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.





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.  




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?



I have been seeing similarities between young children and dogs.  This started after I had a number of patients talk about the benefits of owning dogs and how their dogs help them to feel calm and peaceful.  Some of my patients have used their dogs as "comfort" animals [like a "service" dog] and they tell me that their dogs are able to detect if they [the owners] are experiencing stress. One patient believes that her dog can detect when she starts to dissociate as a way of coping with stress. There are also reports of dogs helping people to overcome their depressive and anxiety symptoms by being with them and not judging them and requiring help to be fed and walked, etc.  

A lot of these attributes also apply to children.  Children are loving and caring as well as being non-judgmental.  I have patients who report that their children are alert to their [the patient's] stress level and can help them to stop their stress reaction by calling attention to the onset of stress and their parent's withdrawal.  I have witnessed young children be very tuned in to their parent's stress and will distract their parent so that their parent will stop their stress response and attend to their child, who keeps them in the present moment.  

Maybe children know mindfulness and meditative practices intuitively?  What do you think?



My patients have made it clear to me how important their feeling responsible for others is in maintaining PTSD symptoms. It seems that taking responsibility for others develops as a way of coping with abuse.  It makes sense in that people who are being abused are not being protected by adults around them and therefore they can feel more in control by taking on responsibility for others.  However, I have wondered what the nature of the control experience is.  Now I believe that it is to prevent things from getting worse. This idea has surfaced with many of my patients who come to me for help with PTSD. They believe that the abusing person will be less likely to lose control if they do this. They also do not feel confident enough to resist taking responsibility for others and standing on their own. Any person who loses control, or threatens to, can cause someone who has PTSD to respond by feeling responsible for them. This maintains the old pattern and as I have previously discussed the brain is very good at helping us to maintain old patterns of behavior.

The significance of feeling responsible for others is that when we act this way because of a fear that things will get worse tells our brains that we need to be on guard to be alert in case the something worse happens.  For this reason it is very important for people with PTSD to have a goal of no longer doing things to keep things from getting worse.  They need to be able to identify all the ways that they act this way and make it clear to themselves [their brains] that they want to stop doing this.  It also helps to be able to tell themselves that they no longer need to fear past stressful situations as they do not have any power over them now.  This requires that we choose to think of past stressful events and then, staying calm, tell ourselves that we no longer need to be stressed by these memories.  Even with this accomplished, the behavior pattern of doing things to keep things from getting worse can continue unless stopping it is addressed directly.  If it is not stopped, automatic stress reactions to past events will continue.  



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