≡ Menu

JAMES WOODS: Teenage suicide is everyone’s business

Young man sitting on a floo with hands on head. Plenty of copy spaceWhile writing this column on teenage depression, I mentioned it to a friend, who happens to be a retired journalist (they seem to be thick as ticks around here). He said, “If you’re writing for the Partisan, you’ll be writing for the teenagers’ grandparents.”

Picturing my own grandchildren, recently visited, I thought to myself, “This scruffy ex-agent of the Fourth Estate is annoyingly accurate.”

So be it. Apart from teenagers themselves, grandparents are well suited to detect and intervene in cases of adolescent depression.

Here’s a depressing statistic: Suicide is the second leading cause of death of 15-24 year olds.

These young adults are healthy critters. They have survived infancy with its genetic and infectious uncertainties. They have not yet gotten to the age when bodies give out and hot cocoa in bed at 8:30 sounds like a great way to spend New Year’s Eve. Not surprisingly, unintended death is the number one cause. I never knew anyone who intended their death except a couple of unfortunate people in the Second Cause group. In third place is Homicide.

Tragic as these numbers sound, only a little over 4,000 folks between the ages of 15-24 lost their lives to suicide in 2013. I say “lost their lives” instead of “took their lives”, because no one in their right mind commits suicide. People kill themselves because they are not in their right minds. Depression usually calls the shots, twisting perspective and eroding self-esteem, until killing yourself looks like a reasonable option. When depression is combined with alcohol or drug use, self-medicating or binging, it is a particularly deadly disease.

But like the tip of any iceberg, suicide is only the most dramatic symptom of depression. The symptoms, which usually persist for years before before they escalate to this point, can be spotted by a caring grandparent. Learn the signs, and more importantly, get to know your grandkids, nieces and nephews. Family and friends prevent more suicides that all therapists and physicians combined.

These are some of the signs parents may notice. If they last for at least two weeks, and they are present on most days for most of the day, what you are seeing may be depression:

An irritable, sad, or cranky mood, most days and for most of the day.

Loss of interest in sports or activities they used to enjoy.

Withdrawal from friends and family, pervasive trouble in relationships.

Changes in appetite, significant weight gain or loss.

Disturbance of normal sleep patterns, insomnia, hypersomnia, (or just hiding in bed).

Physical agitation or slowness, pacing back and forth and/or excessive, or repetitive behaviors.

Making critical comments about themselves, overly sensitive to rejection, tearful.

Poor performance in school, a drop in grades, or frequent absences.

Frequent complaints of physical pain (headaches, stomach), frequent visits to school nurse.

Writing about death, giving away favorite belongings, comments like “You’ve be better off without me.”

I am very frustrated when I read in the medical literature that “these symptoms may be difficult to detect because they are often part of adolescence itself.” I cannot buy that statement. It implies that being cripplingly sad or anxious, feeling absolutely alone and helpless and losing all joy life has to offer is similar to a normal emotional growth pattern. The difference in degree between normal emotional growing pains and the signs of major depressive disorder is similar to the difference between heartburn after pizza and a bleeding ulcer.

I use a physical example because depression is a physical disorder with behavioral symptoms. We aren’t used to diseases that alter our mood and perspective; we are used to diseases that make us vomit or cause a rash. In order to detect and prevent depression we have to think about it in a different way. We have to change our idea that there is a brain/body duality at work here: health versus mental health. That is like thinking that there is a pancreas/body duality at work in diabetes. Serotonin concentrations and activity are the primary targets of the most widely used anti-depressant medications. But there are more serotonin receptors in our GI tract than our brain!

We also have to change our idea of the brain itself. When I was in medical school, 30 years ago, we were instructed that the brain was, for all intents and purposes, a three-pound lump of tofu like material that is oddly static: No new nerve cells grow, we can only lose brain cells to drugs, sex and rock-and-roll, (and aging!). Thank God we’ve got way more than we need and we can spare a few hundred thousand.

That was the party line until neuroscientists got a bunch of great new toys and several boxcar loads of cash to run programs that purchase and use them. The current view is “evolving.”

We now think we know that the brain is dynamic in structure as well as function.

Read and memorize this statement:

“Cal Am Water is competent to solve the Peninsula’s water shortage problems.”

(Special exercise for Partisan regulars).

To memorize anything new ,neural connections must be grown. This requires physical changes of the brain itself. To memorize this particular statement about Cal Am is likely to cause growth of new neurons in the amygdyla as well until there is a detectable change in its volume. The amygdyla is part of the brain associated with anger and with fear responses. Piss off or frustrate someone to the point of rage or despair over time and you measurably increase the size and activity of the amygdyla.

Having exercised your amygdyla until it resembles Mark McGuire’s biceps, try this for two weeks:

For ten seconds every hour, (for 80 seconds out of the 57,600 seconds of an average waking day), generate thoughts of loving kindness toward some being nearby, or even someone in your imagination.

Within two weeks, studies show, your amygdyla may be detectably diminished in size and activity. You might feel less anxious and judgmental. This malleability of the brain is called neuroplasticity.

Talk-Therapy, mind training and meditation can make amazing positive changes in the brain of a person suffering from depression via neuroplasticity.

Current conventional scientific opinion states that for depression of mild to moderate severity it is possible, almost always with the help of a mental health professional, to change your mind,(and thereby your brain), regarding the challenges in your life. You can develop new coping skills and ditch old outmoded ones. For those whose disease is in the high moderate to severe range, multiple studies have shown that combination therapy, (talk/insight+medication), is the optimal approach.

Grandparents, Aunts and Uncles, Listen Up!

1. Get to know the young adults in your life. It’s worth the time and effort.

2. Be familiar with the signs of adolescent depression.

3. Talk to your grandkids if they seem unhappy or isolated.

4. Tell the parents if you suspect a problem. Parents are often to enmeshed in the problem to see it clearly.

5. If the person’s parents won’t listen to you talk to their teacher, minister, friends, principal, and the kids themselves

6. If you suspect suicide, go quickly to # 4. If no time: call 911! (I’d rather undergo the discomfort of being seen as a busybody, than the grief of a funeral.)

Families can conquer depression together. Let’s move suicide out of the Top Ten in 2016!

For a Great Depression assessment tool designed for ages 11-25 go to Link to Columbia Depression Screen, teen and parent versions with interpretations of scores

And here is a list of Mental Health Services in Monterey County.

{ 26 comments }

Detail from the Milky WayThis is the theme this holiday season. Energy, Economics and Enthusiasm, the three engines that drive the Christmas season. All on the scarce side around here.

First of all it caught me unexpectedly. I went to work one day in mid-August, and when I looked at my watch it was December!  No time to generate much enthusiasm for the logistics or sentiment of the season when it skulks up behind you.

As far as expendable income goes:

“The crows are in the kitchen,and

The wolf is at the door…” — Leaving Eden

Energy is mostly scattered into the random corners of displacement activities. My dear friend lies suffering uncertainty and pain in The Pavilion of Impermanence at Stanford Medical Center, but my bathroom is spotless, my ironing done.

Despite these grievous realities and my absurd response to them, there is a feeling of change nascent in the muddy ground of of this blessedly wet December.

The Lotus grows with its roots in the muck at the bottom of a pond. The stifling entropy of the mundane contains the seeds of aspiration for a little sunlight and star shine.

Impermanence applies to the ragged coattails of despair as well as to the coat of clay we wear. Both occur only to be exhausted: the way of the world.

If we keep heart we may see dark clouds parting more frequently than gathering.

The most unlikely smugglers of kindness and joy are those who perceive the reality of suffering and its causes with the highest resolution. I think that is an important fact of life that should be remembered.

In the cosmology of the Buddhist lineage I call home there are countless universes each with countless worlds. The name of the particular field of worldly phenomena we share is Endurance. Aptly named it seems.

Happiness accrues most to those who endure with the most impeccable grace. The rest of us are content to watch our lives in the reflected brilliance of their light.

Christ, Buddha, Mohammed, Meher Baba, Ghandi, Guru Nanak, Pope Francis, The Dalai Lama, Dudjom Father and Son, Rumi, Black Elk, Imam Tariq …and numberless anonymous Bodhisattvas, (our animal and human neighbors), are continually Taking and Giving:

Taking on our suffering as their own.

Giving the radiance of Wisdom and Compassion,

Freely and without discrimination.

Perhaps that is the Spirit of Christmas for me this year.

May I endure with enough kindness in my heart to aspire to walk their path with impeccable Samaya.

Woods is a physician and therapist who has practiced in Watsonville for 25 years. He currently provides medical treatment and psychotherapy for children and adolescents.

{ 10 comments }

happy and smiling girl with a smile painted on paperA Letter to a friend:

This morning was a rotten morning for you. All your feelings of regret and remorse flooded back in.  But later, when we talked on the phone you told me something insightful.

“I think that these habits of thinking have been with me a long time.”

BINGO! Much of our unhappiness comes from self-talk that is negative and based on invalid cognitions. And most of us have been practicing these sorts of thoughts since we were kids. Some of the common invalid cognitions include: “No one likes me”; “I’ll never find someone who makes me happy”; “I’m miserable and it is never going to get better”, “I don’t deserve to be happy”.  So it is important to develop different ways of seeing things that are based on valid cognitions.

But, for people who are live in their head a lot, sometimes the best way to deal with a bad morning is not to try to be objective and “think your way our of it.”  Instead, “do your way out of it.” One thing you can do is to practice relaxation techniques: diaphragmatic breathing, progressive muscle relaxation, visualizing positive images, etc.

There are several reasons why it is important to practice relaxation techniques.  The most obvious is that it feels better to be relaxed than it does to feel wound up and crazy. It is important to practice relaxation techniques when the stress is low and you are in a safe place. With some practice in a low-stress setting you will be able to relax when you are in a stressful situation. You don’t practice self-defense while you are being mugged! You practice in the gym, so that should the need arise you automatically protect yourself. You don’t practice stress reduction in the waiting room before a performance evaluation with a boss that makes Attila the Hun look like Mother Theresa.

For some of us who spend too much time overthinking things, it is not a great idea to try to think our way out of a mental jam. This is the second reason why relaxation techniques are important. If you adopt a physical pose or activity that is incompatible with an emotional state, the physical posture will take precedence and overrule the emotional state.

The most obvious example is deep breathing. When you are anxious or upset you notice your breathing is shallow and fast. You breathe from the top of your chest. That is fine if you are just about to run away from an enemy. Not so great if you are going to your in-law’s house for Christmas dinner.

Diaphragmatic breathing: slow; deep; and relaxed is incompatible with anxiety. If you start feeling anxious, do four or five slow deep “Relaxation Breaths”, and voila. You feel a bit less anxious. This isn’t just an old wife’s tale, (a tip of my hat to all old wives and their uncommon common sense); there is a neurophysiological basis for this. The deep breathing activates the parasympathetic nervous system that opposes the sympathetic nervous system, which is causing all of the distressing physical symptoms of anxiety.

There is a free app called Breathe 2 Relax, that teaches this breathing technique. There are Android and iPhone versions.

Another way to beat the blues is to smile. When we are happy we smile. Simple enough. When we smile we are happy is a bit tougher to believe. If you can smile, even when you feel sad, it will lift your mood.  If you can position the muscles of your face in a smile for 30-90 seconds you will not feel as sad when you finish this exercise, as you were when you started.

Try it out. Rate your happiness on a 1-10 scale with one being “my dog died” and 10 being “I won the lottery”.  Try the smiling exercise, and then rate your happiness again. Your happiness score will have gone up a point or two.  Or try deep breathing using an anxiety scale.  A minute or two of relaxation breathing will lower your subjective feelings of anxiety.

We don’t have too much of a problem accepting that our mental state produces bodily sensations.  When I get anxious it hits my stomach first. I feel nauseated. Great way to lose weight, but I’d rather eat a bushel of celery, (grown locally, of course). It is much more difficult to accept that this neurological boulevard is a two-way street. Dr. Amy Cuddy has done some great work with using “power poses” to decrease stress and increase self-confidence. Here is a link to her TED talk.

Little by little using very simple techniques you can feel better.

Woods is a physician and therapist who has practiced in Watsonville for 25 years. He currently provides medical treatment and psychotherapy for children and adolescents.

{ 2 comments }

grpx_764Rocky: “I’m sure I’ve heard that voice before.”

Bullwinkle: “Rocky, you’ve heard more voices than Joan of Arc.”

The truth is we all have voices in our heads. Not the whispers from the toaster about the conspiracies among the other appliances. Just the everyday voices that seem to run in the background all the time. If you doubt that you have an internal monologue going at all times, try a simple experiment:

Sit down, get comfortable and don’t “do” anything. Just sit. My guess is within a minute the background yammering will rise to the surface of awareness.

There are problems inherent in our relationship with this constant companion of ours. The first is distraction. Studies done using an iPhone app to track 2,250 volunteers’ rates of distraction during everyday tasks revealed that about 50% of the time we are not paying attention to what we are doing. The same volunteers were asked to rate how happy they felt at the moment they reported whether they were paying attention to the task at hand. When distraction is high, satisfaction is low. The conclusion: “A wandering mind is not a happy mind.”

One of the authors of the study, Matthew Killingsworth, commented in an interview how strange he feels to be walking on a crowded street and to realize that half of the people he sees aren’t there. Not like Harvey the pooka was/wasn’t there for Jimmy Stewart in the classic movie of the same name, but just not present in that moment: not paying attention to their surroundings or what they are doing.

Another problem with the voice in our heads is that it is usually negative. If a friend kept rambling on about our past failures and dismal prospects for the future, we’d head for the nearest exit the moment we saw him coming. A brief inventory of our own monologue reveals it to be incessantly negative and rather repetitive. Where is the exit when we need one!

If you doubt the tone of your own internal monologue, try just sitting again. Pick a quiet location, turn off your phone, sit comfortably upright, (no slouching), and wait. You won’t have long to wait before your constant companion starts nattering away at you like a critical parent. “What are you doing? This is a waste of time. My butt itches. My butt is too fat. I should go to the gym. I never follow through with diets. I am lonely. I can’t get a date. If I hadn’t screwed up with my girlfriend, we’d still be together. I’m never going to meet anyone ….”

There is some evidence to support an evolutionary significance for this internal harpy that is so vigilantly critical. If the evolutionary history of Homo Sap was a football field, agriculture makes its appearance on the four-yard line. The industrial revolution and life as we are accustomed to it is on the one-yard line. The rest of the 96 yards was spent in small bands of 40-120 people hunting and gathering, and trying to have sex. Anything that keeps us in the breeding pool tends to be conserved. Whether a trait makes us happy or miserable is of no consequence.

If you are wandering on the savannah and you come across two bushes with berries and one of the berries is edible and the other is so toxic it nearly kills you, guess which one you will remember the rest of your life? For social animals like us, embarrassment, humiliation, rejection, and shame are like the puke-berry: quickly imprinted on our memory and slow to fade.

Fear of certain persons or situations for whatever reason, (personal experience, Fox News, over-protective parents), are also imprinted into our memory circuits for constant perusal. And, peruse we will! The result is that we have a built in predisposition to both anxiety and depression.

There are ways to train your mind so that the actual physical circuitry of the brain is changed in favor of less ruminating and tastier cud to chew when you are ruminating. First you have to be familiar with the content of your internal monologue. Second, you have to be able to ignore the yammering. And third, you have to stock the shelves with more positive memories.

Buddha’s Brain,” by Rick Hansen, is a book I recommend if you are interested in why your brain works the way it does and want to change they way you think. Another great read is, “The Brain that Changes Itself,” by Norman Doidge. They are accessibly written and well supported by current research in neurophysiology. Hansen’s work includes lots of exercises you can try for yourself.

If you decide to pick up a copy of either book, remember to support your local bookstore. The store owner and your brain will both be happy you did.

Woods is a physician and therapist who has practiced in Watsonville for 25 years. He currently provides medical treatment and psychotherapy for children and adolescents.

{ 1 comment }