- No events
“Researchers say their findings may being us closer to a drug that can prevent suicidal behavior.”
In the journal Translational Psychiatry, researchers reveal how a certain variant of the enzyme ACMSD leads to abnormal levels of two acids in the brain, which may encourage suicidal behavior.
The research team – including senior author Dr. Lena Brundin of the Center for Neurodegenerative Science at Van Andel Research Institute in Grand Rapids, MI – say their findings could bring us closer to a blood test that can identify patients at high risk of suicide.
What is more, the study suggests ACMSD could be a promising drug target for suicide prevention.
However, the underlying mechanisms of this association have been unclear, which has hampered the discovery of clinical strategies to prevent suicide. The new study aimed to shed some light.
Past studies have shown patients with suicidal behavior experience persistent inflammation in their blood and cerebrospinal fluid (CSF).
With this in mind, the researchers assessed the blood and CSF samples of more than 300 individuals from Sweden, some of whom had attempted suicide.
ACMSD enzyme variant more prevalent in people with suicidal behavior
On comparing samples, the team found that individuals who had attempted suicide had abnormal levels of both picolinic acid and quinolinic acid. These irregular acid levels were identifiable in samples taken straight after a suicidal attempt and at various points over the subsequent 2 years.
Among subjects with suicidal behavior, levels of picolinic acid – known to have neuroprotective effects – were too low, while their levels of quinolinic acid – a known neurotoxin – were too high.
These abnormal levels were most prominent in CSF, the team reports, though they could still be identified in blood samples.
Since previous research had shown that both picolinic and quinolinic acid are regulated by the enzyme ACMSD – known to regulate brain inflammation – the researchers conducted a genetic analysis of individuals with suicidal behavior, as well as healthy controls.
From this, they found that individuals who had attempted suicide were more likely to possess a specific variant of ACMSD, and this variant was associated with increased levels of quinolinic acid.
While the study is unable to demonstrate that ACMSD activity is directly linked to suicide risk, the researchers say their findings suggest the enzyme could be a potential drug target for suicide prevention.
“We now want to find out if these changes are only seen in individuals with suicidal thoughts or if patients with severe depression also exhibit this. We also want to develop drugs that might activate the enzyme ACMSD and thus restore balance between quinolinic and picolinic acid.”
Co-study leader Dr. Sophie Erhardt, Karolinska Institutet, Sweden
Additionally, since the results show that abnormal levels of picolinic and quinolinic acid can be identified in the blood, the team says they may bring us closer to a blood test that can identify patients at high risk of suicidal behavior.
Anxiety in Grief
Think of something that scares you. Perhaps it’s the thought of giving a speech in front of a crowd, taking a test, asking your crush out on a date, or jumping out of an airplane. Even if you’re mostly fearless, everyone’s got something.
Now think about the thoughts and sensations you typically experience right before doing this thing that scares you; this is your fear and anxiety at work. Maybe your stomach starts doing cartwheels, your heart begins to race, or your breathing becomes rapid. Perhaps your thoughts start running through all the worst potential outcomes and you think to yourself…
“There’s still time. I could still run from this situation.”
I know you know what I’m talking about. Even the bravest people feel fear and anxiety, they just know how to navigate the experience more exquisitely than most.
Are you still with me? Okay good, now take a second and think backwards to a time when you experienced the thoughts and sensations of fear and anxiety in your grief. Maybe this isn’t one particularly traumatic moment, but a prolonged period of time when you experienced ongoing apprehension and worry, upon worry, upon worry.
Using a personal example, I remember feeling panic-like anxiety when my father told me of my mother’s terminal cancer diagnosis, and then the slow hum of persistent anxiety in the weeks and months afterwards as my family frantically searched for treatments and clinical trials. For one year I held my breath and prepared for the worst, knowing that my mother’s death was not a possibility but a probability.
People experience anxiety after the death of a loved one for a number of reasons and, you guessed it, we’d like to discuss a few of them here today.
After the death of a loved one, you may experience anxiety because…
…you are trying to avoid unpleasant thoughts, memories, and emotions.
I want to start by discussing avoidance because the act of avoidance is involved in perpetuating all of the scenarios to follow. When we talk about avoidance in grief we are usually referring to experiential avoidance. As we noted in a previous article about avoidance…
“Experiential avoidance is an attempt to block out, reduce or change unpleasant thoughts, emotions or bodily sensations. These are internal experiences that are perceived to be painful or threatening and might include fears of losing control, being embarrassed, or physical harm and thoughts and feelings including shame, guilt, hopelessness, meaninglessness, separation, isolation, etc. Now please note I say “perceive to be painful or threatening,” these judgements are often subjective and what is perceived as threatening to one may seem totally irrational to another.”
Although grief is always unpleasant and uncomfortable, for some there are aspects that actually seem threatening and these perceptions can lead to attempts to control or avoid frightening feelings and reactions. Although avoidance can be useful in certain scenarios, for many it can become a harmful cycle that persists to the detriment of personal healing.
Many mistakenly think that if they make efforts to avoid their feelings for long enough these unpleasant emotions will be kept at bay or fade away, when in actuality deliberate attempts to suppress certain thoughts often make them more likely to surface. Avoidance is a large factor in the development and maintenance of anxiety.
…it’s a learned response.
There may be elements of your loved one’s death that, in the moment, you perceived as traumatic and terrifying. (We’ve written on traumatic grief before, you can find that article here) One of the quickest routes to acquiring fear and anxiety towards an object or situation is through a direct, negative experience.
When something traumatic happens the thoughts, emotions and sensations experienced in that moment can become paired with objects and situations associated with the event. Psychologists call this phenomena, Classical Conditioning.
Here’s an example, a parent’s phone rings at 5am and the person on the other end tells them that their son unexpectedly died in a car accident the night before (I’m sorry if this situation hits too close to home). Before this moment a phone ringing in the morning might not have given the parent a second thought, but now every time the phone rings before 8am the parent feels a temporary surge of panic.
Many people can pinpoint at least one thing that, since their loss, makes them feel anxious in ways it never did before.
…you fear grief emotion
The relationship you have with your emotions is complicated and nuanced. People begin learning about emotion from a very early age through learning and observation. Beliefs about emotion can be impacted by many factors, but some common influences include…
- Adult role models (what they told us and how they handled emotions themselves)
- Cultural and societal messages and norms
- Television, books, and movies
- Personal experience
The death of a loved can evoke such new and distressing emotions that test your existing understanding of emotion.
After a death mourners often feel as though they are going crazy. If a person interprets their symptoms as dangerous, threatening, or indicative of a larger mental or physical problem, they are more likely to fear their reactions. Those who fear grief responses and grief related emotions (i.e. fear of emotion and anxiety themselves), will likely experience increased feelings of anxiety in a world where emotion is unpredictable and easily triggered. Those who are fearful of their reactions may also engage in maladaptive and persistent avoidance of triggers or reminders of the death or of their loved one, which can prevent the mourner from learning to cope with their thoughts, emotions, and memories, and contribute to the development of ongoing anxiety.
…you aren’t confident in your ability to cope
A person may also experience anxiety if they have little confidence in their ability to cope with their emotions, either because they feel their coping skills aren’t sufficient enough or because they feel that they can’t control their emotions. As noted by Abramowitz, Deacon, and Whiteside (2012),
“Clinically anxious patients typically underestimate their capacity to control or cope with perceived threats, as well as their fear reaction to such threats.”
Although only some people will experience anxiety that would be considered “clinically anxious”, it’s normal to feel anxious about experiencing new emotions, grief triggers, and painful memories. For this reason, we caution people from resisting to temptation to chronically avoid, and encourage people to search for the coping tools that will help them deal with their grief little-by-little.
…you now know bad things can happen.
Prior to your loved one’s death you may have assumed that the world was a good and benevolent place where things happened for a reason. You may have also subconsciously believed that bad things wouldn’t happen to you. When something bad did happen your assumptions about the world became shattered and the world turned upside down. Depending on your understanding of what happened to you and your loved one, you may now hold new beliefs or engage in modes of thinking that contribute to feelings of anxiety such as probably overestimation, cost overestimation, and intolerance of uncertainty.
Probability overestimation: You may overestimate the likelihood of bad things happening. Perhaps you overestimate the likelihood of the event that led to your loved ones death, like cancer, accidents, or violence, happening to you or to other loved ones. Or perhaps your loved one’s death led to the belief that bad things can happen to anyone at any time and now you feel that disaster is likely to strike at any moment.
Cost overestimation: Cost overestimation occurs when someone believes that the consequences of something happening will be worse than they truly are. For example, you may worry that if you encounter a grief trigger in public you will become emotional and lose control in front of everyone and that this will be a mortifying experience. Because you believe that the pain of experiencing this event is so excruciating, you may feel anxiety over the possibility of it happening and engage in avoidance to prevent it. However, by never allowing yourself to experience the event, you are never able to learn that (1) the cost isn’t as high as you assumed and (2) you are capable of coping with the experience.
Intolerance of uncertainty: Some people have a very hard time dealing with even the remote possibility of something bad happening. Even if the odds of an event occurring are very low, the uncertainty of whether it will happen is enough to cause intense anxiety and distress.
Many of you have learned first hand that worst case, low probability, scenarios can happen, so it may be futile for anyone to tell you to take comfort in the likelihood that these things won’t happen. As someone who has experienced the unlikely, the task for you becomes learning to live in an unpredictable world that you can’t completely control.
…you don’t want to find yourself caught of guard.
There an interesting theory put forth by Michelle Newman and Sandra Llera (2011) to explain worry and avoidance in Generalized Anxiety Disorder (GAD) called the Contrast-Avoidance Model. Newman and Llera (2011) theorize that people with GAD, “…use worry as a coping strategy because they prefer to feel chronically distressed in order to prepare for the worst outcome, rather than to experience a shift from a positive or euthymic state to a negative emotion.”
Newman and Llera (2011) point out, that worry preceding a negative event provides protection from experiencing a drastic increase in negative emotions when the event happens. This makes sense if you think about it because our society promotes worry all the time. We say things like, “brace yourself,” and “don’t let your guard down,” which translates to, “don’t let something bad happen when you least expect it.
…you are experiencing an anxiety disorder or post-traumatic stress disorder
Anxiety disorders are one of the most common mental health disorders. Logically, many people who already struggle with anxiety will experience grief. For others, the death of a loved one may lead to new and unfamiliar struggles with anxiety.
While it’s normal to experience a sense of fear and apprehension during times of hardship and high stress, if you feel that you are experiencing excessive worry and panic in the absence of an actual threat and for a prolonged period of time then you might want to speak to a mental health professional. Your situation is unique and the best way to truly understand your anxiety related experiences is to speak to a trained mental health professional in a one-on-one capacity. That said, here are some articles that you may find helpful.
From “What’s Your Grief”
Most people don’t think about the idea of loneliness in great depth. Loneliness is one of those concepts we assume we know. We equate it to the very definable concept of being alone, which means “without other people”, and thanks to “lonely people” archetypes — like the spinster with 10 cats and the misunderstood teenager — we think we know exactly what loneliness looks like.
Google the phrase “mentally ill” and you’ll find the following: “Mentally Ill Man’s Shooting Fits Troubling Pattern.” “Solitary Confinement Out for Mentally Ill?” “Chicago Police to Receive New Training on How to Assist Mentally Ill.”
And so on. There’s a potentially troubling subtext to these headlines, in that it makes “the mentally ill” sound like a separate subset of the population. The fact is, however, that mental illness — which is itself a huge umbrella covering everything from depression to schizophrenia to bipolar disorder and more — affects one in five American adults (or more than 43 million people 18 and over), according to the National Alliance on Mental Illness. Now new research makes the case that simply using the phrase “the mentally ill” may be inadvertently promoting a dangerous level of intolerance.
Darcy Haag Granello and Todd A. Gibbs at the Ohio State University just released a paper in The Journal of Counseling & Development looking at this issue. They took more than 600 people — undergraduate students, adults, and counselors-in-training — and used the Community Attitudes Towards the Mentally Ill (CAMI) survey. The one twist: Half of the respondents got statements associated with “the mentally ill,” and the other half got the exact same statements with “people with mental illnesses” instead. When the phrase “the mentally ill” was used, different groups showed different levels of intolerance. College students are more likely to believe that people with mental illnesses should be controlled and isolated. Adults, on the other hand, are less empathetic or “benevolent” to those suffering from mental illness and are more likely to want to have them separated from the “normal” community.
What’s most surprising is the reaction that counselors have when the phrase “the mentally ill” is used: They’re more likely to believe that those suffering from mental illness should be controlled and isolated from the rest of the community. That’s pretty surprising, given that these counselors are perhaps the ones most likely to be aware of the special needs and varying differences in diagnoses of the group.
Counselors also showed the largest differences in how intolerant they were based on the language, which boosted the researchers’ belief that simply changing language is important in not only understanding people who suffer from mental illness but also helping them adjust and cope. “Even counselors who work every day with people who have mental illness can be affected by language,” Granello said in a press release. “They need to be aware of how language might influence their decision-making when they work with clients.”
The concept of changing the way we refer to people with mental illnesses dates back to the “person-first” (sometimes referred to as “people-first”) movement of the 1990s, when advocates argued that defining a person by their disability robbed them of their personhood and their identity. “When you say ‘people with mental illness,’ you are emphasizing that they aren’t defined solely by their disability,” Gibbs said. “But when you talk about ‘the mentally ill’ the disability is the entire definition of the person.” Despite the “person-first” movement of the 1990s, Granello and Gibbs’s study is the first one to look at how language affects how we perceive this population.
Granello is hesitant to say that a conclusion can be drawn from this, that it was too early to draw definitive conclusions about how different populations responded to the phrase “the mentally ill.” The study participants were mostly white Americans; race might have a huge factor to play. And the authors note that gender could also play a role in a person’s conception of another person with mental illness.
That said, a simple change in our language, while admittedly “cumbersome,” is something that is important to not only give people with mental illness recognition of the fact that they are more than their condition, but also a way to help them integrate into society. “The important point to take away is that no one, at least in our study, was immune,” Granello said in the news release, pointing to how counselors too showed levels of intolerance. “All showed some evidence of being affected by the language used to describe people with mental illness.”
By Tanya Basu
Suicide Bereavement Support, Inc. is a self-help organization served by trained volunteers offering understanding, support, friendship and education to those bereaved and impacted by the suicide death of a child, spouse, partner, sibling, family member, friend, client or co-worker.
From the Board:
We are excited to resume our newsletter after a time of reorganizing the Suicide Bereavement Support organization. With new board members and a committed vision to provide support for those in our community who have experienced a suicide death we have worked on getting the business in order, web page operating, brochures printed, volunteer facilitators trained, and new groups started.
This newsletter will now be online. We are finally catching up with the times, and will be able to support our community better. If you would like to receive a quarterly newsletter, sign up, including your email.
For those of you who need a paper copy, please send us a note with your mailing address and we will happily get one to you. Find us on our new and updated web page: www.sbsnw.org
or on Facebook: sbsnw community page and Facebook group.
My daughter Barbara died in 1982 by suicide at the beginning of her sophomore year of college when
she was 19 years five months and two days old. She was the next youngest of the children. She was
attending a college in Santa Fe New Mexico. Her sister, Laura, her father, and I flew down for the
college memorial service. We returned to Oregon and then to McMinnville where all the children grew
up for Barbara’s service and burial in the cemetery near the family farm.
My son Bill was killed by a drunk driver in a three car crash 21 months later in 1984. Two other young
men were also killed, but not the young 19 year old drunk driver. Bill was 28 and a half years old. SO
again we were in McMinnville at the same funeral home and the same church for the service for Bill.
Then we went out to the Clackamas River to scatter his ashes where he had been kayaking recently.
This time the funeral director had a recommendation that really caught my attention. He suggested that the siblings spend some time together without their divorced parents. Think of the major holes
THEY had to adjust to in their relationships!
I realized how often a young adult is asked “How are your mom and dad doing?” and maybe “How are you doing?” They have known their sister or brother all their life. Their relationship is bond that is like no other. That is very hard to live with. The loss of a sibling is very different than the death of a parent. I know I tell people not to compare and decide what is the hardest, but… maybe the death of a sister or brother can carry a weight that a parent does not always recognize. People often do not know what to say so will avoid or stay away. I encourage people to be present, share that they don’t know what to say, and speak the name of the person who died, share memories and stories. Even though it can be sad, and brings tears, I know how important it is to have the person remembered.
Even though I was very concerned about my children, wanting them to have counseling, I realized I
was blind to much of what was happening in their lives then. I have been involved in the Suicide
Bereavement Support group from the beginning. I am delighted to see the adults that my children
have grown into. Periodically one or another of them steps in to help with SBS and me. They each in
their own way have dealt with the deaths of their brother and sister.
I am fortunate to see new people coming to support the work of the Suicide Bereavement Support
groups. I am thankful to all who have been involved with this important work. Sometimes we lean on
each other and sometimes we are really support for each other.
Virginia Bender, Feb 2014
Thanks to our dedicated Volunteer Facilitators who give their time and energy to provide support for those who come to the Support Groups.
NE Portland – meetings are on the 3 rd Monday at 7 pm
The Peace House – 2116 NE 18 th Ave
Gresham – meetings are on the 1 st Thursday at 7 pm
St Henry’s Catholic Church School Building – 346 NW 1 st Street
SW Portland – meetings are on the 1 st & 3 rd Thursdays at 6 pm
Portland Church – 125 SW Miles St
Clackamas County – meetings are on the 2 nd and 4 th Sundays 2 pm
Clackamas County NAMI office – 10202 SE 32 nd Ave Suite 501
Vancouver – meetings are held on the 1 st Saturday 2 pm
Fair Oaks Community Room – 5404 NE 121 Ave.
We are pleased to be adding 3 new groups, two in the Bend/Redmond area and a second at Portland State University. Stay tuned for details on these new groups.
100 Tricks Every Boy Can Do: How My Brother Disappeared
by Kim Stafford
Kim Stafford is the son of William Stafford, poet, and 40 year old brother Bret, who died of suicide. In this book he tells 100 stories of he and his brother, trying to make sense of his brother’s death, why??
How many tricks does it take to grow up and survive? From a beautiful childhood, the older brother disappears into depression, leaving the younger to endure the story. 100 Tricks Every Boy Can Do explores memory to find a brother lost to suicide—the saint who teaches his family about depression, violence, and the ultimate quest for harmonious relationships. This deftly written, compassionate memoir offers a paradox about family tragedy. With suicide, Stafford writes, there is collateral damage in every direction, but there is also a chance to learn vital stories behind the shadows of silence, depression, and violent death, and ultimately to recover the lost best friend. 100 Tricks Every Boy Can Do takes the reader through what Stafford calls “the chrysalis of the invisible”—a tunnel of fears, silences, and tragedies—in order to find new life.
Taking its title from a pamphlet Kim Stafford’s brother, Bret, ordered as a kid, 100 Tricks works its own magic in portraying two boys, close in age and inseparable in many ways, against the backdrop of an American family in the 1950s. Bret was the good older son, the obedient public servant, Kim the itinerant wanderer. Their father, poet and pacifist William Stafford, occupies a large presence in the brothers’ lives as they find their ways through boyhood shenanigans and forge identities together into adulthood and then apart, when Bret takes his own life at age forty.
This deftly written, compassionate memoir offers a paradox about family tragedy. With suicide,
Stafford writes, there is collateral damage in every direction, but there is also a chance to learn vital
stories behind the shadows of silence, depression, and violent death, and ultimately to recover the
lost best friend. 100 Tricks Every Boy Can Do takes the reader through what Stafford calls “the
chrysalis of the invisible”—a tunnel of fears, silences, and tragedies—in order to find new life.
Guilt is a common reaction one may experience after a suicide death. You may feel that you
somehow were responsible, that you should have known, you should have been able to stop the
death, that it was your fault, something you did or didn’t do resulted in the persons death. Guilt can be
all consuming and suck the life out of you. Below is one woman’s struggle with guilt and one thing she
did that helped her give up that guilt so she could live her life.
The Guilt Group – Judy Rae
My 27 year old son Ryan took his own life 18 months ago. I found this support group experience to be
immensely helpful to me. Guilt can be one of the most difficult issues to address for survivors. I
listened to others’ stories of their feelings of guilt, and I felt so compassionate toward them. Then it
dawned on me how I was condemning myself so harshly at times for very similar reasons. That
realization caused a tremendous shift in me, and helped me let go of the guilt and feel compassion for
myself, and a more realistic view of my participation in Ryan’s life and death.
In addition to sharing our stories and insights, we also did a few exercises and meditations that I also
found valuable. I would like to share my writing from the exercise — a letter from me to guilt — in the
hopes that it may provide similarly beneficial effects for you as it did for me. I highly recommend the
A Goodbye Letter to Guilt
Dear My Guilt,
Letter I have realized that we must break up……
To Guilt You can serve a small purpose in people’s lives, but
you are now out of control. I am not as powerful as
you think I am. You are terrorizing me with the
responsibility you think I have; the power you think I
wield. You are also stealing away my ability to live
my life and be a good loving force for my family and
friends, not to mention my confidence in myself. You
are stealing away my chance for goodness and love
in my life going forward. I have to live here now and
be the best person I can, no matter what has
happened, and I can’t do that with you commanding
so much of my thoughts and attention. Therefore, I
have made a decision to limit your influence on me
by letting you go. I know you originally had good
intentions, (to improve me) but you have gone too far
and I will not let you destroy my life. My son Ryan
would not have wanted that for me.
You must go!
(reprinted from Catholic Charities Loss Newsletter Nov 2013 catholiccharities.net/loss)
From April 2011 – June 2013 202 people in Portland have died of Suicide. That is 34 per 100,000 or three times the national rate, 7.5 suicide deaths per month, or one every 4 days, according to the Portland Police Bureau. There are nearly twice as many suicide deaths as homicides and traffic fatalities combined.
In Oregon, the rate is 35% higher than the national average, 15.2 per 100,000 compared to the national rate of11.3 per 100.000. “Suicide deaths are one of the most persistent yet preventable public health concerns. It is the leading cause of death from injuries – more than even car crashes. Each year 550 people die from suicide and 1,800 people are hospitalized from non-fatal attempts” Lisa Millet, Oregon Public Health.
The number of deaths is heartbreaking. The single most identifiable risk factor is depression, and although not all people coping with depression are suicidal, stress and crisis can overwhelm a depressed person’s ability to cope with life challenges. Stresses such as job loss, life transitions, loss of income, home family or friends, (veterans returning home from deployment) – all increase the likelihood of a suicide death among those already at risk.
Family and friends can support those struggling by being aware of risk factors and being present helping them find the appropriate resources such as counseling or medication.
We are thrilled and extremely grateful to receive a
- A grant from Portland General Electric Foundation. Thank you to Gwyneth Gamble Booth. With this generous donation we will be able to continue the great work of SBS including supporting people in groups, through phone calls, and in local training and interventions about suicide deaths.
We also want to thank all for the following people for their generous gifts:
- Candace Marquardt’s gift was matched by Quantum Data Solutions
- Patricia Wright: In memory of Courtney Ann Wright
- Sandy Trevillian: In memory of Treeka Trevillian We love and miss her so much, Love Mom and Dad
- Sheryl McMahon
- Alison Wesley: In memory of Duncan Wood-Walker
- Nan Swartz: In memory of Gus
- Kay Robertson: In memory of Bryan
- Carma Thurston: In memory of Aaron Thurston
- Virginia Bender: In memory of Barbara Strayer
If you are interested in helping with the important work of helping those after a suicide death, let us know. We are specifically looking for folks to facilitate support groups, Training is provided and those who facilitate find it a very rewarding venture.
Phone Number: 503-200-0382
Suicide Bereavement Support Inc
PO Box 2525
Portland, OR 97208
Suicide Bereavement Support Inc
PO Box 2525
Portland, OR 97208