A New Epidemic

I am not sure depression, anxiety and loneliness is anything new but like many of the issues that came out of the pandemic, these were subjects that found themselves under a new cast of light. The larger focus has been on teenagers and seniors. The growth of self harm in the former, the latter due to the institutionalizing of seniors then not allowing them access to family or even each other out of a fear of contagion exacerbated an already long standing problem.

The reality is that we all are, we all face the same pressures to conform and comply with social norms and concepts of what defines well adjusted, average person. And with that we have numerous articles, essays, books and talking heads weighing in on what “normal” people should do, act and be like. Then we have the new pressure of defining that down even more so, with new added hyphenates to a long list of markers that are to clearly establish our identity outside the basics of name, rank and serial number. Be you a teen or an oldster I have no time for the bullshit surrounding what pronoun you use or if you are binary or not. Truly introduce yourself as who you are, and with that you have given me an idea of how you wish to be called. The rest is details that can come with time. I really don’t need an email signed by a bank employee telling me the pronouns they use, come on. How about your job title and what you can do for me, we aren’t taking this much further than a business transaction, but thanks for sharing!

I have been a nomad or gypsy most of my life. I spent the pandemic doing an inventory of some of the jobs, homes, lovers, friends and family I have known. I missed only one, my beloved dog, Emma. And yet I am glad she has found a place of rest as going through this would have been a burden for both. I have said in the blog many times about my feelings regarding western medicine and the reality is that includes conventional talk therapy and I ended up only of late considering suicide when I was in a classroom down the street and wondered if this was all that will be. I also realized why during my convo with the suicide hotline that I was upset about control and the lack of it. The gig or classroom was not the one I had picked for the day, in fact the two I had been in were both assigned. I have since figured out why the two Admins came in the room that day, there had been problems obviously in that classroom with other subs as this was off the gate, within the first 15 minutes of class and there has never been a visit of this kind in any room prior, hence the two, one a Spanish speaker as the class was largely Spanish speaking and all 9th graders. These two elements seem to make a hideous mix but the reality is that I have been in many of these rooms and yet this one was a visit immediately which meant a flag of some kind, either someone called them or they planned to be there. Regardless, the manner in which they entered and the bitchy nature of the one Admin was enough to push me to the edge. And with that when I returned a few days later, I showed up late, barely before school started and the last gig was left, meaning the easiest. Sure enough all English language learners, in the Gym wing, a section utterly ignored by everyone, and in turn a two hour block which on a half day meant I only had a half of a half day and with that by 10:30 I was out and gone. The same Admin passed me in the office and proudly greeted me with a Good Morning! I thought, “Hey clearly you are an utter idiot and don’t even recognize the person you verbally abused two days ago.” And that was that with spring break beginning I had a normal week. So know your triggers and mine is work in the public schools. And that I had figured out long ago that they are really bad and Seattle was no exception to the rule, Nashville had it to an art and Jersey City is just somewhere in between. With that I have come to accept that I suffer from the same ills just like everyone but with the pandemic the outlets to relieve them were limited.

And with that I link the article in the Times about Teens and the issues that they are facing contributing to the rising tide of suicide. Note one was struggling with the issue of pronouns and living a life largely online and with that a feeling of being watched. The irony is not lost as that is an oxymoron times two when it comes to how all these sites mine data and contribute to further issues and problems. For many kids despite what they say, schools are the lifeline and connection to the world not their own. Most kids come from really shitty families, I was no different I just never saw school as a haven. That has not changed it only confirmed what I suspected as kid and now I know. God I hated school but loved learning and finding a balance was perhaps why I went into Teaching. (I thought at the time office politics and 9-5 is not me) I am not sure 30 years later why I really became one but it is what it is. Pink Collar jobs are thought of being rewarded less financially but more emotionally, but in my case the accounting shows I am running in the negative. And I suspect there are many who feel the same.

So with that the article below discusses the issues facing older adults, from those at the end of the bookshelf we call life. This is who we are as a people, we created this false idol of social media as a way to connect but it is the one tool of which we must disconnect if we are ever to come out of this disease in tact. Elon Musk buying Twitter was the best thing that happened. Maybe it will just fold up its tent and hit the road with the other Preachers who claim to be saving/changing the world.

How Loneliness Is Damaging Our Health

By John Leland New York Times

• April 20, 2022

For two years you didn’t see friends like you used to. You missed your colleagues from work, even the barista on the way there.

You were lonely. We all were.

Here’s what neuroscientists think was happening in your brain.

The human brain, having evolved to seek safety in numbers, registers loneliness as a threat. The centers that monitor for danger, including the amygdala, go into overdrive, triggering a release of “fight or flight” stress hormones. Your heart rate rises, your blood pressure and blood sugar level increase to provide energy in case you need it. Your body produces extra inflammatory cells to repair tissue damage and prevent infection, and fewer antibodies to fight viruses. Subconsciously, you start to view other people more as potential threats — sources of rejection or apathy — and less as friends, remedies for your loneliness.

And in a cruel twist, your protective measures to isolate you from the coronavirus may actually make you less resistant to it, or less responsive to the vaccine, because you have fewer antibodies to fight it.

New York City, where one million people live alone, was for two years an experiment in loneliness: nine million people siloed with smartphones and 24/7 home delivery, cut off from the places where they used to gather. Therapists were booked up, even as tens of thousands of New Yorkers were grieving for a best friend, a spouse, a partner, a parent.

For Julie Anderson, a documentary filmmaker, it sets in every day at 5 p.m. — the hour when she would be thinking of dinner with friends, evening plans, now shrunk to watching television alone. Stephen Lipman, a fine artist in the Bronx, feels it in the idle hours — once a cherished time to work on his art, now drained of ideas or motivation. Eduardo Lazo, whose wife died of pancreatic cancer early in the pandemic, feels it every minute, as the end of the world they made together.

“Who doesn’t see suicide as an option at that juncture of life?” he said. “But I’m religious, and that would terminate any chance I have of being with my wife or my loved ones when I’m dead. I can’t jeopardize that possibility.”

Robin Solod, who lives alone on Manhattan’s Upper East Side, thought she was an unlikely candidate for loneliness.

“I was too busy schmoozing,” she said of her life before the pandemic. “Chicken soup at the Mansion Diner. We would go to Zabar’s on the West Side every week, get a bagel, sit, schmooze. Who was home? I never was home. Then all of a sudden, everything comes to a halt.”

As some pandemic restrictions now finally lift, and New York returns to some semblance of normal, one unknown is the lasting effects of two years of prolonged isolation and the loneliness that came with it. Some people cut off nearly all physical interaction, others were more social, but few got through the various lockdowns and spikes without some sense of loss for the human connections they were missing.

For Ms. Solod, who believed “people are my air,” one of the hardest blows came just before the pandemic, when she had to part with her loyal companion, a rescue Shih Tzu named Annie. Ms. Solod, 67, has health problems that keep her in a wheelchair, and eventually she felt she could no longer care for the dog.

“Now Annie lives out in Long Island, and it’s so lonely without her,” she said. “I never didn’t have a dog. The environment that I’ve always lived in has been my dog, the park, the people with dogs in the building. That was the connection. Everything has changed.”

Biology of an Epidemic

Loneliness, as defined by mental health professionals, is a gap between the level of connectedness that you want and what you have. It is not the same as social isolation, which is codified in the social sciences as a measure of a person’s contacts. Loneliness is a subjective feeling. People can have a lot of contact and still be lonely, or be perfectly content by themselves.

For many New Yorkers, the pandemic brought too much contact with others — in crowded apartments, workplaces or subways. But the contacts were not necessarily fulfilling or desired and maybe seemed dangerous. This, too, is a condition for loneliness.

In small doses, loneliness is like hunger or thirst, a healthy signal that you are missing something and to seek out what you need. But prolonged over time, loneliness can be damaging not just to mental health, but also to physical health.

Even before the pandemic, the United States surgeon general, Vivek Murthy, said the country was experiencing an “epidemic of loneliness,” driven by the accelerated pace of life and the spread of technology into all of our social interactions. With this acceleration, he said, efficiency and convenience have “edged out” the time-consuming messiness of real relationships.

The result is a public health crisis on the scale of the opioid epidemic or obesity, Dr. Murthy said. In a 2018 study by the Kaiser Family Foundation, one in five Americans said they always or often felt lonely or socially isolated.

The pandemic only exacerbated these feelings. In a recent citywide survey by New York’s health department, 57 percent of people said they felt lonely some or most of the time, and two-thirds said they felt socially isolated in the prior month.

“Loneliness,” Dr. Murthy said, “has real consequences to our health and well-being.”

Being lonely, like other forms of stress, increases the risk of emotional disorders like depression, anxiety and substance abuse. Less obviously, it also puts people at greater risk of physical ailments that seem unrelated, like heart disease, cancer, stroke, hypertension, dementia and premature death. In lab experiments, lonely people who were exposed to a cold virus were more likely to develop symptoms than people who were not lonely.

An often-cited meta-analysis by Julianne Holt-Lunstad of Brigham Young University compared the risk effects of loneliness, isolation and weak social networks to smoking 15 cigarettes a day.

“The general public recognizes how loneliness might influence our levels of distress, our emotional or mental health,” Dr. Holt-Lunstad said. “But we probably don’t recognize the robust evidence of the effects on our physical health.”

Nor do we recognize the economic cost.

Social isolation and loneliness are associated with an additional $6.7 billion in Medicare spending and cost employers more than $154 billion annually in stress-related absenteeism, plus more in job turnover, according to studies by AARP and the insurance giant Cigna.

Yet the culture has moved slowly to address the epidemic, Dr. Murthy said, treating loneliness as an unpleasant feeling rather than a public health crisis. “There are more adults struggling with loneliness than have diabetes,” he said. “Yet think about the discrepancy in the attention that we give to these two conditions.”

Chipping Away

Ms. Solod, before the pandemic, was not concerned about any of this. She lived alone, which did put her at higher risk of isolation, but she had always immersed herself among people. “A million friends,” she said.

She had run an electrolysis business, cut hair at Bergdorf Goodman and had a real estate license. She’d even worked as a hostess at Chippendale’s.

“I was beyond dynamic,” she said.

But New York can chip away at one’s social network. Friends get buried in work, move away, find lovers, change dog parks. Men are more likely to be socially isolated, but women are more likely to be lonely.

For people over 60, like Ms. Solod, who are one of the highest-risk groups, the isolation often begins with their health.

Six years ago, Ms. Solod began treatment for lung cancer, then multiple myeloma. Suddenly her life revolved around medical treatments, not socializing, and she needed a wheelchair to get around.

Yet she was still enjoying the city with friends or with her mother, who lived nearby. “I could hear my mother’s voice: ‘Don’t stay home,’” she said. Then a year before the pandemic her mother died. That was a connection she could not replace, a role no one else could step into. She still had lots of social contacts, but she was missing a meaningful connection that she needed. The name for that gap is loneliness.

“The worst was the Jewish holidays,” she said, when all her losses seemed to pile up. “I once had a life. I had a husband, I had a mom, neighbors and friends and relatives. That ceases to exist in the same way when the focal point of the mother is gone, that central person. When that’s gone, nothing can bring back the holidays.”

Then the pandemic hit.

Loneliness in the Genes

Turhan Canli, professor of integrative neuroscience at the State University of New York at Stony Brook, wondered whether there was a gene that turned on or off when a person was lonely. Past researchers had shown that loneliness, like other forms of stress, was associated with depression, inflammation, cognitive decline and heart disease. But how? What pathways were opened or closed when people were lonely, what genes activated or deactivated? From the Rush University Memory and Aging Project in Chicago, he was able to get tissues from the brains of older adults who in their final years had answered questions about their levels of loneliness.

His analysis provided an insight into the physical, cellular nature of loneliness. He found distinct differences between the brains of lonely or non-lonely people. Some genes that promote the proliferation of cancerous cells were more activated in lonely people, while genes that regulate inflammation were turned off.

“We found hundreds of genes that would be differently expressed depending on how lonely these people felt,” he said. “These genes were associated with cancer, inflammation, heart disease, as well as cognitive function.”

He cautioned that, as with many studies of loneliness, his did not prove that loneliness caused these differences in gene expression; it might simply have been more prevalent in people who had them.

Ms. Anderson, the documentary filmmaker, described nights in her apartment when she felt so oppressively lonely that she would not answer her telephone, even though the conversation might improve her mood. “You’d think I would pick up the phone and call people,” she said. “I feel that the loneliness feels so heavy, that if I call someone I’m going to be so down that they don’t want to talk to me. It’s exactly what I should do. I just don’t feel like it.

For Ms. Solod, who had been struggling before Covid, the pandemic brought several new levels of loneliness. There was the abrupt end to casual encounters with neighbors, merchants, the waitstaff at her favorite diner or deli. There were the friends who used to visit, but were suddenly just voices on the telephone.

In December of 2021, she was hospitalized for two weeks in the Covid unit at Memorial Sloan Kettering Cancer Center, so she could receive treatment for cancer and the coronavirus. Since that experience, she said, “I’m terrified.”

So even as she saw neighbors return to some social activity, she remained extremely cautious. Sometimes she’d take her wheelchair into her building lobby to watch the dogs, then go back upstairs, missing her own dog. And always, she said, she was conscious of how many people had died.

“I speak to my friends all the time,” she said. “They call me. But it’s very different, that type of connection. You don’t have the same emotions, the same feelings, as when you see someone in person. And also, when you can hug someone, it’s very different.”

The pandemic has underscored just how important even casual connections are for emotional well-being, said Anne Marie Albano, director of the Columbia University Clinic for Anxiety and Related Disorders. “Even the little things like making room for someone to sit down next to you on the subway, or someone doing that for you — those kinds of things are not happening,” Dr. Albano said. “And that makes an individual who is prone to feel alone feel that more intensely.”

The New Normal?

Even as case numbers in New York have remained well below their peak, Ms. Solod’s loneliness has not eased. If anything, she said, seeing people about their business, without masks, has made her feel even more isolated.

“So many people I know say, ‘Oh, don’t worry,’ and they start quoting the mayor and talk about the kids in school. But even putting the cancer and my illness aside, I would say I’m still very frightened of the virus. I don’t want to have to go back to that world of isolation.”

During the Iranian New Year in late March, an Iranian friend brought her food, for which she was grateful. “But then people don’t like to stay,” she said. “It’s almost like we’ve been ingrained in running out. It’s a quick hello, and see you later. In my world, no one’s really staying.”

Even if life returns to the way it was before the pandemic, it is unclear how far the loneliness of the last two years will lift, or what scars it might leave behind. According to Stephanie Cacioppo, an assistant professor of psychiatry and behavioral neuroscience at the University of Chicago, loneliness, like other forms of stress, may leave lasting damage.

One early indicator is life on the college campus, Dr. Cacioppo said. “Now that students are back, we are hearing so much loneliness and isolation tied to disappointment. College is not what kids expected it to be.” So social isolation was reduced, but a form of loneliness has lingered, in the gap between the social life people want and what they have.

The Moonshot to Cure Loneliness

A paradox: People are more connected now than ever — through phones, social media, Zoom and such — yet loneliness continues to rise. Among the most digitally connected, teenagers and young adults, loneliness nearly doubled in prevalence between 2012 and 2018, coinciding with the explosion in social media use.

Four years ago, the British government appointed a minister of loneliness to address growing concerns among the public. One town set up “Happy to Chat” benches, with signs reading “Sit here if you don’t mind someone stopping to say hello.” The model has proved popular and spread around England and to Canada and Poland.

In the United States, the health care system has focused on social isolation in older adults but been slower to address loneliness as a broad public health problem.

Yet there are interventions that can help, Dr. Cacioppo said.

“For years people thought the best thing you could do for a lonely person is to give them support,” she said. “Actually, we found that it’s about receiving and also giving back. So the best thing you can do for someone who is lonely is not to give them help but ask them for help. So you give them a sense of worth and a chance to be altruistic. Even if we’re getting the best care, we still feel lonely if we can’t give something back. The care is extremely valuable but it’s not enough.”

She also suggested a regular practice of gratitude and altruism, both of which counter a mind-set of seeing others as threats.

But real remedies to the problem of loneliness, Dr. Murthy stressed, must address not just the lonely people but the culture making them lonely.

“We ask people to exercise and eat a healthy diet and take their medications,” he said. “But if we truly want to be healthy, happy and fulfilled as a society, we have to restructure our lives around people. Right now our lives are centered around work.”

From the surgeon general of the United States, this is a moonshot call, to reverse cultural patterns that are decades in the making and that profit some of the nation’s biggest businesses.

Robert Putnam, in his 2000 book “Bowling Alone: The Collapse and Revival of American Community,” charted a steady erosion of social ties dating back to 1950.

Hannah Arendt called widespread loneliness an underlying condition for totalitarianism.

Dr. Murthy’s moonshot called for a complete shift in societal priorities. But the alternative, he said, is literally killing people. Connected people live longer, happier, healthier lives. So a shift is in order, starting in our homes and workplaces.

“We have this powerful force for enhancing health and well-being, in their relationships,” he said. “But how often do we invest in that?”

For Robin Solod, alone in her East Side apartment, this is a need she came to recognize the hard way.

She’d always been too busy running around to think about how much she depended on her connections with people, and how fragile those could be, she said. “But when you take that away, what’s left? What do you replace it with?”

She answered her own question. “Without the connection to other people,” she said, “you have bupkis.”

All Kinds of Loss

As we move into day four of Black History Month I wanted to acknowledge a contemporary Journalist/Columnist who has an actual Opera depicting his life as a young child and his growth into a young man. The Opera, Fire Shut up in My Bones was an amazing piece of work composed by the Jazz Musician, Terrance Blanchard with the Book by Kasi Lemmons, a screenwriter. That particular episode and time in Mr. Blow’s life marked a serious crime of being sexually assaulted by a relative and in turn as he matured and went to college he had to come to terms with that, falling in love and finding out that while he loved her his own sexuality was not fully realized. The opera leaves us at that junction of facing pain and truth and with that we readers of The New York Times have come to know what a passionate and dedicated writer he is about many issues that are both personal and political. But this particular piece resonated with me as I am struggling myself with anger, depression and the pain of isolation that year three of Covid has lent to my life. I say lend as I did not buy it, and like all leases they do eventually come to an end and this is one I am not renewing at all. But with that I note that there is no end date for the lease and I wait, and wait some more.

I have quit writing and aspiring to write I see little there that I am willing to do, to spend money on as I watch/read the endless garbage on Facebook from “writers” who almost all are self published and have not a clue what they are doing but think they are “writers.” I cannot add my name to that list. Seriously the publishing industry and that includes all the contests, the journals and the like are closed doors. They are utterly useless in finding real feedback and with that spending more money on classes to hear also little true constructive criticism has become also a non-starter. That last fiasco of a class through Hugo House was a Coursera class but more expensive. A book could have done more and been way cheaper. All of this is tied to money, mine, and I have said that my pussy like my checkbook are closed for business. I am keen on doing a podcast and feel that at least I can speak out loud, as speaking to myself has me questioning and asking myself if I am actually able to have a conversation with another without that perpetual voice in my head saying otherwise. That is depression, an endless nag that seems to be on a continuous loop that for whatever reason I cannot hit STOP. But with that I continue to get up and do the rounds and I hate every moment of doing them. The going to the store to get food, the stopping for coffee and joking with Baristas, even the Theater has turned me cold. This time last year I was in the same state but for a different reason or not as this is and always will be about Covid and the lack of this nightmare ever ending. And I do not think talk therapy will help as what can I talk about, my rage of being alone and not having a life. Until Covid I was fine alone and had a life that despite all the unconventional-ness worked for me. There were times that it failed but I have, I believe, placed some careful checks and balances that enable me to feel safe and secure and still be a part of society. The number one was giving up fucking men. Smartest decision ever and no regrets on that. But at this point I don’t even know any gender to socialize with, you know that whole hang out go to a show, have a coffee with, shoot the shit with. I don’t need a best friend I just need an activity partner, a trainer for the mind not the body. My last attempt with the neighbor ended badly but I did not even like her, and frankly shooting that one in the foot was needed or it would have only made things on my end worse. I hated the woman, okay, and I had to pep talk myself into talking to her. I am not here to say what about her grated on me but it was significant, but to simply say there was not one fucking thing I liked about her and in turn I hated myself for pretending I did. I am quite serious about my no longer compromising to fit inside a box I did not make nor have any input in the construction or design. Sorry folks we have to do things together and come to agreement on it with active and equal participation. I will no longer follow a scrip that I did not write, but I have not problem in editing one when I have to.

Mr. Blow admits that despite how one appears to the outside and often that is how we are judged by outside appearance, it is often a mask to cover those interior ones we use to hide from ourselves. We all do this in some form or another. We are our own interior decorator and use the tools of fashion and form to often aid and abet the lie. When one thinks of food one thinks of presentation and yet that does not mean it will taste as good as it looks. And we all play our part to present only the best of oneself. I have long stopped doing so. The shades of a room darken it when the blinds are drawn and that it what is like for me. I have wrapped myself in a blanket but it so heavy it is not a comfort, it is a shroud, a very different garment. And with that Death can be a metaphor for a closure and an end. I need some closure for now I am not living life I am simply existing within it.

DEATH CHANGED MY LIFE

By Charles Blow The New York Times Opinion Columnist January 23 2022

My oldest brother died more than a year ago, and that unspeakable loss changed me. I would say that it was the last straw, but there were so many last straws. I will simply say that it was in the final bale.

I have always suffered from a predisposition to depression. It was like the old friend, the constant companion, always a few paces behind or in front. There. I was never truly alone. It was always in the room, sitting on the edge of the bed, wanting to snuggle.

It is sometimes incongruous to hear people who we think of as successful talk about mental and emotional struggle, because we associate struggle with a lack of things that economic stability can provide.

But the struggle can manifest differently, as it did in me: as a feeling of being completely overwhelmed by your life. Even if by all outward measures I appeared to be succeeding, inside I was drowning.

The impostor syndrome can be severe, that feeling that you truly don’t deserve the things you have, that you haven’t earned them and are not talented enough to be in the position you’re in. For me, a poor boy from a tiny town with one stoplight, that was an ever-present worry.

I disguised it well by playing against type: I shrouded a lack of confidence in robes of overconfidence.

Over 20 years ago, I became a single dad. I loved it. I felt that I was doing an amazing thing. People, including my family, told me that I was. But I never said the thing I thought I couldn’t say: that parenthood was too much for me to do on my own, that it was consuming me, that I sometimes felt trapped in it, that it sometimes felt as if someone were sitting on my chest and I couldn’t breathe.

So I did with that feeling what I thought I must: I powered through. That was what men were supposed to do, right? Chin up, stiffened spine. No whining, no crying.

From time to time, when things became too overwhelming, or when I felt my life was truly spinning out of control, I would find a therapist. But therapy never really seemed to work for me. I often felt that I was talking into the void.

Around the time my brother died, my life was a mess. Publicly, I was a columnist at The New York Times, a CNN contributor about to start his own show on the Black News Channel, and an author on the brink of publishing his second book. My first, a memoir, had been adapted into an opera that would soon premiere at the Met. I worked out, and I ate well. “Health is Wealth” was my motto.

But privately, I wasn’t healthy. I was lonely and alone. I drank too much. I lived my life like it was about to end. I was afraid to be alone with my pain, because in the quiet, it got loud.

When people saw me, when they experienced me, they may well have seen a free spirit, even a reckless one. But in truth, what they were seeing was the personification of pain and trauma, walking and talking.

Then, my brother’s death blew a hole in me and made me reconsider everything. What kind of life did I want to live? What kind of man — kind of person — did I want to be?

Within a month, I changed everything. I stopped drinking. I learned to sit with myself, alone, and experience my emotions, and to deal with tough days, and even the exhilarating ones, head on. I was, and am, still dating someone truly special who has taught me what being at peace with yourself looks like.

And I have come to see things clearly again — things that seem so simple to me now, but that somehow I couldn’t see then: that life is a series of peaks and valleys, and it is a fool’s errand to try to flatten them out. That beauty is in the connections we make, to self, to family, to friends, to the earth. That we don’t judge the quality of a life by the volume at which we live it. That I deserve to be kind to myself.

I am finally, fully, at peace.

I have considered for months whether to write this column, whether it’s better to, as some advise, have an impeccably curated public persona. But the only image I want to project is one of honesty, openness and even vulnerability. The mission of my work is helping others any way I can, and that includes using the example of my own life and my own flaws.

My walk in recent years as an openly bisexual man has taught me the amazing power and importance of visibility, how transformational it can be to see someone else who is walking your walk.

As James Baldwin once put it, “You think your pain and your heartbreak are unprecedented in the history of the world, but then you read.” Maybe some people who feel privately broken as I did will read this, and they will realize that they are not alone and that it is not too late to change.

Fast Ball, Slow Curve

Its the Ninth.  We are in the end of the final inning with two outs, players on each base and the next hitter is the ninth man, the last at bat who is older in the game, has had an amazing career with home runs and yet this may be the last he makes before he retires and this is the game that ends all games.  So how does he play it? What will the Pitcher do to ensure that this is the third strike and the game ends with the winners coming in from the field to take the Series?  Will he play it slow, throw a curve or a fast ball.  To know is to know his opponent, his weaknesses, the stats and yet all of those knowns may not matter for there is no predictable outcome when the known is not always as one predicts and believes.  The opponent, the old player at bat could swing wide, he could hit is hard and it fly into the air beyond reach and allow all the players to make it home and the game is his to lose and his to win and yet all the variables, from wind, to the Pitcher, to the Players on the field and those on base and a ball that may not in fact fly that far or be carried by the wind to allow the outcome to favor the man at bat.  That is Covid, too many variables to predict the outcome other than it is highly contagious, highly deadly and is a new player at bat with no history on which to know how to throw.

I used to love Baseball and it has been a long time since I went as we have since learned that being a powerful player meant studying the game, building strength, learning to read the pitch, hit the bat and run like hell, all while knowing how to watch a ball fly through the air to catch it in one hand and/or throw it equally as fast to stop the runner and the game in their tracks.  But then drugs and the ability to enhance performance and the ability to spy on your opponents during practice, to bribe and pay Players to cheat and fail or to alter the outcome are all variables that change the games composition.

Models are created using the stats, the knowledge gleaned from past games, watching Players,knowing their history, using that data to predict the way to play the game from the roles they play and their position on the field. To have top Coaches and Owners  that worked in sync  to ensure they had the training, the plans and the money needed to build a team and do whatever it takes to win.  Sometimes chance played the game and players can change the outcome by having a good day, having a bad day, when injuries rule or when someone crosses the line and in turn penalties are made.  All of the game with the best of intention is planned, organized, strategized and then it plays out and the ending, the outcome was not what was expected.  Where have we heard that before?

Like Baseball we have endless models, strategies and theories that are to stop the spread, eliminate the number of new cases, end the hospitalizations or end the deaths,  Each day the number of innings played changes just like the league playing them -major, minor or little. And that not all innings are played matters just like Covid as you need not have all the symptoms to be the loser there.    The same with the tools used from bats to balls to even the mitts. The players can change and that too can affect the game and all of it hinges on how a man sees the play and if the player is out or in matters.   Ah yes the power of a man to make the decisions that affects the outcome.  Even the rules change dependent upon the league and where one plays.. All of this ends up with games that change on the toss of a coin and it all ends up with decisions made and a game played that could ultimately mean life or death.  What a metaphor.

And we are there now.  There is no end in sight and frankly the fear factor is duly in place and there are those who are trying to cope, the hyper mania ones who are sure we are all going to die,  those utterly confused and trying just to manage,  and then we have the utterly oblivious or ignorant.   I am, depending upon the day, trying to cope and just managing.   Today fell into coping until I again felt I had to school people on a multitude of subjects, from taxes, to payroll to of course the virus. WHAT THE FLYING FUCK?  Is this not the age of information and you cannot look some of this shit up?  But this is the Age of Covid and all logic and sense goes out the window when it comes to this disease.  And why? LACK.OF.LEADERSHIP.

If there was ever a need for a qualified skilled Umpire this is it.  Right now we are just hitting balls randomly and hoping that they land, don’t, get caught, don’t hit someone in the head and that if we run fast enough we won’t be out.  Its going well so far, well no we are in the end of the 1st inning and the Umps are just throwing mitts into the air and walking off the field. A whole new kind of strike.

I got home this afternoon from doing my essential business and of course grabbed a coffee and did my usual co-parenting then came home just again to an email from the Yoga teacher wanting a Zoom session of tea and comfort for those who need to touch base. Uh no thanks I don’t know you and that will not change once quarantine is lifted.  You were and are a service provider I will take the online Yoga classes and then those in real life when they return and when my membership expires I will move onto the next studio and start anew.  That Covid allowed me to hit my reset button is one thing that is a positive out of this.  I sure as fuck don’t want to test positive for Covid thanks.

Then of course came the warning that this will be with us for another year and to that I go, thanks I know.  We will not fully get of quarantine before Covid Version 2.0 for 20.. as well that is the year as that is why it is Covid 19.. the year it arrived with a bang, returns.  So we have flu vaccines that will be utterly useless and I still will get mine and update my winter wardrobe to include fleece face masks and by then have a version of flu paranoia full in place.  In other words limited contact although I hope to go back to Substituting with full social and physical distance in place, my dream classroom as it is what I always did.  I discouraged kids from touching me or anything, the faux shaking of hands also loathsome and in turn they will have to stay at least six feet away so hey not bad.  That works for me.  I never set foot in Teacher’s Lounges, Lunchroom and went to the bathroom was utterly paranoid and touched everything with paper towels and washed hands constantly. Kids are disgusting.  How was I ever a Teacher?   Again, I want to point out it is very different as a Sub versus a full time Teacher so I approach it very differently and exactly what it is – a Gig Worker.   There for the time assigned and then I leave running literally for the door to avoid as many kids as possible.

But while I am very proactive with my physical health I am less so right now with my emotional health and I need to talk to someone sooner versus later.  I am not doing well with the endless demands on my time and even when I volunteer I realize that it is because I cannot stand the misinformation and confusion it goes against my better nature.  Oh yeah I was clearly a Teacher.  But right now I would love one person to actually ask how I am? To talk to me for a few minutes or an hour and actually give a flying fuck about me.  I am in the middle of trying to figure out the next few months and what will happen from worst case scenario to the at least some middle ground of reason and that seems to be next to near impossible and it almost seems that “they” want it that way.  And it is the “they” that I worry about as I have no idea who “they” are.

When my friend told me about his hospitalization for depression at age 18 while denying to me that he had ever experienced trauma, I thought: Well if that ain’t it what is?  Clearly I have a short leash when it comes to mental health.  And this is going to be the leash from hell as much like our bootstraps this one is pulled past its breaking point.

That said I note they are not discussing homicides, violence, sexual and physical assaults and of course other mental health breaks including animal abuse from the rising tides of folks adopting pets and of course the costs that have that built in. And lastly child abuse.  That one will be through the roof too.

So what have we learned? Wash.your.fucking.hands. Stay home when sick. Don’t travel when sick. Get medical attention immediately versus treating it with OTC medicine. Take personal responsibility for your health and well being and save lives that way rather than giving it to everyone else.  Try that one.

The coronavirus pandemic is pushing America into a mental health crisis
Anxiety and depression are rising. The U.S. is ill-prepared, with some clinics already on the brink of collapse.

By William Wan
The Washington Post
May 4, 2020 at 12:57 p.m. EDT

Three months into the coronavirus pandemic, America is on the verge of another health crisis, with daily doses of death, isolation and fear generating widespread psychological trauma.

Federal agencies and experts warn that a historic wave of mental health problems is approaching: depression, substance abuse, post-traumatic stress disorder and suicide.

Just as the initial coronavirus outbreak caught hospitals unprepared, the country’s mental health system — vastly underfunded, fragmented and difficult to access before the pandemic — is even less prepared to handle this coming surge.

“That’s what is keeping me up at night,” said Susan Borja, who leads the traumatic stress research program at the National Institute of Mental Health. “I worry about the people the system just won’t absorb or won’t reach. I worry about the suffering that’s going to go untreated on such a large scale.”

Data show depression and anxiety are already roiling the nation.

Nearly half of Americans report the coronavirus crisis is harming their mental health, according to a Kaiser Family Foundation poll. A federal emergency hotline for people in emotional distress registered a more than 1,000 percent increase in April compared with the same time last year. Roughly 20,000 people texted that hotline, run by the Substance Abuse and Mental Health Services Administration, last month.

Online therapy company Talkspace reported a 65 percent jump in clients since mid-February. Text messages and transcribed therapy sessions collected anonymously by the company show coronavirus-related anxiety dominating patients’ concerns.

“People are really afraid,” Talkspace co-founder and CEO Oren Frank said. The increasing demand for services, he said, follows almost exactly the geographic march of the virus across the United States. “What’s shocking to me is how little leaders are talking about this. There are no White House briefings about it. There is no plan.”The suicides of two New York health-care workers highlight the risks, especially to those combating the pandemic. Lorna Breen, a top New York emergency room doctor, had spent weeks contending with coronavirus patients flooding her hospital and sometimes dying before they could be removed from ambulances. She had no history of mental illness, her relatives have said in interviews, but struggled increasingly with the emotional weight of the outbreak before she died. Days later, reports emerged that a Bronx EMT also killed himself.

Researchers have created models — based on data collected after natural disasters, terrorist attacks and economic downturns — that show a likely increase in suicides, overdose deaths and substance use disorders. **great more models more theories more bullshit covered in hysteria***

And yet, out of the trillions of dollars Congress passed in emergency coronavirus funding, only a tiny portion is allocated for mental health. At the same time, therapists have struggled to bring their practices online and to reach vulnerable groups because of restrictions on licensing and reimbursement. Community behavioral health centers — which treat populations most at risk — are struggling to stay financially solvent and have begun closing programs.

“If we don’t do something about it now, people are going to be suffering from these mental health impacts for years to come,” said Paul Gionfriddo, president of the advocacy group Mental Health America. That could further harm the economy as stress and anxiety debilitate some workers and further strain the medical system as people go to emergency rooms with panic attacks, overdoses and depression, he said.

Just as the country took drastic steps to prevent hospitals from being overwhelmed by infections, experts say, it needs to brace for the coming wave of behavioral health needs by providing widespread mental health screenings, better access to services through telehealth, and a sizable infusion of federal dollars.

Dire warnings in data

When diseases strike, experts say, they cast a shadow pandemic of psychological and societal injuries. The shadow often trails the disease by weeks, months, even years. And it receives scant attention compared with the disease, even though it, too, wreaks carnage, devastates families, harms and kills.

Mental health experts are especially worried about the ongoing economic devastation. Research has established a strong link between economic upheaval and suicide and substance use. A study of the Great Recession that began in late 2007 found that for every percentage point increase in the unemployment rate, there was about a 1.6 percent increase in the suicide rate.

Using such estimations, a Texas nonprofit — Meadows Mental Health Policy Institute — created models that suggest if unemployment amid the coronavirus pandemic ends up rising 5 percentage points to a level similar to the Great Recession, an additional 4,000 people could die from suicide and an additional 4,800 from drug overdoses.

But if unemployment rises by 20 percentage points — to levels recorded during the 1930s Great Depression — suicides could increase by 18,000 and overdose deaths by more than 22,000, according to Meadows.

“These projections are not intended to question the necessity of virus mitigation efforts,” cautioned authors of the Meadows report, “but rather to inform health system planning.”

Suicide experts and prevention groups have deliberately refrained from discussing too widely death projections such as those from the Meadows Institute. Experts say reporting excessively or sensationally on suicide can lead to increases in suicide attempts, an effect known as contagion. And the factors involved in any suicide are often complex, they point out.

“Could the numbers go up? Yes, but it isn’t inevitable. We know suicide is preventable,” said Christine Moutier, chief medical officer for the American Foundation for Suicide Prevention.

Research has shown interventions make a marked difference, such as limiting access to guns and lethal drugs, screening patients for suicidal thoughts, treating underlying mental conditions and ensuring access to therapy and crisis lines to call and text. “That’s why we need to act now,” Moutier said.

On Wednesday, a coalition representing more than 250 mental health groups announced it was convening a national response to the problem of pandemic suicide — an effort that will include at least one federal agency, the National Institute for Mental Health.

‘Poisonous fire hydrant’

Front-line workers — health-care providers, grocery store workers, delivery people — are especially vulnerable to the coming storm of mental health problems.

“We’re used to dealing with sick people and seeing terrible things, but what’s devastating with covid is the sheer volume. It’s like drinking from a poisonous fire hydrant,” said Flavia Nobay, an emergency room doctor.

As infections soared in March in New York, Nobay took leave from her duties at the University of Rochester Medical Center to volunteer as an ER doctor in Queens.

Weeks later, the experience still haunts her: Watching families crumple in the ambulance bay knowing they may never see relatives again. Hearing the relentless alerts every few minutes of crashing patients and respiratory arrest. Sending patients home because they weren’t quite sick enough, knowing they may be coming right back. Or even worse, the chance they may not make it back.

“It chips away at your soul,” Nobay said. “You have to hold on to the positive and how you’re helping in the ways you can. That hope is like medicine. It’s as important and tangible as Tylenol.”

A study of 1,257 doctors and nurses in China during that country’s coronavirus peak found that half reported depression, 45 percent anxiety and 34 percent insomnia.

Pre-pandemic, doctors and nurses were already acutely prone to burnout, research shows, because of the workload, pressure, chaos and increasingly dysfunctional health-care system.

“We’re now hitting a period of uncertainty where a lot of people are asking themselves how long they can keep it up,” said Liselotte Dyrbye, a Mayo Clinic doctor and leading researcher on burnout. “The teapot can only boil for so long.”

Could therapy ease your coronavirus stress? How to decide, what to expect and where to find it.
A broken system when it’s needed the most

This approaching wave of mental injuries will be met in coming months by a severely broken system.

In the United States, 1 in 5 adults endure the consequences of mental illness each year. Yet less than half receive treatment, federal statistics show. As suicide rates have fallen around the world, the rate in the United States has climbed every year since 1999, increasing 33 percent in the past two decades.

Part of the problem, experts say, is the markedly different way the United States treats mental illness compared to physical illness.

In normal times, a heart attack patient rarely has trouble securing a cardiologist, operating table and hospital bed. But patients in mental crises, studies show, consistently struggle to get their insurance to pay for care. Even with insurance, they struggle to find therapists and psychiatrists willing to take that payment. Those who can afford it often end up paying out of pocket.

Experts warn that such parity and access problems may only worsen with the pandemic, which has upended the functions of hospitals, insurance companies and mental health centers.

In a joint letter Wednesday, leaders in mental health and substance abuse treatment pleaded for the Trump administration’s help. The letter — signed by the American Psychological Association, the American Psychiatric Association, the National Alliance on Mental Illness and 12 other organizations — asked federal officials to save community mental health centers facing financial collapse.

The letter also asked the government to lift reimbursement restrictions that have prevented therapists from using phone calls to treat patients. On Thursday, the Trump administration indicated it would do so.

A survey of local mental health and drug addiction centers showed the pandemic has already left many on the brink of financial collapse, preventing them from providing services that generate much of their reimbursement revenue. More than 60 percent said they would run out of funding in less than three months and had already closed some programs.

In a letter to Congress in early April, mental health organizations estimated that $38.5 billion is needed to save treatment providers and centers and that $10 billion more is needed to respond to the coronavirus pandemic. On Friday, the federal substance abuse and mental health agency said it had been allocated less than 1 percent of the amount advocated by mental health groups — $425 million in emergency funding — and has awarded $375 million to states and local organizations.

While Congress recently authorized $100 billion in emergency funds for hospitals and medical providers, very little will go to mental health and addiction service providers because they mainly receive funding through Medicaid. And most of the emergency provider money is being distributed through Medicare.

There are glimmers of hope, experts say, amid the gloomy outlook.

The sudden push into telemedicine could make services more accessible in years to come. And the national mental health crisis could spark reforms and movement toward better treatment.

And while almost everyone is experiencing increased stress, the effect for many will be transient — trouble sleeping, shorter fuses.

The difficulty is identifying and treating those who develop deeper, worrisome mental problems such as post-traumatic stress disorder and severe depression.

“To control the virus, it’s all about testing, testing, testing. And for the mental health problems ahead, it’s gonna be all about screening, screening, screening,” said Gionfriddo of Mental Health America.

For years, Gionfriddo’s nonprofit has offered questionnaires on its website — widely used in medicine — to help people screen themselves for mental health problems. Since the pandemic began, those daily screenings have jumped 60 to 70 percent. And since February, the number of people screening positive for moderate to severe anxiety and depression has jumped by an additional 18,000 people compared with January.

Speaking from her parents’ home in Pittsburgh, Ananya Cleetus said she has felt the increased strain.

First came the closure of her school, the University of Illinois at Urbana-Champaign, bringing to an end her ambitious plans for the semester in computer engineering. Then came the loss of her therapist, forbidden by licensing rules from treating her across state lines. And social media didn’t help — all those posts of people baking bread and living their best #quarantinelife, making hers feel all the more pitiful.  **ya think, or the impending scolding and hysteria… neither good**

It was getting increasingly hard to get out of bed, said Cleetus, 23, who has a bipolar disorder and helps lead a student advocacy group.

“It took me a few weeks and talking to friends to finally realize this wasn’t just something wrong with me,” Cleetus said. Since then, she has poured her energies into creating a daily routine and an online guide for fellow students struggling with the pandemic and mental health.

“This virus is messing with everyone. The anxiety, isolation, uncertainty,” she said. “Everyone’s struggling with it in one way or another.”

Angry? Me Too! (Hashtag taken)

Anger can be either a stifling choking hand or the most energizing batter the bunny could ever wish for.   I read this and as I struggle with my emotional reservoir I know I am not alone and there are others who need to find skills, coping or otherwise, in which to restore.  This may be of some use

How to make a friend of your anger
Working with anger can be a journey of exploration

There is no quick fix to anger issues, but working through them can be a journey that sheds light on who we are and how we perceive the world

by David Woolfson
The Guardian
Sat 11 May 2019

It’s easy to feel hijacked by our anger. After all, anger was one of the primary evolutionary feelings: it was designed for survival. It knows only on and off. But this means that once the trigger is pressed, often by a trivial event, we end up in noise and miss out on the detail and complexity of our humanity. Our capacity for empathy is reduced and we want only to survive, hide, hurt, blame or punish.

Many people come to me expecting a quick fix or a solution to their anger. There is none. But working with anger can be a journey of exploration that offers information about how we perceive the world and shines a light on who we really are.

Anger can drive terrible deeds and behaviours. But it can also be a force for good. It plays out in both healthy and dangerous ways. It drives athletes, philanthropists and protesters, as well as killers and abusers. We usually focus on the “bad” behaviours that come with anger, such as losing your temper, bullying or being heavily critical or sarcastic. But anger itself is just a feeling, not a behaviour. My work, many people are surprised to learn, is not about getting rid of anger but changing our relationship with it.

Ultimately, anger is part of our humanity. Denying it will not make it go away; it creates shame, fear and even more anger. We can change our relationship with anger simply by treating it as a source of valuable information about ourselves and how we see the world.

Us angry people like to blame others for our anger, but taking responsibility for it is an important “growing up” process. These tips will help you understand how you create much of your anger and this will make a difference. But changing your relationship with anger is a deep and profound process that usually requires the support of a skilled therapist.

Tip 1
Don’t get angry about being angry

Anger has a bad reputation. Often, when we are angry, we tell ourselves we shouldn’t be; that feeling angry is somehow bad. Then we get angry with ourselves for being angry and feel ashamed – it’s an inexorable cycle.

Anger can be isolating and the experience of sitting in a group with other “normal” people who all suffer with their anger is transformative. I see this all the time in my groups: the moment you realise “it’s not just me” can be life-changing.

Tip 2
Take a ‘reality check’

Anger is designed to tell us something is wrong. It’s often triggered by perception rather than the truth.

Imagine, for instance, that a colleague is late for a meeting and you get angry because, to you, this means they don’t respect you. The reality may simply be that the traffic was bad, but by the time they arrive you are ready to punish and shame them for their “crime”. Is there any real evidence that your colleague doesn’t respect you? Ask yourself if your opinion is accurate or merely your version of the truth.

Tip 3
Be aware when anger is out of proportion to events

Sometimes small events trigger significant anger. This usually means that the anger is not about what is happening in the present.

Each of us carries a “sack” of anger and history with us, and disproportionate anger tells us this has been triggered. Generally, your colleague’s lateness, or the washing up not being done, are not really big deals and won’t be important by tomorrow. It certainly doesn’t merit much anger. If your anger is out of proportion, it tells you that it is nothing to do with the present event. Recognising this can help you contain the feelings and not act them out.

Tip 4
Be clear about what you feel and what you want

How often do you avoid expressing your own needs for fear of rejection?

I might want a hug, but in not asking for one I create an experience of hurt, anger and rejection. The truth is I have rejected myself though I may blame you, because in my head you should have guessed what I wanted. The truth is that I am angry with myself for not asking and angry with you for not guessing. By letting others know how you feel and what you need, you are less likely to fuel your anger and hurt.

Tip 5
Recognise when you take things personally

Recognising when we make things personal (“all about me”) can help reduce anger levels significantly. This is typical of road rage, when we make being cut up by another motorist a personal attack.

Often when we take things personally, we rub salt in a childhood wound or false story, often around beliefs of not being good enough, being imperfect, or a failure. An imperfect person can never be “lovable”, and this is terrifying for a child. These beliefs often persist into adulthood, creating stress and anger when we “fail”. This pattern is self-perpetuating.

Tip 6
Keep expectations realistic

Unrealistic expectations can create barriers to communication and intimacy. I often see this in couples.

When we demand that the other person makes up for what we lacked in childhood, we set them up to fail and condemn ourselves to conflict and disappointment. When I have unrealistic expectations of others, I miss who they really are. When my expectations of myself ar e unrealistic, I punish myself, I deprive myself of the kindness and generosity I offer to others. I miss who I really am.

Tip 7
Acknowledge and respect difference

Remember the childhood game, rock, paper, scissors? Ask yourself – which one am I? Which one is my partner? Then ask yourself how does a rock relate to scissors/to paper? To another rock? Once you recognise difference, you can start to respect it and see yourself and the other person in a clearer light. Difference, when acknowledged, engenders vitality and binds people more closely.

Tip 8
Confront your inner critic

Many of us carry an inner critical voice that berates us, constantly telling us we are not good enough. This voice feeds on the fact that we do not question it. It is usually derived from childhood experiences we have internalised. It becomes so ingrained that we cannot separate it from ourselves.

Your inner critic is never loving or supportive. It may tell you, for example, that you are a failure and can never succeed. No level of success will ever disprove this view. This thinking becomes habitual and we mistake it for the truth. It infects every aspect of our lives, getting in the way of healthy relationships. Once we identify the critical voice, we can challenge it and start to separate from it.

Changing your relationship with anger is a journey to your soul. Making anger your friend is a profound and life-changing process. Many clients tell me they want to be a better person, to which I reply: “You don’t need to be a better person – but you can be better at being the person you are.”

Think We’re Alone

I wrote my thoughts about the Bourdain/Spade suicide in my essay, Suicide is not Painless. I chose not to share my struggle with the issue in 2012 when coming out of a Traumatic Brain Injury suicidal ideation is very much a symptom of the injury, so I understood that,  but also add PTSD  that was the result from realizing how I sustained said injury.  And that realization, rage and fear  was truly the driver of that car, as in between understanding TBI, PTSD, date rape drugs, medical malpractice, my down time  was spent debating and researching methods and ways in which to accomplish the end so it would be final and I would be found. I had decided on drowning and as I lived within walking distance to Lake Washington I would spend hours going to the very shore I used to walk my beloved dog along planning how and when I would do it. Clearly I never acted upon it and I would love to say I found a great therapist but alas that was not the case.

Here is the rundown of the therapists I encountered in this phase of my life: I was a member of Group Health and the first was a woman therapist who was fired shortly after our first and single encounter where she was convinced I was a pathological liar, never examined my medical records confirming TBI and noted this on my medical records (which are normally kept separate)  as she enabled me to sign off of this. Did I mention that I had amnesia during this encounter and have no recollection of this session?  Amnesia too is a symptom of brain injury and Harborview Hospital dismissed me days earlier without failing to treat me accordingly with relation to my injury.

**This has largely to do whn women or anyone does not have an advocate to defend and discuss patient care, I had insurance and sufficient credit so imagine those who do not.  But hey someone in full blown brain injury should not be responsible or trusted with their care and Harborview could give a fuck less and I sued them alone.. so if you think suicide was not on my mind think again.  I got the whole Bourdain rage when he discussed how he cleaned up without help or support.  There is a rage there that can never be assauged.**

When I finally tracked her down in private practice a year or so later and showed her my complete records and info on this disorder she apologized and admitted she knew none of it. When I asked why she “left” Group Health she lied of course as that would never change. She had a history of misdiagnosing and stepping on boundaries. How did I know this?  The second therapist at Group Health I visited following this encounter, where he showed me my “meeting” with her and in turn noted that I was again a liar and drunk despite my desperate pleas for help in finding out what happened to me that night.  It was later he began to believe me but by then it was too late.   His counsel was so idiotic that I spent most of the time doing just what he thought, lying, rather than getting the help I needed. I made up stories about my family, my ex husband and others just to kill time as I was not paying for these sessions so I saw no point of doing anything to get well.

Michael was so bad that an acquaintance had already called to speak to him about my depression and to get to some understanding, so she made an appointment as a patient to seek counsel as a method of at least seeking some professional counsel as a way to assist in helping me. She was so horrified about what an idiot he was she came clean with all this where I too confessed to my bullshit. And from that we agreed to end as it was at least of waste of time and I proved the point already. 

Then we have the last Therapist that I went to as a promise to her to find someone to help. He was a nice man but two sessions in with him demanding me to learn how to forgive myself I realized it was not I who needed to forgive I needed to understand something in which he could not provide. He also realized I just wanted to rant which frankly is correct but guess what that would have exactly been what I needed and he wanted no part of it. That I was paying for so I turned to writing and massive exercise, a Tarot Card reader and ultimately I realized I was never going to get the answers I sought. So I moved on literally to Nashville.

Why I chose Nashville is for my reasons alone and they were in fact what I needed and wanted. Once those were taken care of and the dental treatments the other reason begun I started to focus on those things extrinsic versus intrinsic. Laughing at the people here may be unkind but I find it quite healing. I still feel very alone, very angry and at times depressed but mostly because I am nearly done with why I came here and I want to leave. All in good time and all on my terms.

But again Suicide is not a universal answer to life’s problems it is just one of many. But it is the most significant and substantive.  It is the final solution.  This essay poses many of the same issues and concepts I have said in many posts and in turn offers another form of insight into why some act upon that impulse and others fail or simply do not.

I recall after my rant in Vanderbilt’s Dental Office that day and I recall how I was in Michael’s at Group Health, it was full of bullshit, manipulative and yes one of anger.  I had come all this way and just wanted teeth, I wanted a treatment plan with costs so I could plan accordingly.  To get a wrong plan with incorrect information I just lost it.  I had dealt with the shock of the public schools, moved across the country and was closing out my legal bullshit from the accident in 2012 and was simply exhausted. I had only been here six months and all of them horrific as I tried to adapt to a place I did not truly belong but came again for reasons I chose to keep to myself as I knew that no one wants to hear any one’s history, their truth, their pain.  And hence I rant, I lie and manipulate as a coping strategy and it was now finally biting me in the ass and when the Cops showed up at my door a week later my first thought:  The gig was up.  And in turn it lead me to still be angry but be isolated and I am fine with it as when I have subsequent encounters with others they remind me of that Patient Coordinator – stupid.  And stupid is as stupid does. So I now laugh at them and sometimes with but I just want to leave and when I go somewhere else it is to run to not away and that is the key difference.  No expectations, no needs, just be anywhere but here.  That may be why many do commit Suicide.  

Artificial concern for people in pain won’t stop suicide. Radical empathy might.
Our language about suffering is suffused with cliches, and they don’t help.

by Richard Morgan The Washington Post June 15
Richard Morgan, a freelance writer in New York, is the author of “Born in Bedlam,” a memoir.

You’ve heard my suicide story before. I contemplated killing myself because of heartbreak, or being beaten by my father, or job woes, or being gay, or being raped, or the come-down after a bender. I took pills once in grad school, vomited them up and stared at the mess. It’s a particularly strange blow to the ego, that slop of having failed even at death. My most recent suicide plan, several years ago, was to jump off the Golden Gate Bridge. Only an intervention of friends, partnering with my estranged mother, set me on a better path. All of that thinking is alien to me today. Now I don’t even joke about wanting to die.

I could perform charisma and humor, but I had what felt like zero affect. I just didn’t care about anything anymore, even myself, and I could entertain these dark thoughts with alarming detachment. That’s the suicide we all know and loathe. It’s a demonic, simplistic creature, a cartoon supervillain, a composite of expectations and tired tropes. It’s a cliche. And for discouraging other people’s suicides, the cliche is a problem.

Part of how I escaped my tedious trap was by drafting suicide notes. I would write one, wait a day, read it and then see if it still felt true. Here’s one: “How bruised does fruit have to be to become not just unwanted but also inedible? And what, then, is inedible fruit? Its purpose is gone. It is a waste. That’s how I feel: I’m a waste. A waste of intelligence. A waste of personality. A waste of talent. A waste of words. A waste of love. I cannot be this man anymore. I am weary of the performance of it — wary of it, too. When I think of ending my life, I don’t mourn the loss. I never knew that guy. He was a feedback loop of habits and obligations. He never made me laugh without feeling insecure about the laughter, and never made me cry without feeling aimless about the tears. People might miss the person they thought I was. But nobody will miss the me I was in the dark. My tears were the loneliest thing about me. Nobody ever touched them.”

Another: “Would anyone I know be proud of my life? I have been blessed with many friends and colleagues — even strangers — who are supportive and encouraging. But I am very aware of the simple truth that, at the end of the day, they are glad they don’t have my life: the anxiety, the depression, the rejections, the loneliness, the poverty, the itinerant vagrancy. In one word, the brokenness. . . . It’s not a life anyone should have. I have lived wrongly. Certainly I have had moments of life the way it was supposed to be felt. Falling in friendship at first laugh, or a lover’s caress reverberating through the decades, or seeing my byline — my idea, my mind, my way of seeing the world — solidified in ink in the world’s best newspapers and magazines. But there are so few such moments. I can count them. They were not enough. And so, by extension, I was not enough. . . . I have been gone a long time already. I am proud that I realized this in time.”

Except, when I returned the next day to read these notes, they felt like they’d been written by someone else. In the elapsed time, I had grown not content but maybe restless — the kind of restlessness that reveals a faint awareness of hope, of faith in hope. Who was this strange man who had my voice but could not tether it to my soul? Reading my notes turned me into a one-man empathy machine. I was able to hold myself, steady myself, hear myself, know myself and love myself. They gave me ideas for how to cauterize my wounds: I’d visit a Korean spa to get a body scrub, gaze at the heaps of discarded skin and think, “The old me is on a tile floor now, being washed down a drain.” These rituals worked. I can’t imagine killing myself anymore — and I have a pretty ambitious imagination. Suicide notes saved my life.

With Kate Spade, Anthony Bourdain and the untold thousands who commit suicide without international attention, we seem surprised to learn that plenty of people do not, as a Kate Spade slogan went, “live colorfully” — without blacks, whites or grays. Apparently life should be a sumptuous confection, a millefeuille of giddy Oprah-resonant adjectives like “blessed” and “glamorous” and “inspired” and “ready.” Apparently we’re supposed to be a woke-up-like-this Beyoncé of flawlessness, even as we step out of an elevator having just watched our sister claw and kick our husband. There is no “perfect life.” No dream job. But we refuse to believe that; confronted with suicide, we understandably say things like Andy Spade, Kate’s husband, did: “It clearly wasn’t her.” He had to dissociate the act from the actor, its own kind of cliche.

So when depression or apathy emerges, we race to theorize about toxic secrets or “personal demons,” as Spade’s husband put it. We call it a “stupid thing, this selfish thing,” as Bourdain himself once described it. That’s a suicide we can absorb. The predictable one: the internal wrestling match. The Kurt Cobains and Marilyn Monroes. These people lost a “battle,” or their dark side “finally overtook ” them. Their soul was in a kind of car accident. They lost control of the steering wheel.

But suicide is more subtle than that. Suicide is a kind of fatal exhaustion. It knocks on your door not as a monster but as a healer making a house call. We have to invite it in. Spade held that red scarf in her hands, Bourdain held that bathrobe belt in his, and both thought, “This will do nicely.” The coroners’ reports will not bother to note if their cheeks were tear-stained, but I think not.

What we need to do is make that knock at the door less appealing. Give it less space to be heard. That’s the obvious takeaway from the Centers for Disease Control and Prevention report about an across-the-board surge in suicides from 1999 to 2016. In 2015, there were 18,000 homicides and 44,000 suicides in America. Suicide is 250 percent more common than murder. There is something missing in our understanding, and it is this: Empathy is not a pro-forma answer to some social problem, to be dispensed in the appropriate dose but otherwise withheld. Amid all those permeating cliches of joy and woe, empathy is too discrete, too intentional. We perform empathy like a child learning to box-step for a school dance, one-two-three, one-two-three. It’s a performance we don’t really care about.

That’s the message we send when we blurt out phone numbers for suicide prevention hotlines, as TV anchors, pundits and social media users did in recent days. I’ve called those numbers. Sometimes, they’re helpful. Often, they’re just another detached bureaucracy; it’s easy to feel processed, shunted through the protocols and scripts. It can be empty empathy. What else do we expect of emotional labor we have outsourced? (Also, repeating those phone numbers assumes they’re easy to call, that they’re not triggering, as if feeling indifferent to or incapable of calling a number isn’t just one more nudge toward suicide.)

When we search for answers to our pain and the pain of loved ones, we see empathy through the lens of danger and disease. We yell, You are not alone! Telling that to a person who feels suicidally alone is the same as asking, “Have you tried not being sad?” We are alone, all of us. Nobody will ever share in the experience of being me. I will never share in the experience of being inside any of my loved ones’ minds or hearts or souls. Empathy is not a cure for loneliness. It is merely a commitment to assert that other people’s loneliness matters, that it is seen and heard and felt as much as possible.

Empathy is about undermining loneliness by flooding it with engagement. Because sometimes, even with a face-to-face human, even with a doctor — you can check yourself into, say, San Francisco General Hospital for depression, have your medical history taken — you may still receive callous and confusing care. Seeking help or offering help is not the same as helping.

Suicide is the third leading cause of death among 10-to-14-year-olds in America and the second leading cause of death among 15-to-34-year-olds. More than 9 million American adults — 4 percent of us — have reported having suicidal thoughts in the past year. For context, 4 percent of Americans is roughly the population of Boston, Chicago, Washington, Los Angeles, Miami and Seattle. It’s not just about our broken mental health system; based on data from the National Violent Death Reporting System — which, jeez, is something we have — 23.8 percent of people who take their lives are on antidepressants. Pills and doctors won’t fix this epidemic. We need the meta-medicine of a better citizenry.

In American high schools, the CDC reports, almost one-fourth of girls have seriously considered suicide, and one-tenth have attempted it. Almost one-fifth of all students have seriously considered it. And yet where are the fights for arts and language and music programs that might channel these anxious and expressive impulses? Instead, the goal of governments and school districts in charge of high schoolers is to pass the buck onto college deans, who are broadly derelict in their duty. Of the largest 100 public colleges in the United States, only 46 bother to track suicides. Arizona State University, for instance, doesn’t tally suicides even though at least two students committed suicide there last year, but its administration can tell you the three-decimal-point GPA of every student athlete. That’s what we care about.

In the end, empathy should be a way of life and love; it should be our other oxygen. It’s not about saying, “I’m always here if you need me.” There is no if. We need each other desperately all the time. That’s what society means. That’s what civilization is. It should be the core of more than just our personal, private conversations. It should be the animating concept behind public policy, taxes, civic duty. There are obvious calls, like throwing the book at a woman who texted her suicidal boyfriend: “You just need to do it.” But what if we paid more to make homeless shelters havens instead of out-of-sight, out-of-mind hellscapes? What if we invested as much in Puerto Rico as we do in Afghanistan? What if we stopped nickel-and-diming our ride-share drivers literally to death? What if we made learning Spanish as necessary to a high school diploma as learning algebra? What if we made “How are you?” real? That’s how you end the cliche.

Suicide Is Not Painless

I have spent a week vacillating about how to approach this subject and do so in a manner that shows sufficient respect and in turn offer a perspective that may not be as acceptable and popular in a world that defines itself by followers, likes and retweets by literally virtual strangers whom you would not know if you passed them on the street and in turn would lend a hand if you tripped on the curb.  But we have a nearly insatiable need to be liked.  The recently departed Diplomat of Panama said upon his resignation that Trump demanded total fealty and if not you were immediately dismissed and considered useless. The current Republican party demonstrates much of this with their bizarre love/hate relationship with said Commander in Chief and they do so at their own detriment but more importantly that of our Country.

Social Media is an absurd name for something that is so clearly anti-social.  It opens up doors and windows into what is ostensibly your private thoughts, your life, your family and friendships or lack thereof to those whom again have an agenda that has nothing to do with improving the quality of life, yours any of those in the bigger picture.  What it does it enables others to monetize your privacy, enable law enforcement to monitor you and in turn allows other to feel free to mock, demean and “out” you in whatever way the mass do to bring harm or money and quasi fame for some.  As this was attributed to the late Andy Warhol:  In the future, everyone will be world-famous for 15 minutes.” (for the record it is debatable if that was the exact quote and if he originated it)

I have always been oddly private which my public persona would contradict but as Libra I am a natural contrarian and this is how I find balance.  My blog is not my name, I don’t have Facebook, Instagram, etc and do not tweet under my name.  I had a hard time deciding to write under my name or a pseudonym as I think few will care and while I suspect that the first collection of essays will not be loved by all and I am fine with it.

Better to write for yourself and have no public, than to write for the public and have no self.     [The New Statesman, February 25, 1933]”
                                                                       ― Cyril Connolly

So fame is an elusive drug and a toxic powerful one.  I decided to write because I actually felt I had a voice and a perspective that needed to be heard if only by one ear.  Writing is therapy and I find it healing.  But this is not about me oddly I joke that everything is, this is about aging, depression, rage, confusion and an examination of a life that may for some means in which to end it on one’s own terms.  Control freaks, mentally ill people, desperate people, normal people, sad people, happy people all come to terms with a crisis in their own ways and some times they come out of it and sometimes they do not.

Jennifer Finney Boylan wrote a op-ed piece in the New York Times on What is Sadness/What is Depression  following the deaths of designer Kate Spade and Chef/Writer/TV personality Anthony Bourdain.   The Spade/Bourdain deaths reminded me of another boomer of another time, Michael Hutchence of INXS, twenty years earlier.   In that time they called it an accident – death by auto erotic asphyxiation.  This was the chosen method by Robin Williams only a few years ago as well.  Did that influence the two?  Who knows.   Whatever, you need to call it it is still death by strangulation.  That is what death they chose, to choke themselves to death and slowly and not without some pain or discomfort prior to death. This is not hanging where in many cases the neck breaks, no this is choking to death.  Let’s call it what it is.  Google it as I have no intention of explaining the time frame for actual death to occur but yes there is pain and a some time before one falls unconscious. 

Last Saturday following my glorious day at Churchill Downs I came back to the hotel and CNN was airing a marathon of Parts Unknown.  I rarely watched that new version of what was No Reservations, as well as I say,  been there done that and frankly how many trips can one watch of Bourdain going to the same country time after time, shoving food down his face and talking politics?  I for one choke on that idea that a white wealthy famous man stays in a four star hotel, flies private and sits with locals for a few hours and eats meat products on a stick  to show how he connects to the common man. Pretentious and absurd.   No Reservations was by far more less calculated and the fame that Bourdain craved and in turn needed was still in its infant stage but by the end he was well enamored of his celebrity.  I recall his trip to San Francisco twice with one time him so violently drunk and out of control that he fell, hit his head and had to be taken to the hospital.  I was living in the City then and knew many who just thought he was a bad drunk and wanted nothing to do with him.  Cut a couple of years later and he is on a new network and was in Seattle twice.  Both times were about music and little interest in the food scene other than a trip to Canlis (a well established old school white tablecloth place).  The big attraction was in fact Marijuana as it is legal and the predominant trips were to the pot shops for drugs and edibles of another kind.  He nearly had a fight in a dump bar and the return visit was again largely the same.   Another year later I am in Nashville and guess who is here as well? Well go figure. Again he dined at the more established place but his visits to the local Meat & 3 Cafeteria as well the hot chicken joints were second tier and not the most famous or well established.  His visit centered on drinking and the music scene that was not about Country in the least and that was his primary interest but again food was not the point if it ever was.  Few recall his visit here and never mention in that fan fuck way many do about Bourdain.

As I grew less inclined to Bourdain as I loathed his politics (he was a well declared Libertarian) I decided to watch the marathon to see if it would change my view and my perspective and the  first episode was his trip (100th?) to Vietnam.  Not surprisingly it bored me but then the two episodes that followed had my hair standing on end.   One was to opioid areas of New Hampshire and other areas he had lived as a youth.  His own drug use was mentioned during an NA meeting and there he spoke how no one gave him an intervention nor helped him get off drugs.  He chose to as he had a seven year old daughter (she is now 11) and he needed to change to see her grow up.  He was clearly in a very introspective mood but it was a dark place throughout te episode with him almost debating with many of the recovering addicts why they wanted to remain alive or help others do so.    This was how I saw it and was tweeting this as I watched.  This was then followed  by a trip to France,  Marseilles specifically, with Eric Ripert the Chef who was with him on this last trip and found him in his hotel room. Again the prescience of thought seemed almost deliberate when you watch this episode and his endless teasing, almost taunting Ripert to get angry, to have him hate and to challenge Bourdain’s  views on enemies and on Ripert’s Buddhism.  I cannot believe that as Bourdain planned to perhaps act upon thoughts that had plagued him for decades the idea of getting the last word/laugh/irony was not lost as he descended to unconsciousness.

True I have a dark view of Bourdain but if you watched, read and knew people who knew him you may understand why I am less inclined to believe he impulsively did it after a night of eating and drinking.  Why one would do it let alone in a country that you do not speak the language, with a camera crew in tow and a friend who has known you for decades but is a spirit of light in contrast to one who is dark cannot be lost that this act of finality was done with two intents, both motivated by anger and rage.

Again I tweeted this and some fucknut on Twitter whom I don’t know but recall past threads of mental health issues promptly schooled me on depression and suicide and when I told her to fuck herself I am entitled to my opinion she informed me that I should not talk about this issue on social media.  Hey moron was I talking about myself? No.  I was talking about what I was watching with regards to Anthony Bourdain.   But in the need to be heard and the need to be in the know we don’t even read the tweets we rage about let alone care about the one on the other end who caused us to rise up off our stupor and respond.   As they say about abortion – don’t like them, don’t have one. Same with Twitter.  Someone says something you do like, stop following or reading them.  Why do you care about someone you don’t know and their opinion.   Agree to disagree and move on.

Which brings me to Kate Spade.  She had not been a part of that “world” for a decade that I knew. Her bags were not part of my world in the 80s and only with the growth of the shops that shared her name (much like dead Lily Pulitzer) did I wander in a buy an accessory or two.  I had not thought about her or what her life was as many businesses have the name on the license which doesn’t mean anything anymore.  But her death at age 55, like Bourdain at 61, did garner my attention as it is my generation whose numbers of suicide, particularly women are growing.  And again, like Bourdain, she chose to kill herself in her own home when her estranged husband was in the home but unlike Bourdain she was found by the housekeeper so her last laugh/irony/fuck you was not what I suspect she envisioned.

I would use this opportunity to talk about myself in this moment, 58, childless, friendless, without family, living in a city I loathe, working at a job I hate and aging badly – dental issues and with that all that accompanies it from facial collapse to weight gain.  But I have not really ever thought this is where I need to die and that alone keeps me alive.  I felt the same in Seattle so clearly I find whatever reason to stay alive and do not act upon the depression that nearly killed me six years ago, following a traumatic brain injury sustained from the accident where my date tried to kill me.  I will never see it any differently and I make it my business to remind myself that it was attempted murder and I lived through that so keep coming death as I was not ready then and when I am you will know after I do.

Suicide is the ultimate last final act of control and of will.  It is planned and it is thought out.  It is impulsive and full of pain or of rage or of fear or of whatever it is that led you there.  There is no one  explanation and just like snowflakes we are different when it comes to resolving those issues that have hurt you.   And those sometimes are final ones.  But it is act of pain just don’t kid yourself otherwise.   Suicide is not painless.

Post Cop Depression

As one who found the Cops at her door early one morning on a wellness check I heard of the story below,  my first  thought:   Well at least they did not kill her.  Most wellness check ends up with the individual dead, which clears that problem up, however.

The week my visit happened a Cop had gone on a suicide call to a woman in a vehicle  who was inebriated, confused and in desperate need of mental health counseling. In the process she released the break and the car rolled into the Cumberland River.  The two Cops were not Seals, nor trained mental health professionals nor even suitably attired  to go into a river that was freezing cold in mid winter and that only certified rescuers should do, jumped in to “save” her.  One died and here we are a year later still mourning his unnecessary death and her being tried for manslaughter. 

Clearly we have a lot of learning to do here about what Cops should and should not do in these situations and yesterday during a Domestic Violence call there was a day long standoff when the individual barricaded himself in the apartment, fired shots and one hit an Officer who thankfully was only  marginally wounded.  This was on the same day that a local foundation/group filed ethic charges on the Mayor as they believe her banging a cop led her  to fail to provide sufficient policies that were with regards to Police oversight.  Ya think?

But needless to say Cops are NOT mental health providers and answering such calls that include Domestic Violence that ends with a SWAT team arriving says that this is not a call one should be making unless they are willing to see bullets fly.

But again when you believe a Nurse would call for Police assistance when they have access to appropriate referrals and  medical professionals available to handle said situation you have this,  a woman forced into mandatory observation and her civil rights taken from her without due process.

I want to say I was surprised but again I was in a medical dental professional building and I was angry and instead of referring to me well someone down the hall, four days later the cops showed. Had I been dead I am unsure how they would know.  Would they then  knock on neighbors doors? Find out where I am employed and call my employer?  Would they bash the door down? Would they get a warrant in which to do so?  No on all of those.  We had such a situation here when a Son called the local Police about his Mother and his concerns that her boyfriend may have done her harm.  The Cops went to the residence knocked, no answer and called the Son and said there seems to be nothing wrong, no one was at home and that was that.  The Son flew out here and went to the residence and found them both dead.  So much for that wellness check, they weren’t very well after all.

But again to commit a woman who is expressing depression and who came willingly in for help the best thing to do is get her help.  Locking her up,  confining her and subjecting her to Police does what exactly for her well being?  Again one of the Cops said to me, “You do seem anxious and depressed.’ As to my response, “Well let’s see I am in my pajamas getting ready for work, I find two Cops at my door asking about my mental health and are you qualified to make said diagnosis and if this does not make someone anxious what does that say about me in another way?” It ended with me getting a dental referral for another Dentist whom I did see and had him review the plan and said his costs would exceed what I was quoted and should pretty much stick with them.  I did not tell him exactly the back story on how I got said referral but the visit was handy as he confirmed the treatment  plan and gave me a solid second opinion.

I want to point out that the woman is on Medicaid and this could be a class issue or one of race but the reality is that women who are poor and of color receive inadequate care and often neglectful care.  This was both.  The reality is we have horrific mental health options for even those insured and the challenges of getting  help regardless is slim to none, particularly for women as the stigma of this issue still exists.  Time’s Up.

Nurse Calls Cops After Woman Seeks Help For Postpartum Depression. Right Call?


February 7, 20185:00 AM ET
Heard on All Things Considered
April Dembosky
From
KQED

Jessica Porten went to a doctor’s appointment with her daughter, Kira, to get help with postpartum depression. She soon found herself in the company of police who escorted her to a hospital’s emergency department.

Four months after having her second baby, Jessica Porten started feeling really irritable. Little things would annoy her, like her glider chair.

“It had started to squeak,” she says. “And so when I’m sitting there rocking the baby and it’s squeaking, I would just get so angry at that stupid chair.”

She read online that irritability could be a symptom of postpartum depression — a condition that affects up to 1 in 7 women during or after pregnancy, according to the American Psychological Association. In California, where Porten lives, those rates are even higher, spurring state lawmakers to introduce a package of bills to improve mental health screening and treatment for new moms.

Porten hopes they help women avoid what she went through.

She went to Capital OB/GYN, a women’s clinic in Sacramento that accepts her Medicaid coverage as payment, to talk about medication options and therapy. Porten admitted to the nurse that she was having some violent thoughts.

“I described maybe hitting myself or squeezing the baby too tight,” she says. “But I was very adamant through the entire appointment that I was not going to hurt myself and I was not going to hurt my children.”

But, Porten says, the nurse’s manner toward her changed. “I could see in that moment that she stopped listening to me,” Porten says.

The nurse called the police. The police escorted Porten and her baby to the emergency room. Hospital staff made her change into a gown and took her purse, but they let her keep her diaper bag for the baby. They put them both in a room, under constant watch, though the hospital staff was sympathetic, Porten says.

“It’s like, everybody knows I’m not crazy,” she says. “Everybody knows that this is normal — but they’re following protocol.”

Finally, at midnight, 10 hours after she first got to the doctor’s office, a social worker sent her home. Porten wrote on Facebook that the whole thing made her feel like a criminal.

“It was all legality,” Porten says. “Everybody was protecting their own liability instead of thinking of me.”

Administrators at Capital OB/GYN declined to comment. Gary Zavoral, a spokesman for Sutter Health, which runs the emergency room where Porten was taken, says that once a patient arrives in the ER for assessment, hospital staff must follow strict protocols.

“The process is to make sure everybody is safe: the individual’s safe, the family’s safe, the staff is safe,” he says. “The process does take some hours, so 10 hours is not unusual.”

When patients reference violent thoughts, it forces doctors to think about things in a different way, says Dr. Melanie Thomas, a psychiatrist at the University of California, San Francisco and Zuckerberg San Francisco General Hospital.

California law allows doctors to involuntarily confine a person with a mental disorder if they are a danger to themselves or others. But Thomas says what constitutes imminent danger can be vague.

“You can imagine a provider, a social worker, any number of people might interpret that phrase in different ways, about what is necessary to report and what isn’t,” she says.

The laws and medical protocols don’t always line up, Thomas says. There have been times she felt asked to rely on legal reasoning over her clinical judgment.

“The fragmented aspects of our system of care make it difficult to get women the help that they really want,” Thomas says.

That is one reason lawmakers in Sacramento are now introducing a package of bills to specifically address maternal mental health. Assemblyman Brian Maienschein, R-San Diego, is backing two of them. One would require doctors to screen new moms for depression; under current law, it’s voluntary.

“The numbers here are so significant that I think it’s something that doctors really should understand and should be prepared to both diagnose and treat,” he says. Screening, he adds, also “educates a woman in that situation that this is an issue that may impact her.”

Maienschein’s other bill would direct the state to tap into a new federal pot of money set aside for postpartum programs and awareness campaigns. It was established under the 21 Century Cures Act, which was passed in the final months of the Obama administration.

“Getting federal money is a great thing,” Maienschein says. “It’s federal money that’s available that I’d like to see California have, versus another state.”

The legislation has given Jessica Porten a new purpose. People have told her that she should sue Capital OB/GYN for calling the police. But she says no.

“I walk into that waiting room and I see tons of Medi-Cal recipients — so they’re all low-income,” she says. “If I sue, it’s only going to cause monetary damages to a facility that is clearly short on resources.”

Instead, Porten says she’ll advocate to get the new bills passed in California. She thinks that is the way to help the clinic’s physicians and nurses do a better job of helping new moms get the care they need.

“I’m not going to take that away,” she says. “I’m going to build it up.”

Crazy Is as Crazy Does

When I read this article below, I thought “this is not surprising.”  I have met many Social Workers in my profession and many are “licensed therapists” and they are cheaper than Psychiatrists and Psychologists so they frequently are the ones insurance will pay for when you are referred to a counselor.  I prefer Ministers they at least have God on their side and can’t be worse.

When I was ill with Traumatic Brain Injury the credentials of the moron I was sent to was that of MSW, a Master in Social Work.  I knew right away I was not going to get the help I need or should have given my injuries as those require a specialized type of professional with duly the equal amount of experience, which my insurance had no desire to pay for.  Add to that  he was also a self obsessed moron, I knew that I would not.  And no I did not diagnose that myself, but two friends, one a clinical psychologist made appointments with him, did not disclose their intent or purpose but to actually see why I was deteriorating under his care.  They needed only one appointment and begged me to see someone else. I chose physical means from naturopathic, meditation, yoga and prayer. I started to recover at a much faster clip.

There is a cross line that many Social Workers have and that is they may not have the power to prescribe drugs but the ability to have people instiutitionalized, their children taken have state or municipal intervention without much documentation nor valid reasoning. They also neglect to do so in many cases for the same reasons they elect to do so – a matter of choice, time and personal issues.

This is not someone I would want monitoring anyone’s care. This type of mental health issue is serious enough to warrant whether she should be in that field of work. Sorry but no I don’t think anyone who has frequent hospitalizations for serious mental health problem is an position to offer anyone help with equally serious problems.

 I am sure she could find any number of related jobs that would enable her to utilize her credentials and her own experience without direct patient contact. Or maybe just find something else such as grocery clerk.   Thankfully she isn’t. But one wonders how many more are like that in her field?

As this comment below from the article says.. she is as well.  We have a problem here clearly:

 This is one of my fears. I work in a group home for people who have serious mental illness and often I wonder if I could end up like them. I struggle with Depression and Anxiety and there have been times in my life where I could barely function. I often wonder if I can truly help the people at the group home when I struggle with mental illness myself. For example one of the residents struggles with major depression and will often come to talk to me about her struggles with depression and advise on how to cope. I feel like a fraud giving her advise when I struggle with just getting out of bed and coming to work. Sometimes I wonder if I would get fired if my supervisors knew how mentally ill I am.

How I went from social worker to psychiatric unit patient 

By Liat Katz
The Washington Post
  February 8 at 2016
 

I am a licensed clinical social worker. And, occasionally, a mental patient. Today, as I eat breakfast in an inpatient psychiatric unit, I am definitely more patient than social worker.

It is Monday morning, and I am eating breakfast across from a muscular, flannel-clad, Paul ­Bunyan-looking patient. Little pieces of his scrambled eggs keep landing on his copper-colored beard. I sort of want to motion with my hand at where the eggs are on his face, but I’m too tired, and I don’t really care. About anything.

My table mate is an odiferous, rebel-flag-T-shirt-wearing, hairy-eared, phlegm-spitting mechanic who, to be honest, would not normally be part of my social sphere. In my professional life, he could be my client. But right now, unshowered and unkempt, I’m looking pretty rough around the edges myself.

At least he is wearing real clothes. Like several others here, I am on suicide watch, so I’m required to wear a hospital gown. I’ve been stripped of my clothes, my ID badge, my degree and my dignity. The staff have even confiscated my bra, explaining that it might be used to hurt myself or others. As if “death by bra” were a common occurrence from which I need protection. Other patients have made the best of our clothing situation, showing runway-worthy ingenuity: Some wear the gown as a robe, others use it as a dress, or use one as a gown and another as an undergarment or sash.

In yesterday’s therapy group, I heard my table mate describe his experience with depression. Now it’s as if we share a secret lover — for to know depression is to make love to the manipulative beast, to learn all of her intimate quirks. Depression draws you to her with such power, making you feel that you’re a willing participant. As she leans in, she whispers in your ear that you are nothing, an incapable nobody, and she gives you murky-colored glasses to see through as a daily reminder.

Depression is seductive

She says that she will stay with you and be your only confidant. She sits on your chest to make getting out of bed difficult. She hangs her full weight off your shoulders, so that even showering or walking feels like an Olympic event. Depression helps you forget anything positive about your life and insists that you sabotage any attempt at living without her. She whispers that the only way out is to die, then reminds you subtly, every day, that you can’t even do that successfully.

The stigma of an intimate relationship with depression means that you can’t reach out for help until it’s too late. My Paul Bunyanesque table mate couldn’t get out of bed anymore to go to his mechanic’s job, nor to maintain a relationship with his girlfriend; I couldn’t get out of bed anymore to work at my Adult Protective Services social-worker job, nor to parent my 3- and 5-year-old daughters.

So what good are we?

After breakfast, I wander into the day room. To make the time pass, I try to guess people’s diagnoses. I think of all the resources and support systems I could set up for my fellow patients. Do they know about that new mental-health housing program? That guy could probably use his VA benefits to pay for his psych meds. Clearly that woman is not ready for discharge — and yet, there she goes. I keep it in my head; that’s not my role here. Social worker, heal thyself (first).

A couple of fellow patients and I play the dangerous, ever-popular game of “What you could use in this place if you really wanted to kill yourself?”

“You could stab yourself with a pencil,” I offer, knowing I’ll get no points for that one — too boring.
“Bundle your sheets together and use them to hang from . . . from . . . from something,” one patient remarks. As we all look around the room for something to hang from, I instantly regret playing this game. What if someone’s not kidding? I think. How irresponsible of me to join in.

“You could just eat the food they bring us,” I say, trying to lighten the mood. I look around. Mood definitely not lightened.

In the hospital, even the simplest tasks become an exercise in humility. I decide that for my major activity of the day, I will shower. I feel exhausted just thinking about it, but I request soap, shampoo and a towel from the 20-something psych tech.

“You’ll just have to WAIT,” she snaps, as if admonishing a whiny child. I hadn’t noticed that she was doing anything; she’s just standing there. I’m twice her age, I think to myself. At home I don’t have to ask permission to get shampoo; I must be really screwed up to need that.

She stalks to the supply closet and comes back. “Here!” she shouts, shoving a bottle at me.

“Can I have a towel, too, please?” I ask in my humblest Oliver Twist manner. (I don’t bother asking for soap; I’ll use the shampoo.) Meanwhile, I’m thinking, “Usually, lady, I’m on the other side of the desk from you, looking at my clients’ charts when I’m here checking on them or consulting.”

She rolls her eyes and brings me a towel. It is only big enough to cover my left nostril.

The shower in my room has no curtain and no handle, just a bare, stripped knob. I try turning it right or left, but I can’t get it to move. I figure maybe its operation is part of my Mini Mental cognitive exam, so I’m determined to figure out how to use it. Surely I can master a shower handle. I summon my years of education and of putting together furniture and toddler toys, but, alas, I just cannot do it.

 I add this to my list of failures in life and, reclothed, emerge defeated from the bathroom. I ask a nurse how to use it.

“Oh, honey,” she says with a slight laugh, “that one’s broken. Didn’t someone tell you? Use the one in the hall.”

I find the hall shower and maneuver the handle to produce a tiny stream of ice-cold water. This shower also has no curtain or lock on the door; anyone could walk in at any time. I feel so tremendously vulnerable, exposed and alone.

Was it worth all this to keep me from killing myself? Really?

This is perhaps my 15th hospitalization, the first being an 18-month stint as an adolescent, after suffering severe abuse at home. But I hadn’t been hospitalized in more than 13 years.

I thought I’d gotten my life together. I have a family, I got through grad school with a 4.0 GPA (after finishing the 10-year depressed-undergraduate plan), and I have a job. I’d thought that if I worked hard in therapy and in life, and took my medicine, I’d be immune to depression and hospitalization.

I was wrong.

It crept on me gradually. Over several months, my ability to do paperwork for my job began to dwindle. I’d call people and not remember whom I’d called. One day I drove to the store in a neighborhood I’ve frequented for years, and I suddenly didn’t know where I was, how I’d gotten there or how to get to where I was going. I pulled over and cried; I could not remember a time when the world was okay.

Protecting my children

Another day, I became disoriented and fell down a whole flight of stairs at home. Bruised and battered, I lay in a heap at the bottom for hours, sobbing. That night, I wrote goodbye notes to my children. Reading the notes aloud after I wrote them gave me pause and a chance to regroup: Even if I couldn’t deal with life, I realized that I wanted to be there for my kids. Those lovelies did not deserve to experience a disturbing, lifelong reality that their mother had killed herself.

I knew that I had to be in a safe place that would protect me from me, so I sucked it up and headed to the ER. After spending 16 hours lying on a gurney by the nurse’s station, I was brought to the psych floor.

Yet today, after my sad breakfast and lonely shower, I feel like I don’t belong here. Okay, I realize that I’m just as worthy of being here as anyone else, but I don’t want to belong here. I will work on getting healthy enough to go home.

I want to garner some respect — to loudly proclaim my credentials:

“I AM A SKILLED CLINICIAN. I AM ABLE TO NEGOTIATE COMPLEX CLINICAL PRESENTATIONS, CAREFULLY ESTABLISHING RAPPORT, AND I HAVE DEFTLY CONDUCTED INDIVIDUAL AND GROUP THERAPIES. I AM AWARE OF THE PSYCHOLOGICAL FORCES THAT UNDERLIE HUMAN BEHAVIOR AND EMOTIONS, AND HOW THESE FORCES RELATE TO EARLY EXPERIENCE. I AM CAPABLE OF GREAT INSIGHT, AND I HAVE HELPED OTHERS TO ACHIEVE INSIGHT AS WELL.”

Instead, I just glance over at the staff at the nursing station.

A nurse, chewing gum and not looking up from her paperwork, declares, “Nine o’clock. Lights out, Katz. Go to bed.”

Katz, a licensed clinical social worker, is a graduate of New Directions, a three-year postgraduate writing program offered by the Washington Center for Psychoanalysis, and editor of its literary magazine. She lives in Rockville with her wife, two daughters, two cats and two bunnies. This article first appeared in the online magazine Pulse — Voices From the Heart of Medicine.

It’s Complicated

When I read the below story, I thought that if this was a man he would have picked up a gun, walked into a casino and opened fire. That is the difference between the sexes. The expression of anger and rage has become now an need for public display and of late we have more bullets firing than fireworks.

My belief that San Bernandino was not a “terrorist” attack as those in Paris where ideologues use religion to express anger and pick random targets in large cities to make a statement, this was personal. I suspect given the history of the male attacker and his friendship with the simpleton who provided guns was a stooge used by the family to marry someone’s Russian sister for immigration purpose and provide weaponry and fuel the bullshit that generated nonsense talking about going on a rampage, in the same manner akin to talking about fantasy football.   As when it really happened it was the young man and his imported bride, instead of his being from Russia, his from Pakistan, a country where we have a complex relationship.  We cannot ignore Pakistan and their role in terrorism as it is one we often neglect to mention. But ask India about their relationship and history with that country.

That said, I have always thought that in the case of most mass shootings this too was sexually charged, inflamed by his wife who I doubt had any friends or relationships with anyone in this country, a new mother, in isolation whose only hobby appears to be spending hours building pipe bombs and planning some attack with her husband. The role of women either in the sexual frustration or instigation cannot be overlooked.

So that attack while on the surface seemed to be some type of Paris scene, it was about work, fitting in and anger that he clearly only expressed to the one person willing to go the distance with him to express that rage, one with equal rage and anger. And that is what depression is. Surprise we are back to the mental health thing again!

Sorry but I see how women rile and anger men in schools with kids and men’s equal frustration and confusion and simple inability to communicate with women that often end up in violence. If you are wondering how and why domestic violence occurs ask yourself if you understand couple dynamics and if you shrug that is your answer. As they say “it’s complicated.”

When you read the story below the light bulb about depression, rage and anger should be clear. Simply connect the dots and realize that when you are marginalized in society and that can be for many reasons, you become frustrated, angry, and in turn depressed. So you act on that either suicidal or homicidal or both.

How Lakeisha Holloway’s striving life veered into deadly chaos on the Las Vegas Strip

By Sarah Kaplan
The Washington Post
December 22 at 6:14 AM

It was 6:35 on the Las Vegas strip: bustling and bright and ostentatiously overstimulating in that classically Las Vegas way. Inside the Planet Hollywood Resort, a bewildered audience watched a wealthy TV personality accidentally give a crown to the wrong beautiful woman. Outside, tourists milled on a crowded sidewalk: a wrestling team from Oregon, a couple from Arizona, a newly-minted 21-year-old from Montreal. They snapped photos of the fake Eiffel Tower, consulted on their evening plans.

Lakeisha Holloway, 24, sat at the wheel of her ’96 Oldsmobile, her 3-year-old old daughter in the backseat. Holloway didn’t want to be among all that gaudy glitter. But she’d been turned away from everywhere else.

It was 6:36 on the Las Vegas strip. Holloway spun the wheel.

In that moment, the car became a deadly weapon, and Holloway an accused murderer. On Monday she was charged with killing a pedestrian when she drove her car onto a sidewalk, over a walkway and then onto another sidewalk, hitting more than three dozen people in the process. A few people raced after her, pounding on the drivers window and yelling for her to stop. At one point, she later told investigators, she recalled a body bouncing off the windshield of her car, shattering the glass. She drove on.

A mile later, Holloway pulled up at another hotel, got out of her car, and walked up to a parking attendant.

Call the police, she told them. She’d just run over several people.

Three years ago, Holloway had defied the odds to become a decorated high school graduate. The daughter of a single parent who had grown up homeless, Holloway swore that her life would be different from those of the people around her. She took college classes, got a job with the Forest Service, had a daughter. She dreamed of opening her own women’s clothing company. As recently as October, she got a judge’s approval to change her name.

Paris Paradise Morton, she was going to be called. A signature that signaled aspiration.

But there she was in the casino parking lot Sunday night, her daughter in the back seat, a bloody crime scene behind her.

What no one can quite figure out is why.

Investigators believe that Holloway may have been en-route to Dallas to find her daughter’s estranged father when she ran out of money in Vegas, according to the Associated Press. For a week, she’d been sleeping in her car in the parking lots of casinos.

According to an arrest report released Monday, Holloway said that she’d been through a stressful period earlier that day. She was trying to sleep inside her car with her daughter, but security officers kept running her out of every parking lot they stopped in. That’s how she ended up on the strip, “a place she did not want to be.”

Holloway was not under the influence of any alcohol or drugs, she told the police — officials have not yet released the results of their own blood tests. But she would not explain what would have compelled her to plow her car into so many people.

It’s not even clear what brought her to Las Vegas from Portland, Oregon, where she lived until last week.

Holloway had a troubled upbringing there, one that she was determined to overcome.

“I was a scared little girl who knew that there was more to life outside of crime, drug addiction, lower income, alcoholism, being under-educated, all of which were things I grew up being familiar with,” Holloway said in a video interview about her high school three years ago.

Improving Life Chances from PortlandOIC+Rosemary Anderson HS on Vimeo.

Holloway didn’t know anyone who had graduated from high school; her mother had only an eighth grade education, and she struggled with alcoholism.

“She drank more, and cared less,” Holloway said in the video. “I was scared out of my mind.”

During Holloway’s freshman year, her mother kicked her out of the house. Holloway spent much of high school homeless.

But in 2012, Holloway graduated from the Portland Opportunities Industrial Center, an alternative high school, with a “role model award” for overcoming adversity, according to the Portland weekly the Skanner. She began taking classes at Portland State University while working for the Forest Service.

In the video interview after graduation, the 21-year-old Holloway is smoothly self-assured.

“Today, I am not the same scared girl I used to be,” she says, not once breaking her gaze from the camera. “I am a mature young women who has broken many generational cycles that those before me hadn’t. Being homeless and on my own taught me to stand on my own two feet.”

But public records show that even then she was struggling. In 2011, according to the Oregonian, she was convicted for driving without a license or insurance.

A year later, her license was suspended for failing to meet insurance requirements, Oregon Department of Transportation spokeswoman Sally Ridenour told the Los Angeles Times. She has been cited for driving without a license or insurance since.

“It’s a pattern,” Ridenour said.

Holloway was driving with a suspended license when she veered into the crowd on Sunday.

To LaShay Hardaway, Holloway’s cousin, almost nothing about the woman portrayed in police accounts or in media reports is familiar to her.

“It sounds like we’re not even talking about her,” she told the LA Times.

To Hardaway, Holloway is a “beautiful person,” she told the Oregonian, someone who is “always thinking about her daughter or the next thing she needs to take care of.” She said that Holloway had a job and was enrolled at Portland Community College, but was looking for other options. That search is what brought her to Las Vegas.

Hardaway also disputed police reports that her cousin had been homeless and sleeping in her car; Holloway had rented a room, she told the Los Angeles Times.

“She’s never been homeless,” she said.

Holloway’s family prayed for the victims after they heard about the deadly crash Sunday, which killed Jessica Valenzuela, 32, of Buckeye, Arizona. And they’re struggling to make sense of what happened to the bright young woman they knew.

Holloway is probably struggling with that herself, Hardaway said.

“I’m sure it’s unbelievable to her right now,” she told the Oregonian

Holloway is being held in a Clark County jail under suicide watch, Public Defender Scott Coffee told the Associated Press; child protective services is taking care of her daughter.

The woman faces charges of murder with a deadly weapon, child abuse or neglect, and failing to stop at an accident involving death or injury; officials plan to file additional charges, including possibly multiple counts of attempted murder, as they gather more information about the incident.

Talk Talk

Laugh and the world will laugh at you but never with you. And that is why many Comedians are successful they get laughed at while dumping their anger on you. It is cheaper and better than therapy but it is also why many comics are addicts to any number of things.

 I was not surprised about the below article as we really know nothing about the complexities of the human mind. We have long been a one size fits all nation and when that doesn’t fit we slip you a drug that will at least make you legally stoned which has to be better, right?

 When I was severely injured with traumatic brain injury I found out the hard way that we know nothing and in turn have no idea how to treat those with severe injuries let alone the accompanying depression and other ailments that fall into trauma care – such as PTSD. So we drug, ignore or hope that someone will fight there way out of. I tried three different therapists and one said, this is all you, I have done nothing but listen.

One was utterly incompetent and admitted he had patients commit suicide on him and a third said, “you just want to vent.” Yes because I am angry and exhausted aka depressed from being constantly angry. And a $125 pop I was getting even more angry. So I never went back after two sessions. It is why we have raging drug dependency from legal to illegal, alcoholism, suicide and I think much of the risk taking behaviors that are often masked as excessive sports.

When you are depressed you are angry and you think you are sad sack, no you enraged and often it does come out in violence be it self directed or externally directed but I am quite confident in saying depression is anger turned inward.

So talking is one method, just as AA is one method for treating alcoholism, but when you realize the myriad of ways to treat this – acupuncture, massage – from Riki to Cranio Sacral, to Yoga, Meditation, nutrition, sleeping and eating well and all of them expensive and seemingly indulgent it does little to offer the opportunities to try something as its better than nothing. I went the alternative holistic route after the failures in the conventional method. True I had male therapists and I hated their guts as it was a man who put me in that situation and yet I had found few women who were equally compassionate and trained.

 The one woman whom I “met” during my period of Amnesia tried to have me committed and when I later asked her about her experience with Traumatic Brain Injury she admitted she had none and had she had proper records and information she would not have done such but it was all too late. So once again the system is as much the problem as the ones who work in it.

 So how do we help people? Well fuck if I know. But at least the truth is starting to emerge about this bogus side of the medical industrial complex.

 Effectiveness of Talk Therapy Is Overstated, a Study Says

 By BENEDICT CAREY
The New York Times
 SEPT. 30, 2015

 Medical literature has overstated the benefits of talk therapy for depression, in part because studies with poor results have rarely made it into journals, researchers reported Wednesday. Their analysis is the first effort to account for unpublished tests of such therapies

Treatments like cognitive behavior therapy and interpersonal therapy are indeed effective, the analysis found, but about 25 percent less so than previously thought. Doctors have long known that journal articles exaggerate the benefits of antidepressant drugs by about the same amount, and partly for the same reason — a publication bias in favor of encouraging findings.

 The new review, in the journal PLOS One, should give doctors and patients a better sense of what to expect from various forms of talk therapy, experts said, if not settle long-running debates in psychiatry about the relative merits of one treatment over another. Five million to six million Americans receive psychotherapy for depression each year, and many of them also take antidepressant drugs, surveys find. Most people find some relief by simply consulting a doctor regularly about the problem, experts said.

 Engaging in a course of well-tested psychotherapy, according to the new analysis, gives them an added 20 percent chance of achieving an even more satisfying improvement, or lasting recovery. Before accounting for the unpublished research, that figure was closer to 30 percent, a difference that suggests that hundreds of thousands of patients are less likely to benefit.

 The new paper is the latest chapter in a broad retrenchment across science in which researchers are scrutinizing past results to weed out publication bias and other, more deliberate statistical manipulations.

“We need to seriously consider publishing all completed studies,” whether encouraging or not, said Jelte Wicherts, an associate professor in the department of methodology and statistics at Tilburg University in the Netherlands, who was not involved in the study. Other researchers cautioned that the analysis was hardly the final word on the effectiveness of psychotherapy.

 “The number of trials they looked at was fairly small, and the different psychotherapy approaches were all pooled together,” said Stefan Hofmann, a professor of psychology at Boston University. In the study, a research team led by Ellen Driessen of VU University in Amsterdam tracked down all the grants funded by the National Institutes of Health to test talk therapy for depression from 1972 to 2008.

The team found 55, most of which used so-called manualized approaches, in which therapist and patient use a standardized manual to guide the treatment. The most commonly studied of these are cognitive behavior therapy — in which people learn to identify and defuse automatic, self-defeating assumptions, like “I’m unlucky in love” or “I always choke” — and interpersonal therapy, which focuses on reshaping how people interact with others. These studies typically have subjects engage in weekly, hourlong sessions with a therapist for three to four months.

The researchers found that 13 of these funded studies were completed but never published, usually because those who did the trials did not think a finding of no benefit stood much chance of being published.

 The team contacted each of the 13 investigators originally paid to do the work and requested their data. Once that data was included with those from the other, published papers, the effectiveness of the therapies dropped significantly — by about a quarter.

 “That seems to be the magic number, a quarter — about the same as you see in the pharma trials” of antidepressants, said a co-author, Dr. Erick Turner, an associate professor of psychiatry at Oregon Health & Science University and the lead author of the 2008 paper detailing bias in those drug trials.

 The team did not have enough information about the original studies’ designs to determine whether the authors massaged any data to make the treatment look better than it was, as happened in some of the drug trials. Had study designs been available, Dr. Turner said, the benefits of psychotherapy might have been lower. His co-authors were Steven Hollon of Vanderbilt University, Claudi Bockting of the University of Groningen, Pim Cuijpers of VU University, and Dr. Driessen. T

he way to think about the results, Dr. Hollon said, is that antidepressant drugs and talk therapies are modestly effective, and the combination is better than either approach alone. But for those who do well or fully recover, “psychotherapy, particularly cognitive behavior therapy, seems to be most effective in cutting the risk for a relapse long-term,” Dr. Hollon said.

 The new report’s findings did not come as a big surprise to many therapists who use talk therapy. “Depression is a tough disorder to treat, and it’s very difficult also to judge treatments because the symptoms of the depression naturally wax and wane — it’s a moving target,”

 Dr. Hofmann said. “There’s a sense of desperation out there because we do need something new, and there’s very little on the horizon.”