Lately I have the attention span of a flea on a hot tin roof, but I just wanted to mention that the Globe and Mail is doing a series this week (it actually started last Friday) called Breakdown: Canada’s Mental Health Crisis. I haven’t been looking at the web site, and I’ve actually been buying the newspaper every day but I’ve only been giving the articles a cursory glance. I’ve got to sit down sometime and check it all out.

Heyyy, that is a great typo on the front page of the Breakdown site: “biopolar disorder.” Nice.

Often I think of my life as being described by (an extremely simplified version of) the Second Law of Thermodynamics. The level of chaos always tends to increase. Lately, it’s more like Newton’s First Law of Motion, where a body in motion tends to stay in motion and a body at rest tends to stay at rest. I either spend my time running around like a chicken with its head cut off or sitting around not doing much of anything. Today, it was not doing much of anything. It was yesterday, too. Ah, inertia. Ah, crappy similes.

One in six teens inflict self-harm (TRIGGER WARNING: if you don’t want to see a photo of cuts on someone’s forearm, then don’t click this link), the Globe and Mail tells us today, and the sub-headline of that article is “Abusing yourself isn’t a suicidal or attention-seeking action, research suggests, but a coping mechanism.”

Well, duh. We’ve been trying to tell people that for years and years¹, but who bothers listening to self-injurers? Especially to teen self-injurers. We are not doing it to get attention.

The research, published in today’s edition of the Canadian Medical Association Journal, shows that 17.6 per cent of teenagers self-harm - a number that includes 21 per cent of girls and 8.7 per cent of boys.

This being the media, though, they have to warp the contents of the actual study, Nonsuicidal self-harm in youth: a population-based survey, so that “Ninety-six of 568 (16.9%) youth indicated that they had ever harmed themselves” from the original journal article, somehow becomes “17.6 per cent of teenagers self-harm” — present tense, plus an inexplicable 0.7 bonus. (Admittedly, I haven’t read the whole study yet because I was having computer problems earlier today and I am lazy, but I shall get around to it, and if there is an explanation that I missed for that extra 0.7, then sorry, my bad.) I suppose it’s mainly a case of people wanting shocking headlines, as the Globe and Mail article does continue as follows:

A total of 568 young people aged 14 to 21 were interviewed. Ninety-six of them said they had, at some point in their young lives, harmed themselves deliberately.

About one-third of the teenagers had done so only once, another third on two to three occasions and the other third had self-harmed repeatedly. On average, their mutilating actions began at age 15.

Much of the article is an interview with the study’s lead author, Dr. Mary Nixon, and it’s pretty good except for one comment that directly contradicts other things in the article:

“We’re trying to raise awareness that it’s not uncommon in young people and not related to mental health problems,” she said.

“It” being self-injury, of course. It’s such a weird quote that I’ve got to wonder if it’s a typo or a misunderstanding or something. I don’t think SI is always related to mental health problems, but I think it is the majority of the time.

The research shows a clear link between self-harm and mental health problems. Those who hurt themselves are more than twice as likely to suffer from depression, anxiety and impulse disorders.

It is not entirely clear why girls are more likely to self-harm than boys, but Dr. Nixon believes it is related to the fact that rates of depression soar at puberty and that girls not only mature earlier but react differently to stress.

See? Does not compute. SI is indeed related to mental health, although it’s very rarely suicidal or attention-seeking. (Never say never. All generalizations are bad. Tee hee.)

Dr. Nixon, a child and adolescent psychiatrist, said when teenagers harm themselves, it is often assumed they are doing so to get attention, but the behaviour is far more complex.

“A lot of these kids hide their cuts and burns. It’s not attention-seeking, it’s something else,” she said.

THANK YOU. I really appreciate somebody saying this and it being national news.

¹Although we don’t phrase it that way, because then it would sound like we were talking about masturbation.

It was a shock to hear the other day that Heath Ledger had died, seemingly due to an accidental or intentional overdose of pills. He was a talented actor, appeared to be a genuinely nice person, according to what his friends and neighbours said about him, and he had a two-year-old daughter he loved very much. I am also crass enough to mention that he was hot, although his death wouldn’t have been any less upsetting if he hadn’t been attractive.

It’s strange that when someone dies and nobody knows whether it’s suicide or an accident, most people’s immediate response is, I sure hope it wasn’t suicide. I’m not sure it’s any less sad if someone who definitely doesn’t want to die suddenly winds up dead. It’s easy enough to think of reasons behind this knee-jerk reaction, though, and here are a few:

• Suicide is considered a major taboo.
• It’s very uncomfortable to think of someone who is suffering and unhappy before they die, and more pleasant to think of them as having had a pleasant and rosy life up until their death.
• People feel that it’s something someone should have seen coming and been able to stop, unlike a freak accident that might have been less easy to predict.
• In a case like this, where it’s somebody who Had It All, you know that this guy had talent, money, fame, good looks, and a child he cared about, and still might have been depressed enough to purposely end his life, and you wonder what the hell kind of chance any of the rest of us have of being okay.

Anyway, suicide or accident, it’s still a tragedy.

I’m going to visit my family for a few days over the holidays, and this year I’m even more worried than usual about it, because my brother is completely unwilling and/or unable to consider anybody else’s feelings, ever. He wasn’t always like this. I can’t picture visiting for a few days without him marring it by, at best, starting arguments and running off. I don’t even want to think about any of the worst-case scenarios. Maybe I’ll be lucky and nothing too bad will happen, just the normal petty squabbles that everybody’s family has. You never know. It could happen.

Via Liz Spikol, I came across this article: Lawyer defends firm’s decision to dismiss worker with bipolar disorder.

Stephen Bird, who represents ADGA Group Consulting Inc., said the company discussed employee Paul Lane’s condition with him after he revealed that he had bipolar disorder and researched the condition on the internet before making the decision to dismiss him.

According to the written human rights tribunal ruling, what managers learned convinced them that Lane, who was hired to test artillery software for a Department of National Defence contract, would not be able to meet the rigours of a stressful job with tight deadlines.

Ooh, tight deadlines! Sooo scary! Look, some people can handle tight deadlines and some people can’t. Having bipolar disorder does not necessarily mean that you can’t.

Liz says, “are you kidding?” re: the company researching bipolar disorder on the Internet and whatever they learned there apparently being a deciding factor in the decision to fire Lane. Which I totally have to agree with when you consider these paragraphs from the article:

Not only does the company believe the tribunal erred in its decision, but Bird alleges that it also over-stepped its jurisdiction in the way it handled evidence in the case.

For example, the tribunal heard from experts on bipolar disorder who didn’t even know Lane, he argued during the case.

“The evidence should either not have been accepted at all, or should have been accepted for very limited purposes,” he said.

Okay, so ADGA looking up stuff on the Internet about bipolar disorder in general, presumably all written by people who didn’t know Lane, and not liking what they found is an okay reason to fire the guy, but when subject experts who also don’t know Lane have their say about bipolar disorder, that shouldn’t be allowed?

On the basis of that article and a previous article about Lane, it would seem that he hadn’t actually had any problems at that particular job; the company just assumed he couldn’t handle it based on what he told them about his illness and whatever the hell they read on the Web about it.

According to the facts presented in the ruling, Lane was dismissed in October 2001, eight days after he started work as a senior test analyst as ADGA. He had told his supervisor that he had bipolar disorder and his behaviour should be monitored.

I am lucky that I’ve always been able to do my work without any special accommodations whatsoever. It wasn’t the case with schoolwork, but it’s been the case with work-work. (Wow, what a mature phrase… “work-work”… clearly someone of my maturity level should have no problem handling a career!) Thus, there’s never been any reason for me to disclose my manic depression to any employers I have had.

The company denied that it discriminated against Lane on the basis of his disability. It alleged he was dismissed because he was not capable of performing the essential functions of the job for which he had been hired. It also said he had lied about the amount of sick time he had taken during a previous job that would have alerted the company to his illness.

However, tribunal adjudicator David J. Mullan found the company did not, as required, make a significant effort to accommodate Lane or properly assess the situation to determine whether it could accommodate Lane’s disability without “undue hardship.”

Lane was hospitalized almost immediately after being fired. I know being fired due to discrimination is a lot more stressful than merely having tight deadlines, but I’ve got to say that I’m pretty sure that if I were fired tomorrow, I couldn’t see myself winding up being hospitalized because of it. It’s really easy to say what you’d do in a given situation when you’re not actually in that situation, so maybe I’m being way too harsh here. Or maybe he actually isn’t a guy who can handle a lot of stress, but still: you should actually give someone a chance to see what they can do before you fire them, and if they have a disability, you do have to take appropriate steps to see if it can be accommodated without undue hardship. Lane didn’t think he’d need much in the way of accommodations.

I know I’m getting just south of coherence here, but mainly I’m frustrated at not knowing nearly enough of the particulars of this case and realizing that it’s my own damn fault that I don’t know. I’ll read the actual tribunal report after the holidays. I don’t have time now.

I just spent over two fucking hours writing a post about Howard Hyde, a man diagnosed with paranoid schizophrenia who died in a jail in Dartmouth, Nova Scotia thirty hours after he was Tasered by police, when Wordpress ATE IT. Or my computer ate it, or something ate it. It just disappeared while I was working on, I swear, the last sentence of it. It should have been autosaved, of course, but somehow it’s still gone.

How about you read a couple of news articles while I curl up in the corner of the room and cuss at technology in general for a while?

• Police informed of tasered man’s psychiatric illness - widow
• N.S. orders Taser review after inmate’s death: Halifax police reluctant to link 45-year-old man’s death to weapon
• Man jolted with Taser needed help, widow says: ‘I really don’t want this to happen to anyone else’
• Panel urged to include mentally ill person: Taser review report will be examined by experts: province

My original post had actual opinions! And more links! And quotes from articles! But I’m not going to bother trying to reconstruct it, because that would just annoy me.

I’ve also been working on a more personal post on an entirely different subject, but it’s been difficult to write because it’s painful for me. Luckily, the draft of that one is still intact. Don’t expect it to be an insightful work of art when it’s finished just because it’s taking me so long. It’s hard enough for me to write it; it would be impossible for me to write it well.

Here’s another one for the “What the Hell Is WRONG With People?” file. I’m not sure there’s much point in linking to this entire article, since it’s from the Saint John Telegraph-Journal, and Canadaeast.com doesn’t seem to keep archived newspaper articles online for a very long time, but here you go. It’s about a New Brunswick teenager who committed suicide in an Ontario prison.

Mentally ill Moncton teenager Ashley Smith, whose death in a segregation cell in an Ontario prison a month ago has sparked several investigations, was often kept in restraints with her cuffed hands chained to a body belt that was attached by another chain to her shackled ankles, Canadaeast News Service has learned.

“We are well aware that these restraints were quite often used in the staff interventions with Ashley Smith,” said Kim Pate, a specialist in prison law and advocate for female offenders.

The restraints may have violated Smith’s human rights and raise questions about why she was in a prison at all, said Pate, national director of the Canadian Association of Elizabeth Fry Societies.

“I can’t imagine a scenario where it wouldn’t violate her human rights, and even if the correctional service perceived it as lawful in order to protect her from self-harm, if they felt the need to use it in segregation, she should have been sent for a full psychiatric assessment,” said Pate, who knew Smith and last saw her alive less than a month before her apparent suicide Oct. 19 in the Grand Valley Institution for Women in Kitchener, Ont.

Ashley Smith committed suicide by asphyxiation in her cell. Several prison staff members are facing charges of criminal negligence causing death, others are being suspended without pay, a new warden has been appointed, and a number of official investigations are being conducted, but it’s all too late for Ashley.

Smith’s odyssey through the prison system began when she went to the Miramichi Youth Detention Centre as a 15-year-old who had thrown apples at a postal worker. The offences that led to an accumulated six-year, one-month sentence were nearly all committed while she was incarcerated, says Pate, who is speaking publicly on behalf of Smith’s parents. Smith’s convictions were for assaulting a peace officer, falsely reporting a fire, uttering threats, theft and assault.

Yes, you read that right. This kid first went to jail for throwing apples at someone. And then it seems that she just didn’t get out. Almost all of her offences were committed while she was in jail, and her sentence just got longer. I can’t say that nobody tried to rehabilitate her, but I can say that it obviously didn’t work. They must have given up on the rehabilitation idea eventually, though, since soon Ashley Smith was spending up to 23 hours a day in segregation.

From an article in the Globe and Mail:

At the time of her death, Ms. Smith was on suicide watch, which called for her to be under constant surveillance, both by prison guards and by a set of video cameras. Her psychological breakdown was not a surprise: For nearly two years, Ms. Smith had been confined to segregation cells, where she lived alone, in conditions that appalled the few outsiders who knew about them.

“Her human rights and her Charter rights were violated,” said Kim Pate… “She was being treated in ways that were inhumane.”

Ms. Smith spent time in several institutions. One of them was in Saskatchewan; a male guard there was later charged with assaulting her. Ms. Pate visited Ms. Smith several times, and complained to prison officials, apparently to no avail. The last visit was on Sept. 24, when Ms. Pate saw Ms. Smith in a bare concrete cell at Grand Valley. Ms. Smith had no shoes, and her only clothing was a security gown, a prison garment that looked like a horse blanket. Ms. Smith’s mattress had been taken away, forcing her to sleep on a concrete slab. There was no blanket.

In Ms. Pate’s view, Ms. Smith was spiralling downward, trapped in a cycle of self-defeating rage against the institution, which reacted with punishments and deprivations.

“She was cold, and she was quite distressed,” Ms. Pate said. “She had been that way for several days when I saw her. Anyone being treated in that way, if they did not have mental-health issues, certainly would have developed them.”

After a suicide in the prison in 2004, an inquest was conducted and recommendations were made to prevent further suicides from occurring. A couple of these recommendations were followed. Others weren’t. A team of British prison inspectors also advised the prison to stop shackling women in leg irons, and this recommendation wasn’t followed, either.

From the Telegraph-Journal article:

CTV News, citing unnamed sources, reported last week that guards had watched her place a ligature around her neck but did not intervene immediately, believing she was not seriously harming herself.

“Rather than receiving treatment, this mentally unstable teenager spent most of her sentence in segregation,” [Kitchener-area Liberal MP Karen] Redman said in question period. “Segregation cannot be confused with treatment.

“The government has ignored several reports calling for a mental health strategy in our prisons. When will the government take action and implement a mental health strategy in Canadian prisons?”

Not that I’ve got a mental health strategy for Canadian prisons up my sleeve, but I think it’s pretty obvious that forcing a suicidal girl, prisoner or no, to sleep on a concrete slab in solitary confinement isn’t going to turn her into a productive member of society.

Speaking of productive members of society, I am working normal hours again and will finally have time to regularly update this blog.

I’m going to assume without even checking that everyone in various mental health blog circles has read this story already. The original article was published five days ago, which in Internet time is the equivalent of about eight thousand years. I link to things I find interesting more so that I can find them again if I want to than to point them out to other people. I don’t actually want to think about this ever again because it makes me feel sick, but unfortunately it’s not the kind of thing that anybody can afford to ignore. I have way too many things to do right now to take the time to make any kind of thoughtful commentary, and really, I’m glad about that, because I suspect that words would fail me if I tried to say anything about this unfathomable cruelty.

Oh, and if you want to know the name of the vile excuse for a human being who emotionally tortured Megan Meier, you can find it in the comments on this post. Her address and phone number are there, too… that is, if she hasn’t changed her number already.

Never thought I’d see the day that I’d consider myself lucky that when I was thirteen, the ex-friend who bullied me told me to my face that I should kill myself. But I got through stuff like that much better than I think I would have if her mother had also been fucking with my mind, too.

There’s a Wired article called Anakin Skywalker: Borderline Personality, Bipolar or Narcissist? that I found via stir-crazy, they found via Mind Hacks, and they found via Omni Brain. I’d especially recommend reading both the Wired story and the Mind Hacks post.

I only have a few comments to make:

1. Hee.
2. Hey, I’ve been told I have bipolar disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder, just like they’re saying about Anakin Skywalker. This can mean one thing, and one thing only: I AM DARTH VADER!
3. The article reminded me right away of a humorous article I’d read years ago in the Canadian Medical Association Journal, “Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne”, so I was extremely happy to see that the Wired story linked to it.

Admittedly, though, I don’t actually think I’m borderline, and I know I’m not histrionic or narcissistic.

According to the authors, who reported their findings at the American Psychiatric Association’s annual meeting in San Diego, Skywalker meets the criteria for the condition: He has difficulty controlling anger, stress-related breaks with reality (after women in his life die or leave), impulsivity (dangerous pod racing), obsession with abandonment (those women again) and a “pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation” (hello, Obi-Wan).

In another sign that he’s borderline, the authors argue that Skywalker suffers from an “identity disturbance.” After all, he did become Darth Vader after being “very unsure of who he was and what he wanted.”

I don’t have difficulty controlling anger, obsession with abandonment, an identity disturbance, or a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation. I am impulsive and have had stress-related breaks with reality. Well, I can live in hope that those two things are enough to MAKE ME DARTH VADER, can’t I?

What is the best treatment for one who has been drawn to the Dark Side of the Force? The opinions of professionals are mixed:

Study co-author Bui said psychotherapy — “long term,” he added with a laugh — would be the best treatment for Skywalker, although he might prescribe a drug to help him sleep.

Bui had mixed feelings about prescribing an antidepressant like Prozac and said he’d avoid tranquilizers like Xanax that could leave Skywalker addicted or send him into “disassociation” (a rupture with reality).

But would Skywalker even go into therapy? “Because of his narcissistic tendencies he would perceive himself as ‘above’ that,” said Sultanoff, who thinks Skywalker also suffers from narcissistic personality disorder, at least in Star Wars Episode II.

I’m going to assume that by “disassociation,” Randy Dotinga means “dissociation.”

Not that there’s much point in trying to help Anakin at this point. He’s dead, yo. Remember?

Everybody has already read about this study and its claims that there is something called “subthreshold bipolar disorder,” and as far as most of us can tell, SBD equates to “simply being human, but big pharma thinks you need antipsychotics for it anyway.” I’m lazy, though, so I haven’t commented upon it until now.

CL Psych posts about the incredibly loose criteria for SBD and the media’s claims that there is “appropriate” medication for it in Subthreshold Bipolar: The Giant Sucking Sound and Subthreshold Bipolar: Media Blitz and Lilly.

Philip Dawdy has also written several posts about subthreshold bipolar disorder, including Name The New Bipolar Disorder, in which he urges people to come up with a better name for SBD. I haven’t come up with anything yet, or rather, I haven’t come up with anything that no one else hadn’t thought of and posted already!

I am vastly confused by the stats from the article in the Archives of General Psychiatry. No, they’re not too complex for me to understand; they’re too stupid for me to understand. Only a 2.4% prevalence of Americans who, twice in their lives, meet half of the criteria for hypomania? I would expect it to be more like 99% than the 4.5% it winds up as in this study once you add the 2.4% to the 1% prevalence for bipolar I and the 1.1% for bipolar II.

I am more of a fan of the bipolar spectrum than some people in the blogosphere are, but this subthreshold nonsense is taking things way, way too far. Honestly, sometimes I like the things that Akiskal has to say, and he’s one of the authors of this study. Some doctors overdiagnose bipolar disorder, and most people who diagnose it overmedicate their patients. But there are still plenty of health care professionals who don’t recognize bipolar disorder. Sometimes, it’s not their fault — they don’t see the patient when he or she is hypomanic, and even if they do ask him or her about past symptoms of hypomania, the patient, in the middle of a depression, is pretty much unable to remember ever feeling okay, let alone hypomanic, and doesn’t — can’t — answer accurately.

Then sometimes there are shrinks who think you’re not manic-depressive if you haven’t, like, married someone you’ve just met and then bought five cars. Doctors who think mania equals euphoria and if you’re having a dysphoric mania, you’re just an asshole. Who think that mixed states or rapid cycling must always be borderline personality disorder instead, and even, believe it or not, doctors who are always going to assume that if you’re psychotic, you’re schizophrenic.

Yes, this “subthreshold” stuff is ridiculous, but within limits, I like the idea of the bipolar spectrum because it makes people aware of things that actually are bipolar symptoms but aren’t necessarily the most classic ones. It’s when you start pathologizing mild things that occur infrequently that it gets to be harmful.

No, I don’t know where the line should be drawn. But I’d say somewhere way before “subthreshold bipolar disorder” as defined in that journal article, anyway.

Philip Dawdy’s post Texas Teen Commits Suicide After Taking Lexapro contains a link to a streaming video of a newscast. At one point in the news story, the dead girl’s father talks about how Kayla was going from highs to lows, typical of most teenagers. Then the newscaster’s voiceover says, “But when the highs became higher and the lows lower, a doctor placed Kayla on Lexapro.”

Now, it’s very likely he could have gotten this wrong. The media gets quite a lot of things wrong. But if he’s right, and Kayla was vacillating between abnormally low lows and abnormally high highs, then it’s not just Forest that her parents should be thinking of suing. Prescribing an antidepressant alone for someone who shows signs of being manic-depressive is criminally stupid, especially if you don’t provide them with adequate information and follow-up care.

I am tired of tragedies happening to families all because of people who should know better, or who should care, and don’t.