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Mental Health Professionals and Suicide

Suicide – Threat of Liability for Mental Health Professionals

Suicide is the third most common cause of death for young adults – and the ninth highest for the general adult population.  This means that a large percentage of mental health professionals will have a patient that commits suicide. It may be as high as 80 percent of psychiatrists, psychologists, social workers, and other therapists, that eventually have a patient who commits suicide.

Serious Mental Health ProfessionalYou might think that professionals are insulated against emotions that come with the death of a friend or acquaintance – but they aren’t.  Many health professionals report that even when death is expected (natural causes), they spend a great deal of time going over their treatment of the patient. They try to find out if they could have done anything different, (given another treatment) in order to help.

But, what may be surprising is the number of liability lawsuits filed against mental health professionals, when a patient commits suicide.  In fact, it is the number-one cause of responsibility lawsuits brought against mental health providers.
The threat of lawsuits, and also the stigma against people working it in the mental-health profession, has led to many psychiatrists refusals to treat the chronically suicidal. The profession sees it as a failure of the doctorMental health professionals are also less likely to see additional suicidal patients after they have had a patient succeed at suicide.

When a therapist or physician is unable, or unwilling, to treat a suicidal patient – it leaves the patient in the lurch.  It produces feelings of failure and hopelessness, without a doubt, compounding the fact that they are suicidal.  It may also be difficult for an extremely suicidal patient to find a new therapist or doctor.  Many patients report that the mental health professionals suddenly “don’t have time”.

We don’t think much about the way suicide will affect those around us – and certainly the professionals are way down the list of people whose feelings are important.

Mental health professionals also report that there is a lack of training on how to deal with suicidal patients, and processing the death of a patient.  More than half of professionals surveyed also Knocking on Heavens Doorstated that they really don’t believe they can prevent a patient from committing suicide.

Oddly, the complaint process against physicians has been shown to increase the risk of the physician becoming depressed. One of the consequences of this will be a worsening of the situation for mentally ill people. (Chronically suicidal patients)

This is a complicated process with no easy answers, but you should know that it is likely that all psychiatrists, therapists, social workers and other counselors probably need to be in counseling themselves.  When you find a new doctor or therapist – you might want to ask.

Even if you aren’t suicidal, you need to know that your counselor is as mentally healthy as possible, certainly healthier than you.

Melissa Lind

Mental Health Professionals Report a Lack of Training on How to Deal With Suicidal Patients

Cutting – An Actual Mental Disorder

Non-Suicidal Self-Injury

A lot of people are shocked and horrified at the thought of self-mutilation and for many years “cutting” was categorized only as a symptom of Borderline Personality DisorderBPD, as you may know, has symptoms of unstable personal relationships, impulsivity, and extreme mood changes (different from Bipolar disorder as they can change on a dime and swing wildly).

The new issue of the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition or DSM-5, includes it as a separate diagnosis of Non-Suicidal Self-Injury (NSSI).  Research has suggested that NSSI can occur independently of BPD but is also often a co-existing or co-morbid illness, occurring alongside BPD, Bipolar Disorder, one of the many anxiety disorders or with other disorders such as anorexia or bulimia.

Cutting DisorderI am the mother of pre-adolescent children – who are beginning to believe they know all about people who act “weird” or do “weird” things (their words, not mine).  My daughter has recently talked about the “EMO” kids – which as a dumb mom, I had to figure out was a social group of kids who were “emotionally dark.”  She includes in her description of an “EMO” as “you know, like kids who are cutters.”  It is stereotypical to think that they all wear black clothing and heavy eyeliner – as some may – but many do not.

Some people who have the disorder would never be suspected of such – but then we are also sometimes surprised when someone who seems to have everything commits suicide, only to find that under the polished exterior was extreme anguish.  Often, cutting will be dismissed as a “stage” and it may be a “stage” – but often it is not.  Many patients – have arms or hips full of patterned scars – proving that it is often a condition all to itself.

Cutting Disorder - Mental IllnessSelf-mutilation most often starts in the early teen years when adolescent emotions are at their height – but often extends well into adulthood.  The majority of “cutters” are female – but not all.  There is often a co-existing mental illness and may have a family history component – but also often occurs following events of abuse – including sexual, physical or emotional abuse.  Sudden life changes such as unemployment or divorce – and isolation may trigger an occurrence.

People who “cut” often express a desire to “feel” as if they cannot truly attach to their own emotions.  Others will say they “cut” to kill the pain – this is because the act of producing pain also causes the body to release endorphins (the body’s natural painkiller) that makes them feel better.  Unfortunately, even though the action may induce temporary euphoria – it is often followed by guilt and a return of the negative feelings.

NSSI is defined as:

• 5 or more days of intentional self-inflicted damage to the surface of the body without suicidal intent – in the past year.
Patients must be intending to:
o Seek relief from negative feelings or thoughts and/or
o Resolve interpersonal problems and/or
o Induce a positive emotional state
• The behavior must be associated with 1 of:
o Interpersonal problems
o Negative thoughts or feelings
o Premeditation
o Ruminating on injury (obsession)

NSSI includes not only “cutting” but also burning, hitting or punching, head banging, biting, non-aesthetic piercing or carving of skin (tattoos and body piercing don’t apply), pulling out hair or other “topical” mutilation.  If a patient has expressed suicidal thoughts or shows suicidal tendencies – it is not classified as NSSI as the intent of a person with NSSI is not to commit suicide.
NSSI should be first viewed as a serious medical condition that truly requires treatment.  It may be resolved by treating an existing co-morbid psychiatric condition – but likely it will also require psychotherapy to resolve some of the underlying issues.

Definition of Self-injury/cutting (Mayo Clinic)

Cutting and Self-Harm: Warning Signs and Treatment (WebMD)

If you see signs of NSSI or “cutting” in a child, teen, or adult that you know – encourage them to seek help.

Melissa Lind (WriterMelle)

An Actual Mental Disorder – Cutting

Borderline Personality Disorder – True Story

A true Borderline Personality Disorder story

BPD – The likeable guy who suddenly isn’t

I once knew a man who I met through a friend.  When I met him, she was already planning on marrying him so I could not say much of anything.  He was an utterly likeable guy who was fun, fun-loving and an all-around joy to be near, but there was something I couldn’t understand.

My friend, due to her previous life experiences involving traumatic loss, was extremely opposed to anyone she loved being in the police service.  Her fiancé had been a marine and had later gone into the military police.  He had retired from the military and was working in his family business as the Vice President but had also grown his hair out, dressed in very casual clothing and loved race-cars.  He swore “blind” that he would never enter the military or law enforcement again.

This fun-loving person with long hair, wearing tank tops and racing cars was the guy I met.  He was also mechanically inept – couldn’t put a shelf on a wall or even put a barbeque grill together with instructions.  After they had got married, my husband and another friend spent many hours doing “fix-it” work around their house – taking things such as grass spreaders and playground sets apart to put them back together correctly.

Borderline Personality Disorder - Swirly MindHe was also very generous – spending money all the time for all and anyone around.  He would take 15 people to see a rock concert or a hockey game, bought the boys new video game systems and video games every weekend, bought garden supplies, supplies to put in a backyard kiln after my friend had said she thought she might want to make a pot, had a pool installed, bought a go-cart and mini-bike for the boys, $3000 vacuum cleaner… He traded her car in for a new, better, bigger car at least once a year, sometimes after only a few months. They were not in financial distress, but he was never concerned with how much money he spent.

I could never reconcile the goofball man with long hair and a beard who used to be a marine and an MP.

Fast forward a few years.  One day, my friend called me, totally hysterical because she came home to find him with a military style haircut, wearing a police uniform with guns and all – preparing to go to a part-time job that he had gotten with a police department in a small town nearby, having done all this in secret.  He swore it was only part-time because they needed the extra income (which they didn’t).

For several months, she expressed her extreme displeasure, fear, hatred.  Each time I would drive to their house, I would think, “What are the police doing here?”

Then I would remember that it was his patrol car.

Fast forward a few more months.  He is now working full-time as a cop – even though he promised it would only be part time.  She hates it.  He is also starting to exhibit bizarre behavior, restrictive rules for the kids, can’t keep from calling her every 10 minutes – even while he is at work, even while she is grocery shopping or picking up kids from school.

Tensions rise, arguments ensue, culminating in an episode involving him threatening to shoot himself in front of the 10 year old who runs from the house in his underwear to hide at the neighbors.

BPD - Borderline Personality DisorderHe eventually calms down and suggests that they need marital counseling – that she needs “help.”  Of course, he says it is “her” that needs help, and he is only going for her problems.

They go to the counseling where the therapist disagrees with his idea that the core issue is her problem.  They are both referred to a psychiatrist.  The psychiatrist diagnoses him with Borderline Personality Disorder – giving him medication and recommends extended therapy.  The psychiatrist gives her a prescription for situational anxiety disorder – as she is having intermittent panic attacks due to his behavior.  He recommends that my friend go to therapy to deal with her emotions surrounding the family issues and for their son to go to therapy to deal with the fact that his father flips out.

She decides to stay – based on his agreement to take medications and go to therapy.  Which he does not.  He does not believe the therapist or the physician were correct.
He then tells her that she needs to go to all of his police and wives functions – and makes plans to join the State Police Controlled Substances Crime division – sponsored by the governor.  Another episode involving a mental breakdown and a couple of loaded firearms occurs.

She puts her kid in the car – and leaves a beautiful home with a pool and all the money she could want, in order to escape.  He calls and calls and appears not to understand what happened, blaming the whole situation on her paranoia.  She never goes back and now lives as a single mom in a low-rent housing unit without financial assistance from him.  Apparently this is much better than dealing with him.

This man, my goofball friend – turned into a raving nutcase and likely it was not the first time (or the last time) he had done so.  He went back to his former wife to marry her for the third time.

Years later, we still get “restricted number” phone calls from him – for no apparent reason other than to check up on her.

Until this experience, I always thought that Borderline Personality Disorder was a fairly benign thing – they were secret manipulators but relatively innocuous – along the same lines as Narcissistic Personality Disorder, which is irritating but not dangerous.  Now I know that is not true, Borderline Personality Disorder, also known as Emotionally UnstablePersonality Disorder is a real and valid psychiatric disorder that should be treated.

It is characterized by:

•    Occupational – Economic issues such as a sudden shift in career field cue to sudden changes in values, self-opinion
•    Antagonism
•    Separation anxiety and abandonment issues
•    Suicidal behavior
•    Multiple separations or divorces
•    Unstable, intense close relationships are vacillating with extreme anger
•    Harmful impulsiveness – including spending, reckless driving, thrill-seeking
•    Physical Violence
•    Chronic feelings of boredom which may contribute to impulsive activities
•    Irresponsibility

The National Institute of Mental Health says that Borderline Personality disorder is likely to last for many years and may be subject to relapse of symptoms which remiss but those core symptoms such as highly changeable moods and impulsive behavior will likely continue.

Melissa Lind

Anxiety and Headaches

Often a lot of people will find that anxiety and headaches can go hand-in-hand

Almost all people with serious anxiety have been able to see the warning signs of an attack with the start of a headache, and you will find that this not something that you must through alone.
You will want to make sure that you talk to your doctor about your anxiety and even the possible depression that you may have because this will help you to control your emotions and you will begin to feel better.

Mental DisorderMental disorders and headaches are extremely common. Most of the thing people who suffer from chronic headaches are people who also suffer from mental disorders like anxiety, OCD, PTSD or post-traumatic stress disorder, panic disorders, and major depression. People who suffer from these types of mental disorders, you will find suffer, almost 80% will have a headache daily.

Some of the things that you can do to help yourself out are by seeking medical attention. Keep in mind that modern medicine is often also mixed with traditional treatments like acupuncture in order to make a quick impact. You will want to keep in mind that there are a lot of people in the world who suffer from this, and there is no need to be ashamed.

You will need to consider your own state of mind and health in general so that you can take the best care of yourself and make the best decisions.

Keep in mind that there are many reasons why you may end up with a headache. It could be from all the pressure that you are feeling, and it simply could be because you have to deal with a lot of things at once. Not everyone can deal with multitasking; however, you will need to keep in mind that it is particularly necessary that you make yourself push thru it all so that you can come out a stronger person.

It is possible for you to have issues that overlap and that your headache could end up being more than you through it could be; however, it is particularly crucial that you get medical attention for chronic headaches. If you are getting them on a daily basis because of the stress that you are under, then you will need to do something in order to step down or relieve some of your stress.

It is extremely important that you think about the long-term side effects that you can get from anxiety and from headaches.

You will need to take your medical condition serious. And you need to do everything you can in order to handle the mental disorders and anxiety that you suffer from so that you can take control of your headaches and pain.

Anxiety and headaches can go hand-in-hand

Is It Really Borderline Personality Disorder?

Borderline Personality Disorder is one of the hardest disorders to diagnose

Borderline Personality DisorderMy diagnosis is formal and was made by a professional.  Don’t use this to diagnose yourself.  We’re all people, we’re all different.  While I match many of the diagnostic criteria, I don’t match them all.  However, if you haven’t been formally diagnosed and you’re reading this and nodding your head, you may want to talk to a professional about it.

So here goes.  What makes Bruce Anderson suffer from Borderline Personalty Disorder (and what doesn’t).

Signs and Symptoms of Borderline Personality Disorder:

1.  Feels emotions more easily, deeply, and longer than others do—CHECK.

Is this a bad thing?  Sometimes.  But sometimes it’s good.  If I wasn’t able to keep those emotions running high, I could’ve never written my prizewinning screenplay, which is emotionally brutal and makes everyone who reads it cry.  But when I get hurt, it takes a long, long time to shut it off.  Something most people get over in a few hours can take me a few days or more.

2.  Exhibits signs of impulsive behavior, such as substance abuse, eating disorders, unprotected sex, and reckless spending or driving—CHECK.

I smoke.  I drink.  At one time, I did drugs.  I’ve fathered two children that I love, but never intended to have.  Casinos are very dangerous places for me.  But I drive like an old man, very slowly, most of the time.

3.  Self-Harm and Suicidal Behavior—CHECK.

The scars are mostly faded, but the razorblades and lit cigarette were once close friends of mine.  So are booze and pills.

4.  Unstable, intense personal relationships—CHECK.

Married twice.  More girlfriends than I can count.  Every relationship ends in tears, usually mine.

5.  Black and white thinking—NO.  Well, MAYBE in the moment.

But I’m pretty realistic when it comes to how I see others.  I realize that no one is all-bad or all-good, though I do have a tendency to idealize my romantic partners.

6.  Manipulative behavior to obtain nurturance—DOUBLE CHECK.

Maybe even triple.  I’ll do anything, things I’m terribly ashamed of later, to get that feeling of being loved and cared for.

7.  Poor sense of self—CHECK, but not so much anymore.

It took me to the age of almost forty to figure out what I wanted to do with my life.  I want to write and teach, and I’m doing just that.  And it feels good.  At the same time, it is sometimes hard for me to know what I value and enjoy.

Do I really write because I like to?  Do I really teach because I love it?  Maybe.  It could be just that I’ve found that I’m good at both, and being good at both gets me attention and admiration from others.  I’m not really sure that I enjoy anything.

8.  Dissociation, feeling empty, or zoning out—CHECK.

Now, everyone zones out from time to time, but probably not to the same level that I do, and probably not for the same reasons.  Periods of high emotions can make me shut down at a cognitive level.  I become so preoccupied by the wave of emotion crashing over me that I can think of nothing else.  Sometimes, this is nice.  Like that first feeling of new love where my heart goes all aflutter.  That’s AWESOME.  But most of the time, it’s a negative emotion that has
my attention.  And that pretty much sucks.

Well, those are pretty much my life in a nutshell.  Sucks to be me sometimes, but not all of the time.  I gotta try to remember that.  Until next time.

Your bother in arms,

-Bruce

Read more from Bruce Anderson here: How I Became the Freak in the Corner

(A page that tells his story from the beginning and has links to several of his articles)

Treating Borderline Personality Disorder

Skills Training Manual for Treating Borderline Personality Disorder

Signs and Symptoms of BPD