“If I was going to kill myself, I wouldn’t tell you or anyone else.”

As a Psychiatric Nurse Practitioner who specializes in crisis intervention and Emergency Room Psychiatry, I hear that a lot. Over 30,000 Americans will take their own lives this year. More people die by suicide each year than homicide, yet suicides rarely make the nightly news. Sometimes it’s hard to know when someone you love and care about may be hurting inside and may need help. If your friends or family are thinking about killing themselves, and they don’t tell you, how can you help them? You can help because there are signs and clues before someone attempts to hurt or kill themselves, a prelude that you may be able to recognize after reading this information.

Anyone can commit suicide. Suicides occur in every ethnic group, gender, occupation, geographic area and socioeconomic status. Suicide is the third leading cause of death in teens and young adults, ages 15-24.

Suicide is preventable. Once you recognize these signs and symptoms in someone, you can help save their life by taking action and getting them to the nearest ER.

Today I have the pleasure of interviewing Jody Smith, creator of the website www.ncubator.ca, who spent 15 years losing the battle against Chronic Fatigue Syndrome. Three years ago, she found treatment that worked for her and is making a comeback. In the process, she’s helping a lot of people. (You can check out her blog, “ncubator” by clicking here.)

You tried many treatments and finally you got there. What worked?

Jody: My naturopath believed that my liver needed relief from its toxic load, and my immune system needed building up.

She put me on a tincture with natural antivirals and adaptogens and vitamins in it, and put me on omega3 oil.

I’d gone low carb some years before which had made quite a difference.

I did dry skin brushing with a loofah, to help lymph move better (removing toxins) and sinus lavage (water up the nose to cleanse sinuses) and juicing (for nutrients to absorb better in a weakened gastrointestinal tract).

Vitamin D helped with orthostatic intolerance and vertigo in noticeable ways. Most of us are deficient of Vitamin D.

Boy where did July go? It’s hard to believe there’s just one more month left in summer. Being that we’re more than half way through 2010, it’s a great time to reflect. Have you thought about your New Year’s resolutions and life goals lately? I have. In fact, it’s all I have been thinking about recently. I’ve been wrestling with the battle between accepting the present while working on improving myself for the future. What stirred up this sudden focus on self-reflection?

I’m enrolled in an online writing course and something the instructor said really hit home. She said that our unconscious drives our behavior and this includes how we treat others, ourselves and even how we write. In fact, if we are not aware of it, it can sabotage our life. That’s kind of where our top five posts comes in and why I’m so grateful to have read them. When we have a deep seated belief that we’ll never make it for example, or the world is a scary place, we could lose hope. Or we worry ourselves sick as a way to gain a false sense of control over the unknown. In the end, however, worrying can’t protect us from rejection or harm.

What can we do? We can instill hope when all seems lost or use our shadow side to foster creativity. Even if you haven’t attained anything on your Resolutions list (who has really?) or accomplished all of your goals, there are still lots to celebrate and much to gain in this last summer month. Go ahead and read our top posts of the week and see if you don’t feel more hopeful after.

Finding Hope: “The Instillation of Hope in Therapy and in Life”

(The Therapist Within) – What’s a four letter word that could change lives? It’s hope and it’s a lot more powerful than you think. Read how hope is not just something to be taken lightly. In fact, it could be said to be a foundation for therapy.

I hate to give press to a “research firm” that doesn’t know the first thing about reporting statistics or basic methodology in their own “research” report. I guess that’s what happens when you get a bunch of people together who are mostly technologists, not statisticians or social scientists.

This past week, MyType, a Facebook personality application that takes your data and then sells aggregated reports based upon your answers to their quiz, released a report about the iPad. They suggested that iPad owners and those looking to buy one were “selfish elites” while those who were iPad critics were characterized as “independent geeks.”

You can already tell that this isn’t exactly going to be a scientific analysis, right?

The airwaves, newspapers and blogosphere were abuzz this week with the fiasco involving Shirley Sherrod, the USDA worker forced to resign over a fabricated racial controversy. The original slur was initiated by a blogger who posted a misleading video clip of a speech by Ms. Sherrod. Ultimately, Sherrod was cleared of any racist leanings, and we must now hope for some genuine soul-searching among all those who failed the most elementary tests of fairness, accuracy and decency in responding to the original charges.

But the other day, amidst all the commentary on Shirley Sherrod, a short article buried inside the Sunday New York Times caught my eye. Innocuously entitled, “No Air-Conditioning, and Happy,”1 the article concerned a certain agricultural scientist and his wife who “…do not use air-conditioning as a matter of personal preference and principle — even on the most hostile days.” The scientist, Stan Cox, recently wrote an op-ed piece for the Washington Post, in which he questioned the excessive use of air conditioning in modern society.

And what does this have to do with the Sherrod debacle?

Well, according to the Times report, Mr. Cox has “faced death threats” since publishing his op-ed, which was followed by “…sixty-seven pages of cringe-inducing email messages”, one of which “threatened to shoot Mr. Cox.” Shoot someone? Over an opinion piece questioning the use of air conditioners? Mr. Cox’s response was a blandly good-natured shrug: “Maybe enjoyment of thermal variety isn’t for everybody,” he opined. But Mr. Cox may not have appreciated that, like Shirley Sherrod, he had been the target of what I call our “Gotcha-Pounce Culture”.

You’ve been diagnosed with a mental disorder and have been in treatment now for years. You’ve done both psychotherapy and psychiatric medications, and now it’s time to try to live life drug-free. You’ve successfully ended your psychotherapy treatment, but now you’re looking for advice and information about how to end your psychiatric medications.

My first suggestion to you would be to talk to your doctor or psychiatrist. Nobody should go off of any medication without first getting their doctor’s consent and, hopefully, cooperation (or, if not their consent, at least their grudging acceptance that it’s your body and you can do with it what you want). Ideally, you’re seeing a psychiatrist for your psychiatric medications and not just your family doctor. If you are just seeing your family doctor, you may need a little more help than someone seeing a psychiatrist, because psychiatrists have much greater familiarity with helping people get off of the medications they previously prescribed to them. (In my experience, I’ve found many family doctors simply have little clue about the idiosyncrasies of discontinuing psychiatric medications, because of their unique tapering properties.)

I keep hearing and reading how the Internet has changed everything. First we learned how it was the end of privacy and no less a man than the head of Facebook (who might have some self-interest involved) noted that the age of privacy was over earlier this year. Of course that’s in Facebook’s best interests to make you believe privacy is “over.” Zuckerberg claimed, without a shred of scientific evidence or data, that lack of privacy is now a societal norm. (Apparently when nobody was looking, Zuckerberg got his Ph.D. and did some sociological or epidemiological research.) Nothing could be further from the truth — privacy is very much a societal norm. It’s also a personal and private decision most of us make on a daily basis. For example:

• How much do I tell my significant other about what happened at work today?
• That’s a cute photo, should I share it with others?
• Should I tweet about what I just that person do in the coffee shop?
• I just got a raise — is it something I should put on my status update?
• Should I tell the clerk about what happened to me this morning?

We make privacy decisions every day, but most of us give little thought to them because we expect little will become of our personal, daily sharing. But when you open that sharing up to the infinite Internet, it can become another thing entirely.

So it was with some trepidation that I read The Web Means the End of Forgetting in the New York Times Magazine recently. But I was pleasantly surprised.

This weekend I got in touch with a different side of my personality: the nature loving one. It’s the part of me that often gets buried underneath daily worries, fears and your garden variety neuroticism. While tending to issues are important, so is taking a break from them. Based on the outpouring of responses I got concerning outdoor activities on Facebook, it seems like I might not be the only one. Isn’t it nice basking in the ray of hope and possibility instead of fear and uncertainty every once in awhile?

That’s what I spent my time doing in a rustic cottage in the country. I stared out the French doors of the tiny cottage for several minutes without fear of boredom or anxiety from doing nothing. I heard and felt comforted by the subtle soundtrack created by the sounds of chickens and horses nearby. The cold floor underneath my feet and the slight creaking my footsteps made on it were music to my ears. I reveled in the experience and after a few days of succumbing to every wish and request my body and mind had for rest and relaxation, I left feeling refreshed and re-energized to start anew again.

I hope that wherever you are on your own personal journeys, you can step away from your worries long enough to feel the serenity that exists outside your door and inside yourself. Why not start with these top five posts for the week?

We Need More Words to Describe Depression

(Bipolar Advantage) – Depression. How would you define it? Having a hard time expressing the feeling in words? You’re not alone. There are some who can feel emotions strongly, but can’t describe it and others who can’t feel it at all. Tune in to your own feelings about depression, then go here to express it yourself.

Twenty years ago, George H.W. Bush signed into law the Americans with Disabilities Act (ADA), a broad civil rights law that forbids discrimination based on any kind of disability — physical or mental. It gives similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964. Some see it as a broad government boondoggle, but it’s the law that makes a simple thing like a curb cut a federal mandate because local governments just didn’t care about the people within their communities who live with a physical or mental disability. Navigating a crosswalk seems like such a simple thing for most of us. But try it in a wheelchair when the curbs don’t have ramps and suddenly it becomes an opportunity to be hit by a car.

More importantly, the law made a significant impact by equating physical and mental disabilities. Up until the mental health parity law was passed in 2008, mental disorders were not always seen as being on the same level as a physical disease, illness or condition. But the ADA made the two equal since Day One, ensuring that people who suffered from severe, chronic depression were treated the same way as someone with a physical disability in the eyes of the law.

What happens when a psychologist writes a memoir?

To tell the truth I have to lie.

To write a memoir these days you had better be telling the truth. When I met with the publisher about Confessions of a Former Child: A Therapist’s Memoir, she specifically asked me if what I wrote was true. I hesitated, and a worried look crossed her face. Finally, I insisted it was all true, except for the parts I made up. She told me I needed to explain.

I told her that in essence, as a psychologist and a memoirist I serve at the discretion of both disciplines — the first devoted to understanding the human condition, the second to the condition of being human. Both employ methods of nonfiction writing to achieve their goal, but with a major difference: A psychologist must follow strict guidelines published by the American Psychological Association on how to talk about case studies of patients.

The Publication Manual of the American Psychological Association, Fifth Edition advises three strategies to disguise case material without changing the variables of the phenomena being described. These suggestions may be helpful for other non-fiction writers as well.

1. Alter specific characteristics
2. Limit the description of specific characteristics
3. Obfuscate case detail by adding extraneous material

One, two, or all of these techniques may be needed to achieve the goal. Depending on your choice you should inform readers that you have made these alterations. The Author’s Note for Confessions of a Former Child: A Therapist’s Memoir, reads:

Out of respect for their privacy I have changed the names of some of the people who appear in this book. When referring to individuals I have worked with in therapy, I have followed the American Psychological Association’s guideline to protect confidentiality.

In Confessions of a Former Child: A Therapist’s Memoir, I reflect on aspects of my life and how these experiences influence work with my patients. This is the life work of a therapist, called countertransference — how memories and feelings in our psyche often merge and intertwine with our clients.

“Insanity is doing the same thing over and over and expecting different results.”

I have heard that quote in my clinical practice so many times in the past year that I decided I have to write about it. Somehow this definition has become part of the collective understanding of abnormal psychology and has been terribly misapplied. I don’t know much more about the context of the quote but I am guessing that it was a bit of a humorous comment on science.

First, to critique the quote. If we are going to take this definition seriously to start, then everyone, yes everyone, is insane. Behavioral research in the early part of the twentieth century taught the world about how human beings learn: through long processes of conditioning based on pairings and reinforcement.

Is the DSM-5 — the book professionals and researchers use to diagnose mental disorders — leading us to a society that embraces “over-diagnosis”? Or was this trend of creating “fad” diagnoses started long before the DSM-5 revision process — perhaps even starting with the DSM-IV before it?

Allen Frances, who oversaw the DSM-IV revision process and has been an outspoken critic of the DSM-5, suggests melodramatically that “normality is an endangered species,” due in part to “fad diagnoses” and an “epidemic” of over-diagnosing, ominously suggesting in his opening paragraph that the “DSM5 threatens to provoke several more [epidemics].”

First, when a person starts throwing around a term such as “over diagnosing,” my first question is, “How would we know we’re ‘over diagnosing’ a condition, versus gaining a better understanding of a disorder and its prevalence within modern society?” How can we determine what is being accurately, better and more frequently diagnosed today, versus a disorder that is being “over diagnosed” — that is, being diagnosed when it shouldn’t be due to marketing, education or some other factor.