Lisa Loren: Catalysis

Do you know that old question about what might have happened to Van Gogh if he’d had antidepressants available? It’s a stupid question, in a lot of ways. He killed himself, probably as a result of the same mental illness that shows up in his work. If he’d had Prozac, he might he might have lived to see his own work become famous.

And yet, people ask. Didn’t he gain something? Didn’t we?

There’s no glory to a life lost to mental illness, whether through time wasted away in sickness or through suicide. There’s nothing romantic about depression. (I write this a few days after hearing about Heath Ledger’s possible suicide.) We, as humans, have lost too many people to mental illness, to early death, to unbearable pain. We have lost brilliant people to psychotic worlds of their own creation. No amount of creativity will ever justify the raw cost of mental illness. No benefit can justify this degree of human suffering. So, maybe Van Gogh never would have painted The Starry Night, and the world would go on without him. Maybe he would have become a better painter, tempered by age and experience. Maybe he would have prevented World War I. We will never know.

I’m going somewhere with this, actually. There’s an article up on The Guardians’ Joe Public blog asking, Would you vote for an MP with mental health issues? The attached poll, at this moment, is resoundly in favor of doing so, but I’m inclined to wonder if Americans would so easily say the same thing. Americans seem to like strong leaders, and I can imagine the fear that someone with a history of depression might break under stress. But I think of Winston Churchill (depression), and Abraham Lincoln (also depression), and I know that these people made spectacular leaders.

Here’s where Van Gogh comes in. People with mental illnesses are, above all, people; some are full of wisdom and some seem stuck in their own minds. However, I think that people with mental illness must derive some advantage from it. I don’t honestly believe that depression has an evolutionary advantage, but as we see in Van Gogh, it does have some connection to creativity. Various studies have found that people with depression tend to gravitate towards creative professions.

I think, also, that depression makes people more aware of the pain of others. Suffering builds compassion, and the pointless suffering of depression helps us to feel for people who have gone through things without actually enduring them.  On a fundamental level, this means that people who have gone through depression and overcome it are more equipped to help those in trouble, tend to those in pain, and console those living with grief.  Where depressive episodes make people less sociable, depression in life can make people better social animals.

I would never wish Van Gogh’s life on anyone. Whatever benefits depression may offer, they aren’t worth hurting innocent people for. I believe, however, that the people out there with mental illnesses can find some benefit in what they’re experiencing, instead of letting themselves suffer for no reason. What differentiates Van Gogh from so many others is that he used his illness to give something to the world.

Thinking of suicide?

Wait. Just for a minute. Take a deep breath. Make yourself a cup of tea, if you like.

Read this first.

I do not want to talk you out of your bad feelings. I am not a therapist or other mental health professional - only someone who knows what it is like to be in pain.

Try this. Or this. Or this. Maybe this.

I believe that people don’t attempt suicide until they’ve run out of other options. I’m putting this page together because I want to offer people way to stay alive for a little while longer. The desire to die does fade, in time, but death lasts forever. This is a list of ways to cope with thoughts of suicide.

Talk to Someone

A hundred years ago, Sigmund Freud discovered something that people have known since we learned to walk upright and draw pictures: talk helps people heal. Talking to another person can ease despair, reduce suffering, and help you cope with pain. Thousands of people out there want to help you so much that they man the phones at crisis centers and suicide hotlines for the chance to help people hurting just like you. These aren’t professionals, and they aren’t getting paid. The only reason they show up is to help people.

• 1-800-273-TALK (8255)
• 1-800-1-800-SUICIDE
• Find a helpline at http://www.befrienders.org/ (US and international)
• Email the Samaritans

Ask for Help

If you have friends of family that you trust to help you out, try talking to them. (Needless to say, if you think someone will be overemotional or angry, he or she is probably not a good candidate for this.) Most untrained people won’t know what to say when dealing with a suicidal friend, so you may have to be clear on what you need. Consider printing out one of these sheets from metanoia.org, this one from the American Association of Suicidology, or anything else that you find helpful. Ask someone to sit with you for a little while, or listen to you. You don’t even need to say that you’re suicidal, although if you’re seriously considering harming yourself, it might be best to let someone else know. Don’t be afraid of waking someone up or interrupting them. Suicidal people often feel guilty, or as if they’re not worthwhile, but you’re important to the people around you. Your friends would much rather lose a night’s sleep than lose a friend.

Learn Coping Techniques

Try Distress Tolerance. Originally developed to handle the suicidality and self-harming behaviors in Borderline Personality Disorder, these techniques can work well for anyone in crisis. Some of it might seem a little corny or oversimplified, but it’s kept people in a lot of pain alive and out of hospitals.

• Distract yourself (the link has examples of ways to do this)
• Invoke your senses (this grounds you and helps you take control of your emotions)
• List the pros and cons of hurting yourself

DBSA has these suggestions:

• Keep a journal to write down your thoughts. Each day, write about your hopes for the future and the people you value in your life. Read what you’ve written when you need to remind yourself why your own life is important.
• Go out with friends and family. When we are well, we enjoy spending time with friends and family. When we’re depressed, it becomes more difficult, but it is still very important. It may help you feel better to visit, or allow visits from, family and friends who are caring and can understand.
• Avoid drugs and alcohol. Most deaths by suicide result from sudden, uncontrolled impulses. Since drugs and alcohol contribute to such impulses, it’s essential to avoid them. Drugs and alcohol also interfere with the effectiveness of medications prescribed for depression.
• Learn to recognize your earliest warning signs of a suicidal episode. There are often subtle warning signs your body will give you when an episode is developing. As you learn to manage your illness, you’ll learn how to be sensitive to them. They are signals to treat yourself with the utmost care, instead of becoming ashamed or angry with yourself.

Educate yourself about suicide. Try Psych Central’s FAQ, the AAS fact sheets, or the chapter on suicide in Andrew Solomon’s Atlas of Depression.

Seek Professional Help

If your feeling about suicide last, or if they’re too strong for you to cope with, you should consider looking for professional help. If you have health insurance, most insurance companies will give you a list of professionals they’ve approved in your area. (They say they’ll only give you a few sessions, but usually will pay for more if it means keeping you out of the hospital. It’s worth a try, at least.) Your local crisis center will also probably be able to refer you to someone. Therapy can get expensive, but some therapists work on a sliding scale. Still, going to therapy is an investment of time and resources.

Call 911

Hospitals see people in crisis all the time. Police deal with people in crisis all the time. It’s extremely difficult to kill yourself in a hospital, so if you’re worried that you might do something impulsive, going to your local emergency room can give you a chance to get a grip on your emotions. I don’t honestly believe that checking yourself into a hospital helps most people get better, but it can buy you time. Furthermore, most hospitals will set you up with outpatient treatment when you leave. When you’re not feeling well, going through your insurance company’s big list of therapists can be exhausting. The people at your local hospital can help you with that.

Don’t try to do it alone.

Most people can’t do everything by themselves, no matter how much they want to. Maybe you’re an exception to the rule, and maybe you don’t need anyone else, but do you really need to take that chance? You’re important. Make yourself a priority. Get help.

There’s a school of motivational theory that basically says hey, kid, you’re never going to be spontaneously motivated to do the laundry. Nobody wakes up at three AM wanting to do laundry unless they’re manic or on cocaine. The trick to finding motivation is to just start doing whatever it is that needs to be done. Even if you aren’t motivated to start, you may be motivated to keep going. The mental process of wanting to start doing something is fundamentally different from the process of wanting to continue doing it.

New research suggests that these two elements of task completion activate biologically discrete systems within the brain. Difficulties in starting tasks may be about more than overcoming fear or inertia. The process is controlled by a system independent of the one involved in keeping a task going.

ScienceDaily: Brain’s Voluntary Chain-of-command Ruled By Not One But Two Captains

Distinct brain networks for adaptive and stable task control in humans (abstract)

I’m looking forward to seeing how this might play out with regards to bipolar disorder and depression.  Could some imbalance between these systems be behind the infamous manic half-finished projects, or the can’t-find-the-car-keys inability to self-start that depressives suffer from?

This article from 2000 has a fascinating take on suicide in China. I don’t really believe its conclusions, but it opens up a window into Chinese mental health seven years ago. A team of psychologists from Canada and the Chinese Academy of preventative Medicine interviewed the families, friends, and neighbors of people who had killed themselves in an attempt to diagnose mental illness after the fact.

Preliminary findings suggest that between 50% and 60% of Chinese people who commit suicide have some form of mental illness. [...] In fact, the importance of mental illness as an explanatory factor in Chinese suicides is not as great as in other countries, which typically report mental illness in over 90% of people who kill themselves. It is therefore a significant finding that up to 50% of young Chinese women who commit suicide may be suffering from no mental illness at all.

In the US, a suicide attempt is (in my non-expert experience) pretty much a de facto diagnosis of some sort of mental illness. Basically, in our current system, a person cannot want to end her own life unless she suffers from some sort of mental problem.

In a complementary research project, the team has interviewed people who attempted suicide but were taken to hospital and saved. Asked when they had first thought of committing suicide, an astonishing 29% reported that they had decided to kill themselves only ten minutes or less before the attempt. Fully 50% reported that they had contemplated suicide for less than two hours.

Tidbits like this made me doubt the methodology of this study. True, impulsivity does play a part in suicide attempts, but there’s quite a difference between “I’ve never contemplated suicide before, and now I’m going to kill myself” and, “I’ve been thinking about this for months, and I’ve decided that today will be the day.” I’d worry that, somewhere in translation, a history of suicidality without immediate intent could be lost. In the process, nearly 50% of suicidal Chinese women might be labeled as stupidly impulsive instead of seriously ill.