Suicide Motivation and Neural Circuits: Connecting the Studies

by Matt Kuntz

Executive Director
NAMI Montana

Note: I've underlined certain sections of this article to clearly link similar analyses in various research. All of this underlining is my own and a should not be ascribed to the quoted individual.


A University of British Columbia research team just completed a systematic analysis to help understand the motivations to commit suicide. The study, led by UBC PhD candidate Alexis May, was published by Suicide and Life-Threatening Behavior – the official journal of the American Association of Suicidology. (Read the study's official press release here.) The study was based on 120 participants who recently attempted suicide. The results suggest many motivations believed to play important roles in suicide are relatively uncommon. For example, the researchers found that suicide attempts were rarely the result of impulsivity, a cry for help, or an effort to solve a financial or practical problem. Of all motivations for suicide, the two found to be universal in all participants were hopelessness and overwhelming emotional pain.

This study's participants were Canadian outpatients and undergraduate students, but it is important to note that the motivations behind the participants' suicide attempts mirror the findings in a similar study of United States’ soldiers. In that analysis, researchers from the the University of Utah questioned soldiers who had attempted suicide. Out of the 33 reasons the soldiers could use to describe their motivation to committed suicide; all of the soldiers included one in particular — a desire to end intense emotional distress. (Read more about that study here.)

According Dr. Craig Bryan, the coauthor of that study, the soldiers tried "to kill themselves is because they have this intense psychological suffering and pain."

Beyond college students and soldiers, the New York Task Force on Life and the Law (New York Task Force) issued a report in May of 1994 stated that "the common stimulus to suicide is intolerable psychological pain." That report cited Dr. Edwin Shneidman's book, Some Essentials for Suicide and Some Implications for Response, which was published in 1986.

The accumulation of multiple decades of research into populations as varied as college students, soldiers, and people with terminal illnesses seem to generally agree that suicidal thinking and actions are a response to intense psychological pain. As someone with a brain wired to occasionally do battle with that demon, I agree with that analysis.

The unavoidable follow-on question is "What causes psychological pain so intense that suicide appears to be the only option." The New York Task Force provides that, "Contrary to popular opinion, suicide is not usually a reaction to an acute problem or crisis in one's life or even to a terminal illness. Single events do not cause someone to commit suicide."

The Task Force further specified that "Studies that examine the psychological background of individuals who kill themselves show that 95 percent have a diagnosable mental disorder at the time of death" Since serious mental disorders can generally be defined as disruptions in neural circuits, the logical conclusion is that there is something within the neural circuitry of a suicidal person's brain that causes them to experience extremely high levels of emotional pain - beyond the scope of any environmental stressors occurring in their life.

Neuroscientists are working to develop a better understanding of the process behind these deadly neural circuitry disruptions. After examining eighteen different studies, researchers from the University of California San Francisco proposed a tentative neural network for psychological pain that involves the following sections of the brain: the thalamus, anterior and posterior cingulate cortex, the prefrontal cortex, cerebellum, and parahippocampal gyrus. (See the abstract of their article in Brain Imaging and Behavior from March 2013 here). The proposed network has significant overlap with the neural network utilized when we experience traditional physical pain.

Take a minute to process that information. The neural circuits that transmit the feeling of physical pain such as a person's hand being on fire are similar to the circuits that transmit feeling of emotional pain. It's not surprising that a disruption in that powerful of a system in the brain would lead to the number one cause of disability in the world, depression, and potentially suicide.

It is hard to pinpoint what causes these neural disruptions and those causes may be different for different people. Genetic susceptibility, emotional trauma, brain injuries, and substance abuse are all potential contributing factors; especially when combined together.

There is no miracle cure for these devastating neural conditions, but recovery is possible through effective treatment and lifestyle changes. Life doesn't have to be a fight for survival.

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If you're experiencing suicidal thoughts and deep psychological pain, please call 1-800-273-8255. If you're worried about a loved one, call that number to learn about what you can do to get them help.

A Written Letter: An Undervalued But Essential Advocacy Tool

Navigating through the mental illness treatment system can be difficult. It can be especially troubling when trying to find care for a loved one who so deeply enmeshed in symptoms that they cannot care for themselves.

With privacy laws and everything else, it’s hard to know who you can even talk to.

Outside of a crisis situation where someone’s life is immediately at risk, the most effective tool to express your about your or your loved ones treatment is also the simplest. Write a letter.

Write the treating clinician a letter describing what you’re worried about, why you’re worried and what you think should be done. If you don’t feel comfortable making specific recommendations, just tell them that you’re worried and ask if the treatment team can review the situation to make sure it’s being handled properly. It’s that simple.

If you don’t receive a response, wait a week or two and then send them another one. And then another one. Make sure to always keep a copy for your records.

Be polite, yet be specific about what you’re worried about and why. Don’t forget to put your name and contact information on the letter.

The same technique also works with city and county attorneys if the situation has become so dire that a 

commitment might be necessary. Or, with institution administrators if your or your loved one is not receiving effective treatment in their facility.

A written letter serves two purposes. The first is to let the person know about the issue. The second to build up a record in case something bad happens. Both of these purposes are important tools to utilize to help you or your loved one get effective care.

To find out more about mental illness, advocacy, and recovery go to www.namimt.org.

p.s. Please share this video with your friends and family to help them understand the power of writing letters in mental illness advocacy.

Joining a Support Group

By Debra Hoppe

This is part five of the recovery plan. To join a group means that you are serious about your recovery plan. You are willing to take that step toward a better you. I myself have been in groups since I was 14 years old. In and out of psychiatric hospitals since that time so I know a few things about group settings.

The one that helped me the most was the one in Amarillo, Texas when I was just a kid. I learned that I could accomplish anything I set my mind toward without anyone laughing at me or pointing a finger at me. I have since learned that people are cruel and do laugh at you but that is because they don’t understand what you are going through and don’t take into consideration the feelings you may be experiencing. Remember, people with mental illnesses are people too and deserve to be treated the same way as people that don’t suffer from a mental illness. The stigma that is so prevalent out there needs to be broken and we are the only ones that can do that. That is why a group setting is so important. It will teach you how to overcome stigma and join in the fight against people that want to look at you as disabled.

I have a certification to mentor a gathering called Peer to Peer. It is a nine week course that teaches a person how to deal with their disorders be it bipolar disorder, schizophrenia or major depression. It is a peer run course that is a very comfortable setting and I enjoyed mentoring a group of 7 people. It taught me how to not be only an inspiration to myself but to others as well. I learned a great deal about myself and the whole group. If you ever have the opportunity to experience a Peer to Peer course then please don’t hesitate. You will find the experience to be utterly refreshing.

I also have a certification in In Our Own Voice which gives me the opportunity to tell my personal story. It is an hour and a half long group that deals with my feelings all the way back to when I was a child to present day. I tell about how I was put into a mental facility and how I survived two comas all in the 52 years I have lived. I can tell you some happy and sad times of my life but the main thing is that I am not letting my disorder pull me down. I am making a difference in people’s lives as well as people making a difference in mine. I hope I have made a difference in yours.

Until next time when we will be studying how not to give up in your everyday life and how to keep fighting for what you believe in. Thank you for your time and I will see you next time. Take care and God bless.

"Of Two Minds" will be Making Its Montana Premiere on April 24th

On April 24th, the movie "Of Two Minds" will be making its Montana premiere at 7:00 pm in the Carroll College Cube at 7:00 pm. The movie examines the experiences of bipolar disorder through firsthand testimony from people living and coping with it.

Lisa Klien, the co-director, writer, and producer will present the film and be available for questions after the showing. Don't miss it

Watch the movie's trailer now!

 



OF TWO MINDS Official Trailer from Douglas Blush on Vimeo.

Please Take Five Minutes to Help Insure Montana's Working Poor

NAMI Montana friends and supporters,

After a lot of back and forth, the Montana Senate passed a bipartisan compromise bill (House Bill 623) to provide a private health insurance option for the working poor who cannot afford health insurance. It was an amendment onto Representative Liz Bangerter’s earlier bill. Republican Senator Ed Buttrey of Great Falls says the proposal the proposal does not expand Medicaid, but rather simply would use the expanded federal Medicaid money starting next year to buy health insurance for thousands of Montanans earning less than 138 percent of the federal poverty level — about $15,400 for a single person.

Here's an article that describes the compromise bill in-depth.

This bipartisan bill will allow Montanans to take advantage of the federal government’s investment in healthcare for the working poor without increasing the state’s long-term investment in Medicaid. Please take a moment to contact Representative Bangerter asking her to approve the amendment to House Bill 623.

Representative Bangerter is in an interesting spot because this was not her original intention for the bill. She is going to need to hear from her constituents and people from across Montana about why this is a good idea. Representative Bangerter is a great person with a huge heart. She’ll really appreciate hearing your thoughts.


Thank you,

matt

UPDATE: Representative Bangerter voted for the bill, but unfortunately it still died on the House floor. Here is a link to an article about the vote.  It's a sad day for Montanans who cannot afford health insurance, but we're truly thankful to legislators like Representative Liz Bangerter who are willing to cross party lines to do the right thing.




Matt Kuntz
Executive Director
NAMI Montana
www.namimt.org

(406) 443-7871

Please “Like” our NAMI Montana facebook page, www.facebook.com/namimontana, to stay involved with the fight against mental illness in Montana.

Please Support SB 11: Mental Illness and Criminal Justice System

Senator Mary Caferro’s Senate Bill 11 to make Montana’s criminal justice system deal more effectively with offenders with mental illness is in front of the Senate Public Health, Welfare and Safety Committee on Friday, January 11^th at 3:00 PM in Room 317 at the Capitol.  Please contact the Committee and individual legislators either online or by telephone before that meeting to let them know you support Senate Bill 11.  (I’ve included a description of what the bill does below my signature.)

Here is a link to the bill, but we did pull out Sections 5-7 in order to gain the support of the LCPCs and Social Workers. There will also be an amendment to make it clear that Guilty But Mentally Ill parolees who have their parole revoked will be directed into the exact same process of being committed to the head of DPHHS as when they were convicted without any additional placement requirements.

 Here are the legislators on that Committee: Jason Priest, Terry Murphy, Mary Caferro, Greg Jergeson, Fred Thomas, Dave Wanzenried, and Art Wittich.

Online: You can leave a message for the Committee or individual legislators with the online message form at this link. http://leg.mt.gov/css/Sessions/63rd/legwebmessage.asp

By telephone: The Legislative Information Desk’s regular office hours during the session are 7:30 a.m. to 5 p.m. weekdays and 8 a.m. to adjournment on Saturdays. Callers may leave messages for legislators or acquire general legislative information by calling the Information Desk at (406) 444-4800. Callers may leave messages for up to 5 individual legislators or 1 legislative committee per call.

Please share this email message with anyone who you think might be interested in helping reform Montana’s criminal justice system.

Thank you,

Matt Kuntz

Executive Director

NAMI Montana

www.namimt.org

(406) 443-7871

Please Support Senate Bill 11

Senate Bill 11 is sponsored by Senator Mary Caferro. The bill revises the parole and probation system to work more effectively for offenders that have a serious mental illness. The bill’s main focus is on prisoners who have been convicted as Guilty but Mentally Ill and sentenced to the custody of the Department of Public Health and Human Services. This is only roughly 1% of the Correction population, but the reason for their unlawful actions are different than other prisoners, so their release dates and the supervision requirements should reflect that difference. It is critically important make this system as effective as possible for public safety, the impact on the offender’s lives, and the significant costs to the State of Montana of both keeping offenders in institutions longer than necessary and having them repeatedly return to the institution.

The Bill also provides for overall training and Parole Board requirements that will help the Corrections system deal with all prisoners with mental illness.

·         The main function of the bill will be to make it clear that offenders committed to the Department of Public Health and Human Services can utilize supervised mental health treatment programs in order to help them qualify for parole. MCA 46-23-101(6)

·         The bill will help get offenders who are deemed ready of the of the expensive institutions and back in the communities in supervised programs that will ensure the offenders continue treating the mental illness symptoms that made them dangerous. MCA 46-23-101(6). The current system of paroling these inmates has a 60% recidivism rate.

·         This bill will make the parole standard for offenders who are deemed Guilty But Mentally Ill solely depend on their ability to be safe in the community through participation in a supervised mental illness treatment system, by excluding them from the broad requirement that offenders must serve a quarter of their sentence before being eligible for parole.

·         This bill will mandate mental illness training for the Parole Board, probation, and parole officers. It will also require two members of the Parole Board to be mental health providers.

·         This bill will make it clear that an offender may have a mental illness and another co-occurring brain conditions such as developmental disabilities and substance abuse conditions. 

Beyond Firing Rates and Magazine Sizes

America is in horror again over another mass shooting.  The twenty-four hour news channels know the drill. This time it was Newtown, Connecticut; before that, tragedy struck Aurora, Colorado; before that, Tucson and Virginia Tech. Examples go back to the University of Texas sniper in 1966 and beyond. With each event, our nation ponders why did this happen and what could we do to prevent future attacks.

This tragedy has sparked a strong conversation about gun control, but it is important to note that any proposed regulation would likely focus on limiting how fast guns can legally fire and how many bullets can be held in a magazine. If successful, these restrictions would decrease the number of casualties in mass shootings; not prevent the shootings from happening. Gun rights proponents recommend the converse – arm more people to fire back at shooters. Security is important and it is worth considering more school resource officers and other options. But again, this is a reactive strategy meant to limit the scope of the violence.


As someone who works with people who live with mental illness and their families, I hope that our nation can look at the broader solution – not the politically easy answer. People who live with mental illness are more likely to be victims of violence than to commit violent acts, but it is also a reality that serious mental illness is linked to some of the nation’s worst acts of violence. The tragedy does not stop there. Untreated mental illness also leads to suicide, homelessness, broken families, and a variety of other criminal acts. Dr. Thomas Insel of the National Institute of Mental Health conservatively estimates that total direct and indirect annual costs of mental illness at well over $300 billion.


The only way to truly prevent these tragedies, not just to the scope of the tragedies, is to focus on the mental illnesses at their root. The current process of diagnosing these brain conditions based upon subjective tests and symptom clusters is simply not good enough. It is common practice for a person exhibiting signs of serious mental illness to receive different diagnoses and treatment recommendations from different treatment professionals.  


Our society knows that this is a problem. We blame doctors, psychologists, drug companies, individuals affected by these conditions and their families. But in reality this is a medical technology problem that our country must solve. We must develop methods of diagnosing these brain conditions that are specific and precise. Methods based upon the actual biology and circuitry of the brain – not just clusters of symptoms.  Methods capable of detecting brain conditions well before the person begins experiencing potentially dangerous delusions and hallucinations. Methods capable of guiding treatment decisions.


White House spokesman Jay Carney correctly stated that “no single piece of legislation, no single action will fully address the problem” of mass violence. But the federal government can and must focus resources on the task of developing effective biologically-based diagnostic procedures for serious mental illnesses. There is promising research in blood testing, brain scans, and other screening technology; but our nation does not have a concerted and well-funded effort to move this research beyond the lab and into the hands of clinicians and the desperate families they serve.


America cannot afford to wait for someone else to solve this medical technology problem. As we were reminded again in Newtown, there is simply too much at stake. It’s time for the President and Congress to step up to the challenge. The results will not be quick or easily implemented. It might take five or ten years, but eventually it will lead to a safer America.


Please sign this online petition to tell the White House that it is time to find a better way to identify and treat serious mental illnesses. 
https://petitions.whitehouse.gov/petition/launch-coordinated-national-effort-identify-biological-markers-serious-mental-illness-fight-these/6z4w0zvV


Thank you,


Matt Kuntz
Executive Director
NAMI Montana