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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

Psychiatric Disorders and Geniuses

A lot of people like to think of themselves as geniuses.  Probably even more people with psychiatric disorders like to think of themselves as geniuses.

MichelangoWho can blame us – with examples such as Albert Einstein, Edgar Allen Poe, Beethoven, Michaelangelo, Charles Dickens, Ernest Hemingway, Winston Churchill, Charles Darwin, Isaac Newton… just to name a few.

As all of these stellar personalities are now deceased and most died before the advent of modern psychiatry, we can only surmise their disturbance – their genius however is clear.

Aristoteles, a Greek philosopher, once said, “There is no genius without having a touch of madness.”

Today, most who are diagnosed with a mental disorder– be it bipolar disorder, schizophrenia, borderline personality disorder, obsessive compulsive disorder, or even major depression, would be classified in previous times as “mad”.

A recent article in Psychiatric Times, by an actual physician – Nicholas Pediaditakis – attempts to link the occurrence of major mental disorders and geniusFreud called the difference in “temperament” of genius from that of “normal” people – “narcissistic neurosis”.

The basic theory as proposed by the author of the article says that people with certain mental disordersbipolar disorder, schizophrenia, and OCD in particular – ‘tend to “think” the world rather than “feel” it.’  He goes on to say that many are dysphoric and tend towards feeling a void and aloneness within themselves which can often lead to substance abuse and suicide – all too true.  His conclusion is that these illnesses cause an absence of adherence to social norms, not because you want to, but because you have to – but that it frees up parts of the brain for creative processes.

In addition, many artists, actors, comedians, writers acknowledge that much of their creativity comes from painpsychic pain not physical pain that is often experienced by those with mental disorders. This doesn’t seem to translate to genius in science, math, or other concrete areas, but the idea of a mind that has free space to concentrate on specialty areas does fit.

While I, personally, find offense in part of his statement (the part about wanting to think rather than feel) – I also find it true.  I, and those I know, would rather “think” rather than “feel”, but often we feel too much and cannot stop.

Aside from my bristling at the implication that mental illness is a choice – I find it amusing that science may be able to prove that there is a “mad genius” in me – someday.

Melissa Lind

A genius with a psychiatric disorder.

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

Why do Bipolar Patients Quit Taking Their Meds?

Why do bipolar and schizophrenic persons quit taking medicine?

Talk to any medical professional about the trials and tribulations of dealing with bipolar patients and they will tell you that the single most bothersome thing is the frequency with which manic-depressives quit taking their meds.

This problem isn’t unique to bipolar patients, but it is more insidious and often more surprising.  Schizophrenics, who quit taking their meds, are identified fairly quickly.  Those with depression who quit taking their meds stay in their houses – this is troublesome but not a public nuisance.

People with bipolar disorder are usually quite memorable both at the best of times and the worst of times.  They are vivacious; they are shining; they are exasperating; they are amazing, and they are irritating.  Generally in order to be diagnosed, a bipolar patient will present one of two ways – either severely depressed or psychotic but their illness has gone unnoticed or unaddressed for a long time.

To be fair, psychiatric patients of any type may quit taking their meds for a number of legitimate reasons.  Well, semi-legitimate.

Mood DisordersLegitimately, a psychiatric patient of any type will have consulted with his or her physician before quitting can be medically supervised while doing so.  Even with medical supervision, the only really legitimate reason for a psychiatric patient to quit taking their meds completely is a person who has been taking anti-depressants for a short period of time (less than one year) who has only had one episode of clinical depression.  In this case, a psychiatrist would agree that a patient who does not have a long term history of depression can taper off the medication because they may not need it forever.  This patient is rare. Once another episode of depression or mood disorder occurs, virtually everyone will agree that it is a chronic problem that should be addressed with medication.  Permanently.

One legitimate reason for temporarily discontinuing use would be pregnancy, to avoid potential harm to the fetus.  In most cases, the medication would be re-started as soon as the patient is able.

Patients may also approach their physician about discontinuing a specific medication to switch to another.  Reasons for this might be ineffectiveness, intolerable side effects or cost.

Unfortunately, for most psychiatric patients there is no legitimate reason to discontinue medication altogether.  The physician will suggest or even prescribe an alternative medication.  The patient may feel that they have been unheard by their physician and while this may be the case, for most patients who “quit”, it is actually more likely that they have not talked to the physician at all.

Bipolar patients and those with other psychiatric conditions most often quit taking their medication without medical supervision or intervention in secret.  Oddly, this is because the brain is a tricky thing – most often they quit when they are doing well.  When the medication is working, they begin to believe that they do not need the medication – that they are “OK”.

Most psychiatric patients don’t want to have a mental disorder – or more likely they don’t want to be told that they have a mental disorder.  This may be in part due to the social stigma, but it may also be because they really like the way they are.  Medication often takes away the “spark” that has made them vivacious, memorable, brilliant and even irritating or dangerous.

It is very difficult to go from “outstanding” – whether it is good or bad to normal.  Bipolar patients in particular also quit taking their medication because their brains are bored.  The brain is used to go up and down, backwards and forwards, in and out.  When medication is working, the roller coaster goes away.

This may be good for a while, after the crisis because life has gotten way out of whack, they need time to recover, rest, and breathe.  But when the fires are put out, and the dust clears, the brain begins to crave the excitement.

Again, this really means the medication is working, and they will quit, yet again, starting the cycle all over again.

So, what can a caretaker, a parent, a spouse, or a friend do?  Likely any attempt at supervision or intervention will be met with anger, avoidance or outright denial.

Bipolar CaosAs bipolar disorder, and schizophrenia most often emerges in the late teens or early adulthood, is should be predictable that they do not want supervision.  They do not want to be told that someone else knows best.

When confronted or even questioned, the bipolar will almost always say that everything is OK – even if it is far from OK.  In short, they will lie.

Again, what can a caretaker, a parent, a spouse, or a friend do?  In short, especially in the newly diagnosed (and for a bipolar or schizophrenic the definition of newly would be likely less than 10 years), there will be no opportunity for supervision.  They will be secretive and untruthful.  You must wait for the crash and be there to assist with the crisis and recovery – only to repeat it again in a few months or years.

The good news is that eventually, the periods between “the crashes” will likely lengthen. When they are thinking clearly, when the medication is working – ask them why they do it.  Encourage them to participate in therapy, join a bipolar or mental disorder group. Realize they may not always go.

Over a period of years, perhaps decades – the patient may eventually become to accept that they truly do need the medication.  Likely they will never be completely compliant but one can always hope.

A caregiver, a parent, a spouse, a friend can look for signs – if you are close, you may be able to keep track of their medication, physician visits, refills but you may not be able to.  You should prepare yourself when you see signs: a developing increase in communication, vivacity, anger – likely followed by erratic behavior and hiding.

Intervene as much as you can but know that your may not be able to stop them.  They quit medication when it is working because it makes them….normal.

Melissa Lind

Anxiety Symptom Awareness

Things to consider regarding Anxiety Symptom Awareness!

Many people suffer from high anxiety.

Symptom awareness can help them to recognize that they have a serious medical condition and are not just “high strung.” Panic disorders are a common psychological problem with potentially devastating effects on the quality of one’s life. Recognizing the symptoms of an anxiety attack can result in sufferers seeking out the treatment they need.

Anxiety for waspsA commonly experienced anxiety symptom is to feel dizzy or lightheaded. If someone feels that way during anxious moments, he or she may want to consider it as a warning sign. This is a particularly dangerous symptom, because the loss of balance it produces can lead to falls and other accidents.

Another anxiety symptom is to feel as though that one cannot breathe. This is a common symptom among those diagnosed with panic disorders and can be quite frightening. Victims feel as though they are unable to catch their breath or as if they are somehow being smothered. If one experiences periods of this sort, one will probably want to consider discussing your situation with a physician.

Others suffering from panic disorders will experience shakes or tremors. These involuntary movements can be extremely frightening and create an increased risk of accident. Nervous tics are one thing, but tremors and shakes related to anxiety are another. They should be taken as a sign that something may be wrong.

Anxiety sufferers often experience a sensation that as if something is crawling all over them during anxious periods. This sensation is by many described as being akin to having ants or other small insects patrolling the body. It is a particularly uncomfortable sensation that can paralyze one with fear.

A particularly scary anxiety symptom is the feeling that one is experiencing a heart attack or some other intense chest pain. Many panic attack sufferers have been quite certain their death was imminent while in the midst of an attack. The pain, although lacking a physiological basis, can be quite real and truly frightening. That fear serves to intensify one’s anxiety, making it part of a vicious circle.

There are, of course, other symptoms. One of the interesting things about panic disorders is that different individuals will experience different manifestations of the problem. While some may sweat profusely during an attack, someone else may notice chills as an anxiety symptom.

The important thing to remember is that if one experience particularly anxious times when someone feel fear, that in retrospect seems disproportionate or other physical reflections of their anxiety. They may have a diagnosable panic disorder. Fortunately, a variety of treatment options are available for those who experience anxiety attacks. Thus, it makes perfect sense to immediately consult with a medical professional if someone feels they may have a problem.

Recognizing some of the common symptoms of disproportionate anxiety may give a person the impetus to seek help. That help may allow them to move on with your life without having to be concerned that another terrifying anxiety symptom will emerge uncontrollably.

Bipolar Disorder and Social Media

Use Bipolar Chat as a Means of Support?

Bipolar disorder chatting online is currently the preferred option for the growing support for people suffering from bipolar disorder (sometimes known as manic depression).Bipolar Online Chat

While bipolar chat option will not replace an appropriate treatment option recommended, everyone can provide some benefits for other bipolar people.

As the Internet has grown, the opportunity to interact with similar interests and conditions has increased.

Although we often assume that the social possibilities in terms of the fans to discuss their passions or professional exchange of ideas, it will also result in the creation of discussion groups and chat rooms for those suffering from certain diseases. The bipolar chat is an example of this phenomenon.

Despite a certain level of social development, mental illness still carries a stigma. Also, just based on symptoms, mental health problems can make people feel marginalized, and can stimulate ineffective separation. In discussing these issues with others in a supportive environment, some of the negative consequences can be minimized.

When there is someone to talk with, bipolar chat can allow victims of depression to feel less alone with their problem. It can help them realize that their struggle with the burden of this disease is not unique to them. This can reduce the feeling of being “out” and can give positive reinforcement as one continue to deal with the condition.

In some situations, bipolar chat may be one of the only real ways in how people can appraise significantly, and interact with other people who suffers from the illness. Those in rural areas or small towns cannot always have a “face to face” is an option, and then online bipolar chat can be extremely useful.

Others may feel uncomfortable with the “face” the situation and still be able to get some therapeutic value of bipolar disorder chat.

Although the online chat option can help, should not replace professional advice or therapy sessions prescribed. The support offered by a group chat can be brilliant but will allow coping skills, and information offered by the program receives professional treatment.

Nevertheless; we should not eliminate the need for bipolar chat medical use of drugs.

We must recognize that bipolar disorder is a hugely serious medical problem that requires * professional medical assistance. * Self-help in the form of a bipolar chat or other possibilities should be done only with the approval of a physician. In some cases, doctors may recommend that a person not involved in the effort and patients should pay attention to medical advice.

Advances in technology led to the creation of a valuable resource for those suffering from mental illness. An opportunity to share and learn from others with a similar analysis can be reassuring and helpful, which is the main reason for the growth of online opportunities such as bipolar disorder chat.

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* professional medical assistance*

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