Category: Depression

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What Are Suicidal Thoughts, and How Do I Cope With Them?

— Suicidal thoughts can feel scary and isolating, but you don’t have to cope with them alone. Here’s how to get the help you need.

Feeling hopeless, trapped, or lonely, or having a mental health condition like depression, are all potential risk factors for suicidal thoughts.

by Shelby House, BSN-RN

Suicidal thoughts — also called suicidal ideation — include wishes, thoughts, and preoccupations with death and suicide, according to StatPearls.

Suicidal thoughts can fluctuate in intensity and duration. They tend to follow a “waxing and waning” pattern, where they’re more intense at certain times and level out — or possibly subside altogether — during others, the authors of the report noted. Sometimes they’re fleeting, passive wishes to simply cease to exist, and sometimes they’re persistent and overwhelming thoughts of harming oneself.

“When such thoughts first occur, they often feel intrusive and frightening,” says Amy Mezulis, PhD, a licensed clinical psychologist and co-founder and chief clinical officer at Joon Care, a mental health care platform for teens and young adults. “For some individuals who struggle with depression or suicidal thoughts for a long time, they can start to feel almost normal,” she says.

The types of suicidal thoughts one experiences can vary from person to person and are considered either passive or active in nature, per the aforementioned report.

Passive Suicidal Thoughts

Passive suicidal thoughts are when someone loses the motivation to live, but they do not have a plan in place to end their life, according to Salt Lake Behavioral Health in Salt Lake City, Utah. “These can be thoughts such as wondering what it would be like to be dead or to not wake up in the morning,” says Dr. Mezulis.

Even though someone with passive suicidal thoughts doesn’t have a plan in place to end their life, these thoughts could eventually progress into active suicidal thoughts and lead to a suicide attempt, per the aforementioned StatPearls report. Passive suicidal thoughts should be taken very seriously.

Active Suicidal Thoughts

Suicidal thoughts are considered active when someone loses the will to live and has a plan in place to end their life, per Salt Lake Behavioral Health.

“Active suicidal thoughts refer to thoughts that focus on methods and plans for dying by suicide,” says Mezulis. “These can be thoughts such as considering different suicide means or making a mental plan for dying by suicide.”

Causes and Risk Factors for Suicidal Thoughts

“Suicide is complex and there is never a single cause,” says Jill Harkavy-Friedman, PhD, the senior vice president of research for the American Foundation for Suicide Prevention. “There are many potential contributors that may combine to create or increase risk.”

Factors that could raise your risk for suicidal thoughts, per Mayo Clinic, include:

  • Feeling hopeless, worthless, lonely, or socially isolated
  • Experiencing a stressful life event, such as the loss of a loved one or financial problems
  • Having a mental health condition like depression
  • Having a substance use disorder
  • Having a chronic disease, chronic pain, or terminal illness
  • Having a history of physical or sexual abuse
  • Family history of suicide
  • Having a family history of mental health conditions
  • Being lesbian, gay, bisexual, or transgender without a supportive family or living in hostile surroundings
  • Having prior suicide attempts

Signs and Symptoms of Suicidal Thoughts

The warning signs that someone may be having suicidal thoughts, per Mayo Clinic, include:

  • Talking about suicide and openly wishing to die or be dead
  • Obtaining the means to end one’s life, such as stockpiling pills or purchasing a gun
  • Withdrawing socially and expressing a strong desire to be alone
  • Having mood swings, such as feeling emotionally high one day but down and discouraged the next day
  • Fixating on death, dying, or violence
  • Feeling hopeless or trapped in a situation
  • Increased drug or alcohol use
  • Changing their usual routine, including sleeping and eating habits
  • Experiencing severe anxiety or personality changes
  • Engaging in risky behavior, such as reckless driving or substance use
  • Giving away personal belongings, drafting a will, or getting their affairs in order when there’s seemingly no logical reason for doing so
  • Saying goodbye to friends and family as if they will never be seen again

How Suicidal Thoughts Affect Your Health and Well-Being

Suicidal thoughts can take a serious toll on your emotional and physical well-being, in addition to heightening your risk of dying by suicide or injuring yourself in a suicide attempt, according to the CDC.

The human brain can only process so much information at a time, says Mezulis. So when a person is experiencing constant suicidal thoughts, much of their cognitive and emotional energy is consumed by them, she says.

“That can be exhausting, both psychologically and physically,” Mazulis explains. “Persistent suicidal thoughts can impact mood and health, contributing to a cycle of negative mood and suicidal thoughts that can be difficult to interrupt.”

The most serious consequences of suicidal thoughts are attempted suicide or death by suicide. People who survive a suicide attempt can be left with serious physical damage to their bodies that can be debilitating or even permanent, according to Cross Creek Hospital in Austin, Texas. The effects can include:

  • Scars
  • Broken bones
  • Hemorrhage, or heavy bleeding
  • Organ failure
  • Brain damage
  • Paralysis
  • Coma

Prevention of Suicidal Thoughts

Suicidal thoughts are often part of a larger issue, such as an underlying mental health condition like depression, substance use disorders, or schizophrenia, according to research. “Treating these underlying mood conditions [or other mental health conditions] can help prevent and reduce suicidal thoughts,” says Mazulis.

But not all people who experience suicidal thoughts have a mental health condition — stressful life events such as relationship problems, the death of a loved one, or eviction can lead to suicidal thoughts, too, according to the National Alliance on Mental Illness. Similarly, addressing those contributing factors (through strategies like talking to a mental health professional about those stressors and finding ways to manage the resulting feelings of distress, for instance) can help lessen suicidal thoughts, too.

Other factors that can protect against suicide and suicidal thoughts, per the CDC, include:

  • Having access to high-quality, consistent healthcare for mental and physical health conditions
  • Developing effective coping and problem-solving skills
  • Focusing on your reasons for living, such as family, friends, or pets
  • Having or developing meaningful connections with others
  • Having a strong sense of cultural identity
  • Getting support from friends and family

How to Cope With Suicidal Thoughts

Suicidal thoughts should always be taken very seriously. Don’t wait to get help for yourself or a loved one who’s considering suicide.

“If you feel like life is not worth living, notice changes in your thoughts and behaviors that make it hard to keep going, or you feel depressed or hopeless, it is important to trust your gut and take action,” says Dr. Harkavy-Friedman.

If you feel like you or a loved one are in imminent danger of suicide, call 911 for emergency help. For immediate crisis assistance from a trained counselor, you can reach the free, 24/7 988 Suicide and Crisis Lifeline by calling or texting 988, or the free, 24/7 Crisis Text Line by texting HOME to 741741.

If you feel you’re not in immediate danger, you should schedule an appointment to see your doctor or therapist to talk about what you’re going through, according to Mayo Clinic. They can help you determine the severity of your suicidal thoughts and come up with a treatment plan to manage them.

Treatment options for people experiencing suicidal thoughts, per Mayo Clinic, may include:

  • Psychotherapy Also called “talk therapy,” psychotherapy involves working with a licensed therapist to explore the root causes of your suicidal thoughts and learn skills to help you manage your emotions.
  • Medications These could include antidepressants, antipsychotics, or anti-anxiety medication if you have a mental health condition. Managing the symptoms of a condition can in turn lessen suicidal thoughts.
  • Addiction Treatment If you have a substance use disorder, getting treatment for it can reduce suicidal thoughts. This could include detox, addiction treatment programs, or self-help group meetings.

Along with professional treatment, practicing self-care can help you feel better and can reduce thoughts of suicide over time, says Harkavy-Friedman. Some self-care strategies that can help are getting regular sleep, exercising, eating a nutritious diet, spending time with friends and family, and making time for things that bring you joy, she says.

You could also reach out to family members, friends, or members of a faith community, for instance, when you feel like you need support. Having a strong support system can help lower your risk for suicide, according to Mayo Clinic.

In addition, it could help to reach out to one of the suicide hotlines described above, even if you don’t feel like you’re in immediate danger. A trained crisis counselor can offer free and confidential emotional support and connect you to resources that could help.

Resources We Love

American Foundation for Suicide Prevention (AFSP)

The AFSP is committed to raising awareness about mental health and suicide, and funding research related to suicide and suicide prevention. They offer specific resources for anyone who is experiencing thoughts of suicide, has survived suicide attempts, has lost a loved one to suicide, or is worried about someone else with suicidal thoughts.

988 Suicide and Crisis Lifeline

The 988 Suicide and Crisis Lifeline provides 24/7, free, and confidential support for people in distress, suicide prevention and mental health crisis resources, and best practices for health professionals in the United States. Dial 988 to speak with a trained crisis counselor who can help you if you or a loved one is experiencing thoughts of suicide. They also have a chat tool for those who are deaf or hard of hearing or who may otherwise prefer a chat option.

National Institute of Mental Health (NIMH)

The NIMH is the lead government agency for research on mental health conditions. It provides a “Suicide Prevention” resource for people experiencing thoughts of suicide or for their loved ones.

Complete Article ↪HERE↩!

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More obituaries acknowledge suicide as openness on mental health grows

Deborah Blum holds a photo of her child, Esther Iris, who died by suicide in 2021. When it came time to write the death notice, Blum was open and specific about the mental health struggles that led to her child’s death.

By Debby Waldman

When Deborah and Warren Blum’s 16-year-old died by suicide in November 2021, they went into shock. For two days, the grief-stricken Los Angeles couple didn’t sleep.

But when it came time to write a death notice, Deborah Blum was clearheaded: In a heartfelt tribute to her smart, funny, popular child, who had recently come out as nonbinary, she was open and specific about the mental health struggles that led to Esther Iris’s death.

“Esther’s whole thing was that people should know and talk about mental health and it shouldn’t be a secret,” Deborah Blum told KFF Health News. “The least I could do was to be honest and tell people. I think being embarrassed just makes it worse.”

Deborah Blum in the bedroom of her teen child, Esther Iris.

While it was once unheard-of to mention suicide as a cause of death in news obituaries and paid death notices, that has been changing, especially in the past 10 years, said Dan Reidenberg, a psychologist and managing director of the National Council for Suicide Prevention.

High-profile suicides — such as those of comic actor Robin Williams in 2014, fashion designer Kate Spade in 2018 and dancer Stephen “tWitch” Boss in 2022 — have helped reduce the stigma surrounding suicide loss. So has advertising for depression and anxiety medications, which has helped normalize that mental illnesses are health conditions.

The covid-19 pandemic also drew attention to the prevalence of mental health challenges.

“The stigma is changing,” Reidenberg said. “There is still some, but it’s less than it used to be, and that’s increasing people’s willingness to include it in an obituary.”

The teen’s drawings.
A card Esther Iris made for their dad, Warren Blum.

While there’s no right or wrong way to write death announcements, mental health and grief experts said the reluctance to acknowledge suicide has implications beyond the confines of a public notice. The stigma attached to the word affects everything from how people grieve to how people help prevent others from ending their own lives.

Research shows that talking about suicide can help reduce suicidal thoughts, but studies have also found that spikes in suicide rates can follow news reports about someone dying that way — a phenomenon known as “suicide contagion.” The latter is an argument people make for not acknowledging suicide in obituaries and death notices.

Reidenberg said, however, the subject can be addressed responsibly.

That includes telling a balanced story, similar to what Deborah Blum did, acknowledging Esther Iris’s accomplishments as well as their struggles. It means leaving out details about the method or location of the death, and not glorifying the deceased in a way that might encourage vulnerable readers to think dying by suicide is a good way to get attention.

A surfboard in memory of Esther Iris, with notes from their community written on it, is outside the Blum home in Los Angeles.

“We don’t ever want to normalize suicide, but we don’t want to normalize that people can’t have a conversation about suicide,” Reidenberg said.

Having that conversation is an important part of the grieving process, said Holly Prigerson, a professor of sociology in medicine at Weill Cornell Medical College in New York and an expert on prolonged grief disorder.

“Part of adjusting to the loss of someone is coming up with a story of what happened and why,” she said. “To the extent that you can’t be honest and acknowledge what happened if it’s a death due to suicide, that will complicate, if not impede, your ability to fully and accurately process your loss.”

People close to the deceased often know when a death was by suicide, Reidenberg said, particularly in the case of young people.

“Being honest can lead to information and awareness, whereas if we keep it shrouded in this big mystery it doesn’t help,” he added.

A study about caregiver depression that Prigerson recently conducted identified avoidance as an impediment to healing from grief.

“Not acknowledging how someone died, denying the cause of death, avoiding the reality of what happened is a significant barrier to being able to adjust to what happened and to move forward,” she said.

Researchers are increasingly seeing bereavement as a social process, Prigerson said, and as social beings, people look to others for comfort and solace. That’s another reason the stigma attached to suicide is harmful: It keeps people from opening up.

“The stigma is based on the perception that others will judge you as being an inadequate parent, or not having done enough,” Prigerson said. “This whole thing with obituaries is all about others — it’s about how people are going to read what happened and think less of you.”

Stigma, shame and embarrassment are among the reasons grieving family members have traditionally avoided acknowledging suicide in obituaries and death notices. It’s also why, if they do, they may be more likely to address it indirectly, either by describing the death as “sudden and unexpected” or by soliciting donations for mental health programs.

Economics can factor in — sometimes people are secretive because of life insurance plans that exclude payouts for suicides. Sometimes they’re trying to protect reputations, theirs as well as those of the deceased, particularly in religious communities where suicide is considered a sin.

Avoiding the word suicide doesn’t necessarily mean someone is in denial. In the days after a loss, which is when most obituaries and death announcements are written, it’s often profoundly difficult to face the truth, especially in the case of suicide, said Doreen Marshall, a psychologist and former vice president at the American Foundation for Suicide Prevention.

Even when people can admit the truth to themselves, they might have trouble expressing it to others, said Joanne Harpel, a suicide bereavement expert in New York who works with mourners through her business, Coping After Suicide.

In the support groups she runs, she said, people vary in how open they are willing to be. For example, in the group for mothers who have lost a child to suicide, everyone acknowledges that reality — after all, that’s why they’re there — but they don’t all do so the same way.

“Some of them will refer to ‘when this happened’ or ‘before all this,’” Harpel said, cautioning against holding all mourners to the same standard. “They’re not pretending it was something else, but using the word ‘suicide’ is so confronting and so painful that even in the safest context it’s very, very hard for them to say it out loud.”

If you or someone you know needs help, visit 988lifeline.org or call or text the Suicide & Crisis Lifeline at 988.<

Complete Article ↪HERE↩!

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To ease my depression, I volunteered to help dying people

— As a hospice volunteer, I expected tears and anger. What I didn’t expect was the laughter and joy.

by Keri Wiginton

My 90-something friend is relieved as I help him collect coats. He’s taking a trip somewhere his family can’t follow, he says, but he doesn’t want them to get cold after he leaves. I keep packing even though his story doesn’t make sense, at least not to me.

Gray clouds catch his eye, and he switches gears to the weather. I ask him what else he sees out the window. He dives in and out of his past, joking and smiling along the way. He was quite the ladies’ man, he says with a wink.

Twice a week for more than a year, I’ve given my time to the dying. Most people I visit have Alzheimer’s disease or another form of dementia. As a hospice volunteer, I expected tears and anger. What I didn’t expect was the laughter and joy.

How did I get here?

It was my therapist’s idea.

A few years ago, my 14-year-old cat suddenly got sick and died. Something in me broke when I felt her stop breathing. Still reeling from the loss, I found out my stepfather had a fast-growing brain tumor. He died five months later.

I learned how different the day feels when you know it might be your loved one’s last, and every second felt saturated with significance.

I savored every dad joke, every spoonful of ice cream, every mundane movie night. And when I watched him unwrap Christmas presents for the last time, I felt hyperaware of how much I’d miss his tendency to tear up no matter how small the gift.

My low mood persisted long after his funeral but not because of my sadness. The experience shifted my perspective on life. Unlike prior depressive episodes, regular exercise, mindfulness meditation, antidepressants and avoiding alcohol weren’t enough to bring me back this time.

So, my doctor set me up with a goal-oriented behavioral counselor.

I told the therapist about my stepdad and that I felt a profound pull to help others process grief or make meaning before their death.

We agreed that volunteering in a hospice might be a good fit, but I felt too overwhelmed to get started. He said to take one small step each week.

I looked at the nonprofit’s website and noted the volunteer requirements. A few weeks later, I applied. It took me three months to go from thinking the whole thing seemed impossible to attending my hospice-care training session. I wouldn’t get my first volunteer assignment for four more months.

That first day, my heart raced as I nervously sat in my car outside the memory care center. I’d never done anything like this before, but I’m glad I willed myself to walk in.

After that, I relaxed into my new role visiting people who are dying.

I give caregivers a chance to nap or run errands. While they’re out, I get to socialize with their loved ones as we listen to big band music from the ’40s, play Scrabble or go outside to feel the warmth of the sunshine while we chat.

Many of the folks I spend time with have memory challenges, so conversations may take twists and turns. I’ve learned to explore with them whatever path they’re on, and we often have fun doing it.

I find immense value and grounding in offering companion care to someone who’s nearing the end of life. I look forward to it every week.

Health professionals in the United Kingdom routinely recommend so-called social prescribing, linking people up with something that matters to them, whether it’s working in a garden, at a museum, or in my case, hospice and memory care.

“People are sometimes scared to develop a relationship with someone who has dementia,” said Rebeca Pereira, a psychology master’s student at the University of Saskatchewan who studies relationship-building in long-term care settings. “But we found that volunteers see that the person is much more than the disease.”

Pereira’s research mirrors my experience. Plus, when I make someone’s day a little brighter, I feel warmth in my chest similar to what wells up during a meditation session called loving kindness, a mindfulness practice where I imagine sending joy out into the world.

My compassion leaves a lasting impression even if my identity doesn’t.

Stephen G. Post, a bioethicist at Stony Brook University and an expert in compassionate care and the relationship between giving and happiness, explained why.

“People with dementia can be very emotionally sensitive and they can pick up on that presence,” said Post, who explores this topic in his book “Dignity for Deeply Forgetful People: How Caregivers Can Meet the Challenges of Alzheimer’s Disease.” “Just because someone’s linear rationality is compromised that doesn’t mean their consciousness is.”

I feel a sense of loss when people die, but our time together matters more because I know it’s short term. I also have found myself to be more present and less anxious, both when I’m volunteering and when I’m not.

I sleep easier at night and am less distracted at work. I have more energy to exercise and stronger shock absorbers for life stressors, including handling little problems such as someone cutting me off in traffic or big challenges like a family member’s Alzheimer’s diagnosis.

A cascade of chemicals such as dopamine, oxytocin, and other endorphins are probably responsible for the “helper’s high” that follows an act of kindness, said Post. These hormones are part of the mesolimbic pathway that responds to food or social rewards, he said, which helps humans cooperate and survive.

In other words, “you’re wired to feel better through doing this,” said Post.

At the same time, pathways that fuel depression symptoms may turn off, “including feelings of bitterness, hostility, rumination and other destructive emotional states,” Post said.

I feel more confident in other areas of my life because I feel successful at volunteering.

“This sense of competence may boost your self-esteem so that when stressful things happen, you feel better able to cope with them,” said Ann-Marie Creaven, an associate professor of psychology at the University of Limerick in Ireland.

We also have a fundamental need to belong to a group or to feel “that we’re important in someone’s life,” said Creaven. And this social connectedness piece may hold the key to how volunteering eases depression for people like me.

My social anxiety skyrocketed after the pandemic. But volunteering offered a structured, time-limited way for me to get out of the house. The more I did it, the more comfortable I felt in my role and around other people.

Because I found hospice work so meaningful, I began volunteering every other week during the school year to help grieving children explore the death of a parent through therapeutic play.

There, I bonded with a group of volunteers. We checked in with each other before and after each session, away from the kids.

Dana Basch, a licensed counselor and community grief specialist with Agrace Grief Support Center in Madison, Wis., where I volunteer, told me there is something “sacred” about coming together for a common purpose as personal as grief.

“There’s value in being able to help somebody else who’s going through something that you went through,” said Basch. “That absolutely helps volunteers heal.”

I also found that helping kids use play to work through their feelings around death can be joyful and, well, fun.

“There’s this idea that grieving kids are sitting around a circle crying,” said Jessie Shiveler, Agrace’s community grief manager. “People don’t understand that there’s laughter here, there’s smiles, there’s a connection.”

I developed a greater sense of peace and purpose after several months of face-to-face volunteering for two to four hours a week, which lines up with the suggestion of two hours a week from Post.

A caveat is that acting altruistically probably won’t trigger the same reward pathways for someone who feels forced into it. And it’s possible to overdo it.

“If any volunteering or care behavior gets to be too much, it can become a stressor in itself,” said Creaven.

According to Post, volunteering for health is kind of like exercise. It doesn’t work for everyone, but most people who do it find a benefit.

“I don’t think there are any guarantees on happiness advice,” Post said. “But I think that you’re better in the long run if you’re reasonably generous and kind.”

Complete Article ↪HERE↩!

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Dealing with death and dying

— How to protect your psychological health

By Bianca Iovino

Aged care staff face a variety of challenges that come with their work and dealing with death, dying and grief is an unfortunate reality of the job.

When frequently dealing with the death of people you are caring for, particularly if you have a strong relationship with them, intense feelings of grief and loss often arise which can be harmful if not dealt with.

Grief is a common response to death. Everyone expresses grief differently and no one can tell another how they should grieve, but it is important to know where to turn to when you are in a state of bereavement and still need to work in the industry.

The Australian Psychological Society acknowledged that aged care workers should be trained to deal with the challenges of their job properly, particularly in areas where trauma or workplace injury may occur, such as the death of a client. But access to psychological services, particularly through your workplace, can be limited as the country faces a shortage of psychology professionals.

Just yesterday, The Medical Journal of Australia released findings that evidence‐based mental health and wellbeing programs are needed for workers in health and aged care organisations to alleviate the ongoing mental health and wellbeing effects of workplace shortages, considerable physical and psychological demands of the job as well as the COVID‐19 pandemic.

As it is in the nature of a carer to do just that – care for others – it is also important for you to care for yourself when you’re feeling weighed down from bereavement.

So what can be done to protect your psychological health?

Heightened exposure to grief in aged care

Exposure to repeated instances of death and grief has been linked to burnout and overwhelming stress in many aged care workers.

Aged care workers are battling staff shortages, increased responsibilities and are still feeling the impacts of the COVID-19 pandemic, increasing the likelihood of experiencing burnout even more.

Grief can also be complicated or prolonged which can be persistent, debilitating and lead to serious psychological distress.

Aged care staff can experience grief more intensely after a resident’s death if:

  • They were particularly close to the person who passed
  • They have limited confidence in caring for people at the end of life, or in talking about death
  • They are facing other stressors, such as heavy workload demands or conflicts and pressures at home
  • COVID-19 can also add to the grief experienced by aged care staff as they are under increased pressure to provide end of life care when family and volunteer visits are limited

Managing grief and bereavement at work

After experiencing death and loss, you may feel the need to start distancing yourself from clients in the name of self-preservation.

You’re not alone. Since the pandemic, many working in the health and aged care field have said they are experiencing compassion burnout – putting the care of vulnerable older Australians at risk. But this strategy probably won’t help you and learning ways to cope with grief can help you build the emotional resilience needed to be the best carer you can be. You can grieve and still care well.

As a first step, it is important for you to acknowledge your feelings of loss and grief. Think about how you are feeling, why you may be feeling it and identify if you think you need to take more steps to help you mitigate these, often intense, feelings.

If you have decided you need more help and support, you can lean on your workplace and fellow colleagues to talk out your feelings and experiences.

Aged care supervisors and staff can support each other by debriefing after a client dies and listening in a non-judgmental way. You may also decide to organise a memorial or attend the client’s funeral if you wish.

Staff should be given time and a private space to debrief after a resident’s death to honour the loss, sign condolence cards for the family and share information about the end of life caring experience. You can ask to know your organisation’s support policy by talking to your supervisor as this should be outlined in an Employee Assistance Program.

Managing grief and bereavement at home

When something happens at work, it’s not easy to simply leave it at the door.

Developing self-awareness is an important step in mitigating the feelings and experiences associated with bereavement and grief. By identifying your strengths and weaknesses as well as understanding why you react the way you do in certain situations, you can better manage your emotions rather than being overwhelmed by them.

If grief and bereavement are becoming unmanageable and starting to impact your home life, maintaining self-care practices is paramount to getting through.

Taking time to rest and relax is key to avoiding burnout and keeping stress levels under wraps.

Where possible, spend time with friends and family so that you have opportunities to talk about your feelings and experiences and also maintain your sense of community support and social connection.

As always recommended, maintaining a healthy diet and exercising in some capacity helps with feelings such as sadness and loss. But you may find you still need a bit more support to help you through.

Seek help by talking to a General Practitioner (GP), a counsellor, a psychologist or other source of professional support.

There are specific bereavement services to help you with grief and loss which may even be available to you through your employer, given the nature of the job.

Dealing with death and dying is no easy feat. We all experience grief loss in our lives but for aged care staff, this reality is constant.

Knowing what to do, where to turn and what supports are available to you when you lose a resident are important pieces of information that can help you grieve healthily while still caring.

Complete Article ↪HERE↩!

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Sometimes I Think About Dying (2023)

— An ode to ‘living’ through a gentle, restrained, yet poetic exploration of isolation

By

Rachel Lambert’s ‘Sometimes I Think About Dying’ relies on a highly individualistic approach. We see its modest workplace through the central character’s eyes. Daisey Ridley (Star Wars Sequel Trilogy) plays introverted Fran, who isolates herself in a cubicle of her own accord.

The world moves around without taking notice of her. Her colleagues chat about their lives outside the office while she sits silently in front of her computer, delegating tasks efficiently and getting lost in thoughts.

We do not hear even a single word from her for a long time. She stays tucked in the comfort of her desk, engulfed in her duties. You see her eyes noticing all the humdrum interactions between her colleagues. But she never partakes. When they all gather to bid farewell to a senior employee, she stands on the side of a table, playing around with a piece of cake with her spoon.

Besides a lack of interest or connection to this collective activity, you feel as if she is making a conscious effort not to get noticed. While they brim with liveliness, she resists expressing herself outwardly. Meanwhile, in her solitude, she daydreams of escaping this dreariness and of ways to kill herself.

The film presents an immersive experience of Fran’s rich inner world through thoughtful narration. We see how Fran’s way of learning is through the things that she allows to be part of her reality. We derive a sense of affinity with her workplace and her colleagues while the camera practically acts as her eyes.

The narrative opens us up to its humane themes through her minute observations and heartfelt discoveries. We perceive her as an enigma whose perception is limited to her confined world. Whether it is a crane she looks at often through her office window or a piece of cheese that she mentions as her favorite food, these personal details from her life become a gateway to building her emotional landscape.

Death seems like a viable solution to her misery, and she fantasizes about it in vivid detail. The film gives us a surreal glimpse inside her wildly imaginative mind through its particularly bleak moments. She sees herself on a bed of grass where light illuminates but does not invite her.

Even the tiniest things around her seem threatening when she indulges in her ruminations triggered by her hypersensitivity. We witness her journey toward being more accepting of herself and her life.

The film builds her limited world with clear understanding and utmost compassion. Set in a small American town on the Oregon coast, the narrative lends its distance from the hustle-bustle of modernity by the location itself. Despite its insular nature, the script resonates due to Fran’s journey to break out of her bubble.

After being shy by her volition, we see her slowly open up to Robert (Dave Maherje). This new employee quickly becomes a part of her office through his natural friendliness. Initially, he learns little about Fran besides the type of cheese she enjoys. She sits awkwardly through this meeting for the sake of showing her face.

Later, he makes up an excuse to initiate a conversation with her. She faintly smiles due to a sense of acceptance she derives from it. They chat further without bringing it to the attention of their colleagues. She sees him as a way to get out of her isolated shell of comfort. Even if the thought of getting emotionally involved in him initially scares her, she warms up to it.

However, their individual communication patterns become reasons for their conflicts. He shares a bucketload of information about himself without even realizing that he did. On the other side, she struggles to communicate even a casual detail from her life. Adding to her refusal to express herself, her stoic bluntness bothers him.

The script handles these communicational conflicts in a mature manner. Aside from its clever writing, Rachel Lambert’s direction uses the minutiae of sounds during its long winding silences and grey tones. It capitalizes on moments of discomfort to break out into fascinating moments of dark humor.

We see how Fran’s inclination toward death turns her closer to bleak fantasies in her mind. She blurts out these fantasies without realizing their absurdity. A clever mix of her innocence and years of isolation makes these moments charming.

Between the film’s overall restrained storytelling, they seem particularly hilarious due to an inherent unpredictability. Amidst all its storytelling elements, Daisy’s penetrating eyes keep us glued to this dreary worldview.

Dave brings an innocent affability to his performance that perfectly complements her silence. With all their contribution, the film gently navigates an introvert’s journey to a better place while learning to embrace momentary discomforts.

Complete Article ↪HERE↩!

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The anxieties of growing old when you’re LGBTQ

Who would you call to bring you chicken soup? For many LGBTQ seniors who are alone, that’s no easy question.

A person holds an umbrella in the rainbow flag colors in the annual Gay Pride Parade, part of the Durban Pride Festival, on June 29, 2019, in Durban, South Africa.

By Steven Petrow

Who would bring you chicken soup if you were sick? For most people of a certain age, that’s easy — a spouse or an adult child would step up.

For many LGBTQ people, however, it’s not a simple question at all.

“Many [would] have to think really hard about this,” said Imani Woody, an academic and community advocate who retired from AARP to start an organization serving LGBTQ seniors. She said chicken soup is a stand-in for having a social support system, which many of us need.

“Build your village right now,” Woody said.

A few years ago, I would have said that my then-husband would be my primary caregiver if I became ill or disabled. I’d have done the same for him. Now I’m 65 and divorced, and this issue — who can I call on? — is top of mind for me.

It’s also a serious concern for many LGBTQ people I know, whether single or partnered. Take one friend of mine, for example, who is 60 and a single gay man. He took care of his dying father last year (as I’d done four years earlier with my parents). During his dad’s lengthy illness, we talked about two questions that terrify us (and I don’t use that word lightly): “Who will take care of us when we need help?” “Where will we go when we can no longer take care of ourselves?”

Of course, aging is an equal opportunity challenge for straight and queer people alike. But in interviews with more than four dozen LGBTQ people, singled and partnered, I heard repeatedly about the anxieties faced by queer elders.

SAGE/Advocacy & Services for LGBT Elders, the National Resource Center on LGBTQ+ Aging, and Healthypeople.gov document the health challenges LGBTQ people face. We’re twice as likely as our straight counterparts to be single and live alone, which means more likely to be isolated and lonely. We’re four times less likely to have children. We’re more likely to face poverty and homelessness, and to have poor physical and mental health. Many of us report delaying or avoiding necessary medical care because we face discrimination or mistreatment by health-care providers. If you’re queer and trans or a person of color, these disparities are heightened further. (There are about 3 million LGBTQ people 50 and older.)

“It’s a very serious challenge for many LGBTQ older people,” said Michael Adams, chief executive of SAGE. “The harsh reality is that there just aren’t as many opportunities for older LGBTQ folks when it comes to creating, building and maintaining social connections. … We’re lacking the personal connections that often come with traditional family structures.”

In part, that’s because LGBTQ people have often found themselves rejected by family, friends and community in their younger years because of their sexual orientation or gender identity. To boot, we could not legally marry until 2015, when the Supreme Court ruled in favor of marriage equality. But even married queer folks can end up alone after a divorce or death, which often brings different challenges than those faced by straight people facing the same life-changing events.

An 80-year-old lesbian put it to me this way: For straight people, “If you were to go into a nursing home, you would not have to worry that people taking care of you did not approve of your orientation, or that the facility would not take you because they were a ‘religious’ community. These are real issues for the queer community.”

Another friend tells me he has no plans for the future except a guest room and a second bathroom. And another said he hopes by the time he needs care, there will be an LGBTQ senior community in his city. “Otherwise, I have nothing,” he said.

A former colleague of mine, a lesbian, told me she worries about the cost of senior living: “I dread it all. I won’t have any dough then, so it’s really up to fate.”

Senior living communities, which provide support for the aging, can be less than welcoming to those who are LGBTQ. Staff, some of whom have traditional views on sexuality, gender identity and marriage, also pose challenges to LGBTQ elders since many facilities lack the training and policies to discourage discrimination, which can lead to harassment, Adams said.

Patrick Mizelle, who lived in Georgia with his husband, told Kaiser Health News several years ago that he worried about how “churchy” or faith-based their local options seemed, and feared they would not be accepted as a couple. “Have I come this far only to go back in the closet and pretend we are brothers?” he asked.

Rather than take that risk, they moved across the country to a queer-friendly senior living complex in Portland, Ore. They are among the lucky ones in that they could afford both the move and the cost of this domestic situation.

How do you find a welcoming LGBTQ senior living arrangement? SAGE publishes a comprehensive list of long-term care facilities (organized by state and city, along with level of care) that it has found to be welcoming.

“We also have resources about the kinds of questions that a consumer can ask to figure out if a provider is paying attention to the steps that need to be taken to become more welcoming to LGBTQ older adults,” Adams said.

SAGE also offers training to staff members at facilities that provide elder care, and has partnered with the Human Rights Campaign, the national LGBTQ lobbying and advocacy organization, in launching the Long-Term Care Equality Index, which sets out best practices to help make these facilities welcoming to the LGBTQ community. More than 75 facilities have made pledges to abide by these best practices. AARP also provides a list of affordable LGBTQ-welcoming senior housing.

What else can LGBTQ people do to find connection, to find a tribe? Many suggest the importance of developing intergenerational friendships early on in life, even as early as your 30s and 40s. Elders can impart wisdom and experience to younger LGBTQ people, who can provide help in return; as decades pass, the young ones become the elders.

Recently, the Modern Elder Academy, which refers to itself as a “midlife wisdom school,” and the founders of Death Over Dinner, launched a program called “Generations Over Dinner” expressly to connect people of all ages.

The Harvard Study of Adult Development, which began tracking more than 238 men (regardless of sexual orientation) in 1938 and continues to this day, has reported consistently that relationships are the critical ingredient in well-being, particularly as we age.

Put simply, the more connected we are, the more likely we are to be healthy and happy. To paraphrase Imani Woody: Start building those bridges.

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Grief vs. Depression

— Which Is It?

It’s important to sort out the differences

By Nancy Schimelpfening, MS

Grief and depression share similar symptoms, but each is a distinct experience. Making the distinction between the two is important for knowing how to treat and cope with your symptoms.

This article discusses the difference between grief and depression, focusing specifically on which symptoms overlap and which symptoms are different. It also presents the various treatment options that are commonly used to treat symptoms of depression and, in some cases, to treat the symptoms of grief.

Clinical Perspectives of Grief and Depression

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) removed a “bereavement exclusion” from the diagnosis of major depressive disorder (MDD).1 In the DSM-IV, the bereavement exclusion stated that someone who was in the first couple of months after the death of a loved one generally should not be diagnosed with MDD.

However, the DSM-5 recognizes that while grief and MDD are distinct, they can also coexist. What’s more, grief can sometimes trigger a major depressive episode, just as with other stressful experiences.2

Studies have shown that the extreme stress associated with grief can also trigger medical illnesses—such as heart disease, cancer, and the common cold—as well as psychiatric disorders like depression and anxiety.

In addition, the DSM-5 text revision (DSM-5-TR) added a new diagnosis for people experiencing extreme grief after one year of the death of a loved one. This condition is called prolonged grief disorder (PGD). It is considered a trauma– and stressor-related disorder.

PGD is marked by intense and distressing emotional pain and yearning for the lost loved one, thoughts that are preoccupied with the loss, disruption in one’s sense of identity, emotional numbness, and avoidance of reminders of the loss. PGD symptoms are disruptive to a person’s everyday functioning and ability to reintegrate into life.3

Given the similarities between grief and depression symptoms, there are times when it may be tricky to distinguish between the two. A better understanding of their similarities and differences can help.

Similarities

Grief may have several symptoms in common with the symptoms of major depressive disorder, including:

  • Intense sadness
  • Insomnia
  • Poor appetite
  • Weight loss

Differences

Grief tends to decrease over time and occurs in waves that are triggered by thoughts or reminders of its cause. This is how it differs from depression, which is more pervasive and persistent throughout all situations.

In other words, a grieving person may feel relatively better in certain situations, such as when friends and family are around to support them. But triggers like the birthday of a deceased loved one or going to a wedding after having finalized a divorce could cause the feelings to resurface more strongly.

Depression, on the other hand, tends to be present no matter what the circumstances are. (An exception to this would be atypical depression, in which positive events can bring about an improvement in mood.4 A person with atypical depression, however, tends to exhibit symptoms that are the opposite of those commonly experienced with grief, such as sleeping excessively, eating more, and gaining weight.)

Additionally, grief usually causes a person to feel a longing for or an urge to see their lost loved one again; depression tends to result in the opposite. Someone with depression doesn’t necessarily feel the urge to do anything or see anyone.5

Grief

  • Intense sadness
  • Difficulty accepting that whatever caused the grief occurred
  • Excessive focus on the episode of grief or avoidance of it altogether
  •  Thoughts of “joining” the deceased
  • Sensation of hearing or seeing things related to the loss

MDD

  • Feelings of sadness, emptiness, or hopelessness
  • Feelings of guilt not related to grief
  • Morbid preoccupation with worthlessness
  • Sluggishness or hesitant and confused speech
  • Prolonged and marked difficulty in carrying out day-to-day activities
  • Thoughts of suicide
  • Hallucinations and delusions

Anger and irritability can be potential signs of both grief and depression as well.

Treatment for Grief and Depression

There are treatment options for the symptoms of depression and grief. Of course, treatment varies based on a person’s unique circumstances. Be sure to consult with a doctor or mental health professional to discuss what options are best for you.

Therapy

Psychotherapy is a treatment option for both grief and depression. It can be greatly beneficial in helping you process what you are feeling and teach you strategies that can help you cope.6

Grief-specific cognitive behavioral therapy may be helpful for some people with prolonged grief disorder. This therapy method uses similar techniques as cognitive behavioral therapy (CBT), like reframing negative thoughts and learning healthy coping mechanisms. In addition, this type of therapy can help you learn how to maintain a healthy attachment to your lost loved one.7

Interpersonal psychotherapy (IPT) is a treatment method often used for depression but has the potential for treating complicated grief as well. IPT focuses on resolving symptoms, building up relationships, and getting involved in mood-boosting activities.8grief counseling made up of components of both CBT and IPT. In CGT sessions, you may repeat the story of how you lost your loved one as well as set personal goals for yourself and your relationships.9

Medication

Antidepressants are the most common class of medication prescribed to treat depression. Examples include:10

For someone experiencing extreme and disruptive symptoms of grief, a doctor might prescribe an antidepressant as well.

It’s most often recommended that for major depressive disorder, you complete a course of medication along with attending therapy sessions at the same time.

Support Groups

Social support can be a powerful tool when you are coping with symptoms of depression or symptoms of grief. Many mental health professionals recommend attending a support group of people who are experiencing similar challenges as you.11

Whether you find a support group for depression or a support group for grief, you may benefit from sharing your experiences with others, receiving their encouragement, and listening to others’ stories.

A Word From Verywell

>While the symptoms of grief and depression are similar, it’s important to talk to a doctor and/or mental health professional who can reach a diagnosis and help you pursue treatment options to cope with your symptoms. Remember, there is relief and there are resources that can help you heal.

Every person grieves differently and there is no right or wrong way to do it. Talk openly with a therapist or someone you trust, and remember that grief is not a sign of weakness.

Likewise, depression is an illness like any other. Reaching out for help when you experience depression symptoms is a sign of strength and can help get you on the road to effective treatment.

Complete Article ↪HERE↩!