Managing Depression and Suicidality

It is common for clients with schizophrenia to feel grief and loss due to the myriad life changes that it triggers (Wittmann & Keshavan, 2007). In this sense, during treatment, it is essential for clinicians to help clients navigate through the grieving process. According to Tait, Birchwood, and Trower (as cited in Wittmann & Keshavan, 2007), depression has been found to lead to the abandonment of treatment by clients due to the isolating characteristics of the disorder. Abandonment of treatment poses serious drawbacks for clients.

Wittmann and Keshavan (2007) assert that the grieving process is a necessary component to coming to terms with a new diagnosis of schizophrenia. Due to the sense of loss experienced by individuals newly diagnosed with schizophrenia, it is essential for them to navigate and work through the grieving process (Wittmann & Keshavan, 2007). According to Lewis (as cited in Wittmann & Keshavan, 2007), by doing so, clients will learn to mourn the life and identity changes that have occurred, along with establishing the ability to integrate such change into their lives. It has been shown that counseling can be beneficial in such a situation.

Grief and mourning are a common component in clients diagnosed with schizophrenia (Wittmann & Keshavan, 2007). This is because the diagnosis of a serious, permanent mental disorder is a major life crisis for most. The disorder affects the mind in very serious ways (Wittmann & Keshavan, 2007). In some cases, clients might spiral into psychosis as a means of dissociating, or defending against facing, the losses their disorder has caused (Wittmann & Keshavan, 2007). Clinicians have a major hand in helping clients manage this crisis.

Numerous models exist to explain grief and mourning, and can also help professionals guide grieving individuals. Elizabeth Kubler-Ross (1969) proposed five stages of grief that individuals can experience while grieving. They include denial, anger, bargaining, depression, and acceptance. In contrast, Worden (2002) proposes four tasks, as opposed to stages of grief. These include accepting the reality that loss has occurred, feeling the pain and emotional responses to the loss that has occurred, readjusting to life after the loss, and finding ways to remember the lost individual. Although these models are meant to aid in grieving a person, individuals diagnosed with schizophrenia are, in fact, grieving the loss of the person they once were and will potentially no longer be. In this sense, these models offer a framework that can be used in counseling to help a client adjust to life after their loss of self.

A Safety Plan for the Newly Diagnosed

Clinicians should develop a safety plan for use in the event that a client presents with suicidal intent or depressive symptoms, as these are both common in newly diagnosed clients. One of the first issues to address is the onset of depressive symptoms or suicidal thoughts. A safety plan can involve listing symptoms characteristic of depression, including those characteristic to the client, as well as those that the client has not felt before, but could potentially feel in the future. This would help foster the client’s awareness of their own symptoms.

Along with such a list, clinicians can help clients determine the course of action to be taken if suicidal thoughts or feelings occur. Action plans can include emergency contact numbers, such as a suicide hotline and that of the primary therapist, the psychiatrist and other medical doctors, and family members or other individuals who serve as the client’s support system. One of these individuals could sit with the client and support them through the situation while attempting to contact appropriate clinicians. If the client has no close friends or relatives, suggest that they join an in-person or online support group.

Clients should be asked to keep a list of depressive or suicidal triggers. During sessions, the counselor and client could develop and implement ways for such triggers to be managed.

Clinicians should urge clients to remove from his or her home any items that could be used to self-harm. Making access difficult reduces the temptation to use them. This might be especially useful for clients who have already made attempts, and would also potentially increase the likelihood of them seeking some form of support or following an appropriate plan of action, rather than engaging in self-injurious behavior.

Clients can be encouraged to keep an up-to-date medication list with them at all times. This will help them if they need to seek out emergency services. During a crisis, it might be difficult for them to recall each of the medications they take, as their minds will be preoccupied.

Clinician should keep a current list of service providers to which clients can be referred. For example, if the client’s symptoms become more intense and overwhelming for them, and more in-depth treatment is required, the clinician should be able to make an appropriate referral or direct the client to an appropriate provider. This could further ensure the client’s safety, as he or she would receive the necessary services, especially if more in-depth treatment is required.

Conclusion

A diagnosis of schizophrenia presents serious implications for newly diagnosed individuals in particular. Those with schizophrenia have a vast series of challenges to face, including overcoming and grieving the loss of a sense of self, experiencing a loss of hope for the future, accepting the diagnosis, facing the fact that social, occupational, educational, familial, and romantic arenas might undergo marked change, and integrating new insights, coping strategies, and processes learned on their journey into their life.

Because the diagnosis of a serious mental illness can cause a major life crisis (Wittmann & Keshavan, 2007), clinician support is critical. This is especially true because depression and suicidal ideation are common in the newly diagnosed (Addington et al., 2004). Along with helping the client manage their diagnosis and helping to facilitate his or her grieving process, clinicians can help ensure client safety by establishing and agreeing upon a safety plan for use in the event that the client is experiencing depressive symptoms or suicidal ideations. Not only will this help clients to feel supported and cared for, but it will also potentially help save a life in the event of an emergency or crisis.

References

Addington, J., Williams, J., Young, J., & Addington, D. (2004). Suicidal behaviour in early psychosis. Acta Psychiatrica Scandinavica, 109(2), 116-120.

Kubler-Ross, E. (1969). On death and dying. New York: Scribner.

Wittmann, D. & Keshavan, M. (2007). Grief and mourning in schizophrenia. Psychiatry, 70(2), 154-166.

Worden, J.W. (2002). Grief counseling and grief therapy: A handbook for the mental health practitioner (3rd ed.). New York: Springer Publishing Company.

Once I learned the initial basic stitches, I was hooked (pun intended). I spent hours in my dorm room crocheting scarves or just crocheting a single stitch over and over. I would go into a completely meditative state and even if there was music or a TV on in the background, I never really absorbed what I was hearing. Now, many years later, crochet is my go-to therapy. In moments of stress and anxiety, my fingers begin to itch for the feel of the hook in one hand and the yarn in the other.

Kathryn Vercillo has written a book that accurately describes that experience and the experience that many others go through when turning to crochet for comfort or relief. Crochet Saved My Life looks deep into the healing power of crochet, knitting, and other needlecraft work, both mentally and physically. Vercillo is a freelance writer, blogger, and crafter whose experience with depression and the relief she found in crochet inspired the book. In it, she describes how she summoned up the strength to drop the knife she once held at her wrist and replace it with a spool of yarn.

In addition to telling her own story, Vercillo tells the tales of many women and men who have found comfort, peace, and solace in the craft. Her book is separated into sections that address the affects of crocheting/knitting on various mental and physical conditions. In addition to the main chapters are the full stories of people she interviewed for the book, including their personal struggles and how crocheting or knitting came to be a part of their recovery or treatment. Her subjects have been through depression, anxiety, OCD, schizophrenia, multiple sclerosis, and Menière’s disease. In her discussion of Post-Traumatic Stress Disorder (PTSD), Vercillo refers to Monique Lang, LCSW. Lang’s quote sums up the chapter on PTSD: “When life has done something that treats you horribly, you need to go overboard in treating yourself well to make up for that while you are healing.”

The author’s introduction is poignant. “Crochet can serve as a form of meditation,” she writes. “It provides you with a focused task that distracts you from the drama that sometimes takes over the brain and tries to wreak havoc there. And it allows you to feel like you are producing and creating something even when you can’t get out of bed and you can barely open your eyes to notice the passing of one day into another.”

But Vercillo is careful to point out that crochet is not a cure-all, nor the only method to combat a mental or physical condition. When discussing the calming effects crochet may have on symptoms of schizophrenia, she points out that the evidence she has to support her claim is minimal and relies heavily on stories shared by interviewees. She reminds us many times that she is not a medical professional in any capacity. She is simply sharing an experience that she has had and that many others seem to have in common. Still, Vercillo does not just use anecdotes to support her claim: Her list of references is substantial and included at the end of the book, with sources ranging from journal articles to governmental documents.

The back of the book also provides a list of resources for crocheters. There are online communities, classes, and professional organizations, interesting websites that discuss crocheting/knitting in relation to various conditions, and recommended books.

My one complaint about the text is the sections describing the individual tales of the interviewees. Although these histories are important for filling in gaps and clarifying how crochet or knit played into these people’s lives, Vercillo shares so much of the details within the main chapters that the individual sections dedicated to them feel redundant. I grew tired of rereading these people’s stories when I had just read them only a few pages prior. At times, they seemed like page fillers rather than informative parts of the book.

Overall, though, Crochet Saved My Life is a worthwhile read. As an avid crafter and crocheter, I found the book at times enlightening, and could relate to much of it. Vercillo’s ability to weave statistics and reports into her narrative is also impressive. Her tone is friendly and sensitive while also being professional and direct—she does not sugar-coat or play down the intensity that can be found within each individual condition she addresses. Nor does she attempt to trump modern medicine or therapy with the value of needlework.

The author’s message, simple as it may be, is that the meditative power of crochet and knit could potentially bring a wealth of comfort and clarity to the suffering and the stressed. I, for one, could not agree more.

Crochet Saved My Life
CreateSpace Independent Publishing Platform, April, 2012
Paperback, 304 pages
$17.95

Cassandra Mae was “rejected” by right-to-die groups because she wasn’t terminally ill. (She wanted to end her life after being bitten by a brown recluse. “It was so painful I wanted to die.”) She found Exoo after a recommendation. Apparently, he’s the go-to guy for individuals who want to commit suicide but aren’t terminally ill. He was happy to help. But Mae changed her mind – after she couldn’t find anyone to look after her pet snake.

Now she’s Exoo’s assistant. However, they have different philosophies. She sees what she’s doing as a business. She charges $7,000 per person. “George sees it as a calling. There’s a big difference there. For me it’s ‘No cash, no help.’”

In response to why Mae assisted a woman with a breathing disorder in committing suicide even though “she was fine” after taking medication, Mae says, “Somebody’s got to pay the bills so you can have some water in that glass you’re drinking.”

This is just one example of the disturbing, bizarre and often unjust stories you’ll find in Jon Ronson’s newest book Lost at Sea: The Jon Ronson Mysteries. (Neither Exoo nor Mae has been charged with any crimes.)

Ronson is a British journalist and the author of The Psychopath Test and The Men Who Stare at Goats (which probably sounds familiar because it became a film starring George Clooney).

Lost at Sea is an eclectic collection of essays organized into five parts: “The Strange Things We’re Willing to Believe,” “High-Flying Lives,” “Everyday Difficulty,” “Stepping Over the Line,” and “Justice.”

Ronson begins his book with the hip-hop duo Insane Clown Posse, known for their over-the-top, violent and really appalling lyrics. He interviews them about their work and the revelation that they’re actually religious.

Ronson also writes about meeting Bina48, a robot commissioned by multi-millionaire Martine Rothblatt to resemble her wife. He writes about being on a cruise ship with Sylvia Browne, one of the most famous psychics who’s known for revealing the locations of missing kids to their parents. Her track record is abysmal – she’s been tragically wrong many times, as Ronson points out – and yet people flock to her.

He writes about everything from a thwarted school shooting at the North Pole to a pop star’s fascination with the extraterrestrial and trip to a UFO conference to a broadcaster’s bogus confession on live TV that he smothered his terminally ill partner.

Ronson’s patchwork of stories reveals the strange things people do and believe in. But he treats many of his subjects thoughtfully and often sympathetically. Readers might even find themselves understanding the behavior of some, while others will remain beyond belief. (I have a very hard time sympathizing with Exoo and Mae, among other individuals Ronson profiles. But I’m sure that’s not the point, anyway.)

Ronson is a skilled storyteller, which makes Lost at Sea a captivating and compelling read. He asks great questions. And his subjects seem to open up to him quite easily. It’s interesting how many people consent to talk to him – along with the sensitive information they reveal.

Ronson stays away from superficial, sensationalist headlines. His stories dig deeper. He ponders people’s motivations and choices, and tries to better understand their behavior. He investigates how other factors — such as people, technology and society — might play a role in those actions, and travels down the rabbit hole they lead to.

For instance, in the story “Who Killed Richard Cullen?,” Ronson creates 13 personas to investigate why so many credit card companies seemed to target Richard Cullen, while Ronson hadn’t received the hordes of junk mail.

Ronson’s investigation leads him to a powerful technology that profiles people and places and explains precisely why Ronson, who lives in an affluent neighborhood, won’t ever be receiving the same “Congratulations! You have been pre-approved…” mail.

At first glimpse, Lost at Sea is a hodgepodge of tales. But each narrative takes a fascinating — and sometimes shocking — look at human nature and our contemporary culture. It’s absolutely an absorbing and worthwhile read.

Anyway. I am writing to share some things I have learned in the last 10 years of therapy. I can only hope it may help one person. If it shortens his or her journey by even one long, painful, depressingly suicidal day it would be well worth it.

The first step for me was realizing everything is not as it could or should be upstairs! This may be glaring and painfully obvious to you all day every day. Take pride in that because you are actually ahead. I was practicing a lot of really reckless behaviors and endangering my life and health almost daily, but thinking that I was “fine.” Realizing this sort of behavior was probably not coming off a basis of any sort of concern or care for my welfare was the start of identifying my poor self-esteem (understatement).

It took some time and therapy but this realization grew and grew until my therapist and I started to see the depths of my problems. It wasn’t just poor self-esteem, it was utter self-hate and loathing. It was cruel and critical, cold and unrelenting, vicious and violent and nothing could halt its path. This voice operated twenty-four hours a day on full acceleration. It was a raging beast and interfered with every second of my days and nights.

At this stage some work was done to intellectually provide me with an infrastructure for another way of thinking. The theory that all of these beliefs about myself were incorrect was introduced to the raging beast. The beast thrashed through this new talk and reduced it to splinters every time it was raised. The only way I could even intellectually entertain the idea that I was not innately bad, evil, filthy, genetically wrong and hideous beyond comprehension literally was to talk about another person. I would never ever treat another person this cruelly. No matter what one of my friends had done in the past, I would never think they were remotely bad. I would want them to love themselves as I loved them. That was a starting point for me.

If you also have this raging beast in your head, you are probably one of those people feels mildly irritated when complimented or does not give it a millisecond to sink in because it’s just plain ridiculous, nearly irrelevant. You can have glaringly obvious talents, but you either have absolutely no awareness or belief in them or think that that one positive is outweighed by 600,000 negative and evil horrible parts.

The next significant step was adding some other types of therapy to open up and expose this secret, dark, raging beast. I had to feel it and express it. I used primal therapy, inner child work and art therapy both to expose the beast and to start to allow my more vulnerable and kinder parts a voice. This was a fairly lengthy process, but I believe it was probably a lot quicker than talking about it because the beast listens to no one. It wasn’t until I felt the feelings that I “got it.”

For example, someone told me that because I was only a child, being sexually abused wasn’t my fault and I wasn’t dirty or bad because of it. Using the process so far as an example I went from denial (“yeah whatever, of course it’s not the child’s fault, I don’t think I’m dirty and I don’t care so shut up”) to “If I thought of my friend/sister/a child on the street it would absolutely never ever be their fault that they were abused and it should never ever happen to anyone and they should never ever have to carry that burden” to feeling the humiliation, powerlessness, degradation, shame, and physical pain of that sexual abuse. This step allowed the beast to start letting in the tiniest momentary, usually temporary rays of compassion.

The other important aspect of this was just exposing the beast, lying on the floor and telling a benevolent witness (therapist) everything this voice was saying. After 10 minutes of emptying the latest derogatory diatribe that was on repeat in my mind, it seemed to have lost so much of its power. It did seem almost childish whereas 10 minutes previously I was a slave to its mastery and perceived wisdom.

Among and throughout these varying stages were periods of crisis, either deadly depression (in bed, staring comatose at the wall, with no will to do anything) or suicidal fantasies and active self-harm. Crisis management became really important. There was no management initially as the beast ruled. There was no sharing of decisions with anyone more mature, compassionate, caring or even sensible. It was what the beast — all the negative thought processes and critical cruel voices — says goes. There can be no other way.

So the first step was becoming aware that there was always something else to do, that these were just feelings and that I was not only made of my negative feelings. At first it was a lot about just stalling action. If I felt tempted to cut or burn myself, instead I would draw the cutting and burning, or I would call a friend, or book a session with my therapist, or get a drink or have a shower. Often in the heat of the moment you think the feeling is forever and so painful and horrible that it could never be stalled. Often, though, it can reduce in a short period of time with a distraction or by expressing those feelings through art or a feeling session or even just moving your body and energy to somewhere or someone else.

Now I have the crises more under control and don’t feel like a danger to myself so much anymore. I am building on this self-love thing. If you search for love with the Google search engine, you’ll find numerous definitions. I particularly like the Wikipedia one: “Love is an emotion of a strong affection and personal attachment. Love is also a virtue representing all of human kindness, compassion, and affection —”the unselfish loyal and benevolent concern for the good of another. Love may describe actions towards others or oneself based on compassion or affection.”

Now that’s a definition I can start to relate to.

Feeling my suffering as a child when I was intellectually and physically unable to defend myself has led to a compassion for myself and an affection of sorts for the wild ways I tried to deal with that pain and the courage I have shown to move through the impasse that seemed so impossible. I’m no Martha Stewart bumblebee now but the beast is more balanced and I think probably relieved that its job is over.

To everyone out there drowning in suffering, depression, suicidal despair and fear and loathing in Las Vegas, hang in there. Try some feeling and expressive therapies, use any tricks you can to ease the self-hate. I know you won’t believe me but you deserve to get better and it really is possible! Hang in there comrades!

An English professor at Michigan State University, Aldrich is a skilled and savvy writer, choosing to craft the book as something of an archive of her friend’s life. There is no narrative and there is no plot. Instead, the book consists of entries listed in alphabetical order. Some are several pages; some, only a sentence.

Throughout the book, Aldrich tries to address this traumatic event through as objective a lens as possible. Although her emotion is palpable, Aldrich almost becomes an observer or a detective, trying to piece together something she knows she can never fully understand. Yet in the process, the hope is that some level of closure can be attained, or at the very least, the grief can be mitigated.

The entries that Aldrich chooses to include are so varied and specific that we can tell she is trying to reach out for anything—trying to take any object, person, event or idea and see if it can help her better understand her friend’s decision.

What is so fascinating about Companion to an Untold Story is that we can almost see Aldrich’s mind thinking. Each entry is chosen with purpose, and in this way, each is designed to elicit something—each aims to bring about greater clarity. In the entry “Bathroom (1),” Aldrich writes:

The bathroom had technical advantages as the final choice of Joel’s occupancy… No stranger could see into this room without windows, set back from the street and reached through a locked garage. The sound of the gunshot would be muffled. Yet it would be the first room police would encounter opposite the front door. He did not want to draw out the search that would be conducted to find him. He would be considerate in his last act, minimizing the trouble his death would cause, minimizing the emotional trauma too.

It could be argued that Aldrich is putting thoughts into Joel’s head, but it must be understood that this was one of her dear friends. She knew him very well. She was intimate—not romantically—with him in a way that it does not appear many others were. As a result, Aldrich is in a perfect situation to read into Joel’s decisions; to infer what he was thinking; to extrapolate seemingly innocuous events and items into nuanced ideas that shed light on the tragedy.

Aldrich’s project seems almost impossible, her goal unachievable. But in a very real sense, she does achieve what she sets out to: she reconstructs the life of a man for whom she cared deeply, a tortured soul who could not bear the weight of the world any longer. In so doing, she does not answer every question, but there is no need to. Part of the goal is to better understand her friend’s decision. She knows she’ll never be able to truly comprehend. But, again, she can inch closer.

In the entry “Informed consumer,” Aldrich writes:

How did he educate himself? Did he frequent gun shops, check out weapons books from the public library? There are books detailing methods of committing suicide, in the how-to, self-help mode, as well as gun catalogs and gun shows. Did he consult anyone for advice? Read magazines? Was the process slow until he narrowed the field to his weapon of choice? Can you try a gun out and return it?

In the search for answers, Aldrich finds herself crossing into some dark spaces. In this instance, she is almost trying to put herself in Joel’s shoes. What did he think about when he was concocting his plan? Was he always going to use a gun? If not, what alternative methods did he consider? And then on to the practical side, how did he actually go about finding which gun to use? These are not typical questions one would find him- or herself asking in the wake of a friend’s suicide, but in the quest to gain closure, Aldrich must put herself in uncomfortable places.

The final obstacle that must be overcome in understanding her friend’s death is relieving herself of self-imposed guilt. Joel had sounded different on the phone leading up to his death. Why did she not pick up on that? Why did she not act on any inclinations? Questions like these are sown throughout Companion to an Untold Story. In addition to gifted writing and a unique premise, they are what drive the reader to keep going. But just as Aldrich never ultimately can, the reader, too, will never be able to completely understand Joel’s decision. As Aldrich writes in the entry “Literary criticism:”

The more diffident Joel became, the more I wanted to understand him. He became a great, difficult poem that unsettles and exhausts me and that I never get to the end of understanding.

Companion to an Untold Story
By Marcia Aldrich
University of Georgia Press: September 15, 2012
Hardcover, 280 pages
$24.95

In her book, Campion discloses the events leading up to every parent’s worst nightmare: the death of her daughter, Luce. Campion describes the heartbreak of witnessing her daughter’s descent into depression and drug use, and the helplessness and guilt she felt as both a psychiatrist and a mother. Sshe and her family were unable to prevent Luce from the early death which seemed inevitable from a young age. In her painfully honest account, Campion also explores her history and that of her family in trying to figure out what may have contributed to Luce’s death.

“Luce looked at me straight on. ‘It really sucks. I get the manic-depressive gene from you, and the weird drug reactions from Dad.’”

Campion talks of her own battle with depression and reveals her youthful suicide attempts. She also talks of her husband’s alcoholism, and the trials her family has endured because of addiction and the trauma of losing Luce. Campion confesses that she didn’t fully realize the scale of the problem until it hit her own family:

I didn’t know then that major depression strikes about one in ten women every year. According to U.S. public health data, among adults experiencing a major depressive episode, fifty-six percent thought that it would be better if they were dead, forty percent considered suicide, fifteen percent made a plan, and ten percent an attempt. Suicide is the eleventh leading cause of death among adults and accounts for well over thirty thousand deaths per year. I would learn only later that what we now call bipolar and unipolar major depressive disorders had surfaced with regularity in my family for several generations.

Much of the book comes across as Campion’s attempt to make sense of her loss and move on from it. Guilt is a recurring theme throughout the book. As Campion recalls trying to help her daughter, she comments that “Every decision I’d made during her illness could be used to flagellate myself.” Any parent will be able to identify with the agony Campion faces as she repeatedly asks herself what she could have done differently.

Looking back on that time, the hardest thing to do is recapture how dense my ‘not-knowing’ was. From today’s vantage point, it is hard – no, impossible – to ignore what would be revealed a few months later in the full-blown manifestation of Luce’s manic-depressive illness. I want to flog myself for not considering what seems so plain in hindsight: her excessive confidence, single-minded purpose, intense energy, and powers of persuasion could indicate a manic episode. Why didn’t they raise my suspicions? Some psychiatrist! Or was I, her mother, just too tempted to welcome her new bright optimism, focus, and appetite for life after years of confusing doubt… The guilt of failing my own child swells up in me like a flooding river, dirty and cold, hauling dangerous debris.

The book serves not only as an incredibly revealing, painfully honest account of a parent’s loss but as a reminder of the importance of family. It is clear from the start how important Campion’s family is to her, and how much the family relies on each other throughout their struggles:

Every single one of us had been traumatized… I thought the best way to heal was to give each other warmth, to huddle close, in order to withstand the real world’s harshness.

Indeed, Campion examines in great depth the effect the tragedy had on each family member. It is this systemic analysis of her story, taking into account the role of each individual family member, which doubtless evolves out of Campion’s professional experience as a psychiatrist. Campion wonders how and why the family were able to stay so strong and reliant on each other during their experiences, and ponders the importance of attachment:

Equally mysterious, and possibly closer to the truth: I have a strong affiliative need that I think is hardwired in most humans and other mammals, expressed in loyalty to their tribe or pride. As if the family was the basic organism whose survival may be more essential than any individual’s, the whole being greater than the sum of the parts.

While this powerful memoir will appeal to anyone who has lost a close family member, it also serves as an important reminder to all mental health professionals that they are not immune from any of the conditions which might plague their clients.

Did I think I was any better than those patients and their families, that I deserved to be spared? By virtue of what? I knew better, except that, deep down, I must have hoped that all the energy I had spent battling addiction and mental illness for years would count in my favor. As if I could bargain with fate, buy protection for my contributions. But destiny is crueler than any mafia goon.

This will be familiar territory for any professionals who might be wounded healers themselves, particularly those who have dealt with their own loss, trauma, addiction, or depression while still attempting to see clients. Campion talks of her own battle to carry on working, until she realizes that it would be unethical, and refers her clients elsewhere:

Another patient told me, on the tenth anniversary of her own suicide attempt, ‘I have been able to resist all those years because you’ve been on my side. But since your daughter died, you’re not as strong and I think I’ll kill myself.’ Her words stabbed me, but she was right and I convinced her to work with another doctor.

Although the book is at times so searingly honest that some readers may find it hard to take, this is ultimately a story of redemption. Writing this book undoubtedly was cathartic for Campion, and a therapeutic means for her to reach some kind of closure over these awful experiences. In the end, it is the simple capacity for happiness and hope which seem to have saved Campion from the same demise as her daughter:

I have been blessed with an innate ability for joy that bubbles easily in me except during the severe depressions I’ve had four times in my life. Even after months of low moods, I recovered completely and regained a buoyancy that reminds me of my grandmother, who soothed us with bedtime stories during the war… I have worked hard to deal with traumas and temper my neurotic traits, but that inborn undeserved talent for enjoying life is a gift I can only give thanks for and celebrate… Luce had no such luck.

Hope triumphs, even through the unknowable. And, for that, we must all be grateful.

Through the Unknowable: Family Life with Depression, Alcohol and Love
By Elsa Campion, MD
Vantage Press:  March 16, 2012
Paperback, 162 pages
$13.95

Dr. Charbit uses the evolution of this story to give a voice to the many people with OCD who do not fit the typical mold of cleaning, checking, or hoarding, but instead have more diverse symptoms that may not be documented in textbooks.  She also exposes our collective susceptibility to manipulation in a way that may have you reevaluating certain interactions in your life.

We meet Maxine, a single, Jewish, late twenty-something, first in the context of her parents’ wealthy home in London.  Since childhood, she has had an intense aversion to possessions — clearly the early manifestation of OCD, but seen by her parents as mere rebelliousness against their prosperity.  Her inner dialogue, though, makes it plain that it is much more:

As soon as I closed the door, it was like the devil was standing behind me and all thoughts of our fun weekend evaporated [… The] corner of my bedroom contained many important items …instead of being a source of pleasure, these items taunted me with their preciousness, holding me prisoner in my home.  Without them, I wouldn’t need to worry about fires, natural disasters, malicious entities, and the apocalypse [… but] I had baggage. (pp. 43-44)

Maxine’s thoughts are so consumed with this and with other obsessions, such as needing the appropriate lighting for her apartment (a process that takes over her life for weeks), that she feels either mentally disabled or slowly losing her mind.  She doesn’t recognize her problems as a diagnosable disorder because all of her exposure to the idea of OCD has been about the cleaning or repetitive checking, not anything like what she’s experiencing, which is “…life where I constantly feared that something would spark a new obsessive thought to add to the already long list that was eating away at my youth” (p. 197).

With so much energy drained by internal battles, Maxine’s social life is nearly nonexistent.  Claude, her brother, used to be a close friend, but now is wrapped up in his new girlfriend, “Miss Perfect”—we never do learn her real name.  It is at her parents’ New Year’s Eve party that her loneliness led them to introduce her to Sam.  Her first impression isn’t positive, but after seeing him again at a Jewish singles event, they begin a complicated relationship. 

From the first sentence of A Life Lived Ridiculously, it is clear that there is something very off about Sam.  He holds himself aloof just enough to feel like he’s rewarding you when he gives any detail whatsoever about his life—which has not been a happy one.  He tells Maxine that he has no family, a late ex-girlfriend, and is terminally ill to boot.  It slowly becomes clear to the reader, though, if not to Maxine, that he is incredibly manipulative.  He disappears without notice for days or weeks at a time and sends mixed signals regarding his desire for intimacy, causing her immense emotional trauma. He avoids all questions about his illness by being very vague about his exact diagnosis, symptoms, and treatment plan.  This works well for Sam, since it is very hard to feel justified in prying into a terminally ill person’s issues and business, especially because he leads Maxine in circles when she tries to establish the nature of their relationship.

Sam uses what Dr. Charbit calls the “ability to monologue incessantly while actually revealing nothing” to wrap Maxine in a cocoon of pity, guilt, shame, and fear, to the point where he becomes the focal point and the epicenter of her universe.  It’s not until she finds his diary that she is confronted with hard evidence of his lies, which include possibly being gay, not having cancer, his whereabouts when he told Maxine he was in treatment, etc.  Sam, of course, shows no remorse or even knowledge that he’s is in the wrong: 

Listening to the flow of garbage that spewed out of Sam[...]  It all seemed so obvious now, his manipulative pity speeches so transparent […] This was all a big game to him (p. 195).

At this point, it is still unclear what Sam’s motivation is.  After further investigation, Maxine is emailed an article from an Australian newspaper.  Sam (alias Shane) is outed as the “Suicide Killer,” a pathological liar and sociopath who has thus far led four victims into committing “murder by suicide.”  Maxine slowly grasps the meaning of this revelation:

…I had spent all those hours in the company of a man who wanted me dead.  I recalled how he had spoken so movingly about his ex-girlfriend who died from anorexia…he wasn’t sorry at all, he was proud, boasting about his achievement and perhaps also trying to plant the suggestion into my head (p. 221).

The severity of Sam’s intentions sinks in, and Maxine realizes she is lucky to have found out before her mental and emotional state deteriorated any further.  She hands over all of his information to the police, hoping, as the only survivor in his chain of victims, to finally bring him to justice.

The book ends with Maxine using her newfound strength to finally see a psychiatrist.  He explains that “OCD can manifest in an infinite number of ways, as is evidenced by your own symptoms,” which has the powerful effect of finally convincing Maxine that she is “not simply a moaner with too much time on her hands (p. 232).”  With a prescription for SSRIs and the number of a therapist in hand, she happily accepts a new job in San Francisco, escaping the prison of her former life.

A Life Lived Ridiculously is well written and well organized, with chapters neatly divided by month in chronological order from January to December, emphasizing the journey of both Maxine’s OCD and her relationship with Sam.  It does take a long time for the story to progress—Sam’s motivations and methods are frustratingly unclear for the first two-thirds of the book.  He seems illogical and without an end game, leading the reader to wonder where, exactly, this is going.  The quality of the payoff when you reach the denouement, however, is well worth the wait.  The farther you read, the more riveting it becomes.

There is also an incongruity between the book’s external portrayal of Sam, in words as a “sociopath” who has Maxine “under his spell,” and who, in the cover illustration, is a very attractive young man—not the decrepit described inside, including Maxine’s initial impression: “I recoiled the moment I saw him (p. 1).”

Don’t be fooled by the uninspiring quotes on the back cover.  You would never know the intensity of plot twists and turns from the bland: “I enjoyed this a lot.  Some really clever writing here.”  In fact, it would be much more helpful if some of the notes in the author’s accompanying letter were in the cover summary instead; for example, “mixing the OCD sufferer with the sociopath is combining a person who feels constant mental pain with one who feels nothing at all.”  Her explanations provide a context for the narrative that engenders a much more positive reaction to the book—now knowing what it is intended to accomplish.  Without this information, it’s easy to get the impression that it’s a whodunnit beach read, when really it’s a fascinating and important look at two important psychological disorders.

Slowly unraveling Maxine and Sam’s story is a satisfying endeavor, pulling away layers of societal presentation in order to reveal the complex workings of the mind.  Dr. Charbit does indeed use her vast experience with the subjects of the book to pull the reader in with remarkably developed characters.  Especially for a first novel, A Life Lived Ridiculously succeeds in its stated purpose: it makes us aware of and think closely about our stereotypes and generalizations in the mental health world.

A Life Lived Ridiculously
By Dr. Annabelle R. Charbit
Firefly Publishing & Entertainment: April 1, 2012
Paperback, 246 pages
$14.95

Acts of violence have always been a part of human nature and will continue unless we become some sci-fi world with better living through chemistry and genetic manipulation. Sure, there are general reasons the experts will point to, such as alienation; access to guns; too much exposure to violence; a society whose leaders lack values; and families who are disconnected from community.

But the reality is that the great majority of teenagers are growing up in this environment and not killing anyone. That doesn’t mean we should ignore steps to reduce the negative influences on their lives and ours. It does mean that no matter what we do, there will always be tragedies. We simply do not have that much control over another person’s life. That is a frightening reality for most parents to accept.

But this doesn’t mean that parents shouldn’t be doing things that make it more likely that their children would turn out okay. Inside each home there are parents asking if their son or daughter could be in trouble and the parents might not know it. Or, even scarier, there are parents who see their children struggling and feel powerless to help. What do we know that will help?

Well, the research points to the same issue nearly every time: children who have stronger relationships with their parents are less likely to end up in serious trouble. My emphasis on “serious” is because too often parents are upset about issues that are not life-threatening or life-determining. Clean rooms, grades and homework, being disorganized, being impulsive and screwing up, foul language, a few extra holes in an ear, some grungy friends, some broken curfews, or the protective or manipulative “lies” that children use to try to get away with things – all normal adolescent behaviors that do not alone signify a child “going down the tubes.”

Adolescence is a time for many teens to experience disconnection and disorientation, to become confused and uncertain about their values or about their capacity for success. It is a time to be scared about changing bodies and changing friends and experiencing failures when success may have usually come easily. It is a time to defy and distrust authority. It is a time, especially in with the phenomenon of the Internet, when teens’ worlds expand exponentially and it is quite a challenge for them to digest and manage all to which they are exposed.

Parents often respond to this by waging battles for control. While it is essential to have some unequivocal rules that involve health and safety and to seek help from others if there are signs of more serious trouble (e.g., depression, explosive outbursts, eating disorders, substance abuse, marked change in personality), it is particularly important to focus less on content and more on process.

What does this mean? Simply, that nothing is a substitute for maintaining the connection between you and your teenager. Time must be found for one-to-one interactions. Parents must be ready to give their attention when a teenager is suddenly ready to talk. Parents need to spend some time inside the world of their teenager and try to do so without being too judgmental. Do errands and chores together. Find an activity that can be shared. Take a teenage child out to dinner occasionally. A parent whose work involves travel can bring along a teenage child and turn it into a significantly valuable time together. Know each other!

Remember that you most likely did some things wrong along the way. It can be helpful to share that. Why should your child be open with you if there is not some reciprocity? That includes sharing some of your current anxieties or mistakes. We all mess up. We all have our vulnerabilities. We all seek safety and security. In that way, you and your teen have much in common. The key difference is that a teen’s life has few real choices and does not have a valued place in our society. We ask them to be responsible but there is little immediate reinforcement for that except to keep the adults from being angry and disappointed with them. Believe in your child, even when he or she is struggling, or simply not meeting your expectations.

For some parents, there is the harsh reality that, despite doing a good job, their child is having significant problems, and the parents are being shut out while nothing seems to be helping. This is definitely painful and scary. Even with professional help and support from school staff, some child will fall into a “black hole,” influenced by biology, peers, and social forces. This underscores another reality about the tragedies that have been taking place: All the perpetrators have been male.

Our society gives out powerful messages that are absorbed by our children. What girls hear and respond to leads them to turn against themselves, especially in the form of eating disorders (and a skyrocketing rate of smoking). What boys hear and respond to leads them to turn against others, in acts of verbal and physical abuse. In the face of all this, parents are worried, possibly more than ever, about the health and success of their children.

But I must return to my primary message of urging parents to have a more optimistic outlook and to not let their anxiety sabotage what is most important, the relationship each parent has with each child. A friend and colleague, Bob Brooks, often speaks about the resiliency of children and what contributes to it. The research clearly indicates that the presence of a “charismatic adult” is one of the primary predictors of turning out okay.

So often I read the stories of successful adults who grew up under terrible circumstances and there is always reference to a parent, relative, teacher, or coach who believed in them and provided guidance and an available ear when needed. Dr. Brooks often ends his presentations by challenging parents to be that charismatic adult in the lives of their children. It is no guarantee that everything will turn out all right. Nothing can do that. But it does make it much more likely that you will end up with an adult child who is not only doing well but is also your friend.

In Depression: A Guide for the Newly Diagnosed, Lee H. Coleman, PhD seeks to explain the signs and symptoms of depression as well as some of the ways that people who have been diagnosed can obtain help.

At a little over 150 pages, this book is not meant to be an extensive compendium regarding depression treatment. As the title suggests, it is sort of a beginner’s guide to dealing with depression. For those who have already been in treatment for a significant amount of time, this book probably will not offer much new information.  For individuals who have just been diagnosed (or who feel that they may be suffering from depression), however, this book offers a wealth of information. Also, for anyone who may suspect that they are suffering from depression, this book will serve as a guide on how to go about finding treatment.

The book’s first two chapters explain the definition of depression as well as how to obtain an accurate diagnosis. Dr. Coleman provides information about depression symptoms and also answers questions the reader may have such as “how do you know you’re not just sad?” For the uninitiated, this can be important information, as many people dismiss some of depression’s symptoms for a long time before trying to obtain treatment. The author makes sure to explain the seriousness of depression and the impact it can have on one’s life if treatment is not sought.

The second chapter gives specific instructions about how to find treatment for depression. The author does a good job of explaining the difference between general practitioners, psychiatrists, and other therapists and the roles that different professionals can have in a person’s treatment. I think the reader is provided good information regarding what to expect when they go to seek help.

In chapters 3 and 4, Dr. Coleman gives the reader a glimpse at the various types of depression treatment. As he explains, his goal is to give people “realistic expectations” of what occurs when a person enters treatment. Though the sections are brief, the book does touch on most of the major methods of treatment, including cognitive-behavioral therapy, mindfulness-based therapy, and of course, medication. There is by no means an exhaustive explanation of all the different treatments, but as an introduction, the book serves its purpose.

Perhaps more importantly, the author includes information about how to tell if treatment is working. He answers questions such as “When should you expect to see some changes?” and “What if you’re not getting any better?” He makes it clear that there is no miracle cure for depression and that effective treatment can only be achieved through collaboration between an individual and their mental health professionals.

The second half of the book focuses on providing tips to manage symptoms of depression. Again, this is not meant to be an in-depth self-help book, but the author does give a number of good starting points for dealing with depression.

It’s especially good to see that Dr. Coleman dedicated an entire chapter to “Managing Suicidal Thoughts.” Not only is this one of the most difficult symptoms of depression to manage, it is also perhaps the most serious. In my experience, I have seen even well qualified professionals have difficulty when dealing with people with suicidal thoughts, so I am sure that the advice the author provides in this section will be helpful for its intended audience.

The chapter about caring for yourself after a depressive episode is also a plus. All too often people relapse because they do not make healthy choices once they start to feel better.

Depression: A Guide for the Newly Diagnosed serves its purpose. Mental health professionals would serve first-time clients with depression well by recommending this book. And it’s worth the read if you or someone you know has recently started experiencing depressive symptoms.

Depression: A Guide for the Newly Diagnosed
By Lee H. Coleman, PhD, ABPP
New Harbinger Publications: May 3, 2012
Paperback, 160 pages
$15.95

Family and friends might be unsure if recovery is possible. They question how they can help. Mental illness creates a feeling of helplessness for everyone involved. My and my family’s experience with chronic mental illness has allowed me to understand how important it is to have a support group. It can define the journey taken to recover from mental illness.

My diagnosis is rare. I was diagnosed with bipolar II disorder when I was 12. While my siblings were attending school and playing soccer on weekends, I was confined to a children’s psychiatric hospital. I remember wondering what was wrong with me. I remember my parents, wide-eyed, watching as my moods shifted by the hour, even the minute. We were all terrified. Mental illness is frightening at its core.

Unsure what to do, my parents brought me to doctors, psychiatrists, therapists and even nutritionists. The various doctors told them I had Attention Deficit Disorder; the psychiatrists told my parents they were parenting me badly. They were certain that explained my erratic behavior.

The therapist asked me to draw pictures that they thought would explain my moods. I refused to use any crayon that was not black, threw the toys that were carefully placed around the brightly lit room, and tore up the paper. I was unable to control myself. She dismissed me as being ‘overemotional’ and ‘narcissistic’ at the ripe age of 11. The nutritionist told me I was allergic to dairy products. My family, in a show of support, stopped eating anything containing dairy.

Fourteen years ago, professionals simply could not believe a child could have a serious mental illness−despite our family tree being defined by mental illness and suicide.

The years before my diagnosis were painful and affected our family dynamic immensely. My two siblings watched their older sister fall apart; they viewed their parents trying to catch me as I fell into blackness. My illness was quickly making my family ill.

It is impossible to capture my experience with mental illness in a few words, but I can tell you that without the support of my family, friends and a support team, I would not be writing these words. Twenty-six years old now, I feel I have some experience under my belt (so to speak) and would like to share different ways in which people can support a loved one struggling with mental illness.

Often, a newly diagnosed person is confused and angry. They may believe they do not need help. They might push away family and friends. As a person living with a chronic mental illness, I can tell you that isolation often results from fear. Mental illness carries stigma and it is frightening.

For example: I fall into a severe and crippling depression each winter. Each time it occurs I am, somehow, surprised. I quickly forget that my life is usually full of color and that waking up each morning often makes me smile. When I become ill I am certain I will never be well again.

If a family member or friend is unstable, the most important thing you can do is remind them that they will become well again. Without my family and friends to help me through each winter, to assure me that my life will become mine again, once spring arrives, I would certainly struggle more.

It is important to have a plan of action. Effective communication will be crucial if the person with mental illness shows signs of a relapse. A plan of action for such an event creates a feeling of security both for the person struggling and for those who love them.

An example: My family and I sat down with my psychiatrist−once it was clear my episodes were seasonal−and made a plan, in writing, that stated the steps that would be taken if I became ill. It was a difficult thing to do at the time. Seeing my diagnosis on paper made it real. But that paper provides a feeling of security for all of us.

The plan can include medication alterations, community outreach, and simple things like charting your mood and recognizing patterns. I believe this can be one of the most useful tools when working to help someone recover from a mental illness. It certainly is not a document that is placed on my fridge—it’s hidden away somewhere—but it has been instrumental in my recovery.

The health of those who support the mentally ill person often gets ignored. When I first became ill, my entire family suffered. My parents, while working full-time and taking care of my two siblings, spent years focused on my illness and recovery. In the process, they became unwell themselves. My mother slipped into a depression and my father worked to keep our family functioning. It was not easy.

Often, when a person must spend so much time focusing on someone they love, they forget to take care of themselves. It is impossible to help someone else if you become sick yourself. Ask yourself: “Do I need to step back?” Sometimes you do. My family has learned both to support me and support each other. It is in this way that we have been able to embrace recovery together.

“Triggered: A Memoir of Obsessive-Compulsive Disorder” is for anyone who is or knows someone who is suffering from mental illness of any type.  While Wortmann wrestles with OCD, he is more than sympathetic regarding all types of mental illness. In addition to making us understand the problems and loss of so much of his life due to his problems, it’s important to him that mental health professionals try to understand things that they may not have personally experienced. If they can’t feel what the patient feels, it is important that they are careful when trying to help and not make light of things. (His well-meaning social worker decided to call his deepest depression “crumping” because she felt it would be easier for him to call it this when he had too much trouble asking for help.  This did not end well.)

Even as a boy, Wortmann tended to use irony in order to survive his disorder.  While it may seem better than complaining and constantly feeling unhappy with the help provided, to the reader it is obvious that this is exactly what kept Wortmann from really asking for help when needed most. 

His fixations — whether they be the perfection seemingly demanded by Jesus in his religion; his obsession with perfection in school and at home; or his very normal embarrassment by a parent picking him up from school — are not unfamiliar to the average person. But the OCD causes Wortmann to have an extreme, painful and almost fatal reaction to such things. 

It is difficult to judge this book because it is well-written by a man who could be writing fiction and making you laugh or cry depending on the moment.  He admits to trying to kill himself more than once. He can’t be sure that he won’t do so at some point in his life, because no matter how much help he gets, no one can take away what he’s been given — which seems to be an overabundance of guilt and worry. Think of the adolescent fear of dating. Then imagine the impossibility of setting this fear aside long enough to understand that a “no” isn’t the end of the world and asking is the only way to get a “yes.”  This is just a small portion of his life.

I think this book will bring many people to a new understanding of OCD because it is filled with interesting anecdotes and compelling sadness along with hopeful events.

To write anything negative about this book would be difficult since I have suffered my own type of mental illness.  I have suffered physical pain, as have most people at one time or another, but mental pain far surpasses this. Wortmann’s pain hurts me as he says “Does it sound embarrassing, trite, if I claim that I feel a kinship between us?”  This, I am sure, means everyone with mental pain.  It feels as though Wortmann “feels” too much, which is probably due to a lifetime of pain that is difficult to pinpoint and difficult for others to comprehend. It doesn’t sound embarrassing or trite to me, because feeling the pain I felt — and knowing there are people like Wortmann who will live with this pain forever and have never known real peace — is painful to me.

Triggered: A Memoir of Obsessive-Compulsive Disorder
By Fletcher Wortmann
Thomas Dunne Books: March 27, 2012
Hardcover, 272 pages
$24.99

Personal relationships form a safety net around individuals to protect them from too much isolation. Long ago, people who strayed from a group had a much harder time surviving the elements or avoiding starvation. While it’s physically safer now to live a solitary life, emotional isolation can still threaten a person’s mental well-being.

Social support is a vital and effective part of depression recovery. It can turn around damaging isolation, affect a person’s life focus, and generate solutions for depression management. Learn more about how this powerful social force can positively effect someone living with depression.

Social Connection Curbs Your Sense of Isolation

Depression is a selfish, abusive captor. It enjoys nothing more than seeing you all alone, feeling like nobody would miss you if you weren’t around. It magnifies your sense of shame, making sure you believe that no one could understand or care about your struggles. You can easily imagine rejection and ridicule for speaking up. Holding your tongue might keep you isolated, but at least you’d avoid petrifying embarrassment.

This can seem like the lesser of two evils and a reasonable tradeoff. But in the end, isolation breeds only more isolation. This creates a reclusive lifestyle that can cut you off from people who mean a lot to you. Your hopelessness and thoughts of despair will only get worse over time. Your isolation can put you at much greater risk for suicidal thoughts (1). So how does social support counteract this destructive spiral?

People are meant to be social beings, and we have better lives when we care about each other. Sharing your innermost feelings can seem like a huge risk. Human beings often do whatever they can to avoid complete rejection from others. But relationships aren’t just for the good times. People lift each other up when they go through tough situations. This often strengthens their personal ties as well. Why? Because it’s real life, and genuine real life has fear, uncertainty, and problems. The good times mean even more when you’ve been through some valleys together.

The isolation that comes with depression can cut you off from these important relationships. Getting help from a caring person isn’t about pity or being a “defective” human being. It’s just the way people are supposed to be with each other. You may need to choose your confidants carefully. If you have a few people in your life who are genuinely concerned for your well-being, then hold on to them. They are a priceless part of your life and depression recovery. However, if you have toxic, unreliable individuals in your life, be very careful. These people may use your personal vulnerability to their advantage, hurting you time and again. A pastor or mental health counselor may be a good place to start if this is your situation.

Social Support Keeps You Connected with Life

An isolated, depressed person can slowly die on the vine, believing the world is better off without him or her (or that that person is better off without the world). Thoughts of death coupled with intense negative emotion are two of the most dangerous aspects of depression. A person who keeps meaningful connections with others stays connected with life. He or she can visualize the future, making plans to keep on living and stay out of harm’s way.

When you are depressed, isolation turns you away from life. This creates a self-fulfilling cycle where you feel increasingly rejected and remain disconnected, increasing the chances that your connections might fade or weaken. This dangerous combination affects how you see your very existence. Instead of turning your vision toward growth and living, you become focused on avoiding the most pain. And unfortunately, death can easily become the leading candidate for pain relief.

Sometimes a support person has to forcibly break through strong walls of isolation to make a connection. This may be met with fierce resistance, especially if isolation has been prolonged or you are feeling suicidal. However, if you have some flicker of life inside (even if it is deeply covered) or you have a great deal of trust in your support person, you can turn your vision from death to life. When the pattern is changed to include regular social time with positive, trusted people, depression’s grip can be loosened. Life is put back on center stage, giving death less and less time in the spotlight.

Social Connection Helps You Find Solutions

If you have depression and you reach out to a trusted, non-depressed person for help, you highlight one of the more important aspects of social support. Helping people, if chosen wisely, will have a vision of health that you can’t muster yourself. A non-depressed person can create and capture a healthier vision of your life, something you truly need in order to get better. It’s so easy to lose perspective when you are inside depression, even forgetting what healthy periods of your life looked and felt like.
Until you can truly capture that vision for yourself, a supportive person can hold on to it for you. It’s hard to reach a goal when you can’t figure out what it looks like. This “borrowed” vision from a support person can keep it real and thriving, even broken down into smaller pieces when that’s all you can handle. As you improve, you can live out and see the vision more clearly. The support person acts much like a compass, helping to reorient you to a healthier path of life.

Depressed thinking often involves replaying many of the same problems, the same negative scripts, and predicting the same (or worse) outcomes from the past. It’s really hard to be innovative or logical about what you really need to do if you only consult yourself. Friends, counselors, trusted health professionals, loving family members, and other supporters can help you generate a variety of solutions.

If you are still quite doubtful or confused about your options, a support person can gently help you see which ones might be the most helpful. You may have clear ideas about what you need but not about how to get started. You may also have a good idea about what hasn’t worked, but not why. When you bounce these issues off someone else, you open yourself up to their encouragement and their fresh ideas. Sometimes, all it takes is some new perspective on your situation to expose more effective solutions.

Social Support: A Vital Part of Depression Recovery

Depression recovery can be a complex process, but you don’t have to do it alone. Social support goes way beyond your friends trying to cheer you up a little. It’s about making genuine connections and spending time with people who care about you. It’s about knowing that you matter to other people. Depression can create a pit of despair and hopelessness inside you. With your loved ones nearby, the pit won’t be nearly as frightening. Your safety net is ready to keep you from falling in.

Reference

Depression, Lack of Social Support Trigger Suicidal Thoughts in College Students

Serani explains the different types of depression (as well as other mood disorders, such as bipolar), the different treatments available for depression, and even provides information and resources for navigating the hoops, roadblocks, and all-around time wasters that comprise the American healthcare and insurance systems.  The remaining 84 pages are filled with lists of famous people who suffer or have suffered from mental illness, resources for finding and getting treatment, references for cited materials, and a glossary and index for important terms used throughout the book.

“Dad’s gun is in the left-hand drawer of his dresser.”  From the get-go, this book slaps the reader across the face.  Serani goes on to tell of her lifelong struggle with depression.  She details her attempts at treatment.  She notes her suicidal impulses.  Most important, I think, is that she offers a sense of hope.  After giving the reader a brief introduction into the life of a person with depression, Serani turns away from memoir mode and begins writing in a more technical yet still straightforward manner.

It is nearly impossible to talk about mental illness knowledgeably without using big words that not everyone can figure out how to pronounce—“cholecystokinin,” for example—but Serani manages well enough.  She details the different types of mood disorders, gives a breakdown of several treatment options (both traditional and alternative) for depression, and then gives her insider information on how to most effectively get treatment when the rest of the world seems to be against you.

Next, Serani explains why it is important to understand that your depression is not your neighbor’s depression.  She also gives some lifestyle advice for avoiding depressive episodes.  Says Serani, “Becoming familiar with what pushes your buttons, sets you off, or presses heavily on you can help minimize relapse or recurrence of depression.”  Then, Serani details what she calls “The 5 R’s.”  These are: Response, Remission, Recovery, Relapse, and Recurrence.  She also gives pointers on how to prevent relapse and recurrence.

Serani dedicates an entire chapter to understanding and preventing suicide.  She gives lists of risk factors, as well as signs of improvement.  Most important, she outlines a plan that someone experiencing suicidal thoughts can implement in his or her own life to get away from the thoughts of suicide.

The closing chapters outline how to deal with the stigma that surrounds mental illness and how to effectively live with depression.  Serani notes that stigma can be anywhere.  It can be in one’s mind, it can be in the workplace.  Even loved ones may demonstrate some kind of fear or irrationality toward someone with mental illness because of their illness.

One thing is very clear: depression is a very real, very dangerous illness.  Having experienced lifelong depression myself, I find it highly encouraging to see that one of my own is fighting to save the lives of others.  Living with Depression really is an amazing book.  It is a quick read, and the advice is practical.  I’ll be keeping this book handy for when I need a reality check.  Perhaps, one day, I’ll even have the courage to seek treatment for my depression.  This book will definitely be a great tool to have when that time comes.  Until then, I’ll be using Serani’s guide to help discover what sparks my depression.  Realistically, I should be implementing her personal suicide prevention plan as well.

Living with Depression is an amazing book authored by an amazing woman.  It captures the essence of depression and lays it all on the line for the sake of bringing light into the lives of the depressed.  I know my attitudes about my depression changed in the few hours it took me to read this book.  I strongly recommend this book to anyone who wants to know more about depression and its treatment, or to anyone who wants to but doesn’t feel they are ready to take that important step toward getting treated.  You may even learn something fun along the way.  Who knew that such great minds as F. Scott Fitzgerald (author of The Great Gatsby), Dr. Stephen Hawking (a physicist), and even pop-culture icon Lady Gaga all suffered from depression?  Knowing that gives me reason to believe that anything—even overcoming mental illness and leaving behind a legacy worth remembering—is possible.

Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing
By Deborah Serani
Hardcover: 199 pages
Rowan and Littlefield, July 2011: $29.95

Throughout the novel we witness Mark’s growth as he begins relationships with his housemate Daniel and a girl named Leah, both of whom are struggling with issues of their own. It is Daniel who pushes Mark to expand his social horizons, including persuading him to increase his involvement with members of the opposite sex. Though hesitant at first, Mark eventually takes Daniel’s advice and begins to socialize more. During a visit to the mental health clinic, he meets Leah, in whom he immediately takes interest. The novel centers on the relationship between Mark and Leah. Through their story, we see how trauma and emotional distress can make it more difficult to form bonds between people, yet at the same time strengthen those bonds that are made.

As a mental health professional, I can’t help but be compelled to examine the novel on multiple levels. As with any novel, the writing and story need to engage the reader. Yet in a work such as this, I feel it is also important that the reader be provided with an accurate depiction of people with mental illness. All too often the portrayal of characters with mental illness is fraught with stereotypes and inaccuracies. In Sleeping With Gods author Michael Fontana provides a refreshingly realistic glimpse at life with mental illness. There are no overly dramatic scenes depicting characters in a psychotic state. You will not find any mental health facilities described like a setting for a Stephen King story.

Instead, Michael Fontana gives the reader a believable portrait of a young man and his attempt to struggle with depression and other stresses. Whether the main character is meeting with his therapist or having a conversation with his housemate, there is a very natural feel to the dialogue. While Mark is shown be morbid at times, you get the impression that he is really just trying to find his way through the world. Although he might be labeled as “mentally ill,” you get the sense that he in the end he is not all that different from anyone else.

Overall, I have mixed feelings about this novel. On one hand, I appreciate the fact that the author is able to provide an accurate representation of characters coping with mental distress. Mark, Leah, Daniel, and the other characters in the novel for the most part are realistically envisioned. When Mark states that by journaling he is “turning language into a control box for the chaos ensuing around me,” I was reminded of several different clients that I have worked with. I have read many books and seen many TV shows and movies depicting characters with mental illness, and Sleeping With Gods contains some of the most honest, true-to-life characters I have seen.

On the other hand, while the novel has a variety of interesting characters, the plot leaves a bit to be desired. The novel is made of a mix of scenes alternating between various points in the narrator’s life. While these scenes give us a better sense of Mark’s psyche, there are certain points when the reader is left to wonder what a particular anecdote has to do with the central relationship in the story between Mark and Leah. Looked at separately, some of these stories make for an entertaining read. However, it feels as if the novel jumps around too much to give the overarching story any coherent flow.  I don’t want to spoil the novel’s ending, yet I will say that it seemed to be somewhat forced.

Sleeping With Gods is not a must-read novel by any means. Yet I would recommend it for anyone who enjoys coming-of-age stories and is interested in reading one with a mental health angle. Author Michael Fontana also deserves praise for providing a rare authentic take on what it’s like to be inside the mental health system. It would be interesting to see how some of the themes in this work (such as mental illness, suicide, trauma, and recovery) might be further explored as he continues to grow as a writer.

Sleeping With Gods
By Michael Fontana
Apodis Publishing, Inc: April 1, 2010
Paperback, 216 pages
$13.95

Jill Bialosky tells the story of her sister Kim Bialosky’s suicide. She shares events of Kim’s life, Kim’s diary entries and conversations she had with her sister before she took her own life. As the author is telling the story of her sister’s suicide, she also takes the reader along a journey to find answers on what leads some people to take their own lives. The book starts out with the author telling the reader how her younger sister took her own life.

On April 13, 1990, Jill Bialosky’s younger sister, Kim called to wish her a happy birthday. Two days later, after a night out with her girlfriends, Kim took her own life, asphyxiating herself with carbon monoxide in her mother’s garage. A local boy who took care of her mother’s yard found her body.

Aching to understand why and how her sister lost the will to live, Bialosky interweaves family history, literature (Shakespeare, Dante, Melville, and Plath appear frequently), medical writings, and Kim’s own journals. The very nature of suicide, the author notes, is as elusive as the great whale Moby Dick, and her writing reflects that slipperiness, circling in and out of memories and emotions.

The portrait Bialosky presents of Kim is a vivid one: a sweet little girl surrounded by adoring older sisters, a sensitive teenager longing for her absentee father, and finally, a broken young woman who, as she wrote in her devastating suicide note, got ”tired of being lonely.” There are times when Bialosky’s pain is almost unbearable (shortly after Kim’s death, she lost two babies), but she’s never maudlin. She writes so gracefully and bravely that what you’re left with in the end is an overwhelming sense of love.

Jill Bialosky also tells of her sister’s use of alcohol and drugs and an abusive boyfriend. (Five years later the boyfriend committed suicide as well). As Kim strove to find answers to a happy life, she was also struggling to help her mother cope with depression and loneliness. Jill and her other sisters repeatedly attempted to counsel Kim to leave their hometown and change her life for the better. However, Kim never managed to escape and only dug herself deeper into emotional pain.

As Bialosky researches suicide, she provides feedback from several professionals, statistics from psychiatric journals and facts about suicide attempts. The author’s purpose here is to let the reader know that not only is she sharing her and her family’s personal experience, but also trying to give the reader information from various publications. Jill Bialosky studies family genetics (her mother’s depression), environmental factors (absent father), and emotional support (Kim not seeking professional help). With all the information that Bialosky includes in her memoir, I was fascinated by some of the connections she makes with her sister’s suicide. Would Kim have taken her own life if she saw more of her father, if her mother had not suffered from depression, and if she had sought help? It is hard to say; however, the author makes some very convincing arguments.

One of the ways Jill Bialosky chose to cope was to attend different bereavement groups. She shares other people’s personal experiences with dealing with a loved one who commits suicide. She is very detailed about the surroundings in the meeting rooms, stories shared by others and what her conclusions are from attending these meetings. It is simple: “There are no answers,” she says. “We only say we are sorry. Sometimes it is all we can do. But it is something. It is not nothing.” (Bialosky, pg. 234)

Throughout this book I feel like Kim is speaking directly to me. With her stories, personal diary entries and the conversations with her sisters, the author convinces the readers that no matter how others feel about suicide, we must understand that when a loved one takes his or her own life, they should be forgiven and their memories should be cherished. We can always look for clues or watch for warning signs coming from someone who is contemplating suicide and take action. However, when someone has decided to take his or her life, one can only hope that they have the tools to cope at that moment.

From personal experiences, I can understand those moments when someone might decide that they can no longer cope with personal emotional pain. However, with strong emotional support a person can seek help at those low moments in their lives.

I found this book to be educational, thought-provoking and very emotionally deep. I highly recommend this to anyone who wants to understand human nature.

History of a Suicide: My Sister’s Unfinished Life
By Jill Bialosky
Atria Books: February 15, 2011
Hardcover, 272 pages
$24