Lack of Health Care Killed 2,266 US Veterans Last Year: Study

WASHINGTON - The number of US veterans who died in 2008 because they lacked health insurance was 14 times higher than the US military death toll in Afghanistan that year, according to a new study.

The analysis produced by two Harvard medical researchers estimates that 2,266 US military veterans under the age of 65 died in 2008 because they lacked health coverage and had reduced access to medical care.That figure is more than 14 times higher than the 155 US troop deaths in Afghanistan in 2008, the study says.

Released as the United States commemorates fallen soldiers on Veterans Day, the study warns that even health care provided by the Veterans Health Administration (VA) leaves many veterans without coverage.The analysis uses census data to isolate the number of US veterans who lack both private health coverage and care offered by the VA.

"That's a group that's about 1.5 million people," said David Himmelstein, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program who co-authored the study. Himmelstein and co-author Stephanie Woolhandler, also a Harvard medical professor, overlaid that figure with another study examining the mortality rate associated with lack of health insurance.

"The uninsured have about a 40 percent higher risk of dying each year than otherwise comparable insured individuals," Himmelstein told AFP."Putting that all together you get an estimate of almost 2,300 -- 2,266 veterans who die each year from lack of health insurance."

Only some US veterans have access to medical care through the VA and coverage is apportioned on the basis of eight "priority groups.""They range from things like people who were prisoners of war, who have coverage for life, or who have battle injuries and therefore have coverage for their injuries for life," said Himmelstein.

Veterans who fall below an income threshold that is determined on a county-by-county basis can qualify for care, but many veterans are "working poor" and fall just above the bracket."The priority eight group, the lowest priority, are veterans above the very poor group who have no other reason to be eligible and that group is essentially shut out of the VA," according to Himmelstein.

The study comes as the US Senate weighs health care reform legislation and whether to offer government health insurance.Himmelstein warns that congressional proposals could still leave veterans uncovered and favors a national health care program similar to those in Britain and Canada.

precipice

I'm standing on the edge of the world. Been standing here as long as I can remember. I guess we have. I wonder if you'll fall. I wonder if you'll take me with you. I wonder if I can stand waiting any longer.

I breathe in. I breathe out. I don't look over the edge. But then I do. I breathe in for you. I breathe out for her. I don't look over the edge.

She would be fine without me. I don't want to leave her, but she would. You... I'm not so sure. I breathe in. I don't look over the edge. But then I do.

Sometimes I dream. But then I watch the edge. Breathe in, breathe out. I wonder if I can stand waiting any longer. Breathe in, breathe out.

If only you'd step away from the edge...

the day after I wrote this I found this in a John O'Donohue book -

"When near the end of the day, life has drained
Out of light, and it is too soon
For the mind of night to have darkened things,

No place looks like itself, loss of outline
Makes everything look strangely in-between,
Unsure of what has been, or what might come.

In this wan light, even trees seem groundless.
In awhile it will be night, but nothing
Here seems to believe the relief of dark.

You are in this time of the interim
Where everything seems withheld.

The path you took to get here has washed out;
The way forward is still concealed from you.

'The old is not old enough to have died away;
The new is still too young to be born.'

You cannot lay claim to anything;
In this place of dusk,
Your eyes are blurred;
And there is no mirror.

Everyone else has lost sight of your heart
And you can see nowhere to put your trust;
You know you have to make your own way through.

As far as you can, hold your confidence.
Do not allow your confusion to squander
This call which is loosening
Your roots in false ground,
That you might come free
From all you have outgrown.

What is being transfigured here is your mind,
And it is difficult and slow to become new.
The more faithfully you can endure here,
The more refined your heart will become
For your arrival in the new dawn."

Every Stinking Year

Clinton 'Asylum of Terror' haunted house angers N.J. mental-health advocates
By Veronica Slaght/For The Star-Ledger

CLINTON -- Every fall, the Red Mill Museum here hosts a haunted house. But this year’s "Asylum of Terror," has angered mental health advocates who said the theme perpetuates ugly stereotypes. The show, which ends today, warns visitors of hopeless, mindless and deranged patients lurking in dark corners ready to lunge.

"Dementia, paranoia, violent sociopathic behaviors, physical abnormalities and deformities ... these are but a few of the afflictions that torment the wretched souls imprisoned within the walls of the Asylum," reads an advertisement for the haunted house. It continues: "In 1942, the doors of the asylum and the grounds were abruptly closed to the patients and the public after the inmates of the asylum overtook the staff and in one devastating night, tortured and then slaughtered all 200 staff members on duty ... Come if you dare."

Nearly 60 cast members put on the elaborate show, performed every weekend in October at the mill, which is located along the South Branch of the Raritan River in Hunterdon County. Celina Gray, executive director of the Governor’s Council on Mental Health Stigma, said she has heard from dozens of people who are upset by the show’s portrayal of the mentally ill as violent and scary.

"So many people white-knuckle through mental illness and don’t realize how it’s impacting their life," she said. "There could be people out there in the audience who are struggling with a mental illness and will not come out and say a word to anyone now." "I look at it this way," Gray said. "I love Halloween ... but there must be another way to celebrate it."

Responding to a letter about the "Asylum" from the council, Charles Speierl, executive director of the Red Mill Museum, said in an email that he forwarded concerns to event organizers and the museum’s board of trustees. Calls to the museum, which is run by a non-profit organization, were not returned.

Mental health advocates at the national level have also gotten involved. The National Alliance on Mental Illness issued a nationwide alert about the Clinton haunted mill.
"It’s trick or treat time again. We don’t mind ghosts and goblins, but when ‘haunted house’ attractions become ‘insane asylums,’ featuring ‘mental patients’ as murderous ghouls, we protest," reads a message on www.nami.org. The alliance is asking people to e-mail the mill to tell them mental illness is a national, as well as local, concern.

According to the U.S. Surgeon General, stigma is the number one reason why people don’t seek treatment for mental health, said Phil Lubitz, associate director of the New Jersey chapter of NAMI. "There are real consequences for perpetuating this kind of stigma," he said. Clinton Mayor Christine Schaumburg said, "I’m sure there were no bad intentions on the part of the mill." She hadn’t been aware of this year’s theme, she said. Gray agreed. "I’m unbelievably encouraged about the conversation that’s happening ... I think this came out of good people not understanding what it is and what the impact is."

Heard this morning... sorta fits

"Rain" by The Wreckers

You never give up
I can't believe anything you say
And it must be my luck
'Cause no one else gets treated this way

And I wanna know
What goes on in that head of yours
Yeah, I wanna know
'Cause I don't think I can take much more

Rain
You must be sick or something
I can't take another day
Rain
Is falling down
But will the sun come out again?

I never speak up
I just try and stay out of the way
But I must have messed up
'Cause that's all I hear you say

And I wanna know
What on earth makes you act like this
Yeah, I wanna know
'Cause I don't think I can take this shit

Rain
You must be sick or something
I can't take another day
Rain
Is falling down
But will the sun come out again?

Accepting the Diagnosis

Many factors influence how well a consumer is able to adapt to bipolar. These include the severity of the illness, level of self-awareness, one’s attitude about mental illness, availability of a support system, and access to quality health care. Some consumers are able to accept their illness after one or two manic episodes. Others remain in denial for years, burning through relationships, jobs, and money until they hit rock bottom.

“Bipolar is one of the illnesses people have the hardest time accepting,” says Sagar V. Parikh, MD, deputy psychiatrist-in-chief at the University Health Network in Toronto and professor of psychiatry at the University of Toronto. “Maybe one third accept [the diagnosis] right away. At least a third totally reject it, and a third believe it, but when they are better for a while, begin to doubt it again.”

“It’s common for acceptance to take years,” agrees Evette J. Ludman, PhD, a clinical psychologist and researcher at Group Health Cooperative in Seattle and coauthor of Overcoming Bipolar Disorder: A Comprehensive Workbook for Managing Your Symptoms and Achieving Your Life Goals (New Harbinger Publications, 2009).

Fully accepting the diagnosis is “almost like joining the priesthood,” Parikh says. “The commitment to treatment is a major one that involves going to the doctor regularly and paying a lot of effort to regulating one’s lifestyle. It’s not just a commitment to medication, but a way of life.”

In his research, Parikh found that consumers with bipolar II have greater difficulty acknowledging the diagnosis than do those with bipolar I, which is typically characterized by clear-cut episodes of mania and depression.

The symptoms of bipolar II are subtle, he explains, making it difficult to perceive the hypomania as a symptom of the illness, rather than part of one’s identity. “Your highs are mild, your brain is working faster, you have more confidence and energy, you need less sleep—it’s the ideal human condition,” says Parikh. Because the symptoms of bipolar II tend to be sporadic, “it is difficult to conceptualize it as an illness,” he adds.

excerpted from the Sept. issue of Bipolar Magazine.

It's NOT all in your mind...

by David Servan-Schreiber, author of Healing Without Freud or Prozac
Modern medicine calls it the "placebo effect." This refers to the cultural and relational factors that make someone who's sick feel better when a doctor prescribes treatment, regardless of its biological impact. Nowadays, doctors think they know everything about the placebo effect. They were taught that 30% of sick people treated with placebos show signs of improvement. But they're also taught that this improvement is subjective and temporary - because the illness continues to take its course.

Yet after studying the placebo effect, some scientists wonder whether it may be one of the strongest driving forces in medicine. A study published in Clinical Psychology Review in 1993 concludes that several types of placebos are effective in treating illnesses such as stomach ulcers, angina pectoris and herpes 70% of the time. In addition, rare but famous cases testify to the effectiveness of placebos in reducing cancerous tumors or regenerating the immune cells of AIDS sufferers. The part of our brains known as the hypothalamus directs the distribution of essential hormones and operates the diffuse network of nerves controlling the function of the internal organs. The most intriguing mechanism is that proposed by pharmacologist Candace Pert, author of Molecules of Emotion: The Science Behind Mind-Body Medicine. She demonstrated that neuropeptides - molecules that help transmit messages among the brain's neurons - affect the behavior of nearly all the body's cells. This means that what we refer to as our mind isn't located just in the brain but throughout the body. It also implies that, driven by the comings and goings of these molecular messengers, the mind constitutes an immense communication network encompassing the functions of the organism.

So what is the placebo effect? Everything we don't know about the capacity of the brain to heal the body. Therein, undoubtedly lies the secret of the shamans and other healers. Their rituals, chants and restorative acts address the most archaic parts of the brain, those that regulate our organism and can participate in its healing ... Scientific medicine has replaced this knowledge with mechanical principles that allow the illness to be cured without speaking to the sufferer's spirit.

Ed. note: As a Reiki practitioner I have personally experienced the healing power of the mind/body/spirit connection. Hopefully, Western medicine will come around.

Black Cocktail

Switters was instantly reminded of something Maestra had said almost twenty years before: "All depression has its roots in self-pity and all self-pity is rooted in people taking themselves too seriously."

At the time Switters had disputed her assertion. Even at seventeen, he was aware that depression could have chemical causes.

"The key word here is roots," Maestra countered. "The roots of depression. For most people, self-awareness and self-pity blossom simultaneously in early adolescence. It's about that time that we start viewing the world as something other than a whoop-de-doo playground, we start to experience personally how threatening it can be, how cruel and unjust. At the very moment when we become, for the first time, both introspective and socially conscientious, we receive the bad news that the world, by and large, doesn't give a rat's ass. Even an old tomato like me can recall how painful, scary, and disillusioning that realization was. So, there's a tendency, then, to slip into rage and self-pity, which, if indulged, can fester into bouts of depression."

"Yeah, but, Maestra---"

"Don't interrupt. Now, unless someone stronger and wiser -- a friend, a parent, a novelist, filmmaker, teacher, or musician -- can josh us out of it, can elevate us and show us how petty and pompous and monumentally useless it is to take ourselves so seriously, then depression can become a habit, which, in turn, can produce a neurological imprint. Are you with me? Gradually, our brain chemistry becomes conditioned to react to negative stimuli in a particular, predictable way. One thing'll go wrong and it'll automatically switch on its blender and mix us that black cocktail, the ol' doomsday daiquiri, and before we know it, we're soused to the gills from the inside out. Once depression has become electrochemically integrated, it can be extremely difficult to philosophically or psychologically override it; by then it's playing by physical rules, a whole different ball game. That's why, Switters my dearest, every time you've shown signs of feeling sorry for yourself,I've played my blues records really loud or read to you from The Horse's Mouth. And that's why when you've exhibited the slightest tendency toward self-importance, I've reminded you that you and me-- you and I: excuse me-- may be every bit as important as the President or the pope or the biggest prime-time icon in Hollywood, but that none of us is much more than a pimple on the ass-end of creation, so let's not get carried away with ourselves. Preventive medicine, boy. It's preventive medicine."

"But what about self-esteem?"

"Heh! Self-esteem is for sissies. Accept that you're a pimple and try to keep a lively sense of humor about it. That way lies grace-- and maybe even glory."

from Fierce Invalids Home From Hot Climates by Tom Robbins... thought provoking, no?

Okay, This is morbid... but fascinating.

It’s 75 metres (245 ft) down from the deck of the Golden Gate Bridge to the water below. That drop will kill most people (after a fall of about 4 seconds, a jumper would hit the water at approximately 140 km/h (87 mph) – lethal in most cases. Those surviving the actual fall usually succumb to hypothermia, induced by the cold (8°C/47°F) water of the Bay.) And that’s exactly what it did to over 1,200 people who jumped off the bridge since its opening in 1937. Over the decades, 26 people are known to have survived the fall and the cold water.

San Francisco’s most famous landmark, the world’s longest suspension bridge at its opening, has earned the sad distinction of being the world’s most popular suicide spot (others include Aokigahara, the “Sea of Trees” at the foot of Mount Fuji [Japan], Niagara Falls [US/Can], Beachy Head and Clifton Bridge [both in England]).

The number of jumpers from the bridge, spanning the over 2 km (6,700 ft) wide strait at the entrance of San Francisco Bay, has varied greatly throughout the years, never more than around 10 until 1960 (with the exception of the 20 of 1948), then rising dramatically to peak at 40 in 1977 and dropping again to a low of less than 10 in 1990.

In 2004, 24 people jumped off the Bridge, spiking to 38 in 2007 – an increase many blamed on The Bridge, a documentary about the place’s fatal attraction. In 2008, authorities voted to install a ’safety net’ six metres below the Bridge (although how this should prevent people from jumping from the net is a question that should definitely be covered by the study to be conducted on the net’s impact).

This cartogram details the exact locations of the suicides, corresponding them with the 128 light poles that line the Bridge (east to west, even ones on the oceanside, uneven ones on the bayside). For obvious reasons, the areas closest to the edges of the Bridge are less popular (most suicides aim for maximum effect, i.e. longest way down). Remarkably, the bayside is a lot more popular than the oceanside. The hotspot is light pole 69 with – if I counted correctly – 56 recorded suicides.

* See a larger version of the map here. Thanks to my Captain for the link.

Perfectionism and the Little Hater

So I've written about the evils of perfectionism (something I sadly know a LOT about;) but I saw this and thought of you and hope that it helps you identify (and choke) YOUR Little Hater...

Don't Ask Why, Ask How

Some therapists are suggesting a new approach to depression. Avoid dark thoughts and temporary distractions; neither confronts or prevents the feelings. Instead, each time the physical symptoms and dark thoughts return, adopt an anthropological approach to exploring the workings of body and mind.

The instructions are unbelievably simple. Sit on the edge of a chair with your back straight and your hands resting on your thighs. Fix your attention on the physical sensations of your body and on finding an image or words that best describe the nature of those feelings. If thoughts come into your mind unbidden, observe them and let them fade. Then look for the next thought or image that follows, but don't judge it as 'good' or 'bad.' Bring your attention back to your breathing and observe what new flow of thoughts is taking the place of the last. Don't worry about why you feel what you feel or why you think what you think; concentrate purely on HOW.

'How' instead of 'why' is so simple, yet so important. If you're unconvinced, imagine a doctor who asks, "Why did you put on 10 pounds?" and one who says, "How are you feeling about your body?" It's the difference between feeling judged and feeling heard. That little word 'how' is a gesture that opens the door to deeper understanding. Professor John Teasdale of Cambridge University demonstrated that it was possible to reduce relapses for patients with depression by more than 50% with meditation, a success rate comparable to that of antidepressant medication. We can all benefit from a finer understanding of ourselves and others. All we have to do is avoid the intimidating 'why?' and offer our trust to the kinder 'how?'

paraphrased from the article by David Servan-Schreiber in Ode Magazine.

Putting Brains on the Couch by Susan Begley

For doctors who treat illnesses that strike from the neck down, a patient's symptoms are only the first step toward a diagnosis. No sooner do they hear 'it hurts when I climb stairs' than they order blood work, x-rays or other tests. In psychiatry, though, the laundry list of symptoms is it, the only basis for diagnosis. Maybe that helps explain why 70% of patients with bipolar disorder are misdiagnosed, as are up to half of women with depression. They take drug after drug, taking each dose of each medication for four to six weeks until one works or they give up, wasting money and time while their suffering continues. It's hard to avoid the sense that psychiatry could stand to be dragged into... well, let's start with the 20th century.

The American Psychiatric Association is updating its immense diagnostic manual, which offers 20 forms of bipolar disorder alone. "But it's still just a checklist of symptoms, which different physicians can interpret differently," says psychiatrist James Greenblatt, who directs the eating-disorders unit at Waltham Hospital in Massachusetts. For him and a growing number of psychiatrists, the search for a modern, objective diagnostic tool has led to the past: the electroencephalogram, first used in 1929 to record the brains electrical activity.

For an EEG, which typically costs about $150 and takes 45 minutes, a patient has about 20 electrodes pasted to his scalp, where they measure the electrical activity of neurons - brain waves - directly beneath. In the 1980's, researchers tried to base diagnoses on EEGs, but it didn't work. The same squiggles could mean different illnesses, and one illness could be marked by different EEG's. The new use of EEG's skips the diagnosis and goes straight to a recommended treatment. An EEG is compared to a database that includes 13,000 pairings of EEGs with which drugs helped in each case. A California company called CNS Response, which runs the database, finds a match and sends the physician an analysis indicating which drugs patients with that EEG are sensitive or resistant to.

That would be humdrum if, say, the analysis said 'Prozac' for a patient with depression. But according to the studies of hundreds of patients "in some three quarters of patients the EEG database leads the physician to something he wouldn't have thought of," says CNS President Len Brandt. The EEG matches aren't perfect. For about one quarter of patients, the $500 analysis suggests treatments that work no better than what they'd already tried. It has proved most beneficial in stubborn cases and in those with no obvious first line drug, such as eating disorders and addiction.

One reason for the sometimes odd pairings of illnesses and drugs is that many different brain states can produce the same mental symptoms, and many different symptoms can arise from the same brain state. The mind has not yielded all its mysteries quite yet.

(Edited for space. Thanks to Al & Judy Peraino for this!)

Who's your anchor? (I know who mine is....)

When Medicine Got it Wrong

NAMI will kick off its 30th anniversary on July 5th at the national convention in San Francisco with a special screening of the PBS documentary When Medicine Got it Wrong. The film, produced by Katie Cadigan, is about NAMI's dramatic grassroots origins and founding as a national organization.

When Medicine Got it Wrong focuses on the years when most doctors blamed parents for schizophrenia or other disorders in their children and the loving parents who rebelled against the conventional wisdom and rejected those theories. Their activism helped revolutionize treatment and spur investment in scientific research, recognizing mental illness as a physical illness involving the brain. The documentary will premiere nationally on PBS in the fall of 2009.

Cadigan hopes the film will inspire people "to evaluate our collective responsibility to treat and care for those among us with severe mental illness... The film will be a success if it sparks dialogue about the current state of our mental health care system." Cadigan's brother, John, lives with schizophrenia and in 2004 she won a NAMI award for producing People Say I'm Crazy, directed by her brother -- the first major film directed by a person living with schizophrenia.

To Dad, with love

This morning I got a text from my dear daughter-in-law that read,"Happy 'Father's day' to a lovely lady who did both parenting roles for two kids. You are loved by all your youngins.!" Tickled me pink to get that as I clearly remember the challenge of trying to fill those shoes... buying my son a jock strap for Little League, explaining the birds and the bees and later having the "protection" talk over a box of condoms- not much fun for either of us. I often fretted about the lack of a healthy male role model, for both of my kids, as a little girl also learns how a woman should relate to a man from her father. But for my son (with the challenge of a mental illness,) this lack of a role model and of the acceptance and approval of a man- it always seemed so hurtful to him. His biological father just wasn't up to the challenge of accepting his boy as perfectly imperfect.

Father's Day means more to me today than it ever has. My life has been graced by a wonderful, caring man who has embraced the role of 'Dad' like he was born to it. His affection and acceptance of my children is unprecedented as he never had any of his own. But it goes beyond that. My husband and I had only been married for 4 months when my son attempted suicide. While my son slept on my couch, not showering, moving only to eat and then to engage only with a computer for months, my new husband rose to the challenge. He attended the 12 week Family to Family course with me and learned about mental illness. He talked to my boy, and really listened, he gave him space, he gave him time. Their relationship has only grown sweeter to me through the last four years. I realized I didn't have to be 'dad' anymore.

I missed out on a father. I'm so glad my kids finally have a Dad. Happy Father's Day.

Bullied to Death

Addressing harassment and suicide prevention in schools
By Charles Robbins, Executive Director & CEO, The Trevor Project and Eliza Byard, PhD, Executive Director, the Gay, Lesbian and Straight Education Network (GLSEN)

The impacts of language and behavior can be deadly, especially in a school environment where young people are already highly impressionable and vulnerable. Unfortunately, this difficult lesson has been conveyed many times when young people resort to drastic and permanent measures to escape the despair of enduring constant bullying and harassment at school.

It is deeply disturbing that on April 6, Carl Joseph Walker-Hoover, an 11-year-old sixth-grader from Springfield, Mass., hanged himself with an extension cord in his family’s home after being subjected to continuous anti-gay bullying and harassment at his middle school. It is equally as disheartening that on April 16, less than two weeks later, Jaheem Herrera, an 11-year-old fifth-grader from DeKalb County, Ga., also hanged himself at home after being the subject of anti-gay taunts from his classmates. These were two completely separate and isolated instances, but the tragic and preventable nature of each unfortunate loss of life remains the same.

Neither Carl nor Jaheem identified as gay, yet their peers’ defamatory language and hurtful behaviors broke the barriers of sexual orientation and gender identity. Being taunted as “faggot,” “queer” or “homo” by classmates is offensive and demeaning to any student – straight, gay, lesbian, bisexual, transgender and questioning alike.

Carl is the fourth middle school student this year to complete suicide due to bullying, and Jaheem was still in elementary school. Older students are also at a high risk, as suicide is one of the top three causes of death among 15 to 24-year-olds and the second leading cause of death on college campuses. Lesbian, gay, bisexual, transgender and questioning youth are up to four times more likely to attempt suicide than their heterosexual peers, and those who come from a rejecting family are up to nine times more likely to do so.

Enough is enough. It is time for school administrators, educators, parents, students and the government to work together to stop bullying and harassment in schools. Furthermore, we must teach young people to understand the profound impact of words and actions, and to recognize depression and suicidal ideations amongst their peers. By helping young people take responsibility for their actions and respect their peers, and simultaneously empowering them with the knowledge and skills they need to understand when their classmates are in crisis, we can work toward ending the dual epidemics of school bullying and youth suicide once and for all.

It is our hope that in memory of Carl and Jaheem, and in honor of all young people who have completed suicide after enduring constant torment at school, we will be able to work together to promote school environments that celebrate diversity and encourage acceptance of all people. Only then will we be confident that our children are receiving the respect and education they deserve today in order to become the successful and equality-minded leaders of tomorrow.

The Trevor Project is the non-profit organization that operates the only nationwide, around-the-clock crisis and suicide prevention helpline for lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. The Trevor Project was established in 1998 to promote acceptance of LGBTQ youth, and to aid in crisis and suicide prevention among that group.

GLSEN, the Gay, Lesbian and Straight Education Network, is the leading national education organization focused on ensuring safe schools for all students. Established nationally in 1995, GLSEN envisions a world in which every child learns to respect and accept all people, regardless of sexual orientation or gender identity/expression

Musing on suicide as we say goodbye to David

On June 4th, we lost one of my favorite actors, David Carradine. I loved the old Kung Fu series and watched it in syndication for years... I still use the moniker "grasshopper" when explaining just about anything to anybody; it will probably always make me smile. I had a huge pre-adolescent crush on Caine, who was so unshakable and such a badass. I was delighted to see Carradine in the Tarantino Kill Bill flicks, back to work in something worthy of him and looking fabulous for his age. I was horrified to hear the news of his death, an apparent suicide.

Of course, now the word "apparent" is taking the forefront; Carradine was working on a film and in good spirits and it seems far more likely that his death was accidental. This brought me back to a recent conversation in our mental health support group - we often talk about suicidal feelings as many of us experience them and support group is for... support. Talking about difficult feelings in a safe place often diffuses them somewhat and it never hurts to know that you are hardly the only one who feels that ending the pain might just be a workable solution.

So anyway, part of this conversation revolved around how many suicides are indeed accidental... the result of simply not being too on top of just how many xanax you've actually taken and rinsing them down with wine instead of water. Let's face it, if you're in the pit of depression or, even worse, flying high on the wave of mania, you are not exactly thinking clearly. You are NOT rational, you are NOT in control, and you are probably NOT the person who should be dispensing your medication, or driving your car, or trying some new risky adventure. But you're probably still going to do those sorts of things and you might end up dead. Even if that really wasn't your intention.

This brings us to the question of having a safety plan. I nag about this constantly. You need to create a plan when you're good, when you're rational, and you need to know it by heart so that when you're not good and not rational, you will turn to it by rote, out of habit. That plan needs to include someone you trust that can look after you a bit, check up on you, say NO to you. That plan needs to include a place of safety and a thing that will take you from zero to survival. The thing can be a walk, a long bath, going to a movie, getting out with people - only you know what will turn you momentarily away from the abyss. Let me emphasize that this thing only has to take you from zero to survival - not to feeling well, or even feeling better. If you're still willing to breathe another breath, that's the ticket.

Maybe David didn't have a safety plan. And maybe it was all just a horrible accident. Either way he will be missed.

And so would you.

Mental Health and the Fairer Sex

A new report released today on gender-based differences in mental health shows women are nearly twice as likely as men to suffer from major depression. The report addresses many other mental health issues facing women, including the effect trauma and violence can have on long term mental health, and outlines action steps for policy makers, health care professionals and researchers.

Action Steps for Improving Women's Mental Health, released by the U.S. Department of Health and Human Services' Office on Women's Health (OWH), brings together the most recent research on mental health issues in women and explores the role gender plays in diagnosing, treating and coping with mental illness. It also points to resiliency and social support systems as key factors in overcoming mental illness. Other highlights include:

*
Rates of anxiety disorders are two to three times higher in women than men.
*
Having a history of violence, trauma or abuse is associated with increased risk of depression, post traumatic stress disorder (PTSD), panic disorder and a tendency to engage in risky behaviors.
*
Female veterans may face a higher risk of PTSD than their male counterparts.
*
Family and other interpersonal connections in a woman's life may play an important role in building resiliency and offering protection from mental illness.

Acting Surgeon General Steven Galson, M.D., M.P.H., emphasizes, "Mental illness is often incorrectly perceived as a weakness, which prevents women from recognizing the signs and symptoms and seeking treatment. In order to reduce stigma, we need to encourage open, honest conversations."

The report also outlines specific action steps for policy makers, health care providers, and researchers to take in an effort to address the burden of mental illness on women's lives and increase their capacity for recovery. "We have an unprecedented opportunity to improve the mental health of women," says Dr. Wanda Jones, Director of the Office on Women's Health and Deputy Assistant Secretary of Health in the U.S. Department of Health and Human Services. "Our hope in releasing this report is that these groups will come together and turn these recommendations into action so that we better the health of our nation."

The Office on Women's Health also produced a booklet for women that addresses the stigma associated with mental health. Women's Mental Health: What It Means To You includes information on the signs and symptoms of mental illness, suggestions about where to turn for support and solutions for preventing and coping with mental illness.

Action Steps for Improving Women's Mental Health and Women's Mental Health: What It Means To You are available for free by visiting www.womenshealth.gov or by calling 1-877-SAMHSA-7 (1-877-726-4727).

Why I Volunteer

I have a tendency to rely on familiar phrases a little too heavily, so I wonder how many times someone has heard me say that no one learns about mental illness until the train hits them. I dearly love the visual of that metaphor ... can think of few things that capture the essence of serious brain disorder more completely than a train wreck. The onset of mental illness is a scene of total chaos and destruction, and it matters little if that onset happens to you or to someone you love. In an instant the world is transformed into a scary and perilous place; there is only darkness, twisted metal and pain.

The train hit me four years ago when a sobbing girl called my cell phone to tell me my son was on his way to St. Joseph's - that he had taken a lot of pills and she had called 911. I was standing in Safeway at the time, and I thanked her and left a cart full of groceries to start the hour drive it would take me to get to the hospital. I wasn't sure what I would find when I got there. It was the longest hour of my life. I don't remember what went through my head as I drove. Maybe darkness, twisted metal and pain.

That was the beginning of this journey, and I've been trying to make sense of the train wreck ever since. Luckily, my son came home with me the next day and began his own journey of recovery, slowly and shakily at first; but always making some progress. Medications, the frustrations of dealing with the VA, relapses, lost jobs, different medications, breaks, weight gain, counselors, blood tests and on and on it goes. Good days, a wedding, and growth as well. Lots and lots of learning - book after book and then the NAMI Family to Family course. A learning curve of unbelievable proportions for everyone. Through it all - love - and a deepening respect for anyone who has to live with these things. And more love.

So why do I volunteer? Penance, I'll tell you with a laugh. Doing time for all the mistakes I made before I understood the nature of the disease. As a way to honor his fight to survive and define my own. But more than that, volunteering is a way for me to help someone who just got hit by a train. Volunteering helps me shine a little light on the wreckage and find the survivors. So I'll teach a class, or facilitate a group, listen on the phone or pass on some information. It takes so little. It does so much.

Find your local NAMI affiliate for volunteering opportunities here.

Listening to Madness

We don't want to be normal," Will Hall tells me. The 43-year-old has been diagnosed as schizophrenic, and doctors have prescribed antipsychotic medication for him. But Hall would rather value his mentally extreme states than try to suppress them, so he doesn't take his meds. Instead, he practices yoga and avoids coffee and sugar. He is delicate and thin, with dark plum polish on his fingernails and black fashion sneakers on his feet, his half Native American ancestry evident in his dark hair and dark eyes. Cultivated and charismatic, he is also unusually energetic, so much so that he seems to be vibrating even when sitting still.

I met Hall one night at the offices of the Icarus Project in Manhattan. He became a leader of the group—a "mad pride" collective—in 2005 as a way to promote the idea that mental-health diagnoses like bipolar disorder are "dangerous gifts" rather than illnesses. While we talked, members of the group—Icaristas, as they call themselves—scurried around in the purple-painted office, collating mad-pride fliers. Hall explained how the medical establishment has for too long relied heavily on medication and repression of behavior of those deemed "not normal." Icarus and groups like it are challenging the science that psychiatry says is on its side. Hall believes that psychiatrists are prone to making arbitrary distinctions between "crazy" and "healthy," and to using medication as tranquilizers.

Hall and Icarus are not alone in asking these questions. They are part of a new generation of activists trying to change the treatment and stigma attached to mental illness. Welcome to Mad Pride, a budding grassroots movement, where people who have been defined as mentally ill reframe their conditions and celebrate unusual (some call them "spectacular") ways of processing information and emotion.

Just as some deaf activists prefer to embrace their inability to hear rather than "cure" it with cochlear implants, members of Icarus reject the notion that the things that are called mental illness are simply something to be rid of. Icarus members cast themselves as a dam in the cascade of new diagnoses like bipolar and ADHD. The group, which now has a membership of 8,000 people across the U.S., argues that mental-health conditions can be made into "something beautiful." They mean that one can transform what are often considered simply horrible diseases into an ecstatic, creative, productive or broadly "spiritual" condition. As Hall puts it, he hopes Icarus will "push the emergence of mental diversity."

Read all of this fascinating article here, and thanks to Mike for the link.

New Web Site

During these difficult times, Mental Health America wants Americans to know that there are tools that can buffer the effects of stress and help them cope better with the many challenges they face. This May, in honor of Mental Health Month, the organization is launching the Live Your Life Well campaign to provide people with 10 specific, research-based tools that can combat stress and promote health and well-being.

From relaxation techniques to journaling exercises to simple ways to get better sleep and improve eating habits, the materials offer a wide range of resources to build resiliency and well-being. The 10 Tools of Live Your Life Well also includes information on seeking the help of a mental health professional.

Check out this new resource here.

Female Vets Struggling to Get Treatment for Post-Traumatic Stress Disorder

The war in Iraq has been now been raging for six years.

It's the first war where women in the U.S. military are in combat roles.

Even years after serving in Iraq, female veterans are still adjusting to civilian life.

At a women's veterans art show in San Francisco vets say the six year anniversary of the war brings back painful memories.

"The 6 year anniversary has me thinking about the friends that I lost. And the friends that I still have who have been forever scared by the war," said Iraq war veteran Lindsey Rousseau-Burnett.

Many of the women we talked to say they are getting psychiatric help from the Veteran's Administration.

But they say the agency is behind the times.


"Because women supposedly aren't in combat they have a higher burden of proof to try and prove they have PTSD," said vet Kayla Williams.

The veteran's service organization Swords to Plowshares says female Iraq war vets are the fastest growing population of homeless.

"There numbers in terms of homelessness is growing exponentially. There are very few services for them because homeless veterans services, VA services have grown up serving a male cliental," said Swords to Plowshares Amy Fair-Weather.

These vets are hoping sharing their stories through pictures and books will help make the road to recovery easier for the women currently serving in Iraq.


© 2009 NBC News

A General's Personal Battle by Yochi J Dreazen

Maj. Gen. Mark Graham is on the frontlines of the Army's struggle to stop its soldiers from killing themselves. Through a series of novel experiments, the 32-year military veteran has turned his sprawling base here into a suicide-prevention laboratory.

One reason: Fort Carson has seen nine suicides in the past 15 months. Another: Six years ago, a 21-year-old ROTC cadet at the University of Kentucky killed himself in the apartment he shared with his brother and sister. He was Kevin Graham, Gen. Graham's youngest son.

After Kevin's suicide in 2003, Gen. Graham says he showed few outward signs of mourning and refused all invitations to speak about the death. It was a familiar response within a military still uncomfortable discussing suicide and its repercussions. It wasn't until another tragedy struck the family that Gen. Graham decided to tackle the issue head on.

"I will blame myself for the rest of my life for not doing more to help my son," Gen. Graham says quietly, sitting in his living room at Fort Carson, an array of family photographs on a table in front of him. "It never goes away."

Suicide is emerging as the military's newest conflict. For 2008, the Pentagon has confirmed that 140 soldiers killed themselves, the highest number in decades.

At a Senate hearing last week, Gen. Peter Chiarelli, the Army's vice chief of staff, told lawmakers that 48 soldiers have already committed suicide in 2009. The figure puts the Army on pace for nearly double last year's figure. "I, and the other senior leaders of our Army, readily acknowledge that these current figures are unacceptable," Gen. Chiarelli said at the hearing.

Beyond Fort Carson, the Army has launched a broad push to reduce the incidence of suicide. Over the next four months, all soldiers in the Army will receive additional training on suicide prevention and broader mental health issues. The Marine Corps, which is also being hit hard by suicide, will give all Marines similar training this month. In February and March, the Army for the first time ever excused units from their normal duties so, one by one, they could learn new ways of trying to identify soldiers in need of help.

Read the rest of the article here.

Yesterday

Yesterday, I got some inspiration to purge... and pulled out some boxes from the garage with the intent of clearing them out and consolidating. Everybody has some stupid cardboard boxes full of stuff, you know. Old stuff that seemed too important to toss but not important enough to have sitting in the room with you. Usually the stuff remains in the cardboard box forever, being dutifully moved from home to home until you die and then your offspring become in charge of tossing it out unceremoniously whilst muttering under their collective breath. This is the way of stuff.

However, I seem to have some odd recessive gene that occasionally prompts me to rid myself of the weight of some of the stuff. Unfortunately, this gene is not of the sort of nature that might suggest that I just march into the garage, pick a couple of boxes at random and heave them into the dustbin without a peek. There must be peeking and consideration, lest I might divest myself of something of deep and irreplaceable value. This is a good thing, as in this last batch of peeking I finally located my long lost divorce decree - which does indeed have some value and although not irreplaceable, could lead to a good deal of unpleasantness if suddenly needed and not available.

Within this box of divorce decrees (keep,) notebooks of adolescent poetry (pitch!) the first board I broke with my fist in karate (PITCH,) tax records from 1998 (still have to keep?) and such, was a rather nondescript envelope. And within the envelope was a photocopy of a death certificate and another copy of a handwritten note. And then I was crying and the purging of stuff came to an untimely end. Like the life described therein.

I wonder if I will ever really heal from the loss of my father. It's funny that I didn't miss him until I was 32 years old. Until then, I had this sad dream of a daddy who died tragically just before my arrival on the scene - snatched from life by an untimely accident. I spotted him occasionally in the pain in my mother's eyes, but beyond that he was only this tragic and beautiful fellow in my dreams. Then, as an adult with children of my own, that death certificate came home to roost and answered my questions once and for all. My father wasn't snatched from life at 25. My father took his life.

So, who am I crying for? Not sure about that. Suffice it to say that I have come far enough to say that I can understand the wish to have it end. Not so much a wish for death... just a wish for an end to the pain of living. Buddhists suggest that we embrace the pain; accept that pain is the whole substance of living - I haven't figured out how to do that. Not by a long shot. There are days that I open my eyes and my first thought is one of dread. Joy feels alien. Sunlight makes me wince. I often wonder if the one cell that my father gave me held all his pain as well. I often wonder if I didn't pass it on to my son.

In another nondescript envelope are some photos of my dad as a kid. As I rifled and sniffled one photo jumped out at me - like I'd never seen it before. Suddenly on a mission, I found another photo from another box and laid the two side by side. My dad at 15. My son at 15. I never noticed how much they looked alike.

I'm crying again. I'm still not sure for whom.

Shame

I don't look at mirrors.
Okay, maybe sometimes. At my face.
I don't mind my face too much,
if I don't look too hard and skip the eyes.
I don't watch as the soap slips along
standing in the shower.
I close my eyes to wash
or watch the water.
Reflections in windows
can be handily avoided
by keeping a sharp eye on the movement of feet;
avoiding judging eyes a value added.
At worst a window glance is brief
and thankfully clothed.
Bathrooms are harder.

The Right Thing

The question, friends, that is always on the tongue of those who live with a loved one with mental illness, is startling in it's simplicity. Because after you have come to grips with a diagnosis, or at least wrapped your mind around the reality that your child, spouse, parent, or sibling is not okay in the traditional sense of the word - after you have educated yourself about that malady and done your homework by reading book after book or endlessly surfing the net - after you've sought out support groups and doctors and counselors and social workers - after all due diligence you find yourself still grappling with that one question.

What is the right thing to do?

I live in America. This is a the "land of the free, home of the brave." This is a culture that looks disapprovingly upon failure, weakness and lack of a stiff upper lip, whatever that is supposed to mean. Homeless? You've failed to 'pull yourself up by your bootstraps.' Jobless? You aren't taking advantage of your opportunities. Ill? Well, how long can it take to get better? Take your pills for heaven's sake and get on with it. Addicted? That's just pathetic; we'll let you hit bottom and then you'll see the error of your ways and become a responsible citizen.

This is how the New Collegiate Dictionary defines the term enabler: "one that enables another to achieve an end; especially: one who enables another to persist in self-destructive behavior (as substance abuse) by providing excuses or by making it possible to avoid the consequences of such behavior." This has become the dirty word to fling at the family of the afflicted - as if they have caught some vile social disease by association. Not enough to blame the victim... blame the victim's family as well. This is how compassionate our culture is to the most vulnerable.

The flipside, of course, is that often our loved ones become most ingenious at using our compassion for them to their own ends. That just because a person is ill, does not mean he or she is not capable of being devious and manipulative, or lazy and unwilling to compromise. A person with mental illness may very well have the ability to decide that sitting at home playing video games trumps working at a dull minimum wage job hands down, or that Mom will clean up the mess if I don't. A little show of temper or the silent treatment may get the family back to walking on eggshells - and off my back. Which brings us back to the question.

What is the right thing to do?

The line between "enabling someone to achieve an end (recovery)" and "enabling someone to continue self destructive behavior" is always in motion. The ability to discern when a behavior is a direct result of the disease or a reactive coping mechanism is an ongoing learning curve - and just when I think I've got it down, I catch myself and have to reevaluate. The line is dependent on so many factors - what illness, how severe, what stage of recovery are we in, what outside factors are contributing, are the meds working, are they being taken... and so on and so on and so on. Sometimes it's too much to grapple with and I abdicate - and my fall back position is usually to help in some way, even if that help is enabling. But I fear that if I am always there to clean up the mess, to provide comfort, or just plain to save his butt from consequences that a normal (as in not mentally ill) person would have to face - that I am somehow doing him a disservice. How will he mature and grow and learn to handle things himself if I never let him deal with his own mistakes?

What is the right thing to do?

Coping with Hearing Voices by Rethink

Most people in modern-day western culture think of hearing voices as a clear sign of mental illness but it's as well to remember that not everyone shares this opinion. A report published by the British Psychological Society in (2000) claims that 10-15 % of the population hear voices or experience other hallucinations at some point in their life. However, only about 1 % of the population is given a diagnosis of schizophrenia and a similar number get a diagnosis of manic depression (often called 'bi-polar disorder'). In some other cultures hallucinations are thought of as spiritual gifts. So not everybody who hear voices is thought of as having a mental illness by themselves, their families or even the mental health services.

Hearing voices in itself may not necessarily be distressing. What really matters is the effect that hearing voices has upon the person's life. For some voice hearers the experience is highly distressing and disturbing and it has a negative impact upon their life. Voices can be critical, hostile and even result in suicide. For others the experience is not distressing; it can even be positive, comforting or inspiring. Sometimes, hearing voices becomes distressing in itself because of the way it is viewed by our culture and because of the way the media portray people who hear voices as dangerous to others, which is very rarely the case.

But many people who hear voices find themselves having to deal with a different world, which may at times be overwhelming and may shut out everything else. As a result reasoning may be almost taken away, making it difficult or even impossible to go about life without being affected by such penetrating and confusing experiences.

What are the voices?

Using brain imaging techniques (ie using a brain scanner), researchers can see which parts of the brain are active during different tasks. So, using these brain imaging techniques researchers can see which parts of the brain are active whilst you are experiencing psychotic symptoms, such as hearing voices. This shows that when you are hearing voices part of the brain, called Broca's area, is active. This is the same area that is active when a person without psychosis makes inner speech, such as when reciting a poem to themselves. This shows that the voices originate within the brain, in just the same way inner speech is generated. The difference is that with hallucinations (e.g. voices) the auditory cortex is also activated. The auditory cortex is normally active when we are listening to sounds, such as somebody talking. So, when you have hallucinations of hearing voices, Broca's area and the auditory cortex are both active, making it seem like the voices are coming from outside. Whereas, in inner speech (such as silently reciting a poem to oneself) only the Broca's area is active and we recognize it as our own silent speech.

See the rest of the article, including strategies for coping, here.

Vets and Depression

* An estimated 9.3 percent of veterans aged 21 to 39 (312,000 persons) experienced at least one major depressive episode (MDE) in the past year.

* Among veterans aged 21 to 39 with past year MDE, over half (51.7 percent) reported severe impairment in at least one of four role domains (i.e., home management, work, close relationships with others, and social life), and nearly one quarter (23.5 percent) reported very severe impairment in at least one of the domains.

* More than half (59.6 percent) of veterans aged 21 to 39 who experienced past year MDE received treatment for depression in the past year.


Recent research indicates that an estimated 25 to 30 percent of the veterans of the wars in Iraq and Afghanistan have reported symptoms of a mental disorder or cognitive condition. Untreated mental health problems can result in long-term negative consequences for the affected individuals, their families, their communities, and our Nation as a whole.

The National Survey on Drug Use and Health (NSDUH) includes questions about military veteran status, major depressive episode (MDE), and treatment for depression. This issue of The NSDUH Report examines data from veterans aged 21 to 39, an age group that includes veterans with relatively recent service.

Read the rest here.

The wolf you may know

"WHEN YOU SAY THE WORD "sociopath" most people think of serial killers. But although many serial killers are sociopaths, there are far more sociopaths leading ordinary lives. Chances are you know a sociopath. I say "ordinary lives," but what they do is far from ordinary. Sociopaths are people without a conscience. They don't have the normal empathy the rest of us take for granted. They don't feel affection. They don't care about others. But most of them are good observers, and they have learned how to mimic feelings of affection and empathy remarkably well.

Most people with a conscience find it very difficult to even imagine what it would be like to be without one. Combine this with a sociopath's efforts to blend in, and the result is that most sociopaths go undetected.

Because they go undetected, they wreak havoc on their family, on people they work with, and on anyone who tries to be their friend. A sociopath deceives, takes what he (or she) wants, and hurts people without any remorse. Sociopaths don't feel guilty. They don't feel sorry for what they've done. They go through life taking what they want and giving nothing back. They manipulate and deceive and convincingly lie without the slightest second thought. They leave a path of confusion and upset in their wake.

Who are these people? Why are they the way they are? Apparently it has little to do with upbringing. Many studies have been done trying to find out what kind of childhood leads to sociopathy. So far, nothing looks likely. They could be from any kind of family. It is partly genetic, and partly mystery." (read more of this article here.)

So here's a little test... actually a question devised by a psychologist to see who thinks like a sociopath. Read the question carefully and give it some thought.

A woman, while attending her own mother's funeral, meets a man. She has never set eyes on him before and yet she finds him to be delightful. She is sure he is 'the one.' But somehow he leaves the funeral before she can get his number, or even his last name. A few days later, she murders her sister. SOOOO, what was her motive for killing her sister.

You'll have to check the comment thread to get the answer... and if you get it right, please let me know (so I can block your email.....:)

Read The Sociopath Next Door last year.... chilling.....