Arlington, VA: what's the difference between wishing your life was over in a general sense and taking affirmative steps to end it? Is there a long distance psychologically between those two?

Kay Redfield Jamison: there is a great deal of difference between the two. thinkinging generally about suicide is not rare but if the thoughts become too frequent or if you find yourself thinking too specifically or wiht too much desperation or hopelessness be sure and seek out help. one general piece of advice for a consultation is to cl call the department of psychiatry at your nearest medical school and ask for the name of a clinician who specializes in mood disorders or suicide prevention. there is a more comprehensive list of referral sources and patient advocacy groups.to follow.

McLean VA: Dr. J

Your books are quite inspirational and educational. Was wondering if could comment on how your evolving love life helped your recovery or your recovery helped your love life. I was particularly taken by your first book's discussion about your relationships after your divorce.

Kay Redfield Jamison: There's no question that a good relationship is a wonderful source of support and very important. I have been very fortunate in that regard. But I have to say that good relationships do not keep depression or suicidal thinking at bay. It is good treatment that does that.

DC: Can you speak to the role that sexual orientation plays in suicide? I'm thinking specifically of the difficulties of being a gay-lesbian-bisexual kid, or of someone trying to "change" their sexual orientation, voluntarily or otherwise.

Kay Redfield Jamison: There is a controversy about the risk of suicide in gay and lesbian people. There appears to be an increased rate of depression and suicide attempts but there is no clear evidence that completed suicides are more common. In any event, it is important for society to extend tolerance to all groups because the kind of discrimination that exists certainly makes whatever depression exists more dangerous. I disagree with the idea that people should feel forced to change their sexual identity through therapy or anything else.

Washington, D.C.: I'm curious about the rash of workplace and school shootings -- one theory is that the shooters are actually attempting suicide. Why would someone want to take so many colleagues with him? Why not just commit suicide right out?

Kay Redfield Jamison: I think that workplace killings are certainly complex in their causes. In some instances, suicide may be the underlying motivation. For most killings, there is probably much more going on. There is a relationship between murder and suicide that is just beginning to be studied and better understood, and there seem to be some biological underpinnings that both share in common. Easy access to firearms almost certainly compounds everything. Also, suicide is essentially an irrational act so it is difficult to know what is going on in the mind of someone who kills not only himself but others as well.

Springfield, VA: I recently read "An Unquiet Mind" and found it helped me to better understand a close family member with Manic Depression. He will be moving to this area at the first of the year, I want to know where I can find good therapy for him as well as for the family. Until your book, we thought that his acts were willful rebellion or at best just foolishness on his part. We so want to help him to over come this disease, but I feel without proper help ourselves that he could be loss to this illness and ultimately windup dead, institutionalized, or incarcerated. I know that he has had trouble in the pass sticking with his medication and at least one attempt at suicide which he denys. Thanks for any advice you could give.

Kay Redfield Jamison: Thank you for your remarks. There will be a list of referrals and advocacy group telephone numbers and webites to follow. Good luck.

Washington, DC: I am currently reading your book-- after trying it twice myself--your book makes so much sense. It is helpful to read that you are not alone in this.

Kay Redfield Jamison: Thank you. It is certainly true that it is difficult enough to be alone with depression or mental illness or suicidal thinking and it is particularly difficult because our society seems so reluctant to discuss these conditions in a straightforward manner or in a manner conducive to the kind of public health problem they represent.

ARLINGTON VA: Is there any way to ease the pain of friends whose 18 year old killed herself last year? They are so terribly sad understandably but is there hope for them to ever feel happy again?

Kay Redfield Jamison: Losing a friend to suicide, especially when you are young, is a truly dreadful thing. In my experience, one of the most helpful things for adolescents, young adults, or indeed almost anyone, is to learn more about what causes suicide. This helps to alleviate some of the guilt that is almost inevitably present, and can provide hope for treatment in the instances where a friend might feel himself or herself at risk for suicide. Again, we need as a society to talk far more openly about mental illness and suicide. The mental illnesses most closely linked to suicide are ones that appear most frequently in adolescents or young adulthood. There is no excuse for so little discussion of such common and potentially deadly illnesses. Although it is devastating to lose a friend to suicide, there's every reason to expect that the friends will go on to have full lives and certainly become happy again. Most people who lose someone to suicide remember it always but often learn from it as well.

Scranton, PA: I read your last book and also recently heard you speak at the Society for Neurosience conference in Miami. Is there anyway to convince people to see seek help? I have a friend that is on SSRI's but won't take them regularly but who should seek actual therapy in addition to medication. I just can't get through to him.

Kay Redfield Jamison: Trying to get people to seek treatment or to stay in treatment is one of the most difficult clinical situations that I know. There is no easy way. Occasionally talking one to one with a friend or family member is effective but more often than not it is not. Sometimes using the "intervention" approach used in alcoholism or drug abuse can be helpful. This means sitting down with a group of family members, friends, colleagues and discussing concerns and recommendations for treatment. It is more difficult to dismiss or deny the concerns of a group than it is and individual. Occasionally having the person read books or articles can be helpful. If it is an emergency, however, more aggressive action needs to be taken. If someone is accutely suicidal, persons should not be left alone; all knives, sharp objects, guns, medications, should be removed from the house; you should call 911 or walk the individual to an emergency room. Often people who are around people who are depressed or suicidal need support and information themselves. There are several groups that can be contacted, to follow, including the National Depressive and Manic Depressive Association, based in Chicago; the National Alliance for the Mentally Ill, based in Arlington, Virginia; and the Depression and Related Affective Disorders Association, based at Johns Hopkins Hospital in Baltimore, Maryland.

MD: I have been diagnosed as clinically depressed, and there have been times when I really didn't feel like living and was certain that nothing would ever get better. Actually killing myself, however, has NEVER crossed my mind. "Why" then, do some people truly want to kill themselves? What is going on in their thought processes? Especially when they are receiving treatment for depression and are getting better....some people still commit suicide. What is going on?

Kay Redfield Jamison: It is not entirely clear why some people think of suicide and others do not. We do know that thinking and acting on suicidal thoughts is related to several things: the severity of the depression and hopelessness, family history of suicide, accompanying alcohol or drug abuse, a volatile temperament or a tendency toward impulsive actions. We do know that committing suicide while seemingly getting better is not uncommon. This is probably due to several things: in some instances, people are dissembling and are not in fact getting better. In other instances, people are protected by a very severe depression because their energy levels are so low and they are paralyzed by indecisiveness. As they begin to recover, they get more energetic and are able to act on their desires to die and they are less ambivalent about dying. Likewise many people as they come out of a depression go into a "mixed state" where they experience symptoms of both depression and mania. The combined agitation and extreme restlessness of mania with morbid and melancholic mood is often lethal.

Alexandria, VA: One of my good friend's sister committed suicide two weeks ago. Needless to say, she is devastated and trying to deal with her own grief, as well as concern for two young children her sister left behind -ages 1 and 3-. Do you have any recommendations for books that deal with grief, particularly geared toward suicide of a loved one?

Kay Redfield Jamison: I would recommend getting in touch with one of the support groups run by either the American Foundation for Suicide Prevention or the American Association of Suicidology. Their numbers will be listed below at the end of the discussion.

arlington va: Dr. J

Any easy understanding of the question of nature vs. nurture? Some folks are born with chemical tendencies towards depression and suicide...some folks are 'driven' to this due to stress -e.g., abuse-. Why do some survive abuse better than others? Some brains are more resilient to the neuro-chemical results of prolonged and-or severe stuff?

Kay Redfield Jamison: Sorry, no easy understanding. But if you ask this question again in about 10 years someone will have a good answer. Scientists are making extremely good progress in sorting out the role of genes and environment, of underlying vulnerabilities and external stresses. But it will be some time before we know what protects and what predisposes to suicide. We DO know that mental illnesses such as depression, manic depression, schizophrenia, anti-social and borderline personality disorders, especially when combined with alcohol or drug abuse, are present in 90-95% of all suicides.

VIENNA VA: How can one get over the suicide of their own child?

Kay Redfield Jamison: I don't know that anyone ever really gets over the suicide of a child. It is utterly devastating. However, I have met hundreds and hundreds of parents who have gone through this. It's awful but people do slowly heal. Support groups, religion, learning about suicide and mental illness, can be helpful. Many parents become involved in advocacy work with other survivors of suicide: they advocate in school systems, they raise money for research and they lobby Congress. These things clearly do not bring back a child but they can help.

College Park, MD: In college, I had a friend who I was getting to know. He told me that he suffered bi-polar dispositions but I could tell that he was actively trying to get involved in student groups and opening up to my peers. He was endearing.
At one point, I think after an argument with his father, he felt incredibly alone and committed suicide. Although I was not very close with him, we had mutual friends. I remember at the funeral so many people visited even though he thought he had no friends.
I am still affected by his death and wish I had done something to prevent it. I remember him vividly but most of all his warmth and laughter he brought to his peers.

Kay Redfield Jamison: It is totally natural to feel somehow responsible for the death of someone you know who's committed suicide. It doesn't seem to matter much sometimes how well you actually knew the person. We all think we could have done more, been more sensitive, gotten the person into treatment, called the doctor, whatever. If someone dies from leukemia we do not tend to feel this way, and yet the cause of the suicide is almost always due to an underlying psychiatric illness.

Washington, DC: My son, who is five, has recently begun making derogatory statements about himself -such as "I hate myself" or "I am stupid"-, and even slapping his legs and his face. He horrified my husband and myself recently when he said -after being verbally reprimanded for running wildly around a store- "I probably should just be dead". Please be aware that he is very rarely spanked, and our household is very physically loving and supportive of him.

We were so concerned that we have taken him to see a psychologist, and she dismisses his behavior as "trying to get attention." Do you agree? IS suicide a concern in a child of this age? Thank you for your input.

Kay Redfield Jamison: I don't know whether or not your son's behavior is simply "trying to get attention" but I do know that I would be inclined to get a second opinion. One should always take seriously any discussion of suicide or desired death and suicide, while very rare in five year old children, is still something to be concerned about.

Washngton, DC: A close colleague of mine committed suicide a few years ago. He had been accused of sexual harassment by a number of subordinates who had taken offense to a few jokes he had told at an event. ALthough he apologized for the jokes the organization felt obligated to investigate the matter fully. His suicide came just before the official investigation exonerated him. My question is it possible that he always had it in him to commit such an act, or can cirecumstances arise that will drive anyone to take their life?

Kay Redfield Jamison: Events in the environment, especially highly stressful ones, can sometimes precipitate suicide or influence the timing of a suicide in vulnerable people. But most people under exceedingly stressful situations still do not commit suicide. There seems to be a vulneralbility to suicide that is required.

Chevy Chase: What should you do if someone confides in you that they want to kill themselves, but makes you swear not to tell anyone else...including , or especially, their parents? I know you should tell -someone-, to try to stop the person from killing themselves, but if you are the only person they trust and then you violate their trust, couldn't this have terrible consequences?

Kay Redfield Jamison: This is a difficult but not uncommon situation. In a clinical situation, disclosing suicidal intent is one of the few legitimate and ethical reasons for breaking confidentiality and patients should be advised this in advance. In friendship, it is a slightly different situation, of course, but life exerts the most important influence. Generally people who are telling you that they're suicidal both hope and do not hope that you will somehow act on what they're telling you. In any event, one should act. One should say "I'm concerned, we need to figure out something to do, there are treatments that work and are available and we need to seek help".

Arlington: I lost a friend this year to suicide and it was very mysterious. He was alive for his brother's suicide and seemed to be working thru it in counseling and friends. Then he was dead one day. No one in his family wants to talk about it. In fact, they won't even use the word suicide. Many of us, who found out about his death several weeks later, are still wondering what the hell happened.

Kay Redfield Jamison: It is human nature to deny the awful, and to avoid thinking about the unthinkable. Many people, despite conclusive evidence from the medical examiners, continue to believe that a person died by accident rather than by intention. This, while understandable, makes it very difficult for other people to come to terms with the individual's death and obviously postpones indefinitely the coming to terms of the family members. Only when newspapers and the rest of the media, when doctors, when teachers, when all of us in society start talking directly about suicide will we have a chance to diminish the stigma and increase the chances that others will get into the kind of treatment they need in order to prevent suicide.

Kensington, Md: Do you see an increase in suicide as we approach January first? Many people seem to invest this particular New Year with mystical and religious import. And there are many so-called millennial groups predicting the end of the world. Does this sort social mania promote suicide?

Kay Redfield Jamison: No. In fact, if the future is to any extent predicted by the past, the suicide rate in January will be one of the lowest of the year. This is because there is a strong seasonal component to suicide with suicide occurring far more frequently in the late spring and early summer and least frequently in December and January. I would be surprised if the sort of "social mania" to which you refer has much of an effect on the overall suicide rate.

washingtonpost.com: Sorry, but we've run out of time. Thanks to all the participants. As promised, following is a list of resources: American Association of Suicidology 4201 Connecticut Avenue, N.W. Suite 408 Washington, D.C. 20009 (202) 237-2280 www.suicidology.org American Foundation for Suicide Prevention 120 Wall Street, 22nd Floor New York, N.W. 10005 (888) 333-2377 www.afsp.org Anxiety Disorders Association of America (301) 231-9350 www.adaa.org Depression and Related Affective Disorders Association The Johns Hopkins Hospital, Meyer 3-181 600 North Wolfe Street Baltimore, Maryland 21287 (410) 955-4647 www.med.jhu.edu/drada National Alliance for the Mentally Ill 200 North Glebe Road, Suite 1015 Arlington, Virginia 22203 Help line: (800) 950-6264 front desk: (703) 524-7600 www.nami.org National Depressive and Manic Depressive Association 730 North Franklin Street, Suite 501 Chicago, IL 60601 (800) 826-3632 www.ndmda.org National Mental Health Association 1201 Prince Street Alexandria, VA 22314 (800) 969-6642 www.nmha.org Suicide Prevention Advocacy Network 5034 Odin's Way Marietta, GA 30068 (888) 649-1366 www.spanusa.org

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