MANAGING STRESS IN OUR LIVES

Sunday
Sep112016

SUICIDE AND GUNS

From the Harvard Public Health magazine of the Harvard T.H. Chan School of Public Health report on "Guns and Suicide...the hidden toll" by Madeline Drexler, Editor of Harvard Public Health magazine. Ms. Drexler summarizes data on the association of suicide and gun ownership.  She reports that many more people kill themselves with guns [19,392 in 2010] then are murdered with guns [11078 also from 2010]. Also from 2010, 38,364 people killed themselves and over half used guns. Thus, suicide by gun was more than all other methods combined.  About 85% of suicide attempts with guns end in death while only 3% of poisoining end in death.  There are a number of reasons that someone would become suicidal and yet the outcome of these thoughts are directly linked to the method used.  A 2008 study by Davis and Hemenway [New England Journal of Medicine 2008; 359:672-3] found that suicide using guns was 3.7 times more likely for men and 7.9 times more likely for women in states with highest rates of gun ownership. Estimates now are that one in three households have at least one gun. Davis and Hemenway also found that while the populations [from 2001-2005 data] were almost even between states with the highest gun ownership [47% of households had guns] compared to states with the lowest gun ownership [15% of households had guns] there were 16,577 suicides by firearms in high gun ownership states and 4,257 suicides by firearms in lower gun ownership states, while suicides by other means were virtually equal [9,172 compared to 9,279].  So of course more suicides occurred in states with more guns but what also seems significant is that there was no difference in rates mental illness, divorces, money stress, etc that might have been a reason for more suicides by firearms in high gun ownership states compared to low gun ownership states.  Also, a 2001 study from Houston, Texas [reported by Davis and Hemenway] looked at the time between someone first deciding to kill themselves and their suicide attempt.  They found that 24% said it was less than 5 minutes; 48% said less than 20 minutes; 70% less than one hour; and 86% less than 8 hours. This highlights the increased risk for suicide when there is access to guns as the decision is made within 20 minutes almost half the time.  This suggests that suicidal berhavior may frequently be impulsive and leads to death if guns are available.  This would explain why more people kill themselves in areas with more guns as the impulse to kill oneself may be more frequent than we think it is. Also of importance is that 9 out of 10 times there are no more suicide attempts after the first one.  Thus if they survive the attempt they are not likely to try again.  Put this with the fact that nearly 90% of suicide attempts with guns end up in death and it is clear how important it is to keep guns out of the hands of suicidal people. 

All of the above highlights the danger of access to guns as this significantly increases the number of suicides.  People who disagree with these findings or feel that access to guns is not the issue point to the fact that there are a number of other countries that have strict gun control laws and yet have significantly higher rates of suicide.  My response would be that that does not change the reality that access to guns dramatically increases the number of people who committ suicide in the United States.  This would suggest that if access to guns in these other countries were increased that their rates of suicide would increase as well.

So what is the solution?  One person suggested always storing guns without bullets and store them outside the home.  Others suggest that fewer guns is more likely to lead to fewer suicides because it is less likely that people will change their behavior patterns and store guns outside of their homes.  This is especially true if people feel a need to have their guns close at hand to protect themselves.  This then points to a need to help people feel that they do not need to protect themselves by having quick access to guns.  This suggest to me that we would have to lower the stress level in people and help them to feel part of the larger community of humans as isolation inceases stress and fearfulness.

So, how do people lower their stress level?  I have written a number of blogs about that. To lower our stress levels it seems to require that we let go of our judging and stereotyping others and begin to see that we are more alike than not and that we need each other in order to be happy and feel fulfilled in our lives. 

Monday
Jul252016

JUST SOME TREES OR A STAND OF TREES OR A COMMUNITY OF TREES?

I just finished listening to a TED talk by Suzanne Simard on "How trees talk to each other." My conclusion from listening to her is that trees form communities and in a number of ways look out for each other, sharing carbon and other nutrients. Apparently, some older trees are like hubs that send out nutrients to different trees that helps sustain those trees. It makes me wonder how many plant and animal species act in similar ways to support each other as they form diverse communities. This would seem to suggest that the homo sapiens sapiens species are meant to do the same thing.  So, instead of being guided by what our dogs would do [what would your dog do?] we might be guided by what our trees do [what would your trees do?]. What do you think?

Friday
Jul152016

NEW SUICIDE DATA

An article in the June, 2016 Clinical Psychiatry News by Howard S. Sudak, M.D. [Commentary New suicide data: Reason to panic or ponder?] discusses new suicide data from the CDC's National Center for Health Statistics indicating a 63% increase in U.S. deaths by suicide for females and a 43% increase for males equaling a national rate of 13.5/100,000.  In actual numbers this represents 42,773 deaths by suicide in 2014 compared to 29,199 in 1994.  Of additional concern was the 200% increase in suicides for girls aged 10-14 and for Native Americans an 89% increase for females and 38% increase for males. Of additional concern is the increased use of hanging or strangulation [presumbably easier access to these methods] while use of guns fell for both males and females.

Dr. Sudak reported about a New York Times article on the CDC Data that theorized that the increase in suicides was related to lower rates for marriage and increased rates for divorce.  Data indicate that unmarried men and women are more likely to die from suicide.  Of additional concern is the fact that divorce rates have doubled for middle-aged and older adults since the 1990's. There is also a correlation of lower marriage rates and increased divorce rates with increased suicide rates for men and women. They also reported that historically when "cataclysmic" events such as World Wars occur the suicide rate goes down while when there is a financial crisis the rates go up dramatically.  I have previously blogged about the connection between the threat of job loss and actual job loss and an increase in the risk of suicide.  

These data would seem to support that stress is a significant factor in the increase in suicides in recent years as the United States has experienced a financial depression as well as a barrage of increasingly alarming news from around the world and the United States.  Stress can cause people to withdraw from others as a way of coping with the stress. This withdrawal can lead to further isolation from others and decisions not to marry or to problems in marriages that can lead to divorce.  It is very clear to me in my work helping my patients that being [or feeling] isolated from others makes overcoming stress much more difficult.  

Importantly, our brains will seem to work against us as they "help" us to be isolated from others as the isolation is part of a pattern of coping to reduce stress and our brains are supposed to maintain patterns. Therefore, to change patterns of behavior we have to make it clear to our brains [ourselves] that we want to make a change and then have to make clear efforts to change these patterns.  This is difficult as we often feel that things will be even more stressful if we interact with others and we are often very concerned about things getting worse. For this reason we need support to change these behaviors and risk trying to interact again.  So, if you know or feel that someone is more isolated or withdrawing from others encourage and support them by initiating interactions with them and listening to them so that they can feel connected to you.  Listening can be very helpful and means hearing others without your own agenda getting in the way.  It is also important and helpful to ask people if they are feeling hopeless or suicidal.  If you are worried about someone's safety please talk to them about it and let someone else know, including professionals or even the police.

 

 

Thursday
Jul142016

ADULT ADHD...FACT OR FICTION?

There has been controversy whether adults can have ADHD/ADD.  There is also some support for children outgrowing their ADHD/ADD and therefore not having the diagnosis as adults.  There is also a question raised about the possibility of the onset of ADHD/ADD as an adult.  

I have assessed a number of adults who were not previously diagnosed with ADHD/ADD and all have both childhood onset of symptoms and continue to have symptoms as adults.  So, what's up?  Well studies that do not identify many children with ADHD/ADD indicate that there are many children who are subthreshold for the diagnosis and yet have symptoms that impact their lives. So, do these children have ADHD/ADD? Maybe the threshholds for making the diagnosis need to be re-evaluated.  I have found that procrastination is a reliable indicator of ADHD/ADD as non-ADHD/ADD individuals are undone by the stress of a deadline and the struggle to finish assignments at the last minute. Maybe procrastination is a more reliable symptom of ADHD/ADD than other ones. It exists in adults who have not previously been diagnosed as having ADHD/ADD and on review of theirt past symptoms it is clear that they have had symptoms consistent with ADHD/ADD. 

So, it seems clear to me that adult ADHD/ADD is a fact and not fiction.  

 

Sunday
Jul102016

IS LETTING GO EVER WITHDRAWING?

My daughter and I just had a discussion about whether letting go is ever achieved by withdrawing from someone and giving up trying to help someone.  My daughter was sad to think that a solution to feeling responsible for others could be eliminating them from your life.  She felt that this would then seem to leave the person who formerly was treated like they were not able to manage on their own and subjected to frequent advice and criticism, feeling all alone as they kept working to take responsibility for themselves and become independent.

Withdrawing from others can seem like a reasonable thing to do if you feel that the other person doesn't follow your advice and then will blame you if things aren't right.  You  could justify withdrawing  from someone in order to not have to feel responsible for them and then be able to let go of that responsibility.  However, is that really letting go or are you still feeling responsible and coping by withdrawing from them so that you will not act responsible for them.  Isn't letting go a process of letting go of the feeling [and behaviors] of responsibility for someone so that we can have a relationship with them.  This will allow us to be supportive and encouraging as we let go of taking over for them [that responsibility thing] and instead, believe in them.

The hard part in my experience is being "encouraging and supportive."  It seems to require that we actually listen to others without our own agemda getting in the way.  This will help us to really see them and be able to see their strengths and abilities.  We then can encourage them by recognizing their strengths and supporting them trusting themselves.  Or, you could withdraw and justify giving up on them. 

Which path do you choose?