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Rockland County Depression and Bipolar
Support Alliance
Volume 1, Issue 4
December, 2014
UP CLOSE AND PERSONAL or Ten
Questions I have for My
Depression by Ralph Inglese
President’s Message
by Leslie Davis
Year in Review and What’s Up For the
Future of DBSA
Q1: Why Me?
Greetings to all. This is my first President’s
Message in this newsletter. This has been quite a year
for Rockland DBSA. We continue to grow and provide
more services for all of our members. January brought
us the first issue of our quarterly newsletter. This was
met with accolades from many areas of the mental
health community. It has kept our members informed,
given them an avenue for their expressions through
writings such as poetry, and lets the mental health
community know who we are.
In April we hosted our first facilitator training
which was presented by DBSA national. Our two day
program had attendees from New York, Connecticut,
New Jersey and Pennsylvania.
We had 2 great speakers during the year. In
March, Venkatesh T. Sawkar, M.D. spoke about
Electroconvulsive Therapy (ECT)
Continued on Page 5
INSIDE THIS ISSUE
1
Message from the President
1
10 Questions for Depression
2
Advisor’s Column: PTSD
6
Writings From Our Members
7
Blood Test for Depression
11
Mistakes When Depressed or Having Panic
13
Treating Depression to Prevent Suicide
15
Ask the Doc
A: My pat answer is…why not you? But actually, in case you
didn’t notice you didn’t win the genetic lottery. Your mom is
classically depressed...your father’s mother was anxiety
ridden…and even your step-grandmother (no relation) had a
nervous breakdown in the 1940’s.
Q2: So I inherited you?
A: Yes. You were also brought up in a bubble…leading to a lack
of confidence and low self-esteem. I also gave you a nervous
stomach.
Q3: I remember. Why did I feel so anxious all the time?
A: We are a package deal, anxiety and I. The chemical imbalance
in your brain lead to a life of confusion. I made sure you were
self-absorbed and isolated.
Q4: Why was I so uncomfortable in my own skin, even when I
tried to be normal? Was that you?
A: You got it. I made sure that everything was difficult…like
making friends. And at school, I added a touch of perfectionism,
so that you had to get the highest grades or suffer the guilt and
shame.
Continued on page 14
Newsletter 1
Post-Traumatic Stress Disorder
by Lois Kroplick, DO, DFAPA
Distinguished Fellow American Psychiatric Society
WHAT IS PTSD?
ANXIETY ORDER
After exposure to traumatic events:
 Actual or threatened death
 Serious injury
 Threat to physical integrity self or others
 Invokes fear, helplessness, or horror
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CORE PTSD SYMPTOMS
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Re-Experiencing
Avoidance
Hyperarousal
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CRITERIA FOR PTSD
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 REXPERIENCING TRAUMA
Flashbacks
Nightmares
Exaggerated reactions to triggers
 AVOIDANCE/NUMBING
Loss of interest
Detached feelings from others
Restricted Emotions
 HYPERAROUSAL
Difficulty sleeping or concentration
Irritability or bursts of anger
Hypervigilance
 TIME
Symptoms last greater than one month
 FUNCTIONING
Impairment in functioning
Significant distress
RISK FACTORS FOR PTSD
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Female gender – 20% (Male 8%)
War Veterans
Previous trauma-childhood trauma
Severity of trauma
History of anxiety or mood disorder
Family history of psychiatric disorders –
30%
Genetic vulnerability
Very young and very old – increase risk
PTSD IN CHILDREN
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CHANGES IN THE BRAIN
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 STRUCTURAL CHANGES
Decreased volume in these areas:
Prefrontal Cortex
Amygdala
Hypothalamus
 HOW COMMOM IS PTSD
Prevalence – 8%
Most people who experience trauma don’t
get PTSD
Occurs at any age
Occurs in families
Specific traumas associated with PTSD
Rape
Combat
Physical abuse
Threat with a weapon
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 BRAIN CHEMISTRY CHANGES
Increase in level of stress
hormones
Low serotonin levels
Low dopamine levels
High levels of norepinephrine
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 DIFFERENT SYMPTOMS
Behavioral symptoms, can’t function at
school
Cutting, suicide attempts
Compulsive risk taking, aggressive, runs
away
Nightmares, fear of sleeping along
Somatic complaints (stomach ache)
 COMORBIDITY
ADHD
Depression, Anxiety
Substance Abuse
Eating Disorders
Continued on page3
Newsletter 2
UNDERDIAGNOSIS
 REASONS
 Lack of Awareness
 Denial
 Shame
 Complex Comorbid Illness
 Atypical presentations-Somatic complaints
SCREENING FOR PTSD
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TREATMENTS OF PTSD
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COGNITIVE BEHAVIORAL THERAPY
 GOALS
Identify distorted thoughts
Change thinking patters
Often people feel guilt or shame about
what isn’t their fault
EXAMPLE: Patient has nightmares after trauma
 ELICIT A TRAUMA HISTORY
Ask if the patient has experienced trauma
Physical abuse
Sexual abuse
CAPS (Clinician-Administered PTSD Scale)
PCL (Patient self-rating-PTSD checklist
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COMORBIDTY OF PTSD
 Alcohol abuse
 Depression
 Social Anxiety Disorder
 Generalized Anxiety Disorder
 Panic Disorder
Irrational Thought: I will never sleep again
Rational Thought: I am struggling with sleeping
right now, but this is a normal reaction to stress
Irrational Thought: I will die from this stress.
Rational Though: I will continue to seek help.
IMPACT of COMORBIDITY
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80% PTSD sufferers have on comorbid
disorder
PTSD often develops with prior psychiatric
disorder
PTSD is associated with onset of other
disorders
EXPOSURE THERAPY
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TYPES OF PTSD
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 ACUTE PTSD
Symptoms begin 1st month
Last up to 3 months
 CHRONIC PTSD
 Symptoms persist > 3 months
 DELAYED PTSD
 Months of years before all
symptoms appear
 TREATMENT OF PTSD
 Therapy
 Medications
 Combined Approach is Best
 GOALS OF TREATMENT
 Reduce symptoms
 Improve resilience
 Improve quality of life
 Reduce Disability
 Reduce Comorbidity
CBT-identify distorted thoughts
Exposure Therapy-Imagine and real life
Anxiety Management
Debriefing-directly after the event
EMDR-eye movement desensitization &
reprocessing
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 GOALS
Help people face and control their fears.
Exposes them to trauma they experienced
safely
Uses mental imagery, writing, visiting place
of trauma
 RULES OF
DESENSITIZATION
Don’t jump into exposure therapy
Always prepare before the therapy
Pair the negative thoughts with positive
emotions
ANXIETY MANAGEMENT (STRESS
INOCULATION TRAINING)
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Relaxation exercises
Yoga
Meditation
Learn to identify triggers of you anxiety
 GOALS
Reduce PTSD symptoms
Reduce anxiety
Look at trauma in a healthy way
Continued on page 4
Newsletter 3
DEBRIEFING
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 DEFINITION
Highly aroused trauma patients express feelings directly after the incident
One session only
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 RESULT
Doesn’t reduce PTSD symptoms
Can exacerbate the symptoms of PTSD
Recommendations: not to do single sessions
EMDR
EYE MOVEMENT DESENSITIZATION AND REPROCESSING
 PROCEDURE
 Move your eyes back & forth rapidly while concentrating on a distressing memory
 Patient articulate a negative cognition and replaces it with a positive cognition
 Ex: Replace “I feel ashamed.” “I am proud.”
 Rate the distress and strength of belief in positive cognition and repeat this procedure.
SELF CARE
 ESSENTIAL TO RECOVERY
 Sleep
 Eating Habits
 Exercise
 Structure Your Day & Set Daily Goals
 Have a Support System
MEDICATIONS
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SSRI’s
Zoloft
Paxil
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ADJUNCT MEDICATIONS –For SLEEP
Remeron
Topamax
Prazosin
Atypical Antipsychotics
Research: Namenda, D-Cycloserine
CHALLENGES TO EFFECTIVE MEDICATION TREATMENT
 Self-medicating with alcohol/drugs
 Feeling that meds are a crutch or weakness
 Fear of addiction
CONCLUSION
 Taking it only when symptoms are sever
 Under/Misdiagnosed
 Not remembering to take the meds
 High comorbidity-substance abuse/depression
POST TRAUMATIC GROWTH
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 HOW DO PEOPLE RECOVER?
Resiliency
Mission/Purpose
Social Supports
Frequently seen in Primary Care
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Remission is attainable
Therapy and medications (SSRI’s) best
approach
Rockland County Depression and Bipolar Support Alliance 4
President’s Message Continued
and in September Lois Kroplick, DO spoke about Post Traumatic Stress Disorder (PTSD). Parts of Dr. Kroplick’s talk
are on pages 2-4 of this newsletter under Advisor’s Column.
We co-sponsored two programs with NAMI: the Mental Health Coalition Public Forum on Schizophrenia. We also
co-sponsored, with NAMI a program entitled The Ups and Downs of Mood Disorders where our medical advisor, Dr.
Lois Kroplick spoke on the symptoms, risks and treatment of mood disorders, Dr. Stephen Levy spoke about dual
diagnosis, and I shared my story of my personal journey to mental health.
I was recognized by DBSA National for outstanding leadership for the work done with our Rockland Chapter. New
York State Chapter also was recognized by National.
We currently have thirteen facilitators as our list of facilitators continues to grow. This year five additional people
went through training, either the one that we sponsored or through the New Jersey State DBSA. We currently have
13 facilitators. In addition to a training program, our facilitators are part of an ongoing facilitator development
program which was developed by our member Victoria who also heads the facilitator support group. Kudos to all of
them.
Rockland DBSA is going through a growth spurt, along with growing pains. These are all good things, but we need to
figure out where the future of R-DBSA lies. We regularly have fifty people attend our weekly meetings for which we
have expanded to five mood disorder share groups as well as a friends and family share group. The DBSA board also
grew in numbers. Each of the twelve board members bring a different set of skills to help us move the group
forward. A change in officers includes Victoria and Leonard sharing the treasurer position and myself resuming the
presidency. Laurie-Jean is continuing as secretary and Eric as Vice-President. Our new board members are Eileen,
now serving as co-president, Lydia, Brian and Barbara.
However as we continue to grow we must consider how to effectively provide services to everyone who attends our
groups. For example we are moving to a larger venue for our weekly meetings, but should we meet more than once
a week? Should we have more than one venue for our meetings? How will we find enough volunteers to meet the
demands of our membership? What kinds of programming does the membership want? All of these questions and
more have taken a substantial amount of discussion time by the Board. To this end, the Board, at its last meeting,
voted to develop a survey to get input from those we are serving, our membership. We want to know where you see
the group going and how we can accomplish that mission.
Attached to this newsletter is a copy of the survey which we encourage everyone to complete. Remember this is
your group and we want to do everything in our power to provide you with the best group possible. A special thanks
to Steve who developed the survey for us and to all of the members of the Board who provided their input.
Rockland DBSA also participated in a focus group with the Rockland County Executive’s Commission on Community
Behavioral Health. DBSA members had the opportunity to express their views about the mental health system in
Rockland County and to provide input as to where improvements could be made.
Finally to all of you, I wish a healthy and enjoyable holiday season. We look forward to another great year for
Rockland DBSA.
Rockland County Depression and Bipolar Support Alliance 5
Writing From Our Members
STANDING OUT IN THE RAIN
Feline
Oh my, how things have changed.
Black cat jumps from
sill,
>
> Chastising red car
rounding
> The road in surprise.
Yes, I was the hippie-era-ish
Stone cold sober, a rinsing rain in the summer, fully clothed,
we’d just stand there and suck it up.
Drenching. Better than a chlorinated pool or even a lawn
sprinkler. Such unjudgemental peace…awash of our troubles.
I’m 59. In the dark hours before the dawn, I saw the same
rain. I took the chance no one was awake to see me do it again.
It felt wondrous and healing.
A brave thing to do considering my diagnosis.
“oh, that crazy woman…she’s standing out in the rain”
Barbara Marsel
(Out to Dinner
Christmas Eve)
victoria 2014
I wish things like that wouldn’t happen,
I can’t stop myself, I jump into action.
Before I realize I’m out of my chair
To help the man on the floor get some air.
My life is depressing at time,
I can’t get the dying out of my mind.
It’s hard sometime to let good thoughts through
My mind races about people turning blue.
My CPR is great
My ABC’s top rate
But my mind is broken, my spirit crushed
Because my heart breaks, I’ve seen too much
The sun declines; its few remaining rays
Color the lake from shore to farthest shore;
The loons cry out; their mournful notes implore
An answer from the hills around; deer graze
Among the pines; the sun-kissed flowers blaze
Their reds and purples out, as though a door
To Heaven opened; hummingbirds explore
Each blossom avidly as light decays.
By Bobbi C., Retired RN
Cat Growing Older
As Warrior rests on my belly
And rises and falls with each of
my breaths,
He seems an old masted ship
on the sea,
Rocking and Rolling
To some ceaseless rhythm
Of eternity.
And I, who bear a darkness in my soul,
Muse on the world around me, and rejoice
That as night grows, there yet is life and light.
So, too, when my world spins out of control
And darkness comes, I still can make the choice
To seek out light even in the darkest night
When Warrior dies
A piece of his hide
Will I save in velvet tin.
As the Natives maintained the
cords of their mothers,
So I will sustain this slice of
my life
Though it grew not from within.
Evening in the Mountains
-Steven C. Hohn
Barbara Marsel
Continued on page 16
Rockland County Depression and Bipolar Support Alliance 6
First blood test to diagnose
depression developed
Health - September 17, 2014 12:54PM
Scientists at Northwestern University have developed the first
objective, measurable way to diagnose depression.
Who Is Your Board
Co-Presidents
Leslie Davis
[email protected]
Eileen Warmbrand
[email protected]
Vice President
Eric Balzer
[email protected]
Co-Treasurers
Victoria
Leonard Davis
[email protected]
Laurie-Jean
Secretary
Board Members Brian Christgau
[email protected]
The test analyzes RNA, the molecules that carry out instructions
from DNA. By observing how RNA changed after a patient was
diagnosed with depression, researchers say they were also able
to identify the biological effects of cognitive behavioral therapy.
Denny Hirsch
[email protected]
"Mental health has been where medicine was 100 years ago
when physicians diagnosed illnesses or disorders based on
symptoms. This study brings us much closer to having
laboratory tests that can be used in diagnosis and treatment
selection." David Mohr, Northwestern University Feinberg School of
Ralph Inglese
[email protected]
Steven Hohn
[email protected]
Barbara Marsel
[email protected]
Medicine
Currently depression is diagnosed using subjective, non-specific
symptoms such as mood, fatigue and change in appetite.
According to the researchers, depressed patients are often unable
to adequately describe their symptoms.
In 2012, co-lead study author Eva Redei developed a similar test
for adolescents. However, most of the RNA blood markers
identified in adults are different than those found in young
people.



First Blood Test to Diagnose Depression in Teens:
Northwestern University News
http://www.northwestern.edu/newscenter/stories/2012/04
/redei-blood-test.html
First Blood Test to Diagnose Depression in Adults:
Northwestern University News
http://www.northwestern.edu/newscenter/stories/2014/09
/first-blood-test-to-diagnose-depression-in-adults.html
First Blood Test to Diagnose Depression in Adults:
Northwestern University News
http://www.northwestern.edu/newscenter/stories/2014/09
/first-blood-test-to-diagnose-depression
Lydia Milbury
[email protected]
Founder
Leslie Davis
Newsletter
Editor
Leslie Davis
Advisors
Lois Kroplick, DO
Mona Begum, MD
www.dbsarockland@org
[email protected]
845-837-1182
DBSA National: www.dbsalliance.org
DBSA New York: www.dbsanystate.org
Rockland County Depression and Bipolar Support Alliance 7
If only money grew on trees…we wouldn’t have to ask.
We are sending you this letter to ask that you please pledge your continuing support to
The Rockland County Depression and Bipolar Support Alliance. In order for our chapter
to continue to provide weekly support groups for persons with mood disorders and their
friends & families we must again ask for your monetary support.
Rockland DBSA is a self-supporting chapter and we do not charge membership fees for
our support groups. We must again ask you to send what you are able, so that our
chapter can continue to offer its services of support to those in need. Rockland County
DBSA is a 501(c) 3 not-for-profit organization and all donations are tax deductible to the
extent allowed by law.
Operating costs to run our support groups continue to increase. We share a portion of
our weekly ‘pass the can’ contributions with St. John’s Church where we meet, which
average between $60 – 80 a month. Annual expenses include insurance costs of $1500,
National DBSA re-affiliation fees of $125, New York State DBSA fees of $225, and a web
page fee of $150. In addition, our mailing fees to publicize our weekly support groups
and advertise our semi-annual Speaker Series run in the hundreds of dollars. Our
participation in numerous health fairs additionally cost hundreds of dollars for brochures
and public awareness.
Attendance at our weekly support meetings continues to increase with over forty regular
attendees in our Mood Disorder and Friends and Family share groups. To better
accommodate the larger membership we have focused on communication and facilitator
training this year. Through your past generous contributions we have been able to:

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Publish a quarterly newsletter;
Host a two-day facilitator training event;
Institute a Facilitator Support group;
Formalize a facilitator training protocol;
Increase public awareness
In the coming year we hope to further increase our services to the community. To do so
we need and appreciate your continued support.
Rockland County Depression and Bipolar Support Alliance 8
Please do not wait to send us your donation. With your monetary contribution, Rockland
County DBSA can continue with our mission to improve the lives of people living with
mood disorders.
Sincerely,
Rockland County DBSA
Leslie Davis, Co-president
Eileen Warmbrand, Co-president
Tear Off Contribution Card
My Rockland DBSA Donation:
Your Name:
Address:
We ask that you make your checks out to ‘Rockland County DBSA’. You may either bring
your tear off contribution card and check to a meeting or mail it to:
Leslie Davis
Rockland County DBSA
13 Case Court
Monroe, NY 10950
If you wish to make your donation with a credit card, you may make your
contribution through Paypal by simply going to our website
www.dbsarockland.org and click the donation tab.
Rockland County Depression and Bipolar Support Alliance 9
ROCKLAND COUNTY DEPRESSION and BIPOLAR
SUPPORT ALLIANCE IS MOVING TO LARGER, BETTER
SPACES
Starting with the Thursday Meeting
February 12, 2015 we will move to
Jawonio, located at 775 North Main
Street, New Hempstead, NY 10977
The group will continue to meet from 6:30 – 8:30 pm
Here at Jawonio we have at least 9 share group
rooms, with additional space to add on. We have a
large room that will hold at least 60 people. We have
a closet to hold our personal items. We have rooms to
have private conversations…and Jawonio is asking for
no money from us, and yes there is a kitchen.
Rockland County Depression and Bipolar Support Alliance 10
6 Mistakes We Make When Depressed or Having a
Panic Attack
By Nikolay Perov
1. Resisting.
the results if you like. Would it be true to say that it’s
not all as terrifying and dreadful as it seemed at first?
When we feel a bad mood, depression, or panic
coming on, our first wish is to get rid of it as quickly as
possible, to change the “bad” mood into a “good” one.
This is natural; it’s how we’re made. But all too often
our attempts just make everything worse.
When you stop feeding your depression with fears
and thoughts it becomes much easier to shake off.
Resistance forces us to think constantly about our
condition, to focus all of our attention on it, to feel bad
because it won’t go away, to wait tensely for relief.
But the simple truth is that you can’t control
everything. Attempting to get your condition “under
control” often leads to extra stress and unwanted bad
feelings. It’s sometimes best just to relinquish control
and cease resistance.
If we relax and let our depression or panic come
without trying to control anything, accepting that
they’re only temporary feelings which will pass in due
course, things become much easier.
2. Feeling bad about feeling
bad.
We start to have thoughts such as “I’m going to die or
go crazy,” “This’ll never end,” and “I hate that I can’t
enjoy life like other people; I feel utterly miserable.”
Our mind starts to add new fears and negative
emotions to the depression we already have. And, as
I saw for myself, these fears and feelings end up
constituting the main part of our condition.
It’s actually your mind, not the depression and panic
themselves, which makes each episode so
unbearable.
If you don’t believe me, try this experiment: The next
time you’re overwhelmed by an attack, try to simply
observe it without getting caught up in or assessing it
in any way. Just watch it in its pure form, without any
thoughts. Try to notice which parts of your body you
feel it in and how it comes and goes.
In this way, you’ll remove your mind from the formula
of your distress. You’ll notice how much weaker the
attacks become when they’re no longer supported by
your thought processes. Give it a try, making notes of
3. Comparing.
“Everything was so good when I wasn’t depressed!
What an amazing time it was, and how awful it is now.
Why can’t I go back?!” These are the kinds of things
many people think, me included, but such thoughts
bring nothing but harm.
If you want to beat depression or panic, you have to
stop comparing. Forget that there’s a past and future.
What’s happened has happened. Don’t dwell on it,
and instead live in the here and now.
Start with what you have, and don’t think about how it
all was before. Learning how to live in the present
moment will make your depression or panic much
more bearable.
4. Asking pointless
questions.
Many people spend hours asking themselves all kinds
of questions: “When will this end?” “Why me?” and
“What have I done to deserve this?”
To make use of a well-known Buddhist parable, these
questions are as much use as trying to figure out the
source of the arrow which blinded you: it’s just not
that important. What you need to know is how to pull
the arrow out.
Questions of the “Why me?” ilk just make your
condition worse, forcing you as they do to complain
and be upset about something that’s already
happened. Focus on what will help you get past your
depression and don’t bother with questions which
don’t serve this purpose.
5. Believing your fears.
We think that because we experience such fear at the
idea of going outside, meeting people, or going on the
underground, it means that something bad is going to
happen. There’s nothing surprising in this, because
Rockland County Depression and Bipolar Support Alliance 11
nature has made fear in order to warn us of danger.
We’re made in such a way that we instinctively
believe this fear and respond to it.
But our fear hardly ever arises due to a real threat.
For example, the fear of losing your mind or
suffocating during a panic attack is simply fallacious.
Stop believing this fear. Whatever it is you’re afraid of
at these times isn’t going to happen.
Fear is nothing more than a feeling, a chemical
reaction in your head. If you’re overcome with terror
when you go down into the underground, it doesn’t
mean that something horrific is laying in wait there.
It’s like a malfunctioning fire alarm—just because it’s
going off doesn’t mean there’s actually a fire.
So stop listening to your “inner alarm” every time it
goes off. Don’t pay it any heed: go out, meet your
friends, get on a plane, and let the alarm keep ringing.
Nor should you try to “switch it off,” as this doesn’t
always work. Just ignore it. In other words, stop taking
your fear as something real.
6. Seeking reasons for your
depression in the outside
world.
This is another mistake I made myself. I thought that
my malaise was linked solely to the way my life and
work were going. I believed that if I could just change
that, I’d be happy.
But then, with meditation, I realized that everything I
needed to be happy was inside me, and likewise what
was causing me to suffer!
I was so edgy, anxious, feeble, caught up in bad
habits, undisciplined, and irresponsible that even if I’d
succeeded in changing the external circumstances of
my life, the traits that had given rise to my depression
would still be there.
In order to get rid of my depression, I had to get rid of
the internal reasons that had caused it.
So don’t keep telling yourself, “If I get a new job,
everything’ll be smooth sailing,” or “If I get rid of
everything I’m scared of, there won’t be anything to
be afraid of anymore.” Your depression and fears
reside inside you, so wherever you are, they will be
too, projected onto the outside world.
Of course, this doesn’t mean that you shouldn’t strive
to improve your life. First of all, though, you need to
direct your efforts inwards.
CONCLUSION: ACTING
AGAINST WHAT FEELS LIKE
COMMON SENSE
Now, when I look at these mistakes and remember
making them myself, I can see the one thing that
unites them.
The reason we make them is that when depression or
panic pounces on us, we start to think and act in the
way our instincts and gut feelings tell to us. “Be afraid,
run away, resist, danger awaits you everywhere,
you’re trapped,” they whisper.
Tuning in to this during a bout of depression
aggravates our situation. This is because our mind,
emotions, and instincts are strongly conditioned by
depression, so listening to them is like listening to the
voice of a malicious, invisible demon intent on leading
you to ruin.
To free yourself from depression once and for all you
have to drop all your notions of common sense;
abandoning your sense of reason, you must act
against them.
Don’t resist your depression, accept your fears and
allow them to simply pass; don’t get caught up in
them and don’t believe them; don’t compare your
current situation to how it was before—all things that
feel illogical when you’re in a state of terror or intense
depression.
What I’m advising may seem to be the polar opposite
of what your gut encourages you to do. But it’s
precisely because people continue to give credence
to and obey these feelings that depression is such a
widespread complaint. You need to act somewhat
paradoxically to get rid of it.
My own experience has convinced me of this. The
understanding I reached allowed me to come through
my difficult situation and continues to help me cope
with challenges I encounter on my journey.
Man breathing deeply image via Shutterstock
Rockland County Depression and Bipolar Support Alliance 12
Treating
Depression to
Prevent
Suicide
AUG. 24, 2014
Inside
Photo
Credit Caroline Gamon
To the Editor:
What Dr. Jamison clarifies by
using her own experience with
suicidal depression is the need
for combined treatment with
psychotherapy and medications
like lithium and
electroconvulsive therapy if
medications fail. This is a
valuable and necessary addition
to understanding that severe
mental illness can be treated.
illness generally is isolation.
The mind is powerful, fragile
and all too alone. We must
ground ourselves in relationship
to one another. Otherwise, our
mind thinks that it knows what
reality is, and it never knows
the whole story. It can’t. None
of us can contain reality on our
own; we have only our
perspectives and perceptions.
Her example as someone who
has been helped to live a
productive life because of
combined treatment should
serve to inform all of us —
psychiatrists, mental health
professionals and ordinary
citizens — of the existence of
effective treatment for severe,
suicidal depression.
Thus, relationship is critical,
and empathy is not optional or
in any way secondary to
professional competence.
RAVI CHANDRA
San Francisco, Aug. 16, 2014
The writer is a psychiatrist.
To the Editor:
Re “To Know Suicide” (Op-Ed,
Aug. 16):
As a psychiatrist trained in
psychoanalysis, I find that my
clinical experience meshes with
Kay Redfield Jamison’s article.
In the aftermath of the public’s
response to Robin Williams’s
suicide, her observations about
the importance of
differentiating types of
depression, particularly bipolar
from other types of depressive
disorders, is particularly
important.
Furthermore, her effort to
describe the painful and
inexorable feeling state that a
person suffering from bipolar
depression experiences comes
as close as is possible to
explaining why a person with
an otherwise successful life
might be driven to suicide.
HENRY J. FRIEDMAN
Boston, Aug. 16, 2014
The writer is an associate
clinical professor of psychiatry
at Harvard Medical School.
To the Editor:
Kay Redfield Jamison provides
insight into suicide and the
struggles of mental illness,
valuable after Robin Williams’s
suicide. I applaud her emphasis
on competent care, but I take
issue with her drawing a
distinction between competence
and compassion. You can’t
have one without the other, and
both are trainable and must be
cultivated at all levels of health
care and society if we are to
prevent suicide and ease the
burdens of mental illness.
One of the chief problems of a
likelihood of suicide and mental
Regarding Kay Redfield
Jamison’s commentary on
suicide: What can we really do
to help?
As a journalist and a survivor of
suicide attempts who has
interviewed dozens of “out”
survivors, I would like to offer a
few ideas rooted in social
justice, a concept missing from
the conversation.
Stop discriminating against
people who have been suicidal.
It takes guts to open up about
this, and yet some people are
fired for it or are expelled from
universities. It’s illegal, but the
fear is enough to keep a suicidal
person silent until it’s too late.
Educate. Just two states,
Kentucky and Washington,
require that mental health
continued on page 14
Rockland County Depression and Bipolar Support Alliance 13
Continued from page 13
professionals be trained in
suicide prevention. Get to know
the emerging movement of
suicide-attempt survivors, who
this year got the country’s top
suicide prevention group, the
American Association of
Suicidology, to create a division
for people who have been
suicidal; released the federally
funded report “The Way
Forward” with demands for
change; and put us front and
center in a field that
acknowledges that it has long
neglected us.
founder of
Attemptsurvivors.com.
Finally, take a good look at us
at Livethroughthis.org, and try
to tell yourself that people who
have been suicidal are really
some nameless “them.”
A version of this letter appears
in print on August 25, 2014, on
page A18 of the New York
edition with the headline:
Treating Depression to Prevent
Suicide. Order Reprints|Today's
Paper|Subscribe
CARA ANNA
New York, Aug. 16, 2014
The writer is a member of the
Attempt Survivor Task Force of
the National Action Alliance for
Suicide Prevention and the
Up Close and Personal…continued from page 1
Q5: That wasn’t very nice. Were you the reason for the drugs and alcohol?
A: Absolutely. You had to self-medicate or literally bust.
Q6: But Igave up the stuff up for 15 years and seemed to be okay. Graduating with honors, bodybuilding, marriage, and all that
comes with career building. Where were you?
A: Waiting. I knew all that over compensation would lead you back to me. I knew you would crash and burn, and return to selfmedicating.
Q7: Ouch. Was I in denial of you and your power?
A: Oh, so in denial. I knew you could give up the substances, so I made sure you were miserable when you were sober.
Q8: I see that now. But did you have to put me in that hole, that awful dark pit of hopelessness?
A: That’s how it works. Remember…I kill.
Q9: What pisses you off?
A: Awareness…treatment…medication…DBSA…AA…and that damn internal spirit to rise above me.
Q10: Will I ever be free of you?
I doubt it. But I’m feeling pretty weak these days…but…I’ll be ready if you drop the ball.
Not a chance…I’m sticking to my wellness program…all the things that piss you off
Rockland County Depression and Bipolar Support Alliance 14
Ask the Doc
Q: A relative of mine, recently diagnosed with bipolar disorder, has been displaying disorganized
thinking, exercising poor judgment without knowing it, overstepping boundaries, with hyper-religiosity.
She does not see these things, but her loved ones do. I want to let her know our observations so she
can get the right help. How do I gently tell her this without upsetting or alienating her?
A: These conversations can certainly be challenging. Despite what you see on television, dramatic
Greg Simon, MD, MPH
confrontations or “interventions” are often not at all helpful. It’s usually best to start with a calm and nonconfrontational one-on-one conversation. Some general advice about how to make those conversations
more effective:
Pick the right time. You may feel the most urgent need to have this conversation right after something
upsetting has happened, like an argument or confrontation. But those can be the most difficult times for
people to feel safe and understood. Try to pick a calmer time when things are going relatively well—
when you are feeling more connected or in agreement about things. It’s natural to want to fix the roof
when it’s raining, but it’s safer and easier when the sun is out.
Describe, rather than label. Try to express your concern about specific things you notice without using
diagnostic labels (like “manic”) or inflammatory terms (like “out of control”). Instead, try using “I”
statements to describe what you see: “I notice that you’re talking faster than usual” OR “I notice that
you’re only sleeping a few hours at night.” If you use any labels, be sure to allow that you might be
wrong: “Last time you were talking fast like this, it turned out that you were getting manic. Could that be
happening again?”
Find common ground. Is something happening that both of you can identify as a problem? You may
be most concerned about your relative’s over-spending, but she may care most about not being able to
sleep. Try to understand what she is most bothered by, even if it is not your highest priority.
Avoid threats and “I told you so.” If you are upset or frightened, it’s natural to want to say things like
“If you don’t get help, then (fill in terrible disaster of your choice)!” The only thing less helpful is to say,
“Didn’t I tell you this would happen if you didn’t get help?” If your relative is not seeing some problems
that you are seeing, then fear or humiliation will not make it easier for her to see them.
Offer to help. Instead of saying, “You’d better get in to see your doctor right away!” it’s usually more
helpful to say something like “How could I help you to check in with your doctor?” Offering and asking
often works better than telling.
Greg Simon, MD, MPH, is a psychiatrist and researcher at Group Health Cooperative at the Center for
Health Studies in Seattle. His research focuses on improving the quality and availability of mental health
services for people living with mood disorders, and he has a specific interest in activating consumers to
expect and demand more effective mental health care.
Reprinted from DBSA National Website
Rockland County Depression and Bipolar Support Alliance 15
Writings From Our Members Continued
Easy
It would be so easy
But I’m well now
Still it would be so easy
It’s logical
There is no logic
Ironic
I still think about it often
But I’m well now
I think about it
About why I think about it
It really would be easy
It feels right
I’m well now
I don’t feel anything
Sad
And that’s why
It would be so easy
Sad
Not depressed
I can think
I’m well
I can think
Well
It would be so easy
Thaw
Winter vines carve dark
Red arcs through crystal air
and
Hover there on snow.
My fog breath whines at
You in icy woods but still
My heart unfreezes.
Barbara Marsel
When I wrote this I didn’t realize how easy. But it wasn’t easy, me, it was thoughtless, as in devoid of thought. I wasn’t
thinking, I’d stopped thinking. I just moved; no senses, no feelings, no mw.
I didn’t know that the disease could strip me so bare. I didn’t think I would succumb again. I’d been through the rigors, I
thought, enough times; inpatient, outpatient, DBT, CBT. ACT, therapy, meds, support groups, friends. I’d learned; to
control, to let go, to ask, to tell. I was well.
I have learned. I don’t know if it is due to the critical impact of the last attempt, or because it was the right time, or, or,
or…it doesn’t matter. There is a shift in my thinking, a movement in my being. I am here, I am grateful, I am supposed to
be here, amongst people, friends, to use my body, my brain to whatever capacity is allowed me, to have an impact upon
my world, however large or small. To not squander my days in despondency and laziness, to take one step at a time, to
forgive myself and not give cause for others to forgive me.
The most precious lesson of all..It is so easy. When the Dis Order has crept in and I am not paying attention, I can get lost.
It may just be so again one day. But, without pressure, rather with diligence, I move through each day aware, unafraid
and I work to maintain the order. Maybe that is my purpose, simply to survive from day to day and that is fine. I just
choose to do it in the very best way I can.
Eileen Warmbrand
Rockland County Depression and Bipolar Support Alliance 16