Blog

The Availability Heuristic and You

Alright, you’ve read this blog before, right? So, what do I hate more than almost anything else, despite the fact that I just can’t stop checking it? Yes, social media. I’ve written over and over and over about how evil it is and how much harm it can cause and blah, blah, blah…

(Okay, yes, I know it isn’t necessarily THAT bad, and that it does have many positive benefits, but people should use it with caution)

Anyway, I had an interesting conversation the other day about how terrible things are in the world and how all it seems like you hear is bad news. My friend and I were discussing this, and he specifically mentioned the Availability Heuristic.

For those of you who didn’t take Psych 101, in the most simple terms possible, the Availability Heuristic is the notion that what you see is what you get. Your mind, when thinking of things, thinks of the loudest or most recent things that it sees.

And this, in turn, can really lead to depression. Particularly in a social media-heavy world.

Think about it: You sign onto social media, and what do you see? TRUMP SETS THINGS ON FIRE! DEMOCRATS SET BABIES ON FIRE!

I mean, I’m kidding…a little. But as you scroll, you get more and more depressed. We’re exposed to a good chunk of statistics and information that other generations couldn’t even fathom. This can warp our perception of the world and alter our moods and feelings.

Given the reality of the Availability Heuristic, I am convinced that this is part of why we have so much trouble in the universe today. We see and think of things that are only immediately available and memorable. And that’s the bad news.

I mention this because I think this is an interesting way of framing the conversation of social media. There’s a set, cognitive bias for why we think and feel the way we do, and the better we understand this, the more sense all of our minds will make. Remember, it’s not just you. Cognitive biases like these exist to poke us in the head and make us see things a certain way. They have their evolutionary benefits to be sure, but sometimes, they can run amok.

So, short of throwing your phone out the window, what can you do if you do find yourself getting depressed by the evening news and your Twitter feed? Remind yourself of this fundamental truth: The bad news is sticking in your brain more than the good. This is normal – even healthy to an extent – but it isn’t as bad as it seems.

New Suicide Statistics Show that Things Are Still Getting Worse, but…

The CDC has released new suicide statistics for 2018 (previous numbers were for 2017). The results, by and large, were problematic. In a nutshell:

  • Suicide deaths in America went from roughly 47,173 to 48,344. That’s an increase of about 1.4%.
  • Believe it or not, there’s good news here. The slope of the increase is starting to flatten: Suicides increased 4% from 2016-2017. This would imply…hopefully…that the rate of suicides is starting to slow down.
  • Suicide remains the 10th leading cause of death in the United States.

More data will likely be available in the future, including a breakdown of suicide methods and age breakdowns of those who died. That information, of course, will be particularly insightful. On a personal level, I’m deeply interested in the numbers in Pennsylvania. Since 2013, we’ve had suicide rates that are above the national average. I suspect that those trends remain unchanged and that we will see a small increase over the 2,030 people who took their lives in 2017.

There are two ways to look at these numbers, and I think that both are valid perspectives. On one hand, the problem continues to get worse. Suicide numbers are accelerating, and the numbers continue to get worse, as they have roughly ever year since around 2004.

On the other hand, as the American Foundation for Suicide Prevention accurately noted, there are reasons to be hopeful:

  • The rate of increase has slowed.
  • Awareness about the problems of mental illness and suicide continues to grow.
  • More and more people are going public with their own struggles.
  • More and more units of government are comprehensively addressing suicide and suicide prevention. Such a strategy appears to be working for opioid overdoses, and that should give us all hope when it comes to suicide prevention.

Indeed, articles like the one run by the Huffington Post on the subject do a great job of discussing suicide. They present the statistics in a rational, reasonable manner. They also present stories of hope and specific, concrete suggestions for how to deal with mental illness and suicide. Those suggestions – reach out, be non-judgemental, understand that suicide is a comprehensive illness – they are all evidence-based.

So, yes. There are reasons to be hopeful, but we must continue to acknowledge that we have a major mental health crisis in front of us. One which will require – demand – public policy decisions.

 

LGBT Marriage Equality Saved Lives

I’ve written extensively on the connection which society forces upon people who are LGBT and have a mental illness. To be clear, there is nothing inherently mentally ill about anyone who is LGBT: It is the societal pressures and discrimination faced by people who are gay or transgender which can give them a mental illness. This is a tragedy and a sin that we must address at a societal level.

If you’ve read this blog long enough, you know that one of the items I regularly harp on is the connection between mental illness and public policy. That connection was first driven home for me in a 2015 study which showed that members of the LGBTQ population had higher rates of mental illness and addiction in states where marriage equality wasn’t the law of the land than in states where it was legal. To be clear, this may be a classic case of correlation not equalling causation, as there may have been other reasons which LGBTQ people had better mental health in these states. However, it would certainly imply that there is a connection between mental illness and discrimination – a finding which was picked up in other countries, like Australia and New Zealand.

Finding that study was a critical moment for me, at least in terms of how I viewed mental health and public policy. Not only does public policy influence mental health, but it influences it in ways which we may not expect.

Well, here’s more proof: As noted in this Upworthy story, suicide attempts by LGBT youth dropped in states that legalized gay marriage and didn’t drop in states that didn’t. Similar findings were replicated in other countries that embraced marriage equality.

Again, the findings aren’t necessarily causational, but they would seem to pretty strongly imply a connection between societal stigma. Countless other studies have proven that treating any typically discriminated group with love, acceptance, and support can reduce their suicide rates. The legalization of gay marriage can make a massive difference here, as it ended a societally-enforced piece of discrimination.

Public policy and mental health matter, and matter deeply. We can, and should, examine all aspects of public policy through a mental health prism, as this connection exists in dozens of public policy spheres – everything from transportation to minimum wage to licensure laws and more.

New study: 13 Reasons Why did not cause an increase in suicides, and may have done some good

I’ve written repeatedly about Netflix’s 13 Reasons Why, and usually in a pretty damning light. Like others (who are far more informed and educated than I am), I’ve expressed my real concern that the show has unintentionally glamorized suicide, and there has been evidence to suggest that it actually led to an increase in suicides.

However, a new study shows that this may not be the case, and, in fact, that 13 Reasons Why may have done some good.

First, a review. 13 Reasons Why tells the story of Hannah Baker, a teenage girl who dies by suicide and leaves behind tapes for people to listen to, explaining why she died and their role in her demise. The show was criticized by many for glamorizing suicide and presenting it as a possible choice, and Netflix eventually removed the three-minute, highly graphic scene in which Hannah dies.

Of course, that removal came after being viewed millions of times, and at least one report directly tied the show to a rise in suicides.

However, a new study came to the opposite conclusion:

But a recent reanalysis of the data by Dan Romer, research director of the Annenberg Public Policy Center at the University of Pennsylvania, found no evidence of an increase in suicides for boys, and (like the original study) an insignificant increase for girls. Romer adjusted the data to factor in trends like an overall increase in adolescent suicides since 2007.

That’s important. But it’s not as important as this finding:

But when Romer conducted a study on 13 Reasons Why’s effects on self-harm, published last April, he found that teens who watched the entire second season of the show were less likely to purposely injure themselves or seriously consider suicide, even when compared with those who did not watch the show. He said that this could be because of the Papageno effect, which occurs when stories that portray people overcoming their suicidal crisis end up reducing suicide rates. The effect is named for a character in Mozart’s opera The Magic Flute who considered suicide until his friends showed him a different way to solve his problems.

The second season of 13 Reasons Why features a character who is depressed and considers suicide – but survives. This is important, and it feeds in with a larger theme in the mental health universe: We have to share stories of hope, of survival, and of seeking help successfully.

Part of the reason that so many (myself included) thought 13 Reasons Why was so damning, as portrayed, is because it features a character dying by suicide in a graphic manner. This can create copycat scenarios. However, the good news is that the Papageno Effect is real and has been repeatedly backed up by science. This is great news: If you can show someone finding hope, you can inspire others to do the same.

I appreciated this alternative perspective of 13 Reasons Why, and I appreciated the hope that it could potentially inspire in others. It also reinvigorates what I have said for ages: Share your story. It’s why I’m so passionate about sharing mine.

You can save a life.

Another Study Ties Higher Minimum Wage with Reduced Suicides

I’ve written about it before: Economics and suicide are tied. To be clear, that’s not to say that poor people are more likely to die by suicide; by and large, suicide crosses economic boundaries. What is more likely to be associated with increases or decreases in suicide rates is a change in economic status: An increase leads to lowered suicide rates, while a decrease leads to higher rates.

And that brings us to this study, published in the Journal of Epidemiology & Community Health. The study examined 25 years of economic and suicide rates in all fifty states and Washington, D.C. From the results of the study:

The effect of a US$1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. We detected significant effect modification by unemployment rate, with the largest effects of minimum wage on reducing suicides observed at higher unemployment levels.

In other words, an increase in the minimum wage can save lives.

This study was picked up in numerous major media outlets, including CNN and NPR. As the CNN story noted, if you assume that the data from this story is accurate, an increase of $2 could have saved upwards of 40,000 lives between 2009-2015.

This study shows many things, but there are two, in particular, I want to focus on.

First: It challenges the idea that suicide is exclusively related to mental health, or at least adds a qualifier and a modifier to that idea. I think that when most people think of suicide, they think that a person who dies by suicide must be mentally ill. That makes sense, of course, and it’s a perfectly logical conclusion to reach. However, it’s not completely supported by the evidence. If depression was the only thing that mattered when it came to a suicide attempt, the minimum wage wouldn’t make a difference unless you assume that economic status is tied directly to mental health.

What this shows, again, is that suicide is not simply a matter of mental illness.

And that leads me to my second point: Everything is connected. Mental health is deeply connected to economics, and if we can ensure a robust social safety net, fair wages and equal opportunity, we can reduce suicides and save lives. This study proves it – again – and it isn’t even the first to make the argument that work and work hours are tied to minimum wage.

As public policymakers, we have a job to address major problems (like the massive spike in suicides) in a manner that is holistic and comprehensive. That means not only improving access to mental health care but reducing the causes of suicide.

That means increasing the minimum wage.

Anxiety and a Rigid Life

I have a sincere question for you, and if you have anxiety issues, I suspect you know why I ask this.

One of the best ways I think I’ve ever summarized anxiety – at least the really bad, crippling kind – was by describing it as a box. You live inside the box. And slowly, as the anxiety ramps up, it gets worse, and the box starts to compress. Little by little, it squeezes you in, trapping you and stopping you from doing things you previously enjoyed. Going out late at night. Living with spontaneity. And then you just find your life stuck inside this box, regimented by routines and a fear of fear that you don’t fully understand but absolutely cannot conquer.

Here’s my question: Is this you? Because it does feel like me.

As I’ve discussed previously, generally speaking, I feel like I live a life in recovery. That’s a bit of a complicated statement because I unquestionably still suffer from a series of anxiety and depression related issues. But I say it because I feel like I can lead a good life and a relatively happy one.

But, there’s no question about it: I lead a life that has been limited by anxiety.

Examples? I can’t stand surprises. I have to know where I’m going and what I’m doing. Open social situations – parties, etc – can be intimidating. Weird thing for a politician to write out, right?

I crave routine. I like to be doing X at this time and doing Y at this time. I’m obsessed with my calendar and my to-do list because they keep me on schedule and knowing what I am doing, something I crave and need.

Do I think I’m living in a box still? No. I don’t. But I do think there are some ceilings in my life. Some things which are limited by my anxiety.

Huh. This has been instructive to write. Might be something I want to bring up in therapy later because it’s not something I want to live with. I’d love to live with a bit more flexibility and spontaneity. I’d love to be able to go out places without…fear.

It’s a defense mechanism for me. A coping skill, one developed by the unfortunate reward your body gives out for avoiding the anxiety caused by anxiety-inducing situations. Repeat this pattern enough times and you have agoraphobia. No, that certainly isn’t me, but it is something I always feel like I have to watch out for because I am a natural homebody. I think this is a big part of why.

All of that being said, if you know what I’m talking about, if this writing strikes a chord with you, please comment below and let me know what you think. Does this sound familiar? How do you deal?

 

Why Words Matter – Even If It’s Not You

 

As some of you may have seen in the news or on my Facebook page, we had quite the day this past Friday. Governor Wolf was in town, holding the first of what will be many mental health roundtables. He announced the kick-off of Reach Out PA: Your Mental Health Matters on Thursday. It’s an overall, comprehensive effort to reform and improve Pennsylvania’s mental health system. It’s fantastic and desperately needed.

At the Governor’s Press Conference on Thursday, the Governor said:

“For those struggling with their mental health, we have one message: your mental health matters and it’s okay to reach out for help. We are stepping up our efforts to ensure every Pennsylvanian can access mental health care and more agencies can respond to the challenges facing Pennsylvanians struggling with their mental health. The act of reaching out for help – or to help – can make a huge difference for someone struggling.”

I opened the roundtable with this:

Obviously, I’ve discussed my depression and anxiety before. I haven’t quite gotten that intimate with how close I came to a suicide attempt, so that was a bit new.

I actually wasn’t even planning on doing that until a few hours before the event, when it hit me: I was going back to the place where I had seriously considered ending my life, standing with the Governor, my Congresswoman, friends, colleagues, and advocates, with the goal of saving lives.

(Random side note: I actually tagged my ex-girlfriend on Facebook for saving my life. We’re certainly on good terms, but I can’t imagine how weird that must have been – she looks at her phone and goes, “Wait, who tagged me? Why did that happen?)

I have to say – on a personal level – how much it meant to share that story. At the table with me was the Governor, my Congresswoman (Susan Wild, who has become a dear, dear friend) and Dr. Rachel Levine (PA Secretary of Health). Dr. Levine is brilliant and one of my favorite cabinet members with the Governor. She’s also a pioneer, serving as one of the highest-ranking transgender government officials in the United States. I cannot imagine how many kids and adults look at her and draw hope from her success and competence.

Congresswoman Wild is an advocate for mental health in and of her own right after she lost her life partner, Kerry Acker, to suicide. And Tom Wolf is truly one of the most recent people I’ve ever met in this job.

To be able to share that story – with those fine people, and everyone else in the room – that was meaningful. It gave meaning to what I had endured.

So, away from myself now. What the Governor has said about mental health, what others in his cabinet have said…it matters deeply. It matters because the Governor is lending his personal credibility and institutional strength to a push for better mental health access.

Public policy, public statements, and stigma are all interwoven. By doing events like this, there are people out there who are recognizing what the Governor is doing. At least some people will be touched by his words, by all of our words. And hopefully, they will be more likely to get the help they need and deserve.

Look, this system needs investment. Massive investment. We need more workers, more funding and less stigma. That all ties together. I hope and pray this was the start of a more comprehensive effort.

But I know that hearing someone as important, well known and well-liked as the Governor say that it is okay to ask for help – that matters. And it should matter if you say it, too.

“People who conquered depression and/or anxiety, what’s the #1 factor that helps you?”

As some of my prior entries have indicated, I’m a big fan of Reddit. If you use it the right way it can be hilarious, inspirational and adorable.

One of the more popular subreddits – and certainly one of my favorites – is AskReddit. In AskReddit, users can post a question to the Reddit community. Some of the questions are serious: “Why can’t you sleep tonight?” Some are hilarious: “You’re being interrogated and so far you’ve held strong. What song do they play on repeat that breaks you?”

And then there’s moments like these:

This was truly interesting. The top responses are largely along the lines of answers you might expect: Sleeping well at night, keep busy, stay away from social media (irony, right?), stop overthinking, etc.

I answered this question (surprise!), but I took my answer in a different direction. Here’s what I said:

I’m gonna spin this one on its head a bit. I think it’s important to address this answer to those of us who haven’t conquered depression or anxiety, and who never will.

Depression for some is a temporary condition as a result of a variety of factors, including social or cultural experiences, genetics, your upbringing or traumatic events. For people like this, time, therapy and/or medication – as well as lifestyle changes – can result in permanently defeating depression, and never seeing it again.

For other individuals – and people like me – it’s a permanent, chronic condition. Personally, I’m lucky – my ups are relatively long and my downs are manageable. For now. But, for people who will never truly rid themselves of depression or anxiety – who will experience it all their lives – it’s important to realize that this may be your world. Some people are cursed with physical disabilities which dramatically alter their lives and the way they experience it. For others, like us, it’s a mental disability.

What’s the #1 factor that helped me? I honestly think that one of them is this knowledge. The idea that I will never, truly be rid of depression. Why has this helped? It takes the pressure off. It makes me realize that I can lead a good life, even if this is always who I’ll be. That the “black dog” – as Churchill called it – will be a constant companion and challenge.

Second: To an extent, I have power over it. No, I don’t think I’ll ever be rid of depression. I don’t think I’ll ever be rid of the sinking feeling in my chest, the tension at the base of my neck, the imposture syndrome, the constant fear of losing everything and everyone I love. But I do have control. If I seize it, there are things I can do. That means self-care – therapy, medication, writing, working out being a type-A personality, etc. I accept that it has ruined other parts of my life, but strove to make me better in a variety of others.

Third: Accepting the positives of depression. It has made me constantly force myself to do something to improve myself, my life or those around me. It has made me tougher. It has given me a perspective and sense of empathy which I could never have imagined. And it has dramatically and positively impacted my career (I’m a State Representative in Pennsylvania, where I work largely on mental health issues – I also write and blog on the topic).

Yeah, leave it to a politician to not answer the question and answer it at the same time………..

My answer was long enough and pretty self-explanatory, but it’s worth noting again: Some people don’t “conquer” depression. They just learn to live with it, how to manage its ups and downs. I think that’s me. Once I accepted that – once I stopped kicking myself for feeling the way I did – it let go a lot of stress.

That being said, I don’t want to make it seem like my answer to the question was somehow crapping on the other ones. Less time on the internet, sleeping right, etc. – those are REALLY GOOD WAYS of beating depression. I just think that, for some of us, the idea of “conquering” depression is a bridge too far, sadly.

But that doesn’t mean it gets to run our life!

 

“Just Water” – What Happens When You Can’t Drink Thanks to Your Anti-Depressants

The other day I made an obnoxious crack about having never entered a Wine Cave (see the Democratic primary debate for more info, or better yet…don’t):

That tweet inspired this thread:

So, let me expand on this, because I think it’s an important topic – particularly if you are wondering if and how to drink when you take anti-depressants.

I didn’t start drinking until after I started anti-depressants, which was the start of my 2nd semester, Freshman year. Even in college, I wasn’t much of a drinker, but seriously, half a beer, and WEEEEEEEEEEEEEE. As I grew up that changed a little bit, but never much. On my best day, it was never more than two drinks before I got a decent buzz going. I didn’t mind all that much, since alcohol was never much of a part of my life.

As I grew older I came to appreciate drinking for the taste . I’d go out, have a glass of wine and enjoy my night. Unfortunately, at some point in my early 30s, that went out the window: I had one drink AND FELT LIKE SUPER DEATH.

There was no cause for it: One drink, and massive hangover. I guess that’s what happens when you get older. As a result, I cut alcohol out of my life completely. I haven’t had a drink in two years.

Am I alone in this experience? Hardly. Most SSRIs (the type of anti-depressants I have always taken) are known for causing issues when it comes to alcohol. According to the Mayo Clinic, alcohol can cause problems for people on anti-depressants and may result in an enhancement of symptoms or a greater than expected intoxication. I was never more depressed when I drank, but I absolutely had a lower tolerance.

Furthermore, I always felt like different parts of me would get drunk at different levels. There would be times where my hand-eye coordination was clearly off, but my mind felt sharp as ever, and other times where the reverse was true. It always felt like different parts of me got drunk at different rates, and I always wondered if that was just me or a result of the interaction between the booze and the anti-depressants.

All of this has led to a bit of an “other” experience for me, and me saying “Just water” at more banquets and dinners than I care to think about. Yes, I do feel a bit apart from others at social events. I won’t lie about that, and it is a bit isolating. Thankfully for me, my wife doesn’t drink at all (no reason – she just doesn’t have a taste for alcohol), so we hang out together, stone cold sober.

Do I wish it wasn’t like this? Yeah, I do. I wish I could go to the bar and have drink. I wish I could have  glass of wine with dinner. But, that’s the price you pay for taking medication which saves your life. Sure, I wish it was otherwise, but it’s basically a question of this: Would I rather drink, or would I rather not want to die?

I’ll add that my experience is not necessarily going to be yours, or even likely. You should absolutely talk with a doctor before mixing alcohol and anti-depressants – mine told me that everyone’s experience was different and I should use caution. I never had any experience with alcohol until after I started my anti-depressants, so maybe I would have had a different experience if it had been otherwise. I also never drank much as I got older, so perhaps my experience would have been different if I had.

It’s a shame, but it is what it is. No question – it’s worth it.

Any similar experiences to share? I’d love to hear them – let us know in the comments!

 

Will new three-digit Suicide Prevention Hotline lead to a surge in calls?

As you may have seen last week, the FCC voted to formally approve the regulatory process which would take the Suicide Prevention Hotline number (currently 1-800-273-8255) and turn it into a three-digit number, 9-8-8. It will take at least a year for the new line to go live.

For many reasons, this is a big deal in the suicide prevention world, and a wonderful development which will save lives. I can think of two reasons why this is so important off the top of my head. First is obvious: It’s an easy number to remember, like 911. Most people haven’t remembered the suicide prevention hotline number (I always have to Google it when I do blog entries like this, and I’m very in tune with the mental health world), and that’s an extra step. When someone is in crisis, you want to make it as easy as possible to get help. For the same reasons, means reductions matters when it comes to preventing suicide.

Second is the cultural statement: Suicide prevention matters. We all know 911 and understand the importance behind needing to call for help as soon as possible. With suicide numbers continuing to rise unabated, having a three digit number is a statement of priorities. It’s our way of saying, “Yes, this is important – really important. So important that we’re going to elevate the ease of getting help.”

But, that’s not to say that issues may not emerge as a result of this very significant and important change. As noted by this article from Pew Trusts, the new number will likely lead to a surge in calls. That’s good if it helps more people get help, but it can only help people get more help if the hotlines are prepared.

As noted by the article, there is not one massive hotline, per se, but a series of local hotlines, and many of them are “woefully underfunded.” Waiting periods and being bounced to a less local line are already occurrences which occur, and this surge in calls may make things worse. Furthermore, some states are in better shape then others. Six states (Georgia, Arizona, Colorado, New Mexico, New York and Utah) have made substantial investments and improvements in their suicide prevention hotlines, centralizing and standardizing systems while also expanding them. These states will be better prepared for the change over, but others may not.

What’s the solution here? The shift to 988 is great – but only if these lines are adequately funded. State and national governments have to expand funding, and they have to do it now. Pennsylvania and the rest of the nation have been utterly devastated by the opioid crisis which has taken more than 70,000 from us in 2017. As a result, we invested tens of millions of dollars in prevention and treatment. Suicide took 47,000 from us in the same time period, and hasn’t seen anywhere near the same levels of investment.

We need to invest the money here, too.