– by Mark Weidenbaum, MD & Thomas Bottiglieri, DO
Mental health awareness requires a recognition that stigma is an obstacle. No one asks for disease of the mind, the same way a person would not ask for hypertension or rheumatoid arthritis. Like all diseases, environment and self-care influence disease. That doesn’t suggest that we should ignore evaluation and treatment for these conditions, or that someone can just will their way to health. Diseases of the mind are preventable and treatable. Specifically the disease that leads to suicide, depression. When depression is treated appropriately the risk of suicide has the potential to be eliminated.
During this time of social isolation due to the COVID pandemic mental heath is a major pubic health concern. Eye contact and personal contact release oxytocin, a chemical in the brain that reinforces connection and has ties to our dopamine reward center. Strategies to mitigate that risk include drawing meaning through shared suffering, finding connection through phone and zoom, and prevention of depression through routines including exercise, proper sleep, nutrition, and sunlight exposure. With that in mind we know that the stress of these times will diminish mental health and well-being. Just as we advise our frontline healthcare workers to take breaks, hydrate, and maintain hand hygiene, we must also encourage not only self-care, but must also encourage that we check-in with one another at work, at home, and in our communities.
Suicide kills, “more firemen than fire, more policemen that crime, and takes more lives that car accidents,” says Kelly Posner, director of the Columbia Lighthouse Project, which is aimed at bringing attention to the Columbia Suicide Prevention Protocol. Suicide is the #1 cause of death of construction workers. Its cause, depression, is the #1 cause of global disability. The thing to know is that those that are suffering silently WANT HELP. Our culture asks us to be strong, resilient, and to find ways of improving grit. These virtues are important, but no more so than reaching out to a person in need. Because asking or help is not always easy, or may not be an apparent way out of suffering, the Columbia Protocol offers a systematic way to ask, as well as insights as to what to do if someone is at risk.
Our society is not always willing to look at the under surface of our virtue. Since the time of Freud, and later with Jung’s shadow archetypes, psychologists have shined a light on the unconscious mind. The ways in which dysfunctional thought patterns and behaviors emerge and can erode well-adapted behavior are described throughout psychology literature. That being said, our culture still has not completely overcome the stigma of mental illness. A society in which we encourage recognition of uncomfortable thoughts, maladjusted behaviors, and safe spaces for communication may continue to emerge. In the meantime, having a system for identifying those at risk in the same way we evaluate blood pressure, body-mass index, or inflammatory markers in the blood has shown efficacy in reducing suicide.
“We don’t judge ourselves for needing glasses,” says Posner, and depression should be no different. The cliche about applying the oxygen mask to one’s self to be able to help others can fall on deaf ears. So that message needs to be shared until recognition of depression as an illness is commonplace. Every suicide impacts an average of 135 people, like throwing a brick in a pond. We have all been touched by this disease in some way. Silence will not going to erase the scars left by depression and suicide.
Approaching someone to ask if they are struggling, and identifying suicidal thoughts will NOT provoke them to do so. There has been a misconception that opening the door to a conversation about depression or suicide might increase that risk. Not so. People want help. In cases of failed suicide or when the downward spiral is interrupted people report that they wished, as they approached the precipice, that someone would ask. Or, if they had taken the step off the ledge, that they could go back and ask for help. 1% of people that have been asked the questions from the Columbia Protocol will be at high risk. That is one person in a hundred. That means we can all have a meaningful impact.
Meet people where they are. Neighbors. Co-workers. Students. Just ask.
Military, policy across all 50 states, jails, and schools have implemented the use of the Columbia protocol. It takes just a moment.
The person on the brink is desperate to be asked.
…spread the word…this is a preventable disease!