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A Suicide Attempt a Minute -
it’s the tip of the iceberg
By Leland M. Heller, M.D.
525,600 minutes and 531,000 suicide attempts per year in the US. 21% of 12
year olds are sexually experienced. Among high school students 27% smoke
cigarettes, 36% were passengers with an intoxicated driver, 1/3 were drunk in
the last month, 26% smoked marijuana, 16% had used inhalants to get high. Road
rage and air rage are front page news. While media and peer influences, the
high divorce rate, latch-key children, and drug availability are part of the
problem, biology plays a far greater role than has been previously recognized.
Public misconception, misinformation and prejudice are making the problem
worse. Surgeon General Dr. Satcher is correct in stating that the stigma must
be removed for mental disorders, as has been accomplished for cancer.
The medical and mental health professions are not responding to evolving
knowledge. Many physicians say things like "I don’t believe in
depression" and deal with these individuals in a disparaging manner.
Mental health practitioners contribute to the problem in four ways:
- Not making all the diagnoses - in medical practice a person with high
blood pressure and arthritis needs both problems treated. High blood pressure
treatment would not be considered a failure if the arthritis symptoms
continued, yet that’s exactly what happens in mental health. A medication
for one problem is expected to treat all of them. Every problem a person has
makes every other problem worse. All their diagnoses need to be treated
comprehensively.
- Refusal to make diagnoses for fear of "labeling" someone. Many
practitioners use their own criteria for making a diagnoses - like every
internist defining diabetes in his/her own way.
- Not keeping up with new information. Research is exploding, and many once
held beliefs have turned out to be wrong. "Growing out of" Attention
deficit disorder is a good example.
- Reluctance to try techniques from other practitioners. I have treated
thousands of individuals with the borderline personality disorder (BPD), likely
a form of epilepsy with mood swings, anger problems, self-destructiveness and
psychotic rage under stress. Many tragedies such as school shootings are due to
the BPD. Medication combinations work extremely well, but the research
information is rarely acknowledged and many psychiatrists are resistant to
trying medical approaches that have been successful for other doctors and their
patients.
The American Psychiatric Association has done an excellent job defining
criteria for the major psychiatric diagnoses. Most Americans would be stunned
to discover exactly how common these "disorders" are - and what the
criteria are. More than one diagnosis is usually present. Many common diagnoses
are likely not diseases at all, but survival genetics that have advantages in
some environments and disadvantages in others. In today’s high pressure
society, these genetic traits have tremendous problems - like having fair skin
in a sunny environment.
Attention deficit "disorder" is an excellent example. The brain
location and some of the biochemistry have been identified. Untreated ADD
usually leads to significant social and legal problems - particularly impulsive
anger and substance abuse (30%). The "cognitive" generalized anxiety
disorder (GAD) causes the individual to constantly worry and think. Being
genetic it starts in childhood and continues through old age. These individuals
always feel stressed, and commonly treat themselves with alcohol, food, and
marijuana.
The information to make a huge difference with all these problems is
available right now. Most of these diagnoses are treatable with the right
combination of medication and counseling/brain retraining. While more research
is always needed, educating the public and doctors/mental health practitioners
of what’s already known can be done immediately, as has been done for
other medical problems. If we don’t, road rage and school shootings will
stop being news.
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