Jan 3 2012

Jamison and Steel: Interviews on Suicide

NAMI’s Interviews With Danielle Steel & Kay Jamison

Last year, Steel published His Bright Light, a memoir of her son, Nick Traina, who committed suicide at age 19 after a life-long battle with bipolar disorder (manic depression). More recently, Jamison has published Night Falls Fast: Understanding Suicide, combining research, clinical expertise and personal experience to explore one of the world’s leading causes of death.On February 8, the Senate Appropriations Subcommittee on Labor, Health, Human Resources, Education & Related Agencies will hold a hearing on suicide prevention that will include testimony from best-selling author Danielle Steel and Professor Kay Redfield Jamison, author of several academic and popular books on mental illness.

Interviews with Steel and Jamison have appeared in “Spotlight,” a special supplement to The Advocate, the quarterly publication of the National Alliance for the Mentally Ill (NAMI). Conducted by NAMI executive director Laurie Flynn, they offer a possible preview of Steel and Jamison’s testimony on Tuesday. Excerpts follow below. Full interview texts are available on request.

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Dr. Kay Jamison

NAMI’s Interview with Kay Jamison
Spotlight (Winter 1999/2000)

NAMI: What do we know about the linkage between suicide and mental illness?

Jamison: The most important thing to know is that 90 to 95 percent of suicides are associated with one of several major psychiatric illnesses: depression, bipolar illness, schizophrenia, drug and alcohol abuse, and personality disorders. These are obviously treatable illnesses. Another thing people don’t think about enough or emphasize enough is that because cancer and heart disease hit older people, they are seen as lethal illnesses. Because the age of onset for mental illnesses is very, very young, people don’t tend to think of mental illnesses as the potentially lethal illnesses they are. It’s important for people to understand that they have an illness to begin with and then that they get good treatment for it.

NAMI: You have spoken specifically of suicide and college students.

Jamison: Yes. Suicide is the second major killer of college aged kids. It’s the second leading killer of young people generally.

NAMI: You also have pointed out that, worldwide, suicide is the second leading killer of women between ages 15 and 45. These statistics are staggering, yet most people don’t seem to be aware of it.

Jamison: Absolutely. Across the world. There are almost two million suicides a year worldwide. I think people just don’t have any sense of the enormity of it. Suicide unfortunately has been so individualized and, because of the early suicide movement in this country, so separated from mental illness. People working in the field of suicide concentrated on existential factors and vague sorts of things, when in fact the underlying science is very clear that they’re associated with a few mental illnesses.

NAMI: Knowing what we do about illness and its treatability allows us to be able to discuss preventing suicide.

Jamison: Right. [U.S. Surgeon General] Dr. David Satcher’s emphasis has been very strong on three fronts. One is public awareness. Secondly, intervention and all that’s involved in making doctors and others more able to ask the kinds of questions needed to uncover mental illness. And then, thirdly, to support the science that’s necessary to study suicide.

NAMI: What else can policy makers and public officials do?

Jamison: I think we have to have public officials talking about it. When you have someone like Jesse Ventura out there saying these outrageous things-I think it’s really beyond the pale-we’ve got to have the president of the United States saying look we’ve got a real epidemic here, and there’s something we can do about it. People are dying from not gaining access to treatment-or from having three days in the hospital, and then going out and dying.

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Danielle Steel, Author

NAMI’s Interview with Danielle Steel
Spotlight (Winter 1999)

NAMI: “His Bright Light” is a very personal story about a very painful subject, the mental illness and death of a child. What did you hope people would learn by sharing your story?

Steel: I hoped first of all that people would come to know my son, and learn what an extraordinary person he was. I wrote the book to honor him, and to share with people what a remarkable person he was, in spite of his illness. I also wrote it to share with people the challenges we faced, so that they feel less alone and less isolated with their pain, in similar situations. I wrote it to give people hope and strength as they follow a similar path to ours.

NAMI: What did you learn from this painful tragedy?

Steel: I’m not sure yet what I learned from the tragedy, except that one can and must survive. But from his life, I learned a great deal about courage and perseverance, and love.

NAMI: Lots of people in America might be facing signs of a mental illness in one of their children. What about Nick’s behavior made you realize that it was more severe than just the normal growing pains of a child?

Steel: Nick was different. Always. His moods were more extreme. I sensed from early on, that despite his many wonderful qualities, there was something very wrong. I knew it in my gut, as I think many parents do.

NAMI: How long did it take for Nick to be diagnosed as manic-depressive and receive treatment for that condition?

Steel: Nick was not clearly diagnosed as manic depressive until he was 16, a good 12 years after we began the pursuit of the causes for his ‘differences’. He received no medication until he was 15, and did not receive the most effective medications until he was 16. A long and very painful wait for all concerned!

NAMI: Prior to knowing of Nick’s manic depression, what did mental illness mean to you? Did you associate stigma with mental illness?

Steel: I don’t think I realized, before Nick, that one could still be functional, or seemingly functional, if mentally ill. I thought of it as something totally incapacitating, and of people who were shut away. I don’t think I realized how intelligent and capable mentally ill people can still be. I’m not sure I did associate a stigma with mental illness. It just seemed like a sickness, and not necessarily a shameful one. I just thought of Nick as sick, whatever it was called, and wanted him to be cured.

NAMI: How did Nick deal with the knowledge that he had a mental illness?

Steel: For a long time, Nick himself was in denial about his illness. And eventually, he accepted it. In the last year, he told people he was manic-depressive. Before that, when he felt ‘normal’ on medications, he believed he was cured. He had a hard time accepting at first that he would be manic-depressive all his life.

NAMI: Are schools able to cope with the mental illness of a child?

Steel: In most cases, I don’t believe they are. It is a huge challenge for all to meet, and certainly hard on the other kids to have one child acting out. We were very lucky, in Nick’s high school years we finally found a wonderful school that understood the problem, accepted him as he was, and was willing to work with him in a framework he could cope with. They were remarkably flexible and creative. But for most schools, it’s asking a lot to expect them to adapt to a mentally ill child.

NAMI: If you could tell a family member who is caring for someone who is mentally ill one thing, what would that be?

Steel: Never give up. Get the best help you can. Keep trying, keep loving, keep giving, keep looking for the right answers, and love, love, love, love. Don’t listen to the words, just listen to your heart.

NAMI: What do you think support groups like NAMI can do for families coping with the mental illness of a loved one?

Steel: I think groups like NAMI can provide support, both emotional and practical—the knowledge that you are not alone. And resources, where to go, who to talk to, what works. You need all the information you can get, and it is just about impossible to do it alone.

NAMI: Stereotyping the mentally ill as violent and dangerous is pervasive in America. How do we change this perception?

Danielle: Information. Obviously there must be some mentally ill people who are violent and/or dangerous. But I suspect that most are not. Nick certainly wasn’t either of those, he was gentle, loving, smart, funny, compassionate, extremely perceptive about people, and very wise. I cannot conceive of Nick as ‘dangerous,’ although ultimately he was a danger to himself. But for the most part, I think the turmoils of the mentally ill are directed within and not without.

NAMI: What do you think the average American should know about mental illness?

Steel: I think most people should know how common it is…I also think people should know how serious it is when it goes untreated. And how potentially lethal it can be. It is vitally important to get good treatment, the right medication, and good support. If you let a bad cold turn into bronchitis and then pneumonia, without medication, it can kill you. If you do not treat serious diabetes, it can kill you. If mental illness goes untreated, it can kill you.

NAMI: We know that having “hope” is important to battling any disease. What hope do you see for people with mental illness?

Steel: I see a huge amount of hope. The medications today can give people whole, happy, productive lives. There are lots and lots of people with mental illness holding down good jobs, even with important careers, happy family lives, and doing great things. It is possible to lead a good and happy life if you are mentally ill. If those who are doing just that would speak up, it would give great hope to all those who are still groping their way along in the dark.

NAMI: What is Nick’s legacy?

Steel: Nick’s legacy is the love we had and have for him, the word we have spread of what a terrific person he was. In his lifetime, he touched countless lives, with his warmth, with his mind, with his music, with his words. Through his experiences, others have and will learn. Through the Nick Traina Foundation, hopefully we can bring help to others, in his name.

For more information or assistance, please contact NAMI at: http://www.nami.org/

Nov 15 2011

Depressed Women

Depression Fits the Hearts of Women

Women experience twice the rate of depression as men.

Women have twice the chances as men

Everyone experiences disappointment or sadness in life. When the “down” times last a long time or interfere with your ability to function, you may be suffering from a common medical illness called depression.

Major depression affects your mood, mind, body and behavior. Nearly 15 million Americans — one in 10 adults — experience depression each year, and about two-thirds don’t get the help they need.

Women experience twice the rate of depression as men, regardless of race or ethnic background. An estimated one in eight women will contend with a major depression in their lifetimes.

Researchers suspect that, rather than a single cause, many factors unique to women’s lives play a role in developing depression. These factors include: genetic and biological, reproductive, hormonal, abuse and oppression, interpersonal and certain psychological and personality characteristics.

Symptoms of depression include:

Little interest or pleasure in doing things
Feeling down, depressed or hopeless
Trouble falling or staying asleep or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself, that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed or the opposite in that you are so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead or of hurting yourself in some way

Women may be more likely to report certain symptoms, such as…

anxiety
somatization (the physical expression of mental distress)
increases in weight and appetite
oversleeping
outwardly expressed anger and hostility

Stay close to your friend

Helping a Woman with Depression

People with depression aren’t the only ones who suffer. Their friends and loved ones may experience worry, fear, uncertainty, guilt, confusion or even be more likely to go through depression themselves.

The situation may be especially trying if your loved one doesn’t realize that she is depressed. You can help by recognizing the symptoms of depression and pointing out that she has changed.

Recognize even atypical signs of depression. Women may be more likely to report certain symptoms, such as anxiety, physical pain, increases in weight and appetite, oversleeping and outwardly expressed anger and hostility. Women are also more likely to have another mental illness-such as eating disorders or anxiety disorders-present with depression, so be alert for depression if you know a woman with a history of mental illness.

To point out these changes without seeming accusatory or judgmental, it helps to use “I” statements, or sentences that start with “I.” Saying “I’ve noticed you seem to be feeling down and sleeping more” sounds less accusatory than “you’ve changed.”

Talking to a Woman with Depression

If a friend or loved one has depression, you may be trying to figure out how you can talk to her in a comforting and helpful way. This may be difficult for many reasons. She is probably feeling isolated, emotionally withdrawn, angry or hostile and sees the world in a negative light.

Although you may feel your efforts are rebuffed or unwelcome, she needs your support. You can simply be someone she can talk to and let her share her feelings.

It’s important to remember that depression is a medical illness. Her symptoms are not a sign of laziness or of feeling sorry for herself. She can’t just “snap out of it” by taking a more positive outlook on life.

Helpful responses include, “I am sorry you’re in so much pain” or “I can’t imagine what it’s like for you. It must be very difficult and lonely.” Instead of simply disagreeing with feelings she conveys, it is more helpful to point out realities and hope.

A woman with depression often expects to be rejected. You can reassure her that you will be there for her and ask if there’s anything you can do to make her life easier.

If your loved one is not diagnosed or not in treatment, the most important thing you can do is encourage her to see a health care professional.

*Never ignore statements about suicide.* Even if you don’t believe your loved one is serious, these thoughts should be reported to your friend’s doctor.

http://www.nami.org/Content/NavigationMenu/Mental_Illnesses/

Depression/Women_and_Depression/Women_and_Depression_Facts.htm

Symptoms of Depression in Women (robertlevine88.wordpress.com)
The depressed helping the depressed (ask.metafilter.com)

Nov 12 2011

Getting Both Barrels

Dual Diagnosis of Mental Illness and Substance Abuse

Drugs & booze are deadly

Dual diagnosis services are treatments for people who suffer from co-occurring disorders — mental illness and substance abuse. Research has strongly indicated that to recover fully, a consumer with co-occurring disorder needs treatment for both problems — focusing on one does not ensure the other will go away. Dual diagnosis services integrate assistance for each condition, helping people recover from both in one setting, at the same time.

Dual diagnosis services include different types of assistance that go beyond standard therapy or medication: assertive outreach, job and housing assistance, family counseling, even money and relationship management. The personalized treatment is viewed as long-term and can be begun at whatever stage of recovery the consumer is in. Positivity, hope and optimism are at the foundation of integrated treatment.

How often do people with severe mental illnesses also experience a co-occurring substance abuse problem?

There is a lack of information on the numbers of people with co-occurring disorders, but research has shown the disorders are very common. According to reports published in the Journal of the American Medical Association (JAMA):

Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

The best data available on the prevalence of co-occurring disorders are derived from two major surveys: the Epidemiologic Catchment Area (ECA) Survey (administered 1980-1984), and the National Comorbidity Survey (NCS), administered between 1990 and 1992.

Results of the NCS and the ECA Survey indicate high prevalence rates for co-occurring substance abuse disorders and mental disorders, as well as the increased risk for people with either a substance abuse disorder or mental disorder for developing a co-occurring disorder. For example, the NCS found that:

42.7 percent of individuals with a 12-month addictive disorder had at least one 12-month mental disorder.
14.7 percent of individuals with a 12-month mental disorder had at least one 12-month addictive disorder.

The ECA Survey found that individuals with severe mental disorders were at significant risk for developing a substance use disorder during their lifetime. Specifically:

47 percent of individuals with schizophrenia also had a substance abuse disorder (more than four times as likely as the general population).
61 percent of individuals with bipolar disorder also had a substance abuse disorder (more than five times as likely as the general population).

For the rest of this article, go to NAMI: http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23049

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When is Enabling, Enabling a Loved One With a Dual Diagnoses? (dianeandjamesplace.wordpress.com)
Even The Oblivious Can Still Find His Mercy (brokenbelievers.com)

Aug 23 2011

Some Simple Facts

•The World Health Organization predicts that by 2020, mental illness will be the second leading cause of disability worldwide, after heart disease.

•Major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institutes of Health‘s National Institute of Mental Health (NIMH).

•When workers with depression were treated with prescription medicines medical costs declined by $882 per employee per year and absenteeism dropped by 9 days (Health Economics).

•Half of all lifetime cases of mental illness begin by age 14, three-quarters by age 24. Treating cases early could reduce enormous disability, before mental illnesses become more severe.

•One in four adults experiences a diagnosable mental disorder in any given year, including our returning troops. One in ten children has a serious mental or emotional disorder.

•Suicide is the third leading cause of death for America’s youth ages 15-24. More youth and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. The vast majority of those who die by suicide have a mental illness-often undiagnosed or untreated.

•Our jails and prisons are now the largest psychiatric wards in the nation, housing well over 350,000 inmates with serious mental illness compared to approximately 70,000 patients with serious mental illness in hospitals.

•One out of every five community hospital stays involves a primary or secondary diagnosis of mental illness.

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Source: NAMI.org

In Mental Illness, Men and Women Differ (bigthink.com)
Mental vs Physical Illness (lifelongbipolar.wordpress.com)
NAMI Calls for Increase in Funding for National Institutes of Health (prweb.com)
Why Mental Illness? (onbeingmindful.wordpress.com)
World Suicide Prevention Day: NAMI Blog Discusses Kurt Vonnegut, Despair and Saving Lives (prweb.com)

Jun 5 2011

How to Relapse, W/O Being a Moron

A Bumpy Road: Dealing with Relapse

There may not ever be a last episode, but there are ways to fend off and mitigate the next one.

By Jodi Helmer

Doctors never talked to Elly L. about RELAPSE.

Although she was hospitalized during a manic episode and diagnosed with bipolar disorder, doctors never mentioned that it could happen again. Instead, Elly was stabilized, handed a prescription for mood stabilizers and discharged. She had no idea that she’d be battling mania and depression for the rest of her life.

“I was told that as long as I took my medications, I’d be okay,” recalls Elly, a mental health coach in Toronto, Ontario.

Elly experienced at least eight relapses between her diagnosis in 1978 and 1991. Each time, she was hospitalized, often placed in restraints and taken to the psychiatric ward in a police car or ambulance. Upon discharge, Elly always promised herself it would be her last hospital admission-but she had no idea how to stave off future relapses.

In bipolar disorder, relapse is defined as the return of depression or a manic or hypomanic episode after a period of wellness. According to a 1999 study published in the American Journal of Psychiatry, 73 percent of those diagnosed with bipolar disorder experienced at least one relapse over a five-year period; of those who relapsed, two-thirds had multiple relapses.

“You can never say that someone with bipolar disorder has had their last episode; relapse is part of the illness,” explains Alan C. Swann, MD, professor and vice chair for research in the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School at Houston and director of research for the University of Texas Harris County Psychiatric Center. “Relapse is self-perpetuating; once it happens, the more likely it is to happen again.”

Searching for Answers

It’s possible to do all of the right things- follow a proper medication regimen, eat well, exercise, minimize stress and get enough sleep-and still experience relapse. Unfortunately, there is no clear understanding of why this happens.

Continue reading →

Feb 18 2011

Schizophrenia: Our Opportunity to Love

Do you know someone who seems like he or she has “lost touch” with reality? Does this person talk about “hearing voices” no one else can? Does he or she see or feel things no one else can? Does this person believe things that aren’t true?

Sometimes people with these symptoms have schizophrenia, a serious illness.

What is schizophrenia?

Schizophrenia is a serious brain illness. Many people with schizophrenia are disabled by their symptoms.

People with schizophrenia may hear voices other people don’t hear. They may think other people are trying to hurt them. Sometimes they don’t make any sense when they talk. The disorder makes it hard for them to keep a job or take care of themselves.

Who gets schizophrenia?

Anyone can develop schizophrenia. It affects men and women equally in all ethnic groups. Teens can also develop schizophrenia. In rare cases, children have the illness too.

When does it start?

Symptoms of schizophrenia usually start between ages 16 and 30. Men often develop symptoms at a younger age than women. People usually do not get schizophrenia after age 45.

What causes schizophrenia?

Several factors may contribute to schizophrenia, including:

Genes, because the illness runs in families
The environment, such as viruses and nutrition problems before birth
Different brain structure and brain chemistry.

Scientists have learned a lot about schizophrenia. They are identifying genes and parts of the brain that may play a role in the illness. Some experts think the illness begins before birth but doesn’t show up until years later. With more study, researchers may be able to predict who will develop schizophrenia.

What are the symptoms of schizophrenia?

Schizophrenia symptoms range from mild to severe. There are three main types of symptoms.

1. Positive symptoms refer to a distortion of a person’s normal thinking and functioning. They are “psychotic” behaviors. People with these symptoms are sometimes unable to tell what’s real from what is imagined. Positive symptoms include:

Hallucinations: when a person sees, hears, smells, or feels things that no one else can. “Hearing voices” is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem.
Delusions: when a person believes things that are not true. For example, a person may believe that people on the radio and television are talking directly to him or her. Sometimes people believe that they are in danger-that other people are trying to hurt them.
Thought disorders: ways of thinking that are not usual or helpful. People with thought disorders may have trouble organizing their thoughts. Sometimes a person will stop talking in the middle of a thought. And some people make up words that have no meaning.
Movement disorders: may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may stop moving or talking for a while, a rare condition called “catatonia.”

2. Negative symptoms refer to difficulty showing emotions or functioning normally. When a person with schizophrenia has negative symptoms, it may look like depression. People with negative symptoms may:

Talk in a dull voice
Show no facial expression, like a smile or frown
Have trouble having fun
Have trouble planning and sticking with an activity, like grocery shopping
Talk very little to other people, even when they need to.

3. Cognitive symptoms are not easy to see, but they can make it hard for people to have a job or take care of themselves. Cognitive symptoms include: