Category Archives: Personal Reflections

More Musings on Donald Trump’s Personality: Spoiler Alert, We’re Not Talking Narcissism Anymore . . . Because it’s Worse than That

Irrigation SunriseAs I mentioned in Part One, much of the focus on DJT has been on whether he meets the diagnostic criteria for Narcissistic Personality Disorder. Allen Francis, who helped write the personality disorder criteria, has expressed many times that DJT is “bad, not mad.” His reasoning is that DJT’s narcissistic traits don’t cause Trump personal distress and haven’t adversely affected his functioning; in fact, DJT was elected president! In diagnostic terminology, Dr. Frances is saying that DJT doesn’t meet either the distress or impairment criteria, at least one of which is needed to make a formal diagnosis.

Despite the objections of Dr. Francis, if you look at the DSM-5 criteria for NPD, it’s easy to see that DJT’s public behaviors could have served as the prototype for the DSM’s authors as they developed the NPD diagnostic criteria. But it still doesn’t mean DJT has NPD. In addition to not meeting the distress or impairment criteria, individuals (even DJT) cannot be diagnosed without a clinical interview, principally because all behaviors occur in context (or within a subculture). What’s even more interesting is that given DJT’s context of being a reality television star, running for president, and being elected president, who are we to say whether his apparent NPD characteristics are diagnosable. In those contexts, having NPD behaviors might be adaptive (at least sometimes).

In particular, the context of U.S. President is of special intrigue. Generally, anyone who runs for president probably has some (or many) narcissistic traits. I’m not saying that all U.S. Presidential candidates are, by definition, narcissistic. I am saying that narcissistic traits in a U.S. President are not especially distinguishing features. It’s sort of like saying, “Hey, I found this fish and I also discovered that it can swim!!” Narcissistic traits in a U.S. President does not a news-flash make.

Besides . . . and here’s where I go down a more frightening path. My sense is that what’s unique and distinguishing about DJT isn’t his narcissism (although his narcissism is palpable, but not diagnosable); instead, I think he behaves in ways consistent with individuals who have antisocial personalities. Again, I’m not making the claim here that DJT should be diagnosed with Antisocial Personality Disorder (APD). Below, I’ll elaborate on my thinking about this.

As I explore how DJT manifests an antisocial personality style (not APD), I’ll be quoting liberally from the amazing work of the late Theodore Millon (see: Disorders of Personality, 3rd ed., 2011). Millon was a psychologist famous for his writings on personology in general, and personality disorders, in particular.

Just FYI: The following quotations and comments don’t refer to APD diagnostic criteria. Millon (2011) believed those criteria were too concrete and simple and therefore inconsistent with the concept of personality. Instead, my focus is on individuals who think and behave in ways consistent with Millon’s formulation of “Aggrandizing-Devious-Antisocial Personality.” These individuals, although not necessarily diagnosable in the DSM or ICD sense, exhibit a style consistent with antisocial psychological and interpersonal dynamics.

Before I dive into Millon’s descriptions, which are fantastic, by the way, let’s take a brief historical tour.

Way back in Aristotle’s time, his student, Theophrastus (371 – 287 B.C.), wrote about specific personalities, one of which was “The Unscrupulous Man.” Here’s one of Theophrastus’s descriptions.

The Unscrupulous Man will go and borrow more money from a creditor he has never paid . . . . When marketing he reminds the butcher of some service he has rendered him and, standing near the scales, throws in some meat, if he can, and a soup-bone. If he succeeds, so much the better; if not, he will snatch a piece of tripe and go off laughing (from Widiger, Corbitt, & Millon, p. 63).

If you recall Aristotelian philosophy, Aristotle was big into virtues or virtuous behaviors. Here we have his student describing someone who isn’t especially virtuous. Theophrastus’s description involves a pattern of taking from others; The Unscrupulous Man apparently thinks that theft of others’ goods and property is acceptable, and perhaps laudable. Serendipitously, I’m reminded of a few examples of this attitude and unscrupulous behaviors in DJT. Specifically, there are well-publicized bankruptcies, reports of non-payment to contracted employees, and a statement in one of his debates with Hillary Clinton that not paying any federal income taxes “makes me smart.” Hardly anyone (other than Sarah Huckabee Sanders) would step up and contend that DJT is neglecting himself because of his interest and focus on the welfare of others. That DJT frequently works systems and people to his advantage is relatively unarguable.

About 2000 years later, interest in The Unscrupulous Man re-emerged. The famous American physician, Benjamin Rush wrote about “perplexing cases characterized by lucidity of thought combined with socially deranged behavior. He spoke of these individuals as possessing an ‘innate, preternatural moral depravity’” (p. 425). Millon summarized Rush’s description: “He claimed that a lifelong pattern of irresponsibility was displayed by these individuals without a corresponding feeling of shame or hesitation over the . . . destructive consequences of their actions” (p. 425). Rush himself wrote: “Persons thus diseased cannot speak the truth upon any subject” (1812, p. 124).

Earlier this year, the Washington Post (May 31, 2018) reported, “President Trump has made 3,251 false or misleading claims in 497 days.” Of course, the Post limited their analysis to public statements, so their estimate is probably low. Rush’s description of someone who “cannot speak the truth on any subject,” has some surface validity in that it sometimes seems that DJT tells unnecessary lies. Given an opportunity to speak freely, it’s not unusual to hear DJT begin exaggerating about inaugural (or other) crowd sizes or to completely dissemble, “I never fired James Comey because of Russia!” or “I’m the only politician that produced more than I said I was going to produce, and we’re only 1 1/2 years in” or ________________. You can fill in the blank, I’m sure.

The history of APD as an entity is peppered with commentary of astonishment (an astonishment similar to the mainstream press) and their repeated surprise that DJT was behaving in ways that were unprecedented, over and over, and in a sense, normalizing combat between the  Office of the President and the Press Corps, who were quickly labeled as “the enemy of the people.” Historically, there was a similar repeated surprise over discovering (and rediscovering) that there was a “type” of mental patient who, in many ways seemed perfectly normal, but in the place where moral values existed for others, there was only emptiness. The usual signs of insanity were missing, but constructs of ethics and morals were viewed as quaint ideas existing only on other planets or in alternative universes. Given this moral lacunae, early on, the condition was referred to as “moral insanity.” This term emphasized the consistent observation that these people appeared sane in all other respects—and often charming. Henry Maudsley (1874), put it this way:

“As there are persons who cannot distinguish certain colours, having what is called colour blindness, so there are some who are congenitally deprived of moral sense” (p. 11).

In the early 1900s, Emil Kraepelin, upon whose work forms the foundation for modern diagnostic systems, described a personality type that he referred to as “morbid liars and swindlers.” These types “were glib and charming, but lacking in inner morality and as sense of responsibility to others; they made frequent use of aliases, were inclined to be fraudulent con men, and often accumulated heavy debts that were invariably unpaid” (Millon, 2011, p. 428). One of Kraepelin’s disciples, a German physician, later added, “. . . that many of these individuals were unusually successful in positions of either political or material power” (Millon, p. 429)

Obviously, DJT has been “unusually successful” both politically and materially. Of greater prescience is a quotation from Jimmy Kimmel Live (May 25, 2016) where DJT described his used of aliases. “Over the years I’ve used alias (sic), and when I’m in real estate and especially when I was out in Brooklyn with my father and I’d want to buy something . . . I would never want to use my name because you’d have to pay more money for the land. If you’re trying to buy land, you use different names.”

Also in 2016, but on a less grand stage, consistent with Kraepelin’s formulation of morbid liars and swindlers, my 90-year-old poker-playing father quickly identified DJT as “a con man” (https://johnsommersflanagan.com/2016/11/05/what-my-card-playing-genius-father-says-about-donald-trump/).

One final note before ending Part Two.

A Kraepelin disciple from Germany made an interesting point . . . and one that Millon repeatedly emphasizes. Not only is it that individuals with antisocial characteristics may not be disordered, in fact, they may be very successful: “Schneider observed that many of these individuals were unusually successful in positions of either political or material power.” (Millon, p. 429).

Part Three is coming . . . although I’m hoping that my Slate Magazine article is coming sooner.

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On Psychiatric Diagnosis and Whether Donald J. Trump has a Personality Disorder

IMG_3063Note — This is a three or four part series focusing on complexities of psychiatric diagnosis; then I ramble into an exploration of what specific psychological and interpersonal dynamics might be driving Donald Trump’s behaviors. This piece and the next two or three are a lead-up to an essay I’m doing for Slate Magazine.

Psychiatric diagnosis looks easy.

All you need is a diagnostic manual. In the U.S., you can use the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; published by the American Psychiatric Association) or the 10th edition of the International Classification of Diseases (ICD-10; published by the World Health Organization). Even easier, you can search for and find online diagnostic criteria for virtually every mental disorder. The power to diagnose is at your fingertips.

If you think your friend has panic disorder, you can type “panic disorder” into your favorite search engine, find the criteria, and confirm your suspicions. The same goes for diagnosing children. Finding the criteria for attention-deficit/hyperactivity disorder (ADHD) is simple. Of special convenience is the fact that if you look at the ADHD criteria, you’ll discover that nearly every child on the planet has ADHD. Odds are, if you look closely at the ADHD criteria, you’ll end up diagnosing yourself. I mean, who really likes waiting in lines?

Technically, you should study the different diagnostic categories and the various checklists of symptoms for each disorder, do a formal observation or interview with the person you want to diagnose, match their behaviors to the checklist, and come to your diagnostic conclusion. But we’re living in a fast-paced world where, like our president, whatever you think must be true because you thought it; never mind that you should recuse yourself from diagnosing your friends, your family, and yourself. Who has time to fact check? Besides, you can just ask, “Siri, do I have obsessive-compulsive disorder?”

Contrary to popular solipsistic fantasies and what you’ll learn from Siri, psychiatric diagnosis may look easy, but in the real world, it’s complex and sticky.

Not only are there 300 different diagnoses (and 947 pages in the DSM-5), many psychiatric conditions overlap, meaning one symptom could be associated with several different diagnoses. For example, having a depressed or irritable mood could qualify your or your romantic partner for bipolar disorder or various depressive disorders, but because bad moods are also associated with ADHD, oppositional defiant disorder, substance use disorders, and many different physical/medical conditions, you’ll need to assess for and rule out these other possible disorders. Then again, there’s the likely chance that you and your romantic partner are bugging the hell out of each other and so your depressed and irritable moods are simply a natural product of your poor judgment, incompatibility, or desperate need for couple counseling.

Sorting out diagnostic signs and symptoms is especially difficult because people will often intentionally or unintentionally minimize or exaggerate their symptoms, depending on the setting and their motivation. Think about your son. He’s a hellion at home, but when you take him to the pediatrician, you come unglued trying to tell the doctor about your hyperactive child. All the while, he sits there, hands folded like a little cherub. You leave the office with a new prescription for valium for yourself.

If you make an effort to go beyond using the diagnosis-is-easy approach, in the end, or in the middle, or somewhere in the diagnostic process you may find the symptoms have changed. You mother may have seemed bipolar and you were closing in on a diagnosis of intermittent explosive disorder for your father, but suddenly, right after you move out, their symptoms vanish. Or maybe they just aged and became more mature or maybe they got out of their miserable jobs, and consequently became less emotionally volatile? This is the nature of working with humans; as much as you’d like them to hold still for a clear snapshot, they move, their relationships change, their employment situation shifts, and you end up with what the venerable psychologist Paul Meehl might have called, a fuzzy notion, rather than diagnostic certainty. Looking back, Meehl might have added that diagnosis is also a sticky notion because, once applied, psychiatric diagnoses are difficult to remove. This is why psychiatric diagnosis is best left to trained professionals. This is also why professionals often get it wrong, and someone ends up labeled with a sticky diagnosis that follows them into the future despite new and contradictory diagnostic information.

As an example, many people and some professionals have concluded that Donald J. Trump has a mental disorder called narcissistic personality disorder (NPD). As satisfying as it might feel to diagnose Donald Trump with NPD, the NPD conclusion is erroneous on two counts. First, no one can or should diagnose Trump without conducting a diagnostic interview. Even then, diagnosing him would be difficult. As Allen Francis, Chair of the DSM-IV Task Force wrote, diagnosticians should “be patient,” because accurate psychiatric diagnosis may take five minutes, five hours, five months, or five years. In the real world of psychiatric diagnosis, accurate and useful diagnoses take much longer and are much more involved than a 5 minute armchair social media diagnosis. Competent and ethical mental health professionals always go beyond diagnostic checklists.

Now, don’t get me wrong, labeling Trump with NPD feels good and feels right. Check it out. There are many, many obvious examples of how Trump fits the NPD criteria. However, other than being fun, entertaining, and gratifying (not to mention offensive), the process and outcome of armchair social media diagnosis is neither fair nor honest.

Beyond simply matching DJT’s behaviors with the NPD diagnostic criteria, over the past two years, many articles and books have been written about Donald J. Trump’s mental health. For some odd reason, I’ve been preoccupied with reading many of these articles and books lately. Although not “fun” content, reading about DJT’s mental state was a welcome shift away from my first impulse after his election—which was to start reading about the death instinct in Freud’s Civilization and It’s Discontents. I’m having way more fun now.

For another odd reason, after reading about DJT’s mental health, I found myself fantasizing that I might have something to add to the conversation.

To be continued . . .

Feeling Anxious? Learn the One and Only Method for Self-Regulation

Back in 1980, one of my supervisors at Woodside Hospital in Vancouver, WA, gave me a big compliment. At the time, I was a recreational therapist in a 22-bed psychiatric hospital. In a letter of recommendation, the supervisor described me as having a special knack for translating complex psychological phenomena into concrete activities from which patients could learn. To be honest, I really had no idea what I was doing.

But I think he was onto something about me and my personality. I like to integrate, summarize, and boil down information into digestible bits. Sometimes I have to get the facts to play Twister to get otherwise incompatible perspectives to fit together. This tendency is probably why I’ve written textbooks on clinical interviewing and counseling theories.

Today, I’m tackling anxiety, anxiety reduction, and self-regulation. This feels more personal than usual, mostly because I’ve been dysregulated, more or less, since November 9, 2016.

After reading and thinking about anxiety and anxiety reduction for 30+ years, I’m strongly leaning toward the position that there’s only one, single, universal method to achieve self-regulation. The method is Mary Cover Jones’s counterconditioning. You probably already know that I think Mary Cover Jones is fabulous.

As a means of exploring this unifying method, I recently did a podcast on it with Sara Polanchek. I’ll write more later, but for now, if you’re interested, check out the podcast. It’s the latest episode (7/19/18 release date). You can listen on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

Or Libsyn: http://practicallyperfectparenting.libsyn.com/

If you do listen, please let me know what you think. That way I can continue with integration and synthesis by incorporating your thoughts into my thoughts. I’ll bet you can find many different ways to communicate with me.

If you don’t listen, no worries, I’ll just keep hanging out here in my personal echo chamber.

Mental Health or Mental Illness: Defining Mental Disorders

East Rosebud

For a while, I’ve been engaged in a debate (sometimes just with myself) about the use of the term “mental illness.” [More on this at a later date]. Civil debates are good for the brain. There doesn’t have to be a winner or loser. Recently I remembered that we addressed this issue briefly in our 2017 revision (6th edition) of Clinical Interviewing. Here’s an excerpt, beginning on page 396:

Defining Mental Disorders

The concept of mental disorder, like many other concepts in medicine and science, lacks a consistent operational definition that covers all situations. From the DSM-IV-TR (American Psychiatric Association, 2000, p. xxx)

It’s often difficult to draw a clear line between mental problems and physical illness. When you become physically ill, it’s obvious that stress, lack of sleep, or mental state may be contributing factors. Other times, when experiencing psychological distress, your physical state can be making things worse (Witvliet et al., 2008).

Why Mental Disorder and not Mental Illness?

Many professionals, organizations, and media sources routinely use “mental illness” to describe diagnostic entities included in the ICD and DSM classification systems. This practice, although popular, is inconsistent with the ICD and DSM. Both manuals explicitly and intentionally use and plan to continue using the term mental disorder. From the ICD-10:

The term “disorder” is used throughout the classification, so as to avoid even greater problems inherent in the use of terms such as “disease” and “illness”. “Disorder” is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions. (1992, p. 11)

The ICD and DSM systems are descriptive, atheoretical classification systems. They rely on the presence or absence of specific signs (observable indicators) and symptoms (subjective indicators) to establish diagnoses. Other than disorders in the F00-F09 ICD-10 block (e.g., F00: Dementia in Alzheimer’s disease, F01: Vascular Dementia, etc.), there is no assumption of any physical, organic, or genetic etiology among ICD mental disorders.

Consistent with the ICD and DSM, we don’t use the term mental illness in this text. We also believe mental illness to be a more problematic term than mental disorder. In fact, often we step even further away from an illness perspective and use the phrase “mental health problems” instead. However, in the end, no matter what we call them, mental disorders are fairly robust, cross-cultural concepts that can be identified and often treated effectively.

General Criteria for Mental Disorders

The DSM-5 includes a general definition of mental disorder:

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. (American Psychiatric Association, 2013, p. 20)

This definition is consistent with ICD-10-CM. Nevertheless, significant vagueness remains. If you go back and read through the DSM-5 definition of mental disorder several times, you’ll find substantial lack of clarity. There’s room for debate regarding what constitutes “a clinically significant disturbance.” Additionally, how can it be determined if human behavior “reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (p. 20)? Perhaps the clearest components of mental disorder include one of two relatively observable phenomena:

  1. Subjective distress: Individuals themselves must feel distressed.
  2. Disability in social, occupational, or other important activities: The cognitive, emotional regulation, or behavioral disturbance must cause impairment.

Over the years the DSM system has received criticism for being socially and culturally oppressive (Eriksen & Kress, 2005; Horwitz & Wakefield, 2007). Beginning in the 1960s Thomas Szasz claimed that mental illness was a myth perpetuated by the psychiatric establishment. He wrote:

Which kinds of social deviance are regarded as mental illnesses? The answer is, those that entail personal conduct not conforming to psychiatrically defined and enforced rules of mental health. If narcotics-avoidance is a rule of mental health, narcotics ingestion will be a sign of mental illness; if even-temperedness is a rule of mental health, depression and elation will be signs of mental illness; and so forth. (1970, p. xxvi)

Szasz’s point is well taken. But what’s most fascinating is that the ICD and DSM systems basically agree with Szasz. The ICD includes this statement: “Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here” (p. 11). And the DSM-5 authors wrote:

Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual . . . . (p. 20)

The ICD’s and DSM’s general definitions of mental disorder and criteria for each individual mental disorder consist of carefully studied, meticulously outlined, and politically influenced subjective judgments. Science, logic, philosophy, and politics are involved. This is an important perspective to keep in mind as we continue down the road toward clinical interviewing as a method for diagnosis and treatment planning.

Why Diagnose?

Like Szasz (1961, 1970), many of our students want to reject diagnosis. They’re critical of and cynical about diagnostic systems and believe that applying diagnoses dehumanizes clients, ignoring their individual qualities. We empathize with our students’ complaints, commiserate about problems associated with diagnosing unique individuals, and criticize inappropriate diagnostic proliferation (e.g., bipolar disorder in young people). But, in the end, we continue to value and teach diagnostic assessment strategies and procedures, justifying ourselves with both philosophical and practical arguments.

Some of the benefits of education and training in diagnosis follow:

  • Clinicians are encouraged to closely observe and monitor specific client symptoms and diagnostic indicators
  • Accurate diagnosis improves prediction of client prognosis
  • Treatments can be developed for specific diagnoses
  • Communication with other professionals and third-party payers can be more efficient
  • Research on the detection, prevention, and treatment of mental disorders is facilitated

Although we advise maintaining skepticism regarding diagnostic labels, having knowledge about mental disorders is a professional requirement.

It seems ironic, but sometimes labels are a great relief for clients. When clients experience confusing and frightening symptoms, they often feel alone and uniquely troubled. It can be a big relief to be diagnosed, to have their problems named, categorized, and defined. It can be comforting to realize that others—many others—have reacted to trauma in similar ways, experienced depression in similar ways, or developed similar irrational thoughts or problematic compulsions. Diagnosis can imply hope (Mulligan, MacCulloch, Good, & Nicholas, 2012).

 

Everything You Already Knew About Sex (But were afraid to talk about)

SistersI’ll never forget the night my sisters saved my life. I was 12-years-old. My sisters were babysitting me while my parents were out. They said, “Sit down, we’ve got something serious to talk about.”

I was a compliant little brother. But because my sisters enjoyed dressing me up like a girl, as I sat down, I was hoping I wouldn’t have to get all dressed up again. To my surprise, their serious topic had nothing to do with girls’ clothing and everything to do with what’s underneath girls’ clothing.

They pulled out a gigantic book. In our family, it was called the DOCTOR book; we only got it out when someone was sick. I started to worry, mostly because I wasn’t feeling sick.

They opened the book and showed me anatomically correct pictures of naked men and women. Then I started feeling sick. While looking at various body parts they explained the relationship between male and female sexual organs. I remember thinking “There’s no way this is true.” My sisters, one 17 and the other 14, suddenly looked much older and wiser. I quickly I was not the smartest person in the room (but I already knew that). They explained: “Mom says it’s Dad’s job to tell you about sex stuff. But Dad’s too shy to talk about it. So tonight, we’re telling you everything.” And they did.

At some point in their explanation that night they explained that a “rubber” was a condom and a condom was a method of birth control and that my penis could get big and send out little invisible tadpoles that could get girls pregnant. Suddenly, I understood several jokes that my fellow seventh graders had been laughing about the week before. My sisters were providing knowledge that was essential to the social life of adolescence. But maybe more than anything else, I remember them saying: “Sexual intercourse is very special. You only have sex with someone you really love.” That philosophy may not fit for everyone, but it’s worked out pretty well for me.

If you’ve got children, you should put your fears and shyness aside and directly discuss sex and sexuality with them on an ongoing basis. If you don’t, you can bet they’ll learn about sex anyway, indirectly and from other people, like their cousin Sal or a pornography website. Given this choice, most parents decide, despite their discomfort, to talk about sex with their children.

In contrast to what I got from my sisters, sex education in America is generally a crapshoot. With social media, the internet, and television’s preoccupation with sexual innuendo, it’s easy for children to absorb less-than-optimal sexual ideas. In a National Public Radio interview, the Pulitzer Prize winning poet, Andrew Hudgins spoke about his sex education from jokes:

“One of the things I talk about in the book [The Joker] is what I learned from the taboo subjects my parents never told me about: sex. So I learned about it from jokes and had to figure it out backwards. … It’s very much a hazard. And because you get a ton of misinformation, you get a ton of misogyny built into your brain at a very early age when your brain is still forming and it can cause long-term complications.” (from NPR interview, Weekend Edition, Saturday, June 8, 2013)

In contrast to Hudgins, I got lucky one evening 49 years ago. I didn’t get any misogyny built into my brain. Instead, I learned about sexuality and relationships from two people who deeply cared about me and whom I respected. I’d love to be able to clone my sisters into universal sex educators so they could magically educate all the boys in the world on how to respect women, which, in the end, is much more important than being able to accurately find a vagina in the big DOCTOR book of life.

Teaching children about sex should begin early. There are many natural opportunities for discussing sex with your children – including television, grocery store magazines, and, more often than we like, politicians who engage in questionable sexual behaviors. Other opportunities occur around ages four or five, when young children begin talking, sometimes excessively and inappropriately, about poop, pee, penises, and vaginas. Although addressing such topics with your children can be uncomfortable, you should begin this process while your children are still interested in listening to you. About 10 years later, when your children begin thinking about sex from a different perspective, they may be slightly less impressed with what you have to say.

Of course if you’d rather not deal with the issue, you can always use the approach my parents used. Just give me a call. I’ll put you in touch with my sisters.

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For more information on sex education and parenting, you can check out our Practically Perfect Parenting Podcast episode on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2 or Libsyn: http://practicallyperfectparenting.libsyn.com/

Bad News in Threes: Kate Spade, Anthony Bourdain, and the CDC Suicide Report

Rainbow 2017

My mother always said, “Bad news comes in threes.” That concept, along with many of her other superstitions, never made much sense to me.

In truth, the bad news never stops. She knew that. I suppose that organizing bad news into groups of three offered hope that the suffering might soon end—at least until the next set of three bad things came round.

This week we’ve had bad news in waves, with three particular pieces distinctly linked to suicide. On Tuesday, there was fashion designer, Kate Spade. Yesterday, there was the release of a new CDC report on Suicide. And then this morning there was Anthony Bourdain.

When people like Kate Spade and Anthony Bourdain die by suicide, it’s hard not to be mystified. By all measures, both Spade and Bourdain were highly successful. They were passionate and fully alive. The dynamics that may have led them to choose death are opaque. We can’t see these dynamics. They’re not obvious.

Another thing that’s not easily seen or especially obvious is the fact that, along with Spade and Bourdain, 865 other Americans will die by suicide this week. Let that number sink in. Many of these other American suicides will be military veterans. These 865 Americans may choose suicide for reasons similar or different than Spade and Bourdain. We can’t know the deeply personal reasons why individuals choose suicide.

In honor of my mother’s desire to manage bad news in groups of three, I’ve got some other threes to share:

Three Things to Remember About Suicide

  1. As Spade and Bourdain’s deaths illustrate, suicide is unpredictable. Many respected suicidologists have thrown suicide risk factors and warning signs into the trash bin. Because we may not know if someone is suicidal, our best strategy is to treat everyone with kindness, compassion, and respect. This approach is all about connecting with others in ways that are meaningful and authentic. Then, from the context of your interpersonal connection, if you suspect or intuit that suicide is possible, ask directly in a way that normalizes suicidal thinking. You might ask something like, “It’s not unusual for people to think about suicide. Has that been true for you?”
  2. As the CDC report highlights, a person’s mental health may or may not be linked to suicide. In the CDC’s analysis, about 54% of suicides were not associated with a known mental disorder or pre-suicide warning signs. This implies that thinking about suicide or acting on suicidal impulses may be something that arises from challenging life stresses or circumstances. This information also means that you shouldn’t blame yourself for suicide deaths. We imagine suicide to be a terrible tragedy for the person who dies, but it’s also a palpable tragedy for many survivors. Of course, if you knew a person who died by suicide you deeply wish you could have known the right thing to say or do to save that person’s life. But the reality is, suicide is unpredictable, and so you and I shouldn’t beat ourselves up over not being able to effectively intervene. If you feel guilty after a suicide, talk about your feelings with someone you trust. Although it’s natural to blame yourself, there’s no point in being alone with your guilt, so please reach out for support for yourself.
  3. The deaths of Spade and Bourdain bring suicide to the front and center of our national consciousness. Although it’s good to shine a light on suicide, the deaths of Spade and Bourdain overshadow the 865 other Americans who have or will die by suicide this week. Many of these Americans will not have sought help. The irony of not seeking help is that there are several excellent talk-therapies that specifically target suicide risk. These therapies can be highly effective. Hotlines are a fine first step and medications might help, but the interpersonal connection that comes with evidence-based talk therapies, is profoundly important to positive outcomes. Effective help is available. Let’s bring the evidence-based talk therapies front and center in our national consciousness also.

Three Evidence-Based Therapies

Here are links to the three top evidence-based therapies for suicide.

Dialectical Behavior Therapy (DBT): https://www.amazon.com/DBT%C2%AE-Skills-Training-Manual-Second/dp/1462516998/ref=sr_1_1?s=books&ie=UTF8&qid=1528498109&sr=1-1&keywords=linehan+suicide

Collaborative Assessment and Management of Suicide (CAMS): https://www.amazon.com/Managing-Suicidal-Risk-Second-Collaborative/dp/146252690X/ref=sr_1_1?s=books&ie=UTF8&qid=1528498077&sr=1-1&keywords=jobes

Cognitive Therapy for Suicide: https://www.amazon.com/Cognitive-Therapy-Suicidal-Patients-Applications/dp/1433804077/ref=sr_1_4?s=books&ie=UTF8&qid=1528497986&sr=1-4&keywords=cognitive+therapy+suicide

Three More Resources

The CDC Report, although depressing, includes excellent information. You can read it here: https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1_w  You can also listen to or read an NPR interview with the report’s lead author, Deborah Stone, here: https://www.npr.org/sections/health-shots/2018/06/07/617897261/cdc-u-s-suicide-rates-have-climbed-dramatically

A while back I wrote an Op-Ed piece for the Missoulian newspaper. This Op-Ed emphasized core factors or dimensions that often drive suicidal behavior. Reading the article can give you a better understanding of suicide dynamics and could help you help others, but in no way will it make you capable of successfully preventing suicide amongst all of your family and friends. This article is available through the Missoulian: https://missoulian.com/news/opinion/columnists/suicide-prevention-ignore-the-math/article_ce3c7f1e-ab86-587e-9505-310cc00b3355.html

In January I had a suicide assessment and intervention article published in the Journal of Health Service Psychology. This article is a good resource for professionals who work with suicidal clients. It’s an easy read and might also be of interest to non-professionals seeking to understand more about how professionals work with suicidal people. https://www.nationalregister.org/pub/the-national-register-report-pub/journal-of-health-service-psychology-winter-2018/conversations-about-suicide-strategies-for-detecting-and-assessing-suicide-risk/

I wish you all a weekend of connection and healing.