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> But I need to be honest with you about what’s likely to unfold,” the doctor added. The best place for adolescents in distress was not a hospital but an inpati

> But I need to be honest with you about what’s likely to unfold,” the doctor added. The best place for adolescents in distress was not a hospital but an inpatient treatment center, where individual and group therapy would be provided in a calmer, communal setting, to stabilize the teens and ease them back to real life. But there were no openings in any of the treatment centers in the region, the doctor said. This is never really questioned. I have some doubts. Seems to me you’re more likely to see success with a radical life change. Moving far away to a different lifestyle. Managing to prevent a suicidal person from committing suicide is a pretty weak target metric imo. How many suicidal people are suicidal simply because the specific lifestyle before them is the only norm they know of and they just don’t want it? Many people cite stats about how previously suicidal people are glad they didn’t commit suicide successfully but it’s got obvious survivor bias from those that did and don’t get a say.

oneplane 4y ago
That is one of the metric problems (both metrics on 'prevention' and survivor bias) which really don't actually help prevention nor does it actually provide usable information. Prevention is not possible in some cases (sometimes genetic or traumatic origin for example), but the root cause is generally a combination of environmental context and vulnerability. If you live in a culture where taboos and other people telling you what you can or can't do in your personal life are part of daily life, a lot of avenues of support (and by extension, prevention) become unavailable. That applies to much tighter scopes like family and much broader scope like city or national levels all the same.
theobeers 4y ago
They go through a little timeline at the end of the article, re: the 15-year-old girl, G. - She spends over a week in the emergency dept. at Boston Children's. - A bed opens up in the hospital proper; she spends another ~3 weeks there. - She moves to an inpatient treatment center (of the kind advocated by the doctor quoted above), spends a week there, and doesn't find it very helpful. - She returns home and spends the summer working at a fast-food place; she still self-harms but manages to hide it for a while. - In the fall, suicidal again (or perhaps she always was), she returns to the inpatient facility for two more weeks, then transitions into an outpatient program. - She's still having a hard time, so she goes to a different hospital and stays for three weeks. By now it's mid October 2021 (iiuc); her initial visit to Boston Children's was in late April. - The last update is that she continues to self-harm, has gotten better at hiding it, and has learned not to admit to adults that she's suicidal. Pretty f'ing bleak! Not that I would have any idea who or what to blame in such a situation. The silver lining is that this person is still alive, a year after the first hospitalization.
- codingdave 4y ago
  That is one story. There are others where it does work out, and learning some coping skills from inpatient was the start of healing. There are yet other stories where the inpatient program identifies a medical problem underlying the suicidal thoughts and they get on meds, figure out how to cope, and end up living a productive life. Our system does work for some people. But it is frustrating and fails others. If anyone wants to build a better one, please do. We need more answers, more options, and more help. ERs are definitely not the answer. The fact that a local family doc can fly someone to a trauma center on a helicopter for a life-threatening physical problem in a matter of minutes, while an equally life-threatening mental problem requires weeks or months of wait lists is a huge freaking problem. We absolutely should be looking for better answers. In the meantime, we do the best we can with what we have to try to save the lives of our children. We all hope for something better in the long run, but I at least appreciate that articles like this are exposing the problems.
  - pmoriarty 4y ago
    "Our system does work for some people. But it is frustrating and fails others. If anyone wants to build a better one, please do." I don't know how we can achieve it, but we somehow need to get to a society which each individual cares for and engages with people in need, and not just wish them away to some system which is supposed to substitute for our own caring and engagement.
    - codingdave 4y ago
      > supposed to substitute for our own caring and engagement. That is an unfair portrayal. Parents are not psychologists, not nurses or doctors, and have limits. We can give our absolute most to care for our children and still need more help.
      - pmoriarty 4y ago
        I'm not suggesting that untrained people provide therapy, but simply engage with and help those in need in some way -- whether that be by volunteering in soup kitchens, schools, hospitals, shelters, senior centers, big brother / big sister programs, summer camps, scouts, tutoring, Kiwanis/Rotary clubs, Peace Corps, AmeriCorps, etc. There are so many ways to help and become more engaged with one's community and people in need. If everyone did more social service of this kind instead of focusing just on themselves and their friends and family, while (at best) paying others to care for people in their community, we'd be so much better off. Kids and adults see a broken society where they and the people around them are just not cared about, ignored, left to rot, or are even actively attacked/harmed. That alone is traumatizing and disheartening. There's so much pain in the world and it's tempting to disengage and withdraw. A more caring world would be a psychological boon to everyone.
nullc 4y ago
> Many people cite stats about how previously suicidal people are glad they didn’t commit suicide successfully but it’s got obvious survivor bias from those that did and don’t get a say. It's pretty much tautological, no? Either you're (still) suicidal or you're glad you didn't previously commit suicide. > How many suicidal people are suicidal simply because the specific lifestyle before them is the only norm they know of and they just don’t want it? Perhaps there is a philosophical challenge in the standard definitions of mental illness, which more or less amount to "thinking in a manner which causes distress or impairs your functioning". We like to pretend that ordinary people ought to have the fortitude to face whatever adversity comes their way-- a belief that is easier to sustain for those who aren't currently facing great adversity.
pmoriarty 4y ago
"Seems to me you’re more likely to see success with a radical life change. Moving far away to a different lifestyle." I'm not so sure. People tend to take their problems with them. Changing external circumstances may help some, but even then the improvement tends to be short-lived until their demons come back to haunt them. Severe depression is rarely so easily cured. "Many people cite stats about how previously suicidal people are glad they didn’t commit suicide successfully but it’s got obvious survivor bias from those that did and don’t get a say." I've never attempted suicide (and if I ever did I'd make sure to succeed), but have felt suicidal throughout most of my life. Am I glad I never did it? Only to the extent that I'm glad I didn't traumatize or ruin the lives of people who care about me. If it wasn't for my reluctance to indirectly hurt people who care about me I'd be gone long ago. Best for me is to have never been born at all. I think a lot of people are only alive because they don't want to hurt people close to them. I very much doubt a failed suicide attempt would change my mind on any of this. It would just have led to more misery for me and the people who care about me. I've seen interviews with suicide survivors who regret trying, and they've tended to be people who just acted impulsively and didn't think through the consequences (teens are a prime example of this). People like me who've thought carefully about it for years or decades are unlikely to fail and unlikely to be glad they survived if they somehow fail anyway.
- wintermutestwin 4y ago
  >People tend to take their problems with them. Changing external circumstances may help some, but even then the improvement tends to be short-lived until their demons come back to haunt them. Severe depression is rarely so easily cured. The context here is teens. Of course the majority of them have underlying "demons," but combining that with the bleak realities of having to decide what to do with your adult life while having drastically limited perspective on your choices is a huge trapdoor that needs to be avoided before they can get to higher levels of self repair.
- mdp2021 4y ago
  > Changing external circumstances may help some, but even then No, it really must depend on what makes one suicidal. A cannot bear his environment, B is afflicted with a chronic pain, C practices inadequate self management, D relives traumas, etc.: if A improves diet, starts to exercise, solves the nuisance of a bad back and hindered sleep, then his situation will improve and yet he will go on hating his life after his own environment - but if A finds an environment that matches his personality and aspirations, he will probably be "happy" (literally - living the fortunate occurrence) even in spite of bearing other "nuisances". It does not seem logical otherwise. It should probably be noted ("just to be sure" in terms of communication) that a number of those conditions may not have a practically easy solution. Also, that an absolute condition of suicidal tendency is not the only cause for suicide.
wintermutestwin 4y ago
>How many suicidal people are suicidal simply because the specific lifestyle before them is the only norm they know of and they just don’t want it? As someone with a lot of experience of teens in crisis, this is the most prevalent underlying theme. Radical broadening of perspective is indeed the solution, but it is a pretty complex thing to achieve in a system that is underfunded and built to allow parents and overarching social structures to avoid taking responsibility.
newsclues 4y ago
I started increasing animal fat in my diet and my thoughts of suicide subsided and come back after a few weeks of no animal fat. I’ve cycled through many antidepressants and people to talk to, but my doctors and therapists don’t seem to know or be interested that diet may impact mental health. PS: Duck fat is delicious to fry potatoes with.
- octopoc 4y ago
  Yeah I had a similar situation. I had issues with depression for a few years (starting very gradually) and then found out that I had an infection in my mouth. After that was taken care of I felt sooo much better it was amazing.
  - mdp2021 4y ago
    I find these posts important on many points. -- The importance of the impact of non-evident factors bringing unwellness; -- Individual difficulties in assessing sources for unwellness and identifying them; -- A widespread disregard for subtleties as an ever-increasing mark in societies. This ever-spreading construct that one can disregard and overcome any stimulus, so people can just live under any condition, which could be dismissed as unimportant (to the point of seeing large masses of people utterly oblivious to all feedback). While others were educated on keeping subtleties in the highest regard...
- pmoriarty 4y ago
  Vitamin B12 and Vitamin D helped with my depression, and gave me more energy. Exercise really helped with my mood, gave me more energey, and helped me destress as well. People's bodies differ, and they may have different nutrient deficiencies/overdoses depending on what they eat and how they live their life (most obviously, those who don't get much sun are more likely to lack vitamin D). Everyone who suffers from depression should definitely take a hard look at their diet and at whether they have some nutritional deficiency or imbalance, and see if they can get more exercise and sunlight, to start with. Of course therapy with a respected therapist you like and trust can be helpful too.. and medication helps some people, though personally I view it as more of a bandaid that only treats symptoms and not the underlying cause.
sandworm101 4y ago
>> Managing to prevent a suicidal person from committing suicide is a pretty weak target metric imo. But that is 100% of the job of an emergency room. They aren't there to save a life. They are there to stabilize a situation, to keep people alive for a few hours/days until they can be triaged and moved on to other facilities. So I would not expect anything more from an ER beyond the simple metric of the person remaining alive through the night. Long term solutions are not their department.
- oneoff786 4y ago
  This answer assumes that the ER room is an appropriate place for a suicidal person to go. It is not. So an ER room’s metric mentality is irrelevant.
  - sandworm101 4y ago
    It is a better place than a bridge. A person about to kill themselves is a person in a medical crisis. When in a crisis an ER is a reasonable choice. So too might be a police station, but an ER is better than many alternatives.
    - oneoff786 4y ago
      That’s a hell of a strawman. And fallacious reasoning on top of it. ER’s are good for some crises, and suicidal inclinations are a crisis, ergo ER is good for suicidal inclinations? No. That’s not logical.
8bitsrule 4y ago
> Moving ... to a different lifestyle. When environment is part of the problem, The idea of returning to an unchanged situation seems unlikely to be productive. A couple of thoughts: Most adolescents need to find a 'peer group' to be part of on the path to independent adulthood. Easy for some; hard for others. I recall a high school student who was having problems and who moved to another ('alternative') school in a different part of the country for a year. There they found a very supportive peer group. When they returned to the original school as a senior, the problems were gone. The school hadn't changed ... their perspective had. I recall from history that a good many 'notable' historical figures left home in their early teens. They were perhaps one-in-a-hundred who are remembered ... not at all uncommon in the past. Were those times more dangerous? One of my grandparents was 16yo when they left behind family and friends in Europe to sail to the US. Another, 16yo grandparent left rural Canada behind to grow-up in the US. (Both joined friends/relatives.) Are these options legal now? Are we 'trapping' our action-seeking/outsider teens? Is 'therapy' another name for 'my way or the highway'?

oneplane 4y ago

That is one of the metric problems (both metrics on 'prevention' and survivor bias) which really don't actually help prevention nor does it actually provide usable information. Prevention is not possible in some cases (sometimes genetic or traumatic origin for example), but the root cause is generally a combination of environmental context and vulnerability. If you live in a culture where taboos and other people telling you what you can or can't do in your personal life are part of daily life, a lot of avenues of support (and by extension, prevention) become unavailable. That applies to much tighter scopes like family and much broader scope like city or national levels all the same.

theobeers 4y ago

They go through a little timeline at the end of the article, re: the 15-year-old girl, G. - She spends over a week in the emergency dept. at Boston Children's. - A bed opens up in the hospital proper; she spends another ~3 weeks there. - She moves to an inpatient treatment center (of the kind advocated by the doctor quoted above), spends a week there, and doesn't find it very helpful. - She returns home and spends the summer working at a fast-food place; she still self-harms but manages to hide it for a while. - In the fall, suicidal again (or perhaps she always was), she returns to the inpatient facility for two more weeks, then transitions into an outpatient program. - She's still having a hard time, so she goes to a different hospital and stays for three weeks. By now it's mid October 2021 (iiuc); her initial visit to Boston Children's was in late April. - The last update is that she continues to self-harm, has gotten better at hiding it, and has learned not to admit to adults that she's suicidal. Pretty f'ing bleak! Not that I would have any idea who or what to blame in such a situation. The silver lining is that this person is still alive, a year after the first hospitalization.

codingdave 4y ago
That is one story. There are others where it does work out, and learning some coping skills from inpatient was the start of healing. There are yet other stories where the inpatient program identifies a medical problem underlying the suicidal thoughts and they get on meds, figure out how to cope, and end up living a productive life. Our system does work for some people. But it is frustrating and fails others. If anyone wants to build a better one, please do. We need more answers, more options, and more help. ERs are definitely not the answer. The fact that a local family doc can fly someone to a trauma center on a helicopter for a life-threatening physical problem in a matter of minutes, while an equally life-threatening mental problem requires weeks or months of wait lists is a huge freaking problem. We absolutely should be looking for better answers. In the meantime, we do the best we can with what we have to try to save the lives of our children. We all hope for something better in the long run, but I at least appreciate that articles like this are exposing the problems.
- pmoriarty 4y ago
  "Our system does work for some people. But it is frustrating and fails others. If anyone wants to build a better one, please do." I don't know how we can achieve it, but we somehow need to get to a society which each individual cares for and engages with people in need, and not just wish them away to some system which is supposed to substitute for our own caring and engagement.
  - codingdave 4y ago
    > supposed to substitute for our own caring and engagement. That is an unfair portrayal. Parents are not psychologists, not nurses or doctors, and have limits. We can give our absolute most to care for our children and still need more help.
    - pmoriarty 4y ago
      I'm not suggesting that untrained people provide therapy, but simply engage with and help those in need in some way -- whether that be by volunteering in soup kitchens, schools, hospitals, shelters, senior centers, big brother / big sister programs, summer camps, scouts, tutoring, Kiwanis/Rotary clubs, Peace Corps, AmeriCorps, etc. There are so many ways to help and become more engaged with one's community and people in need. If everyone did more social service of this kind instead of focusing just on themselves and their friends and family, while (at best) paying others to care for people in their community, we'd be so much better off. Kids and adults see a broken society where they and the people around them are just not cared about, ignored, left to rot, or are even actively attacked/harmed. That alone is traumatizing and disheartening. There's so much pain in the world and it's tempting to disengage and withdraw. A more caring world would be a psychological boon to everyone.

nullc 4y ago

> Many people cite stats about how previously suicidal people are glad they didn’t commit suicide successfully but it’s got obvious survivor bias from those that did and don’t get a say. It's pretty much tautological, no? Either you're (still) suicidal or you're glad you didn't previously commit suicide. > How many suicidal people are suicidal simply because the specific lifestyle before them is the only norm they know of and they just don’t want it? Perhaps there is a philosophical challenge in the standard definitions of mental illness, which more or less amount to "thinking in a manner which causes distress or impairs your functioning". We like to pretend that ordinary people ought to have the fortitude to face whatever adversity comes their way-- a belief that is easier to sustain for those who aren't currently facing great adversity.

pmoriarty 4y ago

"Seems to me you’re more likely to see success with a radical life change. Moving far away to a different lifestyle." I'm not so sure. People tend to take their problems with them. Changing external circumstances may help some, but even then the improvement tends to be short-lived until their demons come back to haunt them. Severe depression is rarely so easily cured. "Many people cite stats about how previously suicidal people are glad they didn’t commit suicide successfully but it’s got obvious survivor bias from those that did and don’t get a say." I've never attempted suicide (and if I ever did I'd make sure to succeed), but have felt suicidal throughout most of my life. Am I glad I never did it? Only to the extent that I'm glad I didn't traumatize or ruin the lives of people who care about me. If it wasn't for my reluctance to indirectly hurt people who care about me I'd be gone long ago. Best for me is to have never been born at all. I think a lot of people are only alive because they don't want to hurt people close to them. I very much doubt a failed suicide attempt would change my mind on any of this. It would just have led to more misery for me and the people who care about me. I've seen interviews with suicide survivors who regret trying, and they've tended to be people who just acted impulsively and didn't think through the consequences (teens are a prime example of this). People like me who've thought carefully about it for years or decades are unlikely to fail and unlikely to be glad they survived if they somehow fail anyway.

wintermutestwin 4y ago
>People tend to take their problems with them. Changing external circumstances may help some, but even then the improvement tends to be short-lived until their demons come back to haunt them. Severe depression is rarely so easily cured. The context here is teens. Of course the majority of them have underlying "demons," but combining that with the bleak realities of having to decide what to do with your adult life while having drastically limited perspective on your choices is a huge trapdoor that needs to be avoided before they can get to higher levels of self repair.
mdp2021 4y ago
> Changing external circumstances may help some, but even then No, it really must depend on what makes one suicidal. A cannot bear his environment, B is afflicted with a chronic pain, C practices inadequate self management, D relives traumas, etc.: if A improves diet, starts to exercise, solves the nuisance of a bad back and hindered sleep, then his situation will improve and yet he will go on hating his life after his own environment - but if A finds an environment that matches his personality and aspirations, he will probably be "happy" (literally - living the fortunate occurrence) even in spite of bearing other "nuisances". It does not seem logical otherwise. It should probably be noted ("just to be sure" in terms of communication) that a number of those conditions may not have a practically easy solution. Also, that an absolute condition of suicidal tendency is not the only cause for suicide.

wintermutestwin 4y ago

>How many suicidal people are suicidal simply because the specific lifestyle before them is the only norm they know of and they just don’t want it? As someone with a lot of experience of teens in crisis, this is the most prevalent underlying theme. Radical broadening of perspective is indeed the solution, but it is a pretty complex thing to achieve in a system that is underfunded and built to allow parents and overarching social structures to avoid taking responsibility.

newsclues 4y ago

I started increasing animal fat in my diet and my thoughts of suicide subsided and come back after a few weeks of no animal fat. I’ve cycled through many antidepressants and people to talk to, but my doctors and therapists don’t seem to know or be interested that diet may impact mental health. PS: Duck fat is delicious to fry potatoes with.

octopoc 4y ago
Yeah I had a similar situation. I had issues with depression for a few years (starting very gradually) and then found out that I had an infection in my mouth. After that was taken care of I felt sooo much better it was amazing.
- mdp2021 4y ago
  I find these posts important on many points. -- The importance of the impact of non-evident factors bringing unwellness; -- Individual difficulties in assessing sources for unwellness and identifying them; -- A widespread disregard for subtleties as an ever-increasing mark in societies. This ever-spreading construct that one can disregard and overcome any stimulus, so people can just live under any condition, which could be dismissed as unimportant (to the point of seeing large masses of people utterly oblivious to all feedback). While others were educated on keeping subtleties in the highest regard...
pmoriarty 4y ago
Vitamin B12 and Vitamin D helped with my depression, and gave me more energy. Exercise really helped with my mood, gave me more energey, and helped me destress as well. People's bodies differ, and they may have different nutrient deficiencies/overdoses depending on what they eat and how they live their life (most obviously, those who don't get much sun are more likely to lack vitamin D). Everyone who suffers from depression should definitely take a hard look at their diet and at whether they have some nutritional deficiency or imbalance, and see if they can get more exercise and sunlight, to start with. Of course therapy with a respected therapist you like and trust can be helpful too.. and medication helps some people, though personally I view it as more of a bandaid that only treats symptoms and not the underlying cause.

sandworm101 4y ago

>> Managing to prevent a suicidal person from committing suicide is a pretty weak target metric imo. But that is 100% of the job of an emergency room. They aren't there to save a life. They are there to stabilize a situation, to keep people alive for a few hours/days until they can be triaged and moved on to other facilities. So I would not expect anything more from an ER beyond the simple metric of the person remaining alive through the night. Long term solutions are not their department.

oneoff786 4y ago
This answer assumes that the ER room is an appropriate place for a suicidal person to go. It is not. So an ER room’s metric mentality is irrelevant.
- sandworm101 4y ago
  It is a better place than a bridge. A person about to kill themselves is a person in a medical crisis. When in a crisis an ER is a reasonable choice. So too might be a police station, but an ER is better than many alternatives.
  - oneoff786 4y ago
    That’s a hell of a strawman. And fallacious reasoning on top of it. ER’s are good for some crises, and suicidal inclinations are a crisis, ergo ER is good for suicidal inclinations? No. That’s not logical.

8bitsrule 4y ago

> Moving ... to a different lifestyle. When environment is part of the problem, The idea of returning to an unchanged situation seems unlikely to be productive. A couple of thoughts: Most adolescents need to find a 'peer group' to be part of on the path to independent adulthood. Easy for some; hard for others. I recall a high school student who was having problems and who moved to another ('alternative') school in a different part of the country for a year. There they found a very supportive peer group. When they returned to the original school as a senior, the problems were gone. The school hadn't changed ... their perspective had. I recall from history that a good many 'notable' historical figures left home in their early teens. They were perhaps one-in-a-hundred who are remembered ... not at all uncommon in the past. Were those times more dangerous? One of my grandparents was 16yo when they left behind family and friends in Europe to sail to the US. Another, 16yo grandparent left rural Canada behind to grow-up in the US. (Both joined friends/relatives.) Are these options legal now? Are we 'trapping' our action-seeking/outsider teens? Is 'therapy' another name for 'my way or the highway'?