If you had two minutes to screen teenagers who were potentially at risk for suicide, what four questions would you ask them? That’s the central inquiry in a study published last month by researchers at the National Institute of Mental Health. The quick screening tool they developed is as interesting for what it doesn’t include—a question about bullying—as for what it does.
The research team, led by Lisa Horowitz, tested 17 questions on more than 500 patients between the age of 10 and 21 who visited the emergency room for either psychological problems or physical illness. There is already a screening tool for teen suicide attempts that’s considered to be the gold standard in medicine, because it has held up well in multiple studies—a 30-question list called the Suicidal Ideation Questionnaire. Horowitz and her colleagues wanted to figure out whether a far shorter list of questions could come close to matching the SIQ for catching kids at risk for attempting suicide. They came up with 17 potential questions for ER doctors and nurses to try on their young patients. The four questions that matched the SIQ results almost perfectly (with 97 percent accuracy) were:
1. In the past few weeks, have you felt that you or your family would be better off if you were dead?
2. In the past few weeks, have you wished you were dead?
3. In the past week, have you been having thoughts about killing yourself?
4. Have you ever tried to kill yourself?
It makes sense that these questions in combination would screen effectively for suicide attempts: They’re either directly about suicidal thoughts or attempts, or about the kinds of thoughts that are strongly associated with depression, a major predictor for suicide. One of the other 17 questions, though, was about bullying: “In the past few weeks, have you been bullied or picked on so much that you felt like you couldn’t stand it anymore?” And what’s striking about this one is that it had the very lowest ranking among the 17, meaning it was the least likely of all 17 questions to match the predictive quality of the SIQ.
The point isn’t that there’s no link between bullying and risk for suicide. Another study in October found that children who say their peers pick on them—like children who are abused or mistreated in other ways—were significantly more likely to have suicidal thoughts than children who weren’t bullied. (The study also found the greatest risk of suicidal thinking among children who were victimized in more than one way.) What’s interesting about the December study, as Ann Haas of the American Federation for Suicide Prevention pointed out to me, is that it suggests that in a world of limited resources, bullying isn’t the factor that makes sense to focus on for suicide prevention. The key here is proportion, and understanding that suicide usually has multiple causes.Read Full Post | Make a Comment ( 1 so far )
Attention, loved ones: I adore you and want you in my life. But ask me just one more time if I am ever going to remarry or why I couldn’t answer the phone when you called yesterday—seven times in a row—and that could change very quickly.
Many families have boundary battles. Relatives, of course, don’t mean to pry and often are honestly concerned and trying to offer help when asking personal questions. But the line between appropriate and inappropriate is open to interpretation.
Knowing how to push back against pushy people is essential to healthy relationships. It takes stamina and skill. No wonder so many of us are lousy at it.
In reporting this column, I heard about adults’ attempts to set boundaries with siblings who criticize and friends who ask probing questions. (Among the most hated: “How much did you spend on that?”; “When are you going to have kids?” and “Don’t you know how to say no?”) Spouses struggle to draw the line over money and how much time they should be able to spend alone.
In an extreme example, last month a 21-year-old Ohio college student made international headlines after winning a restraining order against her parents, who she said installed monitoring software on her laptop and cellphone.
About a year ago, I moved from New York to an apartment several miles away from my parents’ home in Miami Beach. My first night there, I was curled up with a glass of wine and a good book when I heard a knock on the door. I live on the 10th floor of a very secure building, and there, outside my door, was my mom, holding up two frozen yogurts. “How did you get up here unannounced?” I blurted out. “It was easy,” she said. “I bribed the guard with a sundae.”
Now, I love my mom, but a gal needs some privacy. So, the next morning I marched down to the front desk, showed the security guards a photo of my mother and explained she was never, ever to be allowed upstairs again unannounced. Then I gently explained the rules to mom. (“That’s OK,” she said with a smile. “I have other daughters.”)
Some of us, it seems, don’t know the definition of a boundary. In psychological terms it means “knowing what you are responsible for and what you are not responsible for,” says David Reiss, a San Diego psychiatrist. It marks “when your own autonomy and self-esteem are being invaded, and you need to step back and protect yourself, while minimizing any hostility or confrontation.”
Experts say when setting boundaries you can’t worry too much about giving offense. Remember that you have a right to set the boundary. “I often remind my clients that no one has ever died from being disappointed or offended,” says Julie Hanks, a licensed clinical social worker in Salt Lake City.
To establish, or re-establish, boundaries with someone you care about, start with empathy, Ms. Hanks says. Assume positive intent. The other person probably didn’t mean to hurt or annoy you. A mother-in-law who drops by unannounced too often may miss her grandchildren and want a closer relationship with you.
Be clear about what you want and say it to the person, rather than focusing on the unwelcome behavior. Don’t overexplain. “If you explain too much, people will focus on your explanation and forget your original position,” says Hal Shorey, psychologist and assistant professor at the Institute for Graduate Clinical Psychology at Widener University, in Chester, Pa.
Try to control your emotions, and don’t begin the conversation in the heat of the moment. “Everything negative does not require an immediate response or resolution,” Dr. Reiss says.
Start with the positive, says Jerry Cook, associate professor at California State University, Sacramento, and author of the book “Grow Your Marriage by Leaps and Boundaries.” He suggests saying, “Our relationship means the world to me. But what you said bothers me, and I want to make sure that doesn’t happen again because I value our relationship.”
If you are the one told to back off and respect boundaries, ask yourself a question and answer honestly: Were you acting out of concern, or were you trying to fulfill some unmet need of your own? Dr. Cook says you will need to tell yourself, “This relationship is important to me, so it’s OK if my feelings are hurt when we talk about this. I want to get this right.”
Generational expectations often differ because ideas about boundaries change over time. Behavior that is appropriate between parents and small children will change as the children grow.
We sometimes invite others to step into our business by disclosing too much information, or expecting too much sympathy or advice. It’s best not to share marital woes too openly unless you want lots of meddling—or some serious backlash against your life partner. And have you ever told an adult sibling how much you make for a living? Enough said.
And yet there is good news for those who feel boundaries need to be reinforced. “Sometimes, when one person makes a positive change, it encourages others to behave better,” Dr. Reiss says.
Arash Afshar, a 30-year-old artist and graphic designer in San Diego, says it took several years but he finally got his father to leave fewer “venting” voice mails on his cellphone. Until recently, Mr. Afshar says, whenever he didn’t answer his phone his dad would leave a message with questions like, “Why do you even have a cellphone?” Often, he would call back repeatedly to continue his point, Mr. Afshar says.
The problem was partly generational. Mr. Afshar says his father, who was raised in Iran, “comes from a generation where people rushed to pick up the phone, and I come from one where phone calls are a nuisance.” He tried explaining there were lots of reasons why he couldn’t answer the phone, but the logic didn’t work. He started actively avoiding his dad’s calls, and when the two did talk, there were shouting matches.
Then, in psychotherapy, Mr. Afshar began to see that his father felt ignored. He hit on a winning strategy: He returned his father’s calls only when the messages were nice. This, folks, is called positive reinforcement. It’s how they train Shamu.
Mr Afshar says at first he noticed when they talked, his dad’s tone was a little cold but now his father also seems relieved. “We have a much better relationship now,” he says.Read Full Post | Make a Comment ( None so far )
After every act of incomprehensible violence, the world asks whether the killer could have been identified ahead of time. It’s as automatic as the call for more gun control and better mental health services.
Psychologists and psychiatrists have been working for decades to try to figure out whether there’s a link between mental illness and violence, and if so, which people are likely to act. Using an ever-changing tool kit of theories and questionnaires, they’ve made some progress.
It’s now fairly clear, for example, that people with severe mental illness, such as schizophrenia, bipolar disorder and some personality disorders, are more likely to commit violent acts than others. But the risk is small. The vast majority of mentally ill people won’t commit assault, rape, arson or homicide, although the risk rises sharply among those who abuse drugs and alcohol.
These insights are proving useful to psychiatrists, psychologists, judges, school administrators and others who must decide whether someone seems too dangerous to be left alone. But they aren’t good enough to identify an Adam Lanza, the young man who killed 28 people, including himself, in Newtown, Conn., last month. (Lanza’s mother told friends that he had Asperger syndrome, a developmental disorder, but no evidence has emerged that Lanza was diagnosed as mentally ill.)
“There is no instrument that is specifically useful or validated for identifying potential school shooters or mass murderers,” said Stephen D. Hart, a psychologist at Simon Fraser University in Vancouver who is the co-author of a widely used evaluation tool. “There are many things in life where we have an inadequate evidence base, and this is one of them.”
Even when someone has a history of threatening behavior, the killing of innocent people can’t necessarily be prevented.
The woman accused of pushing a man to his death in front of a New York subway train on Dec. 27 had been arrested several times for assault and treated in the psychiatric wards of two hospitals. The man who fatally shot two firefighters and himself in Webster, N.Y., on Christmas Eve had killed his 92-year-old grandmother three decades earlier.
The task of identifying violence-prone individuals is even trickier with young people, who have shorter histories and whose normal development often includes a period of antisocial behavior.
The prospect that the most recent massacre, or the next one, could lead to efforts to find young men contemplating the killing of strangers worries many people. Among those expressing concern are some psychologists and former patients forcibly swept into the mental health system and treated against their will.
“I think people are going toward wanting all their kids to be screened in high school for mental illness and violence risk — and that’s a bad idea,” said Gina M. Vincent, a forensic psychologist at the University of Massachusetts Medical School. “That’s my biggest fear of what’s going to come out of this.”
“We can’t go out and lock up all the socially awkward young men in the world,” said Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at Duke University. “But we have to try to prevent the unpredicted.”
The best-known attempt to measure violence in mental patients found that mental illness by itself didn’t predict an above-average risk of being violent. People released from psychiatric wards were more violent than their neighbors only if they also had drug and alcohol problems, according to the MacArthur Violence Risk Assessment Study, which tracked almost 1,000 former patients in the early 1990s.
Other research has found a link — although not a particularly strong one — between mental illness and violence.
In a 2001 study funded by the National Institutes of Health, researchers asked 35,000 adults whether they had been diagnosed with a mental illness anytime in their lives and in the previous year. They also asked a long list of questions about the subjects’ personal histories and behaviors. Re-interviews were conducted three years later, asking about violent events in the intervening period.
People who reported that they’d had both “severe mental illness” and substance abuse problems in the year before the first interview had the highest rate of violence; 9.4 percent had committed a violent act. The next most violent were people with other types of mental illness (mostly antisocial personality disorder) accompanied by substance abuse — 7.2 percent of them reported violent behavior.
Groups with lower rates of violence included people suffering only from severe mental illness, 2.9 percent of whom reported having been violent; those only with substance abuse problems (2.5 percent); and those with other mental illnesses alone (1.4 percent). People without any of these problems had just a 0.8 percent rate of violence.
Over the years, researchers have made a particular effort to study violence and schizophrenia, a disorder that emerges in young adults and often includes paranoid thoughts.
An analysis of 20 studies published three years ago found that schizophrenia increased the risk of acting violently fourfold in men and even more in women. The risk of schizophrenics committing homicide was 0.3 percent — more than 10 times greater than the average citizen.
The evidence suggests that “there’s a modest relative risk” for violent behavior in people diagnosed with a serious mental illness, said Swanson, the Duke researcher.
If some of the mentally ill are dangerous, can they be found?
Over the years, studies have shown that psychiatrists’ accuracy in identifying patients who would become violent was slightly better than chance — “obviously not good enough, given what’s at stake for public safety as well as for civil liberties,” said John Monahan, a University of Virginia psychologist who helped direct the MacArthur study.
So Monahan and many others came up with a constellation of “risk factors” and “protective factors” for violent behavior — analogous to the risk factors for heart disease, such as age, blood pressure, smoking and cholesterol — and included them in questionnaires.
Some of those instruments rely heavily on adding up scores. Others put more emphasis on the interviewer’s clinical judgment. The most popular current strategy combines both approaches; it forces the evaluator to include any pertinent issue.
All of the approaches consider the presence of a mental disorder as only a small contributor to risk, outweighed by other factors such as age, previous violent acts, alcohol use, impulsivity, gang membership and lack of family support.
There have been numerous efforts to test these violence-predicting tools in recent decades. For example, Monahan and his colleagues incorporated 106 risk factors into a software interview program and administered it to patients being discharged from psychiatric units in Massachusetts and Pennsylvania. Of those judged to be low-risk by this tool, 90 percent committed no violence over the next six months. Of those judged to be high-risk, 49 percent committed violent acts.
“From our research, we could quickly distinguish between a patient whose chance of being violent was 1-in-10 from one whose was 1-in-2,” he said.
Last summer, a large study published in the British Medical Journal found much the same thing.
It analyzed the findings of 68 studies that involved about 25,000 people in psychiatric hospitals, prisons or court-ordered detention. (The studies used a variety of assessment tools.) Of the people predicted to “violently offend,” 41 percent did. Of those predicted to be nonviolent, 91 percent were. In practical terms, that meant that if authorities used the tools for the purposes of public health, they’d have to detain two people to prevent one from becoming violent.
The authors of the analysis concluded that “risk assessment tools in their current form can only be used to roughly classify individuals at the group level, and not to safely determine criminal prognosis in an individual case.”
Most of this research has been conducted on populations already “enriched” with the potential for violence: psychiatric patients, drug users, binge drinkers, people who have been arrested. But some mass shooters don’t fall into any of those categories.
For the general public, there’s no screening tool for violence, and nobody expects that there ever will be.
Is what’s known about the relationship between mental illness and violence of any use after events like the mass shooting in Connecticut?
People who study and provide mental health treatment generally say, “Yes.” However, that’s not because people prone to violence can be found and stopped. It’s because if psychiatrists, psychologists and judges become more aware of the relationship between social circumstance, behavior and risk factors for violence, then they might be able to exert influence long before a killer’s plans are made.
At least that’s the current thinking.
“Most people who are thinking about violence are ambivalent about it,” said Hart of Simon Fraser University. “Our job is to find people who are ambivalent and convince them that violence is a bad idea.”
He cited the recent case in Vancouver of a college student who told a friend she was thinking of killing a homeless man. The friend notified authorities; the student was detained and evaluated with an assessment tool called the HCR-20. She had a “death kit” of tools in her possession and had killed a cat and dog for pleasure. She was convicted of animal cruelty but will soon be released on probation, with close supervision.
But some people warn that a more aggressive mental health system would pose its own dangers.
James B. Gottstein, a lawyer in Anchorage and head of the Law Project for Psychiatric Rights, has won four cases in his state’s Supreme Court supporting patients’ rights to refuse to take psychiatric medicines, limiting conditions for involuntary commitment and other issues. He learned firsthand what it’s like to be forcibly drugged and stigmatized by psychiatric treatment.
In June 1982, he had a manic episode that he attributes to sleep deprivation. He was working hard, suffering from jet lag after returning from Europe and living in a place where the sun didn’t set at night. He was taken by the police to a mental hospital, where he spent a month.
“One of the problems that happens when you become a psychiatric patient is that everything that you do or say can be labeled as a psychiatric symptom,” said Gottstein, 59, a graduate of Harvard Law School.
“If the police knock down your door and haul you off and you get upset, you get labeled as ‘hostile’ and ‘labile.’ If you decide that you’re not going to react to these provocations, you get labeled as having ‘a flat affect.’ If you think something is funny and you laugh to yourself, then they write down ‘responding to internal stimuli,’ ” he said.
It’s not that people don’t want help, Gottstein said, but that “the system basically forces things on them that they don’t want.” He thinks it is “entirely possible to create a system where things are voluntary.”
Essential are peer counselors — people once similarly diagnosed who might be able to connect with the mentally ill when the professionals can’t. There’s a largely unknown movement trying that approach. But he’s quite sure that’s not what people calling for “greater access to mental health services” these days are talking about.
And that worries him.Read Full Post | Make a Comment ( None so far )
No matter how old people are, they seem to believe that who they are today is essentially who they’ll be tomorrow.
That’s according to fresh research that suggests that people generally fail to appreciate how much their personality and values will change in the years ahead — even though they recognize that they have changed in the past.
Daniel Gilbert, a psychology researcher at Harvard University who did this study with two colleagues, says that he’s no exception to this rule.
“I have this deep sense that although I will physically age — I’ll have even less hair than I do and probably a few more pounds — that by and large the core of me, my identity, my values, my personality, my deepest preferences, are not going to change from here on out,” says Gilbert, who is 55.
He realized that this feeling was kind of odd, given that he knows he’s changed in the past. He wondered if this feeling was an illusion, and if it was one that other people shared: “Is it really the case that we all think that development is a process that’s brought us to this particular moment in time, but now we’re pretty much done?”
Gilbert says that he and his colleagues wanted to investigate this idea, but first they had to figure out how. The most straightforward way would be to ask people to predict how much they’d change in the next decade, then wait around to see if they were right. “The problem with that is, it takes 10 years,” says Gilbert.
So the researchers took a much quicker approach. They got more than 19,000 people to take some surveys. There were questions about their personality traits, their core values and preferences. Some people were asked to look back on how they changed over the past 10 years. Others were asked to predict how they thought they would change in the next decade.
Then the scientists crunched the data. “We’re able to determine whether, for example, 40-year-olds looking backwards remember changing more than 30-year-olds looking forwards predict that they will change,” Gilbert explains.
They found that people underestimated how much they will change in the future. People just didn’t recognize how much their seemingly essential selves would shift and grow.
And this was true whether they were in their teen years or middle-aged.
“Life is a process of growing and changing, and what our results suggest is that growth and change really never stops,” says Gilbert, “despite the fact that at every age from 18 to 68, we think it’s pretty much come to a close.”
Personality changes do take place faster when people are younger, says Gilbert, so “a person who says I’ve changed more in the past decade than I expect to change in the future is not wrong.”
But that doesn’t mean they fully understand what’s still to come. “Their estimates of how much they’ll change in the future are underestimates,” says Gilbert. “They are going to change more than they realize. Change does slow; it just doesn’t slow as much as we think it will.”
The studies, reported in the journal Science, impressed Nicholas Epley, a psychology researcher at the University of Chicago. “I think the finding that comes out of it is a really fundamentally interesting one, and in some ways, a really ironic one as well,” says Epley.
He says everyone seemed to remember change in the past just fine. “What was bad, though, was what they predicted for the future,” says Epley.
He notes that if you want to know what your next 10 years will be like, it’s probably good to look at what your past 10 years were like — even though we seem not to want to do that.
Gilbert says he doesn’t yet know why people have what he and his colleagues call the “end of history illusion.”
One possibility is that it’s just really, really hard to imagine a different, future version of yourself. Or maybe people just like themselves the way they are now, and don’t like the idea of some unknown change to come.Read Full Post | Make a Comment ( None so far )
Everyone is familiar with the concept of a periodic medical checkup — some sort of scheduled doctor’s visit to check your blood pressure, weight and other physical benchmarks.
The notion of a regular mental health checkup is less established, perhaps because of the historical stigma about mental illness. But taking periodic stock of your emotional well-being can help identify warning signs of common ailments like depression or anxiety. Such illnesses are highly treatable, especially when they are identified in their early stages, before they get so severe that they precipitate some sort of personal — and perhaps financial — crisis.
“Absolutely, people should have a mental health checkup,” said Jeffrey Borenstein, editor in chief of Psychiatric News, published by the American Psychiatric Association. “It’s just as important as having a physical checkup.”
About a quarter of American adults suffer from some type of mental health problem each year, according to the National Institute of Mental Health, and 6 percent suffer severe ailments, like schizophrenia or major depression. When left untreated, mental health illnesses are more likely to lead to hospitalization — something that could mean time lost from work.
Ideally, doctors should ask patients about their moods as part of a regular wellness visit, Dr. Borenstein said — there doesn’t necessarily need to be a special visit to gauge mental health. But if the doctor doesn’t bring it up, patients can educate themselves and start the conversation with their physicians.
Jeffrey Cain, president of the American Academy of Family Physicians, said family doctors were trained to spot symptoms of mental illness, like depression, and he encouraged patients to bring in questions or concerns for discussion. But people don’t necessarily go to their family doctor and say they are depressed, he said. Rather, they say they’re tired, or that they lack energy, that they’re having trouble concentrating or that their body aches — all of which can be symptoms of depression or anxiety.
There are some well-known screening tools that patients can use as a starting point to assess themselves, to help prompt a conversation with their doctor. Dr. Borenstein mentioned a common tool used by doctors to assess patients for depression: a “P.H.Q.,” for “patient health questionnaire” He cautioned that the idea here was not to self-diagnose using such forms — there are several versions, varying by number of questions — but rather to self-assess, and then discuss your concerns with a professional.
The P.H.Q.-9, which asks nine questions, was developed by researchers at Columbia University and Indiana University, with help from a grant from Pfizer Inc. The form is available on several Web sites, including (phqscreeners.com/pdfs/02_PHQ-9/English.pdf).
It asks about the patient’s outlook and health habits over the previous two weeks. The first question, for instance, asks patients whether they have had “little interest or pleasure” in doing things and asks them to check a box ranging from “not at all,” which scores a zero, to “nearly every day,” which scores a 3. A professional computes a total score, which gives more weight to frequent symptoms; the higher the score, the greater the likelihood of significant depression.
Another set of screening tools for depression and other mental health disorders were developed by Screening for Mental Health, a Boston-area nonprofit that creates assessment tools for use by health plans, colleges, the military and the general public. Founded by Douglas Jacobs, an associate clinical professor of psychiatry at Harvard Medical School, the organization grew out of the first National Depression Screening Day, which is held annually each October during Mental Illness Awareness Week.
Mental illnesses have specific signs and symptoms, much as a disease like diabetes does, Dr. Jacobs said, and those symptoms can be identified and treated. Take depression, again, as an example. It’s normal to be sad for a while after a personal loss or a traumatic event. But when the effects linger and begin to affect your self-esteem, or interfere with your ability to do your job or handle other responsibilities, he said, you may want to consider if you are suffering from a more serious depression that should be treated professionally — with behavioral therapy, medication or both.
At the site helpyourselfhelpothers.org, which is sponsored by Screening for Mental Health, you can find locations near you that offer mental health services. Or, you can use a free online screening tool that can help you gauge if you might be at risk for various illnesses including depression, anxiety, bipolar disorder, eating disorders and post-traumatic stress disorder.
You can choose a specific screening or answer questions to help narrow your choice. For instance, the tool asks you to complete the sentence “I have been…” with phrases like “feeling sad or empty,” or “drinking more than planned.”
The depression screening tool asks questions about how you have been feeling during the last two weeks, like whether you have been “blaming yourself for things” some of the time, all of the time, or most of the time.
The questionnaire concludes with a finding based on your answers. For instance, it might tell you that “Your screening results are consistent with symptoms of an eating disorder,” along with a recommendation to seek a professional evaluation. Gina N. Duncan, an assistant professor of psychiatry at the Medical College of Georgia at Georgia Health Sciences University in Augusta, who has blogged about the notion of a personal mental health checkup, said sleep disruptions were often a sign of stress. If you’re sleeping much more or less than usual, or having difficulty falling asleep, that can be a warning signal.
Many large employers include mental health coverage as part of their health benefits packages, and recent federal rules on benefits “parity” mean such benefits at large plans should not have higher have co-payments and deductibles or stricter limits on treatment than benefits for other medical or surgical needs. Also, most large companies currently offer employee assistance plans, which provide counseling and referrals — both over the phone and in person — to workers and members of their families who are suffering from personal crises.
Helen B. Darling, president of the National Business Group on Health, a consortium of large employers, said employee assistance plans were an important way to screen for mental health problems. Help through them is generally provided free of charge outside of the main health insurance plan, so using the service does not generate an insurance claim.
Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the “essential package” that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.Read Full Post | Make a Comment ( None so far )
Over the past 30 years, I’ve spent nearly 25,000 hours counseling angry men, and until about two years ago, my enthusiasm was beginning to wane. If you’ve worked with angry male clients, you can understand why. These men are generally highly reluctant clients, who are often in your office only because they’ve gotten “the ultimatum” from their wives or girlfriends or bosses or sometimes court judges: “Get therapy for your anger or get out / you’re fired / you’ll go to jail.” Many, considered by everyone who knows them to have an “anger problem,” arrive in your office convinced that they don’t have an anger problem: the real problem is their stupid coworkers, annoying girlfriends, demanding spouses, spoiled kids, or unfair probation officers. However, they arrive at your office with a shotgun at their backs, so to speak, and know they have no choice. They hate the entire situation because it makes them feel powerless.
No wonder they feel powerless: they’re being coerced to lay down their anger, the only weapon they’ve ever had against feelings of powerlessness. They often trace their reliance upon anger to a childhood history of danger, trauma, shaming, and pain. Anger is the emotion they can trust, the one that might keep danger at bay. As they grew up, they continued to use anger to make people they regard as dangerous back away. By the time you see them, they regard just about every person in their lives as “dangerous,” including loved ones. These men have become habitually angry. I liken their condition to the default option on a computer: their anger goes on automatically unless they consciously turn it off.
Of course, it isn’t easy to turn off the default option when the way to do so is hidden deep within the machine’s (our brain’s) control panel. Furthermore, men for whom anger is a default emotional response to life’s vicissitudes are often relatively untrained in experiencing and communicating other emotions. For example, one of my clients “went off”–screaming and threatening bodily harm against his father’s doctors–when his father died, to the point the police had to be summoned, because he couldn’t handle his grief. Anger was the only emotion he could call upon in time of need. Not surprisingly, when these men come to therapy, whether as individuals or in couples or groups, they’re frequently defensive, argumentative, passive-aggressive, protective of their right to be angry, and doubtful about my competence to understand or help them in any way.
It’d be misleading to say that my most difficult clients are unmotivated. More accurately, they’re antimotivated, committed to undermining any behavioral programs or specific anger management tactics I offer. Meaningful change takes many repetitions: “Practice, practice, practice” is a hallmark of anger-management training. For example, taking the time to put a problem into perspective (“On a 1-10 point scale, Joe, how important is it for your teenage daughter to get home every night by 8 p.m.?”) works well, but only if the client is motivated enough to practice putting things into proper perspective perhaps as often as several times a day. It stands to reason that trying to argue such men out of their commitment to anger is pointless. I long ago realized I couldn’t beat them in face-to-face combat; they’re better at in-your-face challenges and making contemptuous remarks than I’ll ever be. I needed a tool that allowed me to sidestep their oppositionality and create a therapeutic alliance.
At a deeper level, chronically angry people have become lifelong victims of what’s sometimes called negative neuroplasticity. They’ve unintentionally trained their brains so well, through countless repetitions of undesired behavior (at least, undesired by the rest of the world), that they’re primed to think, feel, and say things that increase their own anger. For example, Joe may well think that if his daughter gets home after 8 p.m. it means she’s probably having sex with some male punk. That kind of thought pattern is automatic.
So now we have two major concerns. First, some of my clients enter treatment antimotivated. Second, their brains have been programmed to react automatically with anger and hostility to a wide variety of situations. What kind of therapeutic intervention can address these issues?
Focusing on the Brain to Increase Motivation
About six years ago, I stumbled across the answer when I attended a session about the brain at the Networker Symposium in Washington, D.C. The controversial brain researcher Daniel Amen was just beginning his lecture when he mentioned in passing that he’d been browsing through the books on anger in the sales area. “None of them said anything about the brain,” he noted somewhat dismissively. Now many of those anger books he was trashing were my books, so at first I was defensive. But by the end of the talk, I realized he was right, at least about the books I’d authored. I hadn’t mentioned anything about brain processes for a simple reason: I didn’t know anything about them. That led me to immerse myself in the subject of the brain, and as I did so, my enthusiasm for working with angry clients increased exponentially.
How can learning about the brain–particularly the angry brain and how it got that way–possibly influence clients who have a hard time taking in therapy or sticking with anger-management techniques? Aren’t concepts drawn from brain research simply too abstruse, too abstract, and apparently unrelated to daily life to make much difference to them? In fact, what I’ve found is just the reverse: these men are fascinated by information about how anger develops in the brain and why it’s so hard to control, and they consider it far more relevant to their lives than many standard therapy concepts. Getting to understand a bit of what happens “inside their heads” when they get angry resonates deeply with them. In one way, they can cling to their defensiveness and denial systems, since they certainly can’t be accused of deliberately messing up their minds. Sidestepping their defensiveness and emphasizing their opportunity to do something right that will retrain their brains gives them a positive direction and a possible source for well-earned personal pride. Furthermore, hearing me explain how, by regular, committed behavioral practice of various anger-management techniques, they can literally change their own brain circuits, stimulates both hope that they can change and desire to begin. For the first time in their lives, they feel they might be capable of literally using their own brains tochange their brains. It is a real revelation to many angry men.
My own enthusiasm for brain science and my belief in angry men’s inherent capacity to reorganize their own neural circuitry are probably another key to revving up their motivation to try. My “brain talk” to them isn’t just a lecture about applied neurophysiology, but in truth a kind of triggering mechanism arousing their own curiosity and interest. Clearly, my enthusiasm evokes–in their brains–a mirroring enthusiasm for this process. It may well be that my sheer enthusiasm for this endeavor, my joy and excitement about the brain, triggers left-hemisphere mirror neuronal activity that bypasses right-hemisphere negativity and cynicism.
Devron Johnson is a 40-year-old male who’s been divorced for 10 years, partly because of his anger problems. An intelligent but not highly educated man, he works as a heating and cooling technician. He has two adolescent sons, with whom he barely converses and seldom visits. He’s now in a new relationship with Sheila, a 36-year-old mother of three younger children who live with them. Although Devron has never been physically violent with the children, he often frightens them with his angry outbursts.
This man grew up in a tough part of Detroit, where survival was the name of the game. His parents separated and reconnected several times during his childhood. The family atmosphere was markedly hostile–full of negativity, accusations, and occasional violence. Devron said he hated his father because he was never there for him, not even when he became a star athlete on his high school’s baseball team.
Devron sought therapy because Sheila had threatened to end their relationship unless he became much nicer to her kids. He added that he was also in trouble at work because “I gave the finger to my boss once too often.”
Here’s how Devron described his anger: “Man, I had a bad attitude in school. I beat people up if they looked at me wrong. But I gave that up. I don’t hit nobody anymore. But Sheila says I still have a bad attitude. She says I look for problems with her kids. Then I blow because I have a really short fuse. And I have a hard time letting go of my anger, too. Once I get pissed at someone, they stay my enemy forever.” Still, Devron does want to change. He loves Sheila and even grudgingly admits he likes her children. He doesn’t want to lose them. However, he doubts whether I, or anybody else, can help him. A few years ago, he attended an anger-management program for about 10 weeks, but says, “I didn’t get nothing useful from it.”
Like many angry clients, Devron came to counseling under duress–the “get help, or get out” final call. This isn’t a formula for success, since such clients often arrive for counseling thinking that they’ll more or less passively go through the motions to get the wife/boss/law off their backs, and then they’ll be free to revert to previous behavior. By contrast, Devron was directly skeptical and dismissive–derisive, in fact. Instead of pretending to buy the package, he openly challenged me to prove I had something new to offer. It’s uncomfortable to be sneered at by your client, but I’ve learned to recognize an open challenge as a positive indicator for success. Devron’s disdain was a sign of energy that might be used in counseling, if I could develop an alliance with him.
“Actually, Devron, I do have something to offer you that you probably haven’t run into before,” I told him, “I can help you change your brain.” I proceeded to explain with the enthusiasm and energy I usually feel when talking about the brain that he was actually capable of making fundamental, long-term changes in the way he thinks. “Devron, all it takes is commitment and persistence. I know you’re capable of both of those things because you’ve told me how much you love Sheila and the kids–that’s commitment–and how you’ve stuck it out with them when it would have been easier to walk away–that’s persistence.” I emphasized to him that he’d developed lifelong habits of anger that had become deeply rooted in his brain. But I assured him that he and he alone could make changes in those habits if he so desired. However, I cautioned him that real brain change doesn’t come easy. I said he’d need to make a strong commitment to practice new behavior for at least several months, so he could build, improve, and expand new circuitry inside his brain while reducing the power of his negative brain circuits. I briefly mentioned such concepts as neuroplasticity and myleinization, but only as a tactical move, to assure him that I did, in fact, know what I was talking about. I told him I didn’t just believe this brain stuff might work, I was absolutely convinced because I’ve seen many other angry people change their brains in just this way, and because I myself had changed my brain to become much more optimistic and generous.
As I spoke, I watched Devron’s “show me” expression change to hope and wonder. “You mean I can really change the way I think?” he asked. It turned out that Devron’s oppositionality obscured a deep sense of pessimism and hopelessness. He’d believed that change was impossible, in effect dooming him to a lifelong anger career. But now, maybe because of my own sense of conviction, he began to see possibilities. We talked a little more before the hour ended, and I asked him to think about how much he wanted to change his brain and in which ways. I also asked him what positive goals he wanted to pursue–for example, what other emotions he might be willing to experience if his brain wasn’t dominated by anger. A positive goal is important with all clients, of course, but especially with angry clients, who often mistakenly set only the negative goal of being less angry. I explained to Devron that only setting a negative goal like quitting being angry was like deciding that a car that currently could only go in reverse would be just fine if you could get it to stay in neutral. The idea is to move forward in life, to get that car moving ahead. Of course this same idea applies to only quitting drinking (instead of leading a sober lifestyle) or stopping being critical (instead of giving praise).
Finally, I cautioned Devron again that real brain change doesn’t come easy. I told him he’d need to make a strong commitment to practice new behavior for at least several months so he could build, improve, and expand new circuitry inside his brain while reducing the power of his negative brain circuits. I then sent him home with two pages of examples of possible brain change plans he could implement. One example was converting criticism and pessimism to praise and optimism. Another was to convert resentment into forgiveness. A third was to look for the good in people (and himself) instead of the bad.
When Devron returned a week later, he said he’d thought a lot about changing his brain and his life. He’d discussed it with Sheila, who’d told him she’d stick around for a while if she saw him really working to change his behavior. Now he was eager to make a six-month commitment to brain change. I then gave him some handouts I’ve created to help him name his brain-change plan. A person with a good brain plan has given it a name that means something at an emotional level, includes specific initial behaviors to maximize the opportunity for immediate success, and at least speculates about longer-term improvements and additions, and how achieving these changes might affect him or her. I also gave Devron the chapter on neuroplastic change from my book to reinforce the idea that changing his brain was realistic, if and only if he’d make a strong commitment to it.
Devron returned the next week in a quandary. He told me that he and Sheila had had a big disagreement about what his brain-change plan should include. She wanted him to be nicer to her children. Devron told me that he wanted to be nicer to them, but that his first concern was quitting thinking so pessimistically about the world. “If I can’t quit thinking that everyone is out to screw me over, I don’t think my changes will last,” he said. I thought Devron had hit upon a clear understanding of how he needed to change at an existential level. Brain-change plans aren’t simple behavioral alterations: they really change your brain, and in doing so, ultimately affect your connections with yourself, those you love, and the universe. So I affirmed Devron’s insight. However, I did point out that his goal and Sheila’s weren’t contradictory. Being nicer to the kids could well become one way that he altered his mindset of hostility and suspiciousness. After all, deeply held beliefs don’t change completely on their own. Devron needed to try out new behavior and receive positive rewards for doing so in order to give his brain the opportunity to be transformed.
I’d like to offer a side comment here. We often expect our angry clients to act as if they were living in a safe world, a world in which people are pleasant, trustworthy, loving, and consistent. This false belief on our part sets clients up to fail. Devron’s siblings, for instance, regularly engaged in felonious behaviors, such as drug dealing and robbery, and expected him to join them as he often had in the past. He told me during therapy that he’d begun declining these invitations. When I asked him if he’d practiced being assertive with them, he laughed. “I guess if telling my brother to go to hell when he attacked me for not going along with some scam he was into, then yes, I was very assertive.” The result of his new “good” behavior was that his family ostracized him for several months. Fortunately though, Sheila and her children were dependably in his corner, so that Devron could practice new, prosocial behavior around them without being criticized or ridiculed.
Devron named his plan “Learning to Trust.” I was tempted to add “and take in love,” but Devron would have labeled that phrase unmanly. When I asked him how he planned to begin this plan, he suggested he could go to his father to see if he could learn to trust the man he most distrusted in the world. Needless to say, this was a palpably rotten idea: in all likelihood, his father would once again have demonstrated his complete untrustworthiness, potentially undermining everything Devron was trying to do. I talked him out of it with some difficulty by pointing out that he was betting his whole stake on one roll of the dice. “Besides, it’s a bad bet,” I said. “You’d be better off investing in a smaller stake, like letting yourself trust Sheila more.” That reminded him of his real priorities.
He decided to open up emotionally a little more to both his family and a few trusted coworkers. For example, he told some of his history to two of his coworkers, the ones he felt most comfortable with, and they responded positively with their own self-disclosures. Then he took a bigger chance by admitting to Sheila that he had cheated on his first wife. Much to his shock, she told him she’d known about it for a long time–his ex-wife had thoughtfully given Sheila that information when she’d begun dating Devron–but she’d chosen not to mention it and trust that he’d be faithful to her.
Shiela’s disclosure and assertion of trust brought him to tears. At that very moment, his brain-change plan spontaneously expanded to include being trustworthy to others. Since Devron had a long history of lying by omission (“Oh, I must have forgotten to tell you that”) this expansion was quite significant. It had proved harder for him than the initial goal because he’d had to retrain himself not to leave out some of the truth “so nobody could pin me down.” He kept expanding from his core commitment to develop trust. He realized along the way that he’d been mean to Sheila’s children because he didn’t want to get close to them and then lose them. But Sheila came through by rewarding his obvious changes with reassurance that she’d stay with him.
I regularly review a client’s brain-change plan with him or her, rather than just assume it’s working fine. It’s important to challenge clients quickly if they’re letting their plan drift.
The final addition to Devron’s plan was learning how to be more empathetic. Devron acknowledged that empathy was strange territory for him: “Frankly, I never gave a damn what anybody else felt.” But now that he felt safer, he could do what safe people do: care about and take a real interest in others. Like many angry people, he has some difficulty being empathic. Empathy partly depends on automatic attunement processes usually learned in infancy through parent–infant synchronic movement. He experienced few such experiences as a child. We talked together about this deficit, a deficit he was determined to challenge. He immediately made a real effort to put himself in the shoes of others. It’s just that he had trouble first taking off his own shoes. For instance, he told his 12-year-old daughter, Amy, who was being teased by classmates, that he knew exactly how she felt, even though he’d been the bully, not the victim, when he’d been in school. But here again, the principles of neuroplasticity apply. Devron realized he’d misunderstood the situation when his daughter got mad at his reply. He then consciously took the time to listen better. Gradually, this behavior was becoming faster, smoother, and more automatic.
Devron’s plan, then, began with developing some basic trust in the world, which led to being trustworthy himself, which morphed into increased empathy and actually caring about others. He quit working with me after approximately nine months. Our last session included Sheila, who affirmed that Devron had become much less angry, more caring, and far more present in their lives. She’d previously doubted his changes would endure, “But he’s only becoming nicer,” she admitted. “I don’t doubt him any longer.” Devron added that he now felt deep inside his soul that he could trust Sheila. He felt safe in a relationship for the first time in his life. “So now I have no reason to be mad all the time.” Of course, he and Sheila still argue from time to time, as do almost all couples. But Devron controls his initial burst of anger far better than before, calms down quicker, and lets go of his anger sooner.Read Full Post | Make a Comment ( 1 so far )
About a month ago, Declan Procaccini’s 10-year-old son woke him early in the morning in a fright.
“He came into my bedroom and said, ‘Dad, I had a horrible, horrible dream!’ ” Procaccini says. “He was really shaken up. I said, ‘Tell me about it,’ and he told me he’d had a dream that a teenager came into his classroom at his school and shot all the kids in front of him.”
Procaccini’s son is a sensitive kid, frequently anxious, so Procaccini did what he often does when his son crawls into his bed with a fear or anxiety: He explained why the fear wasn’t rational by simply laying out the math.
“The chance of that happening here are 1 in a zillion,” Procaccini told his son, and then continued with a lesson about probabilities and possibilities. “You know, it’s possible that Godzilla could right now come through the trees? Yes. But is it probable? No. I think we both know that it’s not probable.”
This discussion seemed to calm his son down a bit. He shook off his dream and returned to life as usual.
“That worked out for a little while,” Procaccini says.
And then Procaccini’s community became the “1″ in “1 in a zillion.”
‘I’m Going To Need Help For A Long Time’
The day Adam Lanza shot his way through Sandy Hook Elementary School, Procaccini’s 8-year-old daughter was in a reading room just down the hall from the principal’s office.
She had walked herself to her class early and was sitting there with two teachers when the three of them heard the sound of gunfire coming from outside.
“They grabbed my daughter by the arm and threw her into the bathroom,” Procaccini says. “There’s a little bathroom off the reading room, I think it’s a single-person … and the three of them just sat in there, quiet, ’cause he came into the room.”
Apparently, Lanza didn’t hear them because he left, and everyone in the tiny bathroom survived.
In the days after the shootings, though, one of the teachers who had been at the school and knew Procaccini well reached out to him and his wife, Lisa. She wanted them to know just how terrifying their daughter’s experience had been.
You need to get your daughter help, she told the family. Procaccini recalls her saying, “I was literally in the same area as your daughter, and I know what she saw and I know what she heard, and I’m going to need help for a long time. You need to get her help.”
But since the shootings, Procaccini’s daughter has barely talked about what happened, barely registered any emotional distress at all.
“I don’t know if she’s just disassociated. I don’t know if it’s her defense mechanism. Or I don’t know if she just doesn’t get it. I truly don’t,” Procaccini says.
His 10-year-old son, however, has been struggling. Procaccini’s son graduated from Sandy Hook Elementary last year and now attends Reed Intermediate School, which went into lockdown during the shooting, so the boy had no idea what was happening until Procaccini picked him up and told him about it. Immediately, Procaccini says, his son started crying. “I mean, he was crying like a little baby. I haven’t seen him cry like that, you know? He was so scared.”
And as soon as they got home, Procaccini says, his son made a decision: no more school for him. “I’m not going!” he insisted over and over again.
But when Procaccini’s family went to see a therapist the next day, one of the things the therapist made clear was that staying away from school was a bad idea. The more school his son missed, she told Procaccini, the harder it would be to get him to go back.
And so on Tuesday of last week, when Reed went back into session, Procaccini tried to persuade his son to go.
“I said, ‘Come on, I’ll walk you in, I’ll show you!’ And he just snapped. And it was crying and screaming, ‘I’m not going! I’m not going! You’re not leaving me!’ “
For the rest of the week, Procaccini and his son simply drove to the school and walked together through the halls for hours, Procaccini’s car keys safely tucked into his son’s coat pocket so that Procaccini couldn’t drive away by himself.
This procedure was supposed to convince his son that school really was a safe place, but his son doesn’t seem to be buying it, and Procaccini is worried about what will happen after the holiday break.
“I don’t have a plan, really,” he says.
Since the shootings, Procaccini’s son hasn’t had another dream, but Procaccini is certain that if he does, there will be at least one difference in the way that Procaccini responds. Procaccini won’t talk about probabilities and possibilities again. That argument suddenly doesn’t make any sense.
‘Something Somewhere Will Happen’
Zhihong Yang, another parent of a Sandy Hook student, lives two miles away. Yang tells me to call her Jen, and when I walk in, there’s a small pile of papers spread over the table in her kitchen, handouts for Sandy Hook Elementary parents distributed at a conference the night before.
Yang’s son Jerry is in the third grade and was at Sandy Hook during the shooting. Unlike some of the other kids who were at the school, he genuinely seems to be doing OK. But for her part, Yang finds herself thinking about things she had never considered before.
“Yesterday I went to Costco and I can’t help but think: If there was a shooter here, what do you do? I went to the supermarket: If something happened there, what do you do?” she says.
This makes sense, since death is all around Yang. Take her drive to school. Her usual seven-minute route is now lined with families affected by the tragedy. “At least four families that had victims in that accident,” she says, “and when I drive by I feel the pain and I do cry.”
Yang is from China. She says that in college there, she studied math, and then suddenly — totally without prompting — I find myself in another conversation about possibilities and probabilities. Yang, it turns out, specialized in statistics, and since the shooting has been thinking a lot about possibilities and probabilities, reconsidering her original feelings about them.
Yang tells me that she had always assumed that she was safe because the chance of a shooting happening to her specifically was very small. But since the shooting she’s been focused on this one rule of statistics she learned in college, which she calls the “large number certainty theorem.”
“If the base is big enough,” she explains, “even though the probability is small, things will happen with certainty.”
By Yang’s reckoning, this is how the large number certainty theorem applies.
We know that many people have guns, and we know that a certain number of people have disordered minds or bad intentions, and we also know that this is a huge country. In other words, the base is big.
“So, you know, mathematically, something somewhere will happen with certainty,” she says.
And so though Yang previously depended on the idea that school shootings were so rare they would probably happen to someone else, the shooting has taught her that “we should not wait until it actually happens to us to take action.”
Yang has decided to get more involved with fighting for gun control. This, to her, seems like the logical thing to do.
Still, the logic of many parts of all this are not clear to her at all.
“You can safely predict that this will happen, but why it particularly happened to that class? To that teacher’s room? That particular family?” she says.
This obviously is not a question that math can answer. Math can tell us only that something will happen — not when, not to whom.
And so, Yang reasons, morally she should not distinguish between its happening to someone else and its happening to her. Probabilities just aren’t improbable enough for that.Read Full Post | Make a Comment ( None so far )
Seventeen years ago, a couple of criminologists at the University of Maryland published an interesting paper about the 1976 District ban on handguns — a ban that was recently overturned by the Supreme Court on the grounds it was inimical to the constitutional right of Americans to bear arms to protect themselves.
The researchers employed a simple procedure: They tabulated all the suicides that had taken place in Washington between 1968 and 1987. Colin Loftin and David McDowall found that the gun ban correlated with an abrupt 25 percent decline in suicides in the city.
Loftin and McDowall, who now work at the University at Albany, part of the State University of New York, also tabulated suicide rates in Maryland and Virginia over the same period, to test whether suicide rates just happened to be declining in the entire region. There was no difference in the suicide rate in the Maryland and Virginia suburbs before and after the D.C. gun ban. The researchers also tabulated the kinds of suicide that declined in Washington: The 25 percent decline was entirely driven by a decline in firearm-related suicide.
There are many ways to read the Second Amendment to the United States Constitution, but all the versions point to one core idea: Americans have the right to own guns to protect themselves against outside threats, whether the danger comes from a school shooter, a vicious mugger, a robber breaking into a house, a lawless neighborhood — even the government itself.
What the authors of the Second Amendment did not foresee, however, is that when people own a gun, they unwittingly raise their risk of getting hurt and killed — because the odds that they will one day use their gun to commit suicide are much larger than the odds they will use their gun to defend themselves against intruders, muggers and killers.
States with high rates of gun ownership — Alabama, Idaho, Colorado, Utah, Montana, Wyoming and New Mexico — have suicide rates that are more than double the suicide rate in states with low rates of gun ownership, such as Rhode Island, Massachusetts, New Jersey, Connecticut, Hawaii and New York, said Matthew Miller, an epidemiologist at the Harvard School of Public Health. The difference is not because people in gun-owning states are more suicidal than people in states where fewer people own guns, but that suicide attempts in states with lots of guns produce many more completed suicides.
“The evidence is overwhelming,” said David Hemenway, a professor of health policy at Harvard. “There are a dozen case-controlled studies, all of which show the gun in the home is a risk factor for suicide for the gun owner, for the spouse, for the gun owner’s children.”
Turning a gun on ourselves, or having a family member turn a gun on someone in the household, doesn’t intuitively feel as real a risk as muggers, robbers and murderers. Given the choice between trusting our intuitions and trusting the evidence, most of us go with our gut.
If TV dramas about cops and violence were to actually depict the reality of how death and mayhem usually unfold in America, however, these are the scenarios that would stream into our homes each night: An elderly widower, lonely beyond words, shoots himself. A middle-aged executive, who has lost everything in an economic downturn, throws herself off a tall building. Two teenagers pull a Romeo-and-Juliet-style suicide as a protest against an uncaring world.
The reason we can be sure that suicide — and not assaults, break-ins, muggings, school shootings and other fatal attacks by sinister strangers — would account for most of the stories is that suicide dwarfs homicide as a killer in the United States. There were 32,637 suicides in the country in 2005, the latest year for which statistics are available. That year, the collective homicidal mayhem caused by domestic abusers, violent criminals, gang fights, drug wars, break-ins, shootouts with cops, accidental gun discharges and cold, premeditated murder produced 18,538 deaths.
Even the risk of terrorism doesn’t begin to come close to the risk of suicide.
Only a tiny fraction of the 400,000 suicide attempts that bring Americans into emergency rooms each year involve guns. But because guns are so lethal, 17,002 of all suicides in 2005 — 52 percent — involved people shooting themselves.
The grimness of these statistics repeats itself endlessly, year after year, but makes no difference to our collective fantasies and fears about violence — and the reasons millions of people buy handguns for “protection.” Muggers, robbers and gangs feel scary. Most people don’t think of themselves as potential threats — after all, doesn’t suicide happen only to the insane?
Overwhelmingly, the research suggests suicide is usually an act of impulsive desperation — an impulse that passes. Most people who survive suicide attempts do not go on to kill themselves later on. Gun owners are no more likely than non-gun-owners to be suicidal. But within the window of a mad impulse, people who have lethal means at their disposal are much more likely to kill themselves than those who lack such means.
“If you bought a gun today, I could tell you the risk of suicide to you and your family members is going to be two- to tenfold higher over the next 20 years,” Harvard’s Miller said. “There are not many things you can do to increase your risk of dying tenfold.”Read Full Post | Make a Comment ( None so far )
Amid the aftershocks of the senseless shootings at Sandy Hook Elementary School in Newtown, Conn., our ever-more-complex society goes on to publicly discuss what happened and how to avoid such tragedy in the future.
But there are also private considerations and quieter questions of how to respond — on a personal level — to suffering parents.
What can you say to parents who have lost a child? What can you do?
No one is an expert when it comes to this most horrific, most out-of-the-natural-order-of-things disaster. The grief a bereaved parent feels resides deep within and is individually expressed. Different people respond in different ways.
Tragically, my wife, Jan, and I have experience. Our two beautiful, brilliant and ebullient sons, Stone, 24, and Holt, 20, were killed when an out-of-control tractor-trailer crashed into their car — while the boys were stopped in traffic — on a Virginia interstate in the summer of 2009. In one cruelest instant, we lost all of our children.
And so we speak only from our own experience.
As bereaved parents ourselves, we feel deep empathy and compassion for any parent who loses a child of any age — and especially now for the parents of Newtown.
We have an intense knowledge of the personal horror, the chaos, the confusion, the total shock and disbelief the mothers and fathers are feeling. We share their all-consuming pain and that deepest of human longings for it simply to … not … be … true.
We cry for the lost children of Newtown, and we cry for their parents.
But what can you say to someone who has lost a child? “I am so sorry,” is a start. And, we have discovered, it is also possibly all there is to say. There is just not much else to speak of. At least, that’s the way we feel.
And what can you do? There are many things that people have done since Holt and Stone were killed that have been helpful and meaningful. The gestures are simple — and yet profound because of the courage and restraint and, yes, love, it takes to do them.
On hearing the reality-wracking news, dear friends of the boys and of ours came to us to cry with us.
A large group set up a food calendar, a dinner-delivery system that fed Jan and me for months and months — on many days that we did not want to get out of bed, much less shop and cook and take care of ourselves. Friends took turns, preparing one meal a day, bringing it by around sunset, speaking to us a little if we felt like it or leaving it at the front door if we didn’t. We are forever grateful to those who participated.
Other friends have stepped in to do other simple things. One swept our driveway. Others raked leaves and cleaned up the yard. Many have come to the house, one at a time, to spend a couple of hours helping Jan address hundreds of thank-you notes. Others dropped off fresh flowers once a week, offered to go shopping for us, left thoughtful gifts at our doorstep, such as a homemade moss garden and heart-shaped rocks. People donated to various charities in honor of our sons. A neighboring family appeared one morning to shovel heavy snow from our driveway.
Another bereaved parent told us about The Compassionate Friends, a support group for parents and family members who have lost children.
Some friends simply gave us long, deeply felt hugs and held us as we sobbed inconsolably.
And above all, the most important thing people have done — and still do for Jan and me — is to remember Holt and Stone. In little ways, such as posting Facebook messages, texting us on their birthdays or holidays, sharing sweet memories with us. And in big ways, such as establishing memorials at their high schools in Maryland and their colleges in Delaware, Florida and Texas.
Many people helped us establish a foundation to honor the beautiful lives that our sons lived — and many continue to support it.
Simple yet profound gestures.
During the past 3 1/2 years, people have said to us: “I just can’t imagine …” We never, ever imagined this either. But now that this horror has happened to Stone and Holt, and to Jan and me, we ask our friends to try to imagine. The tender ones who have imagination and compassion sit with us quietly and listen — and try to help us feel less alone.
As retired Presbyterian minister and author Eugene Peterson told NPR following the Newtown shootings: “Silence is sometimes the best thing to do, holding a hand, hugging somebody. There are no adages that explain or would make any difference to the suffering. Sometimes people say, ‘I don’t know what to say to these people.’ You know, I say don’t say anything. Just hold their hand. Hold them, hug them and just stay around for an hour or so in silence and just be there. That’s what we need at times like this …”
Actually, it’s what Jan and I, as bereaved parents, will need for the rest of our lives. The world may recover from the deaths of our children. We will never fully recover from such life wounds. How could we?
We imagine that, like us, the parents of Newtown will need love and support and room to grieve — in their own ways and at their own pace. For a long, long, very long time.Read Full Post | Make a Comment ( None so far )
When acts of violence against children become national news, it’s natural for kids to worry and wonder what it means for them.
So amid the coverage of the shootings in Newtown, Conn., that have claimed the lives of 20 schoolchildren, what should parents do for their kids?
“The key thing is limiting their exposure to news media, TV,” says Dr. Daniel Fagbuyi, medical director for disaster preparedness and emergency management at Children’s National Medical Center in Washington, D.C. “We’ve found this over and over in different disasters.”
Kids, especially older ones, will have questions. “You do have the dialogue with them about it,” says Fagbuyi, a pediatric emergency specialist.
Be ready to give reassurance and support. “You want to make them feel secure,” he says. ” ‘Yes, this happened. It was wrong, but here’s what we’re doing to protect you.’ “
A guide from the federal Substance Abuse and Mental Health Services Administration has advice tailored for kids of varying ages.
Infants and toddlers can’t really grasp the details of a traumatic event like this one. But they’re highly attuned to adult caregivers’ emotional reactions and may echo them. Be aware of that.
Preschoolers can understand the basics. “Keep the message simple,” Fagbuyi says. Reassure them, but don’t lie.
Grade-school kids are smarter and more mature, he says. “Be honest with them,” he says. Children this age can handle the facts, but don’t make the details too specific. They may be afraid. “Ascertain what are their fears and then address them,” he says.
Fagbuyi says parents can share their own feelings with kids this age, too, but be sure to explain what adults are doing to keep children safe.
For older children, their own emotional development can come to bear on how they make sense of the news. Some teens may reflexively say everything is OK, even when it’s not.
“For high-schoolers, you have to be upfront and candid,” he says. “They’ll act out. They may be angry.” Let them know it’s all right to express their feelings. “Help them do it in a healthy way that’s not all bottled up.”
If you’ve got older kids, be with them when they are getting information about the shootings from the TV, radio or Internet. Let them ask questions and talk about the coverage. Don’t let them overdo either the talking or the media monitoring.Read Full Post | Make a Comment ( None so far )
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