Jamison and Steel: Interviews on Suicide

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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.

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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

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/

 

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Relapsing [Without Being a Moron About It]

 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.
“There may be changes in the cellular level that cause cycling but their cause is unknown,” says Joseph R. Calabrese, MD, director of the Mood Disorders Program at the Case Western Reserve University School of Medicine in Cleveland, Ohio.

While the neurological causes of relapse are unknown, a few things are certain: Those who are diagnosed with bipolar II are more likely to relapse than those with bipolar I. Their episodes of depression, mania or hypomania are often shorter than the episodes experienced by those with bipolar I but tend to return more often, according to Calabrese. It’s also far more common to relapse into depression than into mania or hypomania. Calabrese estimates that in bipolar II, there is a 40-to-1 ratio of depression to mania; the ratio of depression to mania drops to 3-to-1 in bipolar I.

“The key to recovery is a low tolerance for relapse,” says Calabrese.

In fact, Dr. Roger S. McIntyre, MD, associate professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network, believes that even the mildest symptoms of depression and mania should be treated as potentially hazardous.

“The takeaway message is that we need to seek complete elimination of symptoms as our treatment objective,” he says…

Click here to read the full article, “A Bumpy Road: Dealing with Relapse”

“bp Magazine” is a wonderful “shot in the arm.”  I would suggest that you get a subscription, and for a friend as well.

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Join NAMI today!

When you become a member of NAMI, you become part of America’s largest grassroots organization dedicated to improving the lives of persons living with serious mental illness. And now you can join online.

http://www.nami.org/template.cfm?section=About_NAMI

Stand With Her in the Rain

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“Share each other’s burdens, and in this way obey the law of Christ.”

Galatians 6:2, NLT

By Lisa Schubert, Guest Author

Samantha approached me outside the church on Thanksgiving morning with her hair disheveled and her coat covered with dirt smudges and rain drops. She demanded to borrow my cell phone to find if the Thanksgiving dinner she had requested from a charitable organization would be ready for pick-up in an hour. I was in a hurry. I needed to be inside preparing to lead worship. I begrudgingly let her borrow my phone, but I insisted on dialing the number myself and standing with her in the gentle rain.

Samantha issued commands to the person on the other end of line. When she hung up, the rant continued against our church, our staff, the weather, and this meal that would serve as her Thanksgiving dinner. I had to let her go mid-rant, but not before reminding her that I would keep her in my prayers.

My encounters with Samantha have continued over the past few months. She’s almost always confused, angry and paranoid. She tells stories about growing up with another member of our staff, who never met her until recently. It’s hard to know how to respond to Samantha.Cross-in-the-Rain-

A friend called me recently to ask if our church had any resources for helping congregations to welcome those who struggle with mental illness. I pointed her in a few directions, including the National Alliance on Mental Illness (NAMI) at www.nami.org. Even as I offered her the information, I felt uneasy. Connecting with those who have mental illnesses is a complex, difficult journey.

It was raining again on Monday when I saw Samantha. She was sitting in the front lobby of the church. She shouted at me as I walked out the door, “Be careful out there! Two guys tried to kidnap me, and I wouldn’t want that to happen to you.” Unwilling to believe her, I replied, “Samantha, I’m sorry you had a rough morning. I’ll be thinking of you. Hope your day gets better.” I continued out the church doors and opened my umbrella.

I later discovered that Samantha was mugged that morning. Thankfully, the police believed her while I had blown her off. They arrested the alleged perpetrators that afternoon.

I’m embarrassed by my lack of gentleness and compassion toward Samantha, and I know I’m not alone. I wonder what it means for the Church to embrace, accept and listen to those who have mental illnesses. I wonder how church leaders like myself can grow and help others to deepen their care for people like Samantha.

There are no simple answers, but I think the answer starts in a simple place: We stand with them in the rain.

 

Lisa Schubert is Associate Pastor of Discipleship and Formation of North United Methodist Church, Indianapolis

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Source: FaithNet NAMI-
http://www.nami.org/MSTemplate.cfm?Section=Standing_with_Her_in_the_Rain1&Site=FaithNet
 

When Eating is Out-of-Control

Out of control eating

What is Binge Eating Disorder (BED)?  

Individuals with binge eating disorder (BED) engage in binge eating, but in contrast to people with bulimia nervosa (BN) they do not regularly use inappropriate compensatory weight control behaviors such as fasting or purging to lose weight. Binge eating, by definition, is eating that is characterized by rapid consumption of a large amount of food by social comparison and experiencing a sense of the eating being out of control.

Binge eating is often accompanied by uncomfortable fullness after eating, and eating large amounts of food when not hungry, and distress about the binge eating. There is no specific caloric amount that qualifies an eating episode as a binge. A binge may be ended by abdominal discomfort, social interruption, or running out of food.

Some who have placed strict restrictions on what and when it is OK to eat might feel like they have binged after only a small amount of food (like a cookie). Since this is not an objectively large amount of food by social comparison, it is called a subjective binge and is not part of binge eating disorder.

When the binge is over, the person often feels disgusted, guilty, and depressed about overeating.  For some individuals, BED can occur together with other psychiatric disorders such as depression, substance abuse, anxiety disorders, or self-injurious behavior.  The person suffering from BED often feels caught up in a vicious cycle of negative mood followed by binge eating, followed by more negative mood.  Over time, individuals with BED tend to gain weight due to overeating; therefore, BED is often, but not always, associated with overweight and obesity. Previous terms used to describe these problems included compulsive overeating, emotional eating, or food addiction.

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For the rest of this article, please go to the NAMI site at:   

http://nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=65853   

 

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Tobacco Use: Putting Down the Cigarette

By Brendan McLean, NAMI Communications Manager

Studies have shown that individuals living with mental illness die 25 years earlier than the general population. Part of the reason is due to smoking related diseases. At the end of July, the Smoking Cessation Leadership Center held a webinar on the importance of quitting smoking.

“Peers Helping Peers: Ways to Quit Tobacco with Rx for Change” consisted of a panel of experts from around the country, including Ken Duckworth, M.D., medical director of NAMI, and discussed the addictive power of tobacco, ways that will help people quit smoking and the role peer counselors can play.

Individuals living with mental illness are disproportionately represented among those who smoke. Forty-four percent of people who smoke have a mental illness. However, this percentage can be much higher when compared to a specific mental illness. For example, studies have shown that between 62 and 90 percent of individuals living with schizophrenia smoke.

This high rate of smoking means that one-half of the 435,000 tobacco related deaths that occur in the U.S. each year are people who have a mental illness. NAMI Hearts & Minds was created to offer resources on quitting smoking and other healthy lifestyle choices that promote wellness in both mind and body.

So why is smoking common among people who live with mental illness? As Frank Vitale, the National Director of the Pharmacy Partnership for Tobacco Cessation, states in the webinar , smoking was often used as a reward in psychiatric hospitals. “The culture has promoted smoking in a sense,” he said. “I remember working in a psychiatric hospital and we were literally told to tell patients that if you take your medication you can smoke. Or if you go to group you can smoke.”

Helping individuals living with mental illness who smoke can produce a number of benefits. As described by Vitale in the webinar, there are six benefits.

  1. It can improve the overall quality of life.
  2. It can increase the length and number of healthy years of life.
  3. It can improve the effects of medication. Hydrocarbons, which are produced when anything is burned, cause the body to metabolize medications faster than you normally would. As a consequence, many people who smoke often need more medication than if they did not smoke. However, if the individual decides to quit, their clinician should be alerted so they can adjust the amount of medication the individual is receiving.
  4. It can decrease social isolation. Many people who don’t smoke are often hesitant to socialize with those who do.
  5. It can save money—lots of money. Cigarette packs cost nearly $8 in D.C. and upwards of $15 in Manhattan. Over the course of 50 years, if a person were to only smoke one pack of cigarettes a day, at $6 a pack, one would spend nearly $110,000.
  6. It helps promote recovery.

The problem is that there has been lack of focus on smoking cessation by mental health providers. Some providers believed that doing so caused an increased risk of relapse: symptoms would worsen or the individual would return to abusing drugs or alcohol. However, research has shown that there is no truth to either of these claims.

The truth, though, is that people want to quit. Nearly 75 percent of current smokers have said they want to quit and 65 percent have tried to quit in the last year. But sometimes you just need a little help. To learn more about the importance of quitting smoking and how peers can help, listen to a recording of the webinar online.

Thank You, Nami

This is a terrific post dealing with a major issue with those of us who struggle so hard, with mental illness. Think this through and let me know what you think. Pastor Bryan can be reached at,  flash99603@hotmail.com

“How I finally quit smoking!” A Great Blog and a Super Post.

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Mental Illness Week

Mental illness is a serious medical condition that often disrupts a person’s thinking, feeling, ability to relate to others and daily functioning. Mental illness affects an estimated one in four American families and can have a profound effect on the individual, their family and the community.

Many people affected by mental illness do not know where to turn for information, support, help and hope. NAMI is a lifesaver for tens of thousands of individuals and families, virtually and in local communities across the country. Through clear information resources, free education and support group programs, advocacy initiatives, awareness events and personal connections with volunteer leaders in every state, NAMI works every day to save every life.

 

 

 

 

 

 

 

 

 

 

 

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 NAMIhttp://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23049

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