Thursday, June 14, 2018

Notes on Suicide

I still think that we are talking too much about suicide, but… several informative articles have recently appeared. Thus, I feel obliged to report on them.This comes to us from the New York Times.

A physician from Tulane explains that social isolation, to which famous people are especially prone, can be a contributing factor. This implies, she continues, that social connections are an excellent treatment.

Catherine Burnette, an assistant professor at Tulane University School of Social Work in New Orleans, says if people have lived with untreated depression over time, it can implode in their 40s, 50s or 60s….

For accomplished or well-known people, isolation can be a risk factor, she says. “Social connection is one of the biggest antidotes to suicide,” she says. “I think it can be pretty isolating to be a celebrity, where outside people may seek social opportunities rather than social connection.”

The last point is salient. Celebrities do not become celebrities by developing networks of friends. They do not advance by socializing. They gain status by making a public spectacle of themselves... and this does not make other people want to associate with them.

When they become wealthy celebrities they are often preyed upon by people who want something from them. When that happens, they lose trust in other people. Thus, their friendships disintegrate.

And then, there is the problem of diagnosis. Not all depression is the same. It takes a skilled diagnostician, preferably a psychiatrist to differentiate among the different categories. As it happens, in today’s America, family doctors, general practitioners and internists prescribe most of the anti-depressant medication. When you have received the wrong medication and it does not work, you might more easily give up hope.

Consider the remarks of Dr. Jeffrey Lieberman:

Jeffrey Lieberman, chairman of psychiatry at Columbia University, says 90% of people who die by suicide have pre-existing mental disorders, whether they have been diagnosed and treated or not. The top four conditions associated with an increased risk for suicide are depression, bipolar disorder, schizophrenia and post-traumatic stress disorder.

Another major risk factor for suicide is substance abuse, he says. Heavy drug or alcohol abuse alters the connectivity of neural pathways involved in reward and the emotional and cognitive processing of normal experiences. “It produces chemical changes and ultimately structural changes in a way that becomes permanent,” Dr. Lieberman says.

In the world of biochemistry, we ought also to consider the influence of menopause on the female brain. One suspects that such changes have been veiled in silence:

For women, hormonal changes that come with menopause may play a role. Menopause results in a drop in estrogen, which can cause changes in brain function, which not everyone is able to adapt to, he [Dr. Lieberman] says.

Today's New York Post contains an article about menopause and depression. Link here.

Finally, we read a frightening observation from a therapist in California. She explains that inpatient treatment for severe depression is very difficult to obtain… because insurance companies are only willing to pay for it if they can make money off of it. 

If you have insurance through a P.P.O. you are far more likely to receive extended inpatient hospital treatment than you would if you were insured by an H. M. O. An H. M. O. will make such extravagantly onerous demands that hospitals do not have the time or the manpower to respond to all of them.

I have no suggestion for how to rectify this, but surely the therapist is correct to find the situation horrifying.

I’m a licensed therapist who worked for a major health insurance company for nine months in 2007, on their crisis hotline. I will never forget the way members with H.M.O.s were treated vs. members with P.P.O.s.

In the case of a P.P.O., where the insurance company was not going to make any money off the crisis, authorizations for psychiatric hospitalization were granted liberally, a week at a time, with no reviews necessary.

However, if a member had an H.M.O., the insurance company had to pay directly for all the services and for every night spent at the hospital. So the sooner the member got out of the hospital, the more money the insurance company retained/earned.

Therefore, severely ill patients were given stingy authorizations, 24 hours at a time, with an extensive, 30- to 60-minute review required every single day in order to extend the authorization another 24 hours.

These reviews were time consuming and inevitably humiliating to the hospital doctors and staff, who had to account for every tiny aspect of their treatment, and be told by insurance company bureaucrats what treatment approaches they could and could not take.

The hospital staff could not devote their entire day to reviews, therefore only the absolute sickest patients were prioritized.

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