This Close to Happy

Daphne Merkin, author of This Close to Happy: A Reckoning with Depression, will be the featured guest speaker at a “Readings on Mental Health” event on Sunday, November 19 sponsored by the Mental Health Association in Tompkins County and hosted by Buffalo Street Books.

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Writing in the Wall Street Journal, John Kaag called Merkin’s 2017 memoir “one of the most accurate, and therefore most harrowing, accounts of depression to be written in the last century… Ms. Merkin speaks candidly and beautifully about aspects of the human condition that usually remain pointedly silent.”

Andrew Solomon, reviewing This Close to Happy for the New York Times, wrote: “It is standard fare to say that books on depression are brave, but this one actually is. For all its highly personal focus, it is an important addition to the literature of mental illness.”

Merkin is also the author of Enchantment, Dreaming of Hitler and The Fame Lunches: On Wounded Icons, Money, Sex, the Brontës, and the Importance of Handbags. A former staff writer at the New Yorker, she has also written for the New York Times, Elle, Bookforum, Departures, Travel + Leisure, W, Vogue, Tablet Magazine, and other publications. She has taught writing at the 92nd Street Y, Marymount College, and Hunter College.

Merkin’s appearance is part of “Readings on Mental Health,” a series featuring authors of books on mental health topics made possible by a grant from The Sophie Fund.

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Ithaca, Opioids, and Trump

Ithaca and Tompkins County are among the American localities severely affected by the opioid crisis, prompting intensified efforts by local officials. Overdoses are a common occurrence, and authorities report an average of 15 drug-related deaths a year since 2011. In 2016, the number skyrocketed to 21, compared to two deaths in 2007.

President Trump put a welcome spotlight on the opioid crisis this week, declaring it a “public health emergency” and describing it as a plague that has spared “no part of our society, not young or old, rich or poor, urban or rural.” At least 64,000 Americans died of overdoes in 2016, driven, Trump said, “by a massive increase in addiction to prescription painkillers, heroin, and other opioids.”

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Trump said he was “directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis,” but was short on specifics, mainly rattling off various steps that the federal government had previously taken.

Moreover, Trump’s diagnosis of the crisis and prescription for its cure seemed wide of the mark. His speech focused on blaming foreigners—Chinese and Mexicans—for sending illicit opioids into the country, and on criminal gangs for pushing them on America’s streets. (A key part of Trump’s future plan, he said, is a “massive advertising campaign to get people, especially children, not to want to take drugs in the first place.”)

Trump made no mention of two factors that experts increasingly see as fueling the addiction epidemic—pharmaceutical companies pushing legal opioids, and a national mental health crisis in which people desperately seeking relief from depression and anxiety find relief in opioids.

The Atlantic’s Alana Semuels reported in June:

“Ohio’s Attorney General Mike DeWine filed a lawsuit Wednesday against a handful of pharmaceutical companies, including Purdue Pharma, Teva Pharmaceuticals, and Johnson & Johnson. The lawsuit accuses the companies of spending millions on marketing campaigns that ‘trivialize the risks of opioids while overstating the benefits of using them for chronic pain.’ The companies, the lawsuit alleges, lobbied doctors to influence their opinions about the safety of opioids, ‘borrowing a page from Big Tobacco.’

“The lawsuit follows similar recent lawsuits in Illinois, Mississippi, four counties in New York, and Santa Clara and Orange Counties in California. Last month, the Cherokee Nation filed a lawsuit against distributors and pharmacies in tribal court over the opioid epidemic. In January, the city of Everett, Washington, filed a lawsuit against Purdue Pharma, the makers of OxyContin, alleging that the company knew the drug was being funneled into the black market but did nothing to stop it.”

Also in June, the Washington Post’s Lenny Bernstein reported on a study by researchers at the Dartmouth-Hitchcock Medical Center and the University of Michigan that linked greater opioid use and mental health disorders. The researchers concluded that 51.4 percent of 115 million opioid prescriptions written annually in the United States were given to people with anxiety and depression.

“Those patients may have some form of physical pain, said Brian Sites, a professor of anesthesiology and orthopedics at Dartmouth’s Geisel School of Medicine, who led the study team. But their mental condition may cause them to feel that pain more acutely or be less able to cope with it, leading to increased requests for something to dull it.

“Pain that ‘you may report as a two out of 10, someone with mental health disorders — depression, anxiety — may report as a 10 out of 10,’ Sites said in an interview. In addition, opioids may improve the symptoms of depression for a short while, he said, with patients who experience that then asking for continued refills.

“As a result, doctors trying to be empathetic to their patients’ complaints may tend to overprescribe opioid painkillers, he said. About half of all opioids are prescribed by primary-care physicians, who also manage most routine anxiety and depression.”

Trump’s declaration of a “public health emergency” did not involve the release of emergency federal funding, but the White House indicated that the president would soon ask Congress for additional funding to combat the opioid crisis. Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by Governor Chris Christie of New Jersey, will hand Trump its final report and recommendations next week.

The New York Times quoted experts saying that an effective policy to fight the crisis will cost billions of dollars:

“Andrew Kolodny, the co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, said that no emergency declaration would do much to alleviate the impact of opioids without a substantial commitment of federal money and a clear strategy for overhauling the way the country treats addiction.

“‘What we need is for the president to seek an appropriation from Congress, I believe in the billions, so that we can rapidly expand access for effective outpatient opioid addiction treatments,’ Dr. Kolodny said in an interview. ‘Until those treatments are easier to access than heroin or fentanyl, overdose deaths will remain at record-high levels.’”

Senator Joe Manchin of West Virginia, a state hard hit by the opioid crisis that Trump singled out in his remarks, called for pharmaceutical companies to pay. CNN reported:

“‘This is a business plan. They are liable,’ Manchin told CNN’s Jake Tapper on ‘The Lead’ when asked if he believes the pharmaceutical industry needs to be found legally liable in some cases for the prevalence of opioids in the United States.

“Manchin added that the companies that supply opioids should be charged fees for the drugs they produce and for having inundated the market with the highly addictive drugs.

“‘This is what’s caused it. Can’t we at least charge the pharmaceutical companies one penny per milligram for every opiate they produce?’ Manchin added.

“‘Every state’s been affected,’ he said of the crisis. ‘I’m ground zero, West Virginia, more deaths per capita, more people addicted per capita.’

“‘This is like fighting a war,’ Manchin said about the need for funding. ‘You’ve got your soldiers on the front line fighting … (but) your guys on the front line run out of bullets.’”

Chart: From the Ithaca Voice, October 13, 2017

Save a Life: Learn the Suicide Risk Factors and Warning Signs

Consider sharing this post. It’s National Suicide Prevention Week— please take a moment to review the Risk Factors and the Warning Signs as they may apply to loved ones, friends, colleagues, or even yourself. Click here for the Risk Factors/Warning Signs page of the American Foundation for Suicide Prevention. People with Risk Factors or exhibiting Warning Signs are strongly encouraged to seek treatment—suicide is preventable. If you or someone you know feels the need to speak with a mental health professional, please consider contacting the National Suicide Prevention Lifeline at 1-800-273-8255.

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From AFSP:

“There’s no single cause for suicide. Suicide most often occurs when stressors exceed current coping abilities of someone suffering from a mental health condition. Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Conditions like depression, anxiety and substance problems, especially when unaddressed, increase risk for suicide. Yet it’s important to note that most people who actively manage their mental health conditions lead fulfilling lives.”

Risk Factors are characteristics or conditions that increase the chance that a person may try to take their life:

Health Risk Factors—such as mental health conditions, substance abuse disorders, or serious/chronic health conditions and/or pain.

Environmental Risk Factors—such as stressful life events, prolonged stress conditions, access to lethal means, and exposure to suicide.

Historical Risk Factors—such as previous suicide attempts.

Be aware of Warning Signs.

According to AFSP, most people who take their lives exhibit one or more warning signs, either through what they say or what they do.

Warning Signs relate to a person’s Talk— about “being a burden to others,” or “feeling trapped,” or “experiencing unbearable pain,” or “having no reason to live,” or “killing themselves.”

Warning Signs relate to a person’s Mood—displaying one or more moods such as depression, loss of interest, rage, irritability, humiliation, anxiety.

Warning Signs relate to a person’s Behavior—such as increased use of alcohol or drugs, aggression, acting recklessly, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, and looking for a way to kill themselves.

“Something to look out for when concerned that a person may be suicidal is a change in behavior or the presence of entirely new behaviors. This is of sharpest concern if the new or changed behavior is related to a painful event, loss, or change.”

How to help someone who may be struggling: click here for guidance from the American Foundation for Suicide Prevention.

Click on the infographic below to download a Warning Signs checklist.

When Someone You Know Has Depression

Dr. Susan J. Noonan, author of When Someone You Know Has Depression: Words to Say and Things to Do, will be the featured guest speaker at a “Readings on Mental Health” event on April 30 sponsored by the Mental Health Association in Tompkins County and hosted by Buffalo Street Books.

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Noonan’s latest book is a concise and practical guide to caring for someone who has depression or bipolar disorder, offering specific suggestions for what to say or do to cope with impaired thinking and fluctuating moods. The book contains chapters on mood disorders, signs of depression, support and communication strategies, finding professional help, and caring for caregivers.

When Someone You Know Has Depression, a companion volume to Noonan’s 2013 book Managing Your Depression: What You Can Do to Feel Better, draws on evidence-based medical information as well as her own first-hand experience of living with a mood disorder. As a physician she has treated, supported, and educated those living with and those caring for a person who has a mood disorder. Noonan is a Certified Peer Specialist at McLean Hospital and a consultant to Massachusetts General Hospital and CliGnosis.

Noonan’s appearance launches “Readings on Mental Health,” a 2017 series featuring authors of books on mental health topics made possible by a grant from The Sophie Fund.

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13 Reasons Why: Warning Label

The new Netflix series 13 Reasons Why is generating alarm among many mental health professionals and suicide prevention experts, who are concerned about the risks of glamorizing suicide and the possibility of contagion.

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Netflix kicked up a controversy with the series released on March 31 about a high school junior named Hannah who takes her own life. The series received a 91 percent critics approval rating and an 88 percent audience rating on Rotten Tomatoes. Critics praised the cast’s performances and the “authentic,” “sensitive,” and “hard hitting” portrayal of teenager angst.

However, 13 Reasons Why needs a warning label. The National Association of School Psychologists cautions that the series should not be viewed by vulnerable young people who experience any degree of suicidal ideation. NASP warns:

“Its powerful storytelling may lead impressionable viewers to romanticize the choices made by the characters and/or develop revenge fantasies. They may easily identify with the experiences portrayed and recognize both the intentional and unintentional effects on the central character. Unfortunately, adult characters in the show, including the second school counselor who inadequately addresses Hannah’s pleas for help, do not inspire a sense of trust or ability to help.”

NASP has problems with the accuracy of how mental illness and suicide are portrayed in the series. For example, it is concerned that the series does not emphasize that common among most suicide deaths is the presence of treatable mental illnesses. And that suicide is not the simple consequence of stressors or coping challenges, but rather, it is most typically a combined result of treatable mental illnesses and overwhelming or intolerable stressors.

Despite the strong misgivings, some see the widespread publicity around 13 Reason Why as an opportunity at least to spread greater awareness about suicide and suicide prevention. NASP says that the controversy is an “opportunity to better understand young people’s experiences, thoughts, and feelings,” educate parents, teachers, and students alike about suicide risk warning signs, and reinforce the message that suicide is not a solution to problems.

NASP advises that school psychologists and other school-employed mental health professionals can assist stakeholders such as school administrators, parents, and teachers to engage in supportive conversations with students as well as provide resources and offer expertise in preventing harmful behaviors. NASP published “Considerations for Educators,” guidance on 13 Reasons Why. Download it here.

Experts say if you’re thinking about the safest and best way to lead a discussion with teens about 13 Reasons Why and suicide, read the tip sheet co-authored by Suicide Awareness Voices of Education (SAVE) and the JED Foundation. Click here to download the tip sheet.

Some recommended reading from experts on the subject of suicide contagion:

Preventing Suicide With A “Contagion Of Strength” (National Public Radio February 25, 2015)

The Science Behind Suicide Contagion (New York Times, August 14, 2014)

Teen suicide: Prevention is Contagious, Too (Christian Science Monitor, December 8, 2013)

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]