Dr. Ron Pies writes an eloquent defense of why physician-assisted suicide should not be made a legal right in Massachusetts. He compares it to a doctor helping one of his patients jump from a bridge — something most doctors would never do.

But in making this analogy, I believe we’re removing all context and logic from the decision behind wanting to end your own life because of a terminal illness. For the patient, it’s not about the act of suicide or ending their lives — it’s about alleviating suffering from the disease and choosing one’s own way of dying with a little dignity. It’s about patient empowerment, human dignity and choice.

That’s why in the two states where it is legal for doctors to help patients with a terminal illness, it’s referred to as the Death with Dignity law.

Because the alternative takes much of the dignity out of dying in today’s modern medical system.

Imagine that your father, age 85, has been diagnosed with a terminal illness and given only three months to live.

Fortunately, he is still well enough to walk, and finds himself one night near a tall bridge. Having contemplated the suffering he believes will attend his final days, he decides to end his life by jumping off the bridge. However, he is too weak to hoist himself up atop the protective railing.

Suddenly, he sees his very own physician, Dr. Jones, walking by. He begs Dr. Jones to help him climb atop the railing, adding, “Don’t worry, Doc, it will be my decision to jump.” The doctor is taken aback, but quickly determines that his patient is not psychotic or severely depressed, and is capable of making a rational decision regarding suicide. The doctor tries to persuade your dad that pain and suffering can usually be well-controlled during the final days, but the patient is insistent: he wants to end his life.

Would you agree that Dr. Jones is fulfilling his obligations as a physician by assisting your father in jumping off the bridge?

If not, would you support the doctor’s providing your father with a lethal dose of medication?

Roughly a quarter of people age 65 or older suffer from depression. More than half of doctor’s visits by the elderly involve complaints of emotional distress. Twenty percent of suicides in this country are committed by seniors, with the highest success rate belonging to older, white men.

According to a recent report in the Journal of the American Geriatrics Society, depression is one of the major causes of decline in the health-related quality of life for senior citizens.

Why all the depression?

Rafi Kevorkian, M.D. calls them the five D’s: disability, decline, diminished quality of life, demand on caregivers, and dementia. To combat senior depression, then, requires coming up with creative methods to counter the five D’s.

Here are 12 strategies to do just that: help people break free from the prison of depression and anxiety in their senior years.

All individuals have the right to aspire toward their own personal goals and desires. At times, mental health conditions and problem behaviors, such as aggression or property destruction, can create barriers to reaching those goals.

Fortunately, a number of treatment practices exist that can assist an individual in adopting positive behaviors. If you or a loved one has been diagnosed with a mental health condition and has problem behaviors, consider talking to a mental health provider about the benefits of Positive Behavior Support (PBS).

What is PBS?

Positive Behavior Support (PBS) is a philosophy for helping individuals whose problem behaviors are barriers to reaching their goals. It is based on the well-researched science of Applied Behavior Analysis (ABA). A key component is understanding that behaviors occur for a reason and can be predicted by knowing what happens before and after those behaviors.

I have been working in mental health for about 12 years. I listen to clients in crisis for many hours a day, providing support, empathy, interpretation and direction.

Therapists can easily lose track of their own issues, ignore their own problems, and at times have difficulty shutting off the therapeutic process.

In order to be a good therapist, it is necessary to take care of ourselves — our clients depend on it. Just because we know everything there is to know about stress management doesn’t mean that therapists can’t become mentally exhausted. If you are feeling “depersonalization” toward your clients or possibly yourself, you could be experiencing emotional fatigue.

Here are some ways that I like to keep balanced.

Diana Denholm can relate to the challenges of being a caregiver. A month after her husband proposed, he was diagnosed with colon cancer.

While he survived the cancer, he was later diagnosed with congestive heart failure. Even after receiving a heart transplant, her husband continued to deteriorate and develop other conditions, including severe osteoarthritis, skin cancer, kidney failure, depression and Parkinson’s disease. Denholm was her husband’s primary caregiver for over a decade.

Even though Denholm, Ph.D, LMHC, is a medical psychotherapist, she felt incredibly unprepared for her role and found little direction for navigating the many stresses and challenges of being a caregiver.

This inspired her to write the book The Caregiving Wife’s Handbook: Caring for Your Seriously Ill Husband, Caring for Yourself, which gives women the practical tools to traverse their day-to-day lives and communicate with their husbands.

Marriage can be challenging — even under the best of circumstances. The fantasy of marriage is that, once you’ve found your soulmate (or at least a good stand-in), everything else is downhill.

Nothing could be further from the truth.

All of the stress (and stressors) of a long-term relationship are magnified when one or more of the people in the relationship is dealing with serious mental health issues, such as depression or bipolar disorder. Mental illness amplifies existing problems, and creates new ones while both people in the marriage cope with trying to also cope with the illness together.

That’s why I’m pleased to bring you our newest blog, A Moody Marriage by Rita Brhel. Rita is a writer and editor, and works for Attachment Parenting International. She married her college sweetheart in 2002 who, at the time, had undiagnosed Attention Deficit Disorder and later developed Rapid-Cycling Bipolar Disorder.

We’re proud to be an exhibitor at Alternatives …

Anybody who’s been an administrator in a community mental health system in America in the past three decades knows the drill. During bust times, state governments actually come close to doing a good job with members of society who are at their most vulnerable. Services are — while never fully-funded — well-funded, and for the most part, there’s enough staff to cover the huge need in communities for mental health care for the poor.

But when budgets tighten, the first place governors look to cut are social services. High on the list of social services to be cut are mental health services, because they are often people intensive. Nevermind that most of those people are poorly trained “aides” or others who often have little direct education or experience with people with mental illness.

Governors and state legislatures do this because they know few people complain when government has to cut services to the poor. Sure, a few advocates and agencies may get up in arms about the cuts, but they quickly get drowned out by the fact that nobody wants their taxes to go up and cuts have to be made somewhere.

So as Massachusetts considers more cuts to mental health services, the New York Times yesterday took a look at a tragic case that occurred earlier this year, when someone who was suffering from schizophrenia allegedly brutally beat and murdered his group home counselor and aide, Stephanie Moulton.

“The only thing necessary for the triumph of evil is for good men to do nothing.” — Edmund Burke

“What conditions?” asked Rivera.

“In my building,” responded Wilkins, “there are sixty retarded kids with only one attendant to take care of them.  Most are naked and they lie in their own sh*t.”

This exchange was from a telephone call from Dr. Wilkins, who had been fired from Willowbrook State School in Staten Island, New York. He and a coworker were fired for their concern for the welfare of the inhabitants.  The person they were talking to was a young television reporter: Geraldo Rivera.

On January 6th, 1972, Wilkins and Rivera met at a diner.  Wilkins still had the keys to many buildings, and the plan was set to bring in a camera crew to (illegally) film the inhabitants and their conditions.  On January 10 they entered building No. 6.

In honor of May — mental health month — I wanted to highlight the day those videos were taken because it marks the beginning of the mental health movement in America.  Specifically, who received mental health services and how those services were delivered changed after those videos aired. But the powerful videos taken by Geraldo Rivera weren’t the first time the conditions at Willowbrook were noticed.

As part of May Is Mental Health Awareness Month, many of us here at PsychCentral are participating in a Mental Health Blog Party hosted by the American Psychological Association. Today, May 18, we are all blogging about mental health awareness. Here’s my contribution.

Why do I blog about mental health?

I want to explain to people that depression and other mood disorders aren’t yuppie diseases for folks with the time and resources to ruminate and obsess, that they can be life-threatening illnesses.

That’s right. Depression kills.

As the baby boomers age here in the U.S., they are going to swell the ranks of seniors. And senior care — especially mental health care — is one of the most ignored in America. We act as though seniors don’t matter much, and few health care and mental health care professionals go into specializations, such as geriatric psychology, that can help senior citizens.

Perhaps that will change, with more attention and focus provided on this group of people. Because as we age, we often face many of the same difficulties as we did earlier in life.

Except these difficulties are often amplified, because of the loss of social support — our friends — and isolation — most often from our own family.

The New York Times profiles Marc E. Agronin, M.D., a geriatric psychiatrist to showcase the mental health challenges of our aging population.