https://archive.md/DvlP6

And through all this I keep up my research on my familial disease, pressuring doctors to at least do some tests. I am pretty sure, looking at my genetics, I actually have a mitochondrial disorder. This is an easy test, but they will never do it. They just keep focusing on the same old pathways and that is why there is no progress.

The medications? They do nothing but make me worse. They usually give me drug induced lupus or just make me more suicidal the next day. The only one I can rely on is Klonopin, it works great but I do not take it everyday adn I only take a very low dose, the lowest that works. And every time I get a new doctor I face the stigma of being a drug seeker. Luckily, that is not so much of a problem anymore.

Now iwth COVID, everyone thinks they haev a mood disoder but in reality it is just situational, but they take up all the appointments so now mine are getting pushed further apart.

My nephew hung himself at 14 years old after a doctor thought he had ADHD and gave him ritalin. It was a misdiagnosis.

If you do not have a serious mental illness you have no idea how bad the treatments are and how they ignore any other issues you have in your body. We are the garbage people in this age but we probably used to be the shaman.

So all I can do now is drink a bit to escape, its a great drugs, an awesome calcium channel blocker.

Oh well, that's enough of that. Just wanted to share.

I recently read Van Der Kolk's "The Body Keeps The Score", a book about trauma and its effects. It's a masterwork, and I'll be thinking about it for the next year. But one of the big themes for me is the extent to which he, a well-placed psychiatrist with a strong mix of clinical and research work, had trouble getting the medical establishment to go beyond outdated categories and marginally effective treatments. It's heartbreaking to think of all the patients so poorly supported by the existing system.

It made me realize that as far as mental health goes, we're living in an age that people will later look at with horror. It makes me think of Semmelweis [1], who had the then-radical idea that surgeons should wash their hands before cutting people open. Many in the establishment mocked him. How dare he call them dirty! He ended up being committed to an asylum where he was beaten; he died 2 weeks later from a gangrenous wound. Eventually people realized he was right, but too late for him. And for who knows how many deaths.

[1] https://en.wikipedia.org/wiki/Ignaz_Semmelweis

replied

> My nephew hung himself at 14 years old after a doctor thought he had ADHD and gave him ritalin. It was a misdiagnosis.

I have ADHD and the first to get diagnosed in my family, and now that I'm dealing reasonably well with that, strongly suspect other ASD-related traits: obsessionality, sensory issues, social problems, but these lightly enough that I've been able to make it through life just being a bit "weird" and that's okay because I'm a successful software developer. (Crazy rich guys are just "eccentric", right?)

My father definitely does have many of these too, and if you look back at the family history it's everywhere... from cousins with autism who can't live independently, to back generations with erratic behaviour for which this sort of neural difference is the best explanation.

Now speaking to the quote... my 13 year old has terrible levels of anxiety and depression, and has an ADHD diagnosis. We very briefly tried a stimulant and just as quickly took him off it, whereas they have worked well for me (now, I was also suicidal as a teen.)

Why? He struggles with focus and concentration, which the stimulants should help with, as they do for me. My best guess is that he has a deeper problem in finding life meaningless, a lot of "no point to anything" and "I don't want to live anymore". When he took the stimulants, he was able to focus... but on those thoughts since he had little else he was thinking about and that made the depression and anxiety so much worse. So I can absolutely see how Ritalin could result in suicide. :(

The difference for me was that I knew what I loved, and I knew what I wanted to do with my life, yet I was constantly beset with intrusive thoughts that were telling me I should be doing something "better" with my time. And a fundamentalist religious upbringing had me thinking that was my conscience or God and therefore I should be paying attention to it. But then that almost shrank to nothing as soon as I started the amphetamines.

So I view this as a similar situation to giving antidepressants to sufferers of bipolar and mania; you end up exacerbating the problem.

They are finding there is so much genetic overlap for these disorders which is why you see so much similarity in your child, yet there will be differences that might be influenced by his mothers genetics.

My father was no doubt an Aspie, he was a poor Italian boy in NYC but somehow attained a full ride to NYU when he was 16. My mother, a poor Polish girl who ran away from the coal country to NYC where she met my father. She has the bipolar phenotype running through her side of family and she was in and out of hospitals and attempted suicide a few times as well.

So you end up with me, a mix of my mother mitochondrial DNA and my fathers Nuclear DNA. Bipolar, OCD, Aspergers...

Your experience with amphetamines is like mine with Benzodiazapines. When I took them for the first time I finally understood how other people were able to exist in the world. Klonipin stops my suicidal impulses in a half hour.

Regarding my nephew, I was frustrated with my brother, he did not listen to me. I was given Ritalin when I first saw a psychiatrist in 1996 and it threw me into an insane manic episode (I am still apologizing to my ex-girlfriend). That is how that "diagnosed" my bipolar disorder. So being he was realted, and showing some of the same behavior of my other brother who was also bipolar, I felt it was a wrong diagnosis.

I can tell you the most important thing you can do is get your child's full genome run if you can afford it. To me it is the only thing that will help you find what he needs. I have collected about 15 other people's genetics and I often compare them to mine. By a white European standard, I am a genetic "freak". But through intensive self study of nurtigenomics, I have found a lot about what works for me.

And I am sure you know this, but the less stress on your child the better, we need to live a life that looks nothing like the mainstream, and the more you can let him live how he needs to live the better. But I wish my parents could have helped me as much as you have already with your son. My mother told me that since I was pretty intelligent they felt I could be left to my own devices.

But I think mitochondrial genetics is huge in all of this. I have a family's genetics who have two sons with severe Autism and their mitochondrial genetics are different to say the least.

If you want to email about anything feel free: podgaj@fastmail.org

> My father was no doubt an Aspie, he was a poor Italian boy in NYC but somehow attained a full ride to NYU when he was 16. My mother, a poor Polish girl who ran away from the coal country to NYC where she met my father. She has the bipolar phenotype running through her side of family and she was in and out of hospitals and attempted suicide a few times as well.

Oh yes. I got into family history as a lockdown hobby, and it runs well back on my side of the family. And suspect my wife has some ND traits as well, but her environment led her to develop some exceptional coping skills.

The key difference between my son and I that I note is that I escape into books and learning (as did my father before me), whereas my son escapes into physical activity, much like his mother's side did... surfing, boxing, extreme mountain biking... it's the adrenaline that's his coping 'drug'. (Notably I did get into extreme amounts of exercise at one point to cope, but mine was much less adrenaline... it was long distance and multi-day activity.)

> When I took them for the first time I finally understood how other people were able to exist in the world.

That moment of clarity is incomparable... the only comparison I can make to it from before the stimulants was when I was able to induce "runner's high" in myself.

> Regarding my nephew, I was frustrated with my brother, he did not listen to me. I was given Ritalin when I first saw a psychiatrist in 1996 and it threw me into an insane manic episode (I am still apologizing to my ex-girlfriend). That is how that "diagnosed" my bipolar disorder. So being he was realted, and showing some of the same behavior of my other brother who was also bipolar, I felt it was a wrong diagnosis.

I got a bipolar diagnosis a decade ago. Whether technically a misdiagnosis or not I do not know, but I consider the bipolar symptoms to be resulting from the ADHD... I was forever "failing to live up to my potential" and then when I did achieve miracles seemingly out of nowhere I became manic with "I can do anything" euphoria... only for the cycle to repeat. I think partly I didn't have enough life experience to recognise the cycle, because I did fine up until the end of my undergrad due to the formal external structures that kept me on the right path.

By the time I actually got the formal ADHD diagnosis and the prescription, I had already reached a high degree of self-awareness, and knew exactly what it was I wanted to be able to focus on.

But that when contrasted with my son's experience (and the others in this thread) are crystallising the view I'm trying to express... someone may very well have ADHD and lack executive function, but if they are in a pit of anxiety, depression and despair, then they need to work out what they want out of life and what to focus on first before going anywhere near stimulants. Because if you're focusing on wanting to be dead... well, I'm sure you can see the implication I'm getting at.

The same is true for both my brother and myself... I have a number of quite close friends, yet my preferred interaction is one-on-one.

Couldn't agree more that it's strong social connections that bring purpose. He's struggling on that front being out of school, but school brings other troubles.

(The other aspect of purpose is a sense of achievement in one's work... that's a struggle too.)

For instance, I still struggle with procrastination at work and avoiding starting tasks... I can often take my dose and then proceed to hyperfocus on social media for hours on end. But once I am working, it's great. I first noticed the impacts of the meds when I could actually enjoy just playing with the kids and not constantly battle with feeling like I should be doing something else.

The pill can help you maintain interest in something, not start that thing. I don’t have an answer to this problem. I’m 34. I don’t take anything for my disorder anymore. Either tolerance builds up, or the novelty wears off and my intention to start things declined as a result. And I end up back where I started but now I’m taking drugs everyday.

On my brother. I think that he doesn’t have ADD. That his issues at school were unrelated, and Ritalin just made him more anxious and neurotic.

I hope you can get help. I have a few family members with schizophrenia / bipolar disorder and the way society treats them is like shit.

And yes, like shit is the right way to put the treatment. But I understand, it is so hard for people to not see my disorder as something I willfully express on the world. I know a better understanding is around the corner, but I am afraid treatments will take longer to appear. It is a slow process.

And thanks.

If you do, what treatment options does that offer? Can you pursue that treatment without an official diagnosis?

https://my.clevelandclinic.org/health/diseases/15612-mitocho...

mentions no prescription-restricted treatments, just vitamins, diet, exercise, and rest. It mentions therapy, but general skills therapy, nothing specific to mitochondrial disease.

- What hopes did you have when you were younger?

- What did it look like when you started failing?

- Do you think a different turn of events would have avoided that?

I feel like I was on the high path up to 25 years old, I’m earning now, but I’m getting inexorably rid of my friends, one after another. I’d like to know where I’m at…

All it proves is that there is a big housing shortage.

Have you tried taking your van somewhere where housing is dirt cheap?

I hear small poor towns are better at taking care of the downtrodden too. Walk into the church poor people go to, and see what happens.

And go to a poor town? And not have healthcare, be away from my friends and support? But yes, I have tried it. They ask me what I do and when I say I am on disability they deny me the rental. And many of these towns will not let you live in your van while you are looking.

It is inequality, not a shortage.

I am telling you, you have no idea what it is like.

Advice that I've usually found more valuable was formatted as "here's an option and here are the possible pros and cons". These people also did more listening than 'should-ing'. They also didn't have the audacity to tell you what is best, which is implied by 'should', because they weren't in your shoes and neither completely informed of the context so how would they know what's best?

Which is a symptom of people not caring.

You should seriously understand what you are signing yourself up for if you call one of those numbers on yourself or someone else.

For one you are volunteering that person for involuntary incarceration in a mental health facility for an unspecified and potentially unlimited amount of time.

Need to show up to work tomorrow to avoid losing your job? That probably isn't happening.

Need to pay your bills to avoid losing your house? That might not be within your capabilities for the next several months or longer.

Kids need to get to school? CPS is likely going to be handling that for the indefinite future if they don't have another guardian because you aren't going to be around to do it and you are no longer fit to be a legal guardian anyway.

I'd probably rather end up in Jail than in that system.

Simply put, in our society indicating you are suicidal is a defacto crime and you should never do it(including and maybe especially to a psychiatrist/psychologist who maybe taking on legal risk if they don't institutionalize you after the admission) unless you are ready to suffer the consequences.

The Samaritans hotline (a general distress helpline) is there to listen. Nothing else. They do not provide treatment, judgement or the like. Sometimes that is enough. More importantly its anonymous. You will not be sectioned by phoning them

To be sectioned (ie detained against your will), you _have_ to be assessed by a doctor within 24 hours. You need to be deemed a risk to yourself or others(by at least two doctors) before you can be held any longer.

You cannot be fired for being sectioned in the UK.

So whilst the UK is very far from being perfect in terms of mental health (lord knows we have a multitude of problems, some alluded to in the article) it is not as bad as described in the parent thread.

In fact, you even still accrue vacation time while off sick, I was off sick for a year and when I came back HR came to me with the news that I had extra holiday to use the next year because it been rolled over from when I was off sick.

If you're sick while on holiday you can even try to claim the days back although most people don't as that's seen as taking the piss a bit.

But in general you will be paid full wages for intermittent sickness (ie three days -> couple of weeks)

As you are sectioned you will have a doctor's note by default, so there is no chance of being fired. (employment tribunal will back you up on that. However there is a cost(capped at £750) to that nowadays [thanks david cameron, you utter shitfacewankstain])

There are a number of rights for returning to work as well after a long sickness.

Should that fail, there is still nominally a safteynet of universal credit. However that has become rather inhumane recently (thanks again David you shitbag.) but it is not as inhumane as unemployment insurance in the US.

Three years ago I made a plan to take my own life. Instead of pushing through I contacted a local suicide hotline, it was completely anonymous. I just talked for a bit, but that little moment helped me to find the courage to talk to a family member and that led me to go into therapy which I completed a few months ago.

Initially I was very scared telling my therapist about being suicidal, exactly sketching those horror scenarios. But when I finally talked about it, nothing happened. I remained into complete control of my own therapy the whole period. It helped me turn my life around and I'm incredibly happy I took the leap of faith to start talking about it.

The odds of someone dying through suicide after a suicide attempt is very small (only 2%), but those odds greatly increase if inpatient treatment is provided, instead of reducing. There is a reason for that, and clearly your experience doesn't provide that reason. The stated reason psychiatrists give for this is that only the very serious cases get committed, but research doesn't back that, and for specific institutions (and you have no control over where you end up) it is definitely not true.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710249/

Suicide after inpatient treatment in a psychiatric facility is actually getting close to enter the top-10 causes of death. Whilst that doesn't directly contradict what you're saying, it comes pretty close.

In the Netherlands, it is now actually true that more than 50% of suicides happen with psychiatric help, which mostly means getting locked up. Given that less than 1.5% of the population ever gets committed (but rising fast, especially for kids), that's pretty incredible.

And in a bunch of published cases it isn't even the case that people were committed for a suicide attempt, but for an outburst that was then diagnosed, for example as autism. Suicide came, years later, after years of treatment, a progressively worsening situation, and months in isolation in such a facility, in one case with the person locked up without his glasses.

Wouldn't "the system is mostly good at only putting extremely high-risk people into those facilities" cause the same correlation if it were the case?

Would it be surprising if "people leaving any general hospital" were more likely to die of whatever they had been there for than "people who didn't need to go to hospital"?

Of course the criticism is that they only take the worst problems (even though refusing "complex" cases obviously contradicts that more than a little bit in my opinion). Likewise other studies that assess the ability of professionals to predict who will commit suicide keep coming with very disappointing results, so frankly, I find it hard to believe they could select the serious cases even if they fully intend to do so.

But the group that gets help has a bigger suicide rate compared to the group that doesn't. Quite a bit bigger. So it depends what you believe.

1) do you believe the criticism that they are able to select serious cases (but are unable to prove that in studies specifically checking that) ? Then it is unknown how effective their treatments are, and until they quantise "seriousness" it is impossible to check how effective they are.

2) do you believe the selection process is mostly random and the criticism is invalid? Then the treatments are counterproductive and they cause suicide. That does not (necessarily) mean they mistreat patients. For example, often the inability to leave gets blamed for job, family, and generally the future prospects to evaporate, which in turn causes suicide, which seems to me to find support in the observation that it's most often just after treatment ends that the actual successful suicide happens. The treatment causes suicide, but not directly.

We should make the exceptions that there are plenty of studies about specific institutions where abuse of patients does happen and it is definitely the institution itself that causes suicide.

All the downsides you listed apply to jail time also, but the food is more terrible, the environment more restrictive, and the opportunities for extricating yourself (if you are reasonably cogent) are greatly reduced.

Also, ironically, being in jail on suicide watch is preferable to being in general population.

My basis for making that comment is that at least ostensibly you get due process in the legal system.

Hope you came out the other side in a good place.

[0] That's how long it took for me to get a court date at which point I was released with time served (2 weeks). Getting out of the mental hospital never even required a lawyer (though I'd still recommend retaining one if you're ever in this situation).

Some justice here. Instead of singing songs about rights abuses in whatever country they decided not to like at the moment why don't they look and fix things under their own fucking noses.

Maybe I'm just lucky to have ended up with psychs who will take on more risk to avoid having to commit people, but it's at least a little more complicated than you imply.

The fundamental problem there is that plenty of people have won lawsuits against hospitals/doctors when their loved one mentioned suicide in some way, was not involuntarily committed and then proceeded to kill themself. The amounts involved in those lawsuits tend to be high. In contrast, very few people have won lawsuits against hospitals/doctors who involuntarily committed them when they probably shouldn't have been, and even if they do, the monetary harm that they can recoup is probably pretty small.

This results in very perverse incentives for the institution. In your case either the people involved in your care had a very high personal risk tolerance, or it happened in a state where there is less precedent on handing over megabucks to the families of people who commit suicide.

I'm bipolar, and when I was untreated I would frequently (as on every other day) spend hours locked in a doom-spiral of self hatred, incapable of breaking myself out of it. I could recognize what was going on at some level, and that if I were pulled out of the spiral I would be fine, but in the moment trying to escape that pain seemed to only have one solution, even if I knew I normally wouldn't want to die.

I would basically have to try and hold myself together long enough for my wife to find me and help me back to sanity. Each time I got a little closer to failing. Getting access to medication was life changing.

I am enterally thankful she took away deadly instruments, encouraged me to find reasons to live and recover, and ultimately seek treatment. Whereas you would have just left me to irrevocably take my own life in response to temporary problem that had a medical solution readily available.

:)

For the record, I never wrote, said, or claimed that, and your claim is inaccurate. Please refrain from making false claims about me.

As for the concern about basic rights, I fundamentally agree. For some people, perhaps, they will never get better and in those cases we should have a path to assisted suicide. In all cases, we should do our best to help suicidal people, who are ultimately suffering a lot. I don't think most people who are suicidal want to specifically die more than they want an end to their suffering, to which they see no realistic alternative other than death (which I assure you remains quite scary even when you're really depressed.) I think giving them an escape other than death is morally obligatory and humane, where it's possible.

Is this actually true? I know it's said quite often, but there are countries with much much higher suicide rates where firearms aren't nearly as ubiquitous. Eg Lithuania.

The amount of people who die to suicide is higher in the US because you are much more likely to actually die if you use a gun to commit suicide than other common methods. Higher access to guns increases the rate of people who successfully kill themselves. (Which is probably a bad thing. In general those who survive suicide attempts are happy that they lived.)

The rates in the US are high because of access to guns. It's well understood in public health that easy access to means and methods is one of the factors driving high rates of death.

The rates in Lithuania are high because of a number of other factors -- high alcohol misuse probably being important. Also, there are plenty of guns in Lithuania, and firearms are one of the most frequently used methods.

In general one usually gets more meaningful results when a) comparing geographically and/or culturally similar countries for things like these. E.G the UK has half the mortality rate of the US, Canada and the EU have 2/3 of the US rate. And b) compare trends, not single values. E.G. US rates are rising (which I as a layman would interpret as speaking against the firearms thesis), while the rates of Lithuana and Japan are falling.

This is particularly true if they call you during the bad 1% and directly ask you to stop them from doing the thing.

Consider instead the case where you're a recovering gambling addict who's asked me to make sure you don't gamble again. One night I find you in the pokies room, so I take your wallet and tell you I'll give it back tomorrow morning. I agree that this is theft and possibly morally wrong; however, I don't agree that it breaches your right to self-determination, since most of the time you seem pretty determined not to gamble.

I disagree with the claim that many suicides are like that, I don't think the suicide from the article was like that, and the word "consistently" is doing a lot of heavy lifting.

Intuitively I feel that it's like two different people are making decisions about the one body, and the finality of suicide means the suicidal part of someone is wiping out the future for both, and should thus be prevented.

Again, though, the majority of suicide victims aren't suicidal for large periods of their lives. I feel that in the cases where someone is only briefly suicidal during the worst troughs of mood, the suicidal 1% of a life would wipe out the non-suicidal 99%, which is a monumental loss to inflict.

The right to self-determination derives from an assumption of someone being in a clear state of mind, that's why we have plenty of conditions under which we withdraw that right.

But the 38 year old husband, the subject of the article, who was in an unstable mental state to the point where his wife felt threatened and left for the safety of their children was certainly not in command of his mental faculties.

Someone who is schizophrenic and bipolar and experiences a psychotic break after drastically changing their medication regimen is not in a sound state of mind, and they would be the first to admit it once their condition improves.

First you said they can't do it because they're mentally incapable of making the choice, now you're discussing whether a suicide is "clearly defensible". It doesn't matter if a suicide is "clearly defensible" or not. People don't have to defend their choices to you. That's the point of having the freedom to choose.

Where did you get that idea? This happened in the UK, which has a public health system.

Well, that's an enormous 'if'. Yeah, maybe it's different in that case. But it's not the common case.

Anyway, I didn't consent to being born, why shouldn't I be able to choose to stop living?

(No idea if that is true, but it is the claim.)

I also found when I finally broke down and sought help (not for suicide, granted) the process of trying to take advantage of my company's resources like paying for short-term counseling, etc. was incredibly frustrating. You couldn't get a hold of the people at the company we paid for the plan, everything on their site was outdated and badly maintained, they only covered certain therapists, and they happened to be therapists who make a point of specializing in treating pretty much anything with drugs, etc. Had I been on the edge of suicide or unable to eventually just pay for the care I needed directly, I can only imagine trying to navigate this process could've finished me off, emotionally.

If you can afford it at all, it can make a lot of sense to do this privately, to avoid a lot of this.

But I'm extremely fortunate that I'm both very well off and wasn't suicidal. And it was very apparent to me that if I was different in either respect, I perhaps wouldn't have been able to turn things around.

FWIW, you heard correct. This is true. (I don’t have any clearances myself, but I did work for a major defense contractor in the past, and a family member has some sort of above-top-secret clearance for his work.)

Don't trust phone counselling services. Ever.

Consider this: if the providers of these suicide hotline numbers actually cared about this stuff, they would provide an as pseudonymous as possible way to contact them that makes it as impossible as possible (in a mathematical/cryptographical sense) to identify the caller (think about Tor).

Additionally, the hotline operators would advocate very strongly for a right to encrypt and right of privacy.

But this is not the case, which should convince any rationally-thinking person that all of these claims of anonymity are fraud.

https://www.lifeline.org.au/media/igzp1al2/lifeline-australi...

This comment seems really extreme and it's a perspective I haven't really seen anywhere else.

I had a colleague, now retired, who was the president of state mental health associations, etc. who made the argument that most suicide treatment programs are really designed to protect practitioners and healthcare providers, not the patients. At the time I understood what he was saying, but didn't really understand it until later.

The way it came up with him was more about prediction and risk. He was talking about it because there's basically no way to know if someone is actually imminently suicidal. Most people who talk about it never even make an attempt, and there are lots of people who commit suicide suddenly without saying a word to anyone else ahead of time.

My colleague's point was this: if saying X is totally unpredictive of Y in reality, why react so strongly to saying X? The reason is because it's not really about preventing Y -- you can't -- it's because it legally and morally absolves you of responsibility.

I feel weird writing this because it sounds so cynical, but its a sad truth about the poor state of care of our fellow human beings in contemporary society.

Immediate tingling of danger -- but wondered if my suspicions might be little more than the product of a cynical mind. Didn't think so -- but thanks for the confirmation!

If it's actually unpredictive, then shouldn't committing someone -- taking full control of their life -- make the doctor more responsible for them and not less? Responsible for them not being able to work, pay their bills, etc. and ultimately making their life situation more precarious, thus increasing their mental stress.

https://slatestarcodex.com/2018/03/22/navigating-and-or-avoi...

I don't know if he's considered to be a controversial figure or not generally but he is a real psychiatrist so I'd argue he knows what he is talking about

This paragraph really resonated with me and with the initial thoughts I had whilst reading your comment; I'm pasting it here as I think it provides a very worthwhile perspective:

"And my second excuse is that in the end, this is not an adversarial enterprise. Psychiatrists commit people because they’re scared. They’re scared because they can’t predict what the patient is going to do – and on another level, they’re scared because they might get sued if they don’t follow the rules. If patients who aren’t going to hurt themselves know how to explain that they aren’t going to hurt themselves in a way that reassures their psychiatrist, and in a way that doesn’t leave their psychiatrist legally liable for not committing them, then everybody can be more comfortable and get on with the hard work of actual treatment."

Interventions cannot help all suicidal persons, but being acutely suicidal means one should get help _now_. It's exactly the same thing as a with a stroke or other imminent medical emergency.

This is something that I have had personal experience with, in family, friends, acquaintances, and even enemies, that I wished dead, then was not so thrilled, when my wish came true.

I hang out in circles that experience a lot of … “out of band” … issues. It’s a long story, and not one I feel like sharing on HN. Suffice it to say that I have seen this kind of stuff many, many times.

Getting treatment for mental health issues —and there are very many types of issues, and types of treatments— is important. One way to support people going through this stuff, is to avoid feeding the “shame machine,” and try to realize that we may not have the answers, so we can help people connect with those who do.

In reality mental healthcare feels like only a slight step up from antiquated methods from days long gone. Trying the medication roulette is like spending months at a time throwing darts blindfolded to see if anything helps, hurts or does nothing at all. Waiting months to see professionals who are burned out or just trying their best to not be completely overwhelmed by the demand but are unable to give meaningful care because of how overwhelmed they are. Or not even being able to see a therapist at all because it is cost prohibitive. And then consider basically having to do that on the side while you have your other obligations that you have to tend to. I wouldn't be surprised if only a fraction of people who need help get it, and of that fraction, only a fraction of them see a benefit. It basically boils down to society not caring, or barely caring at most.

In the end I suspect that the efficacy of mental healthcare has its limits, after all it is like trying to fix people after they have been broken, which is way harder than supporting people before they break, but that depends on social structures and support groups that are increasingly weak and strained.

Try to imagine a Random Controlled Trial protocol for a new depression medication. It is miraculous that any have been approved. It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo. Splinting the left shinbone helps only a small fraction of patients who have a fracture.

For validity, RCTs depend utterly on reliable sortative diagnoses. RCT fetishists (which exist, and are common) are mentally unable to process that fact.

You mean Kirsch & Kirsch 1997? Like, that particular study found a really, really small effect in the data submitted to the FDA (so the data chosen by the pharma companies). Even this went away when they used placebos with side effects.

More recent work has suggested that they work for severe depression, which is great but the trouble is that the vast majority of people with a diagnosis of depression don't have MDD (major depressive disorder).

I do agree that mental health is in it's leeches phase right now, and I am deeply concerned for people who end up having to engage with this system.

> It is why you are always seeing articles insisting, idiotically, that RCTs prove depression medications are no better than placebo.

I responded to your claim with a little more colour on that particular trial in order to perhaps start a discussion around what we mean as depression.

Clearly, I didn't succeed at my aim, my apologies ;)

Edit: it's particularly the framing of the trials as "idiotic" that spurred me to reply, so I'd be interested in why you believe this.

> For validity, RCTs depend utterly on reliable sortative diagnoses

So, are you saying you believe an RCT can demonstrate a fact when whichever medication is being tested addresses the actual condition of only a tiny fraction of the participants, and even exacerbates some of the others' various conditions?

Such trials are not idiotic, except as a waste of money. Reporting their results as if meaningful is what I called idiotic.

Or, are you saying you know how to design the protocol for an RCT when you have no idea which, if any, of the participants actually suffer the condition your medication is supposed to treat?

Huh, that's a really good point (which I somehow missed in your original post).

That being said, it's incorrect that it's essential for RCT's to function, they'll still work, but with an attenuation based on the actual treatable population.

> Or, are you saying you know how to design the protocol for an RCT when you have no idea which, if any, of the participants actually suffer the condition your medication is supposed to treat?

Well I don't design said protocols, but I suspect the vaccine manufacturers may be able to point you in the right direction.

I think that your point about reliability of diagnosis is interesting, gonna need to think about it a bunch more, but in general, no diagnosis is without error (as most diagnoses are implemented as checklists, and there's some room for arbitrariness).

Just to note, if your point is correct then it's basically all mental-health, expectancy, placebo, psychotherapy RCT's are essentially worthless, which I suspect is not the right approach to take.

Does it matter if we can diagnose people effectively? Of course.

Does it make it impossible to run an RCT in the absence of effective diagnosis? Not impossible, but it definitely adds an interesting layer of complexity, as well as massively increasing the sample size required.

Consider a pre-trial objective: "We will be testing this medication on patients who have already indicated that it helps with their affliction. Participants will be sorted into groups that get one of (a) a placebo, or (b) reduced, (c) increased, or (d) unchanged dosage relative to the dose they have reported to be effective enough relative to side effects." Such a trial could actually be useful, but good luck getting the epistemology sticklers to sign off on it.

Also, antidepressants characteristically have history-dependent effects. Often, suddenly going off one renders it ineffective if resumed. So good luck with the ethics.

Also: I would like to see the word "affliction" in more medical papers.

I hope you will find gruntling, in time.

But, they are required by law to escalate the issue if they believe self-harm is imminent.

Encourage others to do the same.

Most importantly, Resist the temptation to give advice (unless it’s solicited).

Don’t ask “have you tried X?”… instead ask “what can I do to help you get through this”.

As long as we keep rewarding it by pressing the "rightthink" button when we see it it will keep happening, just like every other cheap gesture that appeals to the lowest common denominator.

  "I'm feeling suicidal, let me call the hotline."

  "I called the hotline and now I feel better, everything's great."

  "I'm feeling suicidal, let me call the hotline."

  "We've notified law enforcement. The police are on their way."

https://en.wikipedia.org/wiki/Suicide_legislation#United_Sta...

If it were me, I would call a professional therapist before calling a government hotline in the US. This is not medical or legal advice.

Afraid CPS will take your kids away? Well guess who goes to the orphanage if you bloody off yourself!

Going to jail is probably better if suicide was inevitable, but if it's inevitable, a person probably wouldn't be calling the hotline.

I think if the hotline was anonymous and untraceable and directly connected a person to a therapist who specialized in that sort of thing with no strings attached, it would be an invaluable tool. Unfortunately it is not that. It certainly could be.

This is 1000% missing the point. They've already decided that being dead is better than being alive with their current life situation. And you're saying they should voluntarily make their lives worse?

Can you imagine: You're at rock bottom, thinking about taking your life. Then someone comes along and says "Hey what if you don't and we lock you up and take your kids. Want to live now?"

Do you see how ridiculous that sounds?

Not every contrarian take makes sense even if it blows your mind on the first reading.

Do you think that people deserve to know that they can be involuntarily held if someone even thinks they're going to kill themselves?

I'd rather make this known and push for laws to be changed. Because I'm telling you that a massive number of people don't reach out to people because of these (real, valid) fears.

Even if it's true in the United States, it may or may not be as severe as the OP suggested. Could depend on the state or county or whatever. The OP write with position of authority that he lacks on a subject that is literally life or death.

He quit his job a couple of days later and has been fine since, so maybe the person on the phone can make a judgement call on whether it's a recurring issue that needs professional help, or something that is an extreme response to an isolated incident and the person will be fine after they're "talked down from the ledge".

So the question is do you want to play roulette with your physical freedom.

But it's mostly true. Do you just want people not to talk about the flaws in the system?

As long as involuntary detention for suicidal people is law, I would never ever ever tell anyone about any suicidal tendencies.

Not being honest about what happens when you call a hotline is also horrible. "Haha! Got you! Police are on the way!"

I can't imagine the dread if that happened to me, knowing my life is about to get way worse even though I'm already at my bottom.

Anyone saying "well suicide is worse!" is completely missing the point.

I have what is essentially a terminal illness and the fuck cancer resonates

You just want to turn to those people and say "I'm dying". While they are trying to be supportive but they completely miss the mark because they don't get it

Similar things can be said about people regarding addiction

Where as "trapped in that system" could be as long as a few decades before one eventually dies.

That's also when I found out that crying to shitty movies is so liberating and cathartic and good for me. Crying is good for you. It only takes a minute. Afterwards, I always felt more alive than I did before.

Just as the sibling post did, I hope this message is not out of line and that it reaches you in a good way.

There is no reason what so ever to think that tomorrow will be just like today. Here's to hoping that you also see that.

I know it's hard to find time for yourself. But what if you did it at night? Your wife and kid, they're both asleep and you've already decided, tomorrow is going to be a sick day, this is my time, and so you put on Real Steel and just become immersed?

After that, watch another one. Or a whole series on Netflix. Turn that day upside down. Then, when you wake up, you'll feel like a different person.

I'm going to try to be better.

Just wanted to say I’m glad you’re there, for him and for yourself. I’m glad you’ve got something to latch onto.

Keep being there, sometimes it’s hard but it always pays off in the long run.

Again, hope it helps

I hope you feel better my friend. You’re not alone here.

I ended up buying a house in my hometown. I work permanently remote now. It's a healthcare company, so it's very busy, stressful, often chaotic - but it is rewarding work and I feel like I am making my own small difference in the world.

My wife wrote a letter to my son about out life during the pandemic yesterday. We will give it to him one day when he is old enough. It made me think that I should create an email address on my server that is specifically for him and write him letters like this so that he can know what life was like and everything he went through. I just want to do everything I can to do right by him. I pray that he will forgive me for any mistakes I may have made while trying to keep him safe during this pandemic.

It means a lot that HN has been so kind to me. It's hard to find kindness these days. People are afraid, angry, in completed despair...but kindness is what we need. Thank you.

What was worst about the whole experience was that my HMO didn’t want to switch me for my benefit, but because prescribing a scheduled substance was inconvenient for them. Too much paperwork or something? The system is not built to protect patient interests.

I have two young'uns (3 years and 6 months), so it was the title and its expansion that got to me the most; telling your kids that their parent is not coming back? I struggle to tell them when mommy is out for a grocery run!

  I told the children early on Saturday morning. “Daddy isn’t coming back,” I said as we lay curled into each other in bed. “He didn’t want to live any more and he made himself die.”

We are not doctors and won't armchair diagnose them, but we figured out something was wrong. We called a hotline for mental health services trying to see how non-family could help. The counsellor from the hotline said that the best we could do was to convince them that they had to seek help. Since they're an adult, we should not put them in a mental health facility forcefully.

The family had put them in a mental health facility but they escaped. They still thought that they did nothing wrong.

We ran out of ideas on how to help them. They've been living on the streets. We feel helpless.

It was a struggle to watch, and to repeat the same tired conversations with him about seeking help. In this case too, there was nothing that social services could, or would, undertake to help if he didn't ask for it personally.

Depending on your city/state, they may send out a mental health specialist. Mine didn't have any available so the police called me and gathered the required information. It was the middle of winter and this individual steadfastly refused to go to a homeless shelter and had a respiratory illness, so it was easy to make the case he was endangering his life. The officer was friendly and explained that if they did find the person to indeed be a threat to themselves, they would be taken to a mental health facility if beds were available. In this person's case, turned out he had a warrant out for his arrest. Part of me felt bad that he went to jail, but the other part was relieved that he was out of the cold. Unfortunately, he fell through the cracks and doesn't seem to have been given mental health treatment during his time there.

Fast forward a few months and I got a call from him. He had made his way to some city in Arizona. He went to a hospital there for some unrelated illness; they quickly realized he was mentally ill and after an evaluation committed him against his will. I hope he gets better.

I’m all for housing stability, but just blindly giving someone a place to stay without any additional support services when there are clearly mental health issues… well it’s a bold move Cotton. Let’s see if it pays off.

Sincerely, I hope that this person gets the help they need.

My friend has been mad because they took the money.

Clinical-level psychiatric cases have increased since onset of the covid-19 pandemic. A number of doctors I have spoken to have said they are seeing twice as many patients, and cannot sustain this case load much longer.

I told them not to bother.

> If you are struggling to cope or have been affected by anything in this story, please contact the Samaritans in the UK at 116 123 or jo@samaritans.org. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. More information at mind.org.uk, samaritans.org and save.org

Years ago, unhappy but not suicidal, I decided to call a suicide hotline. I did this for the same reason we have fire drills and software tests - I was verifying whether it would work if I did need it.

It did not work. I was quite disappointed. After my experience, I would never suggest to anyone to call a suicide hotline, and I realized that most people who recommend them probably have never used one and don't know what they're recommending.

The individual I spoke to asked if I was suicidal - I said I wasn't at the moment, but then that doesn't mean much, does it? _I'm still calling, regardless of what I say._ I would imagine a lot of people who call suicide hotlines might not be entirely honest about the urgency or seriousness of their emotional state. Their reaction was dismissive thereafter.

The person would not make any connection with me - they are clearly trained not to do that to avoid certain problems, but I feel that in a moment where what a person needs most is a connection and is calling to try to seek one out, the total refusal to answer any questions at all or be personable in any way was like having a door shut in my face. The individual continually turned the conversation back to a set of formulaic questions that were of no help whatsoever, and I ultimately disconnected feeling worse than when I'd initially called.

I do wonder if my experience is representative of the norm or not.

So yes, maybe you got someone who had no idea what to do with you. Maybe they did suck at that job. But you were applying the wrong tool to the problem. If you are unhappy, call a therapist. If you are suicidal, call a hotline.

This is very reductive, basic advice. Sounds great, but fails to consider the very real possibility that a suicidal person cannot diagnose themself effectively.

Telling a non-suicidal person to call a hotline isn't the best advice, but accidentally telling a suicidal person to call a therapist is much worse.

If you are suicidal, do not call a hotline.

^ Thought process of a suicidal person.

"do NOT call a hotline" is, IMO, actively harmful advice. If you're debating whether or not you should call, remember that normal people wouldn't even think about it, and call the damn hotline. Save your life.

Don't forget - you are not anonymous when you call these hotlines. Far from it. If you call expecting your anonymity to be honoured, then you are making a grave mistake.

Everything you said above is true, but this is advice that I feel on the fence about giving.

If you call a hotline, it is not unlikely that your life will be disrupted. You may very well be involuntarily committed to a psych ward for days/weeks/months, depending on your mental state. Some psych wards aren't great, but some really aren't all that bad.

It may sound scary to have your life disrupted like this, but hey...

If you are feeling suicidal... Ya know, considering ending your life suicidal... Maybe this kind of disruption is exactly what you need.

It's very easy for someone to say otherwise, unless they have experienced it first hand. Have you?

I called them to be anonymous and not disturb my family, so I could get into a calmer state where I could get help from my loved ones. They utterly failed.

> Years ago, unhappy but not suicidal, I decided to call a suicide hotline.

They tried to use a tool for a state of mind they were not in, then got surprised that it wasn't helpful.

When you need help, you find out pretty quickly that institutional support is like bumpers in a bowling alley gutter - it's crude and manufactured. It might keep you on the lane, it sure doesn't help you bowl any better. You also find out that even well-intentioned people aren't much better.

What sucks about suicidality is that everyone is so sterile about it.

Maybe it's that everyone is so on guard against personal connections except from select loved ones. For some people, it might even require talking to someone in a similar headspace just to get on the same page and start talking for real. But I've found out I helped people after the fact, and if I knew I was playing defense going in, I'd probably would have been too scared to say the things I did.

Anyway, here's a nice article, the first half of which explains that failure to communicate better than I ever could: https://eggreport.medium.com/envying-the-dead-skyking-in-mem...

There are lots of studies that show that such programs are at least moderately effective (https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12...)

If psych facilities prevent suicides 50% of the time in the long term, the correlation exists for the 50% where they were unsuccessful. Psych facilities could be wildly successful, and still suicides would be more common with multiple admittances to the facilities.

I’m not saying you are wrong, but I am asking you to consider you could be wrong, before wading into such a dangerous area.

That said, I personally think calling mental health services is only for true emergencies: they are highly toxic environments where a bunch of loonies are locked up together and the nurses and doctors can also be toxic as hell. Putting an 18 year old girl under the power of a 40 year old male psychologist who demands obeisance is deeply sickening. She told me she had been previously committed “for her own safety” (I guess manic sexual behaviour), and she said she was raped while in the facility. Sometimes someone is mental as fuck and committing someone to the psych ward is necessary, but I personally would try all other avenues I could safely do so, even at risk to myself. It is a nasty situation and there usually is lots of downside risks regardless of choices made.

In fact, there are almost certainly more people admitted on that basis than actually have it, because if someone is not clearly a danger to themselves or others, but seriously needs help, the easiest way for emergency personnel to fudge it is by reporting a mention of suicide.

Can you provide further context on what makes you think there is significant causation in the opposite direction?

If incidence of suicidal ideation goes up with number of involuntary holds then it means that psych facilities are not treating the problem. That is enough: that they are provably not treating it. First do no harm means you have to be causing good; ambivalence is treated as likely harm because it is invasive.

If the people who receive the most chemotherapy sessions have the highest rates of cancer deaths, does that mean that oncologists are "provably not treating" cancer?

Your argument is "more people who are suicidal enough to warrant involuntary commitment end up killing themselves than people who don't reach that point, therefore commitment causes (or at least does nothing to prevent) suicide," which is absolutely illogical.

This is beyond "I don't understand 'correlation != causation,'" and is into either "willful ignorance" or "I enjoy hearing myself talk" territory.

It is like saying that the more times you are hospitalized for illness, the more likely you are to die.

You can't test the effectiveness of a suicide prevention with a dry run. Fire drills don't put out fires either.

Also, you essentially admityed that you were making a false call. That's not going to get a great reply. You shouldn't call 911 to test response time either.

The caller left the experience feeling more disheartened and unsupported. Logically that seems like they were at an _increased risk of suicide_ relative to when they called.

This was not failure of suicide hotline. This was them recognizing he is misusing the service.

He was not trained away from saying it. The question did not even came straight away. If he is afraid to admit suicidal thought for rational reasons, as you say, rational act is to not call at all.

Way more likely explanation is that they realized he is not suicidal, then asked to confirm and end ended that all.

1. Despite my bad experience, recommend suicide hotlines in the hopes that they work even though they didn't for me.

2. Recommend against suicide hotlines while explaining why and cautioning that my experience may or may not be representative of the norm.

I'm going with #2 for the time being, yes.

3. Share my experience, acknowledge this is a single data point, and withhold recommendation.

I don't blame them though. That said whether or not they're optimal.. it's often a good last resort option. Many people might have avoided tragedy through some mild listening. I've seen it happen on other venues.

[0] To be fair.. most psychology professional I ran into were far from perfect.

I'm no stranger to mental illness. I've struggled with suicidal ideation linked to depression and cPTSD, and have been involuntarily hospitalized a few times. But there's mental illness and then there's mental illness.

And yet, having kids has actually made it easier for me to resist those thoughts. They haven’t gone away completely, but I feel more confident that I’m not going to act on them, and their frequency and intensity has definitely declined as well. Maybe I could do that to my wife or family or friends, but I could not do that to my own children. I think that, if there is such a thing as hell-if I did that to them, I’d be going straight there.

Having children has given me a new and very compelling reason to not kill myself. The best reason I’ve ever had. It also has given me a new motivation to try to keep a lid on my own “craziness”, which I think has helped my mental health as well. OTOH, it has also led to a lot of stress, and no doubt that stress has aggravated some of my mental health issues. Still, I think overall, the positive benefits of fatherhood on my own mental health have outweighed the negatives.

The only situation I can foresee myself now actually going through with suicide, is if both our kids died (say in a car accident), or if I’m terminally ill and trying to hurry along the inevitable. Outside of those two scenarios, I’m definitely not doing it. I don’t think I could have been so firm about that before having children.

I do now have an illness that's "almost definitely terminal" (but haven't been given a definitive timeframe yet), and old-me would've just ended it to get it over with without a second thought, but instead now I'm driven to make sure my wife/kids have the best possible life set up before I go.

I will remember too. God bless you.

On the other hand, it is good that they exist, even if they aren’t the world’s most genetically privileged individuals. It is not like they could have had different genetics than they do-either they exist with these genes, or they would never have existed at all. And not all of my genes are bad - our son has inherited my ADHD, my autistic traits, my anxiety - but he’s also inherited an above-average IQ, which gives him an advantage over many other people which partially makes up for those disadvantages. He is in the 3rd grade but he does 9th grade mathematics - most 3rd graders don’t have the genes for that, he does. Our daughter has so far not been so precocious, but I still get the sense from talking to her that she is smarter than the average 4 year old, so I think she has a bright intellectual future as well.

And I think a lot of my problems have been not just due to my genes, but also due to my own lack of self-understanding, and my parents’ poor understanding of me. Even though I can see how I inherited these traits from my parents, my parents possess them in a more attenuated form, and they lack self-awareness that they have them. By contrast, being very well aware of my own traits, and seeing the same traits in my children, I’m hopeful I can give them guidance on how to manage them which nobody ever gave me when I was young-and beyond guidance, empathy-I never felt my parents really understood what it was like to be me, I feel like they wanted to be empathetic but lacked the imagination (theory of mind?) to really do so. I hope I can do better, and our kids might avoid some of the life problems I have faced. We will see.

Then I got a little better and those daily thoughts became weekly, then monthly and nowadays they are simply not there anymore. Well, sometimes they are but they are now very easily dismissed.

I just came here to say that, if god forbid both your kids are taken from you, even then, I would say to you, fucking hell man, don't do it. Your loss will crush you and you'll never be the same. But you'd be alive. And you'd get to see how you'd deal with such a loss. And you wouldn't be alone. Because this shit happens to people and with some support, they live through it.

Anyways, I'm glad you find such joy in being a father. Isn't it great?

Sometimes, kill -9 seems to be a valid option to me, all I'm saying.. (In a responsible way, get your stuff in order, do it in a clinic, etc etc etc)

The pain a suicidal person feels is like nothing else. I hope that after years of mourning I would pick myself up and feel that pain to its fullest and become an expert pain feeler, because those were the cards that were dealt to me. And I hope that I would find some meaning, again.

However, if I find that I have lung cancer and will inevitably drown in my own mucus, I'm pretty sure about the bullet through my head.

Yay, rainbows!

Heavy shit, this.

Maybe we just ignore it until it happens. Seems to be a time tested approach ;)

People have been thinking on this very question since the beginning of people.

If you're invested in another take on them, I would seek out Gudo Nishijimas dharma airs :}