What does it mean to overshare? To overshare is to reveal an inappropriate amount of detail about one’s personal life. I think it is somewhat subjective to determine just what is inappropriate. I think it’s different for everybody and even somewhat situational. In my profession, it is just a way of life.
I just heard these words the other day. “I don’t mean to overshare..but”. I am never sure what the point is of leading with that statement. Does the patient expect me to be shocked? Ask them to refrain from saying what they were going to say? Heck no! My usual reaction is to just buckle up and lean in closer. I can’t wait to hear what they have to say. Usually it is something pretty juicy and intimate….my orgasm was mind blowing from that treatment you did, I had the best sex ever after I started that medicine, a very personal description of a vaginal sensation, etc, stuff like that.
Why worry about saying stuff like that? If you can’t tell the gynecologist stuff like that, who the heck can you tell? My very profession is all about oversharing. It’s not like you can just blurt out stuff about your pelvis just anywhere. But you can here! The best way for me to help you with any of your concerns is to know everything!…every…last….detail. There is nothing embarrassing about it. If you tell me everything, we can either celebrate it or get to the bottom of the problem together. It is a win win. So, c’mon. Let’s start sharing.
I don’t think there is a dry eye or a non-stunned heart in the house when it comes to thinking about the recent sudden passing of Stephen “tWitch” Boss. We are all saddened and stunned. We are all wondering how we missed the signs. We are all asking the question ” How could we prevent this from happening?” Instead of continuing to ask these questions after the fact, it is time to talk about it and get educated for the future. I know I need to.
I recently read an article from the CDC about suicide. I realize that a lot of you may not put value in anything that the CDC says right now, but I am using this as just a resource for some definitions, etc.
First of all, let’s define what suicide is. Suicide is defined as death caused by injuring oneself with the intent to die. A suicide attempt is defined as when someone harms themselves with an intent to die, but they do not die as a result of their actions. It is a serious, devastating, personally intimate, and also public health problem. It is the leading cause of death in the United States, causing up to 45,979 deaths in 2020. This literally translates to one death about every 11 minutes. The numbers of people who think about suicide or attempt it is even higher! In 2020, approximately 12.2 million Americans thought about suicide, 3.2 million planned an attempt, and 1.2 million actually attempted.
Suicide does not discriminate for age. It affects all ages. It was in the top 9 leading causes of death in 2020 in people ages 10-64. It was the second leading cause of death for people ages 10-14 and 25-34.
These statistics are overwhelming. Suicide causes emotional, physical and economic devastation. Survivors may have long term injuries or suffer long term depression. It affects friends, family, co workers, and the community at large. Emotional distress pervades the lives of the victim’s family along with shock, guilt, depression, etc. Sometimes family members can begin to think about suicide. Suicide is also devastating from a financial standpoint. in 2019 suicide and non-fatal self harm cost about 490 billion in medical costs, work loss costs and quality of life costs.
So, what can we do about this? Is there anything? Let’s talk about that. I have been through this before with a friend in high school. We did not reach her in time and I have missed her ever since. I remember being wracked with guilt and self blame, on top of the sadness. Why didn’t I see this coming? What should I have done? The questions kept coming and still do. Let’s talk about some strategies that might help. We’ve got to try something.
It is said that suicide is preventable. I am not sure that is true in every case. I worry that this kind of statement may only lead to more self blame for everyone left behind. Having said that, I do truly believe that everyone has a potential role to play to save lives. We need a comprehensive public health approach as well as a family and friends approach.
This resource explains strategies to reduce suicide with the best evidence that is available at this point. The intent is to help states and communities to prioritize suicide prevention strategies that could potentially have the most impact. The strategies it focuses on the most are 1) strengthening economic supports, 2) Creating protective environments 3) improve access and delivery of suicide care, 4) Promote healthy connections, 5) teach coping and problem-solving skills, 6) Identify and support people at risk, 7) Lesson harms and prevent future risk
Let’s break each of these down.
Strengthening economic supports- This means strengthening household financial security and stabilizing housing
Create protective environments- This means reduce access to lethal means among persons at risk for suicide. Create healthy organization policies and culture. Reduce substance use
Improve access and delivery of suicide care- This means we need health insurance coverage for mental health issues. We need more providers in underserved areas. We need to provide rapid and remote access to help. We need safer suicide care.
Promote healthy connections- Focus on healthy peer norms and engage members of a community in shared activities that are positive.
Teach coping and problem-solving skills- This means teach parenting skills to improve family dynamics. Support emotional resilience through education. Support social and emotional learning.
Identify and support people at risk- The first challenge for this is to be able to identify who is at risk. We will talk about that in a minute. We need to be able to respond to crises and have safety plans and follow up after attempts. OUr job is not done after an unsuccessful attempt. Multiple therapies must be available
Lessen harms and prevent future risk- Again, our job is not done after an unsuccessful attempt. Postintervention is extremely important to prevent future attempts
Now that we have talked about these strategy categories, lets talk about what contributes to risk of suicide. What are we looking for? We need to keep in mind that suicide is rarely if ever caused by a single event or circumstance. It is a range of factors at all levels: society, relationship, community, and individual.
Let’s look at some individual risk factors.
History of depression or other mental illness
Previous attempt
Criminal or legal problems
History of child abuse
Financial or job problems
Violence victim or perpetrator
Hopelessness
Chronic illness or pain
Aggression
Let’s look at Community Risk Factors
Suicide cluster in the community( a pact, etc)
Community violence
Discrimination
Lack of healthcare access
Historical trauma in a community
Let’s look at Relationship Factors
Bullying
Loss of relationship
Violent relationships
Social isolation
Bullying
Family history of suicide
Last, but not least, let’s look at societal factors
The stigma and labels attached to getting help for mental health issues
Unsafe media portrayal of suicide
Easy access to lethal methods
So, what are the warning signs? Look for things like someone talking about being a burden. Look for isolation. watch for increased anxiety. Listen for talking about unbearable pain or feeling trapped. Mood swings are a concern. Watch for too much or too little sleeping. Listen and pay attention if someone talks or posts about wanting to die. Watch out for increased rage. People that are at higher risk include veterans, people in rural areas, mine workers, and construction workers. The LGBTQ population is also at higher risk of suicide.
When we see or hear those warning signs, what do we do? We can use all the strategies we already talked about above: financial support, better access to care, create protective environments, connect people with each other and their community, teach coping and problem solving, identify those at risk and prevent further risk. More immediately, if you think someone is at risk, talk to them. Have them contact the 988 Suicide and Crisis Lifeline. There are two options
Call or Text 988
Chat at 988lifeline.org
This is 24 hour, confidential support with a trained crisis counsellor.
The bottom line of all of this is, keep an eye on the people you care about. Ask questions. Have frank discussions. Seeming OK on the outside does not always mean they are ok on the inside.
As my lymphedema gently nudged me awake from my slumber this morning, I suddenly realized that today is a huge mental load. Today is exactly two years from the day I bolted awake with a feeling of dread, a big lump on my neck and the unconfirmed knowledge that something was horribly wrong. Even though my diagnosis was not confirmed until about two months later, that is where my journey truly started. I should have realized it was coming. On the surface, I was suppressing the memory, but my body knew better. I haven’t felt like myself in days. I had some random panic attacks. My fibromyalgia was flaring like nobody’s business and I got my first migraine in a long time. Now it all makes sense. I was refusing to acknowledge my internal ptsd out loud, but my body was doing it for me.
It occurs to me, now, two years later, that I really need to change my strategy. I have made it my mission since cancer to just keep swimming and pushing and to let nothing hold me up or get in my way anymore. I am always in motion, even if I don’t feel well. I sometimes ignore the need to take a break, because I am afraid that it will slow me down enough that I will start to dwell even more on everything that has happened to me. I also spend too much time chastizing myself for my own thoughts because I assume that my trauma clearly wasn’t as severe as a lot of other people’s.
And where is that getting me? NOWHERE! That gets me panic attacks and prolonged fibromyalgia flares and even more missed time doing what I love. I’ve got it all wrong and I need to change my strategy from constant movement to actual acknowledgement. I need to process and acknowledge/accept? what has happened. Otherwise I cannot really move forward. I read a great article in GoodTherapy magazine from May of 2011 written by Susanne Dillman, PsyD. She said that true acknowledgement of trauma is absolutely necessary for healing to begin. She points out that there is no real hierarchy of pain. Trauma is not scalable. This is a belief that is more flawed than accurate. So, me trying to downplay my trauma and compare it to others is getting me nowhere and I need to stop. She says that trauma lies at the utmost extreme of human experience and there is nothing ordinary or expected about it form the individual’s perspective. You cannot compare the danger, horror and fear involved, regardless of the content. The experience is your own. Once something is extreme, trying to rank how extreme it is is useless.
She also points out that you are literally blocking your healing journey by not acknowledging your trauma because you are denying yourself any sense of self compassion. Healing is the only way to truly detoxify trauma. I don’t think she is talking about sitting back and completely wallowing for weeks at a time. She is just saying that you need to realize that it is real and allow yourself to feel in order to get truly past it.
Have you ever said this to anyone? Do you really mean it? What does it really mean? It means please give me the news, whatever it is, in a straightforward manner with no bullshit. Usually it is used in a situation in which bad news is what’s forthcoming. Is that what people really want? I feel like this phrase is said waaaayyy more often than it is truly meant.
I hear this all the time at the office as well. I have patients tell me that they need to know everything and right away. Sometimes this is a complete trap and it does not go well at all when I “give it to ’em straight.” The trouble is that I still can’t completely figure out how to tell ahead of time.
So, as I am want to do, I decided to do some research. I came across an article in Psychology Today that deals with this subject. Let me summarize it for you.
The article starts out by pointing out that there are as many different types of news we don’t want to hear as there are ways and methods to deliver it. The article basically breaks down the process by a few key questions and answers.
The first question to ask yourself is: Is there any good news you can also give? If the answer is yes, start with the good news. Science tells us that people are pushed to act more by bad news if they hear good news first. Dr Angela Legg, a Pace University psychologist says that she prefers a “sandwich technique, good news first, some bad news, then a concrete solution.” If the answer is no, go ahead with the bad news. If there is no chance of any good news to go with it, just get the bad news over with.
The next question to ask is is there any long-term feedback that could be helpful? If so, make sure you include that feedback when you are giving the news.
The next questions to ask are kind of bunched together. Is if the bad news is based on your own judgement or opinion? Are the reasons for the bad news complicated or are they simple? IS the news serious or are you in an important relationship with the person? Then you have to tell them face to face. That shows more empathy and shows that you are invested in the situation, not just a bearer of words.
These are all great suggestions, but none of them are foolproof. Despite best efforts, the doctor patient communication relationship has taken on a whole new level of strain in the last decade. I have noticed lately that patient empowerment is all the rage in the United States. We have pushed aside the old patriarchy of yore where doctors decided and patients complied. Now all patients want equal partnership, if not complete charge, of making decisions for their healthcare. With the invention of electronic medical records, MyChart, and FollowMyHealth and the like, patients even get their results way before I do. I am in favor of this to an extent. I want patients to be involved in their care, but this thinking has extended too far into more of a patient as a consumer, doctor as a supplier relationship. I am not a supplier in a store that patients can go into and dictate what they want and I charge them a price. That is not how it should work. The Wall Street Journal describes a new business model of medicine which requires a new mantra: The customer is always right. But just as doctors playing God won’t fill the bill, neither will patients playing doctor. Dr. Steven Hatch, author of Snowball in a Blizzard” adds that our healthcare system can champion patient autonomy and facilitate more humane treatment and better care by telling patients our real secret. We just can’t offer the kind of confident predictions that patients expect of us. We go on data, science, predictions, experience. There is power and limitations in simultaneously in everything we do and recommend. We need to find some kind of middle ground. I hope we get there someday.
