Below is information about mental illness and recovery is compiled from the National Alliance on Mental Illness website. This small bit of information is intended to help those not familiar with mental illness to better understand some of the most common illnesses. Additional information about these and several other mental illnesses are available at www.nami.org.
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| Talking About Suicide Can Save a Life |
What is Mental Illness?
I. Major Depression
Major depression is a serious medical illness affecting 9.9 million American adults, or approximately 5 percent of the adult population in a given year. Unlike normal emotional experiences of sadness, loss, or passing mood states, major depression is persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. Among all medical illnesses, major depression is the leading cause of disability in the U.S. and many other developed countries.
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Some Important Facts
About Mental Illness and Recovery Mental illnesses are biologically based brain disorders. They cannot be overcome through “will power” and are not related to a person’s “character” or intelligence. Mental disorders fall along a continuum of severity. The most serious and disabling conditions affect five to ten million adults (2.6 – 5.4%) and three to five million children ages five to seventeen (5 – 9%) in the United States. Mental illnesses strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable. The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports; — National Alliance on Mental Illness |
Major depression, also known as clinical depression or unipolar depression, is only one type of depressive disorder. Other depressive disorders include dysthymia (chronic, less severe depression) and bipolar depression (the depressed phase of bipolar disorder or manic depression). People who have bipolar disorder experience both depression and mania. Mania involves abnormally and persistently elevated mood or irritability, elevated self-esteem, and excessive energy, thoughts, and talking.
II. Bipolar Disorder
Bipolar disorder, or manic depression, is a serious brain disorder that causes extreme shifts in mood, energy, and functioning. It affects 2.3 million adult Americans, which is about 1.2 percent of the population, and can run in families. The disorder affects men and women equally. Bipolar disorder is characterized by episodes of mania and depression that can last from days to months. Bipolar disorder is a chronic and generally life-long condition with recurring episodes that often begin in adolescence or early adulthood, and occasionally even in children. It generally requires lifelong treatment, and recovery between episodes is often poor. Generally, those who suffer from bipolar disorder have symptoms of both mania and depression (sometimes at the same time).
While there is no cure for bipolar disorder, it is a treatable and manageable illness. After an accurate diagnosis, most people can be successfully treated. Medication is an essential part of successful treatment for people with bipolar disorder. Maintenance treatment with a mood stabilizer substantially reduces the number and severity of episodes for most people, although episodes of mania or depression may occur and require a specific additional treatment. In addition, psychosocial therapies including cognitive-behavioral therapy, interpersonal therapy, family therapy, and psychoeducation are important to help people understand the illness and to develop skills to cope with the stresses that can trigger episodes. Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of the illness.
III. Schizophrenia
Schizophrenia is a devastating brain disorder that affects approximately 2.2 million American adults, or 1.1 percent of the population age 18 and older. Schizophrenia interferes with a person’s ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others. The first signs of schizophrenia typically emerge in the teenage years or early twenties. Most people with schizophrenia suffer chronically or episodically throughout their lives, and are often stigmatized by lack of public understanding about the disease. Schizophrenia is not caused by bad parenting or personal weakness. A person with schizophrenia does not have a “split personality,” and almost all people with schizophrenia are not dangerous or violent towards others when they are receiving treatment. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings.
While there is no cure for schizophrenia, it is a highly treatable and manageable illness. However, people may stop treatment because of medication side effects, disorganized thinking, or because they feel the medication is no longer working. People with schizophrenia who stop taking prescribed medication are at a high risk of relapse into an acute psychotic episode.
IV. Obsessive-compulsive Disorder
Obsessions are intrusive, irrational thoughts — unwanted ideas or impulses that repeatedly well up in a person’s mind. Again and again, the person experiences disturbing thoughts, such as “My hands must be contaminated; I must wash them”; “I may have left the gas stove on”; “I am going to injure my child.” On one level, the sufferer knows these obsessive thoughts are irrational. But on another level, he or she fears these thoughts might be true. Trying to avoid such thoughts creates great anxiety.
Compulsions are repetitive rituals such as handwashing, counting, checking, hoarding, or arranging. An individual repeats these actions, perhaps feeling momentary relief, but without feeling satisfaction or a sense of completion. People with OCD feel they must perform these compulsive rituals or something bad will happen.
Most people at one time or another experience obsessive thoughts or compulsive behaviors. Obsessive-compulsive disorder occurs when an individual experiences obsessions and compulsions for more than an hour each day, in a way that interferes with his or her life.
OCD is often described as “a disease of doubt.” Sufferers experience “pathological doubt” because they are unable to distinguish between what is possible, what is probable, and what is unlikely to happen.
V. Panic Disorder
A person who experiences recurrent panic attacks, at least one of which leads to at least a month of increased anxiety or avoidant behavior, is said to have panic disorder. Panic disorder may also be indicated if a person experiences fewer than four panic episodes but has recurrent or constant fears of having another panic attack.
Doctors often try to rule out every other possible alternative before diagnosing panic disorder. To be diagnosed as having panic disorder, a person must experience at least four of the following symptoms during a panic attack: sweating; hot or cold flashes; choking or smothering sensations; racing heart; labored breathing; trembling; chest pains; faintness; numbness; nausea; disorientation; or feelings of dying, losing control, or losing one’s mind. Panic attacks typically last about 10 minutes, but may be a few minutes shorter or longer. During the attack, the physical and emotional symptoms increase quickly in a crescendo-like way and then subside. A person may feel anxious and jittery for many hours after experiencing a panic attack.
Panic attacks can occur in anyone. Chemical or hormonal imbalances, drugs or alcohol, stress, or other situational events can cause panic attacks, which are often mistaken for heart attacks, heart disease, or respiratory problems.
It is estimated that 2 percent to 5 percent of Americans have panic disorder, so you are not alone if you, too have these symptoms. Usually panic disorder first strikes people in their early twenties. Severe stress, such as the death of a loved one, can bring on panic attacks.
A 1986 study by the National Institute of Mental Health showed that 5.1 percent to 12.5 percent of people surveyed had experienced phobias in the past six months. The study estimated that 24 million Americans will experience some phobias in their lifetimes.
Phobias are the leading psychiatric disorders among women of all ages. One survey showed that 4.9 percent of women and 1.8 percent of men have panic disorder, agoraphobia, or any other phobias.
VI. Dual Diagnosis: Mental Illness and Substance Abuse
Dual diagnosis services are treatments for people who suffer from co-occurring disorders — mental illness and substance abuse. Research has strongly indicated that to recover fully, a consumer with co-occurring disorder needs treatment for both problems — focusing on one does not ensure the other will go away. Dual diagnosis services integrate assistance for each condition, helping people recover from both in one setting, at the same time.
Dual diagnosis services include different types of assistance that go beyond standard therapy or medication: assertive outreach, job and housing assistance, family counseling, even money and relationship management. The personalized treatment is viewed as long-term and can be begun at whatever stage of recovery the consumer is in. Positivity, hope and optimism are at the foundation of integrated treatment.
How often do people with severe mental illnesses also experience a co-occurring substance abuse problem?
There is a lack of information on the numbers of people with co-occurring disorders, but research has shown the disorders are very common. According to reports published in the Journal of the American Medical Association (JAMA):
Recovery is a process, beginning with diagnosis and eventually moving into successful management of your illness. Successful recovery involves learning about your illness and the treatments available, empowering yourself through the support of peers and family members, and finally moving to a point where you take action to manage your own illness by helping others.
Untreated Mental Illness: A Needless Human Tragedy
Severe mental illnesses are treatable disorders of the brain. Left untreated, however, they are among the most disabling and destructive illnesses known to humankind.
Millions of Americans struggling with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, know only too well the personal costs of these debilitating illnesses. Stigma, shame, discrimination, unemployment, homelessness, criminalization, social isolation, poverty, and premature death mark the lives of most individuals with the most severe and persistent mental illnesses.
Mental Illness Recovery: A Reality Within Our Grasp
The real tragedy of mental illness in this country is that we know how to put things right. We know how to give people back their lives, to give them back their self-respect, to help them become contributing members of our society. NAMI’s “In Our Own Voice,” a live presentation by consumers, offers living proof that recovery from mental illness is an ongoing reality.
Science has greatly expanded our understanding and treatment of severe mental illnesses. Once forgotten in the back wards of mental institutions, individuals with brain disorders have a real chance at reclaiming full, productive lives, but only if they have access to the treatments, services, and programs so vital to recovery.
Newer classes of medications can better treat individuals with severe mental illnesses and with far fewer side effects. Eighty percent of those suffering from bipolar disorder and 65 percent of those with major depression respond quickly to treatment; additionally, 60 percent of those with schizophrenia can be relieved of acute symptoms with proper medication.
Assertive community treatment, a proven model treatment program that provides round-the-clock support to individuals with the most severe and persistent mental illnesses, significantly reduces hospitalizations, incarceration, homelessness, and increases employment, decent housing and quality of life.
The involvement of consumers and family members in all aspects of planning, organizing, financing, and implementing service-delivery systems results in more responsiveness and accountability, and far fewer grievances.
Signs of Depression and Suicide Risk
Just about everyone has considered suicide, however fleetingly, at one time or another. There is no danger of “giving someone the idea.” In fact, it can be a great relief if you bring the question of suicide into the open, and discuss it freely, without showing shock or disapproval. Raising the question of suicide shows you are taking the person seriously and responding to the potential of his/her distress.
If the answer is “Yes, I do think of suicide,” you must take it seriously.
Ask questions like: Have you thought about how you’d do it? Do you have the means? Have you decided when you’ll do it? Have you ever tried suicide before? What happened then?
If the person has a defined plan, the means are easily available, the method is a lethal one, and the time is set, the risk of suicide is very high. Your response will be geared to the urgency of the situation as you see it. Therefore, it is vital not to underestimate the danger by not asking for details.
Common Misconceptions About Suicide
“People who talk about suicide won’t really do it.”
Almost everyone who commits suicide has given some clue or warning. Do not ignore suicide threats. Statements like “You’ll be sorry when I’m dead,” or “I can’t see any way out” — no matter how casually or jokingly said — may indicate serious suicidal feelings.
“Anyone who tries to kill themselves must be crazy.”
Most suicidal people are not psychotic or insane. They must be upset, grief-stricken, depressed, or despairing, but extreme distress and emotional pain are not necessarily signs of mental illness.
“If a person is determined to kill themselves, nothing is going to stop them.”
Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.
“People who commit suicide are people who were unwilling to seek help.”
Studies of suicide victims have shown that more than half had sought medical help within six months before their deaths.
“Talking about suicide may give someone the idea.”
You don’t give a suicidal person morbid ideas by talking about suicide. The opposite is true — bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.
Persons who may be at high risk for suicide:
How to Find Out If Someone Is Suicidal
Ask these questions — in the same order — to find out if the person is seriously considering suicide:
1. “Have you been feeling sad or unhappy?”
A “yes” response will confirm that the person has been feeling some depression
2. “Do you ever feel hopeless? Does it seem as if things can never get better?”
Feelings of hopelessness are often associated with suicidal thoughts.
3. “Do you have thoughts of death? Does it seem as if things can never get better?”
A “yes” response indicates suicidal wishes but not necessarily suicidal plans. Many depressed people say they think they’d be better off dead and wish they’d die in their sleep or get killed in an accident. However, most of them say they have no intention of actually killing themselves.
4. “Do you ever have any actual suicidal impulses? Do you have any urge to kill yourself?”
A “yes” indicates an active desire to die. This is a more serious situation.
5. “Do you have any actual plans to kill yourself?”
If the answer is “yes,” ask about their specific plans. What method have they chosen? Hanging? Jumping? Pills? A gun? Have they actually obtained the rope? What building do they plan to jump from? Although these questions may sound grotesque, they may save a life. The danger is greatest when the plans are clear and specific, when they have made actual preparations, and when the method they have chosen is clearly lethal.
6. “When do you plan to kill yourself?”
If the suicide attempt is a long way off (say, in five years) danger is clearly not imminent. If they plan to kill themselves soon, the danger is grave.
7. “Is there anything that would hold you back, such as your family or your religious convictions?”
If the person says that people would be better off without them, and if they have no deterrents, suicide is much more likely.
8. “Have you ever made a suicide attempt in the past?”
Previous suicide attempts indicate that future attempts are more likely. Even if a previous attempt did not seem serious, the next attempt may be fatal. All suicide attempts should be taken seriously. However, suicidal “gestures” can be more dangerous than they seem, since many people do kill themselves.
9. “Would you be willing to talk to someone or seek help if you felt desperate? With whom would you talk?”
If the person who feels suicidal is cooperative and has a clear plan to reach out for help, the danger is less than if they are stubborn, secretive, hostile, and unwilling to ask for help.
Further Resources About Suicide
American Association of Suicidology — AAS is dedicated to the understanding and prevention of suicide by promoting research, public awareness, education and training for professionals and volunteers.
Web site: www.suicidology.org (also provides listings of state-by-state suicide crisis lines).
American Foundation for Suicide Prevention — 120 Wall Street, 22nd Floor, New York, NY 10005.
Website: www.afsp.org
E-mail: inquiry@afsp.org
Phone: (888) 333-AFSP (not a crisis line)
or (212) 363-3500.
Covenant House Youth Crisis Line
(800) 999-9999
Suicide Prevention Action Network (SPAN) — A non-profit organization “dedicated to the creation of an effective national suicide prevention strategy.”
Website: www.spanusa.org
Phone: (888) 649-1366 (not a crisis line)
800 SUICIDE
24-hour hotline, (800) 784-2433 National Hopeline Network 24/7
Video/DVD
“The Truth about Suicide: Real Stories of Depression in College”
The American Foundation for Suicide Prevention (AFSP) has developed “The Truth about Suicide: Real Stories of Depression in College” as an outgrowth of its commitment to support colleges and universities in implementing suicide prevention as an integral part of their ongoing campus activities and services. The aim of this 27-minute film is to present a recognizable picture of depression and other problems associated with suicide, as they are commonly experienced by college students and other young adults.
“The Truth about Suicide: Real Stories of Depression in College” is $19.95 (includes shipping and handling) and is available in both DVD or VHS format. A 23-page facilitator’s guide is included with the film, which contains steps and guidelines for facilitators showing the film, as well as suggested discussion topics and frequently asked questions. The film can be ordered by calling (888) 333-AFSP Ext. 10.
“Fierce Goodbye: Living in the Shadow of Suicide”
Mennonite Media, www.mennomedia.org,
DVD $24.95, Video $19.95
This 2005 documentary focuses on stories from people who have experienced suicide in their families or among their loved ones, and how they have found hope amid terrible pain. This documentary seeks to facilitate more open conversation in the church and society about the once-taboo topic of suicide, and thereby help survivors move toward healing.
Dispel the Myths About Mental Illness or Brain Disorders
Learn about some of the myths and facts around mental illness by downloading a PDF file of this chart. Provide a copy of it to your congregation's caregivers and deacons or others who regularly respond to those experiencing difficulties.