HOW IS VOTING A MENTAL HEALTH ISSUE?
As a licensed mental health professional, I was taught to keep politics (and religion) out of the therapy room, to keep the focus on mental health issues. So why am I writing about voting? Because I have come to believe that both the right to vote, and the act of exercising that right, are directly connected to the mental health and well-being of every one of us.
Three of the major crises facing us today – skyrocketing healthcare costs, climate change, and systemic racial injustice – are not only interwoven, as I’ve mentioned before, but impact mental health, and relate to voting. Let’s start with healthcare, and a personal example:
Healthcare costs
In the past year, three of my relatives have lost their jobs, and as a result, lost their health insurance. All are too young to qualify for Medicare, but over 55 – an age group that is especially vulnerable to job loss (yes, age discrimination is real) and also more vulnerable to COVID-19, as well as all of the everyday health issues that tend to increase as we age. They were faced with either having to pay for continued coverage through COBRA, at 3 – 4 times the cost of their healthcare premium when they were working, or foregoing healthcare coverage until they’d spent down all of their assets so they could qualify for Medicaid. Yes, stuck between a big rock and a very hard place. During a pandemic and a collapsing economy.
While optimism tends to run in my family, is it any surprise that each of them have struggled with feelings of anxiety and depression? Clearly their mental health and well-being is impacted. Yet their painful dilemma, and that of thousands like them, could be solved with the stroke of a pen – the signature of the President authorizing Congress to act to lower the qualifying age for Medicare from 65 to 55. Yes, it could be that simple – that is, if we had a President who believed in programs like Medicare, and who felt some responsibility for the health and well-being of every American. That’s one very important reason to vote on November 3rd.
The stroke of a President’s pen won’t solve all of the issues with our broken healthcare system, so that’s why we also need to show up and vote for state and federal legislation that offers a variety of other fixes, and for local and national representatives who are able to understand the complexities of the system and will reach across the aisle to get bills passed.
Climate change
In my other role a mindfulness teacher, I heard from a student that she was having trouble embracing the practice of mindful breathing, as her worry about climate change is giving her nightmares. “How will focusing on my breath help anything, when these are real problems that affect all of us and aren’t getting fixed?” she asked.
Climate change is giving many of us nightmares now! Social psychologists tell us that the human brain isn’t very good at noticing change that happens at a slow pace, which may explain why many people ignored what climate scientists (and Al Gore!) were saying for decades. Now that Mother Nature seems to be clobbering us over the head with all of these extreme weather events, more people are noticing, but they’re reacting with despair. Is it already too late?
A member of my monthly mindfulness meditation group shared, “with all that is going on in the world I have been struggling a bit. Seems like every day something new comes up. The one issue that troubles me the most is being put aside . . . and that is climate change.” He went on to say, “but the good news is there are actions we can take to fight against it. And I have found that by taking action it has been a tremendous help to me in relieving my stress and anxiety.”
Exactly. Taking action almost always helps us feel better, because when we focus on what we have control over, and do something, we become stronger, more empowered, and less helpless. And one important action we can take for climate change is to vote.
“We need to be sure that we are electing politicians who believe in science and know how to listen to scientists, can interpret what they are telling them, and have the courage to act. This is not trivial. . . . It behooves us voters to assess current and proposed political leaders at the federal, state, and local government levels come election time, and after they are elected. This is not time to elect climate change deniers.” (Richard Maurer, League of Women Voters, Eden Area, August 2020 newsletter)
Racial injustice
Recently we celebrated the 100th anniversary of the passage of the 19th Amendment to the Constitution, granting women the right to vote. Actually, only white women gained this right, since Black women weren’t included until the passage of the Civil Rights Act of 1957, and many Native and Latina women were still excluded until 1975, when amendments to the Voting Rights Act of 1965 eliminated literacy and English fluency as requirements to vote.
Early this year, back when we could still travel freely, I was in Austin, Texas, and visited the LBJ Library and museum. As a boomer, I’m old enough to remember when Lyndon Baines Johnson was president, so the museum was a fascinating, and moving, trip down memory lane. I chose just one souvenir from the gift shop, a postcard with this LBJ quote:
“It is wrong – deadly wrong – to deny any of your fellow Americans the right to vote in this country. There is no issue of states’ rights or national rights. There is only the struggle for human rights.”
I had learned from the museum that LBJ didn’t always believe this, since he was raised in a state that had been part of the Confederacy, and that in fact he had been actively involved in voter suppression activities as a young Texas congressman. But his views evolved over his time in office, were greatly influenced by Dr Martin Luther King Jr, and other civil rights leaders of the time, and led him to push for the passage of the Voting Rights Act of 1965, which became the hallmark legislation of his presidency.
However, the voting rights guaranteed by this law have never been enforced in many states, and disenfranchisement of Black voters has been common practice in the South. Furthermore, as a result of a 2013 US Supreme Court ruling (Shelby County v. Holder), which reversed a key provision of the Voting Rights Act, efforts to prevent Black and brown voters from voting have intensified in many states, via voter ID laws, purging of voter rolls, gerrymandering and so on. (For a clear and comprehensive explanation of this dark side of American history, I highly recommend reading Carol Anderson’s One Person No Vote.)
As a white person, raised in the North by educated and progressive parents, and residing in the SF Bay Area for forty years, I confess to being in a bit of a bubble until recently. I took for granted the right to vote, because I didn’t realize how pervasive racial injustice still is. I thought when we elected a Black President we were well on our way towards realizing Dr King’s dream (“I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.”) Instead, it seems that the Obama presidency outraged a certain segment of our society, and we have been experiencing the backlash ever since.
The right to vote is the foundation of any democracy, and democracy is the foundation of a healthy society, a society that values and respects all of its citizens. Thousands throughout our history (including some of my ancestors) have fought for the freedom to exercise that right, and so that it would be granted to all Americans; yet still today there are members of our society who seek to prevent other members from exercising this basic right, based on the color of their skin. Being denied your rights takes a huge toll on a person’s health and mental health; the consequences of systemic racial injustice include higher rates of health and mental health problems, as well as restricted access to health and mental healthcare.
As a clinical social worker, I have seen that simply knowing you have a choice, and that you are empowered to make it, has an immediate and profound effect on lowering levels of stress, anxiety, and depression. I also know that by using our power to vote, we can elect representatives who will fight for our right to better health and mental health care, as well as address climate change and racial injustice, in our local communities and nationwide. So I urge you to 1) make sure that you are registered to vote, 2) educate yourself about the people and issues on the ballot, and 3) VOTE this November 3rd, like all of our lives depend on it!
For more information on voting
The League of Women Voters is a non-profit, non-partisan organization whose mission is to educate and advocate for informed voter participation. To register to vote, confirm your registration status, or learn about the issues on your local ballot, go to Vote411.org.
Sharon Salzberg has a page on her website for Election Season Resources, including some free downloadable images (like the one for this post) and a short audio guided meditation practice.
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Pandemic as Portal to a Better World
My Google calendar reminded me last Friday that I was supposed to be on a flight to Paris, for a ten day vacation. I needed to let that sink in for a moment, so I baked my weekly loaf of banana bread and pondered how the world has changed since I made those plans.
Even if I felt it was safe to spend twelve hours trapped in a large metal cylinder with a bunch of strangers, all of us breathing recycled air (and I don’t), they won’t let me in to France right now! In fact, Americans aren’t welcome in most of Europe, due to our administration’s complete failure to manage the COVID-19 pandemic, causing rates of infection, hospitalization, and death to increase dramatically over the last month, rather than being contained.
Much of Europe, as well as Thailand and Vietnam, two of the world’s poorer countries, have managed to contain the virus, while the wealthiest country in the world can’t provide adequate testing for its citizens, enough protective gear for its front line workers, or paid sick leave so that infected workers can stay home instead of bringing the virus to their coworkers and customers. Worse than that, we have certain news media and elected officials, including the occupant of the White House, telling the American people that the coronavirus is a hoax, that wearing masks is for sissies, and that we should ignore scientific and medical guidelines.
Not only am I now living in a world where I have to worry about catching a deadly virus every time I venture out of my home, but millions of Americans have lost their jobs or are furloughed indefinitely, and economists are warning that the US economy is in the ICU. Certain politicians are asking us to choose between saving the economy and saving our lives. (It’s a false choice: Sweden chose not to implement sheltering-in-place, mask-wearing or social distancing, betting they could manage the pandemic without damaging the economy, and yet they’ve lost more lives to COVID-19 than neighboring countries, and their economy still tanked.)
And if all of that isn’t bad enough, while we’ve been sheltering-in-place and losing jobs, Black people have continued to be killed by police officers at a much higher rate than whites, and when thousands of Black, brown and white people, young and old, have peacefully protested these killings and the systemic racism that underlies them, the protesters have been attacked – not only by angry white people, but now also by agents of our own Federal government.
The world I live in seems to be crumbling into complete chaos and confusion. And yet, I do not despair, in fact, I’m feeling oddly optimistic. It’s not because back in March, at the beginning of the shelter-in-place, I discovered a great recipe for banana bread: it’s gluten free, dairy free, sugar free, and surprisingly quite delicious. I’ve made a loaf nearly every Friday afternoon, when my work week is done, to provide some guilt-free comfort. (I know I’m not the only one who’s been doing more baking and cooking while stuck at home.)
Let me tell you why I’m feeling hopeful these days about the future. First, as I learned years ago, and have been telling my clients over the last few months, every crisis presents not just a threat but also an opportunity. The threats are usually obvious; it takes effort to find the opportunities. While this pandemic is clearly the worst crisis any of us now living have known, history offers evidence that it could become a portal to creating a better world, as the writer Arundhati Roy suggests at the end of this article.
As I see it, the three major crises we’re experiencing in this country – the rising rates of infection and death from COVID-19, the worst economic slump since the Great Depression, and the explosion of outrage over racial injustice – are all connected. (For a more eloquent explanation, see Nicholas Kristof’s recent column in The New York Times.) Consider this: the idea of tying healthcare benefits to employment made sense in the 20th century, but in today’s rapidly-evolving and increasingly gig economy, it no longer does. Losing your job should not mean losing your family’s healthcare benefits. The need for some form of universal healthcare has never been more obvious.
Consider also that the need for social safety-net programs like Medicaid, Headstart, and food stamps is growing, but did you know that the primary reason those programs have been maligned and underfunded for decades, by Republicans as well as Democrats, is due to the erroneous belief that Black and brown people take advantage of these programs, while white folks pay for them? (To find out the real story, read Dog Whistle Politics, by Ian Haney Lopez.)
(By the way, my optimism is fueled by the evidence that people are reading books like his, and that Richard Rothstein’s The Color of Law and Robin DiAngelo’s White Fragility are bestsellers. Democracy requires an educated citizenry, and books are a portal to knowledge, while the media can be manipulated and can also become a tool for social control and oppression.)
Thus we have an opportunity here. If we can change the structural conditions that led to these crises, we can solve them all. We can begin by expanding Medicaid and Medicare to cover anyone who needs it, as well as providing paid sick and family leave for all workers. While we’re at it, we can expand access to daycare and preschool programs, as well as increase wages for childcare workers and caregivers. Changes like these will not only improve the lives of our Black and brown citizens, they will keep the rest of us healthier, provide a better future for all of our children, and create more jobs in the healthcare and social services sectors.
Comfort food can also be healthy and delicious, like my banana bread. Making programs like Medicaid/Medicare and paid sick leave open to all enhances the health and safety of everyone, and in doing so, is cost effective. In taking care of the most oppressed and vulnerable members of our society, we all benefit. I hope that the coronavirus pandemic has made this truth so painfully obvious that voters and our elected representatives will make it happen this year. We can seize the opportunity in the midst of this crisis to create a better world!
HOW MINDFULNESS CAN HELP WITH ANXIETY AND DEPRESSION
I am enrolling now for Mindfulness-based Cognitive Therapy groups, including a new online group. MBCT is an eight-week program using a set of cognitive-behavioral therapy principles and mindfulness practices that are extremely effective in relieving mild to moderate states of anxiety and depression, as well as chronic worry and unhappiness. So I thought you might like to know what we do in MBCT, and how it works!
First, we learn about autopilot mode: our habitual way of functioning that allows us to get through the day, doing the things we have to do, while our minds are elsewhere – usually rehashing events or conversations from the past, or rehearsing events or conversations we anticipate in the future. That constant rehashing and rehearsing is tiring, and it contributes to anxiety and depression.
We learn how to step out of autopilot and into the present moment, using the breath, the body, and our five senses to help us get there and stay awhile. When we’re in the moment, we’re able to notice what’s happening right now, which is likely to be at least neutral, if not positive. For example: I’m breathing and I’m alive, at least 80% of my body doesn’t ache and is functioning just fine, it’s stopped/started raining and the sun is/isn’t shining, and I’m hungry/thirsty/sleepy/restless/bored. In the present moment, things are just as they are, and most of the time nothing bad is happening.
A common misperception about mindfulness is that it means we just live in and for the moment, with no regard for the past or future. That’s a mistaken view. When we’re mindful, we are awake and aware of what is happening, both within us and around us, which includes not only our body sensations, thoughts, and emotions, but also awareness of the past and the future, of our memories and plans. We haven’t forgotten what’s happened to us, we’re just not stuck constantly re-living it. We aren’t oblivious to the future, we just aren’t trying to solve problems that haven’t happened yet.
As we practice stepping out of autopilot (via exercises like the Body Scan and being mindful of routine daily activities) MBCT students work on strengthening the ability to focus attention, using simple meditation practices. This helps to reduce mind wandering and lessen the grip of powerful negative thoughts and emotions. They also practice non-judging awareness, by bringing an attitude of kind and interested curiosity to their experience. These are the foundational elements of mindfulness, also taught in Mindfulness-based Stress Reduction (MBSR) programs.
In addition, MBCT incorporates cognitive therapy concepts like this one: mood influences perception. For example, if you’re in a low mood, you’re more likely to perceive social rejection. We learn that the human mind has a “negativity bias,” and that being anxious or depressed will magnify the effect. MBCT students practice noticing habitual reactions of aversion and attachment, learning how to turn towards uncomfortable sensations, emotions, or thoughts, and to sit with them, rather than ignoring or trying to avoid experiencing them. This is a powerful practice that increases one’s capacity to tolerate difficult mental and emotional states.
Another concept we learn in MBCT is that thoughts are not facts. It is possible to learn to step back from thinking and simply observe your thoughts without being caught up in them, which reduces reactivity and increases stress resilience. And a key concept in MBCT is this: motivation works backwards in depression, meaning you can’t just wait for depression (or anxiety) to go away. You’ll have to push yourself to do things when you don’t feel like it, but if you practice staying in the moment, allowing your feelings to just be, and then focus on simple tasks that bring pleasure or mastery, you will improve your mood, as well as your physical well-being and self-confidence!
For more information about the Fall 2019 MBCT groups, including dates, locations, fees, and how to register, please click here or contact me via the contact form on this website.
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A Mind-Body Treatment for Trauma
I’ve recently completed training in a new therapeutic modality that I’m excited to offer my clients: EMDR. I wanted to learn it because it’s been proven to be one of the most effective treatments for trauma, whether recent or from childhood, and it often works quickly, unlike traditional talk therapy. It also aligns with my belief that the mind-body knows how to heal itself, without drugs, if given time and the right conditions.
So what is EMDR? The initials stand for Eye Movement Desensitization and Reprocessing, which doesn’t tell you much, other than there’s eye movement involved. It’s based on the Adaptive Information Processing Model, which assumes that all of our experience is stored in neural networks in the brain, called “memories.” Trauma causes disruption to the normal processing of experience, leading to traumatic memories being stored in unprocessed form, keeping them stuck in kind of a time capsule, instead of being integrated into the rest of our memories. When this happens, it can lead to symptoms like anxiety, phobias, depression and addiction, as well as a variety of health problems and difficulties with normal functioning in our lives.
EMDR works in a couple of ways: the eye movements seem to activate activity in different parts of the brain, not unlike the rapid eye movement (REM) phase of sleep, when we dream. This allows memory fragments stored in different locations to be released and integrated. Secondly, the EMDR therapist guides the client in simultaneously staying grounded in the present moment while recalling the traumatic event. This dual attention to past and present helps release what’s stuck, relieve the distress, and lay the memory to rest.
As part of the training, my therapist classmates and I practiced on each other, so I got to experience first-hand what EMDR can do to help relieve the distress of traumatic memories. In one case, I chose to focus on my earliest memory: lying in a hospital bed, alone, looking at the pattern that the sunlight streaming through the trees outside the window made on the hospital-green wall, and telling myself not to cry. I was not yet two years old.
I’d recalled this memory many years ago, when I was in therapy as a grad student, and my therapist and I had processed how I’d felt and what it meant, from an attachment-individuation perspective (e.g. I’d already learned that Mom and Dad weren’t always there, and that “good girls don’t cry”).
I didn’t think there was anything left to process, but turns out I was wrong: as I began the back-and-forth eye movements, suddenly I felt a strong sense of constriction in my chest, and it became harder to breathe. I reported that to my therapist, and was instructed to “go with that,” so I did. What came up over the next few minutes were more intense body sensations of chest constriction, a feeling of fear that I wouldn’t be able to breathe, and then the thought, “but it’s okay to cry, because this is scary.”
Which of course it was – not just scary to be in the hospital, and left all alone, but also because of why I was there. I had pneumonia! The EMDR process allowed me to access those long-stored body memories, just as if I was two years old again, yet because I was simultaneously present and grounded in my adult self, I was able to offer my child self some compassion, and gain a new perspective.
In another practice session, I chose a more recent event, and a “little t” trauma: being intentionally excluded from a family gathering. I pictured the worst part, which had been seeing a photo afterwards, with everyone smiling and raising a champagne glass, over the caption “To Rebecca.” When I’d seen that, it felt like I’d been kicked in the gut. I had told myself to forgive and let it go, but it still bothered me. So I decided to see what EMDR could do with that.
What happened was fascinating. Over the course of several minutes of back-and-forth eye movements, I felt a range of emotions: hurt, sadness, confusion, even a moment of rage. I had the thought, “I don’t belong,” followed by the thought, “but I do belong, here in this room, and in the world.” And the most interesting part: the image of the photo in my mind got blurry, faded, and grew smaller, until by the end of the session it was the size of a postage stamp. Now that’s how to let go of an unpleasant memory!
As I recall both of the original memories now, I can still picture what happened, and remember what I thought and felt at the time. But there’s no longer an emotional charge, no uncomfortable feeling in the gut, no distress whatsoever. My mind is just saying, “so that’s what happened.”
Another neat thing about EMDR is that it’s customized to the individual client’s needs. There are a variety of ways to do the eye movements, so each client can select one that’s comfortable for them. Therapy can proceed fairly quickly, or more gradually, depending on the client’s comfort. And best of all, the client doesn’t even need to describe the traumatic event in any detail to the therapist in order for the therapist to guide them through the reprocessing. This can allow trauma victims to heal without having to be re-traumatized by talking about what happened.
So if you’d like to learn more about EMDR, or are ready to start EMDR therapy, please contact me!
(Photo taken at the San Damiano Retreat Center, one of my favorite healing places.)
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Talking About Suicide
I have written about depression, including my own experience with it, many times over the years, yet I have never written about suicide. But after a week in which there were two celebrity suicides, the CDC issued a report on the dramatic increase in suicide rates across the US, and people are talking about suicide on social media, I realized two things: first, there is a lack of understanding about the causes of suicide, probably the result of our natural aversion to talking about it. Second, as a mental health professional, I am guilty of avoiding the topic with my own patients.
Perhaps we need a #MeToo movement for depression and suicide, and maybe we’re seeing the beginning of that now. I believe it’s healthy for our society that people are talking about it, however I have heard from some of my patients that it hasn’t been easy for them – either to be reminded of what may have been an extremely painful time in their lives, or to read the ignorant things that people are saying about those who would consider, attempt, or complete a suicidal act.
Suicide, like rape, has been a mostly taboo topic in our society. To take one’s life is a sin in many religions, and even people who aren’t particularly religious can be very judgmental about it. If you haven’t ever felt suicidal, it can be difficult to comprehend what it’s like to feel that way. It’s frightening to face a friend or loved one telling you they feel such despair, and if you haven’t had training in how to talk someone off the ledge, you may feel powerless to help.
Also, our healthcare system works against people seeking help for suicidal thinking, because if you tell your doctor or therapist, you could be hospitalized against your will and prescribed some heavy-duty medications which may actually make you feel worse. So people learn to NOT tell their doctors or therapists – and we learn to not probe too much, for fear of alienating our patients.
So, this is a serious issue that we need to be discussing, yet it’s often an intensely uncomfortable conversation to have, about a complicated condition for which there aren’t clear and easy answers. In this article, l offer some answers to the “why?” as well as to the “what can we do?” (Apologies in advance for the length – I may be overcompensating.)
What is depression?
Not everyone who attempts or commits suicide is depressed – but at least 80% are, so let’s start here. Depression is part of the human condition, and exists on a spectrum, anchored by suicidal thinking and behavior on one end, with ordinary moments of melancholy on the other, and a very wide range of symptoms and experiences in between. Everyone can relate to feeling sad, unhappy, or discouraged at some point in their lives. We might even have a random thought, “what’s the point of going on?” Yet most of us will never cross that invisible line from ordinary sadness to a mental disorder, or the line after that, into suicidal acts.
And yes, depression is a mental disorder, because it involves distortions of thinking and perception. However, it is also a physical disorder, because it affects energy, sleep, and appetite. And it’s an emotional disorder, because it affects mood and involves powerful negative emotions like sorrow and shame. Finally, it’s a spiritual disorder, because it involves loss of faith, hope, and meaning. We need to keep all of this in mind when we consider how to effectively treat it.
It’s an equal-opportunity illness – anyone can get it, as the recent suicides of celebrity designer Kate Spade and celebrity chef Anthony Bourdain have proven. It might be situational, developing out of grief over a significant loss; or it may be endogenous, existing in one’s genetic make-up. It can also be a learned response to stress and trauma. It often co-occurs with other disorders, like addictions, ADHD, and OCD. It can be temporary, lasting for days to weeks, or it can be a life-long condition. And it can show up differently in different people, or in different ways in the same person at different times.
Depression can be difficult to diagnose
Often people who are depressed don’t know what’s wrong with them. Or they do know, but feel some shame or embarassment, because it’s still regarded as a weakness in our society. So it can be difficult to recognize, both for the person who is suffering with it, as well as for the people around that person. I myself experienced this in the past year – I failed to see the signs that I was sliding into a seasonal depression until I’d been in it for awhile, and no one around me saw it either.
If you don’t know what’s wrong, or you feel embarassed or weak about it, you’re not likely to seek out medical care. And even if you do go to the doctor, the doctor may not recognize that you’re depressed, or to what extent. Most MDs and other healthcare professionals don’t get a lot of education and training in how to diagnose and treat depression, so often they’ll simply write a prescription for an anti-depressant medication without exploring other treatment options.
And it can be difficult to treat
Since the advent of Prozac in the 1970’s, we have developed an over-reliance on medications called SSRIs (selective serotonin re-uptake inhibitors) as the primary treatment for depression. This is one of the factors that has led to the increase in diagnosed depression as well as suicide rates.
Why? First, SSRIs don’t work for everyone – they may not work at all for some, or help just a little for others. Many depressed patients have to try multiple medications over months before they find one that helps. And these meds come with some pretty undesirable long-term side-effects, like loss of libido and weight gain, in addition to these commonly experienced initial effects: headaches, nausea, dizziness, jitters, irritability and insomnia. Is it any wonder that 50% of people either never start their prescription, or stop taking it without going back to their doctor to ask for other options?
Second, in some cases, taking an SSRI can actually increase suicidal thinking and behavior. The American Medical Association recently published a list of medications that may trigger suicidal symptoms, and every single antidepressant is listed!
Not everyone who experiences depression has suicidal thinking or behavior. I never have, and many of my depressed patients haven’t. But among those who have, there is a much greater risk that they will attempt or succeed at suicide during a depressive episode, so it is really important to identify whether a depressed person is having thoughts, mental images, or impulses related to suicide before recommending an SSRI. This means being willing to ask questions that most people, even doctors and mental health professionals, typically avoid.
The deadly combination of factors that leads to suicide
Research on suicidal depression has identified three key factors that increase an individual’s risk of suicide: the first is having a strong “fear of losing control of emotions,” which is often present in people who are successful, perfectionistic, and used to being in control. The second is an inability to tolerate “emotional intensity,” or strong negative emotions like shame and despair. And finally, there is a “sense of urgency to take action” to relieve the emotional pain, which feels like it will never end. These factors intensify the feeling of being trapped in despair with no way out.
I recently saw Brian Copeland’s solo performance, “The Waiting Period,” about his own battle with suicidal depression. He tells the story of reaching a point where he could see no way out of his emotional pain and despair, and went to buy a gun, but had to wait the mandatory 10 days to pick it up. So he couldn’t act immediately, and by the time the waiting period was over, he had found enough reasons to live that he didn’t go back to the gun store. His story is a powerful one, and he’s been giving free performances at the Marsh Theater in San Francisco as a way of encouraging more people to talk about depression and suicide. He has started a GoFundMe campaign to support his outreach efforts, if you’d like to help – or go see his show!
The survivors and their stories
Hearing directly from someone who has experienced suicidal depression and overcome it is one of the best ways to gain a better understanding. How about hearing from a guy who actually jumped off the Golden Gate Bridge – and survived? Kevin Hines did, 16 years ago, and went on to become a suicide prevention advocate, motivational speaker, and filmmaker. His is another powerful story, and his film “The Ripple Effect,” features suicide prevention experts and other suicide survivors.
Another survivor’s story that I came across uexpectedly, while researching resources for suicide prevention, is Stacy Freedenthal’s. Dr. Freedenthal is a psychotherapist, an associate professor at the University of Denver Graduate School of Social Work, and the author of “Helping the Suicidal Person: Tips and Techniques for Professionals.” She also wrote an essay in the New York Times about her own suicide attempt that she had kept secret for 22 years.
And she runs a website, SpeakingofSuicide.com, which has one of the most comprehensive sources of information and resources I’ve seen.
Treatment that helps
Any effective approach to treating suicidal depression must address the distorted thinking and perception that leads someone to feel trapped, while also impairing their problem-solving ability. Cognitive therapy is very effective at this, as Judith Beck wrote in a recent New York Times article.
But simply addressing cognitive distortions is not enough. Remember? Depression is also an emotional, physical, and spiritual disorder in which people feel alone, ashamed, and trapped. So any treatment that offers social inclusion and support, compassion, and physical activity, along with concrete steps that can be taken to climb out of that pit, will help.
One of the simplest approaches is compassionate support in the form of listening without judgment, help to discern the difference between unsolvable and solvable problems, and offering concrete assistance toward solving the solvable problems in the person’s life. This is what happens in 12-step and other support groups. (For a list, go here.)
An effective approach to treating depression that I am trained in is Mindfulness-based Cognitive Therapy (MBCT). Adding mindfulness to cognitive therapy offers specific tools to address key factors in suicidal depression: the inability to tolerate painful emotions, and the impulsivity to act. Some of the psychologists who developed the MBCT curriculum have recently developed a more intensive curriculum for people at risk of suicide.
In summary – if you’re still with me – suicide and suicidal depression are serious and complex issues that we have to stop being afraid to talk about. Now that the conversation has started, we need to find ways to keep it going, so that we don’t let depression have the last word.
(The photo above is by Thomas Hawk, found on his Flickr site, and used with permission. To see more of his incredible photos, go to thomashawk.com)
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