The Deadliest Kind of Economic Depression

Here’s a sobering kind of economic indicator: The number of suicides peak at the lowest point of a recession, according to Elizabeth Bernstein’s thoughful piece, “Angst Is Rising, but Many Must Forgo Therapy” in today’s Wall Street Journal Online.
Mind you, as a clinician on the front lines every single day, I haven’t seen evidence of this spike yet. In fact, I don’t think the recession or a depression will particularly affect the most seriously mentally ill patients. After all, they are on the receiving end of government benefits which, barring social cataclysm, is unlikely to end.
The people I worry about, though, are the middle-class clients, squeezed in every way possible. These are the folks who could lose their benefits if they lose their jobs, who are having to scale back just to feed their gas tanks, who are paying soaring prices at the grocery, and who have virtually no safety net, unlike the rich and the poor. They are, in my opinion, most at-risk for stopping or curtailing therapy, becoming more depressed and finally attempting suicide, some of them successfully.
See Bernstein’s article for a discussion on how many therapists and clients are managing in this miserable climate.Sphere: Related Content
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The Insanity of Methamphetamine

Evidence of the ravages of meth, from the Multnomah County (Oregon) Sheriff’s Office.

The boy jumped up and down on the gurney, naked save for soiled underwear. “Hey, you wanna f*** me? You all wanna f*** me, don’t you?!” he bellowed at us staff surrounding him as we strategized our next move. His screams were punctuated with what sounded like laughs but on more careful listening sounded like involuntary vocal chord spasms. Finally, with a little help from the police officers who delivered this 15-year-old kid to the emergency room, we were able to restrain him chemically and physically.
Some fifteen minutes later, I reentered the room hoping to find a calmer patient I could actually interview. No doubt he needed to be hospitalized, but whether psychiatrically, medically or both was yet to be decided. I was there to determine the psychiatric part.
As I approached the hospital bed to which this child’s legas and arms were leashed by hard rubber restraints, I realized he was motionless, soundly sleeping. He was breathing through his mouth, enough that I could see he had but a few tiny brown stubs doubling as teeth, eroded from at least a few years of what I suspected was methamphetamine abuse. If this wasn’t meth mouth, I didn’t know what was.
My suspicions were confirmed by the police and, later, the boy’s family. He had been a seemingly happy, normally social 11-year-old in the not too distant past, his teary-eyed mother explained. Everything changed with a snort. Apparently he and his skateboarding buddies from the neighborhood had been dabbling with pot for a little added excitement when an older kid in their mostly-white middle class neighborhood introduced them to meth, with promises of pleasure beyond their young imaginings.
From that day on our young patient burrowed himself deeper and deeper into a crystal crypt. His parents, both of whom had to work to keep the patient, his two siblings and themselves in the middle-class lifestyle to which they had all become accustomed, did whatever they could imagine and afford to help their son hoist himself from the tomb to no avail. “He was not interested in stopping and he didn’t care if he lived or died,” his mother recalled.
By 13, he was hallucinating, hearing voices that dictated his every move, but apparently never commanding him to kill himself or others. His addiction snowballed into a daily practice until he disappeared to the streets of Los Angeles nearly prior to this ER visit.
While a denizen of the Hollywood streets, according to police, the patient made his money by selling sexual favors to the men who cruise Santa Monica Boulevard in the twilight hours. Street friends told the officers that for about $10 he would allow anyone to perform oral sex. He’d perform oral sex or allow himself to be anally penetrated, with or without condoms, by any of the johns, ideally for $20, but they said he’d go lower if it was a slow night.
At this point, everyone seemed to agree, this little boy had not only lost his way, but contact with most of reality as well.
Forget malnourishment, meth mouth, depression and anxiety, sexually transmitted diseases, cardiac risks and devastation to one’s life. Amphetamine-Induced Psychosis is a significant byproduct of tweeking. The more speed you do, the more likely you are to lose your mind.
Anecdotally, most of us who work with psychiatric crises can attest that psychotic manifestations following meth use are commonplace. There is an academic problem of teasing out the cases of psychosis where amphetamines are the primary instigator rather than a pre-existing mental illness. The reality, though, is that even if the patient has a history of, say, schizophrenia, their meth use can and will elicit a full-blown psychotic episode.
I’m reminded of a long-ago friend who began experimenting with methamphetamine. Despite all our warnings and protests, he continued using and eventually lost all control. A rising star in the executive suites of entertainment, he lost his job, his reputation, and ultimately his ability to make money. I remember walking into the bedroom of his Hollywood Hills home, its darkness preserved by layers of aluminum foil blocking the bright midday sun, only to find him sitting in a corner talking to voices that existed only in his head. After calling to him several times, he finally recognized my presence.
The last time he was seen, he was homeless and found sleeping in the gazebo of a friend’s backyard. When he was awakened, he expressed paranoid delusions in panicky chatter: The CIA had been following him, listening to his thoughts and he might have to cut his ear off because that’s where their listening device had been implanted. Then, once inside the house, he vanished through a bathroom window, never to be seen again.
Although my friend may have appeared to have been well-enough adjusted and functioning before methamphetamine, I dont’ know that he really was, any more than I believe the thousands of other meth addicts were, either. I say this because I don’t believe you can sever one’s mental health from their addictive propensities. If the drug is not filling some void, I don’t believe there would be as many folks addicted to substances. If one keeps using in spite of the consequences, such as my friend, that indicates to me the expression of a very powerful need. In my friend’s case, I believe meth served as a fast-acting and sexy antidote for his depresson. In patients I have seen, nearly all of them who use meth regard it as an elixir for depression, ADHD, fatigue, and the emptiness of the Borderline Personality. Of course, the drug only leaves them wanting more and feeling worse than when they started, but it provides a fast, euphoric kick-start without having to see a doctor. Yet.
A friend of mine is fond of the saying, “Man doesn’t take the drugs; the drugs take the man.” But they really take so much more: the addict’s family, friends, career, home, personality, body, and sanity. If you have children or work with them, please take a few minutes and visit the Partnership for a Drug-Free America’s Meth Resource Center.Sphere: Related Content
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Police Have it Tough

According to a new study from the University of Buffalo, the stresses of police work increase officers’ risks for high blood pressure, insomnia, increased levels of destructive stress hormones, heart problems, post-traumatic stress disorder (PTSD) and suicide. Based on data from over 400 officers, the study specifically reported that officers over age 40 had a higher 10-year risk of a coronary event compared to average national standards. Seventy-two percent of female officers and 43 percent of male officers had elevated cholesterol levels. As a whole, police officers as a group had higher-than-average pulse rates and diastolic blood pressure.
You can read more on this at ScienceDaily.com.Sphere: Related Content
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Self-Hatred Bodes Ill for Gay Men

“Homonegativity,” or gay self-loathing, predicts a dim future for gay and bisexual men held captve by it, University of Minnesota researchers reported today.
In a study published in the Journal of Homosexuality, researchers surveyed 422 gay and bisexal men in the Midwest at an HIV prevention conference. The surveys gathered data on the men’s attitudes toward affectional and sexual orientation as well as a set of physical and mental health variables. As one might expect, the higher degree of “homonegativity,” the more frequent depression, isolation and poor sexual health occurred.
I say “as one might expect” because it is well-known that secrecy and shame serve as mental prisons where, in their dark, dank interiors, substance abuse, unprotected sex and lies proliferate. Oddly enough, just before reading this story today, I had been discussing the startling death of a colleague’s friend. Otherwise healthy and highly functioning, this young man fell ill on a Wednesday and died two days later. Something about a perforated bowel from an undisclosed anal sex practice, my friend recalled. Of course, this young man was deeply in the closet about his homosexuality and wouldn’t dream of telling any physician he willingly allowed some foreign object to penetrate his rectum. Ultimately, his secrecy, born of his internalized homophobia, killed him.
How many lives have we lost because of the shame and stigma tarnishing otherwise naturally-occurring variations of human sexual and affectional variations?Sphere: Related Content
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Weekly Psych News Roundup

Three Cheers for this Doctor
Dr. Raj Sherman, parliamentary assistant to Canadian Health Minister Ron Liepert, spoke publicly and boldly about his own suicide attempt at 16 years of age. He told his story as he announced that the government will invest $50 million over the next three years into children's mental health services. Read it online at the Edmonton Journal.Sphere: Related Content
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