Suicide and brain damage

The brain is doubly impacted by trauma and addiction. We also know that organic brain disease may increase suicidality, and there are worrisome side effects that come with certain psych meds. Soldiers, football players, boxers, other high-impact sports athletes, car accident victims, and others who have had a traumatic brain injury (TBI) or its milder form, post-concussion syndrome (PCS), are at risk.

Traumatic Brain Injury has two causes:

1. Penetration of the head by a foreign object, such as a gunshot or sharp object.
2. Strong jostling within the cranium from a fall, a blow to the head, a car or motorcycle accident, etc.

The hallmarks of TBI, depending upon the severity of the blow to the head, can be:

• Cognitive impairment, evidenced in poor memory and lack of focus
• Emotional problems, such as depression, anxiety, personality change, aggression, and impulse control
• Impaired motor function, poor balance and coordination, and weakness in the extremities
• Problems with vision, hearing, and touch as well as impaired perception

NFL player Dave Duerson, former star of the Chicago Bears, shot himself in the chest at age 50. Before taking his life with a self-inflicted gunshot wound to the chest, he texted his family, asking that his brain be given to Boston University School of Medicine to be used for research—which is why he shot himself in the chest rather than in the head.

Researchers in neurology discovered that Duerson suffered from a neurodegenerative disease called CTE (chronic traumatic encephalopathy), which is linked to repeated head trauma and promotes the growth of a protein that is prevalent in degenerating brains like those with Alzheimer’s disease. The symptoms of CTE include suicidality, depression, aggression, and impaired judgment.

In 2006, another NFL player, Andre Waters of the Philadelphia Eagles, ended his life at the age of 44. The forensic pathologist who studied Waters’s brain said that it resembled the brain of an 85-year-old man in the first stages of Alzheimer’s.

The current research indicates that CTE is also found among military veterans and young school athletes, including those who play hockey and football, who take repeated blows to head. The soft-tissue damage to the brain is cumulative and dangerous.

Most significantly, the brain damage caused by CTE and TBI can lead to suicide.

A word about substance abuse, addiction and suicide

Research tells us the following:
• Drugs and alcohol increase the risk of death by suicide more than six times.
• The largest risk factors for suicidal thoughts are depression and other mental disorders, and substance abuse.
• More than one in three people who die from suicide are intoxicated, most commonly with alcohol or opiates (i.e., heroin, oxycodone).

Addiction is a brain disorder, not merely a matter of willpower. The brain is held hostage by drugs and alcohol. It is a real disease that is both cunning and baffling. And, it is treatable.

The abuse of substances, drugs and/or alcohol, leads to ignoring your responsibilities, taking risks, relationship problems, and potential legal issues. You are using substances without concern for their impact. It’s a bit like you have begun an unhealthy love affair. You are not quite yourself; you don’t care what others say, and you become more and more entranced with your new “love.” Slowly, and most certainly, you hand your power over to the substances of your choice.

Full-blown addiction harms the body, makes changes in the brain, results in poor life choices, and batters relationships. Addiction also increases feelings of self-hate, shame, isolation, and scheming behaviors. It erodes the spirit. Your life totally revolves around making connections, getting the substance of your choice, using that substance, and recovering from its use. Yet, you continue to use the drugs and/or alcohol even though you know it is bad for you. You are powerless, and the substances now own you.

Why do suicide, substance abuse, and addiction frequently go hand-in-hand?

We know that substance abuse changes us physically, emotionally, and mentally in these ways:

• Decreases inhibitions and lowers defenses
• Increases aggressiveness and violent behavior
• Impairs judgment
• Increases impulsivity. (Adolescents and young adults, especially, feel “bullet-proof,” and that nothing bad could ever happen to them.)
• Amplifies emotional responses such as hopelessness, despair, shame, and abandonment
• Increases and exacerbates emotional fragility already present within certain populations, i.e., those who are dual diagnosed (mental illness + substance abuse) and those suffering with PTSD and traumatic brain injury (TBI)

We know that substance abuse changes the brain. It impacts thoughts, feelings, and actions. Frequently, substance abuse is an anesthetic, a maladaptive habit-pattern, a coping response for stress, pain, and unhappiness. For the emotionally vulnerable person, substance abuse is akin to a match near a can of gasoline. There is a much greater potential for disaster.

Suicide and the Power of Shame

Shame is a feeling state. It is a deep-down, red-faced humiliation and mortification with oneself.

Through the lens of shame, we look at ourselves with complete disgust, revulsion, and contemptibility. We judge ourselves harshly, and show no mercy. We see ourselves as the epitome of gross imperfection, enormous stupidity, complete failure, and abject incompetence. Shame is a powerful force, and it can be a driving factor in suicidal thinking.

Shame is associated with intense feelings of disgrace, dishonor, and condemnation. It is also a major component of ostracism, shunning (think Hester Prynne and her Scarlet “A”), and punishment.

Shame is not the same thing as embarrassment. When we are embarrassed we feel, in varying degrees, uncomfortable with ourselves for something we have done or experienced. We are discomfited by our behavior. For example, we look in a mirror and realize that we had a piece of spinach stuck to our front tooth during our dinner date as we laughed and acted charming.

Nor is shame the same as guilt. We feel guilty when we have violated our personal standard. For example, we forgot to send our favorite Aunt Minnie a birthday card or we didn’t check up on a sick friend.

The etymology of the word “shame” is rooted in the words “to cover up, hide.” And, that’s exactly what we do when we feel ashamed; we want to hide and cover up. We avert our eyes, lower our head, and our shoulders slump. We want to disappear. And when there is intense shame, there is vasodilation (blushing) along with increased body heat and warmth.

Like fear, shame is a learned response. No one is born with shame. Shame is passed along by super-critical parents, relatives, employers, teachers, and the like. They regularly make denigrating comments that make you feel horrible about yourself. You might hear that you are stupid, worthless, unlovable, ugly, fat, a failure, incompetent, and any number of put-downs that attack your very essence. These critical folks (from their own wounded and unhealed hearts) tell you these terrible things about yourself, and you believe them. You unconsciously absorb their personal poison and drink it in as truth. You forever feel not good enough, not lovable enough, not enough enough.

You can feel ashamed when you are stopped for a DUI (i.e., driving while intoxicated); are verbally abused in front of your co-workers; or tell your friends your father died of a heart attack when he actually died by suicide. You can feel shame when you learn you are infertile or you need to file for bankruptcy. You can be filled with shame and the attendant self-loathing after you rage at your children or realize you have sent a scathing email to the wrong person.

Perfectionists, understandably, carry a tremendous load of shame. Members of dysfunctional families where there is addiction, violence, anger, and control issues also live with shame every day of their lives. Shame is all too common in cases of child abuse and child neglect. And, we all carry the secret shame of being ashamed. Shame says, I am a bad person, a horrible person, a no-good person.

Brené Brown, PhD, LMSW, is a researcher and storyteller who studies vulnerability, courage, worthiness, and shame. (Check out her fab TED talks on shame and vulnerability.) Brown has discerned what she calls her 1-2-3’s of shame:

1. “Shame is universal. It is one of the most primitive of human emotions. The only people who don’t have shame are those who have no empathy and lack the capacity for human connection. Here’s your choice: Fess up to experiencing shame or admit that you’re a sociopath.”
2. “We are all afraid to talk about shame.”
3. “The less we talk about shame, the more control shame has over our lives.”

Further, Brown has identified 12 categories of shame:

• Addiction
• Aging
• Appearance and body image
• Being stereotyped or labeled
• Family
• Mental and physical health
• Money and work
• Motherhood/fatherhood
• Parenting
• Religion
• Sex
• Surviving trauma

Within each of these shame categories, we can see a link to suicidal thinking and behavior. Brown reminds us, “Shame is such a powerful emotion that it can literally overcome us.” It can. It does, and, alas, too frequently results in suicide.

Let us watch for and notice the pernicious and dangerous hold of shame. We can circumvent the slippery slope of shame with compassion, discussion and reality-testing. Shame is a powerful, soul-eroding emotion that distorts good minds and twists hearts.

MyNDTALK with Dr. Pamela Brewer

Making Peace with SuicideThis was a great interview with Dr. Pamela Brewer in which we discussed my book, Making Peace with Suicide: A Book of Hope, Understanding and Comfort. I told Dr. Brewer it felt like we were sitting in comfy chairs and sharing a cup of tea. This ranks as one of my favorite interviews.

Her show is called MyNDTALK with Dr Pamela Brewer. To listen to this broadcast, click on the link below. The show runs for about an hour. Enjoy!



The 7 Points On The Spectrum Of Suicide

Every three seconds, on average, someone is attempting suicide, according to research out of India. The numbers of suicide attempts are exponentially higher than the number of completed suicides, which average every 13 seconds across the globe per the World Health Organization (WHO). Tragically, every minute of every day is influenced by some aspect of suicide.

Suicidality shows itself in a range of behaviors and thoughts that can become more fixed and concretized. There is a progression of pain and disconnection. Emotions are not linear. Thoughts can be disordered and scattered. There is no straight line or exact trajectory. That said, there is a continuum of suicide, where aspects of suicidality are portrayed by each individual in their own idiosyncratic manner.

Over my 30+ years of clinical work, these are the aspects of suicide I have seen in the consultation room and through crisis intervention lines. There are seven points on this spectrum, each with its own degree of severity. Clearly, some points are more intense and critical than others, but each is to be taken seriously and warrants professional help.

1. Ideation
Quite simply, you are thinking about suicide. You are rolling the idea around in your brain. Does this make sense for me? Would it be my answer?

Many people consider suicide in the abstract. What if? Thinking does not necessarily mean doing. Ideation is considering the option — usually, when there seem to be few options, and distress and overwhelm are at the fore.

2. Gestures
This is a seeming attempt at suicide by self-injury without serious or fatal consequences. Taking an overdose of aspirin or cutting one’s wrists are good examples.

(Please note, there is a distinction between self-harm and suicidal gestures. Cutting as self-harm is intended to relieve crushing emotions or to be able to feel something and no longer be numb; whereas, the intention of suicide is to cease the painful feelings and end one’s life. That said, be it self-harm — very common with trauma survivors who are at risk for suicide — or a suicidal gesture, both indicate a need for professional help.)

Suicidal gestures are a cry for help and, sometimes, attention. They are an alarm bell for action to be taken. These gestures are often labeled with the unfortunate term “para-suicide,” which minimizes the gravity of the situation. Repeated gestures are frequently a precursor to a completed suicide.

3. Passively Suicidal
This is a form of suicidal ideation. You are thinking about it, but know at this moment you would never do it. It sounds like a plausible idea because you are in so much emotional pain. There is a level of resignation in this thinking.

If someone magically took you out of your misery, you feel certain you would not fight back. You don’t want to feel so much pain any more. You are thoroughly depleted and paralyzed. You are exhausted on every level; you feel powerless and unable to change your current situation.

4. Active Thinking
This form of suicidal ideation is farther along the spectrum. You are developing a plan. You are working out the details. You know exactly what, when, and how you will do it. For some, there is relief in having a plan. For others, there is a grim satisfaction in imagining the impact their death will have on others. Maybe now they will understand how much I hurt.

5. Thinking and Doing
There are two forms of thinking-and-doing; one is planned and the other is impulsive.

You are now making a concrete plan. You are making preparations, securing the necessary accoutrements, and orchestrating how you will make your suicide happen.

Frequently, when individuals have reached this step, they may present themselves as happy to their loved ones and therapists. They have a plan of action. They are resolved, and there is no more equivocation.

Sometimes, the plan is enough in and of itself and serves as a fallback position if everything goes horribly wrong. When there are self-doubts about the viability and impact of the plan, the individual may be open to outside intervention and assistance, and the plan may crumble.

Impulsive thinking-and-doing is, as the name states, impulsive. It’s a flash of a thought and a rush of feeling that makes sense at the time. It’s an immediate way to end the internal anguish. Frequently, this occurs with teens and young adults.

This impulsivity can be accelerated by substance abuse that lowers the inhibitions, a history of risky behavior, unfettered anger, and unrelenting anxiety.

Impulsivity can also be triggered by a psychotic incident where there may be delusions and hallucinations. For example, voices in a young man’s head told him to kill himself immediately because all of his family were now living on another planet.

6. Chronically Suicidal
The chronically suicidal are individuals who, by virtue of mental illness, are always in and out of suicidality. Usually, they have been on psychiatric meds for years, and they have been hospitalized frequently.

Suicide is their default wiring. It’s where they land when their pain escalates; their thinking contracts, expands, or becomes chaotic; and they want to escape from the effects of their medications. The chronically suicidal want out; they want their internal struggle and torment to be over.

7. Slow Suicide
Slow suicide speaks to a long-term history of intractable, unrelenting addiction and substance abuse, such as full-blown anorexia nervosa, chronic heroin abuse and alcoholism.

Slow suicide is evidenced by a lifetime of self-harm that chronically erodes a person’s health, well-being, mental stability, emotional resilience, and vital energy. There is inordinate pain, grief, and anger. Unresolved trauma is likely.

Slow suicidal people choose to stay stuck in their toxic and self-defeating spin and steadfastly refuse any offers of help and assistance.

Suicide is never easy. We know it’s not painless. This spectrum of suicidality delineates the range of behaviors and thinking in order to increase understanding and compassion and, perhaps, circumvent tragedy.

This column was also featured on The Huffington Post Canada.

The death of a child

For a Parent on the Death of a Child

No one knows the wonder
Your child awoke in you,
Your heart a perfect cradle
To hold its presence.
Inside and outside became one
As new waves of love
Kept surprising your soul.

Now you sit bereft
Inside a nightmare,
Your eyes numbed
By the sight of a grave
No parent should ever see.

You will wear this absence
Like a secret locket,
Always wondering why
Such a new soul
Was taken home so soon.

Let the silent tears flow
And when your eyes clear
Perhaps you will glimpse
How your eternal child
Has become the unseen angel
Who parents your heart
And persuades the moon
To send new gifts ashore.

~ John O’Donohue ~

(To Bless the Space Between Us)

Clarissa Pinkola Estes “Refuse to fall down…”

Refuse to fall down.
If you cannot refuse to fall down,
refuse to stay down.
If you cannot refuse to stay down,
lift your heart toward heaven,
and like a hungry beggar,
ask that it be filled,
and it will be filled.
You may be pushed down.
You may be kept from rising.
But no one can keep you
from lifting your heart
toward heaven–
only you.
It is in the middle of misery
that so much becomes clear.
The one who says nothing good
came of this,
is not yet listening.

~ Clarissa Pinkola Estes

Go gently, dear one

Go gently, dear one.

There is no need to push, push, push.

Treat yourself with exquisite tenderness.

You have endured more than imagined possible.

You have swum in unimaginable depths and shadows

Breathe out fear and worry, rage and guilt.

Slowly open the knots in your heart.

Take small sips of breath and

Breathe in hope and possibility.

Pull in equanimity and calm.

Allow your heart to be soothed.

You have been through so much, so very much.

Go gently, dear one.


This is what grief looks like

Loss hammered you incessantly. Grief hollowed you out until you were gasping for breath, empty and fully spent. Your heart was broken and battered into a heap of crumbled bits and pieces. And still, you stood.

Anguish carved you open in unexpected and totally disorienting ways. You lost your footing; you lost your way. Nothing made sense anymore. There were moments when thoughts of your own death seemed like a cool pillow on a sleepless night, blessed relief for the heated pain that endlessly coursed through you. And still, you stood.

You stayed alternating between almost-catatonic numbness and torturous, cycling agony.

Please click here for the full article.


A blessing for times of crisis and chaos

During these days when the planetary movement is a rock-‘n-roll ride and many a wild card is being tossed in the air, may you feel the depth of your soul, the strength of your spirit, and the tenderness of your heart.  You are needed during these tumultuous times.

When the balance in your life has been shattered and you have been punched in the gut by loss and devastation, may you feel your angels and guides, ancestors and allies holding you closer.  You are not alone during these tumultuous times.

When you are exhausted, empty, and bone weary, may you give yourself permission to rest and to be.  You can surrender during these tumultuous times.

When you feel that hope belongs to the past, may you open yourself to possibility and allow yourself to breathe, breathe, breathe. You can connect to your life during these tumultuous times.

When you feel defenseless and vulnerable, may you feel the unseen arms of God around you. You are never alone during these tumultuous times.

When you are filled with terror and fear and your ears echo with an inner howling, may you find the deeply hidden and belonging-only-to-you, safe, inviolate sanctuary within your being where no one can hurt you. You can have a safe place during these tumultuous times.

When you are knee-deep in pain and rolling in crazy-making grief, may you honor the profound experience of your being and become like the water that flows in a myriad of forms of contraction and expansion. You can, when the moment is right, find hard-won acceptance during these tumultuous times.

When you are lost and adrift with no anchor to call home, may you remember who you are and the multitudinous gifts, graces, hard knocks, and experiences that make you the one-of-a-kind, kick-ass human being that you are. You can be survivor during these tumultuous times.


© Adele Ryan McDowell