Five years public: A reflection and a request

It’s Sunday evening as I type this, and it is a beautiful night. And, as Facebook was kind enough to remind me, it’s also a sad anniversary: Today, five years ago, we lost Robin Williams to suicide.

William’s suicide inspired a slew of memorials, sadness and outpourings of grief. It also reinvigorated a conversation about mental illness in American society that desperately needed to happen – and now, needs to continue. Williams had always struggled with mental illness and addiction, and had always been very open about his pain. Now, the extent of his demons were laid bare for all to see.

I was letting my dog out in the backyard when my wife texted me the news of William’s death and suicide. And it hit me hard. As I’ve said repeatedly, if a man like Robin William’s could lose his battle, what hope did I have?

Then, while scrolling through a Facebook status, this comment, from someone I defriended on the spot: “So sad Robin Williams committed suicide. He just needed more faith in Jesus!”

That comment crystallized it for me: People really were this dumb about mental illness.

And that resulted in this Op-Ed in the Allentown Morning Call, by State Representative Mike Schlossberg: Reflections on a Personal Journey with Depression.

From the op-ed, words I had never said publicly before:

It was October 2001 when I began my journey with depression. A freshman at Muhlenberg College, I had been sad before, but never like this. It was a hopelessness that felt like a black cloud smothering everything I did.

It felt like my future was a wall — that there would never be any brighter days. I didn’t know I was suffering from depression at the time, but I do remember I couldn’t see any hope. The words of friends and parents were largely irrelevant, and I didn’t understand how I would ever feel OK again. After suffering through that blackness for many weeks and months, I began to contemplate if suicide wasn’t the better option.

Monday’s tragic suicide of Robin Williams has left millions of Americans baffled. How could a man of such talent, humor and power choose to end his own life? The sad and tragic truth is that mental illness, depression and suicide know no boundaries.

My path to recovery began with Rick at the Muhlenberg College counseling center, who helped teach me how to change my thinking, cope with the stress of a new school and how to deal with a breakup with my girlfriend from New Jersey.

When it became clear words weren’t enough and the anxiety attacks began getting stronger, he recommended me to a psychiatrist, who put me on an anti-depressant and anti-anxiety pill, which I still take to this day. I type these words without any shame. Why would I be ashamed? Are any of you embarrassed to be taking Lipitor for your cholesterol or Prilosec for your heartburn?

My point is this: Millions of Americans suffer from mental illness, and millions recover. There is no shame in saying you are depressed, you are anxious, and you need help.

There are many real tragedies which flowed from Robin Williams’ death. First and foremost is the human one: A husband, father, artist and inspiration left us way too soon. But it can’t be forgotten that William’s death likely caused others to end their lives as well, as a direct result of the suicide contagion effect. One study attributed as many as potentially 2,000 suicides to William’s public suicide. This heaps unmitigated pain on a nightmare.

What studies like this don’t quantify is how many others, like me, chose to go public in the aftermath of William’s suicide. I was one of many, many people to do so – and I can’t imagine the collective, positive impact that all of us combined have made. Nothing occurs in isolation. My struggle and the hope that I hope I was able to inspire only came from William’s suicide.

So today, on this important five year anniversary for me, a request: Share your story, share your pain. It doesn’t require an op-ed or a Facebook status. But relieve yourself of the secret shame which may be surrounding you. It doesn’t have to be bottled up. If my experience as a public official has shown anything to me, it’s that the general public is much more understanding than I ever would have anticipated. Telling my story has improved my life in a million different ways, and many of them deeply personal.

Tell your story. Tell it loudly, proudly and publicly. Be part of the moment which saves someone else.

 

Does hypnosis help – long term – with depression and anxiety?

All of us who suffer are constantly on the lookout for alternative ways to cope with depression and anxiety. As I was putzing around on Facebook the other day, the thought occurred to me: Is hypnosis one of those methods?

I’ve written in the past about the benefits of trying to relax throughout the day. One such way I’ve done so is by listening to ASMR videos, even if they are just running in the background. I’ve also always found guided relaxation videos/tapes to be very calming, and again, that sort of inspired this particular entry for me.

First, let’s review what hypnosis is, and what it isn’t. Hypnosis will not make you cluck like a chicken. It will not train you to become an assassin. It will not make you do anything you don’t want to do.

Hypnosis – true hypnosis, not the exaggerated, movie kind – is defined as heightened concentration, focus and openness to suggestions. While it is often associated with going into a state of deep relaxation, it is not to be confused with going into a coma-like state. Hypnosis patients are fully aware of what is going on, they are just put into a more relaxed state.

I did a little bit of digging about the available research when it comes to depression, anxiety and hypnosis. Healthline refers to hypnosis as a “complimentary therapy” which can be used to treat depression with minimal side effects, but cautions that it shouldn’t be the only type of therapy which a person uses. WebMD does the same, while noting that hypnotherapy can be used for the purposes of suggesting new (and more productive behaviors) or analyzing past traumas. However, both pages noted that hypnotherapy can be associated with the process of implanting false memories – as such, it should be avoided by people who may be sustainable to those, like individuals who suffer from dissociative disorders. Meanwhile, the Anxiety and Depression Association of America goes more in-depth in terms of how hypnosis can compliment cognitive behavioral therapy, describing how hypnosis can be used to generate images about what someone wants or needs.

In terms of specific research, I found a couple of papers. One 2010 study noted that there was a relative “dearth” of actual research on hypnosis’ effect on depression and anxiety, but that it was easy to imagine, conceptually, how hypnosis could be helpful for these disorders. Most interesting is a 2016 study, which made the rather startling claim that hypnotherapy was actually more effective than Cognitive Behavioral Therapy. That’s…interesting. It’s a finding that I’d argue would have to be replicated in order to be believed, but that’s quite the claim!

If nothing else, again – I think hypnotherapy can be deeply relaxing. Guided imagery (a process similar to hypnotherapy) can be effective for relaxing and for stopping anxiety attacks in their tracks. Heck, I remember my therapist once designing a guided imagery recording for me. So yeah, I think hypnotherapy can be useful – when done by a licensed therapist and in conjunction with any other medical professional you may have.

What about you – any experiences with hypnotherapy, positive or negative? Let us know in the comments!

 

What is “depression fog,” and what can you do about it?

If you suffer from depression, you probably read the world “depression fog,” and instantly went, “Yep, I gotcha.” Depression fog is one of the many, many lousy symptoms of depression.

For the unaware, imagine the way a migraine scrambles your brain, or a hangover. It’s basically that: Cognitive dysfunction caused by your mood. Depression fog – or “brain fog” – alters your ability to think and function. It can alter a slew of cognitive and physical functions, including critical thinking, reaction time, memory and more.

You just feel sleepy. Like you just woke up.

As noted by the above Healthline article, depression fog can make it hard for you to pay attention to things. You can’t remember things as well as you normally can. You have trouble concentrating and always feel tired.

I’d add a component of depression fog which I don’t think is adequately covered in the reading that I did on the subject: Guilt. When you can’t function as well as you wish you were, you often berate yourself: “Why aren’t I thinking right? God, why do I suck so badly?!?!” And then you get more depressed…and then the brain fog gets worse…and the spiral continues.

How do you get past the fog? In my experience, this is difficult to do without treating the underlying depression. For me, on the instances when the fog has descended, I’ve felt better as my mood has improved. The two are unquestionably linked. However, there are some treatment options which specifically address brain fog. For example, according to the above Healthline article, a recent study found that the drug Modafinil can be effective at treating cognitive dysfunction.

Other treatments, again, are the same as ones which you use to manage depression and your physical health: Get enough sleep, eat well, get exercise, etc.

I’d add two things: Go easy or go hard.

Again, this is just me talking here, so take everything I am about to say with an entire shaker of salt. But when I’m down, I sometimes just crave my bed. That can be a really good thing, or a really terrible thing. I mean, on one hand, going easy on yourself can be deeply therapeutic, but it can also inspire a ton of guilt and inadequacy. I suppose that part depends on your mood or chemistry. And I have to say – I always get scared when it comes to going easy on myself. I’m always so worried that if I just lie down in bed I will never, ever want to get out of it.

Everyone has their own brain chemistry, wants and needs. So, to that end, I’d make two suggestions. First, if you think that you can chill in bed without hating yourself, do it. Relax. Read a good book. Watch a good movie. Rest up, and then see how your mind is functioning.

Or, if you’re like me, tell your body: “No. I will not surrender to this. I’m going hard” – and then drag your butt to the gym. And fee proud of yourself afterwards.

My two cents, but as always, I’d love to hear yours. How do you fight the brain fog? Let us know in the comments below!

 

The importance of the human touch to prevent suicides

I wanted to talk a little more today about a study which – if the findings are replicatable – could go a long way towards proving that the best way to prevent suicide may be simply showing that you are someone who cares.

The study itself took place in Australia and was run by Dr. Gregory Carter of the University of Newcastle. Carter and his team sent suicide-attempt survivors a postcard eight times over a 12 month period.

The postcard didn’t say much, and it wasn’t fancy. On the front, it had a cartoon dog with a letter in its mouth. On the back was this message: “Dear X, It has been a short time since you were here at the Newcastle Mater Hospital and we hope things are going well for you. If you wish to drop us a note we would be happy to hear from you.” the card also had contact information for two doctors and the hospital.

The results? The group who received the card showed a 54% reduction in future suicide attempts, but the effort worked only for women.

Intuitively, this makes sense, of course. It’s no surprise that social contact and relationships are a preventative factor when it comes to suicides. And showing someone that you care can, of course, make a huge difference. How many times have you heard of a case where someone came back from the edge simply because there was one person who cared deeply about them?

This isn’t a silver bullet, of course. But it does reiterate a basic and sensible human truth: We can pull people back from the edge if we just show them that they care, that they matter, and that there are ways to get help if they are feeling down.

I’d also argue that this shows that all of us have a role to play when it comes to suicide prevention and helping people get through their darkest moments. To be clear, again, none of us are responsible for someone who ends their own life – but all of us can be part of a solution. Care for each other. Follow up with friends who are showing warning signs of depression or suicide. Ask if they are okay. You don’t have to have the solution. But just being a caring human can, apparently, go a long way towards preventing someone from taking their own life.

 

Netflix removes controversial suicide scene from 13 Reasons Why

13 Reasons Why is a Netflix series based on the popular book by Jay Asher. The book deals with the aftermath of the suicide of Hannah Baker, who then sends tapes to people involved in her life, detailing the reasons behind her suicide.

The show was then turned into a hit Netflix series, which generated a ton of controversy for a variety of reasons, chief among them being the graphic depiction of Baker’s suicide, which features Baker, in the bathtub, slitting her wrists, crying in pain and ultimately bleeding to death.

I’d written about the show before, and mainly in terrible terms: It’s premier had been tied to a rise in suicide among 10-17 year olds, and the graphic depictions of Baker’s suicide seemed to violate every best practice of reporting on suicide.

Netflix – in response to the controversy – has changed the season finale of Season One, which featured this scene: It has now been been completely removed. In a statement, Netflix said:

“We’ve heard from many young people that 13 Reasons Why encouraged them to start conversations about difficult issues like depression and suicide and get help — often for the first time. As we prepare to launch season three later this summer, we’ve been mindful about the ongoing debate around the show. So on the advice of medical experts, including Dr. Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention, we’ve decided with creator Brian Yorkey and the producers to edit the scene in which Hannah takes her own life from season one.”

As the Hollywood Reporter noted, a variety of anti-suicide groups praised the removal in a joint statement.

The damn shot should never have aired. In prior statements, show creator Brian Yorkey had said that they didn’t want to make suicide look peaceful and thus glamorize it. I get that. And – if you assume that they were operating with the best of intentions – I get that they were trying to make it seem realistic and less abstract.

But, as Vox notes, that’s exactly the problem:

The theory is that for people who struggle with suicidal ideation, anything that can make suicide feel more familiar to them and cause them to keep thinking about it can be dangerous. That’s part of what leads to suicide contagion, the phenomenon in which media coverage of a death by suicide can lead more people to die by suicide.

As I argued in my entry earlier in the week, we have to be very, very careful with how we discuss suicide, lest we inadvertently plant the idea in someone’s head that suicide is somehow acceptable or “freeing.” While the type of discussion which occurred here is different than the blog entry I was writing about, the concept is the same: Be careful in how you discuss suicide, particularly given the way it could impact the most vulnerable of people.

I’m glad Netflix did this. But the show has generated controversy because their is evidence to suggest that it is correlated with more people dying by suicide. That’s a major problem, and they need to do better.

4 Quick Tips to Break You Out Of Your Funk

My wife and I spent a lot of time this summer at the our local parks. We’re lucky – we live in Allentown, and we have this ridiculous park system. One of the closest to our house – and the largest – is Trexler Park, a gorgeous park with a lake, ample green space and a few paths. Every night last week, we’ve grabbed the kids and hopped down to Trexler. It’s been wonderful.

And I always feel better when we get back.

Look, one of the many problems with depression is that it totally locks you in. You do the same things because you simply do not have the time or mental energy to do anything else. That, of course, can only lead to more depression issues, and that’s something which you have to try and break if you’re ever going to make a recovery.

There are ways, however. The next time you feel stuck, consider doing any of these 5 activities.

Go to the park

Forget your troubles, try to forget everything. Go for a nice walk and lose yourself in nature.

Yes, this does help – and there’s research to prove it. It’s 8am on Sunday as I am writing this, and I just took the dog for a walk around my nearly deserted block. It felt so nice. The best way I can describe how I feel is more centered.

Volunteer at a nearby animal shelter

Our family just adopted a pupper again, and it’s been very nice so far. We took our time making the selection from the Lehigh County Humane Society, and one of the things which struck me when we were there was that they had a slew of volunteers walking in and out of that place, caring for the animals, taking them for walks, etc.

Look, puppies and kitties are more than just adorable: They help you fight depression. Combine that with the general mental health benefits of volunteering, and this one is well worth it. If you’re an animal person, go check out your local shelter and see what volunteer options there are.

Exercise

I’ve written about this one before so I am repeating myself, but exercise when you are depressed can be very beneficial, and again, there’s research to prove it. Depression is fundamentally biological, and exercise can change your biology and physiology, making you feel better.

Take care of yourself

When I think of myself in my most depressed state, it’s this: Covered in a hoodie, unshowered, hair uncombed and unshaven. Sound familiar? When you’re depressed, you lack the energy or mental strength to do even the most basic things, like take care of general hygiene. That, of course, is largely a mental trick, but it works both ways. Doing something small – even if it’s just brushing your teeth -can signal to your body that this is not where you want to be right now. So, to that end, when you’re down, make sure you take care of your body. Do the basics – shave and comb your hair. If you don’t think you have strength for that, try something small – take a warm shower. Try to fool your body into thinking you are okay – and then look the part.

These are four things which work for me and others, but they may not for you. What does work for you? Let us know in the comments!

 

An in-depth look at America’s suicide numbers

This Bloomberg story came out about two weeks ago and reviewed America’s rising suicide numbers. It’s findings, as you can imagine, are damning. Some of the salient points:

  • In 2017, 47,000 people died by suicide – and 1.4 million made attempts.
  • From 2000-2006, the suicide rate increased by 1% annually. From 2006-2016, that increased to 2%.
  • Life expectancy has fallen for three straight years – the first three consecutive year drop since 1915-1918.
  • Suicide is the 2nd leading cause of death for 10-34 year-olds.
  • Suicides cost U.S. businesses between $80-100 billion annually.
  • A lack of resources is to blame for many of these issues. According to some experts, the United States needs 50 mental health beds for every 100,000 people – but some states have numbers as low as 5 per 100,000.

The article goes on to say something I’ve discussed in the past – part of the intractability of our mental health and suicide crisis is the intertwined nature of the problems. Health care, genetics, finances, social support, culture – they all interact to influence mental health. As the article notes, combine that with a rapidly changing economy, advances in technology and a changing cultural scene, and you have a recipe for the disaster we’re currently experiencing.

Mental Health parity (reimbursing physical and behavioral health care at the same rates) and a lack of doctors play a role as well. As recent court cases have noted, many insurers still aren’t adequately reimbursing for mental health services, or they are resorting to alternative methods (such as steering patients to doctors who are no longer even in their network) in order to keep people out of treatment.

The story also noted that changing the way we gather data could lead to additional insights which may result in better treatment of mental health disorders: In 2010, England started measuring overall life satisfaction and recently created a “Minister of Loneliness.”

So, what’s the conclusion of this article? Besides “holy crap this is bad”?

I think I’m gonna be repeating myself a bit here. But the conclusion is that addressing suicide for real will require a huge investment of resources and an acknowledgement that it’s more than just mental health. We have to address insurance and fiscal policies. Create a culture which is more accepting of mental health challenges. Understand that the challenges of mental health are comprehensive ones which tie a variety of areas together.

And I think we have to be willing to pay. For care. For insurance access. For bed space in the event that there are emergencies.

I hated reading this article because it was painful. But we need to know the truth about mental illnesses. And the truth is that this problem will take a long, long time to fully address.

 

The importance of inclusion – for everyone

I caught this article on Facebook the other day – it’s results caught me by surprise (to an extent) but it has a key finding that I really wanted to go over.

In 2014, the University of British Columbia examined the connection between suicide rates and having a Gay-Straight Alliance at High Schools in Canada. The results showed that students were less likely to feel discrimination, experienced lower suicidal thoughts, and have lower rates of suicide attempts.

Just gay students, right?

Wrong. All students.

This is a pretty striking finding. Not only are GSAs positively related to the mental health of gay students, but if the findings of this study are correct, they can also positively impact the mental health of students whose lives would (theoretically) not be impacted directly by the Gay-Straight Alliance.

This is great for many reasons. First, as I discussed last week, LGBT Americans sadly have significantly higher rates of a slew of negative mental illnesses, including suicide. Clubs like GSAs can provide safe places for LGBT teens to congregate, build vitally necessary social relationships and learn they aren’t alone. All of these are mitigating factors against mental illness and suicide.

Intuitively, this makes sense. But the finding that I think is more worth examining is why GSAs are potentially tied to lower suicide rates in heterosexuals. First, a disclaimer: It is worth noting that this study is correlational, not causational. In other words, while lower suicide rates and GSAs appear to be related, the lower suicide rates may not be a direct result of GSAs. Indeed, it is possible that there are more GSAs because of lower suicide rates, or that a third factor (such ass wealth of a school district, education attainment of parents, etc) is tied to both GSAs and lower suicide rates.

However, the fact that both of these items seem related (regardless of the relationship) begs the question: What is the relationship between a more tolerant society for everyone, not just the directly affected groups?

This is one worth thinking about, because it can help change the frame of how we view ideals like inclusion an tolerance. We often have conversations about how they can positively impact effected groups – how marriage equality leads to better lives for LGBT individuals, how a lack of racism can improve the lives of impacted groups, etc.

But I want to change that perspective for a second.

I certainly think I’m not a racist person, and I can’t imagine what it is like to be that way. Being racist means you walk around which large chunks of anger, bitterness and resentment inside you all the time. Doesn’t that lead to higher levels of depression, of anxiety, and self-destructive behaviors?

That’s what I want to know. And it makes me wonder if more studies like this aren’t available – ones which show that a more tolerant and more inclusive society is better for everyone, not just affected groups.

As always, I’d love to hear your thoughts, your experience and if more research is available which proves or disproves this theory. Please let us know what you think in the comments below!

 

The disproportionally high levels of suicide among (some) minority groups

It’s been written repeatedly, and it’s true: One of the most likely demographic to die by suicide are middle aged, white men. But, as a recent report in USA Today helps illuminate, we shouldn’t confuse this reality with the notion that white men are the most at risk – or that other groups don’t need very real assistance.

USA Today’s story, which was published earlier in the week, came with this stark headline: Suicide Rate for Native American Women is up 139%. Native American and Alaska Natives have a suicide rate 3.5 times higher than the lowest group – an astonishingly high number.

The story highlights a very, very ugly truth: In mental health – just like in health care generally speaking, unfortunately – minority communities have it worse. But, in the case of suicides, not every minority community is this way. For example, suicide rates among African Americans and Pacific Islanders have increased, but remain roughly half the rate of suicides as whites, according to the American Foundation for Suicide Prevention:

suicideRatesByEthnicity.png

Meanwhile, according to the Suicide Prevention Resource Center, rates of suicides among Hispanics also remain far below the United States average, with Hispanics dying by suicide at a rate of slightly more than half of the rest of the United States population.

This is good news, of course, and a very rare bit of good news when it comes to health care for black and Hispanic communities. What drives these rates lower? There are many theories, primarily the idea that strong family and community support provide a degree of resilience not available in other cultures, as well as the idea that self esteem and religiosity rates are higher among African Americans.

All of these factors may tie into why other minority groups have higher rates of suicide. LGBT community members are three times more likely to die by suicide. On average, LGBT members as well as Native Americans, have lower levels of self esteem, community support and family bonds.

In total: The minority suicide rates are not what they would reflexively seem to be. That’s something for all of us to keep in mind as we deal with public policy and suicide.

Does CBD help with depression or anxiety?

In 2018, Donald Trump signed the Farm Bill into law. Among other things, this piece of legislation made legal much of the sale of CBD and hemp, as well as research into this area. – This opens up an array of new potential research, but CBD may have a positive impact on depression and anxiety.

What’s CBD, you ask? First, what it’s not: Marijuana. It is not marijuana. CBD is short for cannabinoid oil, and it became legal to be sold after the 2018 Farm Bill was signed into law.

Specifically, CBD is extracted from hemp plants. It works be manipulating your Endocannibinoid System, a part of your body which regulates a variety of bodily functions, including, potentially, your mood.

Here’s an important point though: While some research has been done, more research is DESPERATELY needed in order to determine CBDs usefulness, effectiveness, proper dosages, long-term impact, etc. At the moment, it is not widely regulated by the FDA, though the FDA has sent out cease and desist letters to some companies which have falsely marketed benefits yet to be proven by research.

Indeed, as of yet, there is no formal regulation when it comes to CBDs marketing or ensuring the quality of ingredients. For example, a 2017 Penn State study surveyed 81 CBD products and found that 70% were mislabeled. As such, if you’re going to purchase CBD, your best bet is to ensure that the label notes it has been independently tested. This means that a product has been evaluated by a 3rd party, and that 3rd party has determined that’s it’s labeling is accurate.

Okay. Enough about the legal disclaimers and warnings. What does the research show?

According to one 2014 study, CBD and Marijuana may show anti-depressant like effects. That finding was replicated in 2018, when a study showed that CBD has “anxiolytic, antipsychotic and neuroprotective properties” and may be useful in fighting a slew of problems, including PTSD and depression.

There’s additional research available, but it does seem clear: There’s opportunity here.

While CBD is not marijuana, and will not get you high like marijuana, some forms of CBD (namely Full Spectrum CBD) do contain trace amounts of marijuana. As such, if you ingest this type of CBD, you may feel some effects. Furthermore, it is possible for Full Spectrum CBD to show up on a drug test – so DON’T TAKE IT if that’s an issue for you.

Furthermore, you should not take any CBD product without consulting with your Doctor or medical professional first. While common side effects of CBD are relatively minor, there can be more problematic impacts for people with Parkinson’s, liver issues, or pregnant/nursing women.

Now that we’ve gotten the warnings out of the way: Is their potential for people with mental illness and CBD? I’d say yes. Anecdotal evidence and some research seems to indicate the potential for relief. Again, more research is needed. Again, don’t do anything without talking to a Doctor or medical professional first. But, yes. More research is now being conducted, this area does prove promising.