An open letter to Vynamic CEO Dan Calista: fixing (mental) healthcare

Dear Dan:

I graduated from Archmere Academy in Claymont, Delaware, in 1989 with thirty AP credits, and then headed to Notre Dame.  After three and a half years in South Bend, I graduated Magna Cum Laude with a double major in English and Computer Applications in 1993.  I thought I was going to be a lawyer, eventually, but figured I would work for a while first, so I pursued opportunities in information technology.  I received job offers from Arthur Andersen Tax Technology Group in Chicago, Andersen Consulting in Philadelphia, Price Waterhouse in Washington, D.C. and Ernst & Young in New York City, but I accepted a position with The Travelers in Hartford primarily because their “ACCENT Program”  (accelerated entrance into management) was the hardest job offer to win.  Motivated primarily by the fact that I was “college-sick” after leaving my best friends back at Notre Dame after graduating early, I left The Travelers after just five weeks to become the Director of Information Systems at a fast growing restaurant chain in Delaware — Grotto Pizza.

Four years later in 1997, I was the youngest Principal consultant at American Management Systems’ 1 Chase Plaza office, located just a couple of blocks from Wall Street.  I spent most of ‘96 and part of ‘97 living and working in Zurich for Credit Suisse —  my B2B bill rate was $250 an hour.  Then, on the morning of March 2nd 1998, a warehouse manager in Secaucus, New Jersey, named Norman found me inside of a running rental car that I had turned into a makeshift carbon monoxide gas chamber the night before.  I had a near death experience in the back of an ambulance, enroute to the Jersey City Medical Center, and I woke up a couple of days later in the ICU.

I’m writing to see if you’d be open to having a conversation with me about how we might work together to save lives and reduce suffering by helping to transform mental health care in this country.  I am already doing this work on a volunteer basis on a number of fronts.

I am a board member of the Philadelphia Chapter of the American Foundation for Suicide Prevention, who is working with John Madigan (AFSP VP of Public Policy) to leverage my relationship with Vice President Biden to garner political will for a massive increase in public funding for suicide prevention.  I was high school teammates with both of VP Biden’s sons at Archmere Academy.

I am a Zero Suicide champion working with Dr. Tracy Gaudet, the Executive Director of the National Office of Patient Centered Care and Cultural Transformation at the VHA.  I’m participating in Dr. Gaudet’s panel discussion on Whole Health and suicide prevention in the military in September at the VA’s National Leadership Conference.  Secretary Shulkin is committed to reducing the suicide rate at the VA, and he’s asked Dr. Gaudet to organize a panel of experts to address the VA leadership on the subject.  I’m also working with Dr. Gaudet and David Wright from GetWellNetwork to propagate the Zero Suicide framework via GetWellNetwork’s interactive patient care system.  The VHA already utilizes GetWellNetwork’s platform in over forty facilities. GetWellNetwork’s founder and CEO, Michael O’Neil, is one of my closest friends.  We met at Zahm Hall as freshman at Notre Dame in May of 1989.  

I’m in conversation with Keppler Speakers to begin giving talks nationally at universities and colleges before the end of the year with the aim of reducing the U.S. suicide rate.  Here is a video of me practicing the first half of the talk I will be presenting at my alma mater in South Bend.

As far as I can tell, I am the only person on Earth who is leveraging the genius of Albert Einstein to transform humanity’s understanding of the human condition and “mental illness.” I believe that Einstein left humanity an unheralded prescription for peace that almost no one noticed:  acknowledge that human beings don’t possess free will.  If I am ever invited to speak on the TED Talk stage, I suspect it will be because I am committed to spreading the ideas that I outlined in this piece on Medium.

My writing about suicide prevention and mental health care reform has been published by The Good Men Project and Mad in America, thus far.  Christopher Lane (Guggenheim Fellow and author of Shyness: How Normal Behavior Became A Sickness) and I are wrapping up an interview piece entitled “Creating ‘Mental Illness’” that looks back at a critical event in mental health care history at the center of his book Shyness:  the third revision of the APA’s Diagnostic and Statistical Manual of Mental Disorders or DSM-III.  A work in progress excerpt of that piece is included below.

The attached resume doesn’t include my current consulting engagement.  I was hired to  turnaround a failed client reporting enhancement project at one of the top 10 wealth management firms in the U.S. based on fiduciary assets.  My engagement sponsor is the C-level fixed income officer of the firm responsible for managing a $27 Billion portfolio.

I’ve known Scott O’Neil, CEO of the Philadelphia 76ers, the New Jersey Devils and the Prudential Center coming up on thirty years now.  Scott is Michael’s older brother, by one year, who was at Villanova while we were at Notre Dame.  We met in 1989 when Scott was visiting Michael in South Bend to watch a Notre Dame football game.  I mention this fact because Scott is connected to Mairead Hanna on LinkedIn. I haven’t touched base with Scott about this yet. I was compelled to reach out to you cold first.

If you’re open to having a conversation with me to determine if it makes sense for us to seriously consider joining forces in some way to save lives and go after the triple aim in HIT together, please just let me know.  I would greatly appreciate the opportunity to speak with you.

Thanks a lot for your time and consideration.

Sincerely,
Francesco

Francesco Bellafante
American Foundation for Suicide Prevention Philadelphia Chapter Board Member
Zero Suicide Champion
Theory of Mind ~ leveraging the genius of Einstein to end suicide and to maximize well-being
iameinstein.com

Excerpt from:

Creating “Mental Illness”

By Christopher Lane and Francesco Bellafante

How does someone know if they have a mental illness?  How does their doctor know?  Psychiatrists don’t utilize blood tests or brain scans to diagnose their patients.  Instead, they necessarily rely on subjective observations about how their patients seem.  That, plus they listen to stories told by their patients, and others, in order to identify symptoms of mental disorders.  Given our relative ignorance about how the most complex object in the known universe functions, how does a psychiatrist know that a particular feeling, behavior or pattern of thinking and behaving is a symptom of mental illness?

The human brain is made up of about 86 billion neurons that interact in complex ways with one another and with other neurons throughout the central nervous system.  Absolutely no one can cogently explain how a human being’s neurons interact with the rest of its body and the world that body inhabits to give rise to subjective, conscious awareness of that world. Consciousness remains an enduring mystery.  Given these facts, how does anyone objectively draw a dividing line between mental wellness and mental illness?  What amount, degree, or kind of neurosis, psychosis or distress is a natural part of the human condition? How do we know when a person’s behavior or their psychological and emotional state is indicative of psychopathology?

What is mental illness?  Is it a disease like any other resulting from a defective or malfunctioning organ or system of the body?  Or is mental illness too often a phrase used to mistakenly pathologize and stigmatize the human condition itself?

Two influential books that shape humanity’s understanding of what it means to be mentally ill are ones that most people have never heard of let alone ever read. They are the International Classification of Diseases and the American Psychiatric Associations’ Diagnostic and Statistical Manual of Mental Disorders.  Hundreds of nuanced descriptions of different patterns of thinking, feeling and behaving define the bounds of what constitutes “mental illness” or “disorder” for billions of people.  While some question the inclusion of certain kinds of behavioral disorders within the pages of any catalogue of medical diseases, the stories told by psychiatrists citing the conditions defined in these nosologies are respected as scientifically-validated, unquestionable medical truths by many others, in large part thanks to billions of direct-to-consumer advertising dollars spent propagating this narrative.  Exceptionally effective professional storytelling tactics are employed by for profit enterprises marketing powerful mind altering substances to people experiencing anything from a lack of ease in life to paralyzing distress or despair.

I grant that attempting to assuage people’s distress and despair with psychopharmacological treatments may be well-intentioned, but evidence abounds that giving people powerful mind-altering drugs serves to increase people’s suffering in many cases.  In fact, some psych meds prescribed for mental disorders can cause death by inducing something called Neuroleptic Malignant Syndrome.  I was given an injection of Haldol once, without my consent, that could have induced this potentially fatal syndrome within me.  I am grateful I was not informed of the life-threatening nature of the “health care” I was receiving before I was involuntarily injected with a substance that could have killed me.  I share what I’ve learned about these books with the hope that more people will think more critically more often when they speak and write about “mental illness” and “mental disorders.”

The story behind how the ICD and the DSM came to include certain mental disorder descriptions is a fascinating one.  It was 1893 when the International Statistical Institute adopted the International List of Causes of Death.  By the end of 1949 the World Health Organization published the sixth edition of the International Classification of Diseases or ICD-6.  This version was the first to contain a section for mental disorders.  Three years later, in 1952, the American Psychiatric Association’s (APA) Committee on Nomenclature and Statistics published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).  As the APA’s DSM History page on its website explains, “It contained a glossary of descriptions of the diagnostic categories and was the first official manual of mental disorders to focus on clinical use. The use of the term ‘reaction’ throughout the DSM reflected the influence of Adolf Meyer’s psychobiological view that mental disorders represented reactions of the personality to psychological, social, and biological factors.”

(Source:  https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm)

Thirteen years later, in 1965, Sir Aubrey Lewis, a British psychiatrist responsible for the mental disorder section revisions of ICD-8 removed the word “reaction” from the mental disorder names.  This seemingly insignificant nominal change represented a seismic shift in defining mental illness. Christopher Lane from Northwestern University, a 2005 Guggenheim Fellow, wrote about this seminal event in Shyness:  How Normal Behavior Became a Sickness (Yale, 2007).

“The revisions to ICD-8 were bold, even cavalier, and had lasting consequences.  Consulting few outside experts, a situation unimaginable a generation later, the person appointed to update the manual quietly eliminated the term reaction from many diagnostic labels.  As a result, diagnoses like schizophrenic reaction, which in DSM-I had referred to sporadic psychiatric incidents, evolved almost overnight into schizophrenia, even if the person’s symptoms were rare or not especially violent.  The same was true for terms like paranoid reaction, which the DSM-II task force determined henceforth would be known simply as paranoia.  When I asked Robert Spitzer about these revisions, he confirmed my suspicions, ‘ICD-8 was written by one person, [Sir] Aubrey Lewis at the Maudsley [Institute of Psychiatry, London], and he didn’t have the word ‘reaction’ in the eighth edition, so DSM-II didn’t either. ‘No,’ Spitzer added, ‘there was no discussion at all’ on the  DSM-II task force about the viability or consequence of adopting these changes.  Turning phrases like ‘schizophrenic reaction’ into simple nouns (‘schizophrenia’) may seem insignificant.  But as Spitzer concedes, it was a ‘major shift’ in approach, because it altered at a stroke the very meaning of illness for clinicians and patients.

Robert Spitzer was a Professor of Psychiatry on the research faculty at Columbia University in New York City.  In 1974, he became the chair of the APA’s task force responsible for revising  DSM-III.  Spitzer played a major role in leading a faction of psychiatrists on the task force to significantly revise, and add to the number of disorders defined in the DSM-III, swelling the count of conditions contained in the growing catalogue by an eye-popping 46%.

Year          Edition            # of disorders             % growth

1952          DSM-I               106                                      n/a

1968          DSM-II             182                                      72%

1980          DSM-III           65                                        46%

It has been a decade since Lane penned his assiduously researched and insightful account about this transformation of the APA’s Diagnostic and Statistical Manual of Mental Disorders.  His penetrating explanation of how a small group of psychiatrists privately collaborated in the 1970s to revise the organizing document behind their profession is as amusing as it is unsettling.  The incredible but true tale Lane tells about how shyness came to be viewed as an illness is more akin to political farce than erudite debate about how to classify different types of mental disorders, ostensible or otherwise.  Lane gained unprecedented access to the APA’s archives, and found documents detailing disturbing facts about the lack of scientific rigor employed while revising the third edition of this influential document.  He frames this battle over this revision of psychiatry’s diagnostic bible as one driven by deeply-rooted internal conflicts within the field.  Neuropsychiatrists argued for the radical expansion of the diagnostic criteria into many different disorders with specific symptoms while their Freudian colleagues favored a psychodynamic approach with fewer, and more broadly defined categories that recognized the biological, psychological and environmental factors that coalesce into human distress and despair.  While neuropsychiatry clearly won this battle in the pages of DSM-III, Lane’s writing about the inner workings of Spitzer’s task force illuminate how a supposedly scientific process devolved into one guided more by individual personalities, professional agendas and profit potential.

Reflecting on the legacy of Robert Spitzer shortly after his passing in 2015, Lane wrote a post on his blog about a significant exchange between Spitzer and Isaac Marks, involving the inclusion of Panic Disorder in  DSM-III as a stand-alone illness.  Marks “the world-renowned expert on panic, fear and anxiety” was flatly against the inclusion of Panic Disorder as a separate illness.  From Lane’s blog post:

“Though committed to treating and understanding panic, Marks was steadfastly opposed to its being represented as a stand-alone disorder. He was similarly opposed to the formal identification of Social Phobia/Social Anxiety Disorder as a separate disorder, not least after seeing his own research on the subject (pointing to a different conclusion) cited as a reason for the change. The evidence that Social Phobia should be separated off had not been overwhelming and little had been published since that implied otherwise. But on both counts, Marks was overruled. ‘The consensus was arranged by leaving out the dissenters,’ he said to me ruefully, after Spitzer had told him in the men’s room at that key Boston conference that he ‘wasn’t going to win. Panic [disorder] is in. That’s it.’ ‘Never mind about the pros and cons intellectually,’ Marks continued, characterizing Spitzer’s apparently cavalier rejection of his expertise and objections. “Don’t confuse me with the data. It’s in.”

The Boston conference had been paid for by Upjohn Pharmaceuticals, maker of Xanax, a drug that became widely prescribed for Panic Disorder. As the CEO stood up to give his opening remarks, Marks recalled, he admitted quite openly: ‘There are three reasons why Upjohn is here taking an interest in these diagnoses. The first is money. The second is money. And the third is money.’ Despite concern that his research was being misused, to ends he could not support, Marks was, he said, ‘disinvited’ from subsequent discussions. Panic Disorder and Social Phobia/Social Anxiety Disorder weren’t just included in DSM-III, but, as he feared, given such low diagnostic thresholds (including, in 1987, public-speaking anxiety for SAD) that millions of American adults and children became eligible for a diagnosis, with Xanax, Paxil, and other medication among the most frequently prescribed treatments.

After the fact reflections of people involved in the DSM-III task force reinforce the notion that the conditions described by the disorder names defined within the pages of any version of the DSM are certainly unlike other diseases and illnesses that plague humankind in obvious and important ways.  “There was very little systematic research [involved], and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest,” said a consultant on the revision task force.  Others involved commented that, “The poverty of thought that went into the decision-making was frightening… In some cases, the people revising DSM-III [were] making a mental illness out of adaptive behavior.”  In 1984, four years after DSM-III’s publication, psychiatrist George Valliant warned that the “disadvantages of DSM-III outweigh its advantages,” characterizing the revision as one that “represents a bold series of choices based on guess, taste, prejudice, and hope.”

Maybe “mental illness” isn’t what you think it is…

A different version of this post was published by The Good Men Project where it has been shared almost 400 times so far.  Subsequently, this article was republished by Mad in America where it has been viewed over 1100 times.  I recently submitted it to The Mighty.  I received an email from them explaining why they would not be publishing it which included the line below.

Right now, we unfortunately don’t have the capacity to publish every story on our site.

I sincerely doubt “capacity” had anything to do with The Mighty’s editorial decision regarding this piece.

I’ve spent close to twenty years looking for reasons behind why I was compelled to think and act suicidally when I was twenty seven years old.  While my search has yielded more questions than definitive answers thus far, I’m convinced that sharing what I’ve learned so far will help others.

Events happen, and then people think and say things about those events—let’s call those stories.  No matter how accurate or truthful a story is seen to be, events that have occurred and the stories that people tell about those events, are never the same thing.  They can’t be because one is an occurrence in reality while it’s happening, and the other is an after the fact symbolic representation meant to describe a prior real occurrence.  I’m no linguist, but this is the nature of language, right?  We use language and stories to encapsulate and communicate meaning about our reality and our conscious experience of that reality—every word is a story unto itself making sense of existence.  Every diagnosis of every “mental disorder” relies on a translation of stories.  A person tells a psychiatrist a story, and the psychiatrist maps that natural language story onto a “mental disorder” language story from a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Millions of people assigned a “mental disorder” story or a “mental illness” diagnosis end up failing to see the basic event-story distinction I just pointed out.  They confuse their DSM diagnosis or “mental disorder story” with reality itself.  Unfortunately, many patients are also systematically misled to necessarily attribute the issue that prompted them to see a psychiatrist to a supposed specific brain pathology that mysteriously eludes accurate definition and explanation.

I made these mistakes after nearly killing myself nineteen years ago, in part, because of the forces of institutional corruption at work within our mental health care system written about by Robert Whitaker and Lisa Cosgrove in Psychiatry Under the Influence.  I share this true story as an anecdotal example of those corrupting forces in action.  It is my hope to decrease the likelihood that other people won’t be misled like I was.  I also hope to inspire the many well-intentioned but misguided “lived experience” mental health advocates who are confused like I was to think differently.  They are unwitting participants in this harmful confusion’s perpetuation.

A few days after I nearly killed myself a psychiatrist told me that I was suffering from a “mental illness” called Major Depressive Disorder after talking with me for less than fifteen minutes.  That’s all the time it took him to gather enough information to know which “mental illness” was plaguing me and how to treat it.  He prescribed me an antidepressant as he mentioned something vague about the amount of a neurotransmitter in my brain called serotonin and selective reuptake inhibition.  I also began seeing a psychologist for talk therapy twice a week.  In just three or four months I was feeling like my old self again—the same amount of time it had taken me to go from feeling fine to almost killing myself.  I believed the story my psychiatrist told me about the cause of my despair.  He gave me the name of an apparent disorder with my brain, and a pill to fix the problem.  Back then, it seemed to me that the medication I was taking did more to help me than anything the psychologist and I discussed.  That assumption was a costly one for me, and my family.  It led me to make two consequential mistakes that millions of other people diagnosed with a “mental illness” also make.  First, I failed to see my diagnosis as a view of reality, mistaking it for reality itself.  I conflated a series of actual events from my life with a boilerplate story about a “mental disorder” from a big book.  Doctors are trusted authorities.  When you’re unquestionably hurting, it’s comforting when a trusted authority gives you an officially-sanctioned medical reason for why you feel so horrible, and better yet, a remedy to help you.  My mistake was compounded when I came to believe that my diagnosis mapped onto a specific brain pathology necessarily responsible for my problematic thoughts, feelings and behaviors.  My doctor gave no serious consideration to any psychological, social or environmental factors that contributed to the mindset from which my suicidal behavior emerged.  He couldn’t have—he didn’t know enough about any of those factors.  It is no surprise that I blamed my brain for my problems, like millions of other “mental patients” do.  Our collective confusion about a specific brain pathology necessarily being the sole or at least primary causal culpability for our lack of ease is proof of the influence of the forces of institutional corruption within the mental health care system.

A deeper examination of my suicidal crisis subsequent to receiving my “mental illness” diagnosis revealed how childish, fearful, egocentric thinking and bad luck led me down a path towards self-destruction.  To clarify “egocentric” I’m not talking about arrogance, narcissism or even self-preoccupation.  At the heart of my egocentrism in my younger years was the failure to readily recognize that my view of reality, was a point of view at all.  Growing up I prided myself on being right.  I prided myself on objective, quantitative measures of just how right I was.  I was especially proud when I was deemed 100% right.  Egocentric people become attached to being right, and they often are.  I became so accustomed to being right, that I confused my view of reality with reality itself.  I almost killed myself, in part, because of this confusion, this conflation of what I thought was happening with what was actually happening.  There were four other types of childish and/or fearful thinking that led me from being involved in an awkward exchange during a routine business meeting in Toronto to genuinely believing that I was an unintelligent, overcompensated fraud of a human being destined to disappoint my father and myself.  Those types of thinking are called catastrophizing, overgeneralizing, black and white thinking and past counter-example blocking.  Cognitive behavioral therapy is an effective way to address these often disempowering ways of thinking.  This other narrative that describes the conditions and events that led to my psychological and emotional struggle is patently more accurate and more practically useful than anything my psychiatrist told me about my ostensibly malfunctioning brain.  Nineteen years later, it’s evident that me believing that my suicidal behavior necessarily resulted from a “mental illness” was more beneficial to the psychiatrist who told me that than it was for me.  I’m not claiming that this was a fault of my doctor or a sign of bad faith or ill-intent on his part.  His profession trained him to look for different nails to hit with different hammers, and I was a perfect fit for a hit from an antidepressant.  He was just doing his job—playing his role in a system.  Unfortunately, like millions of other people who are given a “mental illness” diagnosis, I came to see my diagnosis as a defining part of my identity because of my respect for my doctor’s authority, and my belief that my problem was necessarily in my brain.  This belief led me to seriously entertain the fallacy that I was biologically destined to suffer from despair over and over again.

My stay at the private mental hospital subsequent to nearly dying by suicide was five days long. I spoke with my psychiatrist on three separate occasions during my five day stay. We spoke briefly on the day I was admitted. We bumped into each other once, and spoke for less than five minutes. And we spoke for about ten minutes on the day I was discharged.  While reviewing my bill, after being released, I noticed that I was billed for “Individual psychotherapy” five times, one charge for each day of my stay. When I called the mental hospital to inform them of the obvious billing error, I was informed that every patient in the facility was charged in this manner. I explained how this seemed patently fraudulent and unethical to me given the literal definition of the word psychotherapy. The person I spoke with apologized but said there was nothing she could do, remarking something like, “That’s just how it works.” The first time I thought and behaved in a way that matched the diagnostic criteria for a “manic episode” found in the DSM occurred after taking an antidepressant. I’m aware this fact doesn’t prove that the antidepressant was the proximate cause of this development in my life, but given the wealth of evidence supporting the hypothesis that antidepressants often have iatrogenic effects on the people who take them, like inducing mania, for example, it’s reasonable to consider that my treatment for Major Depressive Disorder was a causal factor in me exhibiting behavior that led a different psychiatrist to diagnose me with Bipolar Disorder I.

I’m so grateful that someone was willing and able to inspire me to question the stories psychiatrists told me about the cause of my suffering.  Powerful authority figures implying that brain pathology is necessarily to blame for the suffering behind “mental illnesses” increases the chances of people believing that they need to buy pharmaceutical remedies to be well.  How else are psychiatrists who only prescribe psych meds going to their pay bills?  Ironically and probably unbeknownst to the vast majority of people diagnosed with a “mental illness” the National Institute of Mental Health ceased funding research based on the categories listed in the DSM in 2013.  When announcing that no more federal dollars would be spent on research based on the DSM going forward, Dr. Thomas Insel said that diagnosing a “mental illness” by asking a patient about her feelings was analogous to diagnosing a heart patient by asking her about her chest pain.  I’m not arguing that people don’t experience emotional distress.  I’m arguing that the words used to describe the causes of feeling a lack of ease or distress can perpetuate a person’s lack or ease, or worse, compound it.  I am committed to changing the world by changing the words that people use when they talk about “mental illness.”

Here’s an example:

You have a “mental illness” or a “mental defect” resulting from a specific, yet somehow unidentifiable, brain pathology that is causing you psychological and emotional distress.  You can treat your “mental disorder” with a chemical made in a lab that will hopefully mysteriously correct your brain pathology for as long as you can bear the undesirable effects of that chemical.

Learning more about yourself, the human condition and the many different approaches proven to help other people maximize their own well-being will help you to grow into a person who experiences less and less psychological and emotional distress over time.

Which is more empowering?

If I still haven’t convinced you, please consider this final example from history that hopefully more clearly illustrates my point that a “mental disorder” or a “mental illness” diagnosis is necessarily a subjective story about events, and not an objective description of a constellation of thoughts and behaviors that are necessarily caused by a specific brain pathology.

Imagine it’s 1972 and a man visits a psychiatrist because despite having a great relationship with his lover and a job he loves, he’s miserable.  He’s been estranged from his entire family, and he is suffering a great deal as a result.  He can’t sleep.  He’s constantly anxious, and he’s feeling quite hopeless about things ever getting better.  He explains that all of his problems arose when he admitted to his family, a few weeks ago, that his lover was a man.  Shocked by the revelation, his family said they never wanted to see or speak with him again.  The doctor tells the man that the source of his problem is a “mental disorder” in the DSM called Homosexuality.  The man is the son of a southern Baptist minister, and he has been ashamed of his attraction to men his whole life.  He respects his doctor, and his father too.  In fact, he thinks they’re both right.  He sees his love and sexual desire for men as sinful urges that he is supposed to resist, but he is incapable of doing so.  He sees his homosexual acts as mortal sins, and evidence of brain pathology. Feeling utterly hopeless, lost and beyond redemption, a month after being diagnosed with the Homosexuality “mental disorder” the man kills himself.

Please consider helping me spread the idea that “mental illness” is a harmfully misleading phrase that causes suffering by design.

Is building the Golden Gate Bridge suicide deterrent net a myopic misappropriation of money?

If you are part of the suicide prevention movement, you are likely aware of the fact that work to attach a suicide deterrent system to the Golden Gate Bridge commenced recently.  While reading the piece about this seminal event by Samantha Schmidt published in the Washington Post, I found the exchange pictured below in the comments online.

 I replied to “Kompromat” as follows:

I’ll grant that the claim about finding other means to die by suicide is contradicted by empirical evidence, but I’m curious what scientific studies you’re referring to regarding the other two claims. More than 1500 Americans die every single month due to suicide via a firearm – a death toll of over 1.7 million lives lost over 80 years. Claiming that $200 million is “too high a price” to pay to save hundreds of people from dying by suicide, when thousands or tens of thousands of lives might be saved if this money was directed to firearms means restriction programs seems like a reasonable claim. Unfortunately so too is the claim about life being too painful for too many people to endure.

If/when a suicide occurs at the Golden Gate Bridge after the net is completed, it will surely be the most sensationalized suicide in US history, won’t it? This event, if/when it occurs will also be the most demoralizing, and most costly, financially speaking, for the suicide prevention movement, I imagine.

I think spending over $200 million dollars on this net sets the stage for a suicide prevention movement calamity. The net will be 20 feet below the bridge, right? Imagine a suicidal person at the ceremony commemorating the net’s completion. Imagine this person has a ten foot metal cable concealed under her clothing. One end of the cable has a fastener capable of being quickly attached to the bridge’s railing, the other end is looped around her neck.

Surely, the installation of the net at the Golden Gate Bridge increases the chances of a horrifically tragic event like this happening. The only reasonable reason to spend over $200 million on this project is to create a suicide means restriction symbol.

It seems reasonable to claim that given:

1. the fungibility of money,
2. the relatively minuscule number of lives lost to suicide at the bridge versus suicide by firearms nationally (58 every single day) and
3. the patent increase in the likelihood of the most sensationalized suicide ever, occurring at the bridge, to ill-effect to the cause of reducing the suicide rate…

that a suicide prevention investment of this magnitude for this purpose is so myopic that it’s a moronic misappropriation of money.

Make no mistake, if I could snap my fingers, and cause suicide deterrent systems like the one being built at the Golden Gate Bridge to magically exist under every single bridge on Earth where a suicide has occurred, I would.

That said, surely a life lost to suicide at the Golden Gate Bridge is not more valuable than any other life lost to suicide, right?  In the work of stopping suicide, it’s an absolute value numbers game, isn’t it?

The resources at our collective disposal to prevent suicide are scarce.  For example, The American Foundation for Suicide Prevention, the largest private national non-profit involved in the fight to stop suicide has an annual budget that’s only about $18 Million.  The AFSP is going after reducing the suicide rate in a strategic way to make the best use of the limited financial resources it has at its disposal.  They have a practical plan to reduce the U.S. suicide rate by 20% by 2025.  A primary focus in that plan is to aggressively address lethal means restriction as a way to save lives.  The most common way to die by suicide in this country is by firearm, and the AFSP has recently started working directly with the National Shooting Sports Foundation.  Their collaboration has led to a breakthrough firearms lethal means restriction program.

The AFSP is working with representatives from local gun shops, shooting ranges and hunting clubs to educate retailers and the firearm-owning community on suicide prevention and firearms.  The pilot program, involving community-based AFSP chapters in four states, is the first time a national suicide organization has collaborated with gun retailers, range owners and the firearm-owning community about suicide prevention and firearms.  Many of the strategies of the pilot program will utilize co-developed resources through a new partnership between AFSP and the National Shooting Sports Foundation, the trade association for the firearms industry.  “One of the first areas identified through Project 2025, our initiative aimed at reducing the annual suicide rate 20 percent by 2025, was a critical need to reduce the number of suicides using a firearm. But, we know we can’t do it alone,” said AFSP CEO Robert Gebbia. We will work alongside firearm retailers and range owners and the firearm-owning community to better inform and educate them on warning signs, and what to do if someone may be at risk for suicide.”

I will stipulate that there is a non-zero chance that if the suicide deterrent system at the Golden Gate Bridge is completed that not one single human being will ever again die by suicide at or on the bridge or the net.  That said, given my personal experience with suicidal thoughts and behavior, as well as my experience with other extreme states of highly creative consciousness, I doubt that the net will be the end of suicide at the Golden Gate Bridge.  It would surprise me if the completion of the net is not followed by a suicide at the bridge, assuming that its completion is not marked and forever marred by one.

Dying by suicide by jumping off of the Golden Gate Bridge is one of the most predictably sensational ways to die by suicide on Earth.  Investing in a suicide deterrent system with a price tag of $204,000,000 is a sensational way to deal with a sensational problem.  Not seriously considering how such a sensational act may presage the most sensational suicide of all time seems myopic to me.

I call on all of my brothers and sisters in this movement to save lives to consider thinking more critically and analytically about how we apportion the scant financial resources we have at our disposal to cause the suicide rate to go down as quickly as possible.

Einstein thought shame arose from a gross misunderstanding of the human condition

Kevin Hines is a suicide attempt survivor whose efforts to try to help people struggling with self-destructive thoughts and behavior have inspired me.  He recently posted a video on Facebook about his #mysevenbucksmoment in response to Dwayne “The Rock” Johnson.  In his video Kevin talks about the shame he felt after his suicide attempt.  As a fellow suicide attempt survivor, I’m familiar with how people who live through suicidal behavior feel guilt, embarrassment and shame as a result.  I was watching the final moments of the Obama presidency draw to a close after watching Kevin’s video, and I was inspired to share the following thoughts with him.

Regarding the shame you mentioned…

Albert Einstein (and many other thinkers) believed that emotions of shame and guilt arise from a gross misunderstanding of the human condition. Einstein said that a belief in free will results from a “delusion of consciousness.” There is a growing pile of evidence being amassed by scientists to back this claim up.

I’m compelled to suggest that Albert Einstein’s free will skepticism–his belief that a person is mistaken in thinking that he or she could have done other than he or she did–is an unheralded prescription for peace that this insightful genius left for the benefit of humanity.

I’m compelled to champion this idea within the suicide prevention community. We have GPS technology and many other modern marvels because of Einstein’s genius insights about reality. It’s time to consider leveraging Einstein’s apparent genius insight into the human condition too.

A world full of people who genuinely view free will as an illusion, and who are committed to maximizing well-being is a world without shame. It’s a world without egotistical pride. It’s a world without revenge–a world without hate of self or others. It’s a world full of people being compassionate, loving and grateful.

Recognizing that we may have already extracted as much utility from the likely fictional idea that human beings are autonomous agents consciously controlling their thoughts, feelings, and actions and therefore their lives, is an important conversation that I don’t hear many people in suicide prevention and mental health advocacy having. I’m committed to changing that reality. Recognizing the likelihood that free will is an illusionary creation of humanity is a silver bullet capable of piercing the heart of the stigma surrounding “mental illness.”

It’s evident to me that Einstein would have said that believing in free will is a major risk factor for depression and becoming suicidal. The Buddha would agree as would Nietzsche. So too would neuroscientist Sam Harris and professors Bruce M. Hood, Thomas Metzinger and Thalia Wheatley.

It’s time to seriously consider Einstein’s conception of what it means to be a human being. This guy was clever enough to notice that humanity was grossly misperceiving the foundational building blocks of our reality–time and space. Is it so incredible to fathom that Einstein might have had profound insights into the illusory nature of the “self” and free will worthy of our attention and consideration?

Einstein’s conception of what a human being is and how reality works would suggest that we reconsider how we approach describing the problem of human suffering, including the suffering that leads people to die by suicide.

Looking forward to talking to you.

Best,
Francesco

Are people who die by suicide or attempt suicide selfish?

Thoughts from  about selfishness and suicide via TheMighty.com.

thinkstockphotos-497517286-1280x427

When a Friend Said ‘Suicide Is Pretty Selfish When You Think About It’

“Like… I get that it’s not the person’s fault really but… suicide is pretty selfish when you think about it.”

Flash.

Instantly, it was like somebody lit that spark in my mind that never fails to ignite my passion for mental health advocacy. For me, there’s something about stigma that turns an ordinary passion into the sort of fire you can just see in someone’s eyes.

The above sentence was said to me (paraphrased, of course) a couple of years ago. I was tabling with a fellow Active Minds member and a friend of hers had joined us to hang out. I think we were tabling about suicide, which is why the subject came up.

My immediate reaction when she said this was to be offended. Did she really have the nerve to say that while we were tabling about suicide prevention? Once I took a step back from my emotion I realized that she didn’t mean to insult anyone. She probably didn’t understand how stigmatizing it can be to label suicide as “selfish.” How could I expect her to understand when the topic of suicide is so seldom discussed in our society?

“The thing about suicide is….” I paused, not wanting to offend her or make her think she offended me, “Even if we can call the act of attempting suicide selfish, the person behind it is not acting out of selfishness… if that makes sense.”

I could tell she was truly listening to what I was saying, so I continued. “When someone is so far into that dark place they want to end their life, they might not be thinking about who their actions are going to hurt. Maybe they are in too much pain to think about it. And even if they are aware of how it might impact their loved ones, the desire to end their pain may have become too great to bear anymore.”

If I remember correctly, that’s about all I said. I could’ve gone in-depth about the known risk factors for suicidal behavior. I could have explained how feeling like a burden (a common experience of those contemplating suicide) might make someone think they’re doing their loved ones a favor by taking their own life, which might completely negate any feelings of selfishness or guilt that they might have had. However, I could tell she was really considering what I had just said, and I didn’t want to go too far and overwhelm her.

The notion that suicide is selfish is something I had spent a great deal of time thinking about.

When I was 14 I felt so incredibly guilty for wanting to die, because I knew if I killed myself my family would be devastated. For years, that guilt and the selfishness I felt for thinking about suicide kept me from reaching out for help. All of the stigma about suicide — much of which I had internalized — had me convinced it was better to suffer in silence than to have someone else think what I did: that I was selfish for wanting to die. I’ll never know for sure if that guilt had pushed me closer to the edge or further from it, but I do know that I’m grateful to be alive.

Make no mistake, I didn’t lose any respect for this acquaintance because of her statement, and there was no animosity created between us. In fact I’m glad she said what she said, because it reminded me that the stigma we need to face is not just in the media and our larger social systems, but in the people around us who don’t even realize these ideas are stigmatizing.

It’s one of the things that make the work I do as an Active Minds member or in other advocacy settings that much more important. I also realized that it was important for me to listen and understand where she was coming from too, because a one-sided conversation is not a productive conversation, especially in the pursuit of social change.

Being part of the social movement against mental health stigma can be difficult and discouraging, especially with the seemingly endless sea of misinformation and disrespect shown in various media outlets, but it’s worth it. Thinking back, it makes me happy to remember how respectful and thoughtful that conversation was. It gives me hope to know that “fighting” the stigma doesn’t have to be a fight —sometimes it’s as simple as a conversation.

I wanted to share this story here because I hope to see a day in which we can completely put to rest the idea that victims of suicide are selfish, weak or otherwise bad people, and think instead with empathy by making an effort to understand what someone might be going through if they are contemplating suicide.

My thoughts on the subject:

As a fellow suicide awareness / mental health advocate, I think it’s important to have conversations like the one you describe in this piece. I shared some of the same feelings of guilt regarding my own suicidal intentions and behavior when I nearly died as a result of untreated depression in 1998.

I think the conversation around suicide and selfishness is an important one. I think it’s important to acknowledge the pain and suffering experienced by suicide loss survivors. I think it’s a completely normal reaction for a suicide loss survivor to wonder: how much consideration did my love one give to me before dying by suicide? I think it’s equally “wrong” to blame someone for being suicidal as it is to blame a suicide loss survivor for wondering about the thoughts and feelings of their loved one prior to their death.

I often turn to the dictionary definition of the word selfish in conversations like the one you had: (of a person, action, or motive) lacking consideration for others; concerned chiefly with one’s own personal profit or pleasure.

It seems apparent to me that some people who die by suicide may not give very much consideration to the impact of their actions on others. They do not see themselves as a burden to others, rather their suicidal crisis stems from feelings of shame, embarrassment and guilt. Sometimes simply for feeling and acting suicidal.

I know that some suicidal people go through a series of desperate mental gymnastics to try to think of anything else besides the impact of their death on family and friends. This is part of a process that some suicidal people go through to work up the nerve, to work up the courage to take suicidal action. I know this because I did it, and I don’t believe that my suicidal crisis was unique.

Here’s how I’ve described my thinking in the past about why it doesn’t make sense to think of suicide as a selfish act:

Many view suicidal people as selfish cowards, but I believe it takes courage, massive amounts of courage to turn suicidal thought into suicidal action. Trying to cause your heart to stop beating, while knowing, to some degree at least, how much pain and suffering your death will cause for those who love you requires a special kind of morbid audacity. I won’t claim that there has never been a person who has died by suicide who lived selfishly during his or her life, but I insist that anyone who thinks those two words: selfish and cowardly — about the suicidal act itself, has no first hand experience with the macabre deed. The biological instinct for self-preservation is an almost insurmountable force to overcome. Death is the greatest unknown and fear-inspiring phenomenon facing each of us, which explains why possessing an enormous amount of courage is a prerequisite for dying by suicide.

Suicide can’t be accurately described as selfish either, although it’s understandable why people are prone to do so. The dictionary defines selfish as: lacking consideration for others; concerned chiefly with one’s own personal profit or pleasure. I think it is unavoidable for survivors of suicide, the friends and family of people who die by suicide, to wonder how much consideration was given to them by their loved one or friend, prior to their suicide. Regardless of how much time and consideration someone who died by suicide gave to those left to deal with life after their death, the end of physical and psychic pain resulting from suicide can not bring pleasure nor profit to the deceased. So the suicidal act, by definition, cannot accurately be described as selfish. Suicide extinguishes any notion of the self. An act that causes the sense of self to no longer exist is inherently not selfish.

An open letter to President Obama about suicide prevention | frank talk about mental health | episode 9

November 14th, 2016

Dear President Obama,

Beau Biden was my captain on the tennis team in high school, and Hunter and I nearly won a football state championship together back in 1988.  As a self-declared brother of their father, you are undeniably an honorary member of our extended Archmere family.

I remember the moment during the early morning hours of August 23rd back in 2008 when I got the text message announcing that Joe Biden was your running mate, and I will never forget the moment later that year when you were elected president.  It was that night that I committed myself to getting into a position to leverage my personal connection with Vice President Biden, before you both left office, to the benefit of an important but underserved cause in this country:  suicide prevention.

My namesake and paternal grandfather died in a mysterious explosion at the factory where he worked two days after Christmas in 1951.  Within a year my fourteen year old father-to-be was working two jobs, and giving $40 a month (about $350 in 2016) to his mother to help support her and his two younger sisters.  He joined the Army after graduating from high school where he learned how to be a land surveyor.  After returning from his tour in Europe, he met my mother-to-be, bought a small land surveying firm in Delaware, and started a family.  My father ran the business while my mother ran just about everything else at home.  My parents, two high school graduates, paid for every penny of their four children’s education, which included private grade schools, the same private high school attended by the Bidens, and the colleges of our choice.  Good luck, hard work and love have made the story of Judy and Franco Bellafante an unequivocal example of the American Dream.

I enrolled at the University of Notre Dame in the fall of 1989.  Archmere and AP tests gave me a 30 credit head start, and I earned a Bachelor of Arts in just three and a half years, graduating Magna Cum Laude with a Phi Beta Kappa Honor Society induction to boot.  Mr. Tom Brokaw closed his commencement address to the class of ‘93 in South Bend like this, “It’s easy to make a buck; it’s harder to make a difference.  We need your help.  Go Irish!”  Four years later I became the youngest Principal out of 350 staff at a financial IT consulting firm located a couple of blocks from Wall Street.  I was 26 years old, and my bill rate was $250 an hour.  I won’t deny that I worked hard, but Mr. Brokaw was right.  The advantages afforded me had made it easy for me to become someone who billed in excess of half a million dollars a year in consulting fees.  Back then being successful at my job was paramount to me, while “making a difference” had been temporarily relegated to a distant backburner.

Less than a year later and a few weeks before being accepted into UCLA’s Anderson School of Management, a foreman at a warehouse arriving for work in Secaucus found me clinging to life inside of a running rental car that I’d turned into a makeshift carbon monoxide gas chamber the night before.  I had a near death experience in the ambulance on the way to the hospital, and I woke up a couple of days later in the ICU.  Suffice it to say that my suicidal crisis stemmed from an unshakeable belief that I had become unable to live up to expectations I had for myself as a result of being the beneficiary of so many advantages and so much privilege.  Countless hours of introspection and study over the ensuing years have made me a “lived experience expert” regarding how some young people, with no prior trauma and with many apparent advantages, feel so self-loathing and so hopeless that they become suicidal.

In April of 2015 I left my day job in IT to work full-time in suicide prevention and mental healthcare advocacy.  I became a volunteer in the speakers bureau of the Greater Philadelphia Chapter of the American Foundation for Suicide Prevention.  I began to share some of the lessons I’ve learned since my suicidal crisis by giving talks at Philadelphia area schools and businesses aimed at lowering the suicide rate and reducing the stigma surrounding mental illness.

In June of this past summer, I was on Capitol Hill with hundreds of volunteers from the AFSP advocating for more federal funding for suicide prevention.  Thanks to Hunter and an assistant of the Vice President, I was poised to introduce the executive leadership of the AFSP to the Vice President and his policy staff when the mass shooting in Orlando derailed our plans to meet.  

You are taking questions from the press for the first time since the election as I write this message to you, and I’m compelled to share the following as if I was at the presser and you had just called on me.

Based on 2014 CDC statistics, about 58 Americans die from self-inflicted gunshot wounds every single day—a death toll nine lives greater than the deadliest mass shooting in U.S. history.  Annually that’s 21,334 lives lost to suicide via a firearm.  Comparatively just half as many Americans died by homicide via a firearm in that year, and only 18 Americans died in mass shootings in all of 2014 according to Mother Jones reporting. Imagine that at 12:00 noon tomorrow, 58 Americans simultaneously die by suicide via a firearm.  Imagine that twenty four hours later it happens again—58 simultaneous suicides via a firearm occur at 12:00 noon. Twenty four hours later it happens yet again.  

Am I right to assume that if this slight and absurd modification to the details surrounding the daily tragedy of firearm inflicted suicide occurred in reality, that you would be compelled to say and do things to try to prevent suicide that you have yet to say or do?

If so, why not consider adding more achievements to your team’s list of accomplishments in suicide prevention before leaving office?

There is still time for you to try to change what this picture looks like in order to bend the rising U.S. suicide rate curve.

research-chart

You are an elocutionary potentate and a transformational leader of humanity.  I imagine that you have inspired millions of Earthlings to serve the public’s interest in ways that they might not have without your influence.  I am grateful to include myself in this group.  Your vision for the future of this country inspired me to do the hard work to try to make a difference for others by being the change that I wish to see in this world.

With the election behind us, I’m happy to report that I am in the process of rescheduling the meeting between the AFSP executive leadership and Vice President Biden.  I will be sure to share the time of that appointment with you and your staff once it’s scheduled just in case you might be available to join us.

Thank you for all that you have done to prevent suicide and to improve mental health care in this country.  Thank you for being a constant reminder of the positive difference that someone can make in the lives of others.

Sincerely,

Francesco Bellafante
American Foundation for Suicide Prevention, Greater Philadelphia Chapter Board of Directors
Zero Suicide Champion
frank talk about mental health ~ leveraging the genius of Einstein to stop suicide and to maximize well-being
iameinstein.com

Why do people without trauma in their past become suicidal?

In this post I will answer some of the questions that I posed in frank talk about mental health, episode 7 | Why do people attempt suicide? 

As a reminder, I am a suicide attempt survivor who had a near death experience due to semi-intentionally caused acute carbon monoxide poisoning eighteen and a half years ago when I was 27 years old. 

As I explained in episode 7, I’m aware that my answers to these questions don’t apply to everyone who becomes suicidal or who dies by suicide.  With that said, I still don’t believe that my answers are unique, and apply only to me.  While my answers may not resonate with you or with what you think your loved one was thinking and feeling when he or she attempted or died by suicide, I’m convinced that they apply to many people.  A growing number of suicide attempt survivors are sharing about the circumstances leading up to their suicidal crisis.  While it’s impossible to know for sure precisely what someone who died by suicide was thinking, I believe it’s possible to gain insight into the state of mind of a loved one or associate who died by suicide by exploring the growing number of personal accounts provided by suicide attempt survivors like myself.  By revealing insights about my suicidal mindset, I hope to provide, at the very least, a modicum of understanding and peace to those left to mourn and remember loved ones who have died by their own hand.  

I also hope to be a source of hope for those who may be feeling hopeless and suicidal.

1.  Why do people who have every single thing that they need and almost everything that they want have suicidal thoughts?

If you are a human being that has a sense of self, if you have a sense of personal identity or an ego, I think you are susceptible to having suicidal thoughts.

The problem of suffering arises from our reaction to what-is, our resistance to it, or our interpretation of it, which is a function of our conditioning.

Lionel Corbett

My paternal grandfather died when my father was just thirteen years old.  Within a year of his father’s death, my father worked two jobs to help support his family to the tune of $350 a month (in 2016 dollars).  Neither of my parents went to college, but they were determined to provide my siblings and I with the highest quality education possible given their middle class income.  I went to private school from the time I was in fourth grade through college.  I graduated from the University of Notre Dame in just three and a half years, and by the time I was twenty six years old I was working for an information technology consulting firm a couple of blocks from Wall Street.  My bill rate was $250 an hour.  While on assignment in Toronto, I had a troubling experience at work.  The genesis of the crisis that nearly resulted in my suicide was a single, negative interaction with the senior client on my sub-team in Toronto.  At our first meeting, the senior client manager on the team asked me if I had any prior experience working with commercial lending, credit risk management systems.  The way he framed the question indicated he assumed I would respond affirmatively, but I had no such relevant experience.  I balked at saying no, and then pivoting to explain why I would still be a valuable asset to the team and the project as a whole.  Instead, I responded, “Excuse me?” as if I didn’t hear his question.  The man was less than five feet away from me, and he spoke quite clearly;  I was instantly and irrevocably mortified.  By the time he had finished rephrasing his question slightly, I was ready to give him my “no” which I did, but I failed miserably, in my view anyway, when I tried to pivot back to why he should still be pleased to have me on his team.

I began to suffer as a result of this interaction, not because of what had happened, but rather because of my interpretation of what had happened.  My self image and my sense of self-worth had been based on what authority figures in my life thought of me.  This worked fine for the first twenty six years of my life.  My parents were the first authority figures in my life, followed by my teachers and then my superiors at work.  My sense of self-worth and self-esteem was probably higher than average because the feedback that I had received from these people was overwhelmingly positive.  This incident at work in Toronto changed all of that.  I became convinced that an authority figure (my client) thought very poorly of me.  He never said this, but I believed that he was thinking thoughts like this:  I can’t believe that we’re paying this guy two hundred and fifty bucks an hour!  He’s not worth $2.50 an hour!!   Whether he thought this or not really wasn’t important.  It’s what I thought an authority figure thought about me, and in a very short period of time, I believed it as the irrefutable truth.  I came to see myself as an under-qualified, over-compensated fraud.

It still seems incredible to me how quickly I unraveled; how quickly hope and excitement for the future were replaced by fear and apprehension.  Within a month’s time, my internal monologue became almost unrecognizable to me.  The voice I was accustomed to hearing, one brimming with confidence, resourcefulness, excitement and determination was replaced by one saddled with uncertainty, doubt, indecision and distress.  Thinking and feeling so negatively about myself for an extended period of time was a novel experience for me.  I searched my psyche in vain for something to reverse my psychological and emotional slide, but the unrelenting pessimism of the voice in my head stripped away my self-esteem and hope for things to come.  Silencing my fearful, troubled, constantly-questioning self-talk at night was so difficult that getting sound sleep became impossible.  Night after night I only slept between zero to three hours at most thanks to the ceaseless barrage of dark, automatic thoughts that bombarded my consciousness, and ate away at my sanity.  As I continued descending a downward spiral of disempowering thoughts, I began to ruminate over what I was doing with my life.  I remember the first glimmer of my very first suicidal ideation.  It happened on a particularly turbulent flight home to New York from Toronto on a Friday afternoon.  Normally unnerved by turbulence, I found the unlikely prospect of crashing oddly comforting.  I remember thinking:  If only this plane would go down, I wouldn’t have to worry about this miserable assignment any longer.  

Within just a couple of weeks of my professional faux pas in Toronto, I had discounted all of my prior accomplishments, as my formerly steadfast belief in my ability to intellectually tackle any problem waned.  Some bad luck left me socially isolated as my five closest friends all coincidentally moved away from New York City over the course of a few weeks.  The lack of reassurance received from my usual sounding boards to bolster my flagging self-confidence paved the way for my suicidal crisis.  My ability to concentrate was so impaired from lack of sleep, that completing simple tasks—like deciding what to have for dinner, or packing my bag for the week ahead in Toronto—became cognitively burdensome.  Not surprisingly, given my deteriorating mental faculties, effectively performing the duties of my job became impossible.  I became certain that I wasn’t ever going to be able to live a life that would honor my parents and all of the sacrifices they had made for me.  In a short period of time, my thoughts of death gave rise to thoughts of suicide, followed eventually by a practical plan to end my life.

2.  What goes wrong with someone that has so many gifts, talents, privileges, and advantages?

The good fortune that I experienced through the first twenty-six years of life left me with high expectations for myself and my future.  The incident in Toronto caused me to confuse being unknowledgeable in a particular subject (commercial lending risk management) with being un-intelligent in general.  This cognitive mistake and my faith in the veracity of my conclusions due to my track record of being a high performer in school and at work led me to believe that the expectations that I had for myself were beyond my reach.  I became consumed with feelings of guilt, embarrassment and shame as a result.  I felt guilty that I was even considering the idea of checking out given the depth and breadth of suffering experienced by countless others in the world.  I felt guilty that I had achieved so little in life after having been given so much.  I was embarrassed that I had ever thought I was intelligent and that I could achieve anything that I set my sights on.  I was embarrassed that I was in a situation where I obviously needed help and was mortally afraid to ask for it.  I was ashamed that I was considering ending my life because I feared that I wouldn’t be able to earn an above average living.  I was ashamed of the imagined prospect of having to move back home to Delaware to live with my parents, and get a job in the local shopping mall.

Guilt involves falling short of one’s own moral standards.

Embarrassment is the feeling of discomfort experienced when some aspect of ourselves is, or threatens to be, witnessed by or otherwise revealed to others and we think that this revelation is likely to undermine the image of ourselves that, for whatever reason or reasons, we seek to project to those others.

Shame arises from measuring our actions against moral standards and discovering that they fall short.

Dr. Neel Burton

3.  How can someone who has love for his family and friends and whom is loved by his family and friends be suicidal and not tell a loved one?  How can they not reach out to a loved one for help?

I did reach out to a few close friends to express that I was having trouble, although I never went so far as to explicitly say that I was in need of help.  I even told my closest friend at the time that I had gone as far as considering ending my life.  Regarding reaching out to members of my family, I had a single conversation with my parents from my hotel room in Toronto several weeks before I nearly killed myself, where I expressed concerns about my performance at work.  In each case, my communication was only as effective as the responses that it elicited.  I received constructive advice from one friend—he suggested that I quit my job and try doing something completely different for awhile like go work at a ski resort or on a cruise ship.  Another friend was moved to discuss his concerns about my situation with his father who subsequently telephoned me to check in on me.  The friend I explicitly shared about my suicidal thoughts with became emotional as a result of my revelation, and was supportive in the moment, but he still wasn’t compelled to talk about our conversation with anyone else.  As far as the interaction with my parents, as novel as it was for me to express concerns about work to them, they too didn’t grasp the severity of my situation.  Me engaging in suicidal behavior wasn’t an eventuality that they seriously entertained.

I viewed my deteriorating mental health as a character flaw, because I believed other people would see it the same way, and I believed that asking for help to deal with what was going on in my head was a sign of a personal weakness. Thoughts and beliefs like these lie at the heart of the stigma surrounding mental illness, and explain why many people suffering like I was back then never seek help.

4.  What motivates someone without traumatic experience who has access to loving support from family and friends to harm themselves?

Unsubstantiated beliefs about myself and my future coupled with irrational thinking due to sleep deprivation motivated me to engage in suicidal behavior.

5.  What could a loved one (or anyone else) of a suicide attempt survivor or someone lost to suicide have done to prevent the suicide attempt or suicide?

Obviously, there’s nothing anyone can do to change the outcome of an event in the past.  As a free will skeptic, I don’t believe that human beings consciously author their thoughts or intentions.  We live in a cause and effect physical reality that is governed by immutable laws.  Like Albert Einstein, I too believe that the thoughts and intentions that arise in consciousness do so according to these natural laws.  Given this view of reality, there’s no coherent way to explain how an organism, human or otherwise, makes freely-willed conscious choices.  Einstein believed that the subjective experience of making “choices” was a “delusion of consciousness.”  As a result, Einstein believed that thoughts and feelings like regret, guilt and shame are all based on a gross misunderstanding of reality that arises from an egocentric view of life.  I think Einstein’s answer to this question would have sounded something like this:  There is nothing that a loved one (or anyone else) could have done differently to prevent the suicide attempt or suicide of someone.  The person who blames him or herself for not behaving in a way that he or she thinks would have or could have prevented the suicide attempt or suicide of someone is misunderstanding how the universe works.  For that person to have done something other than they did, the universe would have had to have been in a different state than it was in at the moment in question.  

The universe is going to unfold how it is going to unfold based on the immutable laws of physics, whether we can foresee what’s going to happen or not.  In simple cases, we can accurately predict the future.  In unfathomably more complex cases—predicting the thoughts that arise within a human being’s consciousness and what she is going to do as a result—we cannot reliably make accurate predictions yet.  Our understanding of neurobiology has yet to reach the point where we can accurately predict the output of the most complex object in the known universe:  the human brain.  

screen-shot-2016-11-03-at-3-25-42-pm

Make no mistake, I still believe that preventing suicides from occurring in the future is possible and worthwhile work.  Knowledge of the warning signs and risk factors for suicide and vigilance can be the cause of someone avoiding a suicide attempt altogether.  Also worth noting, there is always help available for someone in the midst of a suicidal crisis.  You can always call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255.

6.  Why was I “gripped by fear” about life?

Fear seems to have many causes. Fear of loss, fear of failure, fear of being hurt, and so on, but ultimately all fear is the ego’s fear of death, of annihilation. To the ego, death is always just around the corner. In this mind-identified state, fear of death affects every aspect of your life.

Eckhart Tolle

I don’t recall precisely when I came to understand that my lungs will cease drawing breath and my heart will stop pumping blood and I will die.  I also don’t remember when I realized that absolutely no one has any certain knowledge about what is going on in existence.  The apparent unknowability of the answers to the “big picture” questions that homo sapiens ponder can be unsettling to some.  The certainty around the inevitability of the death of the body coupled with the uncertainty around what is going on in existence is enough to give any contemplative person pause.