
This Boston Globe article describes the grief and the search for answers in the aftermath of a suicide cluster (six adolescents and young adults within 20 months) in the communities served by the community hospital where I practice psychiatry. While I thought it was thoughtful and searching, I had several concerns (I wrote essentially a version of this post to the reporter and the editor of The Globe).
The article mentions almost in passing the opinion of one set of parents that antidepressant use may have increased their son’s suicidal thinking and contributed to his death. This comment goes unchallenged and unexplored despite the issue being complex and far from incontrovertible. The question of the possible exacerbation of suicidal thoughts by antidepressants has largely been put to rest, after the concern emerged about a decade ago, by substantial sophisticated research and analysis by psychiatric experts in psychopharmacology and suicidology. In rare isolated cases with particularly vulnerable patients, the agitating side effects of some antidepressants could conceivably worsen their distress to a tipping point. But, in most of the cases where a patient feels that their suicidal thinking escalated after beginning a medication, it is more simply that the medication has not yet kicked in to be the hoped-for ‘fix’ to halt the ongoing progression of their depression.
Furthermore, antidepressant prescribing has increasingly migrated from the psychiatrist’s consulting room to the primary care practice over the past few decades. PCPs, internists, pediatricians and family practitioners have briefer and less frequent visits with their patients (Big Pharma has by and large succeeded in persuading them that antidepressant prescribing is simple, does not require much attention, and will facilitate getting nuisance patients without ‘real’ medical concerns out of their offices more quickly). I have many gifted and empathic primary care colleagues but, by and large, they have less specific training and experience than mental health professionals in creating an alliance with a closed-off patient who may not be communicating suicidal distress with clarity or candor. Medical practice increasingly subscribes to the mistaken notion that simply prescribing the right medicine, outside the context of a therapeutic healing relationship, is sufficient treatment. Nevertheless, prescribing the proper medication is an efficient, some say even essential, component of treating a suicidal depression. Not proposing an antidepressant medication to such a deeply depressed patient has been seen as medical malpractice. The danger of reductively suggesting an irrefutable harmful link between suicide and the antidepressants is that it will have a chilling effect discouraging some from accepting such treatment and depriving sufferers of potentially lifesaving options. We saw this a decade ago.
Parenthetically, of far more concern than antidepressants is that suicidal patients are quite commonly given anti-anxiety medications. These include benzodiazepines such as lorazepam [Ativan], diazepam [Valium], clonazepam [Klonopin], alprazolam [Xanax] and the like. These medications act, exactly like the more familiar effect of alcohol, to lower inhibitions. Shy people socialize more comfortably, with a looser tongue, under the influence of alcohol, and anxiolytics work by the same mechanism at the same brain loci. Unfortunately, among the inhibitions they loosen are our compunctions against acting on any self-destructive impulses we may harbor. Both alcohol and anxiolytics are implicated in a high proportion of suicide attempts and successful suicides and, in my opinion and that of many responsible mental health practitioners, should be avoided when one is struggling with suicidal thoughts or urges.
Particularly in this portrait of a grieving community searching for explanations, one must recognize the impact of the social forces that impede delivery of adequate outpatient care. When we are discharging patients from our acute-stay inpatient unit at my hospital after a suicide crisis, it is outrageous that it typically takes weeks or at times months until they can get an intake with a community mental health provider, especially a psychiatrist. Staffs of inpatient units that stabilize patients in dangerous and acute crises are universally demoralized that patients no matter how motivated will be frustrated in finding adequate support to maintain their gains and their safety in the ensuing months. There are far too few providers, for one thing because insurance company reimbursement for outpatient mental health services does not make it worth many providers’ while. Furthermore, in all too many states providers are not even required to provide coverage for mental health treatment in parity to that for other kinds of medical treatment. (Massachusetts is a parity state, not that it makes that much difference.) The relationship between suicide and inadequacy of community mental health service provision ought to be clear.
I’m not actually sure I would call the six suicides in Acton-Boxborough in the past 20 months a ‘cluster’ and I have seen similar incidences in the other nearby communities involving Lincoln-Sudbury and Concord-Carlisle high schools serviced by my hospital. We have seen a wholesale failure to halt the society-wide increase in suicide, particularly among adolescents and young adults. The article considers the possible contribution of local stresses such as academic pressure to suicide. We have grappled with suicide all too often only on the level of individual emotional factors and circumstantial psychosocial stress. However, we ignore at our peril the fact that large-scale cultural stresses and societal breakdown undoubtedly play an important part in encouraging people to take their lives. Particularly since Trump came to power in 2016, Americans have experienced a drastic acceleration in the postmodern erosion of cohesion of the social fabric, the wholesale betrayal of the expectation of the moral integrity of public figures, and relativity in what is even true on all levels. It is essential not to overlook how social breakdown impacts our young adults at times when they have not yet established a sense of the meaning of their lives, what to believe, or whom to trust. In his seminal 1897 treatise Suicide, the luminary French sociologist Emile Durkheim helped us to understand that suicide correlates not just with individual emotional factors or situational stress but with such society-wide strife and anomie. It is now a given in grappling with suicide, and one cannot ignore this level of analysis.
’The Geminid meteor shower has been raining down on us the past few days, and if you want to see it, tonight is the best night.
’Astronomer Carl Wirtanen discovered his namesake comet in 1948. He was a skilled object hunter and used photos of the night sky to spot the quickly moving object, at least astronomically speaking.
Comet 46P/Wirtanen is a particularly active comet – called a hyperactive comet – and tends to be brighter than other comets of a similar size. This makes it a good candidate for viewing. Predictions suggest it will be as bright as a magnitude 3, which is a little brighter than the dimmest star in the Big Dipper, Megrez. However, there are some predictions that keep it beyond naked eye visibility at a brightest magnitude of only 7.6. The dimmest object visible with the naked human eye is magnitude 6, under perfect observing conditions.…’
’Just because you disagree with something doesn’t mean that it isn’t true for someone else.…’
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A Supercell Storm Chaser Photographs Thundering Formations:
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Michael Marshall writes:
Michelle Goldberg, NYT opinion columnist:
’On the morning of November 11, just before 9:30 UT, a mysterious rumble rolled around the world.

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One of the most surprising and least noticed aspects of Mueller’s approach all along:
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’A group of psychologists at Emory University have proposed a new three-part model to explain schadenfreude. Their proposal, published in New Ideas in Psychology, suggests that the motivation behind the feeling is important and that an element of viewing others as less than human is often at play.
Why ‘Changing-Look Quasars’ Appear to Vanish
Director of ‘The Man Who Fell to Earth’ Dies at 90:
’Over the past few years, an international team of almost 200 psychologists has been trying to repeat a set of previously published experiments from its field, to see if it can get the same results. Despite its best efforts, the project, called Many Labs 2, has only succeeded in 14 out of 28 cases. Six years ago, that might have been shocking. Now it comes as expected (if still somewhat disturbing) news.
’These oil tanks in Invergordon, Scotland currently hold the world record.…’
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Temperatures over 100 million degrees:
Secret whale jail discovered by Russian reporters:
Time to be afraid for the future:
’“No matter what the kind of natural disaster, whether it’s flooding or wind damage or fire, the biggest burden of the longest duration falls on the already-poor,” David Lodge, director of Cornell University’s Atkinson Center for a Sustainable Future, told me.
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’The FBI released a report earlier this year on “pre-attack behaviors” of mass shooters, Quartz reports. … The FBI writes in the report’s conclusion:
Why 536 was ‘the worst year to be alive’
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Did you know:
The Lie Behind the Lie Detector
Can AI fix it?:
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Is the appendix a useless organ, an immune system benefactor, a Parkinson’s disease instigator, or all of the above?
An Open Letter to the NRA from American Healthcare Professionals
Help Stop Trump Demonization of Immigrants:
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Five days of fury:
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Can it become a sort of bullshitting itself?
Akim Reinhardt writing in 
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’When the world gets its act together, it can actually solve big problems. Case in point: The ozone hole, which if everything goes according to plan could be healed up by the 2060s, according to a new report from the United Nations.…’
’The Mediterranean region, colloquially called the cradle of civilization, may not be able support much of that civilization within the next 50 years. For starters, it’s poised to suffer from the changing climate much worse than many other locales, according to a paper published by an international network of scientists who worked together to synthesize the predictions and risks for the region.
Pioneer of American Zen dies at 79
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What’s driving America’s mental health crisis:
Trumpeter Who Gave Jazz a Jolt of Youth Dies at 49
Perhaps because they are running scared, the Trump family—and Republicans in general—are going all-in on a campaign of overt racism and white supremacist dog whistles to rally MAGA voters across the country as Tuesday’s midterm elections approach.
’A careful reading of court filings suggests the special counsel hasn’t been quiet. Far from it.…’








’It is not hyperbole to wonder if the outcome of Sunday’s presidential election in Brazil is a planetary game over when it comes to climate change.…’
Humans, as a new paper published today in Nature Ecology & Evolution shows, have been consuming chocolate for a very long time.
Jewish leaders to Trump: until you denounce white supremacy, stay out of Pittsburgh / Boing Boing:
Dana Milbank in the
’Physicians are killing themselves at a higher clip than even military veterans, but their careers depend on denying this sad fact…’
’Brain activity doesn’t tell us what someone is experiencing…’
’Communes have gotten a reputation for being flaky or cultish. But intentional communities have a long history, and many have been successful.…’
’Republicans fought tooth and nail to confirm Justice Brett Kavanaugh to the Supreme Court in spite of serious allegations of sexual misconduct in his past (which he denies) and questions of his character and truthfulness under oath.
’Roughly 108 billion people have ever been alive on planet Earth. If humanity survives another 50 million years (a reasonable length of time compared to other species’ tenures), then the total number of people who will ever live is about 3 quadrillion, or 3 million billion.
More Than a Graveyard Smash:
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Cybersecurity and Russian hacking remain a major concern:
’“There’s a fear of a Benghazi-type situation, that Americans might be targeted.”…’

’English is a phenomenal language, but there are circumstances where words seem to fail us. Often, other languages have already found a solution to expressing the complicated ideas that can’t be succinctly conveyed in English. If you’ve ever wanted to describe the anguish of a bad haircut, the pleasure of walking in the woods, or the satisfaction of finding your life’s purpose, read on.…’
’Many readers buy books with every intention of reading them only to let them linger on the shelf. Statistician Nassim Nicholas Taleb believes surrounding ourselves with unread books enriches our lives as they remind us of all we don’t know. The Japanese call this practice tsundoku, and it may provide lasting benefits.…’