Hey, student nurse. Yes, you, the girl who recently did a rotation on a psychiatric ward. I don’t think that while you are riding on the bus, you are supposed to be telling detailed stories to your friend about the patients in the hospital. You know everybody else around you on the bus can hear you, too, right? But you don’t care at all, do you? Of course not. Most mental health workers I’ve seen don’t give a damn about patient confidentiality, so why should you be any different, student nurse? I bet you think that since you didn’t mention any names, everything is cool, right? Well, guess what. It’s not. By the way, those were human beings you were poking fun at. I understand that dark humour has a place among health care workers, to help them cope with the things they have to deal with in their work. That place is not on the bus, however.

Hey, guy from the bus a month or two ago. I overheard you when you were saying, “It seems like everybody I grew up with is dying. One guy died of a drug overdose. Another friend of mine killed herself in jail in Ontario.”

I wanted to say, “You were friends with Ashley Smith? Man, I’m so sorry about what happened to her.”

But, of course, I didn’t say anything.

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.

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.

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.

Stephany at soulful sepulcher listed my blog as one of her five choices for a Thinking Blogger Award. Thanks, Stephany. Since I know that some blogs have been mentioned multiple times in this meme, I’m going to attempt to list five blogs that make me think, but that I don’t believe have already gotten Thinking Blogger Awards. If I’m wrong and they have received them, well, they’re all excellent blogs, which is why I’m listing them, of course, so go visit them anyway! Oh, yeah, these are in alphabetical order.

1. Bipolar Wellness Writer - Eloquent, and focuses a lot on two of the things that interest me the most — healing and writing. Don’t get me wrong; I love good writing about illness, but there’s so much less good writing about wellness out there in any format that I really appreciate it when I find some.
2. my pockets hurt - Juniper is engaging and honest in her blog about coping with borderline personality disorder and life in general. I love reading her posts on any topic — working for a tutoring company, running into annoying people at the laundromat, whatever.
3. Pole to Polar: The secret life of a manic-depressive - I don’t know how she does it. Seaneen’s posts are so long and so frequent, but they still manage to be jam-packed with interesting, thought-provoking content. I like to imagine that I would write posts like she does if I had any patience or attention span.
4. Roller Coaster - Honestly, I’ve only skimmed over some of the posts in Marja’s blog, because I just discovered it today, but I’ve owned a copy of her book for years and I love her book, so I already know I like her writing. The book is actually one of the main inspirations for the title of this blog! Many of Marja’s posts are about bipolar disorder and Christian faith.
5. Spanglemonkey - Speaking of “I don’t know how she does it,” Jo is one of the most prolific bloggers I’ve ever come across. Multiple posts every day and she has been doing this for years. About bipolar disorder and BPD, parenting, writing, life, the universe, and everything.

These are the rules of the Thinking Blogger Awards:

1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think,
2. Link to this post so that people can easily find the exact origin of the meme,
3. Optional: Proudly display the ‘Thinking Blogger Award’ with a link to the post that you wrote.

Marissa at depression introspection posts about the Virginia Tech shootings, bullying, compassion, and prevention. It’s titled The Most Controversial Post You’ll Ever Read Today, but it’s hard for me to see it as controversial, when I agree with much of what she says, especially the parts about Columbine. When I was in junior high, I never considered killing the people who bullied me, but I certainly understood where Harris and Klebold were coming from. What I’ve never understood is why school shooters also tend to kill absolutely anyone that’s around — why wouldn’t they just target the bullies? Why do they also kill people who’ve never done anything to them?

Gianna at Bipolar Blast posts about labels: Patient, Client, Consumer, User, Ex-User, Ex-Patient, Psychiatric Survivor, the Psychiatrized. My big problem in finding a term to use is that I’d like for there to be an umbrella term for those of us who are “mentally interesting” or who don’t believe they are but who have been in the psychiatric system anyway. I am currently in the psychiatric system and I’m not looking to leave it, so for me, that rules out a bunch of those terms like ex-patient. I’m not technically anti-psychiatry, but I’m definitely against bad psychiatry, and there’s an alarming amount of it out there. I’m not a Psychiatric Survivor, I’m a Survivor of Bad Psychiatry. Anyway, all of these terms focus on the relationship between the individual and the psychiatric system, and I’m more interested in finding one for just the individual, who, in his or her search for wellness, relates to many other people and institutions — family, friends, work, school, society as a whole, etc. — and isn’t defined solely by his or her relationship to psychiatry.

The thing that really bothers me about the term “consumer” is that it makes it seem as if we purchase a product and then do nothing else to further our wellness, that we aren’t active participants at all. Of course, this is what some people do — take the drugs and don’t think about eating and sleeping properly, having good relationships with others, expressing themselves creatively, and all of that. “Consumer” takes the fact that I work damn hard in all areas of my life and reduces it to a simple financial transaction, and that is grossly inaccurate.

You know you are hypomanic when…

…you have thirty-two tabs open in your browser window because you keep jumping from topic to topic, page to page, yet you can’t bring yourself to close any of them.

It’s so depressing. From the Times Online, Bullied girl ’stepped in front of train’.

A 14-year-old girl stepped in front of a train after her stepbrother confronted a classmate accused of bullying her, an inquest heard yesterday.

Kay Miller, who suffered from anorexia and a borderline personality disorder, panicked after her brother, a Welsh Guardsman, pushed the alleged bully over a wall and warned him to leave her alone…

…In a written statement her sister, Chloe, said: “I was with Kay, my stepdad and Geraint when we saw Scott Walker.

“He was in Kay’s class at school and he was saying things to her. Geraint went over and said, ‘Leave Kay alone.’ More of Scott’s friend’s came along. Scott’s sister slapped Geraint across the face. But he didn’t react. Tim told us to go home but Kay just ran away crying. She was a bit hysterical.”

God, I hate bullying. I’m so glad I’m not in junior high anymore. I’m so glad I got through it without killing myself, even though one of the bullies suggested that I should commit suicide. Yeah, like I was going to do anything that they said to do.

The inquest heard that the teenager had suffered from “borderline personality disorder” for six years. But she was tackling her problems and had lectured to more than 300 people on her eating disorder.

Also, how much do you think it helped this girl to diagnose her with borderline personality disorder at the age of eight? Would you say not at all? I would. Would you say it probably hurt her more than it helped her? I certainly would.

I’m just mentioning that this Associated Press article exists: Benefits trump risks for children taking antidepressants: study. I don’t remember reading about it before.

The authors of a new comprehensive analysis of antidepressants for children and teenagers say the benefits of treatment trump the small risk of increasing some patients’ chances of having suicidal thoughts and behaviours.

The risk they found is lower than the one the U.S. Food and Drug Administration identified in 2004, the year the agency warned the public about the drugs’ risks for children.

After the warning, U.S. youth suicides increased and some mental health experts said reluctance to try antidepressants might be to blame.

The new analysis includes data from seven studies that were not part of the FDA analysis…

The abstract of the actual journal article is here, but I don’t think I can read the whole thing for free and don’t really feel like commenting on the study results without having read it.

Anyway, more from the AP article:

“The medications are safe and effective and should be considered as an important part of treatment,” said study co-author Dr. David Brent of the University of Pittsburgh School of Medicine. “The benefits seem favourable compared to the small risk of suicidal thoughts and behaviour.”

Effective, when only Prozac worked better than placebo in depressed children under twelve, and none of the other antidepressants in the studies did? When overall, 61 per cent of depressed kids and teens in the studies improved on antidepressants and 50 per cent on placebo? (The data are better for OCD and other anxiety disorders, which I think we already knew, but I’m less personally interested in anxiety disorders.) I know that research-wise, you can define this as “effective,” but as a patient, it’s not good enough for me. So I at least appreciate that the article mentions the need for careful monitoring of the effects that antidepressants have on children and teens taking them:

Dr. John March, chief of child and adolescent psychiatry at Duke University Medical Center, welcomed the study as “the most comprehensive analysis of the data yet put together.”

He said the suicidal behaviour risk, although lower than that found by the FDA, demands that doctors and families watch for warning signs…

If I thought antidepressants were completely evil, I wouldn’t be taking them. I’ve taken them since I was a teenager. I have found them beneficial at times. I’m finding Zoloft beneficial now. But I think that even if this study is accurate and antidepressants will cause suicidality in only one out of 101 kids who take them (and I’m not saying it is accurate; I haven’t even read the thing), that’s still a cause for concern. And so do the parents of kids who are suicidal or dead because of antidepressants.

Is it wrong for me to be amused that one of the co-authors of the study has the same name as the incompetent boss from The Office? Probably, but hey, if it’s wrong, I don’t want to be right. No offense meant to Dr. Brent, I swear.