Spring Blue(s)

Photo credit: Josephine Ensign, 2015

Why do spring and depression go together? The seasonality of illness is fascinating and is proof that our environment matters quite a lot to our individual and collective/public health. In temperate regions of the world, injuries and drownings go up in the warmer months, and deaths from influenza and carbon-monoxide poisoning go up in the colder months. These make sense. But when we think of depression and suicide risk, most of us would guess that these peak in the fall and winter months–what with decreased hours of sunlight and the stresses of some of the major holidays. In the U.S., September is National Suicide Prevention Month and October is National Depression Awareness Month, and many news reports continue to falsely link higher rates of depression and suicide with fall and early winter.

Yet studies worldwide find that depression and suicide rates peak in late spring and early summer. High pollen counts, increased hours of sunshine, higher temperatures, and even an increase in thunderstorms (ah–that Shakespearean pathetic fallacy!) have been linked to higher rates of depression and suicide. Within psychology and sociology circles, this seasonal link is theorized to be from the fact that people generally have increased social pressures and interactions in the spring, which can increase stress. (see “The Season of Renewal and Suicide” by Brian Palmer, Slate, 12-7-12).

The most current statistics from the CDC on the leading causes of death in the U.S. (for 2013), list suicide (intentional self-harm) as the tenth leading cause of death, with the total number of deaths by suicide as 41,149. (Suicide is the second leading cause of death for young people ages 15-24 years.) This continues the upward climb of suicide deaths in our country since the start of the Great Recession, with the largest increase being in people 45-64 years of age (peak wage-earning years.) With the possible exception of unintentional injuries, such as motor vehicle accidents, suicide is our most preventable form of mortality. And suicide deaths have serious impacts on the family members, friends, co-workers, and care providers who knew and loved the people who killed themselves. Note: they did not ‘commit’ suicide as is still too commonly used; suicide is not a crime or a sin–it is a preventable travesty. Using the term ‘commit suicide’ adds to the already debilitating stigma of mental illness.

So what are interventions that work to help prevent deaths by suicide?

1) Train healthcare providers to screen for depression, drug/alcohol use, bullying at school (for young people), history of adverse childhood events (especially sexual abuse), and suicidal ideation and attempts. In primary care screening for depression and suicide risk (as well as intimate-partner violence), a standard question is “Do you have access to a firearm?” This screening question seems so obvious, as access to a lethal weapon is an important part of the overall risk assessment. Over half of all deaths by suicide are by firearms. But now in Florida that healthcare screening question is illegal for physicians and nurses to ask their patients. (See James Hamblin’s 8-11-14 article in The Atlantic, “The Question Doctors Can’t Ask.” ) And other (mostly Southern, no surprise) states have similar legislative ‘healthcare gag orders’ pending.)

2) Educate the general public about the warning signs of severe depression, problematic drug/alcohol use, and suicide–and give them the proper tools to be able to intervene effectively. Reinforce the fact that talking about suicide in a supportive way does not encourage suicide (just as talking about sex or drug use with adolescents does not encourage them to have sex and use drugs.) An excellent (free and 24/7) resource is the National Suicide Prevention Hotline at 1-800-273-TALK (8255). They can connect people with local crisis centers and assistance.

3) Implement a community-wide public mental health promotion (and depression/suicide prevention) program. One such model program that is cost-effective and that could be replicated in the U.S., is New Zealand’s All Right? Wellbeing Campaign, a Healthy Christchurch project that is being led by the Mental Health Foundation and the Canterbury District Health Board. As they state, “All Right is a social marketing campaign designed to help us think about our mental health and wellbeing. It’s about helping people realise that they’re not alone, encouraging them to connect with others, and supporting them to boost their wellbeing.” Although targeted at earthquake recovery efforts in the Christchurch area, this public mental health campaign could be most effective at building community resilience before major disasters occur.

My students and I stumbled across the work of the All Right? Wellbeing Campaign while we were in Christchurch last year studying community health. I wrote about it in a series of blog posts, including “New Zealand Postcards: The Allrighties” 2-3-14. Some of our health-focused students ‘brought this home’ to Seattle and started the student-led “What’s Up UW?” community for promoting social and emotional wellbeing.

From the All Right? Wellbeing Campaign, Christchurch, New Zealand.




Imbecile, Idiot, Cretin, Funny-Looking Kid

14866775264_dfcefee472_hIdiot, cretin, feeble-minded, moron, mongoloid, retarded, funny-looking kid: all accepted medical terms at different times in history. More recently, the accepted terms are mental retardation, intellectual, or developmental disabilities. People in pediatrics sometimes use FLK for “funny looking kid” to describe a baby or toddler whose face and head “just don’t look right,” but who don’t have an identifiable genetic disorder. I remember the first time I encountered FLK on a child’s medical chart in nursing school. I was shocked when my nursing instructor told me what it stood for. I was even more shocked that she didn’t find the term offensive. FLK seems to be a throwback to phrenology—that pseudoscience of belief that low foreheads and bumps on the skull can foretell the criminal and devious propensities of individuals.

I had relatives with mental illness and mental retardation. My father’s father and brother were tucked far away in the southern Appalachians of Tennessee: our family’s living skeletons in the closet. I was told that my Uncle Charles was retarded, and that my grandmother was convinced it was because she’d fallen down a flight of stairs when she was pregnant. My maternal great-grandmother raised Uncle Charles on her cotton plantation in rural Georgia, so Charles had a thick Southern drawl and was the most openly racist of any of my relatives. He also had a serious speech impediment, talking as if he had a partially paralyzed mouth. He laughed loudly at his own jokes, startling me by suddenly reaching over and tickling me under the chin or slapping me on the arm. As a child he frightened me; as a young adult he embarrassed me. By then he lived with my grandmother and drove a delivery truck for a cousin’s florist. With savant-like abilities in math, he had been tested at Emory hospital at age ten and assigned an IQ of seventy. He was considered feeble-minded, trainable, and partially educable.

In my childhood, we went to my grandmother’s house in Tennessee only at Easter, as if this were part of our family’s annual pilgrimage of penance, death, and resurrection. Grandmother’s house smelled of sick-sweet Easter lilies, slimy collard greens, and Cimmerian dust from the dirt-floor basement’s coal-piles. My grandfather had a mask-like face and lay in a tall four-posted bed staring at the ceiling. He talked infrequently and when he did, it was in staccato monosyllables. Poorly controlled diabetes and bipolar disorder had left him disabled. He frightened me more than Uncle Charles did. Grandfather was a lawyer but had lost his temper in court so many times he was relegated to library legal research. After he lost that job in the Great Depression, he spent his days playing chess at the YMCA, while my loquacious grandmother sold World Books door-to-door. This was the oft-repeated family story.

Southerners are often stereotyped as inbred imbeciles. My Northern-born mother would tell me stories of my father’s family when he wasn’t around—about the mental retardation and mental illness that my father had been able to transcend by escaping to go to graduate school in New York City. Once there, my father was required to take speech therapy to get rid of his speech impediment: his Southern twang. Both of my parents continuously corrected my speech, determined to prevent me from developing a marked Southern accent. My mother examined the official IQ and academic test scores of all four of her children. With every “ya’ll” that slipped out and every “B” obtained, I felt increasingly marked by the Southern blight. It wasn’t until much later in life, while caring for my elderly mother dying of cancer, that she informed me I was related to Varina Davis, First Lady of the Confederate States of America. My paternal great-great grandmother from the Georgia cotton plantation was Varina’s first cousin or something of the sort. I have not found an adequate place for that fact in my history.