“SUICIDAL BEHAVIOR IS A BROAD term that includes death bysuicide and intentional, nonfatal, self-injurious acts committed with or without intent to die. It is associated with severalmental disorders, including depression, substance dependence, and schizophrenia. Borderline personality disorder (BPD) is 1 of only 2 DSM-IV diagnoses for which suicidal behavior is a criterion.“

The emphasis is mine. I thought “what’s the other disorder that suicidal behavior is a criterion?” The answer: Major Depressive Disorder. So, today I am posting the DSM criteria for Major Depressive Disorder. It’s fairly long and I’ve included the “Major Depressive Episode” to clarify. If you’d like to get the full criteria, follow the “continue reading” link.

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Major Depressive Disorder

Single Episode

A. Presence of a single Major Depressive Episode

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Recurrent

A. Presence of two or more Major Depressive Episodes.

Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.

B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition.

Specify (for current or most recent episode):
Severity/Psychotic/Remission Specifiers
Chronic
With Catatonic Features
With Atypical Features
With Postpartum Onset

Specify
Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern

Major Depressive Disorder

Single Episode

A. Presence of a single Major Depressive Episode

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Recurrent

A. Presence of two or more Major Depressive Episodes.

Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.

B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition.

Specify (for current or most recent episode):
Severity/Psychotic/Remission Specifiers
Chronic
With Catatonic Features
With Atypical Features
With Postpartum Onset

Specify
Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern

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Personality Type Might Help Identify Teens at Suicide Risk

Leslie Sinclair

Q-factor analysis of adolescents who have attempted suicide may shed light on personality subtypes of attempters.

Studies of adolescents who have attempted suicide usually focus on identifying how they differ from their nonsuicidal peers. Researchers at Emory University, however, have begun to identify how adolescents who attempt suicide differ from one another.

Their work adds to previous studies that have reported personality subtypes within samples of adult suicide attempters and completers. “Overall, assessing adolescents’ risk of suicide attempt should include not only a list of risk factors but also a deeper understanding and consideration of personality,” wrote lead author Dorthie Cross, a doctoral student in the Department of Psychology at emory University, and her colleagues in the October Journal of Nervous and Mental Disease.

The researchers used a Q-factor analysis to identify subtypes based on the Shedler-Westen Assessment Procedure-II for Adolescents (SWAP-II-A), a 200-item measure of personality pathology administered by clinicians that was codeveloped by Drew Westen, one of the authors of the new study.

“Q-factor analysis is also called inverted factor analysis because it aggregates patients rather than variables, identifying people with similar profiles across a set of items instead of items with similar content across cases,” the researchers noted. “the goal of Q-factor analysis in this study is to identify groups of adolescent attempters with shared personality characteristics that distinguish them from other adolescents who have attempted suicide,” they explained.

The researchers recruited 950 psychiatrists and psychologists with at least three years’ postlicensure experience from membership rosters of the American Academy of Child and Adolescent Psychiatry and the American Psychological Association. Participating clinicians were asked to provide data on a single randomly selected adolescent patient currently in treatment of “enduring maladaptive patterns of thought, feeling, motivation, or behavior—that is, personality.” they were asked to select a patient without a particular diagnosis, yielding 267 patients with a history of suicide attempt. Publications detailing the sampling procedure and the rationale for using clinicians as informants in basic science research, also coauthored by westen and published in the American Journal of Psychiatry, were referenced.

Q-factor analysis of the 267 patients with a history of suicide attempt resulted in six subtypes: externalizing, internalizing, emotionally dysregulated, high functioning, narcissistic, and immature.

• The externalizing subtype comprised the largest group of adolescents, characterized by substance abuse, attachment disruption, and being the victim of childhood physical abuse. It included a higher proportion of males and was a significantly younger age group. “We found that this subtype was related to less-lethal suicide attempts, which may be partially explained by the younger age of this group,” the researchers said.
• The internalizing subtype “reflects a substantial body of literature, showing the risk of suicide associated with mood disorders, independent of other factors like substance abuse,” and was characterized by depression, avoidance, and hopelessness; the group was predominantly female.
• The emotionally dysregulated subtype was characterized by childhood sexual abuse, school problems, borderline personality pathology, and substance abuse, as well as increased risk of comorbid mood and substance use disorders. Adolescents fitting this description were considered to be of highest risk.
• The high-functioning subtype “seems healthy and does not experience most of the risk factors associated with suicide,” wrote Cross and colleagues. They may be perfectionistic, experiencing guilt and anxiety, and their attempts tend to be less lethal. “It is possible … (they) may have less access to lethal means of suicide, or they may have a diminished desire to actually die relative to other suicidal adolescents whose functioning may be more impaired.”
• The narcissistic subtype showed high adaptive functioning and school performance and low levels of substance use disorders and conduct disorder.

The immature subtype displayed marked social isolation and anxiety, as well as significant association with schizoid personality disorder. “although immature adolescents seem similar to socially phobic adolescents who are at an increased risk of suicide attempt, they may represent adolescents at risk for the development of psychotic disorders,” wrote Cross and colleagues.

To validate each subtype, the researchers compared the study subjects across relevant Axis I and Axis II pathology, adaptive functioning, and etiology. “Depression, substance abuse, physical and sexual abuse, attachment disruption, and particular personality characteristics (e.g., impulsivity or neuroticism) are all markers for risk; however, these markers do not apply, nor can they apply, to all suicidal adolescents,” they explained.

In discussing the limitations of their study, Cross and colleagues noted that only adolescents who attempted, rather than completed, suicide were able to be evaluated, potentially omitting meaningful subtypes, though they cited increasing evidence that suicide attempt and completion constitute a single spectrum of risk.
“Despite its limitations, this study shows that the path to suicide may be quite different depending on what type of person is making the decision,” concluded Cross and her colleagues. “Understanding those differences is vital to the prediction and prevention of future suicide attempts.”

The research was funded by a grant from the National Institute of Mental Health.

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Tragic Vikki’s mum can’t forget court recording of girl’s last call

Published on Monday 28 November 2011 07:13

PROUD mum Pamela Bowmaker remembers how her daughter loved singing Spice Girls songs on her karaoke set. She once adored her Barbies, lived to play practical jokes and dreamt of becoming a children’s nurse.

But her final memory is a haunting one. On a night in September 2008, Vikki McGovern made a desperate call to NHS 24, screaming that she was going to kill herself. She repeated the words over and over again until a fire alarm went off in the NHS building. The worker on the other end of the line gave Vikki a telephone number and said she could phone again in ten minutes, before ending the call.

Vikki, 19, never rang back.

The next morning she was found dead in her hostel bedroom. She had taken a fatal dose of methadone. That dose had been given to her by a criminal who knew she wanted to kill herself.

“They played that tape in court three times,” says Pamela. “Vikki kept saying the call better not be traced or she’d run away and hide. She said she wanted to kill herself over and over. I think she was hinting at them to find her, it was a cry for help. Then the fire alarm went off and she was told to call back.

“That’s the last time anyone spoke to her.

“To hear that recording over and over again,” she says, before trailing off.

“It was unlucky what happened, but I think the NHS could have called back. I felt they had enough time to trace the call. Vikki phoned from the hostel’s office phone – from a place for people struggling with mental health. Vikki never got what she needed.”

Heartbroken Pamela visited her daughter’s grave last Wednesday to lay flowers – and let her know the “nasty piece of work” who gave her methadone during her desperate hours had finally been caged.

In Dundee High Court last Tuesday, with Pamela watching, James Whitson was convicted of culpable homicide after giving Vikki the lethal dose of the class A heroin substitute just days before her death in September 2008.

“In court, that lad smirked at us, although his smirk started to drop as the trial went on. It’s the second time he’s gone to court over this. He got off on appeal [in 2009]. When he was sentenced back then he got ten years. I hope he gets longer this time,” she says.

For Pamela, his imprisonment offers some comfort. She says his conviction will give her an opportunity to grieve.

A picture of Vikki as a baby takes centre stage on the living room wall in her Piersfield Place home, surrounded by pictures of her four happy, healthy siblings: Douglas, 19, Dionne, 16, Robert, 14, and Dale, 11.

Vikki, she says, was a girl who had “snapped” after the death of a close family friend – a grandfather figure – when she was 16.

“When she was growing up she was a typical wee girl. She grew up around a big family and she was a lovely girl. Her siblings adored her, they wouldn’t leave her alone.

“But when she was 16 our neighbour died. Vikki had been so close to him, she would tell him everything and she would visit every single day.

“The day he passed away, something snapped in her. She didn’t really react to the death, she just went into herself. She refused to go to the funeral, which I thought was strange.

“She said she wanted to remember him how he was before he died.”

Soon after his death, Vikki started self-harming. The increasingly nervous teen would wear long tops, which she’d pull over her knuckles to hide cuts to her wrists and hands. Vikki’s brother, Douglas, was the first to guess what was going on when he noticed bits of paper covered in blood scattered around his sister’s room.

“After that I’d regularly ask Vikki if I could see her arms,” Pamela says sadly. “But she got good at hiding the marks. She’d cut her legs instead.”

Frustratingly for Pamela, Vikki would try to hide as much as possible from her mother. “When she turned 16, that was it,” she says. “Vikki wanted to be independent and everything was confidential, the doctors would tell me nothing. When we heard in court that she’d tried to kill herself 13 times, I had no idea.

“Vikki was so quiet. She didn’t drink, she didn’t smoke, she didn’t do drugs. It was so hard to get her to accept help. I told her ,‘Shout, Vikki, shout when you get angry’, but she whispered back that she couldn’t.”

Soon afterwards, Vikki moved out of her home to a supported flat in the Meadows. Next, she moved to Cranston Hostel, then to St John’s Hill Hostel, where Pamela says “the problems really started”.

“One night when she was staying in Cranston, Vikki phoned me from the ERI. She’d been cutting herself too much. She told me she had to leave Cranston for her own safety.”

In a rare moment, Vikki confided in her mother that doctors had diagnosed her with borderline personality disorder.

“It made sense when she said it,” says Pamela. “Vikki could switch from telling everyone she wanted to die and was going to kill herself, then a minute later would be talking about her favourite music and what to get her brother for his birthday. I read that people feel very alone even when they’re not, and that makes me so sad.

“My concerns for Vikki got worse when she went to St John’s. Vikki was isolated there and it was full of people addicted to drugs and alcohol. I don’t believe it was the right place for her.”

Pamela also believes that a lot of the fellow residents used to bully her daughter, marching her to the bank so she could withdraw cash they would then spend and taking items of clothing. On the day Vikki died, the tearful mother claims that Vikki’s bag containing her mobile and belongings – things she would “never be without” – was stolen from her room.

“We’ve still never found it to this day,” she reveals. “My last visit to the hostel, about four days before Vikki was found, I remember my exact words to her support worker were: ‘I don’t feel my daughter is safe living here’.”

It was on September 20 that Pamela got the final knock on the door. “CID were standing there and straight away I knew. I remember I wouldn’t sit down because I didn’t want them to tell me Vikki had passed away.

“We later found out in court that the nasty piece of work at the hostel had been wanting to sell methadone. He’d asked Vikki if she wanted to buy it. I don’t know if he gave it to Vikki or she was too scared to say no, so she bought it. She kept saying she wanted to kill herself. Other people were laughing at her, saying she couldn’t even do that properly.”

Her bullies were referring to a previous attempt to kill herself with methadone the month before. In August she ended up in the ERI, where she sent her mother a text message saying she was sorry and that she wouldn’t do it again.

Tragically, Vikki did do it again. But Pamela doesn’t believe her daughter meant to do it. She is furious that methadone got anywhere near her tormented child’s hands.

“Vikki had been having a hard time before she died, but one of the support workers, Shirley, told Vikki on the Friday night that they were going to have a girly day the next day. Shirley found her dead at 9.30am.”

Vikki was buried on October 7 in Piershall Cemetery, just around the corner from where her heartbroken mother lives.

“The main thing is, I don’t feel like I’ve ever had a proper chance to grieve for Vikki. I just hope that now he’ll accept his sentence and let us move on as a family,” she says quietly.

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I’m gonna jump (link)

THE DOCTOR SAYS
By Dr MILTON LUM

The are several factors that increase the risk of a person commiting sucide.

EVERYONE’S life has its ups and downs, with feelings and emotions accompanying many of these situations. Most people adapt and cope with the downs. However, there are some who are so overcome with these emotions that they take their own life.

Suicide is an individual’s intentional act of ending his or her life.

Many suicide attempts are preceded by a history of self-harm, in which there is deliberate injury that a person inflicts on his or her body. This does not mean that the person who self-harms wants to commit suicide, but is an effort by the person to cope with intense emotions.

However, self-harm is an indication that the person needs immediate assistance.

Suicide is a common cause of death in young people worldwide. According to the National Health and Morbidity Survey 2006, there was a 6.3% rate of acute suicidal ideation, and 25.8% of chronic suicidal ideation. The highest prevalence rate of suicidal ideation of 11% was found in those aged between 16 and 24 years.

The National Suicide Registry Malaysia (NSRM) 2008 report stated there were 290 suicides in that year, of which 219 were men and 71 women, with Chinese comprising 53.5%, Indians 27.3%, and Malays 13.9%.

The youngest suicide victim was 12 years, while the oldest was 83 years. The NSRM estimated that there were 425 suicides between January and August 2010, averaging 60 per month, ie two daily.

It is estimated that the suicide rate is similar to that of the United States.

Although women are more likely to attempt suicide and other self-harm behaviour, it is the men who are more likely to succeed in suicide. The suicide rate in men in many countries is about three times that of women.

Risk factors

The reasons why some people commit suicide while others in similar situations do not, have not been determined. However, there are some factors that increase the risk of suicide.

Genetics is believed to be a risk factor as suicide has been found to be more common in certain families. There are several genetic mutations reported that may alter the chemicals in the brain, increasing the vulnerability to suicidal thoughts and behaviour. However, no specific gene for suicide has been identified.

Mental health conditions are the most significant risk factor, particularly serious and chronic mental health conditions. It has been estimated that about 90% of people who commit or attempt suicide have a mental health condition.

Severe depression is associated with misery and hopelessness – there is a 20-fold increase in the likelihood of attempted suicide than the general population.

Sufferers of bipolar disorder alternate between extreme joy to severe depression. About a third of these sufferers attempt suicide, and about 10% commit suicide.

Patients with schizophrenia are unable to think logically, and have difficulty differentiating between real and unreal experiences, with about 5% committing suicide. The risk is greatest when the diagnosis is made, but with the passage of time, they are better able to cope with their situation.

Anorexia nervosa is a condition in which anxiety about body weight leads to extreme efforts at limiting food consumption. About a fifth of anorexics will attempt suicide.

Patients with borderline personality disorder have altered thinking, unstable emotions, impulsive behaviour and unstable relationships. About half of these sufferers will attempt suicide, with an increased risk in those who were sexually abused in childhood.

It is believed that a combination of other factors increases the risk of suicide. These factors may or may not be significant, depending on the person’s vulnerability at the point in time. They include:

• History of a recent traumatic experience, eg end of a relationship, bullying, loss of job, bereavement.
• History of a traumatic experience in childhood, eg sexual or physical abuse, bereavement, parental neglect.
• A parent with a serious mental health condition, eg severe depression, bipolar disorder, schizophrenia, or who committed suicide.
• A previous attempt at suicide.
• Social isolation, with few family members or friends.
• Misuse or abuse of drugs and alcohol .
• Unemployment or poor job satisfaction or security.
• Debt.
• Occupations which permit access to the means to attempt suicide, eg doctor, nurse, pharmacist, planter.

Danger signs

There are warning signs that indicate that a person is suicidal. They include talking or writing about death or suicide threats to injure or kill himself or herself, and actively seeking methods of committing suicide, eg stockpiling medicines, particularly sleeping pills, and/or pills used to treat serious mental conditions.

Other warning signs include:

• Complaints, talk or behaviour that indicate hopelessness or a meaningless life.
• Loss of interest in personal appearance, eg poor dressing, cessation of use of make-up.
• Reckless or risky behaviour without concern for the consequences.
• Sudden mood changes, anxiety, agitation.
• Increased withdrawal from interactions with family members and friends.
• Insomnia or sleeping all the time.
• Abuse or misuse of drugs or alcohol.
• Putting their affairs in order.

When warning signs are noticed, it would be useful to encourage the affected person to talk about it and to listen attentively. One should listen to what the person has to say to let them know that there is someone who cares about them.

A non-judgemental manner and empathy are essential. One should not influence what is said, but rather, facilitate honest and frank conversation.

Any questions raised by the listener have to be open-ended, and not end the conversation.

At the same time, the person’s doctor or nurse should be contacted. If it is not possible to do so, the accident and emergency department of the nearest hospital should be contacted as to how to get professional help for the affected person. If one assesses that the affected person has a high risk of dying by suicide before the arrival of professional help, one should contact the nearest ambulance service.

At the same time, any possible means of suicide should be removed from the immediate environment of the affected person. This would include medicines, household chemicals, sharp objects, etc.

Providing care to a suicidal person is stressful and distressing, and it can impact upon the carer’s mental health. Professional help may be required to address the carer’s emotions after the event.

Preventing suicide

Mental health is no different from physical health. Measures can be taken to improve mental health so that one is stronger emotionally and better able to cope with the downside of life, thereby reducing the risk of developing mental health conditions like depression.

Exercise is effective in the management of depression. Physical activity reduces stress and anxiety, improves mood, and promotes the release of brain chemicals called endorphins, which makes one “feel good”.

A healthy diet not only provides protection against physical health problems, but may also be vital in maintaining mental health.

Avoidance of social isolation is an important measure as it is a risk factor for suicide. Having friends is beneficial for mental health. If there is individual difficulty in making friends, you should consider joining a local activity group or support group. There is evidence that people involved in providing assistance to others through voluntary or charity organisations are mentally healthier than the general population.

Having a positive attitude is vital as persistent negative thoughts increase the risk of isolation. Cognitive behaviour therapy (CBT) is a type of talking treatment that assists in the management of problems by changing the thoughts and actions of the affected person.

Many people use drugs to help them cope with life’s problems. Their misuse or abuse may lead to more problems and increases the risk of developing serious mental conditions like depression.

Even recreational drugs like marijuana, which is perceived to be less harmful, increase the risk of depression and schizophrenia in some people.

Many people use alcohol to help them cope with life’s problems. Its misuse or abuse may lead to more problems and increases the risk of depression. It would be prudent to avoid exceeding the recommended daily alcohol consumption limits – ie three to four units for men and two to three units for women. A unit is the equivalent of about half a pint of normal strength lager, a small glass of wine, or 25ml of spirits.

A consultation with your regular doctor would be helpful if there are problems with drug usage or alcohol consumption.

However, the evidence is that an effective preventive strategy is to educate doctors on how to recognise and treat depression, and restricting access to lethal methods of suicide. Another promising strategy is to train particular groups of people on how to identify those at risk and refer them for treatment.

Support groups provide counselling and practical advice to people who are depressed, or have suicidal thoughts. The local support group are the Befrienders and their contact details are 95, Jalan Templer, Petaling Jaya 46990 (Telephone: 03 7956 8144 or 03 7956 8145; email: sam@befrienders.org.my)

If you do not like the idea of talking to someone on a helpline, you can talk to a family member, trusted friend, doctor or religious leader. You should also consult your doctor, who can prescribe treatment for mental health conditions.

> Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

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Young student raising awareness

by Kevin Mertz

Published: Wednesday, September 28, 2011 8:21 AM CDT

MILTON — Seven-year-old Kiflyn Hockenbrock sat quietly by her mother Dawn Hockenbrock’s side, grinning from ear-to-ear, as Dawn spoke on the pride she has for her daughter, who has launched a fundraising effort to support a worthwhile cause.

Kiflyn, a second-grade student at Baugher Elementary School, will be participating in the Out of the Darkness Community Walk, to benefit the American Foundation for Suicide Prevention, Sunday, Oct. 16, at Lycoming College in Williamsport. She will be joined at the walk by a team of friends and family.

To raise funds for the walk, Kiflyn is spearheading a Chinese auction, to be held starting at 11 a.m. Saturday, Oct. 8, at the New Columbia Civic Center, located on Third Street in New Columbia.

Prevention of suicide is a cause close to Kiflyn’s heart. Her father, Cody Lahr, passed away as the result of a suicide in November 2009.

Dawn said her daughter has been traveling with her to a number of local businesses seeking donations for the auction.

“(I’m) very proud,” Dawn said of Kiflyn. “She’s shy. For her to go out to do this is amazing.”

Dawn said Kiflyn is also growing as a person by heading up the fundraiser.

“She’s learning there’s a lot of people who have the same issues, people who lost people to this issue,” Dawn said. “She’s not alone.”

She said Lahr had been diagnosed with a borderline personality disorder. In the days leading up to his suicide, a number of bad things had happened in his life, including a death in the family.

“It was too much (for him),” Dawn said.

She said Kiflyn is learning that it’s OK to talk about suicide and she hopes others realize that as well.

“(Suicide) is not something that’s really talked about,” Dawn continued. “It’s hush hush sometimes when something like this happens. It’s OK to talk about it. It’s OK to miss her dad or whomever it happened to.”

She said one of the goals of the American Foundation for Suicide Prevention is to get the word out that help is available for those who may be considering suicide and need support in their life.

Dawn said her daughter has had a strong support system since her father’s death.

Anonymous community members made a blanket for Kiflyn using fabric from T-shirts which had been worn by Lahr. A similar blanket was also crafted for Kiflyn’s younger sister, Laney Lahr.

Dawn said the blanket “means a lot” to Kiflyn.

“She slept with it the first couple of nights,” Dawn said. “It’s nice to have that constant reminder.”

She’s thankful for the community members who made the blanket. Members of the United Methodist Church in New Columbia also made pillows made out of Lahr’s jackets for his children, Dawn said.

She and Kiflyn are thankful for the various community members who are assisting in Kiflyn’s efforts to raise funds for the American Foundation for Suicide Prevention.

The family recently received notification that the Local 38 Union will be donating $500 to the cause.

“When we got the call about the $500, we about fell over,” Dawn said. “It is amazing. When I’ll go out and ask people for donation, people will say ‘I knew someone’ (who was a suicide victim).”

Items that will be a part of the Chinese auction include Vera Bradley items, a night’s stay at the Comfort Inn in New Columbia, a lottery tree and at least 50 gift certificates to local businesses.

Team members participating in the walk with Kiflyn and Dawn include: Stephanie Kreps, Jose Castro, Kristy Dreisbach, Kristy Foster, Courtney Haas, Millie Hockenbrock, Michelle Kashuba, Amanda Kiessling, Laney Lahr, Teresa Lahr, Jessica Reich, Donna Schaffer, Becca Stevenson and Genie Ficks.

For more information on the walk or the American Foundation for Suicide Prevention, visit http://afsp.donordrive.com.

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2. I’m going to jump – Suicide Prevention and influencing factors
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Lewis: Like I remember one day I came in with white sticky tape wrapped all around my arm, and I told everyone that it was a cast and I had broken my arm.

Desperate for attention, she convinced her mother she couldn’t see, and got prescription glasses. By age 8 – her behaviors were self-destructive:

Lewis: I had a game, and I called it TP, and TP actually stood for taking pills. I would rummage in my parents’ medicine chest and I would take their pills.

This was only the beginning. Over the next years, Talya knocked her front teeth out with a hammer, started taking drugs, cutting herself, her behavior out of control in school. Her parents, whom she describes as distant socialites, didn’t seem to notice. But then came the wake up call.

Lewis: I overdosed on a bottle of sleeping pills in my high school, in the front lobby, and that was the beginning of what ended up years of long-term confinements in a private psychiatric hospital.

Talya was diagnosed with Borderline Personality Disorder, or BPD. Philadelphia therapist Edie Mannion describes it as a severe and complex mental illness with many symptoms:

Mannion: Difficulty regulating emotion, like a broken emotional thermostat, and difficulty controlling impulses, and what I see as mostly a profound amount of emotional pain.

For people with this disorder, small problems explode into catastrophes, friends become enemies, love turns to hate – often with breath-taking speed. Relationships crumble, jobs rarely last. And their families are along for the ride. Camille Myers describes life with her daughter, who is in her 30s and has BPD.

Myers: You know, at times, she doesn’t want to live, she hates me at times, her world falls apart, at times she’ll walk into a room with my friends and family, and havoc breaks loose.

Myers says relationship with her daughter is an exhausting roller-coaster.

Edie Mannion says the disorder has a bad rap among therapists, and many of the are reluctant to work with those who suffer from it:

Mannion: People were taught that people who have this are manipulative, and split people, and all of these kinds of stereotypes, that make people not want to work with people who have this

A very high suicide risk also scares therapists away. Paradoxically – that’s what attracted the field’s premier researcher to this disorder.  Marsha Linehan of the University of Washington set out to test treatments for highly suicidal patients – and found herself working with borderline patients:

Linehan: They have a ten percent suicide rate, so they are the highest rate of any group that I know, and really they are really incredibly interesting to work with.

Linehan has developed what many hail as the most successful treatment for this disorder.  It’s called Dialectical Behavioral Therapy, and is an intensive, long-term intervention that tries to end the destructive cycle of intense pain and strong reaction.

Linehan: The first thing you have to do is radically accept that you ARE hurt, and be mindful of that emotion, but also, you then have to move to trying to regulate the hurt and regulate actions related to hurt

Patients learn these skills in individual and group sessions, during phone coaching, and the therapists have a strong support system.

Part of the treatment is to teach family members how to de-escalate situations. Camille Meyers has taken the course and gives an example. Recently her daughter asked her for help with directions, but got very angry when Camille printed out maps for her:

Meyers: I don’t want to read maps, I don’t like maps, maps don’t help me!!!!!!!!

Camille remembered not to fan the flames:

Meyers: Previously my reaction would have been okay, I can’t believe you’re telling me this, you asked me to help you, I spent all of this time … if you think they are not going to be helpful to you, I understand, maybe maps don’t work for you

Her daughter has started Dialectical Behavior Therapy, and is doing well so far.

Talya Lewis, meanwhile, says she’s in recovery after many turbulent years. She works as a therapist, helping people understand Borderline:

Lewis: With this disorder I want people to have a wall of compassion, where you protect yourself, but at the same time, you can deal with the person in this kind of ongoing way, and empathetic manner.

She says her disorder didn’t go away, but she works constantly to manage the symptoms.  It is, she admits, exhausting to be her.

By: Maiken Scottmscott@whyy.org

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That dead-eyed anhedonia is but a remora on the ventral flank of the true predator, the Great White Shark of pain. Authorities term this depression clinical depression or involuntary depression or unipolar dysphoria. Instead of just an incapacity for feeling, a deadening of soul, the predator-grade depression Kate Gompert always feels as she Withdraws from secret marijuana is itself a feeling. It goes by many names — anguish, despair, torment, or q.v. Burton’s melancholia or Yevtuschenko’s more authoritative psychotic depression — but Kate Gompert, down in the trenches with the thing itself, knows it simply as It.

It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self’s most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also thoroughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably mostly indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible.

It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain [(the big reason why people in pain are so self-absorbed and unpleasant to be around)], a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one.

The authoritative term psychotic depression makes Kate Gompert feel especially lonely. Specifically the psychotic part. Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who’s being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who’s not being tortured, however, is psychotic, since the outside parties making the diagnosis can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. Thus the loneliness: it’s a closed circuit: the current is both applied and received from within.

The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death suddenly seems more appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who jump from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.

But and so the idea of a person in the grip of It being bound by a ‘Suicide Contract’ some well-meaning Substance-abuse halfway house makes her sign is simply absurd. Because such a contract will constrain such a person only until the exact psychic circumstances that made the contract necessary in the first place assert themselves, invisibly and indescribably. That the well-meaning halfway house Staff does not understand Its overriding terror will only make the depressed resident feel more alone.

See larger image Infinite Jest (Paperback) By (author) David Foster Wallace List Price: $17.99 USD New From: $8.84 In Stock Used from: $8.71 In Stock

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Parents hope to raise awareness of condition that took daughter’s life

Parents hope to raise awareness of condition that took daughter’s life. Sasha Menu-Courey, who took her own life in June after receiving a diagnosis of BPD, spent more than 25 hours per week pursuing her passion for swimming. Her parents will hold a celebration service for her Sunday to honour her life and raise awareness of BPD. Courtesy / Mike Menu

NOEL GRZETIC
July 8, 2011

When a person takes his or her own life, one would imagine it’d be an unbelievable challenge for their loved ones to function under the weight of the tragedy. In the case of Etobians Mike Menu and Lynn Courey, however, they’ve managed the courage to fight back against borderline personality disorder (BPD), the condition that took their daughter away.

The pair have teamed up with Mount Sinai hospital in Toronto to form a foundation to raise funds and awareness of BPD in honour of Sasha Menu-Courey. On Sunday, they will hold a memorial celebrating the life of their 20-year-old daughter at the Etobicoke Olympium, where the avid swimmer spent so many hours.

Popular, intelligent, athletic and creative, friends and family describe Sasha as a well-liked college student who had it all. She was attending the University of Missouri on a swimming scholarship, studying psychology with a minor in sociology. According to her father, she often said swimming was her life, noting in her journal that “her first scent was chlorine.” Sasha spent more than 25 hours per week training, and had a 4.0 academic average to match.

“She was an avid reader – she read for the whole family,” said her mother. Sasha was also a gifted writer who had already been published more than once in a local paper.

This was the Sasha that Lynn and Mike knew when they received a distressed call from her on March 21.

“She said ‘mama and papa don’t worry, I’m just not feeling good right now. I’m going to go to the hospital and talk to someone,’” her mother recalls.

This was not the first time her parents had seen her hit a low. In May 2007, 15-year-old Sasha was in Montreal for swimming and suffered a series of blows: she got an injury, had problems with a roommate and saw the end of a romantic relationship. The intensity of the circumstances was too much – she took a handful of Tylenol and later called an ambulance for herself. After the failed attempt to take her own life, her parents brought her to a Toronto professional but were not offered tangible help.

“They told us she was too young to be labelled with anything, that it was an adolescent scenario that could be worked out through therapy,” said her father. “Now that we know…we think she should have been diagnosed.”

Her parents are convinced that a diagnosis would have allowed them to get her the right type of help.

“[Adolescence] is the time when this disorder appears and affects so many friends, family, people at school. We need to be aware of when it gets intense – it should be a red flag, it shouldn’t be ‘oh well, it’s just a troubled teenager,’” said her father.

The phone call this March came amidst similar circumstances: an injury, a failed relationship and housing problems. This time Sasha was diagnosed with BPD and placed in a campus psychiatric centre for 10 days. She tried to take her life again weeks later.

“We didn’t know what was wrong because she called us 10 days before with the will to live, the will to fix herself. Suddenly all she wanted was to die,” said her mother.

Her parents tried to bring her home but were warned by CAMH of an eight- to 12-month waiting list. So her parents took matters into their own hands. They found a place for her in a community house at McLean Hospital in Boston. At the cost of $50,000 a month, her parents began to see improvements as Sasha followed the course of Dialectical Behavior Therapy (DBT). After two months, her parents could no longer afford the costly treatment and began to speak with Sasha about bringing her home. It proved too much for Sasha, who took an excess of 100 Tylenol and went to sleep. She died later in hospital.

“She was not supposed to die. She had such a bright future,” said her mother. “I want her to be remembered as a great kid – social, that always wanted to help out others.”

The foundation – the Sasha Menu-Courey fund – will be used to fund DBT treatment for other teens in similar situations. Bracelets will be sold on donation at Sunday’s service, and health care professionals from MacLean Hospital will be there to help raise awareness.

Service runs from 5 to 8 p.m. at Etobicoke Olympium, 590 Rathburn Rd., and is open to the public.

Donations can be made to Mount Sinai Hospital Foundation Sasha Menu Courey Fund will at http://www.mshfoundation.ca/fonds-sashamenucourey or call the foundation at 416-586-8203, ext. 3936.

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Missouri swimmer’s suicide might draw attention to disorder

By DAVID BRIGGS
Sunday, July 3, 2011

Sasha Menu Courey loved college life at Missouri.

She was a swimmer with Olympic ambitions but rarely missed a chance to set free a laugh so booming that it seemed to rattle the ceiling of teammates a floor below at Johnston Hall. The sophomore greeted friends — everybody counted as one — as if they were just the person she was hoping to see.

“It was always, ‘Heyyy!’ ” said MU swimmer Caitlin Connor, who met Menu Courey before a home football game their freshman year when she and her roommate from 233 Johnston searched out the source of the bursting cheer in Room 333. “She would talk to you like she had known you her whole life.”

In the classroom, Menu Courey earned a 4.0 GPA her first semester and was already planning for graduate school. The aspiring psychologist had lined up a prestigious internship this summer researching treatment for alcoholism.

“Everything she touched,” said her mother, Lynn Courey, “she was doing great.”

But this spring, Menu Courey fell into the grip of an illness she had kept hidden from the world.

Menu Courey committed suicide June 17 in a suburban Boston hospital. She was 20.

When a series of events one friend described as the “perfect storm” reached a crest, she slipped into a deep depression from which she would never escape.

Menu Courey left the team on March 21. She spent the next 10 days under watch and treatment at the MU Psychiatric Center, where her parents said she was diagnosed with borderline personality disorder, an illness characterized by extreme emotional instability.

Lynn flew in from the family’s Toronto home to be with her daughter when she was released. By then, however, she said she no longer recognized Sasha. Though Sasha often put on a cheerful front to keep friends and family from worrying, she bore an emotional pain too great to endure.

“We have difficulty understanding, as well, what happened,” Lynn said. “My daughter really had a great will to live, and suddenly she had a will to die.”

Now, Menu Courey’s family is celebrating a life that brought joy to so many while searching for answers and striving to raise awareness of a disorder they knew little about until it was too late.

Borderline personality disorder affects 2 percent of adults, according to the National Institute of Mental Health. The illness leads a majority of patients to hurt themselves and about 10 percent to commit suicide. Yet while it is as prevalent as bipolar disorder and more common than schizophrenia, far less research is conducted on BPD, said Dr. Andrew Ekblad, a psychologist at the Centre for Addiction and Mental Health in Toronto. Proper treatment can be difficult to find.

As an organ donor, Menu Courey’s heart has already helped save the life of a 26-year-old man. Her parents hope her story saves more.

¦

Menu Courey was always happiest in the pool, where she thrived most of her life.

Mike Menu remembers being alongside Sasha, the oldest of he and Lynn’s two daughters, for her first big race win. At a 10-and-under provincial competition in Toronto, she pushed past her rivals in the 50-meter breaststroke at the last moment to touch first by the length of a hand.

“It was just an unbelievable moment,” Mike Menu said. “We knew she had something special.”

With broad shoulders and an athletic build, Menu Courey proved a natural sprinter. She was anchoring relays on her club’s 17-and-under team by the time she was 12 and developed into one of Canada’s top youth swimmers. She qualified in six events at the 2008 Canadian National Championships and placed ninth in the 100 individual medley.

“Swimming was her life,” said Mike Menu, a computer consultant in Toronto.

Several colleges in the U.S. showed interest, but signing with Missouri was an easy choice. Menu Courey liked the campus, the coaches and the team, which she knew would include fellow Canadians Lauren Lavigna and Dominique Bouchard.

“I never got the feeling that she wanted to be anywhere else,” said former Missouri Coach Brian Hoffer, who resigned late in the 2010 season.

Though she was ruled ineligible her freshman season because of paperwork issues, Hoffer was impressed by her times in practice. He expected her to contribute on the Tigers’ top relay teams in 2011.

Those plans stalled last summer when Menu Courey suffered a hairline vertebrae fracture and two herniated discs during training. Her parents said the injury got worse, keeping her out of the water for much of last season.

Through the disappointment, Menu Courey remained the same vivacious teammate. Connor said she was a friend who was “so concerned with what was going on in your life.”

The laugh was the same, too.

It came when she tore through a foot of snow last winter wearing only her Missouri swim cap and a sky blue bikini; when she and Connor had only 15 minutes to sprint from English class clear across campus to the athletic training complex for a 2 p.m. weight workout; when she snuck her beloved guinea pig, Maxwell, onto the pool deck one day and set it loose to run along the gutter as her teammates practiced.

“There’s never a time that we saw her pouting,” Connor said.

Menu Courey kept busy last semester with internship applications and a psychology research position. She was “as good of a model as they come,” said Meghan Anderson, an academic coordinator who works with the swim team.

“She was on a roll,” her mother said. “Then things crashed.”

¦

Her parents said Menu Courey felt alone the day she lost control of her life. The stresses had steadily — and quietly — mounted.

The injury affected her more than she revealed, her parents said. Suddenly she was without her compass, the activity that brought her more than 800 miles from home.

Then she was without a home, displaced after her father said a conflict with a new roommate made Menu Courey too uncomfortable to stay at her off-campus residence. Her old roommate, a swimmer, had graduated in December. She spent her final weeks on campus living on teammates’ couches.

When Menu Courey and her boyfriend broke up March 21, she was inconsolable.

“It was the end of her world,” Lynn said.

Menu Courey spent the next 10 days at the MU Psychiatric Center, but her anguish only intensified. The next time Lynn saw her daughter, “all she wanted to do was to die.” Menu Courey attempted to commit suicide two days after she was released, her father said.

Their daughter was sent to a hospital in Kansas City, and Mike and Lynn increasingly learned about borderline personality disorder. Ekblad said BPD is marked by patients’ inability to regulate their emotions. They are prone to extreme mood swings, impulsive behavior and a distorted self-image. Even the smallest perceived slight can lead to acute feelings of rejection.

Those with the illness can lead successful and contented lives with treatment, particularly a system known as Dialectical Behavior Therapy. Yet patients with BPD often face fewer options than others battling mental illness. At some treatment centers in Canada, Ekblad said there is a two-year waiting list for BPD patients to receive intensive inpatient treatment.

Not long ago, a diagnosis of BPD was viewed as a “death sentence,” Dr. Kenneth Silk, a professor at the University of Michigan, wrote in a 2008 issue of the American Journal of Psychiatry. Resources devoted to the illness are only beginning to catch up.

Menu Courey’s parents said the only seeming option was to uproot their lives and enroll their daughter at McLean Hospital in Belmont, Mass., a leader in the treatment of BPD.

The treatment was voluntary, and Menu Courey seemed to be improving. She talked to friends about returning to Missouri, posted messages about her faith on Facebook and was preparing to switch to outpatient treatment in Toronto.

Menu Courey planned to live across the street from Connor next year. They talked every night at 9 when Menu Courey was in Kansas City and weekly when she was in Boston.

“She would put on this front where you couldn’t see” the pain, Connor said. “I don’t think she hid it because she was embarrassed, she just didn’t want anybody to worry about her. … I had it set in my mind that she would come back.”

“That’s what she was aiming towards,” MU Coach Greg Rhodenbaugh said.

Privately, however, Menu Courey struggled with the prospect of leaving Boston. BPD patients often become attached to their treatment. Her journal entries later revealed that she decided the transition to Toronto would be too painful.

Menu Courey’s death devastated her family, including younger sister, Kayla. Yet through the grief came comfort in the overwhelming support that followed. The Menu Courey family will be in town Wednesday for a memorial service at the Newman Center.

“This is when we saw how important she was to a lot of people that we didn’t know,” Lynn said. “If those friends weren’t there, I don’t think we would have been able to survive this. The help has been pouring in, it’s been incredible. Her passing was not in vain.”

A gift gone too soon continues to give. Her family hopes to learn more in the coming weeks about the man who received Menu Courey’s heart. They have started the Sasha Menu Courey Fund to increase awareness of BPD. The fund had already surpassed the goal of $5,000. Donations can be made at www.mshfoundation.ca/fonds-sashamenucourey.

“Too many kids are going through this kind of suffering, and it’s not a reason for them to die,” Lynn said. “With the future Sasha had, she should be alive today.”

Reach David Briggs at dbriggs@columbiatribune.com

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“…BPD is present in about 6% of primary care patients and persons in community-based samples and in 15 to 20% of patients in psychiatric hospitals and outpatient clinics,” writes John G. Gunderson, MD, from the Psychosocial and Personality Research Program, McLean Hospital in Belmont, Massachusetts. “Patients with BPD usually enter treatment facilities after suicide attempts or after episodes of deliberate self-injury. Such episodes result in an average hospital stay of 6.3 days per year and nearly 1 emergency room visit every 2 years, rates that are 6 to 12 times those among patients with a major depressive disorder.”

As you can see BPD has a major financial impact on the health care system, not to mention the distress for the patients and their families.

When reviewing the various treatment options, the author says this about mentalization therapy:

Mentalization-based therapy is a cognitive or psychodynamic therapy including individual as well as group therapy. While assuming a “not-knowing” stance, the therapist insists that the patient “mentalize,” or examine and label his or her own experiences and those of others. This emphasis on thinking before reacting may be a process central to all effective therapies.

That “not-knowing” stance is what I tell the nons that I know: Be a detective, not a judge.

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In my group recently, a non-BPD was questioning his own “sanity” (I put it in quotes because I don’t believe that people with BPD are insane) and speculating that he was the one with BPD. One of our longer-time posters replied:

If you’re not throwing full-blown temper tantrums, freaking out because EVERYONE is out to get you, threatening to hurt or kill yourself, running away from those who love you because you’re afraid they’re going to leave you first, complaining that NOBODY loves or respects you AND popping pills and guzzling alcohol all at the same time… then, I think, you can go ahead and disqualify yourself.

Based on the polls that I have conducted over the past few months, I believe that she is right on the money. Here are the poll results from the last few polls about borderline behavior:

Borderline Behavior Poll Results

As you can see by these polls results, more than 73% responded that their borderlines (or themselves if they have the disorder) indicated that they have engaged in self-injury, suicide attempts and/or substance abuse. While these polls are certainly not scientific and it’s pretty much impossible for me to understand the profile of a person that responded, they results are, for me, striking. If 7 out of 10 (or more) individuals engage in these “low functioning” or ineffective borderline behaviors at some point in their lives, what should that tell us?

I believe that it tells us that the “typical” profile of someone with BPD is the “low functioning” or “classic” borderline. While I am sure there are others out there that operate in pretend mode (and pretend everything is ok while they “white-knuckle” their way through life), the vast majority of people with BPD seem to be caught in a spiral of ineffective and often dangerous behavior. They seem to me to be sending the message that they are in a great deal of emotional pain and are suffering greatly – that they will do anything to stop the pain that they feel. It also indicates to me that it is vital for parents of child with borderline-like traits and feelings do their best to get the child into appropriate treatment before their teenage years.

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Stacy on the label Borderline Personality Disorder:

When I first heard of BPD, it was in a magazine article given to me by a college roommate.  That was back in the early ’90s, and the article said BPD couldn’t be cured, so I either had to resign myself to being crazy forever or dismiss the diagnosis as a way of marginalizing women who refused to be meek and subservient.

My initial reservations about the diagnosis, with which I continued to struggle until I found DBT and, therefore, hope, centered around the question of whether you could diagnose any strange, artistic, outspoken girl with the disorder.  I had a lot of legitimate anger over growing up marginalized, and I had a hard time separating that anger from the maladaptive rages that derailed my life for so many years.

Meeting my DBT therapist and reading Marsha Linehan’s work helped me make peace with the diagnosis and to see it as valid.  When I read the DSM criteria and realized I was nine for nine, I had to admit there was some truth there.  It really was like seeing an outline of my life.  By that point, I wanted so desperately to get better, to build a life not punctuated by constant bingeing and purging and starving and suicide attempts, that I was willing to call my illness whatever I had to call it to get treatment.

As for what borderline means to me today, it is an accurate description of a disorder from which I feel mostly recovered.  I encourage anyone who feels the diagnostic criteria ring true to pursue an official diagnosis and seek out the treatment for which they qualify.

Stacy on relationships as triggers (a study by Dr. Paul Links showed that relationship events are the #1 most important trigger for borderlines):

Relationships were my primary triggers. I wanted so desperately to be loved, validated and saved from my loneliness that I latched onto a string of partners who showed intense initial interest, and I promptly scared them off with the depth of my neediness.

I also had a propensity for seeking out emotionally abusive or withholding lovers. Relationship after relationship ended in emotional flameouts and trips to the emergency room for overdoses. When I entered DBT, I realized this was something I had in common with most of the other women in my treatment program, and I was able to let go of some of the shame I felt about it. Learning that this particular brand of self-destruction was a hallmark of my disorder gave me hope that I could use my DBT skills to avoid forming unhealthy attachments in the future.

Stacy on DBT (and mood stabilizers):

It’s a totally different world!  Life before DBT seemed hopeless, and now it seems exciting and full of possibility.  I trust myself to navigate the storms of day-to-day existence.  Thanks to the DBT distress tolerance and emotion regulation skills, I even weathered a breakup without a suicide attempt, and know that if I ever see my ex again I can hold my head up and feel no shame or guilt over my behavior. I’m really proud of that.

The mood stabilizer Lamictal has also been a godsend.  My moods now swing between happy and sad, not ECSTATIC and SUICIDAL.  Needless to say, I’m a fan.

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Teens with eating disorders more likely to harbor thoughts of suicide, study finds

By Amina Khan, Los Angeles Times

7:21 AM PST, March 8, 2011

Teens suffering from anorexia, bulimia and other eating disorders are more likely to suffer from suicidal thoughts, anxiety disorders and substance abuse — but how much they suffer may depend on the type of eating disorder they have.

That’s according to an analysis published online Monday in the Archives of General Psychiatry that, with 10,123 adolescents surveyed, is the largest and most comprehensive study of eating disorders in teens in the United States.

About 0.3% of the teens surveyed reported suffering from anorexia nervosa, and 0.9% from bulimia nervosa. A full 1.6% suffered from binge-eating disorder. Ethnic minorities were more likely to report binge-eating disorder, and white teens tended more toward anorexia.

Those who had one of these three eating disorders often suffered from other issues as well. For example, those who were anorexic were 1.6 times more likely to have problems with alcohol – but bulimics were 3.1 times as likely, the study found.

As for phobias, people with anorexia were 1.8 times more likely to suffer from a social phobia. Those with bulimia were at 3.9 times the risk, but even that jump was dwarfed by those with binge-eating issues, who were 5.9 times as likely to suffer a social phobia.

Sound scary? It could be worse than we think: The researchers write in the paper that some of these numbers may actually be “a lower bound of the true prevalence of eating disorders.”

Follow me on Twitter @LAT_aminakhan.

Copyright © 2011, Los Angeles Times

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Suicide Attempts Poll

Here are the results with the “Don’t Know” choice removed:

Suicide Poll with Don't Know Removed

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Poisoned Love

I thought it was interesting that she was going to commit suicide with the pills and then impulsively used them to poison the man.

Stockton woman drugged boyfriend’s booze
Dec 14 2010 by Gareth Lightfoot, Evening Gazette

A VULNERABLE woman who spiked her older boyfriend’s drink with a potentially lethal dose of 16 sleeping tablets has been spared prison.

Lyndsey Cook poisoned her partner’s beer with 800g of amitriptylene, which is used as a sleeping tablet, at a mutual friend’s Stockton home after a day’s heavy drinking.

She later admitted slipping him the pills wanting to sever contact with him as he was “doing her head in”, Teesside Crown Court heard.

Prosecutor Anthony Dunne said her boyfriend Phillip Ross, 34, collapsed shortly after drinking a very fizzy can of lager on March 6.

Cook called the ambulance and Mr Ross was treated in hospital on the assumption of an opiate overdose.

The truth emerged the next day as 20-year-old Cook confessed to her church support worker then to police as she handed herself in.

Cook, of Grange Road, Stockton, said she stole the drugs from her gran to take them herself, but impulsively put them into Mr Ross’s drink.

With no previous convictions, she admitted a charge of administering poison or a noxious substance “with intent to injure, aggrieve or annoy”.

A forensic scientist said the dose was “of severe toxicity”, leaving amounts of the drug in Mr Ross’s bloodstream two days later.

A lower amount had been known to kill, the court was told yesterday.

Graham Brown, defending, said Cook was vulnerable, disadvantaged, severely emotionally damaged and of low intelligence with a borderline personality disorder.

He said it was an unplanned, “spur-of-the-moment act of stupidity” when she was depressed and thinking of using the tablets to kill herself.

He talked of a background of an “abusive relationship” with Mr Ross “from a time and an age when such a relationship was not appropriate”.

Now Cook had the support of people who had given her a controlled environment and her life had moved on.

Judge George Moorhouse said the crime justified an eight-month custodial sentence, but suspended it for two years with supervision.

He told Cook: “I accept that this was not a premeditated offence and I accept that you stole these pills from your grandma with the intention of taking your own life.

“You’ve had at times a horrible life through no fault of your own,” he added, expressing the hope that she could get her life back to normal with support.

Read More http://www.gazettelive.co.uk/news/teesside-news/2010/12/14/woman-drugged-boyfriend-s-booze-84229-27822538/#ixzz18Ib1n2I1

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Failure of system spirals into family tragedy

George and Alice Schellenberg took it as good news when their daughter Laura, just out of high school, coming off a nervous breakdown, was diagnosed with borderline personality disorder.

Borderline. How bad could that be?

Over the next 17 years, the Saanich couple found out.

It was hell. Laura began doing things totally out of character — she shoplifted, got angry, shaved her head twice, began cutting herself, then tattooed the lacerations on her arms.

On and on. She worked as a hairdresser and had a doting partner, but the internal demons were always there to pull her down. Obsessive compulsive disorder and severe depression piled on. She wouldn’t open her mail. Wouldn’t pay bills. Wouldn’t answer the phone. She could be anxious, unresponsive, violent. Doctors just increased her medication.

Her parents desperately tried to get her help, but there was always a barrier, a box that couldn’t be ticked, to prevent her from getting into a program or facility. “There was always something that didn’t fit,” George says. Most of the time, the system would spit her back out, so it fell to her parents to pick up the pieces on their own.

Desperate for advice from the professionals, they got none. Indeed, privacy laws prevented mental-health workers from bringing George and Alice into the loop. “Nobody ever told us how we could help,” he says.

Laura’s disease would sometimes lead her to sabotage her own life when things were going too well. One day in February 2008, thinking it might get her admitted to a hospital where a “new doctor” would help her with her obsessive thoughts, she started a small fire in her living room. Instead, she got done for arson and was locked away. “That was the beginning of the spiral with the corrections system,” George says.

In November 2008, her obsessive compulsive disorder sent her to her now ex-partner’s home in Duncan, a breach of her probation. Charged with assault, she was incarcerated in the Surrey Pretrial Services Centre, even though everyone — cops, lawyers, health professionals — agreed that kind of confinement was the worst thing for her. Laura got depressed, wouldn’t eat or wash and ended up in solitary for much of the four months she spent awaiting trial. Her parents’ pleas that she needed to be in a psychiatric hospital with ongoing treatment fell on deaf ears. Laura lost 100 pounds.

On April 7, she went to court, where the court-appointed psychiatrist suggested federal time — two years plus — so that she could get better mental-health treatment not available at the provincial system. The judge agreed.

Laura’s lawyer and parents were aghast at the idea of her being locked up for that long. Fine, said the judge, your option is to take her yourself: 18 months of home arrest, with Laura not even allowed out for a walk around the block.

Stuck in their home, she sank further into depression. On Easter weekend, after she asked for a gun with which to kill herself, Laura’s parents took her to the Archie Courtnall Centre.

They wanted her admitted to the Eric Martin Pavilion, but getting a bed there was impossible. “I think it would have been easier for me to get an appointment to meet the pope,” George said. Instead, Laura was held for three days. Then her parents were told to come get her, the alternative being the cops hauling her to prison.

So they brought her home, well aware of how ill-equipped they were to care for their own troubled daughter.

A week later, on April 19, 2009, Laura Schellenberg finally gave up. She hanged herself in the family home. She was 34 years old.

Over a year later, the Schellenbergs’ despair and frustration remain. Politicians might boast of $1.2 billion in mental-health funding, but it did nothing for them or their daughter.

“The judicial and mental-health systems don’t converse,” says Alice. “They don’t know what to do with these people,” says George. “It is no use throwing good money after bad if the system is dysfunctional.”

As the Schellenbergs say this in the living room of their Broadmead home, another couple sits and listens, heads nodding at the familiar tale. So much of what is said about Laura could be said of their own son, still desperate for treatment. The couple, who contacted the Schellenbergs after reading a letter they wrote to the Times Colonist, say the system lacks co-ordination, empathy and understanding.

It’s people like them whom the Schellenbergs want to help now.

“We are committed to trying to help make a difference,” Laura’s parents wrote this week. “Too late for our dear daughter but not for many others if there is a collective political and personal will.”

jknox@tc.canwest.com
© Copyright (c) The Victoria Times Colonist

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May 13, 2010

Online Talk, Suicides and a Thorny Court Case

By MONICA DAVEY

The seemingly empathetic nurse struck up conversations over the Internet with people who were pondering suicide. She told them what methods worked best. She told some that it was all right to let go, that they would be better in heaven, and entered into suicide pacts with others.

But the police say the nurse, who sometimes called herself Cami and described herself as a young woman, was actually William F. Melchert-Dinkel, a 47-year-old husband and father from Faribault, Minn., who now stands charged with two counts of aiding suicide.

Mr. Melchert-Dinkel, whose lawyer declined an interview request on his behalf, told investigators that his interest in “death and suicide could be considered an obsession,” court documents say, and that he sought the “thrill of the chase.” While the charges stem from two deaths — one in Britain in 2005 and one in Canada in 2008 — Mr. Melchert-Dinkel, who was indeed a licensed practical nurse, told investigators that he had most likely encouraged dozens of people to kill themselves, court documents said. He said he could not be sure how many had succeeded.

The case, chilling and ghoulish, raises thorny issues in the Internet age, both legal and otherwise. For instance, many states have laws barring assisting suicide, but rarely have cases involved people not in the same room (much less the same country) or the sharing of only words (not guns or pills).

The case also brings up questions about the limits of speech on the Internet: How does one assign levels of culpability to someone who shares thoughts with people who say they are already considering suicide? And for some who counsel against suicide, it points to a growing area for worry, an online world where the most isolated and vulnerable might be touched in a way that they would not have in the past.

Groups that work to prevent suicide compare suicide chat rooms to “pro-ana” sites, Internet sites that portray anorexia as a lifestyle as opposed to a disease. Anti-suicide advocates say that there has been more than one instance recently where a person killed himself on a Webcam as others watched. Papyrus, a charity in Britain that works to stop young people from killing themselves, says it has tracked 39 cases in that country alone where young people committed suicide after visits to “pro-suicide” chat rooms.

It was the untrained, unpaid Internet sleuthing by Celia Blay, a 65-year-old from a tiny community in Britain, that helped lead to charges in April against Mr. Melchert-Dinkel. “He was practically invisible,” she said. “I tried to talk to any police I could, and most of them would have nothing to do with it. The first one I talked to told me, ‘If it bothers you, look the other way.’ And that really bothered me, because by then I was pretty sure people had died.”

About four years ago, Ms. Blay, who describes herself as a “computer illiterate,” became friends online with a young, depressed woman who had entered into a suicide pact. Ms. Blay persuaded her not to proceed, but the incident sent Ms. Blay searching for the other member of the pact. It was someone who called herself Li Dao, another screen name that the police later said Mr. Melchert-Dinkel used.

Making inquiries on a Web site aimed at people talking about suicide, Ms. Blay said she found at least half a dozen people who had similar pacts with Li Dao, a name that popped up on all sorts of suicide Web sites. She and a friend uncovered Mr. Melchert-Dinkel’s name and e-mail address after setting up a sting in which her friend posed as someone preparing for suicide and was, she said, approached by Mr. Melchert-Dinkel.

By then, the police in Minnesota say, Mr. Melchert-Dinkel had already aided the suicide of Mark Drybrough, 32, of Coventry, England. A coroner’s report found that Mr. Drybrough, who was suffering from a psychiatric illness, hanged himself from a ladder in his home in July 2005. His computer showed that he had posted a question in a suicide chat room about how to hang oneself without access to something high to tie a rope to, and that Li Dao — Mr. Melchert-Dinkel, the police say — had offered details on how to use a door.

In March 2008, Nadia Kajouji, 18, disappeared from her college in Ottawa. The Canadian authorities investigating her disappearance searched her laptop and discovered that she had been talking online with a person who used the screen name Cami. In e-mail messages, the authorities say, the pair agreed to a pact in which Ms. Kajouji would jump from a bridge into a river (to avoid, at Cami’s suggestion, the police say, creating a mess) and Cami would hang herself a day later. In April 2008, Ms. Kajouji’s body was found in the Rideau River.

Around the same time, Ms. Blay contacted the St. Paul Police Department through an acquaintance in Minnesota. By then, she said, she had grown frustrated with what she described as the authorities’ unwillingness to study the huge file she had amassed with the stories of 20 to 30 people who had been approached online. Over time, she said, she had tried to tell the story to a police department near her home, a member of parliament and even law enforcement in the United States.

Since at least the 1970s, many states have barred assisted suicide, though criminal charges are rarely filed. Physician-assisted suicide is allowed under certain conditions in Oregon and Washington.

In Minnesota, 12 charges of aiding suicide have been brought since 1994, when the state began keeping track, and about half of those have resulted in convictions. That state’s law, a felony, applies to “whoever intentionally advises, encourages or assists” another in taking his or her own life; convictions carry sentences of up to 15 years in prison.

Barbara Coombs Lee, the president of Compassion and Choices, who has advocated for laws like the one in Oregon, said she found it “perfectly appropriate” that Mr. Melchert-Dinkel faces such charges. “This is so egregious, so clearly wrong, that I’ll be very disappointed if assisted-suicide statutes do not reach this,” she said. “There is a bright line between aid in dying and assisting in suicide like this.”

Still, legal experts suggested that there may be room for challenges. The Minnesota law itself, some suggested, could be seen as too ambiguous or too broad to include protected speech that falls short of actually leading someone to suicide. The deaths occurred in other jurisdictions, posing potential issues, other lawyers said.

Terry A. Watkins, a lawyer for Mr. Melchert-Dinkel, said it was premature to describe what defense he intends to present but made it clear that he had questions about the law itself, as well as the dissection of causes that lead to any suicide. “As a society, we need to be careful when we start putting together laws that prohibit things like ‘encouragement’ without a really clear definition of what in God’s name you’re talking about,” he said.

Mr. Melchert-Dinkel, who is scheduled to be arraigned on May 25 in Rice County District Court, has had his nursing license revoked. He had held it since 1991, despite a record that included repeated discipline for complaints of leaving a nursing home patient unattended, being too rough, sleeping on duty, failing to take vital signs and failing to track a patient’s medications.

But Mr. Watkins said his client was basically a good person. “This is not a monster,” he said.

Shortly after the police interviewed Mr. Melchert-Dinkel last year, he checked into a local emergency room, state records show, saying that he was dealing with an addiction to suicide Internet sites and feeling guilty over advice he had given to people to end their lives.

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Are you and your BP on the same team?

When someone is highly emotional, they need to know that they have an advocate and that someone is on “their side.” I often ask my consulting clients (especially partners of people with emotional regulation issues) if they feel that their partner and they are “on the same team.” Many times the answer is no. Why does someone have a desire to have someone on their side, even when the “sides” are not desired, intended or even clearly delineated? The answer in my mind comes down to shame and rejection sensitivity.

If a person has shame (or even low self-worth, which is similar), then the person is likely to have a high level of rejection sensitivity. Being rejected by others is painful, especially for emotional people. Having an advocate of their “side” of the issue, which is essentially answering, “I am on your side no matter what the situation,” is tantamount in these highly emotional, social interactions that involve rejection. One can be “on their side” emotionally without condoning whatever behavior that one doesn’t agree with.

There are teaching moments and there are times that one doesn’t teach. If you try and teach, punish or impart values during a period of emotional dysregulation, the relationship will be damaged and nothing effective will be accomplished. Instead, emotional validation and support can be used to cool the bonfire. Once it is cool, then a teaching moment can present itself.

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Chantix, Zyban must carry depression warning

FDA warns: Depression and Suicidal Thoughts caused by Chantix

NEW YORK – The Food and Drug Administration will require two smoking-cessation drugs, Chantix and Zyban, to carry the agency’s strongest safety warning over side effects including depression and suicidal thoughts.

The new requirement, called a “Black Box” warning, is based on reports of people experiencing unusual changes in behavior, becoming depressed, or having suicidal thoughts while taking the drugs.

The antidepressant Wellbutrin, which has the same active ingredient as GlaxoSmithKline PLC’s Zyban, already carries such a warning.

The FDA is also requiring an additional study on Chantix and Zyban to determine the extent of the side effects. Pfizer Inc., which makes Chantix, said it is still discussing the potential study design with the FDA. The study could include patients with and without psychiatric conditions to determine the true incidence rate of psychological side effects, Pfizer officials said.

Pfizer had already updated its labeling following the beginning of an FDA investigation into the potential side effects in 2007. That investigation was sparked by several reports of psychiatric problems in patients.

Despite the new, stricter warnings, the FDA said consumers and doctors still have to weigh the benefit versus the risks when taking the drug.

“The risk of serious adverse events while taking these products must be weighed against the significant health benefits of quitting smoking,” said Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research. “Smoking is the leading cause of preventable disease, disability, and death in the United States and we know these products are effective aids in helping people quit.”

Last fall, the FDA also began looking into scores of patient reports about blackouts and injuries while taking Chantix. The Federal Aviation Administration later banned use of Chantix by pilots and air traffic controllers. The drug’s label also warns that patients may be too impaired to drive or operate heavy machinery.

Chantix was approved in 2006. Sales reached $846 million in 2008.

“The labeling update underscores the important role of health care providers in treating smokers attempting to quit and provides specific information about Chantix and instructions that physicians and patients should follow closely,” said Dr. Briggs W. Morrison, senior vice president of the primary care development group at Pfizer.

Pfizer said it made the revised label warnings in agreement with the FDA and is immediately making the information available to health care providers and patients.

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Isolation

Mother I tried please belief me
I’m doing the best that I can
I’m ashamed of the things I’ve been put through
I’m ashamed of the person I am
Isolation, isolation, isolation

New Dawn Fades

Different colours, different shades
Over each mistakes were made
I took the blame
Directionless so plain to see
A loaded gun won’t set you free
So you say

Passover

Forgive and forget’s what they teach
Or pass through the desserts and wastelands once more
And watch as they drop by the beach
This is the crisis I knew had to come
Destroying the balance I’d kept
Turning around to the next set of lives
Wondering what will come next.

Atmosphere

Your confusion
My illusion
Worn like a mask of self-hate
Confronts and then dies
Don’t walk away

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Thursday, Jan. 08, 2009

Minds on The Edge

By John Cloud/Seattle

Doctors used to have poetic names for diseases. A physician would speak of consumption because the illness seemed to eat you from within. Now we just use the name of the bacterium that causes the illness: tuberculosis. Psychology, though, remains a profession practiced partly as science and partly as linguistic art.

Because our knowledge of the mind’s afflictions remains so limited, psychologists–even when writing in academic publications–still deploy metaphors to understand difficult disorders. And possibly the most difficult of all to fathom–and thus one of the most creatively named–is the mysterious-sounding borderline personality disorder (BPD). University of Washington psychologist Marsha Linehan, one of the world’s leading experts on BPD, describes it this way: “Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”

Borderlines are the patients psychologists fear most. As many as 75% hurt themselves, and approximately 10% commit suicide–an extraordinarily high suicide rate (by comparison, the suicide rate for mood disorders is about 6%). Borderline patients seem to have no internal governor; they are capable of deep love and profound rage almost simultaneously. They are powerfully connected to the people close to them and terrified by the possibility of losing them–yet attack those people so unexpectedly that they often ensure the very abandonment they fear. When they want to hold, they claw instead. Many therapists have no clue how to treat borderlines. And yet diagnosis of the condition appears to be on the rise.

A 2008 study of nearly 35,000 adults in the Journal of Clinical Psychiatry found that 5.9%–which would translate into 18 million Americans–had been given a BPD diagnosis. As recently as 2000, the American Psychiatric Association believed that only 2% had BPD. (In contrast, clinicians diagnose bipolar disorder and schizophrenia in about 1% of the population.) BPD has long been regarded as an illness disproportionately affecting women, but the latest research shows no difference in prevalence rates for men and women. Regardless of gender, people in their 20s are at higher risk for BPD than those older or younger.

What defines borderline personality disorder–and makes it so explosive–is the sufferers’ inability to calibrate their feelings and behavior. When faced with an event that makes them depressed or angry, they often become inconsolable or enraged. Such problems may be exacerbated by impulsive behaviors: overeating or substance abuse; suicide attempts; intentional self-injury. (The methods of self-harm that borderlines choose can be gruesomely creative. One psychologist told me of a woman who used fingernail clippers to pull off slivers of her skin.”

No one knows exactly what causes BPD, but the familiar nature-nurture combination of genetic and environmental misfortune is the likely culprit. Linehan has found that some borderline individuals come from homes where they were abused, some from stifling families in which children were told to go to their room if they had to cry, and some from normal families that buckled under the stress of an economic or health-care crisis and failed to provide kids with adequate validation and emotional coaching. “The child does not learn how to understand, label, regulate or tolerate emotional responses, and instead learns to oscillate between emotional inhibition and extreme emotional lability,” Linehan and her colleagues write in a paper to be published in a leading journal, Psychological Bulletin.

Those with borderline disorder usually appear as criminals in the media. In the past decade, hundreds of stories in major newspapers have recounted violent crimes committed by those said to have the disorder. A typical example from last year was the lurid tale of an Ontario man labeled borderline who used a screwdriver to gouge out his wife’s right eye. (She lived; he got 14 years.”

There are several theories about why the number of borderline diagnoses may be rising. A parsimonious explanation is that because of advances in treating common mood problems like short-term depression, more health-care resources are available to identify difficult disorders like BPD. Another explanation is hopeful: BPD treatment has improved dramatically in the past few years. Until recently, a diagnosis of borderline personality disorder was seen as a “death sentence,” as Dr. Kenneth Silk of the University of Michigan wrote in the April 2008 issue of the American Journal of Psychiatry. Clinicians often avoided naming the illness and instead told patients they had a less stigmatizing disorder.

Therapeutic advances have changed the landscape. Since 1991, as Dr. Joel Paris points out in his 2008 book, Treatment of Borderline Personality Disorder, researchers have conducted at least 17 randomized trials of various psychotherapies for borderline illness, and most have shown encouraging results. According to a big Harvard project called the McLean Study of Adult Development, 88% of those who received a diagnosis of BPD no longer meet the criteria for the disorder a decade after starting treatment. Most show some improvement within a year.

Still, the rise in borderline diagnoses may illustrate something about our particular historical moment. Culturally speaking, every age has its signature crack-up illness. In the 1950s, an era of postwar trauma, nuclear fear and the self-medicating three-martini lunch, it was anxiety. (In 1956, 1 in 50 Americans was regularly taking mood-numbing tranquilizers like Miltown–a chemical blunderbuss compared with today’s sleep aids and antianxiety meds.) During the ’60s and ’70s, an age of suspicion and Watergate, schizophrenics of the One Flew Over the Cuckoo’s Nest sort captured the imagination–mental patients as paranoid heroes. Many mental institutions were emptied at the end of this period. In the ’90s, after serotonin-manipulating drugs were released and so many patients were listening to Prozac, thousands of news stories suggested, incorrectly, that the problem of chronic depression had been finally solved. Whether driven by scary headlines, popular movies or just pharmacological faddishness, the decade and the disorder do tend to find each other.

So, is borderline the illness of our age? When so many of us are clawing to keep homes and paychecks, might we have become more sensitized to other kinds of desperation? In a world so uncertain, maybe it’s natural to lose one’s emotional skin. It’s too soon to tell if that’s the case, but BPD does have at least one thing in common with the recession. As Dr. Allen Frances, a former chair of the Duke psychiatry department, has written, “Everyone talks about [BPD], but it usually seems that no one knows quite what to do about it.”

Inside the Mind

To have coffee with Lily (a pseudonym), you wouldn’t get much sense of how she has suffered. She is 40 but could pass for 30. She has blue eyes and long blond hair that falls across her shoulders in slightly curly tendrils. On the December day we met at a diner outside Seattle, she wore a pink wool cap pulled down tight and an Adidas jumper zipped all the way. She was friendly but not terribly expressive, and she carried an aura of self-protection.

At one point in the late ’90s, Lily was taking five drugs that doctors had prescribed: three antidepressants, an antianxiety medication and a sleeping pill. Borderline patients are often overmedicated–partly because therapists see them as difficult–but for Lily, as for most borderlines, the meds did little. “Drug treatment for BPD is much less impressive than most people think,” Paris writes in Treatment of Borderline Personality Disorder.

As a teenager, Lily felt little self-confidence. “Junior high and high school just sucks, right?” she said, laughing. “But I had a propensity to take it a little more seriously.” With the help of therapy, she made it through high school and college, but in her late 20s, she became dissatisfied with her job selling specialty equipment. One October day, as she headed out for a mountain-biking trip, she looked at the dun sky and had the feeling that something was wrong. Bleakness massed around her quickly, much faster than it had when she was younger. Soon, nothing gave Lily much joy.

She recalled a talk show in which girls had discussed cutting themselves as a release, a way to relieve depression. “I was so numb,” she said. “I just wanted to feel something–anything.” So she took a knife from the kitchen and cut deeply into her left arm.

If Lily had a hard time figuring out what was behind such dark emotions, she was in good company. When a psychoanalyst named Adolph Stern coined the term borderline in the 1930s, borderline patients were said to be those between Freud’s two big clusters: psychosis and neurosis. Borderlines, Stern wrote rather poetically, exhibit “psychic bleeding–paralysis in the face of crises.” Later, in the 1940s, Dr. Helene Deutsch said borderlines experience “inner emptiness, which the patient seeks to remedy by attaching himself or herself to one after another social or religious group.” By 1968, when Basic Books published the groundbreaking monograph The Borderline Syndrome, the No. 1 characteristic of borderline patients was said to be, simply, anger.

Eventually, borderlines became pretty much anything a therapist said they were. Says Dr. Kenneth Duckworth, medical director of the National Alliance on Mental Illness: “If you hated the patient–if the patient was pissing you off–you would bandy this term about: ‘Oh, you’re just a borderline.’ It was a diagnosis that was a wastebasket of hostility.”

It was Linehan who changed all that. In the early 1990s, she became the first researcher to conduct a randomized study on the treatment of borderline personality disorder. The trial–which showed that a treatment she created called “dialectical behavior therapy” significantly reduced borderlines’ tendency to hurt themselves as well as the number of days they spent as inpatients–astonished a field that had come to see borderlines as hopeless.

Dialectical behavior therapy is so named because at its heart lies the requirement that both patients and therapists find synthesis in various contradictions, or dialectics. For instance, therapists must accept patients just as they are (angry, confrontational, hurting) within the context of trying to teach them how to change. Patients must end the borderline propensity for black-and-white thinking, while realizing that some behaviors are right and some are simply wrong. “The patient’s first dilemma,” Linehan wrote in her 558-page masterwork, 1993′s Cognitive-Behavioral Treatment of Borderline Personality Disorder, “has to do with whom to blame for her predicament. Is she evil, the cause of her own troubles? Or, are other people in the environment or fate to blame? … Is the patient really vulnerable and unable to control her own behavior …? Or is she bad, able to control her reactions but unwilling to do so …? What the borderline individual seems unable to do is to hold both of these contradictory positions in mind.”

Linehan’s achievement was to realize that borderlines are, in fact, on the border between various dualities–dualities that they have to learn to accept and reconcile in order to change their lives. That’s easy to say but seems impossible to do–until you see it work.

A Life Redeemed

After she cut herself, Lily was horrified. In a panic, she called her father, who took her to the hospital. When she was released, she and her parents redoubled their efforts to find her good psychiatric treatment. Through a friend at the University of Washington, they heard about Linehan and contacted her Behavioral Research & Therapy Clinics, which are housed in a homey little annex on the UW campus, where you might find little foil-wrapped chocolates next to the coffee and tea.

Linehan, who grew up in Tulsa, Okla., and spent several years as a nun before becoming a psychologist, embodies several dialectical contradictions: a nun who has never lived in a convent; a careful scientist whose most engaging feature is her wry irreverence; a 65-year-old who has a maternal steeliness but was never a mother. It doesn’t pay to underestimate Marsha Linehan. In Cognitive-Behavioral Therapy for Borderline Personality Disorder, she writes, “If the patient says, ‘I am going to kill myself,’ the therapist might reply, ‘I thought you agreed not to drop out of therapy.’”

In one intense session a few years ago, a patient told Linehan that her work stress was going to lead her to suicide. The patient said Linehan could never understand this stress because she was a successful psychologist. Suicidal borderline patients often confront and alienate therapists in this fashion; for many years, this kind of confrontation was seen as a defining characteristic of the disorder. Linehan believes that borderlines are hurting, not manipulating, but that doesn’t mean she indulges them. In this particular confrontation, Linehan responded, “I do understand. I live with a similar amount of stress … You can just imagine how stressful it is for me to have a patient constantly threatening to kill herself. Both of us have to worry about being fired!”

Such in-your-face tactics were highly controversial when Linehan started out. Other mental-health professionals accused her in public meetings of being heartless, even unethical. But her therapy has saved so many lives and worked so well in randomized trials that few criticize her today. For Lily, who calls Linehan’s therapy “Zen philosophy meets tough love,” Linehan was the first therapist to understand that managing Lily’s illness would require Lily to take a new kind of responsibility–a willingness to grow the emotional skin she never had.

In the beginning, Lily resisted Linehan’s assistance. She felt no one could truly understand the depths of her pain. But Linehan was the first therapist who responded to Lily with more than just endless psychoanalysis and pills. Instead, Linehan taught her practical methods of getting by day-to-day. Once, just after she started with Linehan, Lily locked herself in her parents’ bathroom and swallowed six or seven antidepressants in a half-hearted suicide attempt. Her father broke the door down; her mother called the police. Lily never lost consciousness, but the cops said she had to go to the hospital anyway. Linehan advised Lily’s parents not to accompany her. She also told them they needed to get Lily to work the next day. Lily learned that she wouldn’t be cosseted.

Linehan also taught Lily various skills to regulate her emotions. Among the most important is one Linehan calls the “wise mind”–a kind of calm, Zen state that Linehan insists even the most debilitated patients can achieve. “Generally,” she writes, “I have patients follow their breath … and try to let their focus settle into their physical center, at the bottom of their inhalation. That very centered point is wise mind.” Lily remembers this sensation clearly; she came to feel that her dark moods had a physical location in her body–her solar plexus–and when she focused on it, she could deactivate a destructive emotion.

Another skill Linehan taught Lily (and many others, via a popular DVD called Opposite Action) was an anti-anger technique for social situations: “Don’t make the situation worse,” Linehan counsels on the DVD. “And if possible, be a little tiny bit on the kind side. O.K.?”

If some of this sounds like advice you heard in kindergarten, it should. Remember that borderlines have never learned to regulate their emotions. It’s important to note that Linehan doesn’t just practice tough love with her patients; she also tells them she knows they are hurting and doing the best they can. She emphasizes that she believes in them even though many therapists have tossed them aside. “Clients cannot fail,” she says. “But both treatment and a therapist can fail.” Both compassion and irreverence, both validation and tough love–these are the dialectics at the heart of Linehan’s approach.

One criticism of Linehan’s Zen-derived method is that for some patients, it seems too foreign, too removed from Western experience. Linehan knows her therapy works for most people, but that doesn’t mean she’s unwilling to list its faults. “It takes too long. There are too many components. It takes too much training for therapists,” she says.

Such shortcomings have not dissuaded other therapists from learning Linehan’s techniques. Some 10,000 of them have been trained in dialectical behavior therapy, and Linehan, to her dismay, has become something of a cult figure. “Cults in psychology hurt patients,” she says. “People should try whatever works, not my therapy because it has my name on it.”

Lily, for one, is glad that it’s the therapy she did try. One of her favorite films used to be James Mangold’s 1999 adaptation of Girl, Interrupted, in which Winona Ryder plays a real-life borderline author. When Ryder’s character learns she has received a diagnosis of borderline personality disorder, she indignantly asks, “Borderline between what and what?” It’s a question that weighed on Lily for years and one that many of us may start asking if borderline diagnoses continue to increase. But today Lily is able to laugh about the film because she knows, finally, that the answer doesn’t really matter. The key is not defining that uncertain borderline but learning to be happy there.

Related posts:

1. Time to Give Angelina Jolie a more detailed possible BPD analysis
2. Article about bipolar depression that mentions BPD
3. Holy Moly! An article about the girl who doused her face in acid that actually gets it!

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Newsday.com

Mindy McCready in hospital after another suicide try

BY ROBERT KAHN

December 18, 2008

Anguished country crooner Mindy McCready has been hospitalized after what appears to be her second suicide attempt this year.

McCready, who was treated at a Texas rehab center this summer after an attempt to kill herself, was taken to a Nashville hospital yesterday morning with wounds to her wrists, according to local police officials.

The attempt comes at the end of a tumultuous year for the 33-year-old singer, who went public in April with claims that she was the other woman in an adulterous affair with superstar pitcher Roger Clemens. Clemens has never acknowledged such a relationship took place.

-Click here to see photos of Mindy McCready through the years

Nashville police last night said that McCready, whose legal first name is Malinda, called her assistant, Brent Young, at 7:50 a.m. to say she needed him to come over, because “she had done something bad.” Young arrived at 10:15 a.m. “and discovered that she had cut her wrists and taken several pills.” McCready was taken to Centennial Hospital, according to the report.

McCready’s attorney, Lee Offman, told Newsday last night that he was “still trying to gather details.” A call to Clemens’ agent, Randy Hendricks, was not immediately returned.

As recently as last month, McCready was publicly discussing the alleged affair with Clemens. “Carrying on a relationship with him is not something I’m proud of,” McCready said on the syndicated program “Inside Edition.”

McCready met Clemens at a Florida karaoke bar when she was 15 and he was 28. She has said her attraction to the athlete was instant.

“He treated me like a princess,” she said. McCready says the relationship did not become intimate until several years later. Her mother has said she believes the pair shared a “platonic” friendship.

Clemens has only apologized for “mistakes” in his personal life. Congress this year held hearings on the baseball pitcher’s alleged use of performance-enhancing drugs. Even as she attempted to refocus on her music career, McCready was interviewed by FBI agents for Clemens’ perjury investigation.

McCready suffered what she called a “nervous breakdown” in July and entered into rehab. After her release in September, she told reporters she was excited about recording a new CD.

The singer, who was once engaged to ” Superman” actor Dean Cain, has written a song about the tumultuous past few years in her life, “I’m Still Here.”

A prescription drug problem has landed her in jail twice. She most recently served time for violating probation after a drug arrest. Last month, she told “Inside Edition” she was optimistic about her future. “Redemption is out there for everybody to get, and just watch me. I’m gonna show you how to do it.”

-Click here to see photos of Mindy McCready through the years

Copyright © 2008, Newsday Inc.

Related posts:

1. Celebrities with Borderline Personality Disorder (possibly, not for sure)
2. Mindy McCready and BPD
3. Courtney Love’s BPD-meter now getting in the red zone

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Suicidal Tendencies

In May 2005, McCready’s ex-boyfriend, Billy McKnight, was arrested and charged with attempted murder after beating and choking McCready. The following July, McCready was found unconscious in a hotel lobby in Indian Rocks Beach, Florida after attempting suicide. She was hospitalized for a drug overdose after washing down a large amount of undisclosed drugs with alcohol. That September, McCready, who was then pregnant with McKnight’s child, attempted suicide for a second time by overdosing on antidepressants.

Substance Abuse

In August 2004, McCready was arrested in Tennessee for using a fake prescription to buy the painkiller OxyContin. Although she initially denied the charge, she pleaded guilty and was fined $4,000, sentenced to three years probation, and ordered to perform 200 hours of community service.
In May 2005, she was stopped by Nashville police for speeding and then arrested and charged with driving under the influence and driving with a suspended license. A jury later found her not guilty on the charges of DUI, but guilty of driving with a suspended license. That July, she was charged in Arizona with identity theft, unlawful use of transportation, unlawful imprisonment, and hindering prosecution.

Difficult Relationships

In May 2005, McCready’s ex-boyfriend, Billy McKnight, was arrested and charged with attempted murder after beating and choking McCready.

Inappropriate Sexual Behavior

In April 2008, the New York Daily News reported on a possible long-term relationship between McCready and baseball star Roger Clemens that began when she was 15 years old.

Clemens’ attorney Rusty Hardin denied the affair and also stated that Clemens would be bringing a defamation suit regarding this false allegation. Clemens’ attorney admitted that a relationship existed, but described McCready as a “close family friend”. He also stated that McCready had traveled on Clemens’ personal jet and that Clemens’ wife was aware of the relationship. However, McCready confirmed the relationship as being sexual in nature.

On November 17, 2008, McCready spoke in more detail to Inside Edition about her affair with Clemens. She stated that their relationship lasted for more than a decade, and that it ended when Clemens refused to leave his wife to marry McCready. However, she denied that she was fifteen years old when it began, saying that they met when she was sixteen and the affair only became sexual “several years later”.

Related posts:

1. Amy Winehouse gets off easy – but maybe not with her dad
2. Amy Winehouse is back in the news again
3. Mindy McCready Pops Up Again on the BPD-o-meter

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Fla. teen commits suicide with live Web audience

By RASHA MADKOUR – 1 day ago

MIAMI (AP) — A college student committed suicide by taking a drug overdose in front of a live webcam as some computer users egged him on, others tried to talk him out of it, and another messaged OMG in horror when it became clear it was no joke. Some watchers contacted the Web site to notify police, but by the time officers entered Abraham Biggs’ home — a scene also captured on the Internet — it was too late.

Biggs, a 19-year-old Broward College student who suffered from what his family said was bipolar disorder, or manic depression, lay dead on his bed in his father’s Pembroke Pines house Wednesday afternoon, the camera still running 12 hours after Biggs announced his intentions online around 3 a.m.

It was unclear how many people watched it unfold.

Biggs was not the first person to commit suicide with a webcam rolling. But the drawn-out drama — and the reaction of those watching — was seen as an extreme example of young people’s penchant for sharing intimate details about themselves over the Internet.

Biggs’ family was infuriated that no one acted sooner to save him, neither the viewers nor the Web site that hosted the live video, Justin.tv. The Web site shows a video image, with a space alongside where computer users can instantly post comments.

Only when police arrived did the Web feed stop, “so that’s 12 hours of watching,” said the victim’s sister, Rosalind Bigg. “They got hits, they got viewers, nothing happened for hours.”

She added: “It didn’t have to be.”

An autopsy concluded Biggs died from a combination of opiates and benzodiazepine, which his family said was prescribed for his bipolar disorder.

Biggs announced his plans to kill himself over a Web site for bodybuilders, authorities said. But some users told investigators they did not take him seriously because he had threatened suicide on the site before.

Some members of his virtual audience encouraged him to do it, others tried to talk him out of it, and some discussed whether he was taking a dose big enough to kill himself, said Wendy Crane, an investigator with the Broward County medical examiner’s office.

A computer user who claimed to have watched said that after swallowing some pills, Biggs went to sleep and appeared to be breathing for a few hours while others cracked jokes.

Someone notified the moderator of the bodybuilding site, who traced Biggs’ location and called police, Crane said.

As police entered the room, the audience’s reaction was filled with Internet shorthand: “OMFG,” one wrote, meaning “Oh, my God.” Others, either not knowing what they were seeing, or not caring, wrote “lol,” which means “laughing out loud,” and “hahahah.”

An online video purportedly from Biggs’ webcam shows a gun-wielding officer entering a bedroom, where a man is lying on a bed, his face turned away from the camera. The officer begins to examine him, as the camera lens is covered. Authorities could not immediately verify the authenticity of the video, though it matched their description of what occurred.

Montana Miller, an assistant professor of popular culture at Bowling Green State University in Ohio, said Biggs’ very public suicide was not shocking, given the way teenagers chronicle every facet of their lives on sites like Facebook and MySpace.

“If it’s not recorded or documented then it doesn’t even seem worthwhile,” she said. “For today’s generation it might seem, `What’s the point of doing it if everyone isn’t going to see it?’”

She likened Biggs’ death to other public ways of committing suicide, like jumping off a bridge.

Crane said she knows of a case in which a Florida man shot himself in the head in front of an online audience, though she didn’t know how much viewers saw. In Britain last year, a man hanged himself while chatting online.

In a statement, Justin.tv CEO Michael Seibel said: “We regret that this has occurred and want to respect the privacy of the broadcaster and his family during this time.”

The Web site would not say how many people were watching the broadcast. The site as a whole had 672,000 unique visitors in October, according to Nielsen.

Miami lawyer William Hill said there is probably nothing that could be done legally to those who watched and did not act. As for whether the Web site could be held liable, Hill said there doesn’t seem to be much of a case for negligence.

“There could conceivably be some liability if they knew this was happening and they had some ability to intervene and didn’t take action,” said Hill, who does business litigation and has represented a number of Internet-based clients. But “I think it would be a stretch.”

Condolences poured into Biggs’ MySpace page, where the mostly unsmiling teen is seen posing in a series of pictures with various young women. On the bodybuilding Web site, Biggs used the screen name CandyJunkie. His Justin.tv alias was “feels_like_ecstacy.”

Rosalind Bigg described her brother as an outgoing person who struck up conversations with Starbucks baristas and enjoyed taking his young nieces to Chuck E. Cheese. He was health-conscious and exercised but was not a bodybuilder, she said.

“This is very, very sudden and unexpected for us,” the sister said. “It boggles the mind. We don’t understand.”

___

Associated Press Writers Jessica Gresko and Lisa Orkin Emmanuel and the AP News Research Center in New York contributed to this report.

(This version CORRECTS sister’s last name in next-to-last graf.)

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There’s good self-consciousness, and then there’s toxic, paralyzing,
raped-by-Bedouins self-consciousness. I think being shy basically means
being self-absorbed to the point that it makes it difficult to be around
other people. For instance, if I’m hanging out with you, I can’t even
tell whether I like you or not because I’m too worried about whether or
not you like me. (David Foster Wallace)

You see, I often hear Non-BPs (the loved ones and family members of people with BPD) tell me that they feel that their loved one with BPD is extremely “selfish” or very “Narcissistic.” I always try to caution them on this statement because, when someone is in pain, yes, they will tend to look inward, but it’s not selfishness or Narcissism, in my opinion. It’s the ravages of deep shame and shyness that cause people with BPD to take such a view of the world. A person with BPD will dread the judgment, punishment and/or disapproval of other people. That is the kind of self-consciousness that is present in BPD.

To further follow up on this idea, here is a quote from me to a member of the ATSTP list from about two years ago. I was responding to the “lack of empathy” that his significant other (SO) was showing toward him:

It is frustrating and part of it seems very selfish on their part. My
wife actually showed sympathy for me this morning – I had a bit of an
upset stomach, so she said “I hope you feel better” a couple of times.
Of course, initially she thought I was mad at her or something (there
was still a lingering feeling that it was about her).

I also think there’s a step beyond empathy, and that’s compassion. I
think if you look at the spectrum of understanding for other people
you have something like self-centeredness (but not necessarily
positive) – pity – sympathy – empathy – compassion. (and there’s
probably a bunch of feelings in-between. The spectrum seems to run
from extreme self-interest to selflessness, of course, I could be
wrong on all of that – just an idea. It is easy to have compassion and
unconditional love for your kids, but for your SO it can be more
difficult because there are expectations on each side of the equation.
When your SO doesn’t live up to those expectations, even if they are
simple consideration, it is disappointing. I know it is difficult with
my wife as well – some of the time. Even my kids are wary of my wife’s
behavior at times.

I wonder if our SO’s don’t have much understanding of other people’s
pain because of the judgment factor. Perhaps they believe that
with “understanding” comes a level of judgment at least for
themselves. Or it could be that they believe no one actually
understands them, so the process of understanding others is pointless.

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1. Toxic Shame
2. Understanding Emotional Agony Through David Foster Wallace’s Eyes

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When Hope is Not Enough
Get the Non-BPD book that is designed for
staying and working on the relationship

Substance Abuse

I don’t think I have to cite any references on this one. The bio I read makes it clear that Cobain was a junkie and used consistently. Also, despite his slim frame (5’7″, 130 pounds), he used far more heroin than others in his final days and his body was, for the most part, able to take it. He did overdose numerous times. Abuse of pain killers (of which heroin is one), is not uncommon with BPD (sometimes called “Bellman’s Syndrome”).

His heroin use eventually began affecting the band’s support of Nevermind, with Cobain passing out during photo shoots. One memorable example came the day of the band’s 1992 performance on Saturday Night Live, where Nirvana had a shoot with photographer Michael Levine. Having shot up beforehand, Cobain nodded off several times during the shoot. Regarding the shoot, Cobain related to biographer Michael Azerrad, “I mean, what are they supposed to do? They’re not going to be able to tell me to stop. So I really didn’t care. Obviously to them it was like practicing witchcraft or something. They didn’t know anything about it so they thought that any second, I was going to die.”

Eating Disorder (or chronic pain leading to one)

Kurt Cobain had a chronic, undiagnosed stomach disorder from which he developed an eating disorder, being unable to keep down food.

Throughout most of his life, Cobain battled chronic bronchitis and intense physical pain due to an undiagnosed chronic stomach condition. This last condition was especially debilitating to him emotionally, and he spent years trying to find its cause. However, none of the doctors he consulted were able to pinpoint the specific cause, guessing that it was either a result of Cobain’s childhood scoliosis or related to the stresses of performing.

Volatile Relationships

His relationship with Courtney Love was volatile. He also had volatile relationships with others in his band and with managers and ex-girlfriends.

Love arranged an intervention concerning Cobain’s drug use that took place on March 25. The ten people involved included musician friends, record company executives, and one of Cobain’s closest friends, Dylan Carlson. But Bassist Krist Novoselic tipped him off as he considered the idea to be “stupid”. However, by the end of the day, Cobain had agreed to undergo a detox program. Krist Novoselic drove him to the airport to catch his flight, but Cobain was far from wanting to go, in a fit of panic, Cobain drew violence and the two fought at the airport, eventually Cobain freed himself and ran through the airport lobby screaming “fuck you”, this would be the last time Krist would see Kurt alive.

Shame and Unstable Self Image

His lyrics probably do the best for this…

All Apologies:
I wish I was like you
Easily amused
Find my nest of salt
Everything is my fault
I’ll take all the blame
Aqua seafoam shame
Sunburn, freezeburn
Choking on the ashes of her enemy

Dumb:
I’m not like them
But I can pretend
The sun is gone
But I have a light
The day is done
But I’m having funI think I’m dumb
Or maybe just happy

Radio Friendly Unit Shifter:
What is wrong with me?
What is what I need
What do I think I think?

This had nothing to do with what you think
If you ever think at all
Bi-polar opposites attract
All of a sudden my water broke
I love you for what I am not
Did not want what I have got
Blanket acne’d with cigarette burns
Speak at once while taking turns

And of course, there are probably twenty more examples in his various lyrics. The only other musician that I can think of off the top of my head who consistently used the words “shame” and “I’ll take the blame” is Ian Curtis (Joy Division’s lead singer who also committed suicide).

Suicide Attempts

I think these go without saying, considering his eventual actual suicide. But we know of at least one other:

Following a tour stop at Terminal Eins in Munich, Germany, on March 1, 1994, Cobain was diagnosed with bronchitis and severe laryngitis. He flew to Rome the next day for medical treatment, and was joined there by his wife on March 3. The next morning, Love awoke to find that Cobain had overdosed on a combination of champagne and Rohypnol (Love had a prescription for Rohypnol filled after arriving in Rome). Cobain was immediately rushed to the hospital, and spent the rest of the day unconscious. After five days in the hospital, Cobain was released and returned to Seattle. Love later stated that the incident was Cobain’s first suicide attempt.

Related posts:

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2. Understanding Borderline Personality Disorder from WHYY
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Amy Winehouse threatens to kill herself

Singer on 24-hour watch by worried friends

Monday, 6 October 2008

Amy Winehouse is said to be on suicide watch after she allegedly threatened to stab herself.

The singer is thought to have been pushed further downhill after her husband Blake Fielder-Civil rejected an offer of parole last month – because he didn’t want to stay with his mum Georgette Civil or wear an electronic tag.

Amy, 25, apparently held a knife to her chest in front of friends.

‘She said she was “caught up in a nightmare”,’ a source tells the Daily Star. ‘Her friends managed to get the knife away from her but are now holding a 24-hour watch on her.

‘Her emotions are exaggerated. She is either high as a kite or, when she hears something she doesn’t like, she is suicidal.’

Blake, 26, is being held at Edmunds Hill Prison after he was found guilty of GBH and attempting to pervert the course of justice. It is now thought that he has accepted another offer of early release.

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1. Amy Winehouse and Husband Battle it out
2. Media Reports the Amy Winehouse may have had Borderline Personality Disorder
3. Amy Winehouse found dead at 27

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More than half firearm deaths are suicides

• Story Highlights
• Recent Supreme Court ruling on guns focused on protection from home invasion
• Suicides accounted for 55 percent of nearly 31,000 firearm deaths in 2005 in U.S.
• More gun-related suicides than homicides and accidents in 20 of last 25 years
• Research shows if gun in home, higher likelihood of suicide or homicide in home

ATLANTA, Georgia, (AP) — The Supreme Court’s landmark ruling on gun ownership last week focused on citizens’ ability to defend themselves from intruders in their homes. But research shows that surprisingly often, gun owners use the weapons on themselves.

Suicides accounted for 55 percent of the nation’s nearly 31,000 firearm deaths in 2005, the most recent year for which statistics are available from the Centers for Disease Control and Prevention.

There was nothing unique about that year — gun-related suicides have outnumbered firearm homicides and accidents for 20 of the last 25 years. In 2005, homicides accounted for 40 percent of gun deaths. Accidents accounted for 3 percent. The remaining 2 percent included legal killings, such as when police do the shooting, and cases that involve undetermined intent.

Public-health researchers have concluded that in homes where guns are present, the likelihood that someone in the home will die from suicide or homicide is much greater.

Studies have also shown that homes in which a suicide occurred were three to five times more likely to have a gun present than households that did not experience a suicide, even after accounting for other risk factors.

In a 5-4 decision, the high court on Thursday struck down a handgun ban enacted in the District of Columbia in 1976 and rejected requirements that firearms have trigger locks or be kept disassembled. The ruling left intact the district’s licensing restrictions for gun owners.

One public-health study found that suicide and homicide rates in the district dropped after the ban was adopted. The district has allowed shotguns and rifles to be kept in homes if they are registered, kept unloaded and taken apart or equipped with trigger locks.

The American Public Health Association, the American Association of Suicidology and two other groups filed a legal brief supporting the district’s ban. The brief challenged arguments that if a gun is not available, suicidal people will just kill themselves using other means.

More than 90 percent of suicide attempts using guns are successful, while the success rate for jumping from high places was 34 percent. The success rate for drug overdose was 2 percent, the brief said, citing studies.

“Other methods are not as lethal,” said Jon Vernick, co-director of the Johns Hopkins Center for Gun Policy and Research in Baltimore.

The high court’s majority opinion made no mention of suicide. But in a dissenting opinion, Justice Stephen Breyer used the word 14 times in voicing concern about the impact of striking down the handgun ban.

“If a resident has a handgun in the home that he can use for self-defense, then he has a handgun in the home that he can use to commit suicide or engage in acts of domestic violence,” Breyer wrote.

Researchers in other fields have raised questions about the public-health findings on guns.

Gary Kleck, a researcher at Florida State University’s College of Criminology and Criminal Justice, estimates there are more than 1 million incidents each year in which firearms are used to prevent an actual or threatened criminal attack.

Public-health experts have said the telephone survey methodology Kleck used likely resulted in an overestimate. iReport.com: Watch William Bernstein share his views on gun ownership

Both sides agree there has been a significant decline in the last decade in public-health research into gun violence.

The CDC traditionally was a primary funder of research on guns and gun-related injuries, allocating more than $2.1 million a year to such projects in the mid-1990s.

But the agency cut back research on the subject after Congress in 1996 ordered that none of the CDC’s appropriations be used to promote gun control.

Vernick said the Supreme Court decision underscores the need for further study into what will happen to suicide and homicide rates in the district when the handgun ban is lifted.

Today, the CDC budgets less than $900,000 for firearm-related projects, and most of it is spent to track statistics. The agency no longer funds gun-related policy analysis.

Now, consider that a person with BPD is 400 times more likely to commit suicide than the general public. And consider that:

Nearly 3/4 of borderlines attempt suicide or display self-mutilating behaviors like cutting themselves with razors or burning themselves. Only about 10% of suicide attempts are successful.

If only 10% of suicides are successful and 75% attempt suicide, what do you think the successful suicide rate for BPD would be if they all had access to a gun? Suicide attempts in BPD are usually impulsive. They are not usually a “call for help” or manipulative. A lot of non-BPs think that they are, but typically the suicide is not thought out. The BP just wants to end the huge amount of pain that they are in. They will use whatever method is at hand (i.e. take all the pills in the cabinent). If a handgun is at hand and loaded, suicide is much more likely to occur.

If you look at Kurt Cobain (who MAY have had BPD), he tried to commit suicide with pills at one point (that we know of) and drug overdose is not very effective. When he got a hold of his shotgun, the deed was done. From the above CNN article:

More than 90 percent of suicide attempts using guns are successful, while the success rate for jumping from high places was 34 percent. The success rate for drug overdose was 2 percent, the brief said, citing studies.

So, gun suicides are 90% sucessful, drug overdose 2%. Please don’t keep a loaded gun around someone with BPD.

Related posts:

1. Pre-teen Girls Suicide Rates Go Way Up
2. BPD: What’s in a Name and How does it feel to be that person?
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Admitted for depression

Vicki Salemi

Heather Locklear has checked herself into an in-patient treatment facility in Arizona. The quintessential evening soap opera vixen is on the road to recovery. And no, it’s not for substance abuse.

As for the reason? To deal with issues of anxiety, depression, and to re-evaluate her current condition. We give props to the 46 year-old actress who apparently recently switched doctors and is taking a pro-active stance towards her mental health. The new doc recommended that her condition and medication be re-evaluated.

While her publicist confirmed that Heather’s been dealing with anxiety and depression, it seems she’s taking it head on: by entering the facility she’ll get a proper diagnosis and treatment.

Actually, a few months ago paramedics were called to her home. Her psychiatrist called 9-1-1 and told authorities there was concern for a possible overdose attempt on prescription meds. Well, paramedics left her home extremely quickly after arrival and deemed everything was all right.

As for the back story, last year her ex-husband and Bon Jovi band member Richie Sambora stayed in a treatment facility last year. Their ten year-old daughter Ava is staying with family at the moment.

Best wishes, Heather!

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New! An eBook that can help you in your relationship with someone with Borderline Personality Disorder. Beyond Boundaries is the next step in the evolution of the Non-BPD/BPD relationship.

Self Injury

In June 2001 Rolling Stone she said that during her very early teens she started “thinking about not wanting to be around. It was when the reality of life set in, the reality of surviving.” Also, Angelina used to hurt herself during her early teens but stopped around the age of sixteen. She explained in a 2000 Maxim article, “You’re young, you’re crazy, you’re in bed and you’ve got knives. So shit happens.” But in 1999 Access Hollywood interview she explained it more in-depth, “I was..trying to feel something….I was looking at different things..thinking romantically about…about blood. I really hurt myself,” and also said, “I was just….a kid. I was like 13, And, I was saying that it is not something that is cool. Its not cool. And I understand that it is a cry for help…”

In a 2000 Jane interview she said, “This person asked me about cutting myself when they saw a scar. I’m very open, but because of that, people think that they know everything about me, and, actually, they don’t know anything. I say things that other people might go through. That’s what artists should do – throw things out there and not be perfect and not have answers for anything and see if people understand. But this person made the cutting sound interesting, like it was something I do now. [For the record, she did, but doesn't now, and doesn't endorse it.] And then I met somebody who said they’d seen movies of mine and then showed me where they had cut themselves. I had to explain, first off, not to do that. But it made me really fucking angry at the people who represent me in a way that would get that person to do that and show me. I don’t understand why people would want to use something so damaging. It’s like, let’s make me look ‘cool’ and worry a lot of people in my family.”

Suicidal Tendencies

“Yeah. I was in a New York hotel room,” Jolie says. She was going to use a knife and sleeping pills. In preparation, she wrote a note for the housekeeper asking her to call the police, so that the housekeeper wouldn’t have to suffer the distress of finding her body. Then Jolie spent the day walking around. She almost bought a kimono, then she realized how crazy that was. “I didn’t know if I could pull the final thing across my wrists,” she says. But it was the sleeping pill part of the equation that stopped her, at least on a practical level. Worried that she didn’t have enough, she had asked her mother to mail her some more, and she realized that her mother would feel responsible. She realized something else, too: “That we can make that decision any time. And I kind of lay there with myself and thought, `You might as well live a lot, really hard, and not give a shit, because you can always walk through that door.’ So I started to live as if I could die any day.”

The next day, she went back and bought the kimono.

Did you ever feel that low about living again?

Well, I had felt like that before. When I was thirteen or fifteen.”

Did you ever feel like acting on it?

“Yeah. It’s seems like there’s always been times. This is going to sound so insane, but there was a time when I realized I was going to have to hire somebody to kill me. It comes from a place of … With suicide comes the guilt of all the people around you thinking that they could have done something. With somebody being murdered, nobody takes some kind of guilty responsibility.”

Poor Self-Image

Later, Jolie frets about the ways she’s sometimes talked about. “I am fragile and fucked up. There are lots of things about my life in recent years that people don’t know anything about,” she says. “People assume . . . People have said things about me, they’ve said I’ve slept with my brother, they’ve said that I’m a drug addict and that all I do is get fucked up, and they’ve also made it seem like I’m some slut. I’m far from perfect as a person ….. She shakes her head.

Volatile Relationships

She tells me anyway. It was just before she and Thornton got married. She was sectioned for seventy-two hours at UCLA. “What happened,” she says, “is we didn’t know if we were going to be able to be together.” She pauses. “I remember him driving somewhere and not knowing if he was OK…. We had wanted to get married and then for all these different reasons we thought we couldn’t. We both were just … are just, it’s a beautiful kind of love, but it’s also a little insane, and I for some reason thought something had happened to him and I lost the ability to … I just went a little insane.”

Confused Sexuality

When Barbara Walters asked her if she was bisexual, Jolie responded: “Of course. If I fell in love with a woman tomorrow, would I feel that it’s okay to want to kiss and touch her? If I fell in love with her? Absolutely! Yes!” - July 2003

In an interview with Elle magazine, Jolie said: “Honestly, I like everything. Boyish girls, girlish boys, the heavy and the skinny. Which is a problem when I’m walking down the street.” – June 2000

Eating Disorder

The tattooed former wild child — who in her younger years battled an eating disorder and self-mutilation and later famously wore a necklace containing a drop of her then-husband Billy Bob Thornton’s blood…

Substance Abuse

A British tabloid newspaper has published images of a video which allegedly shows Angelina Jolie in a “drug den” with a woman who is openly smoking heroin.

The actress is shown in video images published in The Sun newspaper looking disheveled and wide-eyed as she smokes a cigarette and tells the camera of her past drug use. The video captures the star reportedly saying, “I’ve done coke, heroin, ecstasy, LSD, everything.”

Last month, it was reported by the National Enquirer a videotape of Jolie allegedly smoking and snorting heroin had been offered for sale for $70,000. But in this footage, thought to be taken in the 1990s when she was in her 20s, Jolie does not take drugs, telling the camera, “I gave them up long ago.”

Well, that’s it for now. I think an argument can be made for her impulsiveness (married 3 times) and for Brad Pitt’s impulsiveness too. I have to say though, she and Brad have much better management people than some other celebs. You don’t hear much now about her nutty behavior. She has found someone to control the press – something that Britney, Lindsey Lohan and others could learn a lesson from.

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Magistrate Tells Man to Kill Himself

(WXYZ) – Court officials in Novi say a magistrate “could have chosen better words” when she told a man convicted of drunk driving and other offenses that he should commit suicide by jumping to his death or slitting his wrists in a bathtub.

52nd District Court Magistrate Judith Holtz made the shocking statements during a hearing on April 10 as she was sentencing 20-year-old Michael Robert Dickey on a charge of Minor in Possession of alcohol. Dickey had two prior convictions for drunk driving and, according to the court, “had failed to comply with his bond conditions to remain drug and alcohol free.”

According to court transcripts obtained by WXYZ, Dickey admitted to Holtz that he’d “made a lot of mistakes” — and that’s when she unleashed from the bench.

“I don’t mean to be offensive, but you have two Operating While Intoxicated convictions and then you blow a .223 and you’re still not twenty one?, Holtz said.

“Here is my suggestion to you, Mr. Dickey, climb up on the roof of your house and jump off; either that or get in a bathtub filled with hot water and slash your wrists; then you will be dead; it will be cheaper; it will be faster and in the long run it will be less painful to anybody who cares about you, because that’s where you’re headed now, and the best part of it is you won’t take somebody else with you.

“Who do you think you are? You don’t have the right to go out there and endanger innocent people and you know it. And you have had two convictions for drunk driving and you’re not twenty one and you still drink.”

Holtz is a veteran magistrate who joined the court in 1992 after practicing law for 18 years. She declined to talk with WXYZ about the tirade, but 52nd District Court officials offered an explanation late Monday.

“The words chosen by the Court’s magistrate to convey the seriousness and severity of the defendant’s actions and crime could have been better chosen,” the court said in a statement. “The magistrate was attempting to convey, through an analogy, that the defendant’s actions and past behavior has continually put the community at risk.”

The court’s statement to WXYZ also sought to prove Dickey remains a risk to the community. “It should also be noted that Mr. Dickey, at a probation appointment on May 12, 2008, tested positive for cocaine, marijuana and amphetamines in a urine screen.” Dickey has been sent to a rehab program.

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Woman indicted in fatal MySpace hoax on girl

By Dan Whitcomb2 hours, 11 minutes ago

A 49-year-old Missouri mother accused of using a fake MySpace persona to “torment, harass, humiliate and embarrass” a 13-year-old girl who hanged herself was indicted on Thursday on federal charges.

Lori Drew, accused of helping dupe 13-year-old Megan Meier into believing she was chatting with a teenage boy, was indicted on conspiracy and other charges by a U.S. District Court jury in Los Angeles.

Meier’s suicide in October of 2006 made worldwide headlines and prompted calls for social networking sites like MySpace to crack down on cyber-bullying.

“Any adult who uses the Internet to bully or harass another person, particularly a young teenage girl, needs to realize that their actions can have serious consequences,” U.S. Attorney Thomas O’Brien said in announcing the indictment.

Meier for several weeks had what she thought was an online relationship with the fictional 16-year-old boy, “Josh Evans,” when in fact she was exchanging messages with Drew and others.

Drew, 49, is the mother of a teenage girl who had a falling out with Meier.

Meier hanged herself in the closet of her bedroom in a St. Louis suburb on October 15, 2006, after “Evans” told her he did not want to be friends with her anymore and that “the world would be a better place without you.”

Prosecutors say Drew and others created the fake persona using the picture of an unwitting teenage boy.

A former employee of Drew, 19-year-old Ashley Grills, told ABC’s “Good Morning America” in an interview that she set up the fake MySpace account because Drew wanted to find out what Meier was saying about her daughter.

After Meier killed herself, Drew had the hoax MySpace account deleted and told an unnamed juvenile who knew about it that she should “keep her mouth shut,” according to the indictment.

It said “defendant Drew and the co-conspirators used the information obtained over the MySpace computer system to torment, harass, humiliate and embarrass the juvenile MySpace member.”

Drew, who faces a maximum sentence of 20 years in federal prison if she is convicted on all of the charges, was expected to surrender to authorities in Missouri.

(Editing by Vicki Allen)

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The study, “8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual,” is the latest analysis of a randomized trial first reported in AJP in October 1999 and titled “Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial.”

Joel Paris, M.D., an expert on BPD, explained that mentalization therapy, developed by Bateman and Fonagy in the 1990s, is based on attachment theory and on observations that BPD patients have a failure of “mentalization”—the ability to observe their own emotions and those of other people and to appreciate how their behavior may affect others.

“Mentalization-based therapy can be considered as an amalgam of psychodynamic and cognitive methods,” he told Psychiatric News.

For instance, a case report included in the study describes a 24-year-old woman who was referred from forensic services after her arrest for setting fire to her university dormitory.

She had a history of recent suicide attempts and regularly burned herself with cigarettes and a hot iron. In individual sessions, treatment initially focused on clarifying her own feelings and others’ experience of her; later it progressed to helping her appreciate how her experiences of self-doubt and emotional turbulence led to a sense of fragmentation that was controlled only by experiences of intense physical pain, according to Bateman and Fonagy.

“The individual therapist identified these processes while focusing on the way she represented her own mental states and those of others with whom she interacted,” they wrote. “Gradually this was explored within the relationship with the therapist.”

They report the patient as stating, “It never occurred to me that what I did had an effect on anyone else.”

I have to say the suicide figures are astounding, especially when it comes to attempts. I mean, over 80% in two of the categories!

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(For those of you who don’t know who Pete Doherty is: he’s the lead singer of two British bands: Babyshambles and the Libertines. He dated Kate Moss and he is a regular in the tabloids in London for his erratic and criminal behavior.)

Self-Harm

Painting in one’s own blood seems to indicate self-harm. Here’s another article about Doherty’s self-harm.

Quotes from the self-harm article:

Graphic footage of rock star Pete Doherty deliberately harming himself will not appear in a forthcoming fly-on-the-wall documentary about the former Libertines’ singer, as had been feared by mental health charities.

The scenes of Doherty cutting himself with a broken bottle feature in a rough edit of the documentary, to be shown on BBC3 on Sunday 28 August. The images of Doherty slashing his chest, taken from the edit, were leaked to the national press last week, raising concerns about his mental health.

Substance Abuse

Well, duh… He’s been put in jail numerous times for drug offenses, including heroin and cocaine abuse.

Quotes:

He appeared at Ealing Magistrates’ Court to face charges of possessing heroin and cocaine.

The 26-year-old was arrested by police after he was spotted driving a speeding car in west London on 30 November.

The former Libertines singer has continually been in the headlines over his drug abuse and his relationship with model Kate Moss.

He is due to reappear at Ealing Magistrates Court on 8 February.

The prosecution said police pulled Mr Doherty over after he was spotted speeding and officers said he had a glazed look.

He was found to have three packets of heroin, with a weight of 0.875gm (0.03oz), and one packet containing 0.234gm (0.008oz) cocaine.

Inappropriate Anger

More quotes:

Babyshambles singer Pete Doherty has been fined £750 after he admitted assaulting a BBC reporter in March.

The star pleaded guilty at Thames Magistrates’ Court to kicking a microphone out of her hand outside the same court after a separate appearance.

In a statement, the 27-year-old said: “If I hurt this lady I’m sorry.”

The star, who is currently being treated for drug addiction, was also ordered to pay £250 compensation and another £200 in court costs.

Painful hand

He had previously pleaded not guilty to a charge of assault by beating after he kicked out at Radio 1 Newsbeat’s Trudi Barber.

His defence lawyer, Sean Curran, said Doherty changed his plea after watching television footage of the attack.

Indentity Issues

He’s turning to Islam? I wonder how long that will last.

Quotes:

One of Doherty’s friends said: “He’s been reading the Quran since he went into segregation. He’s got a lot of Muslim friends and they’ve been on at him for ages to study it. Now he’s on his own and he’s got time on his hands to study it.

“I’m surprised how much it has calmed him down as he was very on the edge inside. He definitely seems more chilled. He’s lapping it up and really interested in it. I think it’s helping him in there.”

Doherty has been having a difficult time since his 14-week sentence began for violating probation by taking drugs.

Volatile Relationships

The UK hottest couple, Pete Doherty and Kate Moss, split up, after the beautiful supermodel dumped Pete, arguing she cannot stand his way of life anymore, always worrying about him.

On July 22, 2005, Pete Doherty was involved into
a street fight. British newspapers The Sun and Daily Mirror reports that Pete and musician friend Alan Wass fought with a group of Somali youths after they shouted “crackhead” at him.

Farid Khan of Supersave store in Camden Town, said: “The singer ran in pursed by six man. There was a big fight. We got them out but they hurled a brick at the door.”

Kate reportedly told friends: “I can’t go on spending day and night worrying about Pete. He would disappear without a word and I would not hear from him for days. He has to change his lifestyle. Until that happens we are finished.”

Sexual Confusion

DOHERTY: ‘I WAS A GAY RENT BOY AND DRUG DEALER’

Troubled rocker PETE DOHERTY has shocked fans by boasting he worked as a homosexual prostitute and drug dealer to fuel his drug addictions, before he shot to fame in his former band THE LIBERTINES.

The wild singer confesses he was so desperate for money to fund his cocaine and heroin habits, he worked as a rent boy and once robbed a gay client after tying him up at his home.

Dangerous Driving

Babyshambles singer Pete Doherty has been fined £300 and disqualified from driving for two months.

The 27-year-old admitted two charges of driving without insurance or a licence at Thames Magistrates Court in London.

District Judge Jane McIvor warned the singer that he faces jail if he drives without a licence again.

The rock star was arrested in November 2006 by officers who spotted him driving his Jaguar erratically near his east London home.

Shame

So you’ve got this support act, some posh bloke with a discomfited smile, slowly eating himself from the inside out from pure embarrassment. One guy with a guitar strumming idle fancies like ‘The Blue Ridge Mountains Of Dakota’, incapable of holding a note or playing a tune, and, what’s worse, he clearly hates himself for it. Pretty soon, he’ll be dead. And then he’s joined by a nonchalant Doherty in trenchcoat and hat. The place breaks out into hysteria. I’m blinded by about twenty camera phones flashing, then I’m nearly sucked under by the wave surging forward. Even Doherty, the boy in the bubble, advises everyone to move back because there’s a girl in the front whose eyes are bulging.

Suicide Attempts

Pete Doherty tried to kill himself in rehab after discovering that Kate Moss was dating a new man. British tabloids tattled that the ‘Babyshambles’ singer downed an entire bottle of pills-he just ended up making himself ill.

“He saw an opportunity to take an overdose and took it. He told me he didn’t know what the pills were but thought ‘fuck it’ and took them all,” says a NOW insider.

“He doesn’t care what drugs do to him—in fact, he likes finding out.”

“To begin with Kate was ringing him up all the time, concerned for his well-being.”

“But when Pete started to quiz her about the new guy, she was evasive and it got to him. She messed with his head.”

Impulsive Behavior

Anthony Thornton, the reviews editor of NME and an authority on The Libertines, said: ‘Pete is at a lower point than he was a year ago. He’s hit depths he didn’t even know existed. He’s not aware of how bad a state he’s in, and the drugs make it worse. He’s incredibly impulsive, he doesn’t take on responsibilities, he’s unreliable and likely to do himself harm.

Unsafe Sexual Behavior

I think anyone who was a male prostitute qualifies in this regard.

So, ole’ Pete hit just about all the categories that I applied to other celebrites. While I am not a doctor and can’t officially diagnose anyone… Pete Doherty looks suspiciously like he may have Borderline Personality Disorder (or something very close to it). And everyone, you will notice that I used mainly news articles in this analysis (with a bit of blogging, didn’t have time to look up interviews for shame – although I’ve been told he says he hates himself and he is a bad person).

Here’s his Wikipedia entry.

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Troubled mind
The discoveries added to the puzzle surrounding Kazmierczak.

While friends, family, educators and investigators remain baffled and shocked at the gunman’s acts, a closer look reveals that Kazmierczak’s friendly exterior masked a troubled mind.

University Police Chief Donald Grady said, without giving details, that Kazmierczak, 27, had become erratic in the past two weeks after he had stopped taking his medication.

A former employee at a Chicago psychiatric treatment center said Kazmierczak’s parents placed him there after high school. She said he used to cut himself, and had resisted taking his medications.

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ABC News Report of Suicide Story

I decided to use this report to point out something important about this story. What her parents have gone through in this case is monstrously painful and I don’t, by any means, take up this tragedy to criticize her mother. I can only imagine the amount of pain and anguish her mother and father must be going through. I know if one of my children did this I’d be beside myself in grief and loss.

The reason I bring it up is because of this quote from her mother about the details of the incident:

Megan was distraught. Tina, angry about the nasty online exchanges, insisted that Megan log off the computer.

“Megan got upset with me and yelled — not yelled, but was crying and said ‘You’re supposed to be my Mom and you’re supposed to be on my side,’ and then took off running upstairs,” said Tina.

Twenty minutes later, Tina went to check on her daughter and made a horrible discovery. “I went upstairs and opened the door and saw her hanging in the closet,” she said. “And I screamed and ran over and tried picking her up.”

The key to this interchange is that Megan was distraught. Her mother could see that plainly. I find it unfortunate that her mother apparently had not be trained in validation and emotional distress skills. If her mother HAD been so trained, I suspect she might have approached Megan differently. When someone is emotionally upset and dysregulated, especially in as much pain as Megan obviously was at the time, the best approach is not criticism, but validation.

Like I said, I don’t think the mother’s (Tina’s) reaction is unusual, nor am I saying that a different response might have prevented her suicide. However, when someone is THAT emotional and “distraught” as her mother indicated, the most effective response is validation of the emotions (which is not agreement with behavior). Based on her response to her mother I see certain things: 1) She did not yell, she cried… that is sadness, not anger in her and 2) She took the mother’s response as judgmental and critical of her, at a time when she was emotionally vulnerable and 3) She felt attacked and without comfort (the “not on my side” comment). Again, before I get angry emails defending her mother, it should be stated that her mother didn’t CAUSE the original problem – that was caused by Megan’s own emotional reactions to the “mean” messages. The messages themselves (since we don’t have the full text of them) could have been vicious and nasty, but, even if they were, Megan’s REACTION to the messages – her emotional reaction – was what was at issue. By not being validating of Megan’s emotional reaction, her mother (inadvertently for certain) invalidated her child’s emotional reaction. Emotional invalidation causes despondency and shame.

I wonder what would have been Megan’s reaction had her mother validated her emotions by saying FIRST: “Wow, Megan you look so sad, what happened?” And then after finding out, she had said, “I can see how these mean messages would make you feel so sad. I think anyone who received these would feel both sad and angry. I can also see why you responded with such anger. Those messages would make me mad too.” Finally, if she’d left the “teaching/scolding” moment about the language in the messages until later – who knows what would have happened?

My point is that it is extremely important that parents, partners and friends of highly emotional people (and in highly emotionally-charged situations) learn some emotional validation skills. Again, I don’t know if it would or could have prevented Megan’s death, but if they come at the right moment, these skills can help cool down the emotions so that a child has the opportunity to make a different (and hopefully, more effective) decision.

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For all young people between ages 10 to 24, the suicide rate rose 8 percent from 2003 to 2004 – the biggest single-year bump in 15 years – in what one official called “a dramatic and huge increase.”

The report, based on the latest numbers available, was released Thursday by the Centers for Disease Control and Prevention and suggests a troubling reversal in recent trends. Suicide rates had fallen by 28.5 percent since 1990 among young people.

The biggest increase – about 76 percent – was in the suicide rate for 10- to 14-year-old girls. There were 94 suicides in that age group in 2004, compared to 56 in 2003. The rate is still low, fewer than one per 100,000 population.

Suicide rates among older teen girls, those aged 15-19 shot up 32 percent; rates for males in that age group rose 9 percent.

“In surveillance speak, this is a dramatic and huge increase,” Dr. Ileana Arias said of the overall picture. She is director of the CDC’s National Center for Injury Prevention and Control.

More research is needed to determine whether this is a trend or just a blip, said one child psychiatrist, Dr. Thomas Cummins of Children’s Memorial Hospital in Chicago. “We all need to keep our eye on this over time to see if this is a continuing trend.”

http://www.cbsnews.com/stories/2007/09/06/health/main3239837.shtml

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The true problem was that Cho was mentally ill and did not seek treatment for his mental illness. I am not going to postulate as to what actual diagnosis that Cho had (I am not qualified to do so) – I will suggest that his true problem was probably emotional. He was unable to control his anger and rage. I would also like to point out that he carried around shame and self-hatred. When inner shame is left untreated, it often leaks out as anger and rage. It is extremely difficult for a person with inner shame to take ownership of that shame. Instead, it bubbles underneath the surface and comes out as anger toward those that have wronged them. I suspect this was Cho’s real problem. He was humiliated throughout his life and, quite possibly, had a biological pre-disposition to emotional dysregulation. The combination of these two factors – biological and environmental – adds up to self-hatred, shame and a persecution complex. I am not suggesting that all people with this sort of make-up and history are dangerous or would take that rage out on other people. In fact, many people with those issues end up taking their inner rage out of themselves – through suicide or risky behaviors. It seems to me that Cho couldn’t handle his shame or his intense emotions, so he acted to take revenge on other people. In doing so, he handled his emotions poorly (obviously). He probably also believed that shame to be true; meaning, he hated himself and thought other’s teasing and bullying was deserved. In pointing out the feeling that he believed to be true (that he was a bad, worthless person), he took revenge on all other people, regardless of whether they participated in his belittling.

The point of this post is to say that what we really need in this country is better and more assessable mental health care. We need to teach people, adults as well as children, about the functions of emotions and the skills that can be utilized to handle those emotions. We educate people about academic subjects everyday, but do very little to teach self-regulatory skills for emotional states. For some people, these emotional regulation skills are the very ones that can save their lives (and, in Cho’s case, the lives of others).

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The most important thing is, Do not hospitalize a person with borderline personality disorder for any more than 48 hours. My self-destructive episodes – one leading right into another – came out only after my first and subsequent hospital admissions, after I learned the system was usually obligated to respond. Nothing that had happened to me before being admitted to a psychiatric unit for the first time could even approach the severity of the episodes that followed.

Should you hospitalize your BP? Maybe not.

http://ps.psychiatryonline.org/cgi/content/full/49/2/173

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