Perhaps I can be forgiven for my pessimism about ameliorating the violent side of human nature. Like everyone else, I am assaulted on a daily basis by stories of violence, including war, genocide, terrorism, homicide, rape and child abuse. Compounding this routine assault, I have specialized in psychological trauma, which entails professional immersion in suffering and illness associated with victimization by violence.

A decline in violence?

Given my pessimism, I was intrigued when I learned of Harvard psychologist Steven Pinker’s book, The Better Angels of Our Nature: Why Violence has Declined.” I needed hope. Consider his conclusion:

“The decline of violence may be the most significant and least appreciated development in the history of our species.”

As Pinker states, the extensive research demonstrating “we are living in an unusually peaceful time” routinely elicits incredulity. We must take a long view, stretching over several millennia. Glossing over detail and variability, as well as intermingling different time frames, here is a sample of the kinds of violence that have declined dramatically over time: homicide, torture, capital punishment, slavery, war, genocide, terrorism, lynching, rape, domestic violence, child abuse, corporal punishment and abuse of animals.

Homicide rates are a broad indicator of cultural violence proneness. By this standard, Western and Central Europe have taken the lead in ameliorating violence, and the United States lags behind; yet there is great variability within the United States: The northern states are similar to Europe, compared to the relatively high rates in the southern and westerns states.the book

Taking the long view

Pinker’s book is not a dry catalog of statistics; it is an engrossing and informative—oftentimes horrifying—history of violence. He takes great pains to understand and articulate several broad social and political factors that have led to the taming of our species. This monumental synthesis of extensive research leaves no doubt: We have become far more civilized.

But Pinker elucidates our natural human propensities for violence, ranging from predation, dominance, revenge and sadism to falling prey to pernicious fundamentalist ideologies that abet intergroup conflict. Fortunately, these “demons” in our nature are offset to varying degrees by “angels,” such as empathy, altruism, self-control and reason.

To put our violence into perspective, we need a long view, and we need data—numbers. I read Pinker’s book in its 700-page entirety, and I became a believer. Yet my daily dose of exposure to violence through the media continually boggles my mind as I easily lose the historical perspective.

Ironically, as Pinker states, our horror at the daily violence is a reflection of our gradual civilization; we no longer take brutality for granted (much less, revel in it). I read Pinker’s book to buttress my hope. We must be realistic, and we have plenty of data regarding our continuing violence.

Cause for hope

But pessimism and gloom about our violent human nature is narrow minded, and it is self-defeating. We have become more civilized by virtue of dogged human effort over many centuries—the recent rights movements (e.g., civil rights, women’s rights, children’s rights, gay rights, animal rights), albeit works in progress, are inspiring examples of such effort.

No one in his or her right mind can be sanguine about violence. In our field of mental health—and psychological trauma especially—violence warrants keen attention. In his now-classic book, The Vital Balance, Dr. Karl Menninger and his colleagues defined hope as “the positive expectations in a studied situation which go beyond the visible facts.”

We need hope to motivate our efforts to continue the civilizing process—first and foremost in homes, which are the most dangerous place to be. We don’t know the future, but Pinker has given us a studied situation and reason for positive expectations.

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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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Speaking up and out to reduce the stigma of mental illness

by Nancy Trowbridge May 28, 2014

As 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 […]

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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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