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An Open Letter to Responsible Gun Owners

I was one of the television reporters on the scene of Oregon’s first mass shooting, May 21, 1998. When Kip Kinkel opened fire in a lunchroom full of his fellow classmates, many of the students thought the sounds of gunfire was a joke or they would have ducked for cover sooner.
I’ll never forget the ashen faces of young people standing in shocked silence outside the police line, dressed in the uniform of youth, jeans, t-shirts, hoodies. Two of the girls I interviewed still had blood spatters on their tops.

Kinkel, who’d also murdered his parents the night before, loaded and unloaded the three weapons he’d brought with him, a .22 caliber rifle, a .22 caliber handgun and a 9mm Glock automatic pistol. “He just kept shooting,” one of the girls said. “The sound is still ringing in my ears.”
By the time Kinkel was finished, two were dead, twenty-five students were seriously wounded. “Jake finally stopped him,” the student told me. “After Kip shot Jake, Jake must have thought, what the hell, we’re all going to die anyway.” The girl pushed her shoe in the mud.

I thought I’d witnessed the worst trauma our state could endure. Not even close. In October, nine  people were killed and seven more seriously wounded in another campus horror. It’s the 296th mass shooting in America in 274 days. Columbine followed Springfield, Virginia Tech followed Columbine, Sandy Hook followed the Colorado theater shooting. Keeping track of the horror is a mind-boggling exercise.

When you read the descriptions of the history of mass shooters in America, you recognize one thing immediately. They are all male. They are young when they shoot up schools and middle-aged when they shoot up their offices. They are obsessed by guns and in various states of psychological unraveling. They are described as loners, and they are often known to their friends and families as being “in trouble.”

Access to mental health treatment in America is like running the gauntlet of the worst kind of bureaucracy. Services are fractured. There are far too few psychologists and psychiatrists, especially in rural areas, where mass shootings tend to occur more frequently. Treatment is often prescribed in the form of anti-depressants, which can induce mania and ideation in young people.

And yet, access to guns is easy. It’s as simple as buying on the internet or buying from a gun show dealer who is exempted from conducting a private background check. Angry callers on talk radio shouted, “If only we allowed all students to be armed.” They maintain that the mass shooting problem will be solved with more guns. There are 310 million guns in America and 11. 1 million people carry a concealed weapon legally. Yet, the number of mass shootings stopped by an armed civilian in the past thirty years is one, a documented account of an Uber driver who stopped a passenger from opening fire on a crowd in Chicago. http://www.businessinsider.com/uber-driver-with-concealed-handgun-prevents-mass-shooting-in-chicago-2015-4

The other numerous events sent to me for review are not verifiable.

Owning a gun has been linked to higher risks of homicide, suicide and accidental death by gun. For every time a gun is used in self-defense, there are 7 assaults or murders, 11 suicide attempts, and 4 accidents involving guns in or around the home. These are not made up statistics. The Centers for Disease Control is non-biased, evidence-based and gathers data only from verified sources.

Responsible gun owners, what is your solution? You must look at these mass shootings with the same concern for your children that I have for mine. Can we have a real conversation about gun violence in America? Could we at least agree that the parents of deeply troubled young men shouldn’t be buying more guns to fuel the obsession? Could we agree on safer storage methods? No? What then? Is there a dialogue we can have and change we can make that doesn’t end in more violence?

Four years ago, my daughter and I were talking about terrorism and the various measures America had taken to make itself safer. “I’m not afraid of terrorism,” she said, looking out the window. “I’m afraid of being shot at school.”

Demand Hope. Demand Recovery. Nothing less than life will do.

I hosted a public celebration at Pioneer Courthouse Square to mark the end of a hugely successful fundraising campaign for the OHSU Knight Cancer Institute. The Phil and Penny Knight Foundation challenged Oregonians to raise $500 million dollars to fight cancer. Make that goal in two years, Knight said, and his foundation would match the giving. OHSU raised the money in a record sixteen months, with 85% of the giving coming from within Oregon. We made it. It was a moving and emotional experience to learn of the remarkable breakthroughs in saving the lives of people diagnosed with cancer, and to imagine the gains that will accrue after a one billion dollar investment in cancer detection and prevention.

In nearly every area of public health, startling improvements are being made. If research on cancer, heart disease, stroke and diabetes has proven anything, it is that research investments save lives. As Dr. Brian Druker pointed out, research dollars devoted to leukemia allowed him to create a lifesaving drug, Gleevec, which has revolutionized the quest for a cancer cure and saved countless lives.

Sheila Hamilton, Mark Ganz, Ceo of Cambia Health Solutions, Oregon Governor Kate Brown

Sheila Hamilton, Mark Ganz, Ceo of Cambia Health Solutions, Oregon Governor Kate Brown

Now, let’s look at the tenth leading cause of death. Suicide. In 2014, 41,000 people died by suicide, and yet, public and private investments in research are meager, according to the U.S. National Suicide Prevention Research Efforts 2008-2013 Portfolio Analysis. Unlike other causes of death, the suicide rate has shown no decline over the last fifty years. Overall, Americans are now more likely to die by suicide than in an automobile accident. Suicide is the second leading cause of death for teens ages 15-34. And the rate of suicide among middle-aged Americans has increased by 30% since 1999.

What is most perplexing is the accepted rate of failure. Many people who die by suicide are under the care of physicians. In the month before their death by suicide, about half saw a general practitioner. According to the National Alliance for Suicide Prevention, thirty percent of those who die by suicide saw a mental health professional. Health care professionals often fail to ask about suicide risk because they were never trained to or they don’t know how to recognize suicide warning signs.

If we could improve suicide identification and care in primary settings, or in emergency departments, where most people go when they are feeling suicidal, we would have the potential to save lives. If we adopted the expectation of recovery in care settings, we could save lives. If we invested in the prevention of suicide like we invest in the prevention of heart disease and cancer, we could save lives. We know this because we are watching the rate of suicide decline in other countries that have made suicide prevention a priority.

41,000 lives a year are in the balance.

The dedicated folks at OHSU have a great saying. “We fight cancer differently. We win.”
Imagine a similar phrase for the prevention of suicide. “Demand Hope. Demand Recovery. Nothing less than life will do.”

Dr. Xavier Amador, “I Am Not Sick, I Don’t Need Help!”

Among the greatest frustrations in caring for a person with mental illness is Anosognosia, or lack of awareness. Dr. Xavier Amador talks with me about how to get the help your loved one needs. Amador is the director of the LEAP Institute, an internationally renowned leader in his field, with numerous books, authoritative research, worldwide speaking tours and extensive work in mental illness.

Some Words of Encouragement

All the Things We Never Knew

I chose to write about mental illness in All the Things We Never Knew for one reason–to give people hope. It was excruciating to watch my former husband descend into mental illness and not know where to turn or who to ask for help.

The unexpected gift of writing on this topic is that people now share their most closely held stories with me; they are vulnerable and open, recounting life experiences that aren’t generally water cooler talk.

After hearing about my book, the big burly guy who sat next to me on an airplane told me in detail about his brother, an Iraq war veteran, who suffers from PTSD so severely he sweats through his sheets every night. “He served three tours,” the man said, “and he’s still at war.”

A hairdresser told me about her battle with postpartum depression, and how, after months of seizures she believed were caused by anti-depressants, she attempted to take her life. If her baby hadn’t crawled in the bedroom as she was downing a bottle of pills, she says, she wouldn’t have found her way to recovery.

An older gentleman listened quietly to my brief description of the book and then whispered, “You young people are so brave. I’ve never told anyone about my depression.” I smiled and said, “I’ve never told anyone else I’m not young.” We shared a good laugh.

One in five Americans suffers from a mental health disorder. But, those numbers don’t hint at the tens of thousands of people who suffer in silence. Darkness wins, shame wins, and people feel more alone, and unworthy of love.

Brene Brown defines vulnerability as “Emotional risk, exposure, uncertainty.” It fuels our daily lives. As a therapist in her 12th year doing research, Brown says, “Vulnerability is our most accurate measurement of courage; to be vulnerable, to let ourselves be seen, to be honest.” What stops many from showing vulnerability is shame. Shame, according to Brown, is not guilt. It is a focus on self. Shame is highly correlated with addiction, depression, violence, aggression, bullying, suicide, and eating disorders.

So, here’s my message: If you are one of those people shaming yourself, denying yourself love, hiding from your emotions, know this. You are not alone. There are so many people who want to hear your story and they want to help. People who care are waiting to hear from you at Lines for Life, NAMI, Trillium Family Services, and your local County Mental Health services. These people will fight for you, with kindness and compassion. Be vulnerable, be open, and do not give up. Demand hope. Demand recovery. You are worth it.

Dealing with a mental illness? Here are your legal protections

One of the most beautiful and heart-wrenching experiences I’ve had since writing this blog is hearing your stories regarding mental health. A mother shared her hope after finally finding a medication that worked for her daughter’s depression and anxiety disorder. A daughter grieved the normalcy she had before her brother had his first schizophrenic break. And a  well-known personality in the Portland area contacted me to say that he suffers from bi-polar disorder and is terrified of telling his employer. He doesn’t fear the stigma as much as the thought that he will likely be fired if his employer learns of his diagnosis.

I asked Dana L. Sullivan, one of the leading employment attorneys in the Northwest to offer advice for people who may be hiding a mental illness from their employer.

A new stage of grief: forgiveness

SunsetDr. Elisabeth Kubler-Ross has described the five stages of grief as denial, anger, bargaining, depression and acceptance. When a loved one commits suicide, that list is incomplete. We are haunted by the questions, “Why would he?” or “What could I have done differently?”

I’d propose one more stage of grief to Kubler-Ross’s list in the case of suicide: forgiveness. It was not until I reached this stage of forgiveness that I was able to sort out my own failings from those of my husband. In accepting responsibility for my part in David’s death, I was able to understand his sense of futility and his unwillingness to face his illness. I forgave him. And in doing so, I was finally able to understand his decision.

In all of the research I’ve done to attempt to understand David’s decision, one particularly well written piece by Jay Neugeboren sticks with me. Jay’s brother, Robert, had been in the New York mental health system for nearly forty years, and had been given nearly every antipsychotic medication known to humankind. Jay began interviewing hundreds of former patients who had been institutionalized, often for periods of ten or more years, and who had recovered into full lives: doctors, lawyers, teachers, custodians and social workers. He was fascinated with the question–what had made the difference?

Some pointed to new medications, some to old. Some said they had found God. No matter what else they named, they all said that a key element was a relationship with a human being. Most of the time, this human being was a professional, a social worker or nurse, who said, in effect, “I believe in your ability to recover, and I am going to stay with you until you do.” The author points out that his brother had recently recovered from his mental illness, without a recurrence for more than six years, the longest stretch in his adult life.

Given the lack of hope or optimism during David’s hospitalization, this study affects me deeply. But it also provides a blueprint for those of us who want to commit our lives to connecting deeply with others, especially those who may be suffering. We need one another to lead healthy lives, and when faced with the prospect of illness, be it mental or physical, we need to believe others can help us through to the other side. We need to believe that it is no different to ask for help with a brain illness than it would be for a cancer patient to ask for chemotherapy. We need to have faith in our own ability to endure, and when hope wanes, as it will with the illogical ups and downs of any disease, we should track our way back to our hearts.

Sheila Hamilton is the author of All the Things We Never Knew, available for pre-order on Amazon.com. For more information on Sheila’s story, please read prior blog posts, or contact the author below. Thanks!

 

Unreachable

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My father’s parents both died before he turned ten years old. He essentially grew up as an orphan, and yet he was the happiest person I’ve ever known. At the age of seventy-nine, he simply refused to believe that the cancer eating away at his jaw would ever claim him. “A bump in the road” was the way he softly described the recurrence of his illness to me on the phone.

Five days before his death, he got out of his hospice bed, wobbling as he put on his pants, and announced that he needed to “go back to work.” I still believe he went to his death pissed off that he didn’t get one more day.

My former husband was raised by two of the most brilliant and charismatic parents I’ve ever known. They were movie-star gorgeous and equipped with languages and experiences I could only imagine. David traveled the world, ran a successful building company, and earned the most profound love of his life, our daughter. He skied, hunted, and fished. And he killed himself at the age of fifty-three.

What makes one person fight for every breath and another take his own life? Brain illness. There are a lot of theories about why people experience brain illnesses. In my time searching for answers, I’ve heard neurologists discuss disruptions in the brain while naturopaths point to an inflammation of the gut. I’ve seen behavioral therapists declare it is the result of a lack of meaningful relationships and a flawed, negative thought process. Psychiatrists talk about past traumas and a problem with chemical regulation.

I’m not a doctor, and I don’t pretend to know which of the disciplines will eventually be proven right, but I have a hunch. They are all right. As human beings, we are holistic beings. The interconnectivity of our genetics, our diet, our sleep patterns, and our past traumas create a delicate and sometimes disastrous dance. Everything I’ve read suggests resilience comes from a healthy lifestyle, meaningful relationships, experiences like yoga and mindfulness that draw you inward, and a dedicated perspective that allows you to believe things will get better.

My father’s body was racked with disease when he joked with me about who should control the remote. “From now on, I watch what I want,” he laughed. “I have cancer. You have to be nice to me.” When his oncologist flatly told him there had been a mistake on the tests and he’d better start putting his affairs in order, it was as if my father suddenly developed hearing loss. He refused to believe anyone was going to end his party.

David pulled away from us in the early stages of his brain illness and refused to share concerns about his lethargy, irritability, and confusion. He was, after all, a dignified man who rarely asked for help. When he was finally diagnosed with Bipolar II, it was as if his family, his work, and any semblance of a life that might have sustained him through his illness no longer mattered. He simply couldn’t bear the darkness that descended on his brain.

What mechanism allows one person to fight for every breath, even as their body is racked with a biological illness, and the other to end their life before they even get gray hair? I’d love to hear your thoughts.

“Look to the living, love them and hold on.” Douglas Dunn

Kevin Hines: Survivor

Kevin Hines

When 28-year-old Kevin Hines hurled himself from the Golden Gate Bridge, his first thought was, “What the hell did I just do? I don’t want to die.”

According to the New England Journal of Medicine, one-third to 80% of all suicide attempts are impulsive acts. Ninety percent of people who survive a suicide attempt do not end up killing themselves later. For many, the suicide attempt (a failed shooting or an overdose) may serve as a spiritual awakening.

Kevin Hines jumped from the bridge in 2000 after pacing for a half hour while people ignored him. Like many other suicidal patients, he employed an irrational and confusing logic — “If someone, anyone shows me they care, I won’t jump.” A tourist saw him, tears streaming down his face, and asked if he would take her picture. He snapped the photo. And then he jumped.

Listen to this incredible conversation of a life transformed. Kevin now believes life is the single greatest gift we are given. He is one of America’s most coveted mental health advocates, a popular speaker and author.

Recovery is possible.

brainThe one thing I wish more families heard when their loved one gets sick from a brain illness is this: Recovery is possible.

In the days after David’s suicide attempt, I learned about the stubborn reliance on psychotropic drugs as the main solution for people in mental health crisis and I witnessed the shocking limitations of an overtaxed and impersonal system. I was so grateful just to get a psychiatric bed for David. He’d lingered in the system for a few days after his suicide attempt, but many patients wait weeks for a bed — we were lucky, or so I thought.

The receptionist gave me directions to the psychiatric center. It took up one wing of the hospital. A social worker had prepared me on the phone for what I’d encounter once I got to the facility. A small box on the wall with a button. You push it and the people inside look at you through a camera to determine if you are safe. Two sets of heavily locked doors open. Then you surrender your purse, your shoes, and your belt. Only then can you see the patient.

The communal room was bare of windows, no pictures, no art anywhere. (Glass is considered dangerous.) Four tables were set up on one side of the room leading to a kitchen. There were small seating areas for families to visit, the kind of furniture you see in group homes that haven’t been updated in a decade.

The muted, bland colors on the couches would make anyone depressed.  One man shuffled past, disoriented and mumbling. He took tiny steps, a couple of inches at a time, as if he were recovering from a stroke. The lighting was horrible, artificial, dim. The staffers sat behind heavy shatterproof glass laced with wire. They were completely walled off from the patients.

David led us to a furniture grouping, four chairs divided by a low table. His affect was flat, defeated. He told me hadn’t seen a doctor and didn’t expect to see his psychiatrist until the following week. I wondered what he would do in this bare and dismal place. He hated to sit still; it made him antsy and nervous. He was used to handling a dozen jobs, flying around in his truck, juggling two cell phones and the demands of clients. Hospitals are always boring, but this was even more so. There were no books or magazines, and no recreation room. There appeared to be nothing for him to do here. This place looked like One Flew Over the Cuckoo’s Nest, only smaller.

“Is that for the kids?” I asked, noticing a table in the corner set up with crayons and coloring books.

“That’s for us.” He raised his eyebrows. “They invited me to color this afternoon.”

Tears filled my eyes. I remembered my friend Claudine telling me once how she’d never asked a question David didn’t know the answer to. Whether it was politics or religion or history or mathematical theory, David was a walking encyclopedia. Full of stories. Full of life.

His psychiatrist was a brisk, no-nonsense woman who never made eye contact with David. When one drug made him so catatonic he couldn’t move, she simply administered another drug to correct his seemingly paralyzed and lifeless limbs. Her notes in David’s charts were unhopeful. “Patient not responding to X. Attempt Y.” The list of drugs attempted, doubled in dose, reduced, and then abandoned took up half a sheet of paper.

Medicines work wonders for many patients, but for others, there is often only partial relief and a number of unpleasant side effects. In David’s case, there was far too much emphasis on finding the right cocktail of drugs and far too little on helping him process the spiritual and emotional crisis he was suffering.

If I knew then what I know now, I would have worked with David’s family to find a gifted therapist, someone like Brian Goff.

Goff’s specialty is suicide. He’s seen more than 500 significantly suicidal patients. Goff says, “A large percentage of survivors I work with say they regret the choice of attempting suicide. Rarely have people actually wanted to die. They just didn’t want to live the way they were living.”

Goff has worked at the forefront of several therapies that offer promise for the most deeply troubled patients. Intensive therapies, such as dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT), have reduced rates of repetition of deliberate self-harm. Goff cofounded a DBT clinic and has used that technique successfully with hundreds and hundreds of patients. Now, he’s combined what he sees as the best elements of both in a treatment that uses mindfulness blended with cognitive behavioral psychotherapies.

Goff begins with this premise: people want to live a life worth living. And if they can be given the tools to help them ease the struggle of their present condition, they can begin building a life worth living. The new hybrid therapy,  acceptance and commitment therapy (ACT), focuses on modifying the functions rather than the forms of symptoms, using acceptance and mindfulness strategies.

Goff asks his patients a theoretical question that provides insight into the behavioral component of suicidal ideation: “If I had a magic wand and I could do something, anything, for you, would you say, ‘Please kill me’? In all the years I’ve asked it, I’ve never heard ‘Yes, please kill me,’” Goff says. “The answer is, ‘Cure my Parkinson’s.’ ‘End my depression.’ ‘Save my marriage.’ ‘Prevent my bankruptcy. I want to live, just not like this.’”

 

I can’t erase the past. I learned so much from it.

Sophie and Sheila

Sophie and Sheila

Our daughter celebrates her birthday each June. I can’t help but measure her birthdays with an equal sense of apprehension and elation. She’s a teenager now, and still no sign of the brooding, the polarity, the darkness that descended on David like Portland’s thick gray clouds in January, refusing to budge. Yes, she has his intellect but she also has my relatively sunny nature. She is physically stunning with long, muscular legs and a waist that defies her voracious appetite. She has David’s European cheekbones. The color of her skin is his. Her ears have the same shape. There are times I find myself staring at one of her features for too long. She bats me away, “Mom, enough.”

After David’s death, I’d read every book I could get my hands on about bipolar disorder. I’d measured the likelihood of a genetic inheritance against the things I could influence– her diet, her sleep, exercise, a sense of well-being and unconditional love. She is just fine, so far.  Becoming aware of our family’s genetic vulnerabilities was painful, but it provided a unique gateway to also focus on our genetic strengths, and Sophie has inherited a majority of the good stuff. She’s attending college now with the sensitivity, compassion and intellect of a person who will be better than “just fine.”

Mental illness, unlike breast cancer, isn’t celebrated with big marches or pink ribbons. The stigma is stifling and it prevents most people from seeking help. David refused to accept the label of bipolar disorder. He could not imagine a life of medications and therapy, which did so little to help. David’s path is not unique. Suicide is now the ninth most common cause of death for men and women in America. Every thirteen minutes, another American dies from suicide. What could we have done differently? What should we have known?

It is my belief that many people could benefit from hearing more about how psychiatric conditions unfold. In the years, months and days leading up to David’s death, I didn’t classify him as mentally ill. I missed many signs. I ignored others, believing it could get better. And I scrambled, as the world came crashing down around us, I scrambled to maintain my own sanity and the health of our daughter.

In the weeks and months ahead,  I’ll be using this blog to share what I’ve learned. I’ll be interviewing the world’s best researchers and scientists who are working to find a cure for mental illness. I’ll be sharing dispatches from mental health conferences and from my work at the Foundation for Excellence in Mental Health Care, a dedicated group of scientists, psychiatrists, psychologists and researchers who believe people with lived experience can recover. ”
My interest is in preventing another loss of life as exquisite as David’s. I welcome your emails, your stories, and hopefully, your support. If you so desire, you can order “All the Things We Never Knew” on Amazon.com and sign up for my newsletter. I’d be so grateful if you did both.