Tag Archives: suicide

Thinking about suicide

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Do you think about dying? I do, quite often.

In an article published last week in the Sydney Morning Herald, Daniel Mezrani wrote about his father’s suicide. Daniel’s tone was honest and heartfelt. His message was sobering. Daniel’s father was an emergency physician, highly respected, with “three teenage children, dozens of enamoured colleagues and an innumerable network of people he had touched with his generosity, humour and passion for social justice”, yet he ended his life.

Throughout the article, Daniel approaches suicide through a social framework. “I don’t think that suicide should be viewed as a purely psychiatric issue” he writes. “The idea that suicide is always the consequence of a definable mental illness continues to dominate the public consciousness despite a growing consensus among the academic community that there is much more at play.”

“We know that isolation significantly increases suicide risk, as do other social stressors such as unemployment and relationship failure. A new paradigm in suicide prevention emerges – if we begin to see people in context, we become privy to external factors that may be causing them distress and can thus look out for more subtle cues that they may be at risk.”

He’s not incorrect. Social factors are important to a person’s risk of suicide, though mental health is very important too.

“There is no simplicity in this conclusion, but there is promise. It means that anything we do to address stigma, discrimination and hardship at a systemic level has the potential to bring down our national suicide rate. If we really want to stop people dying in this most horrific way, we need to make it easier for them to live.”

True again. More suicides are prevented through decisions at a systems and government level than through direct personal intervention.

He concludes by saying, “They are tangible reminders that things can get better, and that we are never, ever alone.”

It’s a lovely way of rounding out an article on a very difficult topic, I give him credit for that. And for the average person, it seems like a very reasonable thing to say … things do get better, no one is ever truly alone.

Except that’s not how someone who’s suicidal will see it.

Daniel succinctly encapsulated the essence of suicide earlier on in his article: “The final common pathway is not neurochemical disturbance or a discrete socioeconomic stressor, it is an anguish that feels otherwise inescapable; hopelessness manifest.”

I’ve battled with depression for a long time now, the chronic latent adversity of pathological hopelessness. Most of the time it sits on me like an emotional weight vest, making the simplest tasks feel like so much more of an effort, subtly stealing my energy, tempering my sense of joy. But there are times when I feel like I’m being crushed by a tonne of wet sand and I can’t move or breath or see. There are other times where I feel like someone has ripped out my heart and is pouring battery acid into my chest, and all I can feel is pain.

I think about suicide. Depending on where my mood is, there are times when I think about it a lot. The recurrent theme connecting all those times is hopelessness.

Shame brings isolation, inequality brings inertia, but it is hopelessness that finally destroys.

Most people have never felt the depths of despair that true hopelessness brings, and I hope they never do. Unless you’ve been there, it’s impossible to truly understand how overwhelming it is. The only way I think I could describe it would be to imagine that you’re out to sea and your boat sinks, leaving you stranded in the middle of the ocean at night in the middle of a storm – it’s dark, it’s disorientating, numbingly cold, fighting to try and keep your head above the water when the swells and the currents are constantly dragging you down.

Things can get better, and we are never alone, but when overwhelmed by deep existential despair, you can’t see it.

It might sound like I’m against addressing stigma, discrimination and hardship, but I’m not. The purpose of this article isn’t to advocate for one solution or another. I certainly don’t pretend to know all, or maybe any of, the answers. The purpose of speaking out like this is simple … I want to add to the conversation.

At the opening plenary of the conference I attended this weekend, Dr Geoff Toogood, a doctors mental health advocate, spoke about his own personal journey with mental illness as a way of starting the conversation. It’s a hard conversation, but it’s one we have to have, and it needs to be authentic if it’s going to have any real resonance. It would be much easier to simply hide away, masking the pain, pretending it’s not there, but lets face it, we’ve tried that strategy already and it’s killing us.

I can’t offer answers, but I do promise authenticity.

I also wanted to broach the key issue of hope. How do we give people hope? Hope doesn’t come from a pill or a program, but where does it come from? Can we mobilise hope? Can we give hope to the hopeless, and if so, how do we communicate hope to those who struggle the most to hear it?

I know there will be people reading this who have thought about, or might even be thinking about suicide. I know what you’re feeling. I know how hard it is.

Again, I don’t pretend to know all the answers. All I can say is that you’re not the only one, and you’re not alone. I know it’s not easy, but find even the faintest glimmer of hope – in your family, in your job, in people around you, in a faith. Hold on to it. The storm will pass and day will break.

Sometimes even the simplest connection to another person can help. If you need to talk to someone, there are always people that can help. In Australia, call Lifeline ~ 13 11 14, BeyondBlue ~ 1300 22 4636 or https://www.beyondblue.org.au/about-us/contact-us or the Suicide Callback Service ~ 1300 659 467 or https://www.suicidecallbackservice.org.au. In the USA, call the National Suicide Prevention Lifeline ~ 1-800-273-TALK (8255). In New Zealand, call Lifeline Aotearoa 24/7 Helpline ~ 0800 543 354. In the UK, call Samaritans ~ 116 123. For other countries, Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines.

Kudos to Daniel Mezrani. It’s shattering to lose someone you love so much, and it takes a special kind of person to turn that tragedy into something that will help other people. I wish him and his family all the best as they continue on their difficult journey.

Stigma, discrimination and hardship do need to be addressed at a systemic level if we are going to help lower our nation’s suicide rate.

We also need to better understand hope, how to foster it in those whose hope is dormant, and how to help those who have lost all hope to find it again.

We need to keep talking too. The conversation is extremely challenging, but without an open and authentic dialogue, many will continue to suffer, silent and alone, instead of getting the help they deserve.

The lost art of joy – Joy blindness

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Light at the end of the tunnel …

Joy is a ubiquitous human experience, almost an innate function of the human brain.

Joy is a bit like vision for the soul.

Writing an entire months worth of blog posts on joy, then, is a little writing series of blog posts on art appreciation. The readers of a blog on art appreciation will be able to see the art, the blog helping them to better understand the art. The vast majority of people who will be reading these blogs on joy will be able to experience joy and (hopefully) the posts will help them better understand joy.

But what happens if you can’t experience joy in the first place? What about those people who have ‘joy blindness’, so to speak?

As I’ve been writing this blog every day, I’ve been mindful of those people who struggle to experience joy. For the most part, growing joy in our life is related to our actions or decisions, such as learning acceptance, aligning our direction in life with our values, forgiving ourselves and others etc. Hence why I have been exploring these concepts in my blogs thus far. But there are some people who will read these blogs and say, “But I’ve tried to do all these things, and nothing has worked. I want to experience joy like everyone else but all I have is sadness, anger, loneliness, mourning … I must be doing something wrong … it’s all my fault that I can’t experience joy … I don’t deserve to be happy.”

Remember yesterday when I talked about the work of Sonja Lyubomirsky and her colleagues who estimated that that intentional actions can contribute as much as 40% to a person’s feeling of happiness, where as circumstances could only contribute 10%? In their estimates, our genetics contributed to the other 50% of our overall happiness. Yesterday I made the comment that, even allowing for the generous estimations that were used to come to those final numbers, our actions were of much greater importance in our overall level of happiness than our circumstances.

But there was a second point to come out of the work of Lyubomirsky et al, that our happiness is related to factors beyond our control more than it is related to factors within our control.

For the vast majority of people, our genes, the biggest contributing factor to our joy, work fine. But there are some people whose genes do not work the same way, which makes them much more vulnerable to the effects of circumstances or personal actions. These are the people with major depression, who do not feel joy like the everyday person. There may be sources of joy all around them, but try as they might, they can not perceive it. They have ‘joy blindness’.

Depression is an abnormally low mood for an abnormally long time. Major depression sucks. Major depression is not just letting yourself feel miserable. So often, those without depression think that those with depression are weak, malingering, or wallowing in child-like self-pity. Despite the enormous strides in mental health education and awareness that have been made in the last couple of decades, there’s still a strong current of stigma that flows through our society, adding an additional barrier to improvement for anyone living with or recovering from depression.

Depression affects a lot of people too. About one in ten people will suffer from an episode of major depression in their lifetime.

There’s a lot of good and easily accessible information already available about depression, from organisations like Black Dog Institute or Beyond Blue. I’ve also written about depression and Christianity (Part 1 and Part 2). I don’t want to try and repeat all of that information here.

Rather, I wanted to say just a couple of things. Firstly, if you’re suffering from ‘joy blindness’ – if you long to experience joy in your life but all you feel is sadness, please don’t blame yourself or beat yourself up. It’s not your fault.

And you’re not alone. The depth of despair is so lonely, so isolating. But there are others out there who have gone what you’re going through and have come out the other side. And there are people around you to help you through – whether they’re friends, family, or professionals who can help, like your GP or a psychologist. Those suffering from depression benefit from specific counselling, or talking therapies, and occasionally those suffering from depression might need medication to assist them in their recovery.

For most people who suffer it, ’joy blindness’ isn’t permanent. It’s more like walking through a long dark tunnel rather than being trapped in a cave. If you can keep moving forward, you will eventually get through the other side. I know it’s hard, because I’ve been there myself. I know that in the middle of the tunnel, it feels like there is no end, that you’ll never experience joy again.

The key is hope. Hope keeps us moving forward. If you can keep moving forward, you will overcome the joy blindness of major depression and you will experience joy again.

Don’t lose hope, and you will experience joy again.

If you are struggling with mental illness and you need urgent assistance, please talk to someone straight away:

In Australia:
Lifeline ~ 13 11 14
BeyondBlue ~ 1300 22 4636 or https://www.beyondblue.org.au/about-us/contact-us
Suicide Callback Service ~ 1300 659 467 or https://www.suicidecallbackservice.org.au

USA:
National Suicide Prevention Lifeline ~ 1-800-273-TALK (8255)

New Zealand:
Lifeline Aotearoa 24/7 Helpline ~ 0800 543 354

UK:
Samaritans ~ 116 123

For other countries: Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines.

Dr Caroline Leaf – Howling at the moon

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The night is darkest just before the dawn, so says the age-old phrase.  It’s funny how we just accept these old adages as true, but when you actually think about it, they’re nothing more than a concoction of the imagination.  The night isn’t darker just before dawn – it’s just as dark when the sun goes down as it is before the sun comes up again.

In the same way, we so often accept things said by ‘experts’ as truth when in reality, they’re also just some particularly imaginative concoctions.

Take, for example, Dr Leaf’s latest e-mail newsletter and blog for June 2017.  In it, she merrily gloated about how a recent UN Human Rights report “exposed the current failings of diseased-based psychiatry” and “challenges the dominant narrative of brain disease and its overreliance on psychoactive drugs”.  The smugness is palpable – she finally has something more authoritative to try and back up her psychiatric antagonism than just the collective ranting of an outspoken, ill-informed fringe group.

Dr Leaf is a communication pathologist (essentially an academic speech pathologist) though she continues to delusionally claim that she’s a cognitive neuroscientist.  She also grandiosely believes her training in speech pathology make her a mental health expert, above psychiatrists with actual medical training and decades of real clinical experience.  She might feel vindicated by this report and her ill-formed friends, but her view is naive and her narrative is based on inaccurate statistics and logical fallacy.

For example, this paragraph encapsulates Dr Leaf’s statistical errancy and general self-deception: “Several of my previous blogs, as well as some of my FAQs, deal with the current state of mental health care, which has crippled so many lives, led to countless deaths, and left millions of people thinking that there is ‘something wrong with my brain.’ Indeed, an estimated 20% of the American population take psychiatric drugs, which amounts to a staggering cost of $40 billion, as mental health advocate Robert Whitaker points out (a 50-fold increase since the late 1980s).”

It’s a “see-I-told-you-so” attempted justification, except that modern mental health care has not “crippled so many lives” or “led to countless deaths.”  It’s actually untreated mental illness which really cripples people’s lives, or ends them.  Suicide is an unspoken epidemic that is so often the end result of undiagnosed or untreated mental illness.  Suicide is the major cause of premature death among people with a mental illness and it’s estimated that up to one in ten people affected by mental illness die by suicide.  Up to 87% of people who die by suicide suffer from mental illnesses. There are more deaths by suicide than deaths caused by skin cancer and car accidents.  Up to three percent of adults have attempted suicide within their lifetime and it’s estimated that for every completed suicide, at least six other people are directly impacted in a significant way [1].

On the flip side, the use of any anti-psychotic medication for a patient with schizophrenia decreased their mortality by nearly 20% [2]. In another study, the mortality of those with schizophrenia who did not take anti-psychotics was nearly ten times that of the healthy population, but taking anti-psychotic medication reduced that by a factor of five! [3]  Dr Correll and colleagues summarised the literature, noting that, “clozapine, antidepressants, and lithium, as well as antiepileptics, are associated with reduced mortality from suicide. Thus, the potential risks of antipsychotics, antidepressants and mood stabilizers need to be weighed against the risk of the psychiatric disorders for which they are used and the lasting potential benefits that these medications can produce.” [4]

As for her example taken from the equally prejudiced Robert Whitaker that “an estimated 20% of the American population take psychiatric drugs, which amounts to a staggering cost of $40 billion … (a 50-fold increase since the late 1980s)”, even if it were true, it’s simply misleading and ill-informed.  Twenty percent of the US population might be taking “psychiatric drugs” but some of them might be taking them for different reasons.  For example, tricyclic anti-depressants are no longer used primarily for depression but have found a niche in the treatment of chronic and nerve-related pain.  And so what if there’s been a 50-fold increase in the use of psychiatric medications since the 1980’s, that doesn’t mean they’re being used inappropriately.  Her analogy is like saying that because there has been a 900-fold increase in the number of road deaths since the turn of the century [5], cars are being used inappropriately and we should all start travelling by horse-back again.

It’s the height of arrogance for Dr Leaf to sit in her ivory tower and condemn modern psychiatry based on her utopian fantasy, but mental illness affects real people and causes real suffering – like the two heart-broken parents told a Parliamentary Enquiry in Australia a few years back, “We would rather have our daughter alive with some of her rights set aside than dead with her rights (uselessly) preserved intact.” [6]

Dr Leaf may smugly think the sun is shining on her, but she’s still in the darkness of night, barking and howling at the moon like a rabid dog.  If she really wants to step into the light, she should try looking at the mountain of scientific evidence supporting modern psychiatry and if that’s not enough for her, then she should at least look at all those afflicted and distressed because the mental illness they or their loved one suffered from was ignored in favour of an ideology that claims to support human rights but which ignores the most basic human right of all, the right to life.

References
[1]        Corso PS, Mercy JA, Simon TR, Finkelstein EA, Miller TR. Medical costs and productivity losses due to interpersonal and self-directed violence in the United States. Am J Prev Med 2007 Jun;32(6):474-82.
[2]        Tiihonen J, Lonnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009 Aug 22;374(9690):620-7.
[3]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.
[4]        Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World psychiatry : official journal of the World Psychiatric Association 2015 Jun;14(2):119-36.
[5]        “List of motor vehicle deaths in US by year” https://en.wikipedia.org/wiki/List_of_motor_vehicle_deaths_in_U.S._by_year Accessed 18 June 2017
[6]        “A national approach to mental health – from crisis to community – First report” 2006 Commonwealth of Australia http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Former_Committees/mentalhealth/report/c03 Accessed 18 June 2017

Kintsukuroi Christians

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When I was a kid growing up, there wasn’t much that my father couldn’t repair.

Dad was extremely gifted with his hands, a talent that I certainly didn’t inherit. He was able to take a problem, come up with a practical solution in his mind’s eye, then build it out of whatever scraps of wood, metal or plastic he could lay his hands on. It was the ultimate expression of frugality and recycling that comes from a limited income and four growing children.

Dad was also able to resurrect nearly everything that broke in our house. Plates, cups, teapots, toys, tools … it seemed there wasn’t anything that couldn’t be fixed by the careful application of Araldite.

Araldite, for those unfamiliar with it, is some sort of epoxy resin that, in the right hands, possesses mystical properties of adhesion. It would stick anything to anything.

Dad’s gift for repairing things with Araldite meant that a lot of our things were patched up. Some of our most loved possessions were the most cracked. Despite being glued together several times, each item was still functional. Maybe not as pretty as it may have once been, but still useful, and more importantly, still treasured. Each time the Araldite came out, it taught me that whilst all things have the capacity to be broken, they also have the capacity for redemption.

There’s an ancient Japanese tradition that shares the same principles. For more than 400 years, the Japanese people have practiced kintsukuroi. Kintsukuroi (pronounced ‘kint soo koo ree’) is the art of repairing broken pottery with gold or silver lacquer, and the deep understanding that the piece is more beautiful for having been broken.

The edges of the broken fragments are coated with the glue made from Japanese lacquer resin and are bonded back into place. The joints are rubbed with an adhesive until the surface is perfectly smooth again. After drying, more lacquer is applied. This process is repeated many times, and gold dust is also applied. In kintsukuroi, the gold lacquer accentuates the fracture lines, and the breakage is honoured as part of that piece’s history.
Mental illness is a mystery to most people, shrouded by mythology, stigma, gossip or Hollywood hype. It’s all around us, affecting a quarter of the population every year, but so often those with mental illness hide in plain sight. Mental illness doesn’t give you a limp, a lump, or a lag. It affects feelings and thoughts, our most latent personal inner world, the iceberg underneath the waters.

On the front line of medicine, I see people with mental health problems every day, but mental health problems don’t limit themselves to the doctor’s office. They’re spread throughout our everyday lives. If one in four people have a mental health problem of one form or another, then one in four Christians have a mental health problem of one form or another. If your church experience is anything like mine, you would shake hands with at least ten people from the front door to your seat. Statistically speaking, two or three of them will have a mental illness. Could you tell?

It’s a fair bet that most people wouldn’t know if someone in their church had a mental illness. Christians battling with mental illness learn to present a happy façade, or face the judgment if they don’t), so they either hide their inner pain, or just avoid church altogether.
Experiencing a mental illness also makes people feel permanently broken. They feel like they’re never going to be whole again, or good enough, or useful, or loved. They’re often treated that way by well-meaning but ill-informed church members whose idea’s and opinions on mental illness is out-of-date.

The truth is that Christians who have experienced mental ill-health are like a kintsukuroi pot.

Mental illness may break them, sure. But they don’t stay broken. The dark and difficult times, and their recovery from their illness is simply God putting lacquer on their broken pieces, putting them back together, and rubbing gold dust into their cracks.
We are all kintsukuroi Christians – we’re more beautiful and more honoured than we were before, because of our brokenness, and our recovery.

I’m pleased to announce that my book, Kintsukuroi Christians, is now available. I’ve written this book to try and bring together the best of the medical and spiritual.
Unfortunately, good scientific information often bypasses the church. The church is typically misled by Christian ‘experts’ that preach a view of mental health based on a skewed or outdated understanding of mental illness and cognitive neuroscience. I want to present a guide to mental illness and recovery that’s easy for Christians to digest, adopting the best spiritual AND scientific perspective.

In the book, I look at some scientific basics. Our mental world is based on the physical world. Our mind is a function of the brain, just like breathing is a function of our lungs. Just as we can’t properly understand our breathing without understanding our lungs, so it is that if we’re going to understand our thinking and our minds, we are going to have to understand the way our brain works. So the first part of this book will be an unpacking of the neurobiology of thought.

We’ll also look at what promotes good mental health. Then we’ll look at what causes mental illness, specifically looking at the most common mental health disorders. I will only look at some of the most common disorders to demonstrate some general principles of psychiatric illnesses and treatments. This book won’t be an encyclopaedia, and it doesn’t need to be. I hope to provide a framework so that common and uncommon mental health disorders can be better understood. I also discuss suicide, which is sadly more common than most people realise, and is rarely discussed.

I know mental illness is difficult, and we often look at ourselves or others as though the brokenness is abhorrent, ugly and deforming.
My hope is that through Kintsukuroi Christians, you’ll see the broken pieces are mended with gold, and realise that having or recovering from a mental illness doesn’t render someone useless or broken, but that God turns our mental brokenness into beauty.

Kintsukuroi Christians is available to purchase from good Christian bookstores around the world including:

Kooyong = https://www.koorong.com/search/product/kintsukuroi-christians-christopher-pitt/9780994596895.jhtml

Amazon US = https://www.amazon.com/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Amazon UK = https://www.amazon.co.uk/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Smashwords = https://www.smashwords.com/books/view/720425

~~

Mental illness can be challenging. Sometimes learning about mental illness can bring up difficult feelings or emotions, either things that you’ve been through yourself, or because you develop a better understanding of what a loved one is going through or has been through. Sometimes old issues that have been suppressed or not properly dealt with can bubble up to the surface. If at any point you feel distressed, I strongly encourage you to talk to your local doctor, psychologist, or pastor. If the feelings are so overwhelming that you need to talk to someone quickly, then please don’t delay, but reach out to a crisis service in your country

In Australia
Lifeline 13 11 14, or
BeyondBlue
Call 1300 22 4636
Daily web chat (between 3pm–12am) and email (with a response provided within 24 hours)  https://www.beyondblue.org.au/about-us/contact-us.

USA = National Suicide Prevention Lifeline 1-800-273-TALK (8255)

New Zealand = Lifeline Aotearoa 24/7 Helpline 0800 543 354

UK = Samaritans (24 hour help line) 116 123

For other countries, Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines.

Should pregnant women still take antidepressants if they’re depressed? – SSRI’s and the risk of autism

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As is my usual habit, I sat down tonight to do something useful and wound up flicking though Facebook instead.  Procrastination … avoidance behaviour … yeah, probably.  But at least this time it turned out to be rather useful procrastination, because I came across a science news story on Science Daily about a study linking the use of anti-depressants in pregnancy with an 87% increased risk of autism.

Actually, this is old news.  Other studies have linked the use of some anti-depressants with an increased risk of autism, such as Rai et al in 2013 [1].

The latest study to come out used data from a collaboration called the Quebec Pregnancy Cohort and studied 145,456 children between the time of their conception up to age ten.  In total, 1,045 children in that cohort were diagnosed with autism of some form, which sounds like a lot, but it was only 0.72%, which is actually lower than the currently accepted prevalence of autism in the community of 1%.

What the researchers got excited about was the risk of developing autism if the mother took an antidepressant medication at least at one time during her pregnancy.  Controlling for other variables like the age, wealth, and other health of the mothers, a woman who took an anti-depressant during pregnancy had a 1.87 times greater chance that her baby would end up with ASD, compared to women who did not take an anti-depressant [2].

An 87% increase sounds like an awful lot.  In fact, it sounds like another reason why anti-depressants should be condemned … right?

Well, like all medical research, you’ve got to consider it all in context.

First, you’ve always got to remember that correlation doesn’t always equal causation.  In this particular study, there was a large number of women being followed, and their children were followed for a long enough time to capture all of the likely diagnoses.  So that’s a strength.  They also tried to control for a large number of variable when calculating the risk of anti-depressants, which also adds more weight to the numbers.

Although the numbers are strong, studies like these can’t prove that one thing causes another, merely that they’re somehow linked.  It might be that taking anti-depressants causes the brain changes of autism in the foetus, but this sort of study can’t prove that.

Even if the relationship between anti-depressants and ASD was cause-and-effect, what’s the absolute risk?  Given the numbers in the study, probably pretty small.  With a generous assumption that ten percent of the study population was taking anti-depressants, the increase in the absolute risk of a women taking anti-depressants having a child with ASD is about 0.5%.  Or, there would be one extra case of autism for every 171 that took anti-depressants.

Hmmm … when you think of it that way, it doesn’t sound as bad.

You also have to consider the increase in risk to women and their offspring when they have depression that remains untreated, or in women that stop their anti-depressant medications.  There is some evidence that babies born to women with untreated depression are at risk of prematurity, low birth weight, and growth restriction in the womb, as well as higher impulsivity, poor social interaction, and behavioural, emotional and learning difficulties.  For the mother, pregnant women with depression are more at risk of developing postpartum depression and suicidality, as well as pregnancy complications such as preeclampsia, and an increase in high-risk health behaviour such as smoking, drug and alcohol abuse, and poor nutrition.  Women who discontinued their antidepressant therapy relapsed significantly more frequently compared with women who maintained their antidepressant use throughout pregnancy (five times the rate) [3].

So the take home messages:

  1. Yes, there’s good evidence that taking anti-depressants in pregnancy is linked to an increased risk of a child developing autism.
  2. But the overall risk is still small. There is one extra case of autism for every 171 women who take anti-depressants through their pregnancy.
  3. And this should always be balanced out by the risks to the mother and child by not adequately treating depression through pregnancy.
  4. If you are pregnant or you would like to become pregnant, and you are taking anti-depressants, do not stop them suddenly. Talk to your GP, OBGYN or psychiatrist and work out a plan that’s best for you and your baby.

References

[1]       Rai D, Lee BK, Dalman C, Golding J, Lewis G, Magnusson C. Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study. Bmj 2013;346:f2059.
[2]       Boukhris T, Sheehy O, Mottron L, Bérard A. Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatrics 2015:1-8.
[3]       Chan J, Natekar A, Einarson A, Koren G. Risks of untreated depression in pregnancy. Can Fam Physician 2014 Mar;60(3):242-3.

Dr Caroline Leaf and her can of worms

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Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. She also likes to think that she’s an expert on mental health. So this morning, she felt like she was quite justified in publishing a meme about the evils of psychiatric medications.

She quoted Professor Peter Gøtzsche, stating that “Psychiatric Drugs are the third leading cause of death, after heart disease and cancer.” Then followed it with “Take all thoughts into captivity, not drug all thoughts into captivity. You have the mind of Christ! (1 Cor 2:16) **DRUG WITHDRAWAL should ALWAYS be done under the supervision of a qualified professional. These drugs alter your brain chemistry, and withdrawal can be a difficult process.”

The subsequent comments were primarily made up of the usual sycophantic responses that Dr Leaf has cultivated by blocking anyone that disagrees with her. But there were more than the usual responses confused by her meme, and quite a few that we’re asking for help in weaning off the medications that they were on.

Then there were those who weren’t happy at all. One respondent, a certified Nurse Practitioner, wrote, “I am appalled that you are posting this inaccurate information and causing vulnerable people to possibly stop taking medication that may be allowing them to function and live.” The same person followed up with another comment soon after, quoting the CDC figures for the top ten causes of death in the US, in which the third on the list wasn’t psychiatric drugs at all, but chronic lower respiratory diseases.

LeafWorms02

The overall response must have taken her aback, because Dr Leaf posted a follow-up comment to explain herself, an unusual step for her.

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In it, she said, “I do not speak out against psychiatric medication because I want to condemn people, or make them feel guilty. I want to help people. If, for example, I knew that eating some food could kill you or seriously injure you, and kept this to myself, you would justifiably be angry at me. These drugs have serious, proven long term side affects that are hidden from the public, and the logic behind them is not God’s desire for you to be healthy in your spirit, soul and body. Psychiatric drugs are based off of a theoretical view of evolution as a mindless, unguided process that created you as mechanistic individual with a biological brain that has chemicals that need to be “balanced”. You are more than your biology; you are the temple of the Lord, created in his image. This is not a game: these drugs can decrease your lifespan by 15-25 years. I want you to have those 15-25 years, and I want them to be characterized by God’s perfect, good plan for your life. I ask you to not to just take my word for this, but to do your own research. You can find a multitude of references on my site http://www.drleaf.com under Scientific FAQs. It is my earnest desire that people do not perish for lack of knowledge (Hosea 4:6). **DRUG WITHDRAWAL should ALWAYS be done under the supervision of a qualified professional. These drugs alter your brain chemistry, and withdrawal can be a difficult process.”

But it was too late. Dr Leaf had opened a can of worms, and once out, those wriggly little critters are impossible to put back in.

Both her initial offering and her reply shows just how poor Dr Leaf’s understanding of mental health truly is. She is fixated on the notion that the mind controls the brain, and she is unwilling to consider any other notion, instead preferring to accept any opinion that conforms to her world view, no matter how poorly conceived it might be. This includes the work of Gøtzsche, accepting it as gospel even though he has critics of his own.

It’s important to examine Dr Leaf’s reply in more detail as her statement has the potential to cause a great deal of harm to those who are the most vulnerable. Lets break down Dr Leaf’s statement and review each piece, and then I will outline some other important and contradictory considerations of Dr Leaf’s stance.

  1. The safety of psychiatric medications

Dr Leaf claims that “These drugs have serious, proven long term side affects {sic} that are hidden from the public” and “This is not a game: these drugs can decrease your lifespan by 15-25 years.”

Dr Leaf is right in saying that psychiatric medications have serious proven long term side effects. And we should be careful. I mean, if you knew that thrombocytopenia, anaphylaxis, cutaneous hypersensitivity reactions including skin rashes, angioedema and Stevens Johnson syndrome, bronchospasm and hepatic dysfunction were the potential side effects for a medication, would you take it?

Most people wouldn’t.   Reading the list makes that drug sound really dangerous.  We should be up in arms about such a dangerous drug … except that this list of side effects isn’t for a psychiatric drug at all, but is actually the side effect profile of paracetamol (Panadol if you’re in Australia, Tylenol if you’re in the US). People take paracetamol all the time without even thinking about it. Saying that we shouldn’t take medications because of potential side effects is a scarecrow argument, a scary sounding straw man fallacy. All drugs have serious proven long term side effects, and most of the time, those serious long term side effects don’t occur.  Licensing and prescribing a medication depends on the overall balance of the good and the risk of harm that a medication does.

Oh, and no one has ever hidden these side effects from the public as if there’s some giant conspiracy from the doctors and the pharmaceutical companies. The side effects are listed right there in the product information (here is the product information for fluoxetine. See for yourself).

As for Dr Leaf’s assertion that psychiatric medications decrease your lifespan by 10-25 years, I think that’s a red herring. I read through Dr Leaf’s ‘Scientific FAQ’ and I couldn’t find any references that back up these statements, so who knows where she got this figure of ’15-25 years’ from.

On the contrary, what is known is that severe mental illness is associated with a 2 to 3-fold increase in mortality, which translates to an approximately 10-25 year shortening of the lifespan of those afflicted with severe depression, schizophrenia or bipolar disorder [1]. So Dr Leaf has it backwards. It isn’t the medications that cause people who take them to die 25 years earlier than they would have without the illness, but it’s the illness itself.

  1. The benefits of long term psychiatric medications

So psychiatric medications have their side effects, true, but they also have protective benefits which Dr Leaf consistently fails to acknowledge.

Correll and colleagues note in the conclusion to their article that “Although antipsychotics have the greatest potential to adversely affect physical health, it is important to note that several large, nationwide studies providing generalizable data have suggested that all-cause mortality is higher in patients with schizophrenia not receiving antipsychotics.” [1]

More specifically, in one recent study, the use of any anti-psychotic medication for a patient with schizophrenia decreased their mortality by nearly 20% [2]. In another study, the mortality of those with schizophrenia who did not take anti-psychotics was nearly ten times that of the healthy population, but taking anti-psychotic medication cut that back to only four times the risk [3].

These findings are mirrored by other studies on other psychiatric medications. For example, as noted by Correll and colleagues, “clozapine, antidepressants, and lithium, as well as antiepileptics, are associated with reduced mortality from suicide. Thus, the potential risks of antipsychotics, antidepressants and mood stabilizers need to be weighed against the risk of the psychiatric disorders for which they are used and the lasting potential benefits that these medications can produce.” [1]

So psychiatric medications are not useless. Let me be clear, I’m not saying that taking psychiatric medications always makes life a cake-walk – there are still side effects from the medications, and the disease isn’t always fully controlled. But on average, well treated patients with psychiatric conditions clearly do better than patients who are not treated.

Therefore Dr Leaf’s assertion that psychiatric medications are harmful are inaccurate. And given that there are genuine benefits to these medications, particularly in the prevention of suicide, Dr Leaf’s discouragement of these medications has the real potential to result in real harm to those of her followers who take her at her word.

  1. The ‘logic’ behind psychiatric medications

Dr Leaf says in her statement, “the logic behind them (psychiatric medications) is not God’s desire for you to be healthy in your spirit, soul and body. Psychiatric drugs are based off of a theoretical view of evolution as a mindless, unguided process that created you as mechanistic individual with a biological brain that has chemicals that need to be ‘balanced’. You are more than your biology; you are the temple of the Lord, created in his image.”

Dr Leaf’s argument here is that based on a false premise and some straw man fallacies which inevitably leads to a false conclusion.

Evolution is a mindless unguided process
Evolution says that you are just a machine
Psychiatric illness is because of a chemical imbalance in that machine (a false premise)

therefore taking psychiatric medication is accepting evolution (a straw man fallacy)

and

You are more than your biology,
you are the temple of the Lord, created in his image,

therefore evolution is wrong (another straw man fallacy)

therefore psychiatric medications are not God’s desire (false conclusion)

The problem with this logic is that it could be applied to all medications, since modern medicine has predominantly been devised by agnostic scientists within an evolutionary framework, and nearly all disease is defined by an imbalance of one thing or another.

For example, simply rewording Dr Leaf’s statement shows up the distorted logic that it entails:

“Insulin can have serious, proven long term side affects that are hidden from the public, and the logic behind it is not God’s desire for you to be healthy in your spirit, soul and body. Diabetes is based off of a theoretical view of evolution as a mindless, unguided process that created you as mechanistic individual with a biological pancreas that has chemicals that need to be ‘balanced’.”

You can’t have this both ways. If psychiatric medications are against God’s plan, then all medications are against God’s plan. But if we accept medications for physical ailments, then we also have to accept medications for psychological ailments.

  1. The Mind-Brain link

Dr Leaf tried to protect herself with a glib disclaimer at the end of both posts in question today, “**DRUG WITHDRAWAL should ALWAYS be done under the supervision of a qualified professional. These drugs alter your brain chemistry, and withdrawal can be a difficult process.”

Which is interesting, because in her Scientific FAQ, Dr Leaf has this to say about the mind,

“The Brain is part of the Physical Body and therefore is controlled by the Mind. The Mind does not emerge from an accumulation of Brain activity. Brain activity, rather, reflects Mind activity. Even though the Mind controls the Brain, the Brain feeds back to, and influences, the Mind. The Brain seats the Mind, and therefore the Mind influences the Physical world through the Brain.”

So if that’s true, then why is withdrawal from psychiatric medication so difficult? If the mind is outside the physical realm and controls the brain as Dr Leaf proposes, then the medications effect on brain chemistry should make little or no difference to the mind, and withdrawal should be simple.

The fact that withdrawal from these medications is not simple is testament to the fact that the mind is a function of the brain, and does not control the brain as Dr Leaf proposes here and through her books and other written materials.

Issuing the warning is responsible, but shows again just how far Dr Leaf’s teaching is from scientific reality.

  1. Dr Leaf’s motivations

Finally, I want to talk about Dr Leaf’s motivation. In her statement, Dr Leaf said, “I do not speak out against psychiatric medication because I want to condemn people, or make them feel guilty. I want to help people.” And, “I want you to have those 15-25 years, and I want them to be characterized by God’s perfect, good plan for your life … It is my earnest desire that people do not perish for lack of knowledge (Hosea 4:6).”

I want to state, for the record, that I believe Dr Leaf when she says this. I don’t doubt her motives are to try and help people. But good intentions are not enough. What she says has real life consequences.

Dr Leaf is idolised by her followers and portrayed as a mental health expert by the churches she preaches at. People don’t question experts recommended to them by their pastors or their friends. So when she says that psychiatric medications kill people, people on psychiatric medications will want to come off them, because of fear, because of stigma, because of their desire to live true to God and his good and perfect plan. Without wanting to sound melodramatic, there is a very real chance that some of those people who were stable on their medications but who unnecessarily cease them because Dr Leaf told them to, may harm themselves or take their own life, since that’s what the studies tell us [1, 4]. At the very least, they are likely to have a shorter life expectancy because of it [2, 3]. So telling people that psychiatric medications are dangerous is morally and ethically dubious.

There are also potential legal implications too. God forbid, but if a person committed suicide because they went off their medication because of what Dr Leaf wrote, law suits could easily follow. No one wants that situation. Dr Leaf also runs the risk of being accused of practicing medicine without a licence, since some of her followers have asked personal medical questions in the comments, and the reply from Dr Leaf’s Facebook team is to direct them to their programs like the 21-day detox, which depending on the legal interpretation and the mood of a judge, could be seen as giving medical advice, which Dr Leaf is not legally qualified to give.

LeafWorms01

To summarise, I certainly hope that neither of these hypothetical scenarios becomes reality, but Dr Leaf and her social media team are skating on thin ice, and a glib disclaimer at the end of a post won’t necessarily cut it.

I would hope that Dr Leaf and her social media team would reconsider their approach. In fact, I would suggest that Dr Leaf unequivocally apologises for what she’s written, retracts her statement, and encourages people to see their doctors if they have concerns about their medication, or their mental health.

Indeed, I would implore Dr Leaf to step back and re-evaluate the entire breadth of her teaching, and the advice that she is giving. Dr Leaf is obviously a very smart woman and a very engaging speaker. With great power comes great responsibility. If she were to reconsider her teaching and start from a basis of scientific fact, then she could be a major force for the good of the church and its physical and mental health. At the moment, I fear that she is doing the opposite.

This is not a game: people’s lives are at stake. I hope that Dr Leaf sees this before it’s too late.

References

[1]        Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World psychiatry : official journal of the World Psychiatric Association 2015 Jun;14(2):119-36.
[2]        Tiihonen J, Lonnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009 Aug 22;374(9690):620-7.
[3]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.
[4]        Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P. Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Archives of general psychiatry 2012 May;69(5):476-83.

Here’s my glib disclaimer: This article is a rebuttal of Dr Leaf’s opinion regarding psychiatric medication.  This blog doesn’t constitute individual medical advice.  If you do not like your medication or think you should come off it, please talk to your own GP or psychiatrist.  Do not stop it abruptly or without adequate medical advice.

The Prospering Soul – Just what is mental health?

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When Paul wrote to the church at Thessalonica a couple of thousands years ago, he said, “May God himself, the God who makes everything holy and whole, make you holy and whole, put you together—spirit, soul, and body—and keep you fit for the coming of our Master, Jesus Christ.” (1 Thessalonians 5:23 -The Message)

The modern western church has two out of three. As modern Christians, we have the fitness of the Spirit pretty well down, and we’re not too shabby on our physical fitness either. Unfortunately, we still have a way to go on the Soul thing.

In 2013, Rick Warren stood in front of his church after the suicide of his son, and promised he would work to reduce the stigma of mental illness in the Christian church (http://swampland.time.com/2013/07/28/rick-warren-preaches-first-sermon-since-his-sons-suicide/). Rick Warren experienced the stigma and destruction of poor mental health first hand. So have many others in the church, as have I.

It’s my passion to help the Christian church prosper, our bodies, our spirits, AND our souls.   Over the next few months, I’ll be doing a series of blogs on mental health, to encourage and help those in the church battling mental illness, and everyone else in the church to know how to assist them in their battle.

Together, we can help to eliminate the stigma and destruction that mental health can bring into the lives of Christians, and that we may prosper in all things and be in health, just as our soul prospers (3 John 1:2).

To start with, it would help if we knew what it meant to be in good mental health, and what separates mental health from mental illness. The distinction isn’t always so obvious. There are a few ways to define or conceptualise mental health and illness, but to cut through the thousands of words of medical and scientific jargon, the difference between good mental health and bad mental health is often to do with changes to our thinking, mood, or behaviour, combined with distress and/or impaired functioning. [1] Our mental health is intimately linked with our physical health, and often physical illness will lead to changes to our thinking, mood, or behaviour, combined with distress and/or impaired functioning too, although strictly speaking, that’s not a pure mental health disorder.

What IS important for the average church goer to understand is that we all experience some changes to our mental health at different times in our lives. For example, we all experience grief and loss at some time in our lives, and at that time, it’s normal to experience extreme sadness, sleeplessness, anger, or guilt. What differentiates grief from depression is the trigger, and the time the symptoms take to resolve. In general, how we perceive our thoughts and behaviours, and how much any signs and symptoms affect our daily activities can help determine what’s normal for us.

There are some common signs that can help in knowing if professional help may be needed. This isn’t an exhaustive list, but if you or a loved one experiences:

  • Marked change in personality, eating or sleeping patterns
  • Inability to cope with problems or daily activities
  • Strange or grandiose ideas
  • Excessive anxiety
  • Prolonged depression or apathy
  • Thinking or talking about suicide
  • Drinking alcohol to excess or taking illicit drugs
  • Extreme mood swings or excessive anger, hostility or violent behaviour

then consult your family doctor or psychologist, or encourage your loved one to seek help. With appropriate support, you can identify mental health conditions and explore treatment options, such as medications or counselling.

Many people who have mental health conditions consider their signs and symptoms a normal part of life or avoid treatment out of shame or fear. If you’re concerned about your mental health or a loved one’s mental health, don’t hesitate to seek advice.

If you or a loved one have, or still struggle with, mental illness, I welcome your comments.

I can’t give specific counselling or advice in this forum, but if you are suffering from mental health problems and need help, see your GP or a psychologist, or if you’re in Australia, 24 hour telephone counselling is available through:

Lifeline = 13 11 14 – or – Beyond Blue = 1300 22 4636

References

  1. National Institute of Mental Health, Mental Health: A Report of the Surgeon General, U.S. Department of Health and Human Services, Editor 1999, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services: Rockville, MD.