Episode 20
The Drive Toward Destruction and Death
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HOPE on the Other Side Episode 20 Program Notes:
Today Dr Ken’s guest is a man who had a dark period in his life with hopelessness, lack of self-love, and suicidal thoughts. He is a personal acquaintance from a local club. This interview is to help bring awareness to the issue of suicide in the context of a caregiver of a loved one who is living with schizophrenia. It is the goal to gain a greater understanding of this difficult and somewhat mysterious topic of self-destructive urges, and what to do about them
Jared is a man in his mid-thirties, mixed race. (no surname used to help protect his privacy). Originally from the North East, then the Washington DC area where he worked in non-profit organizations. Later he moved to California and got into technology company work. From a mental health perspective, he has had longstanding depression, anxiety, coupled with a period of suicidal thinking. He is willing to share his experience and hope as an example of this topic. It is Dr Ken’s belief that Jared’s history can generalize to parts of the case of suicidal thinking in a person living with schizophrenia.
Jared described job loss as part of the beginning of his depression. Alcohol and drugs were involved as he searched for emotional and mental relief. In the case of those living with schizophrenia there can be mourning and a sense of loss. Examples for the case of a young adult with schizophrenia include: loss of college career, loss of employment, loss of “future dreams and plans,” also there may be thoughts of fear and shame, experiences of being stigmatized, and rejected. For the caregiver / parents there can be mourning and loss as well. In this case it may be loss of their sense of career or future marriage plans for their teen or young adult child; due to the stigma of mental illness, there could be a sense of loss of social standing and respect in the community for the parent of an adult child with schizophrenia. Sometimes grieving and mourning and the bereavement over the real and potential losses can lead to a more independent depression in the mind and body. Then there may be a further descent into hopelessness and then suicidal thinking. The goal here is to bring awareness to these dark pathways, and shine light on them, and avert that path for as many listeners and their friends as possible.
It is a somewhat controversial Freudian idea in organized psychiatry, particularly in Analysis, that there is a drive or an urge in humans toward death and destruction,. This drive also gets translated into aggression. Freud gave the theory that the drive toward self-preservation, maintaining the species, sexual activity, and other creative processes, the “EROS” drive was balanced by an opposite drive. That is the drive toward death and self-destruction, and destruction in general.
Jared discussed his time of hopelessness, darkness and depression emotionally and mentally. He looked to outside things for relief, but what he did only made his sense of shame and worthlessness and hopelessness get worse. In the case of schizophrenia, the stigma over severe mental illness in some people can result in self-hatred and shame. We want to avoid this thinking pattern.
Medical School training in the 1980’s taught that those diagnosed with Schizophrenia had up to a 10% completed suicide rate. Recently, some authors now report about 6% rate. In the United States overall, according to data from the CDC, the Center for Disease Control, between the years 2000 and 2016 there was an increase in completed suicides in working age Americans from 12.9 per 100,000 up to 17.3 per 100,000. That is a 34% increase. Working age Americans were defined to be between age 16 and 64). For those living with schizophrenia in the US, there is a huge number who think about and may even attempt suicide, 40%. (the data from various studies gives a large range for those with schizophrenia suffering with troubled thought about suicide as between 30% and 70%).
Jared went on to describe a period of days of suicidal thinking. During that time he planned and ruminated on suicide as a relief from his emotional suffering while on the East coast and after moving to California. Both Jared’s story, and the fictional TV, movies and books also describe suicidal thinking and planning. So, the information & these ideas are not secret, and available to most folks in the modern world.
Next, we talk about getting in touch with clinical professionals. Jared describes his personal family history of others with serious mental health issues and experiences. In his adult life he was in contact with counselors, psychiatrists for medications, and even some psychotherapy, and support groups. Written pamphlets and referrals helped him, too. This is parallel to the kind of things available to a person living with schizophrenia.
Jared then had a turning point, one day his inner drive toward life, led him to a business card with a local county suicide prevention hotline phone number. He called up and a caring compassionate conversation and assessment followed. His crisis moment passed, and they set up an outpatient appointment. In previous podcasts (Episode # 3 with Dr Wilson) we addressed some of the legal issues, such at the 5150 detention here in California. The 5150 allows peace officers to take a person to an emergency room where a hold may be started for up to 72 hours when they cannot care for their own food, clothing or shelter, or for danger to self or to others. Both private hospitals and the public county psychiatric hospital have emergency room services to address suicidal thinking and behaviors. Questions are asked to assess the potential risk of completed suicide, his or her support network & housing situation are assessed, along with the clinical observations of the staff. Then a decision is made about the next step. The good and hopeful news is that the vast majority of people thinking about self-destruction and suicide are able to be safely helped in the community with both personal and family support along with professional clinical help. Again, the theorists believe that there is a normal drive toward death within all humans which balances the creative drive.
The ER contacts, and phone numbers are the sort of thing that can be in a written in a Wellness and Recovery Action Plan, and in the Emergency Plan by the person living with Schizophrenia. Then this written plan can be shared with caregivers before there is any crisis. This is addressed in HOPE podcast episode #13 with Dr. Sonia Peterson.
The natural personal support systems in the community, family, church, groups, are very important. The sense of loneliness and alienation is a fundamental problem here for anyone with mental health problems, and for those living with schizophrenia. Concerned others in a person’s life are a big part of what keeps hope alive. Jared tells of the positive example of ongoing contact with his supportive family. He also indicates the “two-way-street” nature of this process, bridge building is key here for both the caregivers and the person who is moving toward a balanced, healthful, meaningful and respectful life.
Keeping a positive and optimistic mental attitude for Jared is very important. The CBT, cognitive behavioral therapy, ideas that the common and habitual thoughts and attitudes of a person and a his / her family are the foundation for a good life. What you think about determines in part how you live your life. This preparedness for a healthy mental and spiritual life is key for people both with and without any formal identified psychiatric diagnosis. Life can be a wonderful and meaningful adventure.
Hope and optimism while caring for and living with someone with Schizophrenia is very powerful in Dr Ken’s opinion and the mission and vision of the Schizophrenia Care Project Foundation.
Links
- Hotline / Telephone: NSPL
National Suicide Prevention Lifeline
This is a 24 hour, 7 days a week service.
1-800-273-TALK (8255)
- “Suicide in the Early Stage of Schizophrenia,” Frontiers in Psychiatry, v 7:116, June 27, 2016.
See free pdf article on psychosis at the website:
NAMI list of 5 common myths about suicide:
https://www.nami.org/Blogs/NAMI-Blog/September-2018/5-Common-Myths-About-Suicide-Debunked
NIMH National Institute of Mental Health on suicide :
https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml
Schizophrenia Care Project Foundation
www.SchizophreniaCareProject.org
FaceBook Group: S-Project
https://www.facebook.com/groups/140778123234472/
Face Book Page for HOPE podcast:
https://www.facebook.com/HopePodcast/
HOPE Podcast on Linked-In:
