

But, even if we had the courage to enact them, these ideas alone are not enough to stop America's gun violence.  That's because America's gun violence isn't just found in mass shootings. 

CDC data indicates that there were 11,078 firearm homicides in 2010. That's an average of 30 deaths per day -- 30 people killed by guns per day. That's a Newtown every single day.

There were also 19,392 firearm suicides in 2010. Hopefully, steps will be taken as I proposed in an earlier post that might help bring this number down. 

Our biggest problem is not mass shootings.  I would posit that our biggest problem is the objectivizing and marginalizing of our fellow citizens, which causes daily violence.  Some Americans nourish a hatred for people who are not like them, and some feel as if they're in competition with everybody else.

 

Oryx Cohen, in a blog post, claims that we are all responsible for the mass shootings. He says, "[W]e are all responsible for creating healthier communities so these types of tragedies do not occur. We all have more power than we realize." He suggests some common-sense steps we could all take to avoid marginalizing people who are different from the norm. It's worth your time to read.

My friend, Heather, commented on a previous post,

"When you live in a country that has so many people vehemently against providing basic health care for everyone, it leaves you wondering just how much a human life is worth to these people? When you have people say that those without insurance and cannot afford care should just die? Is it any wonder that we have so many people killed with guns."

Heather just might be on to something here.

A CNN article reminds us that mass shootings are only a small fraction of America's gun crime. Its authors agree with Heather that many shootings are caused by societal ills, saying

"Through a complex mix of violence, institutional arrangements and exploitation, black Americans were pressured into ghettos, which are the hotbeds of contemporary gun violence. Their inability to escape their conditions is not a choice but rather the byproduct of continued structural discrimination. Slowing the tide of inner-city deaths through gun control is therefore a modern-day civil rights issue." (italics and bold type mine)

Randolph Roth, author of American Homicide, who researched homicide rates over a four-century period in America and western Europe, makes the following observations:

"[H]omicide rates among adults are not determined by proximate causes, like poverty, drugs, unemployment, alcohol, race, or ethnicity. Instead, factors that seem on the face of it to be impossibly remote—like the feelings that people have toward their government, the degree to which they identify with members of their own communities, and the opportunities they have to earn respect without resorting to violence—determine homicide rates." (italics mine)

"The killers were already predisposed to violence. They were already prepared to view people as enemies or rivals or prey."

"The predisposition to violence is not rooted in objective social conditions. . . . The predisposition to violence is rooted in feelings and beliefs." (bold type mine)

Jamilah King relates, in an excellent article at ColorLines.com, that people in Chicago are examining gun violence from multiple angles. A group called CeaseFire sees the root of the violence as untreated trauma and views it as a public health problem.

But David Brotherton, a criminologist at John Jay College, says that "Gangs are caused by people responding to massive levels of marginalization." (italics mine)  He thinks that CeaseFire is limited because that group can't "create jobs, they can’t make society shift real resources to the poorest areas.” This view sees violence as a political challenge rather than a public health one.

An op-ed in Yes! Magazine states that "U.S. society tends to deal with violence by treating it as an individual occurrence—focusing on the “perpetrator” and how he is different from us." The writer describes gun violence as a cultural issue.

So we have multiple perspectives on the gun violence that threatens Americans every single day:

• It's a gun control issue.
• It's a school safety challenge.
• It's a mental health issue.
• It's a civil rights issue.
• It's an issue of feelings and beliefs.
• It's a public health problem.
• It's a political challenge.
• It's a cultural issue.

The causes of gun violence are far more complex than what the president's plan addresses.  In addition to his plan, we need to make changes that allow people to feel valued.  We must make changes that allow people to believe they can achieve the American Dream. 

This means that we have to make our schools vibrant and attractive centers of learning, not for-profit operations.  We have to encourage our most talented and brightest people to be teachers, in part by paying them great salaries.  We have to make college affordable so people can learn to think critically and to advance beyond their class of origin.  We have to stop sending drug users to prison and get them help. We have to learn to really live by the Golden Rule, not just give it lip service. 

American Christians have to read the red letters in the Gospels and really love one another.  This means willingness to assist our fellow citizens who are in need, not to punish and penalize them.  It means that we are all created equal.  It means we must end the greed, selfishness, resentment, and inequality bred by our system of unfettered capitalism. 

Fixing this problem of American violence also requires leadership, compassion, and courage from the people we elect.  Unfortunately, there hasn't been much in the behavior of Republican politicians to make us think we can expect leadership, compassion, or courage from them.  They couldn't even pass an amendment that closes loopholes in background checks.  Let us pray that this obstructionism ceases.

Since 1971 I've been voting, reading, writing, educating people, trying to be more loving and peace-giving, contacting my state and federal legislators by phone and email to advocate for compassionate legislation, and attending small and huge demonstrations to call attention to issues.  I don't know what else to do.

We all, including you, must continue to take action to restore the American Dream and live by the Golden Rule.  This is the only way to end the carnage in America.

Can we rise to this challenge?

Scapegoating the crazy folk

I've been looking at the President's plan to reduce gun violence.  There's some good stuff there, but I have lately wondered if there is too much emphasis on mental health.  As if mentally ill people are the only ones shooting people. 

The President's plan, in the section on background checks, says some alarming things.  It contains a whole section on mental health care, and it discusses mentally ill people in the section about background checks.  The plan uses the euphemism, "dangerous people," to refer to mentally ill people.  So now, along with being called nutjobs, maniacs, lunatics, and monsters, we are "dangerous people." 

The NRA's LaPierre calls for a "national database of the mentally ill."  I guess we get put on his list, whether we are "dangerous" or not, just because we happen to be sick. 

But that's not right.  The majority of gun violence isn't attributable to mental illness, so don't blame crazy people for it.  There's no word for that except "scapegoating."

In an interview, Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration warns that we must

"disconnect the discussion about mental health from the discussion about violence. While there is no question that some people with mental health problems perpetrate violent acts, so do lots and lots and lots of people who don’t have mental health problems."

The Huffington Post gives us the sad information that, as of February 1, U.S. Gun Deaths Since Sandy Hook Top 1,280.    The article discusses many accidental shootings, and talks about "silly arguments" becoming "final arguments," but it doesn't mention any crazy people doing the shooting.

My friend, Heather, commented on a previous post,

"When you live in a country that has so many people vehemently against providing basic health care for everyone, it leaves you wondering just how much a human life is worth to these people? When you have people say that those without insurance and cannot afford care should just die? Is it any wonder that we have so many people killed with guns."

Heather just might be on to something here. 

Randolph Roth, author of American Homicide, researched homicide rates in America and western Europe for a four-century period. Discussing his book, he reveals that

"[F]actors that seem on the face of it to be impossibly remote—like the feelings that people have toward their government, the degree to which they identify with members of their own communities, and the opportunities they have to earn respect without resorting to violence—determine homicide rates."

Homicide rates aren't correlated with poverty, drugs, alcohol, unemployment, or race, according to Roth. Rather, it's the predisposition to "view people as enemies or rivals or prey" that determines whether people "are emotionally prepared to be violent at the slightest provocation or whether they refrain from violence even if they are brutalized or humiliated."

In Roth's discussion of his research, he never even mentions mental illness as a factor in high homicide rates.

A CNN article reminds us that mass shootings are only a small fraction of America's gun crime. Its authors agree with Heather that many shootings are caused by societal ills, saying

"Through a complex mix of violence, institutional arrangements and exploitation, black Americans were pressured into ghettos, which are the hotbeds of contemporary gun violence. Their inability to escape their conditions is not a choice but rather the byproduct of continued structural discrimination. Slowing the tide of inner-city deaths through gun control is therefore a modern-day civil rights issue."

Got that?  A civil rights issue, not a mental health issue.

Mass shootings are certainly heart-breaking and shocking.  And it's good that people understand how hard it is to get mental health care.  But an article published shortly after the Newtown shootings cautions against focusing on mental health care as the cure for gun violence:

"Such discussion, say psychiatrists and mental-health experts, may be beneficial if it actually leads to increased care and treatment, as well as better funding of treatment programs. But it also runs the risk of further stigmatizing mental illness or reducing civil liberties of the mentally ill, if people start to associate mental illness with violence."

Whether you want to call it stigmatizing or scapegoating, it's clear that blaming mentally ill people for gun violence is no way to stop the problem.

Bad. Very bad.

Today's in-box contained a letter titled "Message to Our Nation’s Health Care Providers" from the US Department of Health and Human Services.

Its release today suggests that it is part of the President's new gun policy proposals.

The letter says, in part,

[T]he Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule does not prevent your ability to disclose necessary information about a patient to law enforcement, family members of the patient, or other persons, when you believe the patient presents a serious danger to himself or other people.
 

It goes on to say that

The HIPAA Privacy Rule. . . . allows the provider, consistent with applicable law and standards of ethical conduct, to alert those persons whom the provider believes are reasonably able to prevent or lessen the threat.
 

This is bad.

You can take a look at the letter and see what you think.  When I read it,  I see confusion.

The letter bounces around a lot, telling providers that the HIPAA Privacy Rule doesn't prevent them from betraying their clients' confidentiality, talking about their "professional ethical standards," "the laws applicable to their profession in the states where they practice," and ending with "providers play an important role in protecting the safety of their patients and the broader community."

This letter/policy will have two effects.

1.  Clients will not trust their providers.  A client's relationship with her/his therapist must be based upon trust. 

Some clients or potential clients will have thoughts of suicide, thoughts of murder, thoughts of murder-suicide, or other forbidden thoughts.  It is important that they be able to verbalize these thoughts.  Verbalizing, processing, and understanding these thoughts is important.  Perhaps verbalization would prevent a client from acting on these thoughts.

But if clients with these thoughts value their possession of guns, if they hunt, if they shoot skeet, if they like to shoot targets on a range, if they are survivalists, or if they just don't want to be on a list, they will either stop seeing their counselors, hide their thoughts from their counselors, or refrain from seeking therapy altogether. 

If they do seek therapy and their provider tells the authorities that they are dangerous, how, then, do they continue therapy with that provider?  How, then, do they trust any counselor again?  They are done with therapy.  Maybe forever. 

This is bad.

2.  Providers will be confused.  How do you tell your client or patient that everything s/he says is confidential except suicidal or homicidal thoughts?  Oh, but only if s/he's serious.  What?  What if the entire reason the client is there is because s/he is suicidal?  Or having murderous thoughts?  How does one decide if someone who verbalizes such thoughts is likely to act on them?  Is that even possible?

Ah, but then there is another shooting.  It is revealed that the deceased shooter sought therapy.  The deceased victim's family sues the therapist.  It is a sensational trial.  The therapist's notes are subpoenaed. and they show that the shooter discussed his thoughts about killing another person.  The therapist is ordered to pay damages, and a career is ruined.

After this happens once or twice, providers will learn.  They will understand that they must report anyone who discusses any thoughts of violence or risk their careers and livelihoods.  No more professional discretion, just report it all.

This is bad.

Both of these situations will prevent people who need treatment from seeking it.  These situations will further stigmatize those who seek treatment for a "mental" condition.  They will further shame anyone who has taken psychotropic medications.  They will remove confidentiality from the therapist's toolbox.  And they may not even prevent gun violence at all.

I commend the President and Vice President on assembling a variety of recommendations to end gun violence.  But this letter to providers is a mistake.

I stand by my original proposal¹, that people should be added to the no-gun list only if they are admitted to a mental health facility as a danger to self or others.  Any less-strict criteria will only lead to more gun violence, not less. 

And this is bad.


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¹ Put me on the crazy list, Crazy list part 2

 

Crazy List part 2

An anonymous commenter wrote the following thoughts about a previous post:

I guess I'm wondering if we would have . . . a decrease in those willing to seek treatment for the fear of losing the privlage. I do have a permit to cary a weapon and if I thought I would lose that permit by going to the hospital for help, I'm not so sure that I would go. I have been a hunter since I was 12 and value my permit as much as my drivers licens. I'm wondering how many people would try to push through it instead of getting help if losing there permit was seen as being a punishment for being mentaly ill?

I realized when I wrote the original post that a decrease in seeking treatment could be an unintended outcome, but I decided not to address it.  My thinking was that I can only put so many concepts in a single post before my reader gives up on the post.

But now that this person has asked the question, let's talk about it!

Please note that people who are involuntarily admitted to a mental health facility, because they are a danger to themselves or to others, are already prohibited from possessing, using, manufacturing, controlling, selling or transfering firearms under PA law.  These people would already be labelled as "mental defectives" (!) under federal law, and prohibited from purchasing firearms when a background check is performed.  Thus my proposal would have no effect in this situation.  The change I propose would only affect those who admit themselves voluntarily. 

That being said, I would like to address two things from the comment.

First, the commenter says, "if I thought I would lose that permit by going to the hospital for help, I'm not so sure that I would go."  It's really not likely that you would need admission to a hospital for help with depression.  There are many other treatments for depression besides a hospital stay.  You could get help from a psychologist, psychiatrist, an outpatient program, or even your primary care physician.  You could be treated via talk therapy or medication.  According to WebMD,  over 90% of depression is treated on an out-patient basis.

Second, I'd like to discuss the commenter's assertion that her/his carry permit was just as important as her/his driver's license.  I tried to picture how that would feel:  What if  admitting myself to the hospital for suicidality would result in losing my driver's license? 

Please bear with me now as I try to respond to this honestly.

My gut response was that, of course, I would still admit myself.  After all, if I didn't get into a safe environment, there would be no more driving anyway.  Or sleeping, or eating, or anything.  Because I would end up dead if I didn't get into the hospital.

After some more honest consideration, however, I wondered if I wouldn't try to "push through it instead of getting help," as the commenter suggested.

Because here's the thing.  If I admitted myself to the hospital, I would do so under the assumption that it would stop me from killing myself. And that I would eventually be released.  It would be very important for me to have my driver's license when I left the hospital, especially because I live in a rural area where driving is a necessity. 

So maybe I would not admit myself if I thought I'd be released and then not have my driver's license.

But, dear commenter, I'm afraid I have to reject the idea that guns are as important as drivers' licenses for many Americans, and guns would not be a consideration when seeking voluntary admission to a hospital for suicidality.  Most depressed people would not worry about losing their guns, because they simply don't have any.

I formed this opinion from statistics in the following articles:

There are more women than men in the United States.  Women suffer from depression at roughly twice the rate of men.  So I think it's safe to say that more than two thirds of depressed people in the US are women.

Another study finds that 45% of men own guns, whereas only 10% of women own guns.  So it looks like only a small percentage of depressed people own guns.

And remember that per WebMD, only about 10% of depression cases require hospitalization.

It appears that the loss of firearm privileges would affect only about 2% of depressed people.*  And I would expect that an even smaller percentage would be as passionate as the commenter about potential loss of their Second Amendment rights if they were considering admission to the hospital for suicidality.

So, in answer to the anonymous commenter, I do not think that my proposal to add voluntarily admitted people to the no-gun database would much decrease the likelihood of seeking treatment for depression.

      
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* I tried to come up with a formula to represent what percentage of the population would actually be affected by my proposal, but I'm a word person, not a numbers person.  This is how I did it.  Feel free to correct me!

women - 66% of depression cases  x  10% hospitalization  x  10% own guns
men - 33% of depression cases   x  10% hospitalization   x   45% own guns

so

for women  -  .66 x  .10  x  .10   =   .0066   = my proposal affects .007 of depressed women or 0.7%
for men  -  .33  x  .10  x  .45  =  .01485   =  my proposal affects .015 of depressed men or 1.5%

add depressed women and men  -  0.7%  +  1.5%   =  2.2%

Thinking outside the box of sanity

Yeah, I hate that "outside the box" cliche, too, but it just seemed to fit.

Please consider the following.  I understand that it is probably so far out of the experience of most people as to be offensive.  But hear me out.

Adam Lanza killed 20 children and 7 adults besides himself.  But nobody seems to understand why he chose that elementary school.

What if Lanza thought he was doing the children a very big favor?

Here's the thing.  In my very darkest time, I thought it would be merciful to take another person's life.  I felt a terrible certainty that the person would eventually feel the same anguish I was going through.   So it just made sense (to me) that I should save that person from despair by killing him or her before the torment came.

So if Lanza was depressed enough, as research has shown that 78% of mass shooters have been, he may have gone to the school to save those children from that unspeakable despair. 

Perhaps he was so depressed, so hopeless, in a black pit so deep that he could see no way out ever, that he sought out children to save them from enduring that same despair.  A mercy killing of sorts.

In his mind, maybe the adults he killed were also fortunate, for the same reason.  They just didn't know it.

I am not excusing his murderous behavior, just trying to get a handle on what he may (or may not) have been thinking.

I had an appointment with my psychologist the week after the shooting. 

I asked her the question, "What if Adam Lanza thought he was helping those children?"

She said, "You're the second person who has asked me that this week."  So I'm not the only person who thought of this. 

Does this explain his targeting of young children?  We'll probably never know.

But thanks for reflecting on this with me.

Put me on the crazy list.

First and foremost, let me state that mentally ill people are far more likely to be the victims than the perpetrators of violent crime. And that it's not clear that the Newtown shooter was being treated for any mental illness. And that I don't speak for anyone but myself. Other people will have other, perhaps conflicting, ideas; I welcome your ideas in the comments section below.

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I have been seriously suicidal multiple times. I have been hospitalized because of this, also multiple times. If you read my previous post, you can see that I was definitely a danger to myself. And sometimes I was a danger to others.

I have been healthy for a decade at a time and then gotten depressed and suicidal again. So, regardless of how happy and healthy I appear to be, there is a chance that things will change and I will become suicidal again.

I should never be able to purchase a gun.*

Since the Sandy Hook shootings, I have been drowning in research. Here is some of what I found:

A Harvard School of Public Health study that analyzed data on three groups of adolescents found that "[t]hose who died by suicide were twice as likely to have a gun at home than either of the other two groups." They agree with my previous post that firearms are a more lethal means of suicide because there is no changing your mind once the trigger is pulled. Take a look at their chart showing the fatality rate for different methods of suicide.

Also consider that for individuals who kill their children and commit suicide (filicide-suicide), "The large majority (73%) of parents killed their children by shooting." A 1993 study concluded that there was a correlation between defensive gun ownership and suicide, but not beween sporting gun ownership and suicide. There is also a multitude of research on mass shootings, if you want to check it out.

It has also been shown that severe mental illness is a common feature of filicide-suicide.

So firearms are the most lethal means of suicide and the most prevalent method of filicide-suicide. And many people who commit filicide-suicide have a serious mental illness. To me, this suggests that we must stop seriously mentally ill people like me from having guns.

I understand that changes to background checks wouldn't have made a difference in the Newtown shootings, because the shooter used weapons that his mother purchased legally. So should background checks include searches for those who live with the potential buyer? I have had to list people who lived with me for an employment background check. If it's okay to review this for employment, why not include this search in firearms background checks?

Currently, one of the reasons you can be denied the purchase of a gun is if you have "been adjudicated as a mental defective or ha[ve] been committed to any mental institution" (page 9). The NRA's Wayne LaPierre thinks we should go even further and have "an active national database of the mentally ill." In fact, 38 states already have such databases. The problem is that it's a patchwork project, and each state has different criteria.

Some firearm owners are afraid that such a database is a slippery slope. Other people reject the idea of a database listing those with "a history of mental illness." So do I; that terminology is much too broad.

There is also a concern about labelling and stigma. Some people object to being labelled as "mentally ill" at all, let alone being on a federal list. Being on such a list could cause more shame for those who already feel stigmatized. But the rules already state that the person performing a background check will not see "any of the underlying information in the records checked by the system" (p. 113).

My friend Neil is afraid that the method of getting on such a list would be hinky, and that the list could be used for other purposes, up to and including denying employment. This is another slippery slope, where initial intent could be corrupted by a panicky public.  And I share that concern.  But if this is a piece of the puzzle that will help stop mass shootings, I am willing to take that chance.

Clearly, the language for this must be precise. Stop referring to people as "mental defectives" and don't target people with "a history of mental illness." Here are my suggestions:

• Change the language to say that you cannot buy a gun if you have been admitted to a hospital because you were a "danger to yourself or others," whether you were adjudicated or you admitted yourself.
• Only designated employees of hospitals should be able to add to the list.
• The list should only be available to firearms dealers and the Bureau of Alcohol, Tobacco, and Firearms.
• It must be a federal database, with uniform, specific criteria regarding who should be added to the database.

 

And put me in that database right now.

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* It makes me very sad to say this, because, having gotten used to the idea of killing myself, the thought of suicide is like an old friend, and I would really like to have a gun to keep that old friend company.