Rude Facts

Gawkers, voyeurs and righteously indignant moralists will find references at the reading list page. The CDC maintains a list of annual US suicide statistics. It remains unchanged despite all manner of suicide prevention programs and cruel false hope hotlines.

The work of Kipling Williams lately of Purdue University on ostracism may also be useful.

There are no suicide/crisis hotline numbers here because they are not only ineffective, but their use of deceit and dishonesty in the use of police and the forced loss of individuals’ civil rights in the absence of any evidence-based effective help for people suffering unbearable pain is unethical, ineffective (the biggest risk for suicide is a previous attempt) and cruel false hope snake oil substituted for effective evidence-based compassionate care.

Moreover, emergency department personnel have no specific interest, education or expertise in addressing suicidality.

The detective asked the man’s story, what brought him out here, and a dialogue began. The man, in his early 20s, explained that he had no job and no place to live, Detective Keszthelyi said.

“You might seem like you are alone, but you are not really alone,” he told him.

Lots of people lose jobs — and find others they like better, he said.

“You just have to find something in life that you enjoy doing, and when you find that special thing in life, you are going to be successful at it,” Detective Keszthelyi assured him.

The man wanted to know what would happen if he came down. The officers know to be truthful. “In my experience, you don’t want to lie to somebody like that,” Detective Keszthelyi said.

The detective told him that he would be escorted into an ambulance and taken to a hospital, where he would be evaluated and assigned a social worker and therapist.

As opposed to the NYT police interviewee who told a suicidal sufferer a standard whopper that he would be assigned a social worker and a therapist at a hospital, that’s an outright lie. Emergency department staff, like the NYT’s wet dream of its description of the ESU, are all about being adrenaline junkies. These folks live for trauma, clinical instability and quick resuscitation efforts along with races to the OR. They largely resent people who are suicidal and in distress, and they very often are sadistic and cruel toward them. In any ED, there are physicians and nurses who brag about the cruelty they reserve for suicidal patients – unlubed large bore nasogastric tubes, extra doses of activated charcoal, strip searches, ridicule, unnecessary urinary catheterizations, “misses” in IV starts, unnecessary use of restraints and seclusion as punishment and retaliation and on and on and on. Psychiatrists have the absurd notion that patients’ experiences must make them want to avoid remaining (malingering in their parlance) in the hospital – the psychiatrists delusionally viewing the prison like atmosphere as hotel-like.

Almost 100% of people seen in EDs for suicidality, suicide attempts and suicide ideation not only do not receive those resources, but they receive no followup care or contact at all.  They are left to their own devices to relieve their unbearable suffering after learning that “care” is based on dishonesty, deceit, coercion, humiliation and the loss of basic civil rights and dignity. That “therapeutic alliance” invoked by mental health providers is not based on a single ethical principle, and it’s aim is only at compliance. Trust is used to sucker in victims.

As a humane, painless death is not available to them, they are forced to turn to methods which entail self harm and violence. Companion animal end of life ethics are by far more advanced in the US than is terminal psychic suffering.

That’s all, folks

I’ve scoured the interwebs and continue to come up empty.  Suffice to say that the US is a predatory, brutal place with a societal culture that promotes predation.  As someone who was committed to patient advocacy, and yet failing miserably when I needed and sought help, I don’t want to lead others on a wild goose chase predicated on false hope and foolish optimism.  Those lead to betrayal, failure and more suffering.

That, in all of this medical mecca town, not a single psychiatrist, psychologist, psychiatric social worker or academic program offers any effective care and treatment to reduce unbearable psychological distress, nor is interested in doing so, speaks for itself.

That no one is interested on this blog or any other in discussing approaches or treatment alternatives sends a clear message.

Only I can find a place on the interwebs where no one else resides and Google turns up no results. WordPress putting all of my blog posts and comments on other WP blogs into spam was also a large factor in stopping.

In how many ways can one be ostracized?  I’ve lost count.  But I also just don’t give a damn anymore. They’ve got me where they want me – disappeared so as not to ugly up the place.

For the all one person (annalaw, that would be you) who read and commented, I am very grateful and appreciative.  I wish you the best in your quest for minimally acceptable care.

The reading list will remain in its messy, disorganized place.

And I will remain in this living hell until I can get myself euthanized and catch up to the social death.

Fuggeddiboudit

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Previously I noted that disparate studies suggest that incessantly assessing suicide risk without providing distressor relief may actually kindle – make worse – suicidality.  Over the recent past this has been my experience. The chief source of “treatment” such as it is, is by serving as a lab rat in studies.  I have been subjected to incredibly intrusive and distressing assessments on a very frequent basis.  I haven’t responded to any of the treatments and have instead had side effects including a liver injury from one – where the CRO (for profit contracted research organization) and IRB disappeared into the ether and left me to my own devices.

Last week I served as a subject that I thought wouldn’t involve distress or harm because I needed $$ to pay for treatment I received as a result of the liver injury.  Well, the assessment was awful to the extent that I called a crisis hotline – was treated to a rude and dismissive response and then the crisis provoker hung up on me. “Just read a book,” she commanded.  And,
“I’ve never been suicidal,” she crowed.

I lost time after that – a few days at least.  Apparently I threw the phone away, which makes sense.  No one calls me, and it isn’t needed since no one responds to calls for help, either.  One cost reduced.

I’m withdrawing from the other studies.  I can’t tolerate the distress.

I used to blog to try to stay current in health policy and clinical practice, but I’m too far gone to do that or to care.

So I’m signing off at this juncture with a link to what looked to be a thoughtful and fairly comprehensive report about the state of suicidality “treatment” in the US with some Western countries’ best practices thrown in.

And a plea to offer a humane death for those of us ostracized by you.  There’s a difference in wanting to hurt oneself and desiring a peaceful death. I failed at finding a means to the latter, and am forced to resort to the former.  That is cruel and unusual punishment for being deemed a worthless freak.

TNTC

TNTC in the healthcare trade refers to too numerous to count, often referring to types of cells on a slide.

I’ve been reading all sorts of studies and reports and have managed to keep TNTC tabs open.  I’m not able to concentrate well enough to put them into much of an interesting and pertinent context, so here they are, more or less in list form.  Perhaps another day the noggin will be more willing to oblige in the coherence and cogitation departments….

Kaiser Health News (an excellent resource) reports on states cutting mental health budgets concurrent with need and use increases.

Despite the sketchy, COI (conflict of interest) riddled authors, this is an interesting review.

This review summarizes the phenomenon of adult hippocampal neurogenesis, the initial and continued evidence leading to the development of the neurogenesis hypothesis of depression, and the recent studies that have disputed and/or qualified those findings, to conclude that it can be affected by stress and antidepressants under certain conditions, but that these effects do not appear in all cases of psychological stress, depression, and antidepressant treatment.

This study refers to people who committed suicide as “depressed suicides”.  Ahem, authors, suicide is a verb and not a noun to be used to pathologize a person as an act. I included it because it found credible evidence of neuroinflammation in people who were diagnosed prior to their deaths with severe depression. (I’ve been eating an anti-inflammatory diet which has provided some health benefits, but to date, has not mitigated depression or PTSD.  However, my labs are golden.  Whoopee.)

These results provide the first evidence of altered cortical astrocytic morphology in mood disorders. The presence of hypertrophic astrocytes in BA24 white matter is consistent with reports suggesting white matter alterations in depression, and provides further support to the neuroinflammatory theory of depression.

Shotgun ’em. This study looked at the outcomes of people who were prescribed antipsychotic medications for anxiety. Except for the adverse effects, not much good happened. Lesson: don’t let this happen to you.

Lithium has a reputation for lowering the suicide rate. When it was stacked up next to valproate, not so much.

Despite the high frequency of suicide events during the study, this randomized controlled trial detected no difference between lithium and valproate in time to suicide attempt or suicide event in a sample of suicide attempters with bipolar disorder.

Australian national youth suicide prevention strategy didn’t affect the suicide rate – just like every other prevention strategy globally.

Yet another suicide rating scale – this time it’s the Columbia-Suicide Severity Rating Scale C-SSRS. It’s apparently reliable for suicidality but not for actual attempts. Kindling effect, people. Keep asking questions which demand extensive detailed thought about planning, the method, the needed resources and the desire, and hey – look at this bright shiny object – the biggest risk factor for suicide is prior attempts. Practice and rehearsal (mental as well as physical) makes perfect. Still conflating assessment with treatment with iatrogenically lethal result.

I’m stopping here, although there are many, many more links to go.

Yale Open Philosophy Course: The Suicide Lectures

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The course is entitled, The Philosophy of Death, taught by Professor Shelly Kagan at Yale University in 2009. Each lecture is just under an hour.  The written transcript and reading references are available on the individual lecture pages.  The course link above will take you to the introductory lecture and all of the lecture links.

Course Index

Philosophy of Death
The Nature of Persons: Dualism vs. Physicalism
Arguments for the Existence of the Soul, Part I
Introduction to Plato‘s Phaedo; Arguments for the Existence of the Soul, Part II
Arguments for the Existence of the Soul, Part III
Arguments for the Existence of the Soul, Part IV; Plato, Part I
Plato, Part II: Arguments for the Immortality of the Soul
Plato, Part III: Arguments for the Immortality of the Soul (cont.)
Plato, Part IV: Arguments for the Immortality of the Soul (cont.)
Personal Identity, Part I: Identity Across Space and Time and the Soul Theory
Personal Identity, Part II: The Body Theory and the Personality Theory
Personal Identity, Part III: Objections to the Personality Theory
Personal identity, Part IV; What matters?
What Matters (cont.); The Nature of Death, Part I
The Nature of Death (cont.); Believing You Will Die
Dying Alone; The Badness of Death, Part I
The Badness of Death, Part II: The Deprivation Account
The Badness of Death, Part III; Immortality, Part I
Immortality Part II; The Value of Life, Part I
The Value of Life, Part II; Other Bad Aspects of Death, Part I
Other Bad Aspects of Death, Part II
Fear of Death
How to Live Given the Certainty of Death
Suicide, Part I: The Rationality of Suicide
Suicide, Part II: Deciding Under Uncertainty
Suicide, Part III: The Morality of Suicide and Course Conclusion

There are three suicide lectures.  Part I and transcript, Part II and transcript and Part III and transcript may be viewed at the links.  From the latter part of the Morality of Suicide lecture:

So, the utilitarian position is in the middle. It doesn’t say suicide’s never acceptable, doesn’t say suicide is always acceptable. It says, perhaps unsurprisingly, it’s sometimes acceptable; it depends on the facts. It depends on the results. It depends on comparing the results of this action, killing yourself, to the alternatives open to you. We have to ask, is your life worse than nothing? Is there some medical procedure available to you that would cure you? If there is, and even if your life is worse than nothing, that still doesn’t make it the best choice in terms of the consequences. Getting medical help is a preferable choice in terms of the consequences.

We can even think of cases where your life is worse than nothing, you’d be better off dead, and there is no medical alternative of a cure available to you, but for all that, it still isn’t morally legitimate to kill yourself in terms of the utilitarian outlook. Because, as always, we have to think about the consequences for others. And there may be others who’d be so adversely affected by your death that the harm to them outweighs the cost to you of keeping yourself alive. Suppose, for example, that you’re the single parent of young children. You’ve got a kind of moral obligation to look after them. If you were to die, they’d really have it horribly. It’s conceivable then, in cases like that, the suffering of your children, were you to kill yourself, would outweigh the suffering that you’d have to undergo were you to keep yourself alive for the sake of your children. So, it all depends on the facts.

Still, if we accept the utilitarian position, we do end up with a moderate conclusion. In certain circumstances suicide will be morally justified — roughly speaking, in those cases where you’re better off dead and the effects on others aren’t so great as to outweigh that. Those will be the paradigm cases in which suicide makes sense or is legitimate, morally speaking, from the utilitarian perspective.

Watch it on Academic Earth

Poor Put Upon Psychiatrists

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MovieDoc is perturbed that patients who are contemplating suicide telephone.  Instead, he avers that they should be telephonally instructed to hang up and call another number.

Despite the ubiquitous “If this is an emergency, hang up and dial 911” message I wonder how many patients who are sufficiently ambivalent about ending their lives to call their psychiatrist would call 911 instead. There seems to be an expectation (standard of care?) that psychiatrists can somehow talk them out of it over the phone, or attempt to stop the patient by involving 911 or other resources. I find it ironic that many argue that video conference (eg, Skype) is inadequate for even routine psychiatric encounters and yet expect psychiatrists to, on the spur of the moment, handle a life or death situation over the phone. Why not send these calls to the people who handle them all the time, crisis lines, and stop trying to be the hero like one of those movie psychiatrists?

In Sybil Dr. Wilbur goes to her patient’s apartment to rescue her. How far should one go to stop the patient from killing herself? Why stop with a telephone call?

Should we pretend to do something we cannot do? Does providing access outside of an appointment encourage or reward dysfunctional and potentially dangerous behavior?

“If you’re suicidal, leave a message and you’ll get a free telephone session with your physician who wants to be your hero and rescue you and provide you with attention and make you cared for, warm and fuzzy.”

I don’t disagree that patients shouldn’t try to contact their psychiatrist, when they have one, but my disagreement is for different reasons. MovieDoc buys into many myths which have been exposed as such by Thomas Joiner. For example, the myth of impulsivity, selfishness and suicide notes are addressed:

To my knowledge, no study has reported a rate of note leaving among suicide decedents to exceed 50%. Moreover, most studies find rates between 0% and 40%4; a reasonable average rate would be approximately 25%.

 

Why are suicide notes so rare? Some have reasoned that because impulsivity is involved in suicidal behavior, suicidal persons often kill themselves before they have a chance to write a note. There are problems with this viewpoint, however. A major problem is that it draws on the distinct myth that dying on a whim is common. Another problem is the lack of empirical support that compares those who leave notes with those who do not. If it were true that note leavers are much less impulsive than those who do not leave notes, then this distinction should be easy to demonstrate in forensic studies that examine the lives, characteristics, and personalities of decedents. This difference has not been clearly demonstrated.

 

The relative rarity of suicide notes reveals the state of mind of those about to die by suicide. To say that persons who die by suicide are lonely at the time of their deaths is a massive understatement. Loneliness, combined with alienation, isolation, rejection, and ostracism, is a better approximation. Still, it does not fully capture the suicidal person’s state of mind. In fact, I believe it is impossible to articulate the phenomenon, because it is so beyond ordinary experience. Notes are rare because most decedents feel alienated to the point that communication through a note seems pointless or does not occur to them at all.

Suicide hotlines are staffed by people with all sorts of education, backgrounds and skill sets. There are no therapeutic standards of practice.  There is no accreditation, licensure or certification requirement for crisis hotlines or the people who staff them.  Caller beware.

As a caller, I’ve been treated to someone chewing his food and multiple hang ups (“I’m sorry I can’t help you. I have to go now.” Click. That was verbatim, and so must be in the script for getting rid of undesirable calls)

I refuse to ever have contact with any aspect of hospital based psychiatric services, as do I suspect a majority of people with past suicide attempts. The trauma and harm that caused is something I won’t expose myself to again.

But I would not contact a psychiatrist either since the power to force treatment is an ongoing threat. Suicidality is obviously not safe for me to discuss with anyone, and until euthanasia is “on the table” I can’t foresee trusting any provider enough to discuss core concerns. Moreover, I have no desire to distress someone else, provider or otherwise, with my concerns.

All this to get to the point that I hypothesize that there really isn’t a big patient population that would be likely to call their psychiatrist with lethal suicide intent.

Just as most people who commit suicide don’t leave notes, I doubt that they make impulsive “save me and be all warm and fuzzy about it” phone calls, either. I certainly learned that no one is interested, nor can help, via that route.

Indeed, I learned that there is no useful therapeutic treatment for suicidality. The current standard of incarceration (they call it containment), assaults and batteries (forced medication, restraints, isolation, refusal to allow patient chosen visitors to be present) and intrusive observation sans human interaction (unskilled people who do not speak to, touch or care for patients, but who literally remain in views at all times) is dehumanizing, demoralizing and confirms the extant hopelessness. It doesn’t ever address suicidality and its attendant concerns of thwarted belongingness and perceived burdensomeness.  It does nothing whatsoever to relieve the unbearable distress that predicates suicidality. It’s all about restraints, control and power.

Discontinuing mental health services and contacts was necessary to halt distressing assessments that were conflated with care and continuing trauma from a lack of effective care.  At least the iatrogenic harm stopped.

Like many others, I came out worse than before I received “treatment”.

So I find it ironic that the psychiatrist feels undue burdens in the theoretical situation of a patient contacting him or her with a perceived degree of unbearable distress.  Is it any wonder that the suicide rate is highest for psychiatrists?

When they remove the double speak and have that oh-so-critical insight into what will be done to them if they seek treatment for suicidality, psychiatrists, like most physicians, do not seek treatment and avoid seeking peer support or disclosing their “illness”.

The biggest walking, talking, suiciding ads for anti-psychiatry are distressed psychiatrists.