What I have learned from my suicidal patients • Hacker News Board

Re: What I have learned from my suicidal patients

#111

Post by jdmcnugent » Sun, Nov 24, 2019, 4:42 AM UTC

jdietrich wrote: post #77

shrimp_emoji wrote: post #2

>The soldier who hiked out on to the moor, lay down in the heather and overdosed. Émile Durkheim, the great sociologist, theorised as to why suicide is so common among military personnel – not simply because of the devastating effects of war, or because of their easy access to weapons, but because of the depersonalising effect of army training: “Military esprit can only be strong if the individual is self-detached, a…

>Is this saying that veterans can kill themselves more easily because they have more rational clarity about the situation? I don't think so. Doctors and veterinarians have an unusually high rate of suicide, partly because they have access to highly lethal means of suicide but also because they've become inured to mortality. For most people, the practical realities of death are somewhat foreign, which creates a psycho…

Interesting side note about suicide among physicians (in the U.S. at least), every state license or hospital privileges (including renewals) I have applied for asks “have you been diagnosed with or received treatment for a mental health disease such as depression, anxiety, etc”. Obviously any rational person would at least hesitate to seek mental health treatment if it meant they could incur increased scrutiny just to continue to do their job, much less knowing that their peers (and sometimes competitors) on the hospital credentialling committee would be aware of their struggles. I have personally known at least 8 friends / coworkers in the medical field who have committed suicide since I entered the field and I cannot help but imagine that this contributed to at least some of them.

Re: What I have learned from my suicidal patients

#112

Post by michaelmrose » Sun, Nov 24, 2019, 6:15 AM UTC

0xcde4c3db wrote: post #38

> To feel depressed about the state of your life is to demonstrate capacity to imagine something different, and that spark of imagination can prove a motive to change. This was arguably true for me, but not in a good way. I'm pretty sure that I started having intrusive suicidal thoughts because my depression had motivated me to try to change. Said changes utterly failed to even make a dent in my depression, finally c…

That is very insightful thanks for sharing this.

Re: What I have learned from my suicidal patients

#113

Post by donretag » Sun, Nov 24, 2019, 6:37 AM UTC

hestipod wrote: post #84

I won't make it through the end of the year and it's all preventable. Nearly everything I see posted about suicidal people from non-suicidal people, and ESPECIALLY doctors get it wrong and avoids root causes in some self serving attempt to justify their failures or live with that existential fear. Most people I have known professionally when I was a provider, and personally since I became a victim, who were suicidal…

There are some things you simply cannot control, like who your family is. You cannot focus on them. As far as others go, they might not be doing things in the right way, but they are trying in some capacity. Some do not even have that. Everyone is dealing with their own problems as well.

We are thinking of you here on HN. I can do nothing for you, but would always make time for you.

Re: What I have learned from my suicidal patients

#114

Post by chas » Sun, Nov 24, 2019, 6:56 AM UTC

brookside wrote: post #92

cassowary37 wrote: post #89

Earlier quoted context omitted.

and HN refusal to pay attention to data when it relates to depression in 3..2..1... https://www.ncbi.nlm.nih.gov/pubmed/29477251 for moderate to severe depression, the kind most posters are talking about, they're consistently better than placebo. It is true that placebo is often effective too. But most people I talk to would rather have that extra chance of getting better.

"We excluded trials that included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression " This is an honest question - is it fair to exclude people for whom antidepressants don't work in an analysis of if antidepressants work?

If “placebo-resistant depression” and “treatment-resistant depression” were synonyms, we would expect that excluding treatment-resistant depression from your study would result in the studying showing precisely no difference between treatment and placebo. The fact that the meta-analysis shows any difference at all suggests that “treatment-resistant depression” might be a meaningful category.

Re: What I have learned from my suicidal patients

#115

Post by mjevans » Sun, Nov 24, 2019, 7:19 AM UTC

whatshisface wrote: post #7

shrimp_emoji wrote: post #2

>The soldier who hiked out on to the moor, lay down in the heather and overdosed. Émile Durkheim, the great sociologist, theorised as to why suicide is so common among military personnel – not simply because of the devastating effects of war, or because of their easy access to weapons, but because of the depersonalising effect of army training: “Military esprit can only be strong if the individual is self-detached, a…

One one hand, we have a growing body of research saying that almost nothing anybody does is rational, and that most "rational explanations" that people deliver are post-hoc rationalizations of something they did on a whim. The popular interpretation is that this represents evidence against free will, but that may be a little overblown. On the other hand, there is a parallel cultural trend of people arguing that suici…

Here's a hypothesis to consider.

Q: Is there a strong correlation between being lonely and being heavier?

H: Being lonely has several relations to eating 'worse' food, and more of it. An economical standpoint (at least in the US). A social activities promote things other than eating to fill time. A 'rewards' perspective, where lacking other forms of joy fatty, sugary, salty foods fulfill a basic stimulation requirement.

It would be interesting if a mental health research institution designed and ran a fundamental research study to determine if one, some, all, or more (possible) of these causes were related.

Re: What I have learned from my suicidal patients

#116

Post by bmer » Sun, Nov 24, 2019, 7:57 AM UTC

hestipod wrote: post #84

I won't make it through the end of the year and it's all preventable. Nearly everything I see posted about suicidal people from non-suicidal people, and ESPECIALLY doctors get it wrong and avoids root causes in some self serving attempt to justify their failures or live with that existential fear. Most people I have known professionally when I was a provider, and personally since I became a victim, who were suicidal…

Hello hestipod.

I have been in your situation, and I have had certain privileges you do not have which helped me. So, I do not want to tell you: "just do XYZ and you'll be better". In fact, I agree with you that suicidal tendencies are not due to mental health issues; rather, they are due to deep societal injustices. Since I can't fix those, I can't truly help you. There is a reason why indigenous communities are particularly hard hit by suicide...

I am also not going to try and convince you to not go through with it. That would be selfish on my part. I don't want to have to deal with the hard truth that someone chose to stop existing because of the shittiness of this world.

I am however, going to ask you to reconsider what meditation is. I don't care about any of the religious crap around it, and I am also not going to reduce it to "sitting down and breathing deeply". "Meditation" must happen in every moment. I think about meditation as a sort of self-awareness which provides acceptance, and through acceptance, resilience.

I recommend reading Jon Kabat Zinn's "Where You Go, There You Are".

I had an allergic reaction to the idea of acceptance when I first came across it: things like "opium of the masses" came to mind. This is not that sort of acceptance. This is the sort of acceptance that provides internal stability when there is no source of external stability; it is the sort of acceptance that lets go of the disappointment and frustration, and then frees mental power to consider: "what now?". It's the acceptance that provides resilience which leads to improvements in social justice (and social justice starts with small, everyday victories: moments, individuals, and then society). Or the sort of acceptance that provides the freedom to explore things you would have been too scared to explore otherwise ("a person who has nothing to lose...").

In this vein, I think mathematics is an amazing way to spend time. Not only does it not deal with people, but it also helped me see a...largeness...to the world that I find hard to describe. I suggest starting from here: http://www.cs.toronto.edu/~hehner/FMSD/

In a sense, you're free. You're free of the "chains" of life. Breathe deep, not because you're meditating, but because you should relax: the chains of life no longer bind you. Let your mind roam now, as it is meant to roam. Build palaces of systematic ideas, which lead to results that are surprising and enjoyable. Explore the world around you: forget about space, but instead consider the amazing orchestra of chaos that is biology. How the hell does a cell work? Layers upon layers of beauty that is hidden because of the shit of our human world...

Or...pick something else to study that isn't what _this_ stranger cares about. Devote yourself to it. Do not let yourself be disappointed with the boring, care only about the exciting. Let the excitement of finding the amazing fuel your devotion.

Dare I say: "don't end the freedom you have earned by going through this pain early; use it, before you end it"?

Re: What I have learned from my suicidal patients

#117

Post by boomboomsubban » Sun, Nov 24, 2019, 8:43 AM UTC

mabcat wrote: post #78

boomboomsubban wrote: post #40

Earlier quoted context omitted.

>Nearly all medicine have side effects. People should be informed about them (it is included with the medicine, at least here). Most medicine has minimal side effects for most people. "Very common" side effects are ones that effect 10% of people taking the medication. People should be aware that side effects are possible, but they are unlikely. Going in with the attitude that side effects are inevitable makes one mor…

We ran a clinical trial of a very common antidepressant. Blinding was difficult because on the active arm damn near everyone had observable side-effects within 40 minutes of administration. Clearly not related to the placebo effect in this case, only the pharmacist knew what was in the capsules until the nausea started.

>Clearly not related to the placebo effect in this case, only the pharmacist knew what was in the capsules until the nausea started.

Right, and it could only be the placebo effect if those capsules contained sugar.

Re: What I have learned from my suicidal patients

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Post by pasabagi » Sun, Nov 24, 2019, 10:12 AM UTC

heavyset_go wrote: post #86

pasabagi wrote: post #37

Earlier quoted context omitted.

All anti-depressants have severe or annoying side effects for some people . Most anti-depressants have almost no side effects for most people. The trick is to change prescriptions until you find one you like. (I'm on my third prescription, and have no complaints.)

> Most anti-depressants have almost no side effects for most people. This isn't true for all anti-depressants, especially when you look at dosage. For example, if you look at clinical trial data and studies for a certain drug, 60% of people experienced weight gain. Another drug caused nausea in nearly 70% of patients. Paroxetine has a reported sexual dysfunction rate of nearly 75%, and patients who take 20mg of vorti…

You're right, of course. However, first, I think you'd be hard pressed to find someone who prefers depression to sexual dysfunction, weight gain, or nausea. Second, you can just try different medications until you find one that has none of the above problems.

To be honest, I find the discussion of side-effects in anti-depressants really strange. Depression is an extremely dangerous, life-threatening, life-ruining condition. The side effects, when they are present, are typically trivial. However, I have met many people who have not begun a course of medication because they were worried about them.

Re: What I have learned from my suicidal patients

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Post by friendlybus » Sun, Nov 24, 2019, 10:25 AM UTC

starpilot wrote: post #109

cassowary37 wrote: post #64

A colleague of mine calls suicide 'a permanent solution to a temporary problem' - not to diminish it, but to recognize that for most people the desire to die is a temporary state. Whenever depression comes up on HN (as it does with surprising frequency), I'm both touched by people's willingness to share their own stories, and frustrated by otherwise very rational and logical people's speed to dismiss data. Initial tr…

I suspect the amount of non-responsive patients is greatly downplayed by most therapists. Obviously they have a strong incentive to do so. From SSC: > I work in a clinic with about ten therapists. Some are better than others, but all of them are competent. I send my patients to them. In a few hundred patients I’ve worked with, zero have had the sudden, extraordinary, long-lasting change that the therapy books promise…

It's so hard to find the other side of the argument for therapy, I appreciate your links!

The advertising for CBT as an entry point for therapy is over valued. Therapy should really advertise more effectively as a social role rather than going deep into the task oriented stuff.

Re: What I have learned from my suicidal patients

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Post by 0db532a0 » Sun, Nov 24, 2019, 10:58 AM UTC

sdegutis wrote: post #76

3pt14159 wrote: post #30

I have such conflicting views on suicide. On the one hand suicidal feelings are often temporary across the grand expanse of life, on the other hand surely there is a better way to handle people that have suffered such hardship than sterile mental hospitals, drugs, and societal shaming. It's so strange that we're allowed to have Do Not Resuscitate medical necklaces but they're only followed if something outside the pe…

The more people try to decide their own “truth” instead of living in reality, the more they will run into depression, despair, and suicide. The real solution to these is to encourage facing reality in its entirety, including being honest when someone has a self destructive habit, tendency, interest, reaction, or hobby.

There is no one reality that we can talk about as a group. There is only personal experience. You might be interested to read about phenomenology a bit: https://en.wikipedia.org/wiki/Phenomenology_(philosophy).