In our impotence to undo the travesty that took place at Sandy Hook Elementary, we console ourselves with conversation – and arguments – about what to do to prevent similar tragedies in the future. As we do so, we ask what we might learn from science to guide us.

Analyzing the numbers

For example, what are we to make of the statistics on mass killings in the U.S.? In response to an online comment that all countries have mental illness but only the U.S. has mass shootings on a regular basis (schools, movie theaters, shopping malls, etc.), a fellow social scientist and friend of mine responded with some interesting numbers. Being a research-oriented person, I took note.

He observed that, when one compared the U.S. to European countries and factored in the sizes of the populations, the rates of death by mass shootings (say, per 100,000 population per year) were actually lower in the U.S. The United States is a big country (now over 300 million), so when you divide the deaths by the U.S. population compared to, say, Finland, you get a lower number for the U.S.

What are we to make of such an analysis, or the many other analyses that seem to suggest that, well, the problem may not be as great as many think, and perhaps significant changes in what kinds of weapons are available to what kinds of people aren’t really needed?

The tolls we pay

Upon reflection, a question occurred to me that may be obvious to some but is sometimes lost on numbers-oriented people like my friend and me:

What of the toll on the soul of our society?

What of the toll on the hearts of our children, who don’t understand statistics, but certainly do experience the reality that no one – not even Mom or Dad – can confidently reassure them that they will come home safe after school – indeed that they will not encounter a tortured soul who blows them away with a weapon designed for just such a purpose?

What of the cost to the peace of mind of parents, teachers and principals?

What of the toll on people who suffer from psychiatric disorders, who would never harm anyone, but who will always feel the wariness of friends, employers, even family members, who cannot help but associate them with these crimes?

How is this damage to our society’s soul to be quantified in a cost-benefit analysis of the size of ammunition clips or the portion of the taxpayer’s treasure to devote to fixing a broken mental health system?

You see, the cost of a slaughter at a Virginia university or a Colorado movie theater extends far beyond the body count. Far beyond the suffering of families and friends whose grief may never heal. Far beyond any cost-benefit analysis. The cost of a mass killing of good, innocent human beings permeates an entire society, and eats away at its soul.

The next few months and years will be notable for how our nation responds (or fails to respond) to the hideous killing of babies in a Connecticut elementary school. Many facts and figures will be presented, as each side tries to convince the other of the rightness of its proposals.

As we witness or perhaps participate in this process, take it from someone who makes his living looking at the “facts.”

Facts and figures are only one perspective on truth. We also must look to our hearts to decide what we want our society to feel like, to ourselves and, more importantly, to our children. And then we must act.

Editor’s note: If you enjoyed this post, you might also like these other posts about the tragedy:

• Where is providence in the midst of tragedy?
• Shifting Sandy Hook information landscape means understanding will have to wait
• Was the Sandy Hook mass shooting “evil?”

Perhaps the commonest observation about the 2012 election was that it painted a picture of “a nation divided,” red in the middle and blue around the edges. But there’s at least one sentiment that unites us all: relief that it’s over. One more attack ad might have been just too much to bear.

That’s the good news.

The bad news is, as we put the drama behind us, we now face the suspense of the “fiscal cliff.” Unless you’ve been without television or Internet access for the past several months, you know that the fiscal cliff refers to the calamity we face at the end of the year (that’s this year), when terms of the Budget Control Act of 2011 are scheduled to go into effect. At midnight, as we ring in the New Year, an assortment of tax reductions will end and more than 1,000 government programs, including the defense budget and Medicare, will be automatically cut by more than $800 billion. Economists tell us that this almost certainly will wipe out the economic gains of the past few years and drag the economy back down into recession and higher unemployment.

Why is a mental health professional writing about this in a forum devoted to promoting human well-being? Take a look at the chart below, from a recent issue of The Lancet.

It shows how the steady increases in U.S. suicide rates in recent years have tracked with the struggles of the U.S. economy, the unemployment rate in particular. According to this analysis, during the recession, 4,750 people lost their lives to suicide who might have survived in better economic times. This is not a unique observation; for example, the suicide rate in Greece has risen more than 60% since the onset of the economic crisis in 2007.

This makes complete sense from a psychological standpoint. Suicide occurs when people with vulnerabilities, such as depression, schizophrenia and certain personality traits, encounter stressful situations that push them beyond what they are able to manage. Unemployment is one example; equally pertinent to recent struggles in the U.S. is the mortgage crisis, in which hundreds of thousands of people lost their homes to foreclosure. Divorce and addictions, both suicide risk factors, also worsen during hard economic times.

So, it is not an overstatement to state that lives depend on resolving the fiscal cliff dilemma.

Of course, we might reassure ourselves, “With stakes so high they’re bound to figure something out at the last minute.” But this once safe assumption might not be consistent with a new normal in Washington; for this election has left us with essentially the same Congress that not long ago stalled so long on increasing the debt ceiling that Standard and Poor’s actually lowered the credit rating of the U.S. Government, an unprecedented event that most had considered unimaginable.

It is time to tell our elected officials that their responsibilities regarding the fiscal cliff extend beyond any partisan political agenda or message that they may want to send to their respective bases. Lives literally hang in the balance, and the fiscal cliff is not a problem that mental health professionals are in a position to treat.

Today, September 10, is World Suicide Prevention Day. This is potentially a time to reflect and celebrate how far we’ve come.

Would that we could.

Death rates from many of the top killers in this country – AIDS, cancer, heart disease, homicide – have dropped, dramatically in some cases, over the past couple of decades. 

You might assume that suicide, the number 10 leading cause of death, would have shown a similar decline. You would be wrong.

More than 100 people per day die by suicide in the U.S., 37,000 in 2009, the most recent year for which data are available. This translates to a rate of 12.0 deaths per 100,000 population per year. The rate 10 years ago was 11.0. Fifteen years ago it was 11.4. Twenty years ago it was 12.0.

Picking up a pattern here? These number drive suicide researchers like me to distraction.

Have we made no progress? Actually we have – lots. We understand the factors that make certain individuals vulnerable to suicide better than ever, and this knowledge is leading to the development of tailored treatments that show great promise.

But no major cause of death has ever been defeated simply by treating people with the illness. Public health problems like suicide require major artillery aimed at reducing vulnerability before it becomes a problem (think seat belts, one reason why deaths from traffic accidents have decreased in recent decades).

To begin to understand why suicide has remained stubbornly entrenched as one of the leading causes of preventable deaths in this country, consider these facts:

This table shows several leading causes of death in the U.S. and levels of research funding by the National Institutes of Health. One quickly sees that the funding levels do not match up well with the numbers of lives lost. This becomes more apparent when we display these numbers by dollars per death, as shown in this bar graph:

In the words of the famous philosopher, “What’s up with this?”

Lacking an obvious answer, we can only speculate, but the question of stigma must be raised. AIDS once killed more Americans than suicide; now, more than three times more lives are lost to suicide than AIDS. AIDS activists, including many celebrities, have done a remarkable job of combatting the stigma that AIDS sufferers experienced early on, and their work has been rewarded with the funding reflected in these figures.

We are only beginning to see such movement on the suicide front. For example, I recently wrote about the commendable work of Sports Illustrated has done in shining light on mental illness and suicide among elite athletes.

But, as these figures remind us, we have a long, long way to go.

So, no, World Suicide Prevention Day is not about celebrating our gains; to the contrary, it is to remind us that we have work to do. Millions of people in this country, perhaps including you, have suffered the trauma of losing a loved one to suicide. We have an election coming up. Take the opportunity to ask a meaningful question of your elected officials, to wit:

“What’s up with this?”

Editor’s note: If you enjoyed this blog post, check out two of Tom’s other recent posts on SayNoToStigma.com:

• Is the Internet making my child crazy?
• On Junior Seau, toughness and an anti-stigma hero you might have missed

What’s a parent to do?

The recent Newsweek cover story on psychological hazards of Internet use and other “screen time” activities (such as texting and playing videogames) leaves one wondering whether to cut all electric power to one’s home or just wait till the next study comes out contradicting what we think we now know.

I can only imagine how most parents feel. I’m confused, and I’m a psychologist. And a researcher! 

The Newsweek article is definitely worth a read. To summarize: Various forms of screen time have been linked to depression, ADHD, obsessive-compulsive disorder and diaper rash (OK, that last one’s not true, but the rest are).

More alarming to me, as a father of two boys born with silver joysticks in their hands (sorry, another slight exaggeration), there is also brain imaging research showing changes in the brains of heavy Internet users that resemble those of drug addicts. A separate study showed that the brains of non-users began to resemble those of heavy users after only five hours of Internet use (this I am not making up). 

On the other hand…

We see a story in TechNewsDaily about a new study from the University of Wisconsin showing that prior research findings of a “Facebook depression” effect may not be as dire as previously thought. They monitored 190 undergraduates over the course of a week; after dividing the sample into groups of low (less than 30 minutes per day), medium and high Facebook users (more than 2 hours per day), they found no differences in depressed mood. 

What’s a parent to do? Here’s where the media often overreact, suggesting, for example, that if eating eggs is shown to be not quite as deadly as previous studies indicated, then perhaps all health-related research is a bogus game of flip-flopping in response to the fad of the day. But we can do better than that.

So, short of throwing out both baby and bathwater, here are some thoughts, admittedly delivered with only a modicum of confidence (probably more in role of father than psychologist):

1. Most studies of effects of electronic activities, from violent videogames to Facebook activity, show increased risk of harmful effects, not one-to-one correspondence. One implication is that it is the at-risk kids, those already on the margins due to adverse histories and challenging living conditions, that we should be most worried about. As one of the researchers in the Facebook study commented, “Parents don’t have to be overly concerned [as long as] their child’s behavior and mood haven’t changed, they have friends and their school work is consistent.”
2. If your child is at-risk – struggling socially or academically – particular attention needs to be paid to addressing that child’s needs, including significant monitoring of screen time. Studies show, for example, that economically disadvantaged children tend to spend more time engaged in electronic activities than their more affluent counterparts.
3. Even if your child has all the advantages of economic security, stable home life and good adjustment at school, you’re still not off the hook as a parent. It is impossible to read the Newsweek article (not to mention actually watching a young person at a computer) without becoming convinced that various forms of electronic entertainment, from videogames to online pornography, have significant addictive properties. Excellent resources are available from such sources as the American Academy of Pediatrics or SafeKids.com, providing guidance for parents. Foremost among safe practices is parent involvement, including having the computer and other electronic gear in a public area such as your den, where you can easily monitor what your child is up to (this is sometimes quite interesting, by the way).
4. Insist that your children spend at least as much time in the real world (face-to-face conversation, shooting an actual basketball through an actual hoop, etc.) as in the virtual world (expect mainly contempt in reply, at least until the first swish of the basketball net).
5. This last point brings up an important issue (caution: psychologist hat now firmly in place). Children’s electronic activities are highly rewarding (behaviorally reinforcing), not just for children, but also for parents. Child activities that are otherwise annoying, intrusive and inconvenient (such as actually wanting to talk to you) drop to negligible levels when the child’s mind is absorbed in a virtual environment (often interacting with someone across town or even on the other side of the globe). This peace and quiet can, in itself, become quite addictive to parents; but, in large quantities, it is a definite no-no to anyone interested in the child’s mental health, not to mention a reasonable relationship with said child.

I will be interested to see comments in response to this post. If someone has better answers than these (a fairly likely scenario), then my time engaged in this particular session of screen time will have been well worth it.

There’s a notable journal in the mental health arena that you might not have considered for your must-read list. It contains thorough, highly informative articles on mental health issues that are scientifically informed yet highly relevant to experiences of real human beings.

It’s called Sports Illustrated.

Of course, SI is not exactly a scientific journal or a clinical periodical, but you should know that it has a consistent track record of taking readers beyond the machismo and glamor of elite athletics to zoom in on the human beings whom millions of us watch and identify with week after week. A recent issue, for example, told the stories of four minor league baseball players, one of whom made a deliberate decision to use performance-enhancing drugs, was the only one of the four to make it to the big leagues and who paid the price in emotional problems, addictions and thoughts of suicide. Also enlightening has been SI’s regular reporting on the toll of concussions on football players and the reluctance of the NFL to take action to protect the players.

However, what has impressed me most has been SI’s stories on mental illness among high-performing athletes. The leadership of the magazine, together with the courage of the athletes who talk publicly about their struggles, has been of incalculable value in reducing the stigma of mental illness and making it more acceptable to seek help.

Sharing stories

For example, about this time last year, in an article titled, “A Light in the Darkness,” SI writer Pablo Torre told the stories of three major league baseball players who were willing to speak about their emotional problems, substance abuse and suicidality, as well as their journeys in treatment. In it, Torre noted, “Baseball is taking the lead in pro sports in addressing depression, anxiety and other mental health problems.”

More recently, in telling the story of Junior Seau’s suicide (blogged about recently by colleague Michael Ulanday), SI eschewed any inclination to present a sanitized, hero-worshiping piece in favor of one that spoke to the humanity of the man, for better and for worse. Seau was the stuff of football legend: a fierce, hard-hitting linebacker, perennial all-pro and well-liked teammate, who seemed impervious to pain. (In a 14-year career in the NFL, he missed a total of 9 games.) A retrospective on his personal life revealed many red flags that went largely unacknowledged by others or even by himself.

Indeed, in a soul-searching commentary in the same issue, Peter King confessed that he was among the writers who lionized Seau for his disregard for pain:

“Seau insisted that if you could walk, you could play. And we all ate it up. There’s much in that to be admired, certainly. But when you don’t acknowledge pain in your professional life…how will you ever acknowledge pain when the cheering stops? By all accounts, Junior Seau never acknowledged his personal pain – whether it was the black veil of depression or the misery of not having a life he wanted to live – to anyone.” 

Thus, what might have been an idealized but empty tribute to an icon, with shrugged shoulders about the “mystery” of why “a guy who had everything” would suddenly kill himself, unfolded instead as a poignant lesson in reality: the blood, bone and psyche of a giant.

Suicide theory

It is worth noting that a prominent current theory of suicide maintains that a key factor that makes suicide possible, despite our robust survival instinct, is repeated exposure to injury. This desensitizing process is thought to take some of the fear out of self-harm, to the extent that depression and despair are able to evolve into self-destructive action. Might this be a factor in the suicide of athletes, when combined with depression, substance abuse, loss and other vulnerabilities? Should we, in fact, be discouraging “toughness” in sports?” 

Not at all, in my view. There is a place for toughness in sports, just as there’s a place for toughness in the military, in the healthcare professions, in ballet and in life in general. But the lesson here is that there is an overriding need for balance in health and well-being, comprised not only of toughness, but also of self-knowledge, self-nurturance and knowing when to persist in the face of pain and when to yield to it. The last of these qualities is much easier named than accomplished and requires perspective that is often missing in sports and too often missing in other life arenas as well.

We can hope that in telling stories such as Junior Seau’s, Sports Illustrated is helping athletes and their mentors develop this too-rare form of wisdom.

Whitney Houston dies at 48.

Fox TV personality Bill O’Reilly has encountered a firestorm of protest in defense of Whitney Houston following his provocative remarks about her death. However, he may have done all of us a favor by opening a door to discussing something on all of our minds.

Here’s what he said (as part of a general statement opposing efforts to reform drug laws):

Nobody takes drugs for that long if they want to stay on the planet. She follows in the footsteps of Elvis, Janis Joplin, Michael Jackson, and scores of other entertainment figures. The hard truth is that some people will always want to destroy themselves, and there’s nothing society can do about it.

If we filter out some of the harshness (and perhaps add names like Judy Garland and Joseph McCarthy), we might express this as a question:

Just as a healthy lifestyle reflects desire to live, doesn’t it make sense to assume that people with unhealthy or reckless lifestyles have a death wish?

While this brings us uncomfortably close to “blaming the victim,” one can’t help but notice something appealing about this perspective. It certainly gives us something to do with the anger we inevitably feel about poor decision-making by someone we cared about. And, conveniently, we note that the issue gets buried with the individual. After all, the problem was in the mind (soul?) of the deceased. Case closed. Better yet, as seen in O’Reilly’s remark that such will always be the case and “there’s nothing society can do about it,” we are forever excused from worrying ourselves, looking for ways to address other influences, whether social, psychological, biological or otherwise. Nope, not much you can do about human stupidity.

Must feel pretty crummy to Whitney’s family…

Here’s the fly in the ointment: Applying this mindset, we suddenly all have a wish to die. Certainly this includes all smokers and couch potatoes, who we know have shorter life expectancies. But even among us non-smoking, exercising, healthy-eating, seatbelt-wearing respectable citizens with good judgment, which of us adheres perfectly to our medication prescriptions? (Studies say less than half.) Who among us never exceeds the speed limit or occasionally takes a peek at our cell phones while driving? Doesn’t this point toward at least a hint of a death wish?

A death instinct?

Probably not. Sigmund Freud thought this was an intriguing idea and wrote at length about a “death instinct,” but eventually abandoned it as unsupportable. Suicidologists still occasionally talk about “indirect suicide” in the form of everything from unsafe sex practices to sky diving; but as we do so, we soon find that the construct of suicide itself evaporates, because it ultimately becomes identical to living itself.

A human agenda

A more reasonable idea is that we — all of us — have the same basic agenda to find happiness and manage physical and psychic pain the best we can. The fact that some get lost on this quest and end up destroying themselves in the process does not change the fact that the wish in most cases is not to die, but to find a path, at least, to a more tolerable existence.

By the way, here’s another problem with observations like O’Reilly’s: A circular explanation is one that loses meaning because it turns back onto itself. To wit: Why did Whitney do those unwise things, resulting in her own death? Because she wanted to die. How do we know she wanted to die? All together now … because she did all those unwise things!

Really, O’Reilly. We can do better than this. Scientific research over the past few decades has revealed a great deal about motivations behind unhealthy and self-destructive behaviors, and effective treatments have resulted. We still have a lot to learn, and we still lose battles more often than we would like. But stigmatizing and blaming the sufferers only impedes our efforts to win the war.

Try a thought experiment: Imagine you’ve been asked to predict whether it will rain day after tomorrow, and someone’s life depends on your accuracy. And the loved ones of that someone are looking to you to get it right. If you fail, and this person dies, they not only will be devastated (not to mention how you will feel), but they may very well hold you responsible in court for their loved one’s death.

Assessing risk

Feeling a little (or a lot) nervous? Then you’ve begun to understand what it’s like for a mental health professional doing a suicide risk assessment. Believe it or not, much like the weather, suicide is not predictable with a high degree of accuracy. To the contrary: Even highly sophisticated statistical models get it wrong more often than they get it right. Although researchers have identified a wide variety of risk factors associated with suicide (such as depression, social isolation and substance abuse), the vast majority of people with these risk factors do not kill themselves. Thus, predicting suicide based on risk factors results in huge numbers of “false alarms.” Likewise for questionnaires: helpful but not prophetic. 

To add to the frustration, merely asking an individual if he or she is planning to end his or her own life raises a bundle of other issues. The last thing on the mind of a seriously suicidal individual is sharing that information; anyone knows that this would likely move others to intervene. Preservation of life, a given among loved ones and professionals, is not a goal that this person shares. 

This is enough to make a mental health professional fantasize about a blood test or some other kind of crystal ball that would solve this terrible conundrum.

Genius at work

Matthew Nock, PhD (photo courtesy of John D. and Catherine T. MacArthur Foundation)

Dr. Matthew Nock*, a Harvard psychologist and recent recipient of a MacArthur Foundation “genius” grant, doesn’t have a crystal ball, but he is asking an interesting, fundamental, question: Might there be a way of detecting suicide risk otherthan asking the patient or looking at the patient’s history for clues to the future?

Enter the Implicit Association Test (IAT).** This is a pretty straightforward, computer- administered task that requires the test taker quickly place words presented on the screen in one category or another. For example, does the word “apple” belong in the category “red” or “blue”? Sweet or salty? Food or tool? Now try this one: Obama – me or not me? This one’s a little different, for now we begin to get into matters of values and emotions. And such internal processes as these are not fully known to us; they are often unconscious (hence the term “implicit”), but the IAT has shown that they are detectable.

So, how about this one: Death – me or not me?

A better predictor?

The actual task is a bit more complicated than this; but, in essence, what Nock has discovered is that people at risk for suicide take slightly more time (in milliseconds) to make discriminations around death and suicide than nonsuicidal people. Moreover, performance on this task predicts future suicidal behavior above and beyond depression, clinical assessment, past suicidal behavior or even the patient’s own predictions. In other words, a measureable process, beneath the individual’s level of conscious awareness, predicts future behavior better than professional judgment or self-report.

This method is still in its infancy and is not nearly ready for “prime time” in clinical practice. But it does inspire some hope that research eventually might enhance our ability to save lives in an arena where clinical wisdom thus far has fallen short. 

Perhaps there’s hope for better weather forecasts as well. 

*To sample this test with respect to such emotional issues as political preference or racism, visit www.implicit.harvard.edu. It’s free and anonymous.

Editor’s note: Dr. Nock will give a presentation describing his work at Grand Rounds October 5 at the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine.

We’ve all heard the truism about mental health professionals: They go into training in mental health looking for solutions to their own problems. As a psychologist, I’ve always felt a little offended by this stereotype, even while acknowledging its unsettling kernel of truth.

Psychologist and patient

Marsha Linehan, PhD

Now Dr. Marsha Linehan shows us that, far from being cause for shame, this is something one might actually feel good about. Linehan is the iconic creator of dialectical behavior therapy (DBT), a form of cognitive-behavior therapy that has revolutionized the treatment of borderline personality disorder and suicidal behavior.

DBT challenges patients to approach therapy as a balancing act between learning better ways of coping with stress and trauma while working equally hard at accepting oneself and one’s situation exactly as they are. Not only did she introduce this innovation to the clinical community, she proved through rigorous research that it really works.

When, through the years, I have heard fellow professionals smugly whisper, “You know, there’s a reason why Linehan understands borderlines so well,” I’ve never known quite what to say. Now, as a result of a remarkable act of self-disclosure, the answer emerges: The rumors are true – get over it.

In a recent interview in the New York Times, Linehan for the first time publicly discusses her own mental health history. More than two years in a psychiatric hospital in the early 1960s. Multiple suicide attempts and acts of self-harm that left her arms a “macramé of faded burns, cuts and welts.” Medical treatments that included high doses of antipsychotic medications and two courses of electroconvulsive therapy. All before the age of 21.

Her explanation for making this disclosure at age 69, after achieving success in the mental health arena equaled by only a handful of other professionals?

“I owe it to them. I cannot die a coward.”

Coward? As if it weren’t enough to emerge from her hellish past, not only to survive, not only to thrive, but to show the way to recovery to countless other sufferers, she now presents herself as proof that there is hope, even from one in such dire straits that her own care providers saw little hope for her.

In good company

Dr. Jamison's classic memoir.

Linehan is not alone as a mental health professional in revealing her own demons as a means of giving hope to others. World-class bipolar disorder researcher Dr. Kay Jamison did so in poetic fashion in An Unquiet Mind, as did York University psychologist Norman Endler in Holiday of Darkness.

Such acts of courage go far, not only toward destigmatizing mental illness for the public, but also toward showing all of us that mental health professionals are not perfect and need not present themselves as paragons of mental health. Indeed, it is in dealing with our own demons that we become most human and perhaps better able to connect with those we seek to serve.

Editor’s note: For another post about Dr. Linehan, check out “Renowned psychologist acknowledges personal struggle with mental illness.”

Let’s begin with a little humor. OK, here goes:

A cancer patient, a rape victim, and a Holocaust survivor walk into a bar….

Are you amused yet? Probably not. In fact, I’m lucky you’re even still reading this. Why? Because the people in question all have suffered in some terrible way. We know that it’s common decency not to laugh at the expense of other peoples’ suffering.

Why are we laughing?

Yet somehow talk show hosts and others in the entertainment industry never seem to tire of ridiculing Charlie Sheen. And, God help us, we the public can’t seem to resist taking a peek, clicking on the occasional web link, just to keep up with the hoopla, we tell ourselves. Of course, we often feel uneasy afterwards, like when we laugh out loud at the latest Saturday Night Live characterization. We know a man is being kicked while he’s down, and we perhaps know on some level that we all are diminished when we participate. Yet the urge to chuckle along sometimes seems irresistible.

How can we understand this? Perhaps, we tell ourselves, we’re allowed to laugh at someone who’s being such a bonehead: He’s simply behaving badly! After all, we laughed at him in Two and a Half Men when his character behaved in much the same way. Anyone who is this obnoxious, self-aggrandizing and irresponsible deserves to be laughed at. Um, right?

Charlie Sheen, actor and "bi-winner"

Suppose we look a little more closely: Here is a public figure who is not merely making a mistake or two, but saying peculiar things and behaving strangely over an extended period of time. (This thought experiment could be applied to a variety of individuals, whether it be Sheen, a young and wealthy starlet who inexplicably shoplifts or a Congressman whose own staff quits after he refuses their pleas to get psychiatric help.) To “explain” these extreme and perplexing behaviors as simply “stupid” or “asinine” or even “crazy” is to satisfy ourselves with words as substitutes for comprehension.

In our defense, we should acknowledge that an alternative explanation isn’t readily available. Certainly, it would be more charitable to suggest that people like these aren’t fully in control of their behavior. Perhaps they are ill, but we don’t know that. To be sure, some signs of illnesses such as bipolar disorder and substance dependence are apparent, but that’s hardly the basis for diagnosing someone (although that doesn’t seem to stop some commentators, unfortunately).

Two scenarios

However, we can ask ourselves this question: Which scenario is more likely? A) that a bright, attractive and talented individual would – on purpose – do things that cause untold suffering and damage to himself and everyone who cares about him, or b) that he is being affected by a bio-behavioral disorder that is distorting his perceptions, damaging his judgment and compromising his impulse control? If you favor option a), please bring data, because there’s quite a bit of evidence to the contrary that supports option b).

Sorry I can’t close with the humor promised above, but I would like to share a Huffington Post quote from a fellow psychologist, Dr. Robert Leahy, who (without “diagnosing” Sheen), came down on the side of option b), summarizing as follows:

“Laughing at mental illness is a sad reflection of our lack of understanding of its devastating effects. People crash from manias and they and their families and those who love them may feel left alone to pick up the pieces…. Laughing at Mr. Sheen is like laughing at someone who has been badly mangled in an accident. This is serious business. Illness is not a matter of entertainment.”

Suddenly, that irresistible urge to chuckle seems just a little more resistible.

Editor’s note: Just to be transparent, Dr. Ellis has never treated nor is he currently treating Mr. Sheen. Also, if you enjoyed this post, please check out these recent posts by Dr. Ellis:

• It’s a bird, it’s a plane, it’s … my therapist?
• It’s a funny thing about suicide

My colleague and fellow blogger Cody Dolan recently sent me information about an approach to suicide prevention that, as far as I know, is unprecedented: comic books. OK, I know, the correct term nowadays is graphic novel, and I’m giving away my age by using the wrong term (Disclosure: When I was a kid, we actually called them “funny books.” I know – old!).

In reality, this is more than a semantic distinction: The level of artistry and complexity in these publications is a quantum leap beyond anything I saw when I was young, and they don’t seem to hesitate to wade into some pretty deep waters.

My reaction to Superman and Captain America coming to the aid of suffering people on the brink of suicide is pretty straightforward: Why not?

As a suicide researcher, I can tell you there are lots of potential why nots, the main one being that that well-intentioned, feel-good efforts to prevent suicide (such as elaborate memorial services and public tributes to the deceased) can sometimes actually make things worse, because young people (in particular) tend to be vulnerable to modeling effects from role models: We tend to imitate those we admire, especially if we don’t feel good about ourselves as we are.

Cursing Cobain

That is why many of us were actually relieved when, in 1994, Courtney Love angrily cursed at her recently deceased husband Kurt Cobain after he took his own life, reminding everyone at the gathering that problems can be solved without resorting to such desperate measures. Researchers later found no indication of imitation suicides in the grunge rock capital (Seattle) in the months following Cobain’s death.

To the credit of the Marvel company, rather than sensationalize or glorify suicide, they send a message that adversity can be overcome and that there is nothing shameful (indeed, something heroic) about seeking help. Their listing of the national suicide hotline (800-273-TALK) will in all likelihood save lives. Well done.

Superheroes and role models

Finally, as a psychologist, I must say (speaking of role models) that it’s tempting to identify with these superheroes. It’s a flattering comparison, but unfortunately any similarities break down quickly. We helpers are getting better at what we do (see my previous blog entry), but we are well aware of our limitations and vulnerabilities.

As much as we, the public and our patients might wish otherwise, therapists have no capes, masks, silver bullets or super powers. We have no x-ray vision to read minds and no super strength to bring about changes through sheer force of will. Ironically, to be helpful, we need help from the very people we’re trying to help. And getting a little help from the funny books certainly doesn’t hurt.