tag:blogger.com,1999:blog-7772182113499451603.post511796868112029778..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: The Most Important Fact About Suicidal ThinkingGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-7772182113499451603.post-78199167734926937712019-03-21T06:44:42.511-05:002019-03-21T06:44:42.511-05:00I would have done the exact same thing.
I don'...I would have done the exact same thing.<br /><br />I don't "cast" their thought process one way or another. That is not how psychotherapy works. I talk with them and help them figure out what is really going on.<br /><br />You are saying that it is logical for a person to be suicidal because of benzodiazepine withdrawal. I disagree.<br /><br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-44038819319011040522019-03-21T00:59:00.881-05:002019-03-21T00:59:00.881-05:00I think what I'm trying to get at isn't th...I think what I'm trying to get at isn't that their suicidal ideation is due to their depression, but that it shouldn't be cast as irrational.<br /><br />I remember talking to one person who was finding suicidal ideation very distressing, and through talking with them I mentioned that it might be because they were withdrawing from benzo's. It was like a 10 ton boulder had been lifted from their shoulders. They had a logical reason for why they had suicidal ideation, so it no longer concerned them.<br /><br />I know that to you the suicidal ideation is irrational, because you know how to treat it, you've seen people with it before and you've seen them get better. But to them it may not be irrational, because given the information they have at hand it looks logical. And I think that framing it as irrational may not be helpful because you're undermining their confidence in their judgement and they might feel ashamed that they still feel that way. It also discourages them from digging deeper and trying to understand how it all logically connects. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-89662102526147315242019-03-15T15:26:03.033-05:002019-03-15T15:26:03.033-05:00Agree - the idea that someone is euthanized for a ...Agree - the idea that someone is euthanized for a treatable condition, especially one that predisposes to hopelessness and suicidal thinking is unconscionable as far as I am concerned. <br /><br />As far as ethical self government goes - it is a guess what that means on any given day.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-69487980935077896402019-03-15T15:07:25.370-05:002019-03-15T15:07:25.370-05:00Assisted suicide related to euthanasia is one of m...Assisted suicide related to euthanasia is one of my least favorite subjects and here's why. With sensible guidelines for the terminally ill in pain, it barely goes beyond a DNR order and is probably more humane. However, in actual practice, the government (see Europe) screws up sensible guidelines and it morphs into a killing field for people with reversible disorders such as depression and somatic syndromes. It's something we should be able to do right, without much of a problem, but we can't because someone will push it too far. It doesn't say much about the human capacity for ethical self-government that we can't manage what I think is an ethical and pragmatic lay-up.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-33721365401320763052019-03-14T23:42:23.455-05:002019-03-14T23:42:23.455-05:00For some reason this did not post through the usua...For some reason this did not post through the usual mechanisms so I cut and pasted it here:<br /><br />Joel Hassman has left a new comment on your post "The Most Important Fact About Suicidal Thinking": <br /><br />I am genuinely insulted by this overgeneralization of yours, there are times where suicidality has basis. The provider needs to help refocus with the patient that they have to consider other people's feelings and impact from a suicide death, but just to dismiss it as always irrational thought is so insensitive!<br /><br />Wow, I truly am speechless and have nothing else to write...<br /><br />--------------------------------------------------------------------------------------------------------<br />I am insulted every day by the way the media treats suicide as a mystery and a problem that cannot be solved. Or in the case of the NYTimes editorial today inadequate advice about taking care of the problem.<br /><br />My "overgeneralization" as you put it is a reality based psychotherapeutic strategy - elaborated slightly more in the paragraph following the first response.<br /><br />In case you are wondering, that means I am not telling the patient they are irrational. I am talking with them about their thought patterns and illustrating it.<br /><br />I obviously can't put those kind of notes on a blog and the average reader would not understand them anyway. Any interested reader can pick up a text on how to discuss suicidal ideation, but in most psychotherapy texts that chapter is missing.<br /><br />You can characterize whatever way you wish, all I know is that people appreciate feedback right in the session and have a clear sense of relief. I see many people who tell me they stopped seeing therapists because they got no feedback or dialogue. It was a never - ending recital of their symptoms and problems.<br /><br />I don't understand the silence of professional organizations or the advice to see a professional when it is obvious many people never make it that far. We have a generation of people hearing that people can bully you into suicide or talk you into suicide or that suicide is a mystery.<br /><br />It is not. It is a problem to be solved.<br /><br />Once again - this post is here to give them hope based on all of the people I have talked with and their response to this discussion. <br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-25976018404449452202019-03-14T23:04:15.790-05:002019-03-14T23:04:15.790-05:00Thanks for the advice - but I guess you missed th...Thanks for the advice - but I guess you missed the explanation about the intent and context of this post.<br /><br />It has nothing to do with the care of the terminally ill.<br /><br />I am the kind of guy who was sent terminally ill people to my inpatient psych unit simply because they had a psychiatric diagnosis and happened to be in the ED.<br /><br />It was up to me to treat them including their medical complications and find appropriate hospice care. And it didn't happen overnight.<br /><br />So I guess you are wrong about the "kind of guy" I am as well.<br /><br />I didn't need an attending. I was the attending.<br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-13363910497567584392019-03-14T21:30:48.684-05:002019-03-14T21:30:48.684-05:00I know this is incredibly rude, but, for the rest ...I know this is incredibly rude, but, for the rest of your career, never work with terminally ill people, this post is just so insensitive...<br /><br />Thank God during my residency I had a case working with woman in her mid-70s with horrendous metastatic breast cancer, she taught me a lot how to handle people with terrible terminal disease trying to have quality of life at the end.<br /><br />My attending totally agreed with me this was a very painful and difficult case, and we made sure the family was completely involved with the way we tried to direct her care before she was discharged from the oncology service.<br /><br />You're the kind of guy who would have demanded I hospitalize her on an inpatient psych unit, and thank God you were not my attending...Joel Hassman, MDhttps://www.blogger.com/profile/18428102819014299270noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-66963965985620860142019-03-14T19:16:11.745-05:002019-03-14T19:16:11.745-05:00Disagree completely.
First off this is not a char...Disagree completely.<br /><br />First off this is not a characterization. It requires discussion with the person and argumentation in the Socratic not the political sense. <br /><br />Second it occurs in the context of a well defined relationship. People see me as a psychiatrist for treatment of severe disorders and associated problematic thinking. I am not seeing anyone with terminal illness debating assisted suicide. I am seeing people with reversible disorders and the goal is to restore their functioning.<br /><br />I have never encountered suicide as a logical solution in that situation and helping that person depends on me pointing that out. In fact the idea that you bring up was one of my reasons for this post. <br /><br />With all of the suicides of healthy young people in the news - nobody seems to be getting this message out. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-76334718272911990882019-03-14T16:51:29.616-05:002019-03-14T16:51:29.616-05:00For some people characterising suicidal thoughts a...For some people characterising suicidal thoughts as irrational may be helpful, but it's unlikely to be helpful in all cases. Suicidal ideation occurs in fairly predictable psychological and sociological circumstances, which indicates that there is some logic to it. Sometimes it's more effective to characterise suicidal ideation as a logical solution to a problem that can be addressed in other (better) ways. Anonymousnoreply@blogger.com