Suicide Is Not Unspeakable. Let’s Talk about It.

When the subject of taboo subjects comes up, we tick off politics and religion, then maybe money and sex. Suicide doesn’t usually come to mind–that’s how unspeakable we, as a culture, have deemed it. Here in the middle of National Suicide Prevention Week, I have some things to say about suicide:

• Talking about it does not cause it. Asking a person if s/he is considering suicide does not make the person more likely to kill him- or herself. It doesn’t “give them the idea.”

• It is not unusual for people to have an occasional thought of suicide float through their minds. We consider and dismiss hundreds of options of all sorts, all day long. But when self-injury or suicide starts to float in more often, starts to sound like a more viable option, or comes to dominate as one of a very few options, talking to a helping professional can assist the person in regaining a more balanced perspective.

• ”Asking for help” doesn’t always come in the form of a specific request. The person might tell you s/he has had disturbing thoughts or dreams lately, or s/he might say that more and more these days, life seems pointless or hopeless. These subtle statements are invitations to a conversation.

• There are no perfect words to use when you talk about suicide. There is no magical way to say it. It will most likely be difficult, frightening, painful, and/or awkward to talk about, whether you’re asking someone about their feelings or trying to talk about your own.

• However, there are some responses that are discouraged. Expressing criticism, condemnation, rejection, or disbelief is risky. Telling a person that s/he is wrong to think about suicide could confirm to the person that suicide might be a good choice for someone so “messed up.” That person might not be willing to ask for help again, from anyone.

• The phrase “commit suicide” is still very common, but this is changing. The reason is that “commit” implies wrongdoing–criminality, sinfulness. While some religions do condemn suicide and it is illegal in some places, the mental health community recognizes that using this term perpetuates blaming the victim. Notice in this excellent article that the writer, Kim Painter, does not use this phrase. (It does appear in the photo caption, but captions and headlines are usually written by someone other than the bylined journalist.)

• There is a national phone number that anyone can call to be connected with help. The same number will also get you to a special assistance program for veterans. The National Suicide Prevention Lifeline is 1-800-273-TALK (8255). Save it in your phone so you’ll always have it handy if someone needs it. Read more at the National Suicide Prevention Website: www.suicidepreventionlifeline.org.

• Social media can help prevent suicide. We’ve all heard horror stories of people who posted their intentions to kill themselves and were mocked or ignored. We can change this pattern. Take any mention of suicide seriously. Facebook has introduced a new way to forward posts about self-harm or suicide so the person can receive help. Here is a link to Facebook’s help page for this function.

• It is true that some people threaten suicide to get attention, and it is normal if you feel offended, used, manipulated, and suspicious going forward if you responded appropriately and found out the threat was a ploy. RESPOND APPROPRIATELY ANYWAY, every time. People whose mental illness or circumstances cause them to make false threats of self-harm do sometimes follow through and kill themselves.

• If you know someone who does this, perhaps ask yourself why s/he needs this attention. Exaggerated bids for attention indicate that something is missing for that person. No matter how obnoxious you might think the person is, shift into your empathic mindset and ask yourself what could be causing this. You don’t necessarily have to be the one to provide what the person is missing, but understanding it can help you to have a more helpful perspective on his or her behavior.

• If you are in a relationship with someone who uses threats of suicide to control you, get help for yourself. This is not a normal or healthy relationship dynamic.

• If threatening self-harm or suicide is something you have done, knowing that you really didn’t intend to do it, ask yourself why you felt compelled to go to this extreme to get your needs met. Is it the only way you know of that works? If you’re willing to try, you can learn safer and more effective ways of getting what you need. Talk to a counselor or call 800-273-TALK and ask for help.

• Set a good example by not joking about self-harm. Don’t say “if I don’t get [X], I’ll kill myself.” Careless language and exaggeration make it that much harder for people to respond appropriately to true suicidal statements.

• Educate yourself so you can recognize warning signs, and know how to connect a person with help, but also understand that it’s not your fault if you miss those signs or if someone dies by suicide despite your efforts. The same resources that can educate you and help a suicidal person in crisis can also help you not to be harmed by others’ pain. All any of us can do is offer compassion and referrals to help; we can’t make anyone accept that help.

• Recognize that your increased awareness and empathy do make a difference, whether or not you’re ever called to use them directly. Simply by learning about suicide prevention, you are making an important contribution to our world.

 

September Is AD/HD Awareness Month

It’s AD/HD Awareness Month and I’m in good company.

Janet Barclay’s “Professional Organizers Blog Carnival” this month features posts on AD/HD from 11 of my colleagues plus this one from me. See the whole show here.

Silver lining: If you arrived here because you got distracted and started browsing randomly, at least you’re going to learn some things!

 

Product Suggestions 3-15-12

Here are some products and systems that have recently come up in conversation with clients:

Instant Pendant Lights:

These are available from home improvement stores like Lowe’s and also from ImprovementsCatalog.com. They’re a nice retrofit option if you find that looking up into ceiling can lights is hard on your eyes.

A DIY project to retrofit your existing can lights.

Recessed Light Diffusers:

Another way to diffuse can lights, which looks nice in an office:

These clip into existing can lights. This one is by Juno; they make many other styles. I've seen them at Lowe's and in various online stores.

Closet Door Alternatives:

If you took off your closet’s sliding doors so you could see the entire closet, but now you’re overwhelmed at the visual noise of the open closet, here’s a compromise.

This inexpensive curtain wire from IKEA lets you replace closet doors with any curtains you like.

 

Misinterpreting Research: Don’t Believe the Hype

A pill for PTSD? Not so fast. But this article, entitled “Pill Could Erase Painful Memories, Study Shows,” and unfortunately many others like it, would certainly have you believe it could soon be that simple.

The study they’re referring to investigated the impact of blocking glucocorticoids (GCs; the most familiar of these is cortisol, a.k.a. the “stress hormone”) after a lab-induced traumatic experience. The researchers showed volunteers a disturbing film clip and gave them either the GC-inhibitor metyrapone or a placebo, and they found that those who received the drug were notably less able to recall details of the film four days later. The study was published in the August 2011 Journal of Endocrinology and Metabolism. The full text is not freely available, but the abstract makes no mention of the concerns I’m about to explain.

I could pick apart the methodology on several bases, but I’m most alarmed by the interpretation of the results. The abstract attributes this conclusion to the authors:

“These results show that decreasing GC levels via metyrapone administration is an efficient way to reduce the strength of an emotional memory in a long-lasting manner.”

This is specious logic. First, four days does not constitute a long-lasting result in this context. More importantly, the fact that the subjects could not recall the details does NOT necessarily mean the memory was reduced in strength. It could mean the memory was suppressed, which makes it even more likely to cause emotional harm later. It’s the psychological equivalent of creating an antibiotic-resistant “superbug.”

The ideal outcome in PTSD treatment is NOT eliminating memories of trauma; rather, it is eliminating the unbearable emotion attached to those memories. People who have been successfully treated do not have their memories “erased”; they instead become able to remember the factual content without reliving the event emotionally and physiologically.

I agree that research into the neurochemical cascade that follows a traumatic event is worthwhile and promising, but this research–and ALL research–must also acknowledge the risks of misinterpretation.

I encourage you to question the conclusion of every study that is important to you. Do you agree with the researchers’ takeaways? Always consider whether some other explanation is possible. A well-written study includes some “yeah-buts”–alternative conclusions proposed by the authors: yeah, we think the data means this, but it could also mean that, or that, or that. If a study has no “yeah-buts,” I wonder whether the researchers maintained professional objectivity throughout the experimentation process.

And don’t rely on the media for your interpretation. Find the original study yourself (or at least the abstract, which is usually free). You don’t have to be a clinician or statistician to understand it. Read the intro and conclusions, and ask yourself whether there could be some other explanation. Usually there can be. This is why we need to see a consistent outcome across multiple studies before we can be confident that we’re actually seeing what we think we’re seeing, and even then, the interpretation of the data must be sound.

I’m confident the data outcomes of this study could be replicated, but that still would not support the conclusions these authors have drawn about that data. You can see a thousand images of orbs, but that doesn’t make ghosts a thousand times more likely to exist.

 

Deb Joins Online Experts Panel to Discuss Hoarding

I’m a featured expert in an Everyday Health panel discussion about OCD and hoarding. You’ll find the full discussion here. While you’re there, check out the site–Everyday Health is a comprehensive health-oriented online community that seeks to provide sometimes complicated information in an accessible, user-friendly format.

Sneak preview: My answers to two of the ten questions:

Is hoarding always a bad thing?

Hoarding is a coping mechanism: The behavior helps the person to cope with something. In that sense, it’s not a bad thing. The problem is that hoarding usually becomes a “maladaptive” coping mechanism, meaning it doesn’t work and it causes the person even more trouble over time. As with any maladaptive coping mechanism, the more it is used, the less opportunity the person has to develop healthier ways to deal with pain or new challenges. Eventually, acquiring and hoarding become the reaction to every stressor in the person’s life, and the habits themselves become stressors.

Do reality TV shows accurately portray hoarding?

No, they are not accurate. I call them … [dramatic pause ... click here for the rest of the answer ].

 

Half the Battle

I’ve built a section on my website called Knowledge Heals* with resources (books and websites) on a variety of topics related to my work with mental health, chronic disorganization, and hoarding. Colleague Cena Block of Sane Spaces gave it a kind assessment on her own resources page.

A few of the topics listed so far: giftedness, dementia, traumatic brain injury, senior services, and diagnoses such as PTSD, AD/HD, and OCD. There are 17 topic sections as of today.

Each topic has relatively few resources, and that’s intentional. This could easily become overwhelming for readers, so I’m keeping it streamlined. I add items periodically (basically, whenever I read something and think “Ooh! That’s a good one!”), but I’m not blogging about every new entry, so you might want to bookmark and check back now and then.

*Why did I call it that? Psychoeducation is a big part of my theoretical basis as a counselor. I believe that giving people access to information, either by teaching them things I know or by pointing out other resources, supports their innate desire and ability to self-actualize. Or to put it in non-psychobabble terms: Knowing what’s going on is half the battle, so I like to help people figure out what’s going on and then use that knowledge to decide what to do about it.

 

Quick Thought: Not Imagining It

This phrase just came to me: “Disincentivization of resource absorbers.” When you get the feeling that the process to obtain rights and services you’re entitled to is harder than it needs to be and you’re wondering if it’s intentional, this is what you’re pondering. “Are they making this so hard that people just give up?” You’re not imagining it: Sometimes disincentivization of resource absorbers really is built into the access or application process. It’s a very effective cost-cutter. It’s also evil, but that’s beside the point.

 

Knowledge Heals

Identifying the problem is half the battle.

The other half is

• learning about it through books, articles, websites, podcasts, and videos;
• talking to people who “get it” (including others with the same problem and professionals who treat it);
• deciding what you believe and don’t, and what you agree with and don’t, so you can know your own mind about the problem;
• and making peace with the problem so you can keep living your life while you work at resolving, reducing, or managing it.

This is why education is such a big part of what I offer my clients, and it’s also why I’m committed to maintaining an ever-growing resources section on my website.

 

Naked ADD

AD/HD, or just ADD as it’s often called by those who have it or treat it, is one of those conditions that causes people embarrassment or shame until they learn to accept it, work around it when necessary, and even find its hidden advantages. People with ADD learn, through often painful experience, to mask it when they’re among non-ADDers–to try not to fidget, interrupt, talk too much, talk too little, or forget things.

Tall order, and exhausting.

Which makes ADD-focused events such a treat. CHADD chapter meetings, annual events like the Michael Golds Memorial AD/HD Conference–these are places where it’s safe to let your ADD show, kind of like taking off your clothes at a nude beach. Nobody will point and laugh, or judge, or act superior, because everyone is equally, and voluntarily, exposed. When people who have it, treat it, or otherwise accept ADD get together in a group, the fun aspects can come out: spontaneity, flights of creative thought, exuberance, fresh ideas, witticisms … conversations that sound more like improvisational jazz than the orchestrated exchanges typical in the wider world. People don’t have to apologize or take offense for talking over each other; it’s not rudeness, it’s just ADD.

The normalizing, confidence-building parts come out too: Stories of things forgotten, things said and regretted, opportunities missed, feelings hurt … confessions that are most often met with “That’s happened to you TOO???” No one is “the only one” at these events. Then the stage is set for sharing ideas for managing the condition (tricks for being on time, getting your to-dos done, under-promising and over-delivering, deciding whether to use meds) and advocating for your needs and rights.

Over the past decade or so, there has been an increase in the number of adults diagnosed with ADD. Many of them come to suspect it when their children are diagnosed and they realize that they themselves had (and often still have) the same symptoms. The diagnosis can be life-changing: You see your entire life in a new light. Sometimes there is grief–”If only I had known this back then…”–and often there is relief, like the book title says: “You mean I’m not lazy, stupid, or crazy?” And there are many more great books and websites on the subject, offering the newly diagnosed adult a wealth of comforting perspective.

I help my clients with AD/HD to integrate this reality into their self-image, understand how their brains work, and find the organizational techniques that will best serve them as they learn how to manage its challenges without losing its creative and motivational blessings. Along with all of that, I encourage them to join their peer community–their neurochemical soulmates, you could say–and soak up some much-needed acceptance and support.

And since I do all of that, I get to share in the revelry at ADD events. As Katharine Graham said, “To love what you do and feel that it matters–how could anything be more fun?”

 

National PTSD Awareness Day

Today is National PTSD Awareness Day. Seems like everyone has heard the acronym “PTSD,” but do you really know what it is?

• Post-Traumatic Stress Disorder
• Caused by a (or more than one) traumatic event that generated intense fear, helplessness, or horror.
• In the news often in relation to veterans, but many civilians have it too.
• Occurs in about 8% of the general population and 10-30% of combat vets (varies by war). Chances are you know someone struggling, possibly undiagnosed, with PTSD.
• Common causes include any form of assault, victimization, disaster, or situation that put the person in fear for his or her life or someone else’s.
• Symptoms can mimic depression, other forms of anxiety, AD/HD, sleep disorders, learning disability or conduct disorder in children, and other physical and emotional conditions.
• Not a character flaw or weakness.
• Treatable.
• More info: http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
• And more info: http://www.ptsd.va.gov/index.asp