Education Update

January 2012 Archives

I Hear You: Responding to Cries for Emotional Help

By Dr. Lloyd I. Sederer on January 27, 2012 4:35 PM | Comments |

Cries for emotional help come in all forms. We witness these cries in ways direct and indirect: from outright requests to help me stay alive to the less direct but no less obvious self-starvation of anorexia or leaving empty pill bottles or illegal drugs in plain sight.

We recently witnessed a modern-age cry for help when Sinead O'Connor declared on Twitter: "does any1 know a psychiatrist in dublin or wicklow who could urgently see me today please? im really un-well... and in danger." Why a celebrity needs Twitter to find a psychiatrist is beyond me. Sure, we can all quip about how hard it is to get an appointment with a doctor, but I suspect that is not what this was about.

Nor can I know, since I am not personally familiar with this celebrity, her medical community, resources, or for that matter, her state of mind when she turned to such a ubiquitous form of social media for help. But as a psychiatrist, I understand how people reach out in ways that we need to listen to: The ultimate fear is that they will find no one there, which is the saddest situation of all. Suicide, as has been said, is not just the product of hopelessness; it is the result of believing that you are all alone, with no one to turn to and no means of exiting from the psychic pain that is crushing your soul.

Mental or emotional pain hurts no less than physical pain. In some ways, mental anguish can be more unbearable because it is often laced with several horrible additives. The first is a common tendency for a person to blame themselves for the condition they are in: They feel guilt, shame, a failure for not having willed themselves better. In addition, there is stigma: The way that people with mental disorders are shunned, castigated and marginalized as if that person is a low-life who needs "to get a life." External injury is thus added to personal agony and self-blame. Topping it all off, there is no broken bone, tumor or infection to point to that explains what's causing the pain. This can create upheaval in a person's sense of self as they search for a way of comprehending what does not have the same explanatory power as do the myriad of conditions that appear visibly on the body, or by blood or imaging tests, or by looking at cells under a microscope.

The Australians launched a social media campaign a few years ago called "R-U-OK?". The Aussies suggested something far more personal and meaningful than waiting for someone to arrive at an emergency room after an overdose or sending a distress signal by email, Twitter, Facebook or some other channel in our rapidly-expanding universe of social media. If you see someone in emotional distress or displaying the consequences of psychological problems (such as social isolation, compromised work performance, poor self-care), they urged to reach out to that person: Ask, R-U-OK? and then sit back and listen non-judgmentally and support the part of that person that wants to live, to love and to be connected to their family, friends and work community. It is there, I assure you, but often buried under hurt and disappointment and hopelessness.

Don't be afraid of saying the wrong thing. Saying nothing, letting somebody stew in their psychic pain, is far more likely to result in something unfortunate happening than is offering a kind word and support for taking what steps are needed to begin to change a situation or treat a problem. When no one asks, when no one notices, cries for help generally escalate -- and not only by tweeting.

Human behavior is purposeful. We do things for a reason. Sometimes that reason (or reasons) is obvious and sometimes not. Behavior is "crazy" only until we understand it, then it is not crazy anymore. Self-destructive behavior happens for a number of reasons, including a need to communicate with others how bad the pain and loneliness is.

You may not be able to answer a celebrity's Twitter cry. But you can listen for cries for help from those you love, from friends and from co-workers. You can answer their cries for help. If not, who knows where or how the cry will next appear?

Originally published in The Huffington Post on January, 18 2012.

Visit my website www.askdrlloyd.com for questions you want answered, reviews, commentary and stories.

Psychological Demons

By Dr. Lloyd I. Sederer on January 10, 2012 2:07 PM | Comments |

A book review of "Henry ’s Demons: Living with Schizophrenia , A Father and Son’s Story", by Patrick Cockburn and Henry Cockburn

Remember Pete Earley’s book, "Crazy: A Father’s Search Through America’s Mental Health Madness?" Earley, a former Washington Post journalist, tells the story of his son, who suffers with a psychotic illness, and the madness of America’s mental health (and correctional) system. There is nothing quite like having a top-notch professional journalist on a mission to deliver a compelling story. We now have another fine journalist who brings us into the world of mental illness, family, community, and the mental health system—but from across the Atlantic, in the United Kingdom, via Henry’s Demons. Through alternating father and son chapters, Henry’s Demons depicts Henry Cockburn’s descent into and slow emergence from severe mental illness. His father, Patrick, is an accomplished war reporter for the Financial Times and the Independent whose life is forever changed by his son’s mental illness; he wrote the majority of the book. Henry was the first of two boys in the Cockburn family, where the mother was a college professor who cared for the boys, while the fatherwas usually at far-off and dangerous war zones. Henry was a creative child who never quite fit in with his peers, and he smoked a lot of marijuana as a teenager (”too much,” he remarked).

Through father and son, we enter the world of mental illness in personal and painful ways. However, memoirs are now common, and suffering is often their métier. What distinguishes this book are the plethora of lessons learned, none delivered in didactic or pedantic ways but instead through narrative and experience. I recommend this book to families and mental health practitioners because it teaches us 1) that what we often see as denial (“there is nothing wrong with me”)is a means by which a person defends his or her identity and grasps to maintain the integrity of his or her very being; 2) that moments of lucidity in people with mental illness where they see the gravity of their illness and its consequences on their lives may be impossible for them to endure; 3) that mental illness can induce a state of idiosyncratic narcissism in those affected, in which concern about the effect of their illness on their families and others seems to vanish; 4) how marijuana and other mind-altering drugs erode what little protection against mental illness a constitutionally vulnerable person may possess; 5) how families can be seduced into unaffordable financial investments to care for their loved one when, in fact, the care that they may buy is often no better, and many times worse, than what a good public sector service system can provide; 6) that families that communicate with others about their struggle discover that they are not alone, which can be essential in continuing to be able to provide support over a lifetime to a loved one with a mental illness; 7) that intramuscular administration of antipsychotics for some people who will not take oral medications may be the only way to build a foundation of sanity, on which critical psychosocial interventions can occur; 8) that clozapine, which is proven to be more efficacious for treatment-resistant schizophrenia, is substantially underutilized; and 9) that we have yet to establish the community equivalent of the asylums of the 1800s, where people with serious mental illness can have safe and supportive communities in which recovery can take place.

Patrick is a keen observer of the limits of mental health care and the profound turmoil that mental illness produces in those closest to the ill person. His journey began by thinking that schizophrenia was a disease to be cured, but he evolved to understand it as a disorder that can be controlled and need not drive a person to states of dangerous behavior and a life fated to be without love or work. Henry tells his story with seeming naiveté and remarkable vividness, still half-believing the varied delusions, hallucinations, and psychotic views of the world he experiences. However, he does so from a growing state of recovery in which he can understand what unhinges him (e.g., smoking marijuana, not adhering to his medication regimen) and what he needs to do to contend with his psychosis. As the book ends, both father and son have achieved a sense of growing optimism that their lives, while irrevocably altered, can be rebuilt in ways that they have yet to fully understand.

Originally Published in the American Journal of Psychiatry January 2012.

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January 2012 Archives

I Hear You: Responding to Cries for Emotional Help

Psychological Demons

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