Tag Archives: suicide

Happy Afternoon at ACES in Seattle: Now, Let’s Talk About Suicide Assessment and Treatment Planning

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In a few minutes, along with Kelley McHugh, I’ll be doing my second ACES presentation today. This one is titled, “A New Model for Teaching and Learning about Suicide Assessment and Intervention.” Hana Meshesha was scheduled to join in the fun, but she wasn’t able to come today.

Along with our other doc students, Kelley and Hana are fabulous, focused, smart, and they contribute to my learning.

In the following powerpoints, you’ll see how Kelley, Hana, and I are thinking about how counseling students and professionals should be trained in suicide assessment and intervention. As always, we’re interested in your feedback. Here’s a link to the ppts: ACES Suicide Seattle 2019 Final

And here are a couple suicide assessment/treatment journal articles that might be helpful: Conversations About Suicide by JSF 2018 and SF and Shaw Suicide 2017

On the Road from Suicide to Happiness: Please Send Directions!

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Buddhists often say that life is suffering. Some days, for many of us, that feels about right.

But on other days, the inverse also rings true. Life is joy. Joy is the dialectical sunshine that intermittently breaks through clouds of suffering to interrupt our melancholy.

Don’t worry. Even though there’s currently a September Winter Storm Warning happening in Montana, I’m not going all weather on you. Besides, there’s not much I love more than clouds, rain, and winter storms. Also, to be fair, Buddha and the Buddhists recognized long ago that there’s a road we can take to get away from storms of suffering.

Maybe it’s my penchant for bad weather that’s drawn me, for the past two years, deeply into the professional monsoon of clinical depression, suicide assessment, and suicide interventions. What’s odd about that is that I don’t believe that depression or suicidality should be as pathologized as they have been. I’m a proponent of the right to die. I also find light and hope in the existential perspective that encourages us to embrace and integrate our darker, depressive sides, so we can emerge more whole and, as the existentialist Kirk Schneider likes to say, experience a Rediscovery of Awe.

For the past two years, focusing on suicide has felt very important. Our society isn’t very good at discussing suicide in an open and balanced way. All too often, suicide gets inaccurately conflated with illness or shame or moral weakness. These inaccuracies have inspired me to talk openly about suicide whenever given the opportunity.

But, to be honest, talking and writing about suicide—even from a professional perspective—isn’t all that fun. Those who know me know how much I like to tell funny stories. For years, I’ve had an untreated addiction to showing Far Side and Calvin and Hobbes cartoons during presentations. You wouldn’t believe how hard it is to find suicide cartoons that are workshop-worthy. When I show my cartoon with the white rat in the cage hanging itself and the lab scientist saying, “Looks like discouraging data on the antidepressant” if there’s any laughter it’s a painful and strained laughter, at best.

I do have one amazing depression cartoon; it’s a Gary Larson Far Side scene of a sad looking man on a bed in a messy room with the caption, “The bluebird of happiness long absent from his life, Ned is visited by the Chicken of Depression.”

But let me get out of my addiction and to the point. In my work on suicide prevention and intervention, I’ve slowly realized that we need to paddle upstream. I won’t stop talking about depression and suicide, but I want to more explicitly acknowledge that disabling depression and tragic suicides are often the inverse of well-being or happiness turned upside down. To address this effort at integration, I’m preparing materials to teach and present on the science of happiness. This is where I need your help. Yes, please send more suicide and depression cartoons, but even more importantly, send me happiness cartoons! I’m expanding my focus, and getting ready to spend more time talking about how we can all live happier and more meaningful lives. One way I’m doing this is by teaching a new “Happiness” course this spring at the University of Montana.

As background, I should let you know that I’m familiar with the Yale Happiness Class, the Penn Positive Psychology Center, and other popular resources. Although I’ll use this mainstream material, I want to do something different.

Here’s how you can help.

I’m looking for lecture material and happiness lab activities. Examples include,

Lecture content

  • Video clips
  • Songs with meaning
  • Demonstration activities
  • Quirky/meaningful stories

Lab activities

  • 30-60 minute specific experiential activities that can deepen student learning
  • Evidence-based experiential activities that demonstrate how to counter depression or embrace meaning

Because I’ll be delivering the course to undergraduates, as you contemplate sending me a map with directions to happiness, please put on your 19-year-old hat and help me find destinations with academic substance, but that will still appeal to the college-age generation.

As always, thanks for reading. I wish you a weekend (and life) filled (at least intermittently) with the sort of happiness and joy that’s palpable enough to sustain you until the next bluebird of happiness lands on your shoulder. And if you live in Montana, be sure to stay warm in the winter storm.

John S-F

When Happiness Ran Away: Thoughts on Suicide and the Pursuit of Happiness

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Several days prior to driving across the state to a party with her family, a friend met up with Rita and me. We talked about happiness. She said she liked the word contentment, along with the image of hanging out in a recliner after a day of meaningful work.

Following the party, she wrote me an email, sharing, rather cryptically, that her party planning turned out just okay, because,

“Sigh. Some days happiness runs so fast!”

I loved her image of chasing happiness even more than the image of her reclining in contentment.

As it turns out, being naturally fleet, happiness prefers not being caught. Because happiness is in amazing shape, if you chase it, it will outrun you. Happiness never gets tired, but usually, before too long, it gets tired of you.

In the U.S., we’ve got an unhealthy preoccupation with happiness, as if it were an end-state we can eventually catch and convince to live with us. But happiness doesn’t believe in marriage—or even in shacking up. Happiness has commitment issues. Just as soon as you start thinking happiness might be around to stay, happiness suddenly disappears in the night.

Maybe our preoccupation with happiness is related to that revered line in the U.S. Declaration of Independence about the right to life, liberty, and the pursuit of happiness. Grandiose words indeed, because, at this point in the history of time, I’m not so sure any of us have an inalienable right to any of those three wondrous ideals.

But don’t let my pessimism get you down. Even though I’m not all that keen on pursuing happiness, I believe (a) once we’ve defined happiness appropriately, and (b) once we realize that instead of happiness, we should be pursuing meaningfulness, then, (c) ironically or paradoxically or dialectically, happiness will sneak back into our lives, sometimes landing on our shoulders like a delicate butterfly and other times trumpeting like a magnificent elephant.

Another reason not to feel down is because next Tuesday, October 1, I’ll be in Red Lodge, Montana as the speaker of the month for the Red Lodge Forum for Provocative Issues.

How cool is that?

My Red Lodge Forum presentation is: Suicide, Suicide Prevention, and the Pursuit of Happiness.

Just in case you’re passing through Red Lodge or happen to know someone in the general vicinity, below I’ve pasted the promotional email for the event. Please come if you can. There will be a fancy dinner, which inevitably involves a full stomach, which, even though I’m talking about suicide, might provide you with a twitch or two of happiness.

Here’s the promo:

From: Red Lodge Forum <redlodgemtforum@gmail.com>
Sent: Sunday, September 22, 2019 2:13 PM
To: ‘Red Lodge Forum’ <redlodgemtforum@gmail.com>
Subject: Tuesday October 1st Forum for Provocative Issues. Dinner reservations open

Forum for Provocative Issues

Suicide, Suicide Prevention, and the Pursuit of Happiness

Tuesday, October 1

PROGRAM

Beginning in 2005, death by suicide in the U.S. began rising, and despite vigorous national and local suicide prevention efforts, suicide rates have continued rising for 13 consecutive years. Depending on which metrics you prefer, suicide rates are up from somewhere between 33% and 61% from their levels at the turn of the century.

In Montana, we have the dubious distinction of the highest per-capita suicide rates in the U.S., at about 29.0 per 100,000 Montanans. Why? What is so peculiar about Montana?

But suicide is about much more than numbers. Join us on Tuesday, October 1 when Distinguished Professor at the University of Montana, John Sommers-Flanagan talks about what contributes to suicide, why Montana’s rate is so high, what’s wrong with suicide prevention efforts, and how we should talk with friends about suicide. Although suicide is a difficult, emotionally charged, subject, John will explore emotions that can create and sustain happiness.

FORUM CATERER CHANGE

In the next section, you will notice our caterer has changed. Martha Young, who has faithfully served our delicious meals for eight years, first at Café Regis, and more recently at the Senior Center, is unable to caterer our October meal. Prerogative Kitchen, an outstanding local restaurant,  has agreed to stand in.

DINNER RESERVATIONS NOW OPEN

Dinner at the Red Lodge Senior Center (13th St and Word Ave) will start at 5:30 pm and our program shortly after 6. If you plan to have dinner, email RedlodgeMtForum@gmail.com (no text or calls) with:

  • your reservation request,
  • your general meal choice (meat/fish, veggie, non-gluten), and
  • your cell number

If you don’t receive an email confirmation of your request promptly, please resubmit it. When I know specific dinner choices later this week, I will ask you to confirm your choice.

If you plan to attend the forum but not eat, come around six but donate $5 to help defray room rental and other expenses.

The price for this  dinner is $18. Please bring a check written prior to your arrival to Prerogative Kitchen for $18 per person. It will reduce traffic at the door, seat everyone faster, and make our cashier’s job easier.  If you want to leave an additional gratuity, simply leave cash on the table. Do not include gratuities in your check.

If you have friends who are interested in attending the forum, feel free to forward this message.

HAS YOUR EMAIL CHANGED?

If you change your email address and want to continue receiving forum notices, remember to send the change to RedlodgeMtForum@gmail.com.

INFORMATION ABOUT UPCOMING AND PAST FORUMS

For quick access to all news about upcoming and past programs, become a member of our Facebook group page, which supports FPI programs.  To access the page, simply search “Forum for Provocative Issues.”  This is an open group, but we carefully screen applicants to avoid potential problems by asking three simple questions.

USE OF FORUM EMAILS

I never share the emails of forum members. However, I have on occasion sent information about community issues and events that I think members will find valuable.

FORUM SUGGESTIONS

If you have an idea for a forum, email it to RedlodgeMtForum@gmail.com.

FUTURE FORUMS

The dates for our 2019/2020 season follow. Mark them on your calendar now to avoid conflicts.

  • November 5, The Future of Nuclear Energy, Redfoot
  • December 10, Japanese American Internment Camp Conditions in WWII, Russell
  • January 14, Fighting Fires, Saving Homes, Trapp
  • February 4, Apollo 8 and the Race for Space, Dragon
  • March 3, Subject TBD, Darby
  • April 7, Dark Money in Politics, Adams
  • May 5, Genetics and the Future of the Human Race, Gunn

 

 

Trauma, Suicide, and Motivational Interviewing: A Handout for BYEP Mentors

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Trauma may be the most common underlying factor contributing to mental disorders. Unfortunately, trauma is often overlooked, partly because it can manifest itself in so many different ways. That said, here are some common definitions. Trauma always involves a stressful trigger that activates a trauma response. Because, like everything, trauma responses are brain-based and involve the body, symptoms affect the whole person.

Old, informal, and useful definitions include:

  • A stressor outside the realm of normal human experience (but sadly, trauma is all-too-common)
  • A betrayal . . . (e.g., something that should not happen)
  • Occurrence of an event that’s emotionally overwhelming

Below I’ve listed the essence of the DSM-5 definition for Post-Traumatic Stress Disorder (note that the whole idea of PTSD centers on the chronic or long-lasting effects of trauma).

Exposure to a traumatic stressor that involves direct personal experience, witnessing, or learning about events involving threatened death, serious injury, or a threat to your physical integrity. The trauma response includes:

  • Intrusion symptoms (recurring unwanted memories, nightmares, flashbacks, and triggered distress)
  • Avoidance of trauma-related thoughts or external cues
  • Negative cognitive alternations (e.g., memory gaps, no joy, etc.)
  • Arousal and reactivity (e.g., irritability, risky behaviors, hypervigilance, insomnia, startle response)

Trauma and trauma responses can be big, medium, and small. Big traumas meet the DSM-5 diagnostic criteria for PTSD or acute stress disorder. Small traumas are usually disturbing and disruptive, but the body and brain adjust to them within 2-3 days. Medium size traumas have lasting effects, but don’t meet formal diagnostic criterial, and are usually referred to as subclinical.

I like to think of Trauma with an uppercase T (like in the DSM) and all other traumas that are difficult, challenging, and require adjustment as traumas with a lowercase t.

What to Say

Sometimes trauma responses or symptoms are visible and obvious. If so, it’s good to say and do some of the following:

  • Listen and show compassion
  • Reassure participants that physical/psychological responses are normal, take up energy & need soothing
  • Note that very effective treatments are available (e.g., This American Life)
  • Brainstorm on what helps
  • Remember: A pill is not a skill
  • Link and universalize (“It’s normal to have pleasant and unpleasant reactions to things we talk about”)
  • Brainstorm on more and less healthy reactions (Using substances is a quick distraction, but not a fix)
  • Share hopeful stories (what skills can be developed?)
  • Self-disclosure can help. But be careful with self-disclosure and remember that it’s not about you

Trauma is a normal and natural human response. You may experience trauma just by listening to people talk about trauma, or you may have your own direct experiences. When in the business of helping others, be sure to take good care of yourself.

Three Suicide Myths

Myth #1: Suicidal thoughts are about death and dying.

Most people assume that suicidal thoughts are about death and dying. On the surface, it seems like a no-brainer: Someone has thoughts about death, therefore, the thoughts must be about death. But the truth isn’t always how it appears from the surface. The human brain is complex. Thoughts about death may not be about death itself.

Myth #2: Suicide and suicidal thinking are signs of mental illness.

Not true. Philosophers and research scientists agree: nearly everyone on the planet thinks about suicide at one time or another—even if briefly. The philosopher Friedrich Nietzsche referred to suicidal thoughts as a coping strategy, writing, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.”

Myth #3: Scientific knowledge about suicide risk factors and warning signs allows for the prediction and prevention of suicide.

Believing in this myth can make surviving family members, friends, and helping professionals experience too much guilt and responsibility. In fact, even the most famous suicidologists say that it’s impossible to consistently and accurately predict suicide.

Tips for Talking about Suicide

We need to be able to talk directly about suicide with courage and calmness. But first, we should listen. Here’s what you should listen for in general

  • Emotional pain
  • A sense of feeling trapped or ashamed
  • Not believing that anything can possibly help to reduce the pain and misery

While listening, show acceptance, empathy, and compassion. Remember: suicidal thoughts are not signs of illness or moral failing; if you judge the person, it will make it harder for the person to be open. Also remember: when people talk with you about their suicidal thoughts, that’s a good thing, because you can’t help unless they’re comfortable enough with you to speak openly about their suicidal thoughts and feelings.

Traditional warning signs in particular

Although it’s good to know these warning signs, there’s not much research supporting the idea that anything predicts suicide.

  • Active suicidal thinking that includes planning and talk about wanting to die
  • Preparation and rehearsal behaviors (stockpiling pills, giving away belongings, etc.)
  • Hopelessness related to feeling that the excruciating distress will never end
  • Recklessness, impulsivity, dramatic mood changes
  • Anger, anxiety, and agitation
  • Feeling trapped
  • No reasons for living, no purpose in life, broken relationships
  • Increased alcohol or substance abuse
  • Immense shame or self-hatred

How should I ask about suicide?

The answer to this is always, “Ask directly.” But we can do even better than that. We need to de-shame suicidal thoughts and talk. Before asking, communicate that you know suicidal thoughts are a normal and natural response to emotional pain and disturbing situations. For example, you could ask it this way, “I know that it’s not unusual for people to think about suicide. Have you had any thoughts about suicide?”

What should I say if someone admits to thinking about suicide? You can say things like,

  • Thanks for telling me.
  • It sounds like things have been terribly hard.
  • Thanks for being so honest, that takes courage.
  • I know I can’t instantly make everything better, but I want you to live and I want to help.
  • How can I best support you right now?
  • What can we do together that would help?
  • When you want to give up, tell yourself to hold off for one more day, hour, minute—whatever you can.
  • Or . . . use your good listening skills and reflect back the feelings and thoughts that the person shared.

Resources for Help

  • National Suicide Prevention Lifeline: Call 800-273-TALK (800-273-8255)
  • Crisis Text Line: Text HOME to 741741
  • Bozeman Help Center – 24-Hour Crisis Line: (406) 586-3333

What is Motivational Interviewing?

Motivational interviewing (MI) is an evidence-based approach to treating substance problems, health concerns, and other mental health issues. MI is “person-centered” and based on the foundational principle that clients should be the ones who make the case for change in their lives. MI:

  • Focuses on the common problem of ambivalence about change.
  • Relies on four central listening skills (OARS): open questions, affirming, reflecting, and summarizing.
  • Helps clients transition from less healthy to more healthy behaviors

Four overlapping components combine to create the spirit of MI:

  • Collaboration (partnership; dancing, not wrestling)
  • Acceptance (UPR, accurate empathy, autonomy, affirmation)
  • Compassion (honoring the client’s best interest)
  • Evocation (tapping the client’s well of wisdom)

MI is a specific treatment approach that requires professional training. However, operating on a few basic MI principles can improve nearly anyone’s approach to helping others. For more information, see the book: Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Press.

This handout is from a mentor workshop for the Big Sky Youth Empowerment Program. These ideas are based on research and collected from professionals who have experience working with people who are feeling suicidal. These guidelines should not be considered medical advice and are no substitute for getting an appointment with a licensed health or mental health professional. See: johnsommersflanagan.com for more information.

The End of Suicide Prevention Week

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The September 12 edition of the New York Times included an opinion piece titled “What Lies in Suicide’s Wake” by Peggy Wehmeyer. Ms. Wehmeyer previously worked as a correspondent on ABC’s “World News Tonight.” In the opinion piece, Ms. Wehmeyer shared experiences following her husband’s death by suicide in 2008.

Wehmeyer’s account of widowhood by suicide grabs you by the throat and brings you to your knees. If you’re a suicide survivor, read it with caution, because it will bring you anger, sadness, pain, and guilt.

Wehmeyer’s story also made me want to take action. I wanted to do to her what Robin Williams did to Matt Damon in his role of the therapist in Good Will Hunting. Williams looked at a file on Damon’s history of abuse, and then stood in front of him, saying,

“All this shit. This is not your fault. Look at me son. It’s not your fault.” Then Williams repeated “It’s not your fault” until Damon collapsed crying in his arms.

Some burdens are too big. I want to take Ms. Wehmeyer in my arms and tell her she’s taking on too much. Her former husband chose suicide. That’s a tragedy. But it’s not her fault.

After a suicide, shame and guilt spread like warm butter on hot toast, seeping into crevices, muscles, joints, and neurons. Guilt stabs you in the heart and then pummels your brain with the most obvious, most painful, most important, and most impossible question, “Why?”

Why . . . is a stupid, impenetrable, devious, and unhelpful question. But suicide survivors can’t stop themselves from painfully ruminating on, Why did this happen? If I were the god of suicide recovery, I’d cancel that question from the genetic blueprint. After a suicide, the question Why is pointless and unanswerable.

I’m a psychologist and a counselor. I’ve got plenty of friends in the mental health professions. Many of my friends, being of the post-modern or existential ilk, like to exclaim, usually with intellectual delight and breathless discovery, that “Humans are meaning makers!!” Well, duh.

Of course humans are meaning makers. Basically, that’s all we do. We make up shit all the time in an effort to explain our existence and our experiences. Let’s say your romantic partner breaks up with you, if you’re like most humans, you’ll wonder “Why?” And then you’ll painfully exfoliate your soul until you corner yourself with some irrational bullshit like, “I must be unlovable” or “I’m defective” or “I’m undesirable.” Or, if you’re inclined the other direction, you’ll quickly conclude, “He was an asshole” or “She’s defective” or “I hope my ex gets hit by a train.” And there are the new-age explainers who repeatedly wax philosophical, saying, “It wasn’t meant to be” or “The universe is telling me that it’s not my time for a romantic relationship.”

Asking why shit happens (and then answering yourself) is simply not helpful; it’s not helpful because you will, being human, come up with dozens of stupid, irrational, and unhelpful explanations for terrible things that happen. In the aftermath of suicide, if you’re like Ms. Wehmeyer, and many of us are, most of your stupid, irrational, and unhelpful explanations will involve blaming yourself. You’ll think things like, “I should have loved him better” or, you’ll embrace the ultimate piece of bullshit, that, somehow, as Ms. Wehmeyer wrote, “I missed those [suicide] signs until it was too late.”

No she didn’t. Wehmeyer didn’t miss the signs. And neither did you. Predicting suicide is impossible for even the best suicide researchers on the planet. Like Robin Williams said: It’s not your fault. You’re not the god of suicide prevention. Things happen. Shit happens. People kill themselves. Suicide started eons before you were born and it will continue for eons after.

Accepting tragedy sucks. It sucks more than nearly anything else we can think of. But tragedy strikes. And most of the time, tragedies are outside our control. Does that mean you should stop trying to prevent suicide and save lives? Of course not. Do what you can when you can. Does it mean you should stop blaming yourself for actions and choices that other people make and that are beyond your control? Hell yes!

In case you missed it, National Suicide Prevention Week is just ending. All week we’ve been encouraged to watch for warning signs, to follow up on our concerns by directly asking friends, family, and colleagues how they’re doing, and if they’ve been thinking about suicide. All this is great stuff. But, along with the many educational messages we’ve heard, somebody has to point out the cold, hard truth.

Sometimes you track the warning signs, you ask all the right questions, and you love people with all your heart, and they’ll still die by suicide. If that happens, it doesn’t mean you missed the signs or that you weren’t lovable enough. If suicide happens, you need to take care of yourself; you need to talk about your sadness, pain, and regrets. But you need to add one more thing. You need to listen to Robin Williams (who also died by suicide) and forgive yourself, because . . . All this shit. This is not your fault. . . . It’s not your fault.

****************************

Resources for help

  • National Suicide Prevention Lifeline: Call 800-273-TALK (800-273-8255)
  • Crisis Text Line: Text HOME to 741741
  • Bozeman Help Center – 24-Hour Crisis Line: (406) 586-3333

 

Want to Learn More about Suicide Interventions and Treatment Planning? Here’s a link to a brand new CE course

John and Max SeattleOver the past several months I’ve been busy writing a 2-part continuing education course on a strength-based approach to suicide assessment, interventions, and treatment planning. As you may recall, Part One of this course was published last May (see: http://www.continuingedcourses.net/active/courses/course114.php ).

Today, I’m announcing that Part Two, titled, Suicide Interventions and Treatment Planning for Clinicians: A Strength-Based Model, is now available. To check it out, go to: http://www.continuingedcourses.net/active/courses/course115.php

Just in case you’d rather watch a CE video on this topic, last year I also did a cool three-part (7.5 hours total) continuing education video on suicide assessment and treatment.with Victor Yalom and Psychotherapy.net. Here’s a link to that resource: Psychotherapy.net: https://www.psychotherapy.net/video/suicidal-clients-series

Happy Labor Day!

John SF