Make your LOVE last the distance...even for long-distance relationships

http://tinybuddha.com/blog/making-love-last-even-long-distance/

Making Love Last, Even When It’s Long-Distance

By Lavinia Lumezanu

Love as much as you can from wherever you are.” ~Thaddeus Golas

At the time I’m writing this article, I have been in a relationship for 1,369 days out of which 716 have been long-distance.

Yes, I keep track of the days, not just the months or the years, because I live every day, not every month.

I will not pretend the long-distance part has been an easy journey; and anyone who has dabbled even for a little bit in the idea of long-distance relationships can tell you that it takes a lot of love, but more importantly it takes a lot of faith and courage.

My boyfriend and I met in the most casual way at a friend’s fundraiser in a club in Times Square. It wasn’t love at first sight; it was laughter at first sight.

He only knew one person there and everyone I knew was mostly busy organizing everything, so we ended up laughing and talking the entire night. That was the beginning.

Life kept us in New York for a while, then took us to Los Angeles, and then took him even father away to a whole new country and continent. Yet from the moment we met, there was this invisible purple string that always kept us connected across continents and oceans.

Along this journey of faith and courage, I’ve learned a few things that have kept our relationship going strong even through the most challenging times and have made the purple string unbreakable.

Some of them are directly related to the long-distance challenge and others are just about being in a relationship.

1. Physical distance doesn’t automatically mean emotional distance.

Yes, you will have somewhat separate lives, but making an effort to still have a life together makes all the difference. Making an effort to share our lives, our victories, our sad moments, and our celebrations sometimes made the distance seem shorter 

2. The little things matter even more.

All those little things that we all do, especially at the beginning of a relationship, matter even more now. The “happy morning” text messages, or wishing each other good night, reminding each other that how much we miss and love each other. And going even beyond that: sending flowers and love letters, randomly calling just to say “I love you,” preparing little surprises.

3. Making time for each other.

It’s easy to get carried away with daily life and activities and not even realize the last time you actually spoke in person or saw each other on FaceTime. Make time for it, a sacred time every week that’s just for you, a time when you’re not rushed or tired, a time that makes sense for both time zones and make that your date night.

Chances are, if you have a hectic schedule or if the time difference is too big, that date night will be different every week, but make sure it still happens and make it into a real date: have a meal together, talk about your lives, do all the things that make you happy with the other person.

4. Challenging each other and doing things together apart.

Find something that you both enjoy and do it together apart. For us, it was these crazy home workouts.

We started them at the same time, we’d keep each other accountable, we’d compare results, victories, the good days and the bad days, we’d bring each other up on the days when we didn’t feel like working out and kept on track because it was something we did together. It also got us in incredible shape. 

5. There will be fights. Don’t worry.

Conversations over the phone or text always have the extra challenge or not actually seeing the body language of the other person. We receive 55 percent of information through non-verbal cues and body language, so you can imagine how much can be missed in a phone conversation.

Sometimes you will feel like hanging up the phone; try not to. If you think you might say something that you will later regret, ask for a short time out, take a little time to breathe, come back to yourself and continue the conversation. Don’t leave things hanging. 

6. Be kind and reassuring.

There will be moments when either one of you or both of you will lose faith, you’ll doubt the mere viability of the relationship, you’ll doubt your courage, their courage, your love and their love. When you see your partner lose faith, remember it’s not about them losing faith in you or the love you have it’s about distance getting the best of them. 

7. Offer information.

As people we tend to fill in the gaps when we don’t have enough information. Don’t let your partner just fill in the gaps; offer them the information they need. Since distance bends the rules of normal relationship, maybe offer a little more than you think it’s necessary.

Tell your partner about new friends and co-workers, talk to them as if they actually know them and you’re just sharing your day.

8. There’s an infinity in a moment.

Never ever waste a moment together with fighting or focusing on negative things. Your moments are your infinity, and they will live in your heart as a moment repeated over and over again.

You will relive those little moments so many times. What do you want to relive? A quiet morning full of love and light, a last stolen kiss at the airport, or a silly fight over random things? Most of the times, you won’t even remember the moment; you’ll just remember the feeling, so make that infinite moment worth it.

9. Last but not least, love unconditionally.

Unless you can give it your all, love with every last cell of your body, your relationship will crumble under the weight of the distance, the string that holds you together will stretch so far that it will break. Unconditional love is the only thing that reinforces the string over and over and never lets it break.

Love is always a journey, and it just so happens that our journey took us from one coast to the other and then across another ocean, but no matter where life takes us, the purple string that holds us together will always reach.

It’s a journey of love and faith, and most importantly a journey of courage, the courage to believe in love.

Couple silhouette image via Shutterstock

About Lavinia Lumezanu

Hailing from a family of engineers, Lavinia combines her artistic sense with scientific analysis to see the colors behind the numbers and the numbers behind the colors. She specializes in marketing and publicity and loves writing about human nature and challenges. Lavinia speaks fluent English, Romanian, French, and dabbles in Chinese Mandarin and Spanish. Find her at JustLav (http://www.justlav.com).

About Lavinia Lumezanu

Hailing from a family of engineers, Lavinia combines her artistic sense with scientific analysis to see the colors behind the numbers and the numbers behind the colors. She specializes in marketing and publicity and loves writing about human nature and challenges. Lavinia speaks fluent English, Romanian, French, and dabbles in Chinese Mandarin and Spanish. Find her at JustLav (http://www.justlav.com).

‘Depressed’ Mumbai student creates ruckus, delays flight by an hour(Mumbai Mirror)

http://www.mumbaimirror.com/mumbai/others/Depressed-Mumbai-student-creates-ruckus-delays-flight-by-an-hour/articleshow/40822047.cms

Depressed’ Mumbai student creates ruckus, delays flight by an hour

By Aditya Anand, Mumbai Mirror | Aug 24, 2014, 12.31 AM IST

A 21-year-old student from Mumbai, reportedly suffering from depression, created ruckus on an Indigo Airlines flight from Delhi on Friday afternoon, delaying the flight for an hour. He was later asked to get off board. 

As the flight started to move towards the runway for takeoff at 2.30 pm, Rishabh Sethi ran to the cockpit door and started banging on it, demanding to see the captain. When prevented, he started screaming and had to be overpowered by passengers in an exercise that lasted about 20 minutes. 

Airline crew said they tried to talk to Sethi but he refused to budge. He manhandled a crew member when she tried to call the captain using the intercom. "He snatched the handset from the crew member and tried to speak to the captain," an airport official said. As Sethi got more aggressive, some passengers intervened and overpowered him. 

In the interest of passenger safety, the pilot took a call to reject the takeoff and returned to the aircraft bay, where Sethi was handed over to the Central Industrial Security Force (CISF) personnel, who had been alerted by the Air Traffic Controller (ATC). 

Since Sethi had two checked-in bags that also had to be offloaded, the flight was delayed for an hour and took off only at 3.39 pm. 

A case under the Aircraft Act and Indian Penal Code was registered against Sethi at Indira Gandhi International Airport's domestic police station. "We are investigating Sethi's strange behaviour. He was immediately arrested but later released on bail," said Irshad Haidar, DCP-Airport, Delhi police. 

Haider said Sethi's maternal grandfather and an aunt, who live in a Haryana village on the outskirts of Delhi, rushed in on being informed and later bailed him out. 

"They told us that Sethi had been suffering from depression for a while. We have asked them to furnish complete details of his condition and the medication he was under," Haider said. Statements by fellow passengers and crew indicated that Sethi might have been under the influence of some drug. 

In the last five days, Sethi is the second unruly passenger to be handed over to security personnel at Delhi airport. On Wednesday, a passenger on Air India's Melbourne-Delhi flight got unruly after a few drinks and allegedly tore clothes of two flight pursers and tried to beat up and bite some fellow passengers.

Nutritional Deficiencies that could lead to Depression

http://www.healthy-holistic-living.com/10-nutritional-deficiences-that-cause-depression.html?t=mam

10 Nutritional Deficiencies That Cause Depression and Mood Disorders

 

Depression and mood disorders are devastating health problems today. When you go to your doctor, their answer is often a prescription for one of the various popular anti-depressant drugs. Many doctors do not investigate for metabolic or nutritional deficiencies that may be the ‘real problem’ for your depression. Patients have no idea why they feel so awful or where to start looking for the answer. They expect their doctor to give them real solutions. Instead they get drugs as the easy fix. Drugs are not an easy fix because of the serious side effects that come with taking them. Doctors prescribe these drugs from information they get from the drug sales rep which often is only part-truth. The side effects and dangers of these drugs are down-played or left out altogether. Prescription drugs should only be prescribed after other medical problems have been ruled out.

Learn About 10 Nutrient Deficiencies That Cause Depression and Mood Disorder Symptoms:

If you suffer from depression or mood disorders you may be deficient in one of the nutrients below. Researchers have found that many people who suffer from depression and mood disorders are deficient in not just one nutrient but several, all contributing to the symptoms.

#1: Healthy Food Deficiency? Junk Food Diet

Is your diet filled with sugar, junk foods, sodas, or processed foods? Do you often skip meals. If you suffer from depression or mood disorders, start a food diary of the foods you eat every day. You will find answers to your health problems while doing that. Your shopping cart and refrigerator tell the story of your health. My husband works as a cashier at Walmart. People shopping for their family fill their cart with junk sugar filled cereal, chips, candy, soda, , TV dinners, and over-processed food in general. Seven-Elevens thrive on selling candy, soda, and chips to the eat-on-the-run customers. There are very few fresh vegetables or fruit on the average American’s grocery list. This is why so many Americans are obese, depressed, and suffering from diabetes. If your life is not going well, eating junk food is not going to improve your outlook.

#2: Omega-3 Fatty Acids Deficiency:

These are found in foods such as fish and Flax Seed Oil. A deficiency of Omega-3 fatty acids or an imbalance between Omega 3 and Omega 6 fatty acids may be one of the contributing factors to your depression. Omega 3 Fatty acids are important to brain function and your mental outlook on life. They also help people who suffer from inflammation and pain problems. Researchers have found that many patients with depression and mood disorders are deficient in Omega 3 Fatty Acids. It is important to buy fish oil that has been cold processed and tested for heavy metals and other contamination. It should state that on the label.

#3: Vitamin D Deficiency:

Important to immune function, bones, and brain health. Sunlight is the richest source for natural Vitamin D. The Journal Clinical Nutrition in Jan 21st, 2013 published the result of research that analyzed over 18000 British citizens for Vitamin D deficiencies and associated mental disorders links. They found that a deficiency of Vitamin D was present in patients with depression and panic disorders. The study results stated that people who are deficient in Vitamin D are at higher risk for developing depression later in life. Most seniors are deficient in Vitamin D. Often people working long hours in offices are deficient as well. Get out in the sun. Take a walk during your lunch break or walk your dog. Play a game with your kids outside away from computers and the television. Get out of the house and into the sunshine. Just don’t overdo it if you are sensitive to the sun. Overdoing it is not good either.

#4: B-Vitamins Deficiency:

There is much research in Neuropsychiatry that proves the link between B-Vitamin deficiencies and mood disorders including depression. Buy gel capsules instead of tablets with at least 25 mg for each of the different B- Vitamins included in the formulation.

#5: Zinc , Folate, Chromium, and Iron Deficiencies:

Patients with depression are often found deficient in many nutrients including these. Often today’s foods are sadly lacking in minerals and trace minerals.

#6: Iodine Deficiency:

Iodine is necessary for the thyroid to work properly. The thyroid, part of the endocrine system, is one of the most important glands in your body. The thyroid gland affects every function of the body including body temperature, immune function, and brain function. Iodine is found in foods such as potatoes, cranberries, Kelp, Arame, Hiziki, Kombu, and Wakame. This problem was once solved by using Iodine enriched salt. Today iodine deficiency is again becoming a problem with salt free diets. Salty chips, processed foods, and junk food do not contain iodized salt.

#7: Amino Acids Deficiency: There are 9 necessary amino acids that cannot be manufactured in your body. You must supply them to the body by eating quality food choices.

Amino acids are found in meat, eggs, fish, high quality beans, seeds and nuts. You need to eat a variety of different foods to furnish the body with all the amino acids needed to be healthy. Not all foods contain all nine amino acids. Vegetable food sources for amino acids include Moringa Oleifera leaves. Your brain uses the amino acids found in the food you eat to manufacture neurotransmitters needed for optimal brain function.

What are neurotransmitters and what do they have to do with depression?

Healthy brain function needs the proper balance of neurotransmitters. Some neurotransmitters calm the brain and others excite the brain. Their balance in the brain creates stability of emotions and thinking. Often depression and other mental disorders are caused by imbalances in neurotransmitters. Dopamine, noradrenaline, and GABA are three important neurotransmitters often deficient in depression. Orthomolecular physicians have found that treatment with amino acids including tryptophan, tyrosine, phenylalanine, and methionine can correct different mood disorders like depression. The Orthomolecular doctor first takes urine and blood samples to test your amino acid levels. Then if he finds imbalances, you will be given amino acid supplements in the optimal dosage to correct the problem. Orthomolecular doctors treat the base cause for the depression or mental symptoms. If it is a nutritional imbalance such as a Omega 3 deficiency, you will be prescribed that supplement. Instead of treating with drugs, they treat the deficiencies that cause the mental symptoms with vitamins, minerals, and amino acids.

There are tests that prove nutrient deficiencies. The problem is often your standard medicine doctor will not give clearance for the tests, nor will your insurance pay for them. Most doctors are not schooled in nutrition and diet. They have no time to go over your eating and lifestyle habits. Saying that, a few companies and health providers exist who do have preventive health programs. The reality is a majority of people do not get quality preventive healthcare, especially those on Medicaid or Medical. You need to visit a holistic doctor who knows his nutrition. More than likely you will have to pay out-of-pocket for the tests. You can go through Life Extension Institute. After becoming a member, you can receive the tests through the mail. You take the kit to a lab to get your blood drawn. You then send the kit back by mail and receive the results by mail. They do not give you interpretation for the tests nor how to correct the problems found by testing. You can at least find out what vitamins and minerals you are deficient in. Drug-focused therapy is the main reason that so many people never get diagnosed properly. Insurance plans will pay for drugs but not nutritional supplements. That is the sad state of our health care system here. You must take control of your health and find a doctor whose goal is holistic and preventative medicine.

Immune system linked to mental Illness-says new research

Immune system linked to mental Illness-says new research

Mind and body: Scientists identify immune system link to mental illness

Date:

August 13, 2014

Source:

University of Cambridge

Summary:

Children with high everyday levels of a protein released into the blood in response to infection are at greater risk of developing depression and psychosis in adulthood, according to new research that suggests a role for the immune system in mental illness. The study indicates that mental illness and chronic physical illness such as coronary heart disease and type 2 diabetes may share common biological mechanisms

.

Children with high everyday levels of a protein released into the blood in response to infection are at greater risk of developing depression and psychosis in adulthood, according to new research which suggests a role for the immune system in mental illness.

The study, published in JAMA Psychiatry, indicates that mental illness and chronic physical illness such as coronary heart disease and type 2 diabetes may share common biological mechanisms.

When we are exposed to an infection, for example influenza or a stomach bug, our immune system fights back to control and remove the infection. During this process, immune cells flood the blood stream with proteins such as interleukin-6 (IL-6), a tell-tale marker of infection. However, even when we are healthy, our bodies carry trace levels of these proteins -- known as 'inflammatory markers' -- which rise exponentially in response to infection.

Now, researchers have carried out the first ever longitudinal study -- a study that follows the same cohort of people over a long period of time -- to examine the link between these markers in childhood and subsequent mental illness.

A team of scientists led by the University of Cambridge studied a sample of 4,500 individuals from the Avon Longitudinal Study of Parents and Children -- also known as Children of the 90s -- taking blood samples at age 9 and following up at age 18 to see if they had experienced episodes of depression or psychosis. The team divided the individuals into three groups, depending on whether their everyday levels of IL-6 were low, medium or high. They found that those children in the 'high' group were nearly two times more likely to have experienced depression or psychosis than those in the 'low' group.

Dr Golam Khandaker from the Department of Psychiatry at the University of Cambridge, who led the study, says: "Our immune system acts like a thermostat, turned down low most of the time, but cranked up when we have an infection. In some people, the thermostat is always set slightly higher, behaving as if they have a persistent low level infection -- these people appear to be at a higher risk of developing depression and psychosis. It's too early to say whether this association is causal, and we are carrying out additional studies to examine this association further."

The research indicates that chronic physical illness such as coronary heart disease and type 2 diabetes may share a common mechanism with mental illness. People with depression and schizophrenia are known to have a much higher risk of developing heart disease and diabetes, and elevated levels of IL-6 have previously been shown to increase the risk of heart disease and type 2 diabetes.

Professor Peter Jones, Head of the Department of Psychiatry and senior author of the study, says: "Inflammation may be a common mechanism that influences both our physical and mental health. It is possible that early life adversity and stress lead to persistent increase in levels of IL-6 and other inflammatory markers in our body, which, in turn, increase the risk of a number of chronic physical and mental illness."

Indeed, low birth weight, a marker of impaired fetal development, is associated with increased everyday levels of inflammatory markers as well as greater risks of heart disease, diabetes, depression and schizophrenia in adults.

This potential common mechanism could help explain why physical exercise and diet, classic ways of reducing risk of heart disease, for example, are also thought to improve mood and help depression. The group is now planning additional studies to confirm whether inflammation is a common link between chronic physical and mental illness.

The research also hints at interesting ways of potentially treating illnesses such as depression: anti-inflammatory drugs. Treatment with anti-inflammatory agents leads to levels of inflammatory markers falling to normal. Previous research has suggested that anti-inflammatory drugs such as aspirin used in conjunction with antipsychotic treatments may be more effective than just the antipsychotics themselves. A multicentre trial is currently underway, into whether the antibiotic minocycline, used for the treatment of acne, can be used to treat lack of enjoyment, social withdrawal, apathy and other so called negative symptoms in schizophrenia. Minocycline is able to penetrate the 'blood-brain barrier', a highly selective permeability barrier which protects the central nervous system from potentially harmful substances circulating in our blood.

The 'blood-brain barrier' is also at the centre of a potential puzzle raised by research such as today's research: how can the immune system have an effect in the brain when many inflammatory markers and antibodies cannot penetrate this barrier? Studies in mice suggest that the answer may lie in the vagus nerve, which connects the brain to the abdomen. When activated by inflammatory markers in the gut, it sends a signal to the brain, where immune cells produce proteins such as IL-6, leading to increased metabolism (and hence decreased levels) of the 'happiness hormone' serotonin in the brain. Similarly, the signals trigger an increase in toxic chemicals such as nitric oxide, quinolonic acid, and kynurenic acid, which are bad for the functioning of nerve cells.

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Story Source:

The above story is based on materials provided by University of Cambridge. Note: Materials may be edited for content and length.

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Journal Reference:

1. Golam M. Khandaker, Rebecca M. Pearson, Stanley Zammit, Glyn Lewis, Peter B. Jones. Association of Serum Interleukin 6 and C-Reactive Protein in Childhood With Depression and Psychosis in Young Adult Life. JAMA Psychiatry, 2014; DOI: 10.1001/jamapsychiatry.2014.1332

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It's a risk we all take- but beware, Pesticide exposure during pregnancy can lead to Autism!

Pesticide Exposure in Pregnancy Tied to Autism Risk – Full Study

POSTED BY COVVHA - AO2GEN CHILDREN OF VIETNAM VETERANS HEALTH ALLIANCEON JUNE 23, 2014 ·

In a new study from California, children with an autism spectrum disorder were more likely to have mothers who lived close to fields treated with certain pesticides during pregnancy.

Proximity to agricultural pesticides in pregnancy was also linked to other types of developmental delay among children.

“Ours is the third study to specifically link autism spectrum disorders to pesticide exposure, whereas more papers have demonstrated links with developmental delay,” said lead author Janie F. Shelton, from the University of California, Davis.

There needs to be more research before scientists can say that pesticides cause autism, she told Reuters Health in an email. But pesticides all affect signaling between cells in the nervous system, she added, so a direct link is plausible.

California is one of only a few states in the U.S. where agricultural pesticide use is rigorously reported and mapped. For the new study, the researchers used those maps to track exposures during pregnancy for the mothers of 970 children.

The children included 486 with an autism spectrum disorder (ASD), 168 with a developmental delay and 316 with typical development.

Developmental delay, in which children take extra time to reach communication, social or motor skills milestones, affects about four percent of U.S. kids, the authors write. The Centers for Disease Control and Prevention estimates that one in 68 children has an ASD, also marked by deficits in social interaction and language.

In the new study, about a third of mothers had lived within a mile of fields treated with pesticides, most commonly organophosphates.

Children of mothers exposed to organophosphates were 60 percent more likely to have an ASD than children of non-exposed mothers, the authors report in Environmental Health Perspectives.

Autism risk was also increased with exposure to so-called pyrethroid insecticides, as was the risk for developmental delay. Carbamate pesticides were linked to developmental delay but not ASDs. Read More: http://www.nydailynews.com/life-style/health/study-links-pesticides-autism-article-1.1840200

Treat Depression with Compassion, commitment and competence

http://www.nytimes.com/2014/08/16/opinion/depression-can-be-treated-but-it-takes-competence.html?_r=0

The Opinion Pages | OP-ED CONTRIBUTOR

To Know Suicide

Depression Can Be Treated, but It Takes Competence

By KAY REDFIELD JAMISONAUG. 15, 2014

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BALTIMORE — WHEN the American artist Ralph Barton killed himself in 1931 he left behind a suicide note explaining why, in the midst of a seemingly good and full life, he had chosen to“Everyone who has known me and who hears of this,” he wrote, “will have a different hypothesis to offer to explain why I did it.”

Most of the explanations, about problems in his life, would be completely wrong, he predicted. “I have had few real difficulties,” he said, and “more than my share of affection and appreciation.” Yet his work had become torture, and he had become, he felt, a cause of unhappiness to others. “I have run from wife to wife, from house to house, and from country to country, in a ridiculous effort to escape from myself,” he wrote. The reason he gave for his suicide was a lifelong “melancholia” worsening into “definite symptoms of manic-depressive insanity.”

Barton was correct about the reactions of others. It is often easier to account for a suicide by external causes like marital or work problems, physical illness, financial stress or trouble with the law than it is to attribute it to mental illness.

Certainly, stress is important and often interacts dangerously withdepression. But the most important risk factor for suicide is mental illness, especially depression or bipolar disorder (also known as manic-depressive illness). When depression is accompanied by alcohol or drug abuse, which it commonly is, the risk of suicide increases perilously.

Suicidal depression involves a kind of pain and hopelessness that is impossible to describe — and I have tried. I teach in psychiatry and have written about my bipolar illness, but words struggle to do justice to it. How can you say what it feels like to go from being someone who loves life to wishing only to die?

Suicidal depression is a state of cold, agitated horror and relentless despair. The things that you most love in life leach away. Everything is an effort, all day and throughout the night. There is no hope, no point, no nothing.

The burden you know yourself to be to others is intolerable. So, too, is theagitation from the mania that may simmer within a depression. There is no way out and an endless road ahead. When someone is in this state, suicide can seem a bad choice but the only one.

It has been a long time since I have known suicidal depression. I am one of millions who have been treated for depression and gotten well; I was lucky enough to have a psychiatrist well versed in using lithium and knowledgeable about my illness, and who was also an excellent psychotherapist.

This is not, unfortunately, everyone’s experience. Many different professionals treat depression, including family practitioners, internists and gynecologists, as well as psychiatrists, psychologists, nurses and social workers. This results in wildly different levels of competence. Many who treat depression are not well trained in the distinction among types of depression. There is no common standard for education about diagnosis.

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Distinguishing between bipolar depression and major depressive disorder, for example, can be difficult, and mistakes are common. Misdiagnosis can be lethal. Medications that work well for some forms of depression induce agitation in others. We expect well-informed treatment for cancer or heart disease; it matters no less for depression.

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We know, for instance, that lithium greatly decreases the risk of suicide in patients with mood disorders like bipolar illness, yet it is too often a drug of last resort. We know, too, that medication combined with psychotherapy is generally more effective for moderate to severe depression than either treatment alone. Yet many clinicians continue to pitch their tents exclusively in either the psychopharmacology or the psychotherapy camp. And we know that many people who have suicidal depression will respond well toelectroconvulsive therapy (ECT), yet prejudice against the treatment, rather than science, holds sway in many hospitals and clinical practices.

Severely depressed patients, and their family members when possible, should be involved in discussions about suicide. Depression usually dulls the ability to think and remember, so patients should be given written information about their illness and treatment, and about symptoms of particular concern for suicide risk — like agitation, sleeplessness and impulsiveness. Once a suicidally depressed patient has recovered, it is valuable for the doctor, patient and family members to discuss what was helpful in the treatment and what should be done if the person becomes suicidal again.

People who are depressed are not always easy to be with, or to communicate with — depression, irritability and hopelessness can be contagious — so making plans when a patient is well is best. An advance directive that specifies wishes for future treatment and legal arrangements can be helpful. I have one, which specifies, for instance, that I consent to ECT if my doctor and my husband, who is also a physician, think that is the best course of treatment.

Because I teach and write about depression and bipolar illness, I am often asked what is the most important factor in treating bipolar disorder. My answer is competence. Empathy is important, but competence is essential.

I was fortunate that my psychiatrist had both. It was a long trip back to life after nearly dying from a suicide attempt, but he was with me, indeed ahead of me, every slow step of the way.

Kay Redfield Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine, is the author of “An Unquiet Mind: A Memoir of Moods and Madness” and “Night Falls Fast: Understanding Suicide.”

A version of this op-ed appears in print on August 16, 2014, on page A19 of the New York edition with the headline: To Know Suicide. Order Reprints|Today's Paper|Subscribe

In the wake of Robin Williams apparent death by Suicide it becomes imperative that we focus on the family left behind-The Suicide Survivors

http://www.health.harvard.edu/blog/suicide-survivors-face-grief-questions-challenges-201408127342

http://www.feedspot.com/?dadi=1#feed/fof_fo_445083__f_22990/article/1358596691?dd=21393203

Suicide survivors face grief, questions, challenges

POSTED AUGUST 12, 2014, 1:21 PM

Carolyn Schatz, Former Editor, Harvard Women's Health Watch

The death of Robin Williams, reportedly from depression-related suicide, can seem paradoxical. How can such a funny, lively, and successful person be depressed enough to end his life? Crushing sadness can hide behind humor.

In the United States alone, nearly 40,000 people a year die by suicide. Each of these leaves behind an estimated six or more “suicide survivors” — people who’ve lost someone they care about deeply and are left grieving and struggling to understand.

The grief process is always difficult. But a loss through suicide is like no other, and grieving can be especially complex and traumatic. People coping with this kind of loss often need more support than others, but may get less. Why? Survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help.

What makes suicide different

The death of a loved one is never easy to experience, whether it comes without warning or after a long struggle with illness. But several circumstances set death by suicide apart and make the process of bereavement more challenging. For example:

A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, survivors may need to deal with the police or handle press inquiries. While still in shock, they may be asked if they want to visit the death scene. Sometimes officials discourage the visit as too upsetting; other times they encourage it. “Either may be the right decision for an individual. But it can add to the trauma if people feel that they don’t have a choice,” says Jack Jordan, Ph.D., clinical psychologist in Wellesley, MA and co-author of After Suicide Loss: Coping with Your Grief.

Recurring thoughts. A suicide survivor may have recurring thoughts of the death and its circumstances, replaying over and over the loved one’s final moments or their last encounter in an effort to understand — or simply because the thoughts won’t stop coming. Some suicide survivors develop post-traumatic stress disorder (PTSD), an anxiety disorder that can become chronic if not treated. In PTSD, the trauma is involuntarily re-lived in intrusive images that can create anxiety and a tendency to avoid anything that might trigger the memory.

Stigma, shame, and isolation. There’s a powerful stigma attached to mental illness (a factor in most suicides). Many religions specifically condemn the act as a sin, so survivors may understandably be reluctant to acknowledge or disclose the circumstances of such a death. Family differences over how to publicly discuss the death can make it difficult even for survivors who want to speak openly to feel comfortable doing so. The decision to keep the suicide a secret from outsiders, children, or selected relatives can lead to isolation, confusion, and shame that may last for years or even generations. In addition, if relatives blame one another — thinking perhaps that particular actions or a failure to act may have contributed to events — that can greatly undermine a family’s ability to provide mutual support.

Mixed emotions. After a homicide, survivors can direct their anger at the perpetrator. In a suicide, the victim is the perpetrator, so there is a bewildering clash of emotions. On one hand, a person who dies by suicide may appear to be a victim of mental illness or intolerable circumstances. On the other hand, the act may seem like an assault on, or rejection of, those left behind. So the feelings of anger, rejection, and abandonment that occur after many deaths are especially intense and difficult to sort out after a suicide.

Need for reason. “What if” questions can arise after any death. What if we’d gone to a doctor sooner? What if we hadn’t let her drive to the basketball game? After a suicide, these questions may be extreme and self-punishing — unrealistically condemning the survivor for failing to predict the death or to successfully intervene. In such circumstances, survivors tend to greatly overestimate their own contributing role — and their ability to affect the outcome.

“Suicide can shatter the things you take for granted about yourself, your relationships, and your world,” says Dr. Jordan. Some survivors conduct a psychological “autopsy,” finding out as much as they can about the circumstances and factors leading to the suicide. This can help develop a narrative that makes sense.

Sometimes a person with a disabling or terminal disease chooses suicide as a way of gaining control or hastening the end. When a suicide can be understood that way, survivors may feel relieved of much of their what-if guilt. “It doesn’t mean someone didn’t love their life,” says Holly Prigerson, Ph.D., professor of psychiatry at Harvard Medical School and Director of Psycho-Oncology Research, Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute.

Support from other survivors

Suicide survivors often find individual counseling (see “Getting professional help”) and suicide support groups to be particularly helpful. There are many general grief support groups, but those focused on suicide appear to be much more valuable.

“Some people also find it helpful to be in a group with a similar kinship relationship, so parents are talking to other parents. On the other hand, it can be helpful for parents to be in a group where they hear from people who have lost a sibling — they may learn more about what it’s like for their other children,” says Dr. Jordan.

Some support groups are facilitated by mental health professionals; others by laypersons. “If you go and feel comfortable and safe — [feel] that you can open up and won’t be judged — that’s more important than whether the group is led by a professional or a layperson,” says Dr. Prigerson. Lay leaders of support groups are often themselves suicide survivors; many are trained by the American Foundation for Suicide Prevention.

For those who don’t have access to a group or feel uncomfortable meeting in person, Internet support groups are a growing resource. In a study comparing parents who made use of the Internet and those who used in-person groups, the Web users liked the unlimited time and 24-hour availability of Internet support. Survivors who were depressed or felt stigmatized by the suicide were more likely to gain help from Internet support services.

You can join a support group at any time: soon after the death, when you feel ready to be social, or even long after the suicide if you feel you could use support, perhaps around a holiday or an anniversary of the death.

Getting professional help

Suicide survivors are more likely than other bereaved people to seek the help of a mental health professional. Look for a skilled therapist who is experienced in working with grief after suicide. The therapist can support you in many ways, including these:

• helping you make sense of the death and better understand any psychiatric problems the deceased may have had
• treating you, if you’re experiencing PTSD
• exploring unfinished issues in your relationship with the deceased
• aiding you in coping with divergent reactions among family members
• offering support and understanding as you go through your unique grieving process.

A friend in need

Knowing what to say or how to help someone after a death is always difficult, but don’t let fear of saying or doing the wrong thing keep you from reaching out to a suicide survivor. Just as you might after any other death, express your concern, pitch in with practical tasks, and listen to whatever the person wants to tell you. Here are some special considerations:

Stay close. Families often feel stigmatized and cut off after a suicide. If you avoid contact because you don’t know what to say or do, family members may feel blamed and isolated. Ignore your doubts and make contact. Survivors learn to forgive awkward behaviors or clumsy statements, as long as your support and compassion are evident.

Avoid hollow reassurance. It’s not comforting to hear well-meant assurances that “things will get better” or “at least he’s no longer suffering.” Instead, the bereaved may feel that you don’t want to acknowledge or hear them express their pain and grief.

Don’t ask for an explanation. Survivors often feel as though they’re being grilled: Was there a note? Did you suspect anything? The survivor may be searching for answers, but your role for the foreseeable future is simply to be supportive and listen to what they have to say about the person, the death, and their feelings.

Remember his or her life. Suicide isn’t the most important thing about the person who died. Share memories and stories; use the person’s name (“Remember when Brian taught my daughter how to ride a two-wheeler?”). If suicide has come at the end of a long struggle with mental or physical illness, be aware that the family may want to recognize the ongoing illness as the true cause of death.

Acknowledge uncertainty. Survivors are not all alike. Even if you are a suicide survivor yourself, don’t assume that another person’s feelings and needs will be the same as yours. It’s fine to say you can’t imagine what this is like or how to help. Follow the survivor’s lead when broaching sensitive topics: “Would you like to talk about what happened?” (Ask only if you’re willing to listen to the details.) Even a survivor who doesn’t want to talk will appreciate that you asked.

Help with the practical things. Offer to run errands, provide rides to appointments, or watch over children. Ask if you can help with chores such as watering the garden, walking the dog, or putting away groceries. The survivor may want you to sit quietly, or perhaps pray, with him or her. Ask directly, “What can I do to help?”

Be there for the long haul. Dr. Jordan calls our culture’s standard approach to grief the “flu model”: grief is unpleasant but is relatively short-lived. After a stay at home, the bereaved person will jump back into life. Unfortunately, that means that once survivors are back at work and able to smile or socialize again, they quickly get the message that they shouldn’t talk about their continuing grief. Even if a survivor isn’t bringing up the subject, you can ask how she or he is coping with the death and be ready to listen (or respect a wish not to talk about it). Be patient and willing to hear the same stories or concerns repeatedly. Acknowledging emotional days such as a birthday or anniversary of the death — by calling or sending a card, for example — demonstrates your support and ongoing appreciation of the loss.

Helpful resources for suicide survivors are available at from the American Foundation for Suicide Prevention and the American Association of Suicidology.

(An earlier version of this article appeared in the July 2009 Harvard Women’s Health Watch.)

Related Information: Understanding Depression

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