A suicide attempt a minute -
itís the tip of the iceberg
By Leland M. Heller, M.D.
525,600 minutes and 531,000 suicide attempts per year in the US. 21% of 12 year olds are sexually experienced. Among high school students 27% smoke cigarettes, 36% were passengers with an intoxicated driver, 1/3 were drunk in the last month, 26% smoked marijuana, 16% had used inhalants to get high. Road rage and air rage are front page news. While media and peer influences, the high divorce rate, latch-key children, and drug availability are part of the problem, biology plays a far greater role than has been previously recognized.
Public misconception, misinformation and prejudice are making the problem worse. Surgeon General Dr. Satcher is correct in stating that the stigma must be removed for mental disorders, as has been accomplished for cancer.
The medical and mental health professions are not responding to evolving knowledge. Many physicians say things like "I donít believe in depression" and deal with these individuals in a disparaging manner. Mental health practitioners contribute to the problem in four ways:
1) Not making all the diagnoses - in medical practice a person with high blood pressure and arthritis needs both problems treated. High blood pressure treatment would not be considered a failure if the arthritis symptoms continued, yet thatís exactly what happens in mental health. A medication for one problem is expected to treat all of them. Every problem a person has makes every other problem worse. All their diagnoses need to be treated comprehensively.
2) Refusal to make diagnoses for fear of "labeling" someone. Many practitioners use their own criteria for making a diagnoses - like every internist defining diabetes in his/her own way.
3) Not keeping up with new information. Research is exploding, and many once held beliefs have turned out to be wrong. "Growing out of" Attention deficit disorder is a good example.
4) Reluctance to try techniques from other practitioners. I have treated thousands of individuals with the borderline personality disorder (BPD), likely a form of epilepsy with mood swings, anger problems, self-destructiveness and psychotic rage under stress. Many tragedies such as school shootings are due to the BPD. Medication combinations work extremely well, but the research information is rarely acknowledged and many psychiatrists are resistant to trying medical approaches that have been successful for other doctors and their patients.
The American Psychiatric Association has done an excellent job defining criteria for the major psychiatric diagnoses. Most Americans would be stunned to discover exactly how common these "disorders" are - and what the criteria are. More than one diagnosis is usually present. Many common diagnoses are likely not diseases at all, but survival genetics that have advantages in some environments and disadvantages in others. In todayís high pressure society, these genetic traits have tremendous problems - like having fair skin in a sunny environment.
Attention deficit "disorder" is an excellent example. The brain location and some of the biochemistry have been identified. Untreated ADD usually leads to significant social and legal problems - particularly impulsive anger and substance abuse (30%). The "cognitive" generalized anxiety disorder (GAD) causes the individual to constantly worry and think. Being genetic it starts in childhood and continues through old age. These individuals always feel stressed, and commonly treat themselves with alcohol, food, and marijuana.
The information to make a huge difference with all these problems
is available right now. Most of these diagnoses are treatable with the
right combination of medication and counseling/brain retraining. While
more research is always needed, educating the public and doctors/mental
health practitioners of whatís already known can be done immediately, as
has been done for other medical problems. If we donít, road rage and school
shootings will stop being news.
Dr. Heller, a Family Physician, has written two books on mental health and has answered a thousand "Ask the Doctor" questions on the Internet at www.BiologicalUnhappiness.com.
His first book, "Life at the Border - Understanding
and Recovering From the Borderline Personality Disorder," is on the
recommended reading list at the National Institute of Mental Health. His
new book is "Biological Unhappiness."