Robin Williams suicideFor the last several days, we have been riveted by the tragic suicide of Robin Williams, a larger-than-life favorite on both the large and small screens.

However much we know about the prevalence of depression and of suicide itself, we are still shocked when someone who feels so familiar chooses this way to disappear. Yes, we have heard about the chaotic private lives of many high-profile entertainment figures, but too often in the media, that is the story — one of scandal and hijinks.

What we usually don’t know much about is what is really going on inside their heads, in those internal landscapes of thoughts and feelings. Those are private worlds, however — we don’t have to know about them, and we shouldn’t. But somebody who can help needs to be allowed in, and this applies to all of us. I would go so far as to say that no one is 100 percent immune to the powerful, magnetic idea of suicide. When misfortune and stress become overwhelming and we feel like we’re boxed into a corner of hopelessness, it may seem to be the only way out.

I don’t know the whole story of the life of Robin Williams, nor is it my right to know. But I’m sure there was a lot of pain and suffering inside. When it’s after the fact, like now, it’s inevitable for those close at hand to feel not just the personal loss, but regret and even guilt about ways they might have tried harder to help.

A psychiatrist friend of mine, Steve Dubovsky, who is chair of psychiatry at the University of Buffalo, was quoted yesterday saying that “the best way to prevent someone from committing suicide is to ask about suicidal thoughts.”  Good advice. It’s hard to do, but the less it’s secret, the better the chances are to figure out other options.

Depression is a brain disorder, and we shouldn’t be ashamed of it. There are good treatments that work — not always at first, but almost always in the long run. 

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I have been attending professional conferences for more than 30 years, so they have become rather predictable to me. Plenary sessions, research paper presentations, skills workshops: Sessions are generally informative, though sometimes deadly dull.

suicide preventionThat said, my experience at the 2014 conference of the American Association of Suicidology in Los Angeles a few weeks ago was anything but dull or predictable. At this meeting, it was announced that a movement to establish a new AAS division for members with lived experience – people who had made suicide attempts and survived – had been successful.*

I write because I recently expressed concerns here about this movement.

Stories of suicide-attempt survival

A session I attended on the topic was, well, atypical. One audience member compared it to a Grateful Dead concert – perhaps a bit of stretch, but, to be sure, one does not commonly experience whistles, whoops and multiple standing ovations at a professional conference (see above).

This particular session consisted of four brave individuals, one after another, telling stories of adversity, despair, desperate acts and recovery. The stories were wrenching, heartrending and triumphant. Resisting any urge to evoke pity or idealize their recovery, the speakers delivered a remarkably consistent message: I’m not out of the woods yet; I sometimes still have suicidal thoughts, but I am hopeful and committed to pursuing the meaningful and joyful life that all human beings should have. The implicit message:

“You can do this, too. I went into that dark place and came out the other side, not only alive, but stronger for having been through it.”

Lasting impression

It is this latter message that impressed me most.

I realized that in expressing the unease that I and many mental health professionals have about giving up privacy regarding one’s history of suicidal thoughts and attempts, I was not fully appreciating the fact that this “coming out” was about much more than just shedding the burden of stigma (sufficient motivation in and of itself); more, it was about the therapeutic impact that the communality so evident in this packed room had on the participants and potentially to anyone in the audience, whether physical or virtual.

Which brings us to the issue of coming out digitally.

In my prior post, I noted that fighting stigma by posting one’s private information on the Internet, whether about suicide attempts, HIV status or any other protected health information, is a quantum leap compared to other forms of disclosure, in that it reaches a worldwide audience and is “out there” essentially forever, available to future employers or potential romantic partners, who might not be as open-minded as one would hope.

So here’s the trade-off for the loss of privacy: The collective nature of this coming-out – potentially large numbers of kindred spirits as well as potentially huge numbers of struggling individuals desperate for a ray of hope – adds up to a potential bonanza of therapeutic benefit that has heretofore not existed. Translated, this means many lives potentially saved.

Goodness knows, we mental health professionals can use the help on this sacred mission.

Does this mean I’m totally OK with people coming out about suicide attempts online? Let’s just say I will still advise my patients and anyone else who asks to put a lot of thought into the decision, carefully weighing advantages against disadvantages. The thing is, while the column listing disadvantages remains, the advantages column just grew considerably, as a result of the whistling and whooping at that otherwise predictable conference.

*AAS already had divisions for clinicians, researchers, prevention specialists, crisis workers and survivors (those who have lost a loved one, friend or patient to suicide).

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National Mental Health MonthAs a staunch advocate for eliminating the stigma surrounding mental illness and brain disorders, Menninger encourages conversation in our homes, our communities and our media outlets.

So let me begin this conversation by offering kudos to the Houston Chronicle editorial writers for the May 19 admonishment “Low Blow” that said the tactic of leaking a political candidate’s treatment for depression by the opponent’s camp went too far.

Politics and mental illness

An outgoing politician aligned with Lt. Gov. David Dewhurst released documents revealing Sen. Dan Patrick’s voluntary mental health treatment.

Mental health history, like a history of diabetes or even recovery from alcoholism or other addiction, doesn’t belong on resumes. Neither does skin color. Neither does where you grew up.

Sen. Patrick used the situation as an opportunity to right a wrong.  He issued a statement that said he had indeed received “treatment decades ago for depression and exhaustion.” And today he’s arguably a successful Texas businessman, regardless of your views about his politics.

It’s up to all of us to capitalize on such newsmakers and promote the facts about brain disorders such as depression, anxiety (the most common category of all brain disorders) and other conditions. It’s up to each of us to let our family, friends, co-workers and others who care for us know that brain disorders happen to many people, treatment works and speak up when we need support or attention from professionals for help.

National Mental Health Month

There’s no better time to have that discussion than in May, which is National Mental Health Month.

Speaking of speaking up and out, I’m reminded of a conversation I witnessed earlier this month. In front of more than 800 guests at Menninger’s annual signature luncheon, which raises funds for research, training and patient care, University of Houston’s Brené Brown, PhD, LMSW, and Academy Award-nominated actress Mariel Hemingway chatted about mental illness.

With the stage set as close to a living room as a ballroom’s stage can be, the women opened up about the realities of coping with a brain disorder. Mariel said she realized that in creating her documentary, Running from Crazy, the idea of telling her story was more scary than actually telling it.

The lesson learned: “We all need to tell our story,” said Mariel. Before she did, she equated it to trying to hold a ball under water. “When you tell the truth, it is freedom like nothing else.”

Our life’s picture includes our parents, our children and pets, our friends. It also includes our work and hobbies as well as our ups and downs, our sickness and health.

It’s time to place our mental health in our personal portrait and be willing to share it. Clearly, Mariel and Sen. Patrick do not view their portrait as less than whole for sharing that part of their story.

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Addict, junkie, pothead, crackhead, loser: Putting tired old labels to rest & challenging stigma

by Beth Eversole, LMSW, LCDC May 22, 2014

Labels play a large part in defining our experiences; they also play a role in stigmatization. Webster’s Dictionary defines stigma as “a mark of disgrace associated with a particular circumstance, quality, or person.” Just take the word “addict,” a common label for people who use substances. The mark of disgrace here is the label. Many […]

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Caring for the mentally ill & combatting stigma is the heart & soul of psychiatric nursing

by Marilyn Warnock, RN May 9, 2014

Every year during National Nurses Week I think back on the start of my career more than 20 years ago and how I always knew that my life’s passion was nursing.     On a search to discover which aspect of this care-giving profession would be most fulfilling to me, I started out working in […]

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A mother’s recollections of postpartum depression

by Ann Marie Buckley, LCSW May 9, 2014

Motherʼs Day always invites me to recall my early days as a new mother, more than 27 years ago. Among all the sweet baby-breath, bath time, first smile and first sleep-through-the-night memories that warm my heart, I also remember an afternoon when I was walking the floor with my new baby, trying to soothe her, […]

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Do you want fries with that? A provider’s view on “drive-thru” mental health treatment

by Hannah Szlyk, LMSW April 3, 2014

“Popular female celebrity has gone into rehab. She expects to make a full recovery and return to her tour and her fans by next month, says the publicist.” How many times have we read this in the news? As I write, I am thinking of Justin Bieber’s recent DUI arrest, and I can only help […]

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Marijuana: The modern-day trojan horse we need to talk about

by John O'Neill, LCSW, LCDC, CAS March 27, 2014

For the first time in history more than 50 percent of Americans support the legalization of marijuana. Those of us in the addiction field are faced with new attitudes about a substance that is not as innocent and harmless as many of its proponents would like us to believe. Contributing to the confusion about the […]

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Can public education decrease the stigma of mental illness?

by Jon G. Allen, PhD March 14, 2014

I do not know the answer to this question, but I have some thoughts about one aspect of it. A significant public education effort has been mounted to decrease the stigma associated with mental illnesses by emphasizing their neurobiological basis. We can rightly think of psychiatric conditions as brain disorders with a partly genetic basis. […]

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Is psychiatry’s drug addiction increasing the stigma of mental illness?

by Jon G. Allen, PhD March 11, 2014

I deliberately chose a tendentious title for this essay – misleadingly metaphorical rather than literal – to highlight, as one of my recent posts outlines, my alarm stemming from reading research on stigma. With many others, I had assumed that treating psychiatric disorders as “a disease like any other” (i.e., like any other general medical […]

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