Optimal Nutrition Guidelines

Here’s a brief synopsis of what we recommend people do in terms of eating and drinking. These are not ho-hum guidelines. They are meant to represent the optimal means of getting healthy, staying healthy, and extending our quality life years.  There is mounting evidence-based research supporting our guidelines. Remember, the food we eat is the number one determinant of our overall health. Unfortunately, in our country, and in the Western world as far as that goes, we are exposed to way too much conflicting, inaccurate, and biased information about nutritional research. We continue to have epidemics of heart disease and stroke, cancer, type II diabetes, weight control challenges, dementia and other medical conditions, most of which are preventable. We fully understand that some people are unwilling or believe that they are unable to align with these fairly detailed guidelines. Well, that is what it is, and we just ask that people will do their best and at a minimum, add to their daily eating rituals more plant-based foods, perhaps five or six servings per day; there is nothing but advantage in doing that.

These principles we believe will provide us with optimal body weight, energy and vitality, superb longevity and disease avoidance. Our goal as we seek enhanced physical, mental, and spiritual health is to have more quality life years where we are not dependent on medications or overly dependent on the traditional medical system. Our goal is to enhance our health span. There are many lifestyle factors that interact to determine our health status, but food intake is primary … we must get this one right!

1.)              Consume a ‘whole- food plant-based’ (WFPB) eating plan. This helps to avoid the toxicity found in many animal-based foods and ‘Keto-like’ diets that are disease promoting.

2.)      Processed food: In order to prevent many of the principal chronic diseases, we recommend that you minimize consumption of processed foods; these foods contain many undesirable ingredients including unhealthy refined grains, food dyes, multiple types of unhealthy sweeteners, extracted oils and many unspecified natural flavorings; these foods promote illness, and lead to weight gain. If you consume  processed foods, be sure to see the ‘Nutrition Facts’ label to verify that the item contains no saturated fat, no trans-fat and no cholesterol per serving. 

3.)              Food Labels: One of the most important things regarding our health that we can know about is a few facts about reading food labels. We should be able to glance at the ingredients label and make a decision in 10 or 20 seconds about whether this is an acceptable food or not. 

4.)              Moderation: Buying into the idea that we can consume all things in moderation can be very risky and lead to ill health. So, we must use moderation in moderation because of the inherent ‘slippery Slope’ involved.

5.)              Be sure to limit or eliminate extracted oils in your daily eating. Even olive oil and coconut oil can contribute to ill health, because of saturated fat, high calories and related predisposition to disease.

6.)               Vegetables: We recommend that you eat a large raw salad every day that includes a variety of green leafy vegetables like kale, spinach, and baby bok choy; also include foods like cucumbers, carrots, olives, tomatoes, red onions, broccoli, cauliflower, celery, bell pepper, beets and other tubers, and red cabbage.

7.)              Fruit: Consume several servings of fruit daily. Berries contain particularly potent, healthy plant compounds. Limit fruit juice is it contains concentrated sugars and lacks some of the nutrients in the whole food.

8.)              Other plant foods: Eat whole grains (preferably 'intact' grains), onions and garlic, beans of all sorts, seeds and nuts, cooked mushrooms; starchy vegetables like potatoes and squash, corn, sea vegetables, healthy herbs and spices and all other plant foods that you have a preference for. Starchy vegetables should probably be limited for those with pre diabetes or Type 2 diabetes.

9.)           Select the most colorful foods that you can find and consume them regularly. Examples are prunes, red bell pepper, pomegranates, beets, red lentils, black rice, kiwifruit, and etc.

10.)         You do not need to count carbohydrates, protein grams or calories as long as you are consuming a variety and sufficient quantity of plant-based foods.

11.)         Eat until you are satisfied, not full.

12.)         Always select certified organic and ‘Non-GMO’ food when you can.

13.)         Eat most of your food raw or gently cooked.

14.)         Food Supplements and Super Foods: always take a low dose vitamin B12 supplement and assure that your vitamin D levels are within limits. Never use vitamins or other food supplements as a substitute for a poor, unhealthy diet. Foods like organic Cacao powder, Maca powder, Amla powder, Chia seeds, hemp seeds, and all berries can be used in smoothies. Actually, all plant foods are super foods because they contain about 100,000 healing nutrients that act in an amazing synergy to keep us healthy.

15.)         Sweeteners: we recommend not using artificial sweeteners, table sugar and products that contain high fructose corn syrup. Date sugar is an excellent and nutritious sweetener. Guard against sugar addiction as it is a major contributor to the disease epidemic that we have. The natural sugars in whole fruit are quite healthy for us because they are packaged with a huge number of healing nutrients and fiber. Blackstrap molasses is loaded with important minerals.

16.)         What do I drink? The best beverage is clean, filtered water; we recommend reverse osmosis as one good filtering method. The healthiest teas are green white tea. Coffee in moderation has benefits, but also some downside. Organic and non-GMO nondairy milks are okay but be sure that they are not overly processed, containing too many unhealthy ingredients. In our house we drink Non- GMO soy milk that has 2 ingredients: filtered water and organic soybeans. Fruit juices are processed, high in calories, foster sugar addiction and the dietary fiber is altered resulting in less polyphenol nutrients that are chemically bound to the fiber.

17.)          If you decide to consume animal-based foods, we would recommend that you limit this to not more than 5% of calories consumed. Be careful of the ‘slippery slope’ involved in this decision as you can easily find yourself consuming hot dogs, barbecued pork,  luncheon meats and cheeses regularly. And, choose only certified organic, drug-free, grass fed &/or pasture-raised meat, poultry, and dairy; but know that even these foods have many drawbacks because they are acidic, contain no fiber, contain too much fat and raise levels of hormones that may be linked to the onset of cancer. Avoid all farm-raised fish. Those of us with chronic disease like cancer, heart disease, Type-2 diabetes, dementia, autoimmune disorders and weight management issues must avoid all toxic foods.

18.)         As I have stated before, fast Food is mostly a nutritional nightmare! And, restaurants in general present many challenges. We are advocates of using our kitchens, doing our own food selection and preparation, and using restaurants selectively and sparingly.

19.)         Blended 'green' drinks as freshly prepared organic vegetable juices have their place as tonics or additions to an in place healthy plant-based eating plan. 

20.)          Is it important to seek variety every day in the plant foods that you eat because each category of plant foods may contain different nutrients that act together to promote health. We believe that small amounts of food with more variety may provide more diverse bioavailable nutrients and be more healing than larger amounts of food with less variety. So, making chili with a 15 bean mix may be more desirable than making chili with only black beans; also, making chili with only tomatoes, beans and onions would be less desirable than making chili with tomatoes beans, onions, carrots,, corn, green bell pepper, red bell pepper, garlic and five different spices. The variety we seek is diversity in plant parts, plant food categories, and foods within plant food categories.

21.)         Tastes Good! Do not confuse good tasting food with healthy food. Most Americans will say:’ oh, that was sooo good!’ Well, was it good for our health? Our task is to prepare dishes that are both tasty and good for us, like our meatless chili. Here are the ingredients: several types of beans, organic corn, chopped tomatoes, grated carrots, tofu crumbles (a soy-based meat substitute), green and red bell peppers, onions, garlic and several great seasonings including turmeric, chili powder, curry powder, and cayenne pepper. This is one of our staple meals that is hugely nutritious, contains no animal-based foods and is a very satisfying meal. We recommend that everyone use their kitchens generously and have 8 to 10 great meals/recipes that they rotate regularly. These should make up the bulk of their eating and will typically include a variety of soups, stews, stir-fry dishes, and salads, as well as seven or eight delicious sandwiches.  Unhealthy dishes are not in good taste!

Five to One Fiber Rule: Dietary fiber is a super ingredient in plant-based foods; it reduces the risk of many if not most of the chronic diseases. To assure that you get more fiber, just check out the processed food Nutrition Facts Label and look at the ratio of grams of carbohydrates to grams of dietary fiber; we want to have a result of 5.0 or less. Using this measure, Ezekiel bread and Genesis 1:29 bread are examples of the best foods.

Those consuming plant-based foods often neglect to consume enough appetite satisfying starchy vegetables like potatoes, rice and corn. However, there is evidence that starchy vegetables may be a problem for overweight, prediabetic and diabetic people.

 Fasting: Fasting provides us with a powerful means of minimizing the toxic load that we are confronted with everyday. These toxins are a major input to many of the chronic diseases. Water fasts as well as juice fasts can yield very significant health benefits. But Be very sure to check with your physician before initiating a fast because there are many medically-related issues that need to be considered.    

References:

Campbell, T.C.: ‘Whole, Rethinking the Science of Nutrition,’ Ben Bella Books, 2013.

Davis, Garth: Proteinaholic: How Our Obsession with Meat is Killing us and What We Can Do About It,’ Harper Collins books, 2015.

Diehl, Hans and Ludington, Aileen: ‘Dynamic Health: a Simple Plan To Take Charge Of Your Life,’ Thomas Nelson Incorporated, publishers, 2003.

Fuhrman, Joel: ‘The end of dieting,’ HarperCollins Publishers, 2014.

Greger, Michael: ‘Carbophobia, the scary truth about America’s low-carb craze,’ Lantern books, 2005.

Katz, David: ‘Disease Proof: Slash Your Risk of Heart Disease, Cancer, Diabetes, and More By 80%, The Penguin Group, 2013

McDougall, John: ‘The Starch Solution,’ Rodale, Inc., 2012.

Zahler, William: ‘Health, Inertia, and Information: Why Are We Sick?’ Create Space, March 2018.

Zahler, William: ‘Synergy and the Dynamics of Lifestyle Change,’ Create Space, January 2019.

William A. Zahler, MSW, DipACLM

November 2019

Culture, Mortality and Disease

Culture and Mortality, Part 4: The Epidemic Disease Burden

This is the fourth of four articles about Culture and Mortality

Despite the fact that we have more scientific research, health related research, pharmaceutical products, self-care products, and more sophisticated medical interventions than ever before in history, we continued to have a remarkable disease epidemic. This includes a significant increase in suicides, and a persistence in cancer, heart disease, autoimmune disease, type II diabetes, gastrointestinal disorders, Alzheimer’s disease and other dementias.

Here are some 2017 United States statistics: Number of deaths for leading causes of death:

• Heart disease: 647,457
• Cancer: 599,108
• Accidents (unintentional injuries): 169,936
• Chronic lower respiratory diseases: 160,201
• Stroke (cerebrovascular diseases): 146,383
• Alzheimer’s disease: 121,404
• Diabetes: 83,564
• Influenza and Pneumonia: 55,672
• Nephritis, nephrotic syndrome and nephrosis: 50,633
• Intentional self-harm (suicide): 47,173

Addiction

·       Drug overdose deaths continue to increase in the United States.

• From 1999 to 2017, more than 700,000 people have died from a drug overdose.
• Around 68% of the more than 70,200 drug overdose deaths in 2017 involved an opioid drug.
• In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999.
• On average, 130 Americans die every day from an opioid overdose.
• Cigarette smoking remains a persistent source of chronic disease, including cancer, with about 7% of the population smoking.
• Vaping has developed into a profitable industry that is now killing people; people need to be breathing good clean air not tobacco smoke or vaping liquids

·         What about cannabis? Well, cannabis is a gateway drug for many people. It is a mood-altering drug with habituation and addictive potential.  There are certain curative characteristics with cannabis use and we believe that medical personnel should be making decisions about therapeutic use of cannabis.  In an accident culpability analysis, persons testing positive for THC and particularly those with higher blood levels, were 3 to 7 times as likely to be responsible for a motor-vehicle accident as persons who had not used drugs or alcohol before driving. In comparison, the overall risk of a vehicular accident increases by a factor of almost 5 for drivers with a blood alcohol level above 0.08%, the legal limit in most countries, and increases by a factor of 27 for persons younger than 21 years of age. Not surprisingly, the risk associated with the use of alcohol in combination with marijuana appears to be greater than that associated with the use of either drug alone.

• Food addiction is real for millions of people who continue to consume highly processed foods that are loaded with high levels of fat, sugar, and salt that create hyper-palatability and addiction. These foods are directly linked to type II diabetes, obesity, dementia and other conditions.
• We need to operate from a good dose of common sense when it comes to normalizing the use of mood-altering substances. It is not mentally or emotionally healthy to be reliant on the brain-altering compounds contained in addictive drugs.
• Millions of people are in trouble with alcohol, and in my view, one of the worst things we could do would be to add additional mood- altering substances to the mix.

Healthcare costs continue to climb, and this system is quickly becoming unstable and unsustainable. In this context is important to understand that’s only about 3% of our population maintains healthy levels of all four of these health behaviors: non-smoking; healthy weight and BMI, body mass index; consuming five fruits and vegetables daily; regular physical activity. Given this, we can readily see that most of this disease burden is a lifestyle related and is under the control of the patient.

Some believe that psychosocial risk factors need to be given a much higher priority as we negotiate the impact of disease economically, and in terms of mortality and morbidity. This includes such issues as stress, mental illness, isolation, and the addictions. We will elaborate on the issue of addiction in a separate article.

A significant part of the disease burden involves taking medications and all of the huge number of side effects from these medications. The European Commission estimates that adverse reactions from prescription drugs cause 200,000 deaths; so together, about 328,000 patients in the U.S. and Europe die from prescription drugs each year. This makes prescription drugs a major health risk, ranking 4th with stroke as a leading cause of death. 

Dr. Beth Frates, a leader in Lifestyle Medicine, has some very important comments about this disease epidemic. She expresses great concern about our country being absorbed in a health care crisis. There is a clear increase in the incidence of morbidity , in the number of Americans who are coping with chronic disease. One of the repercussions of this is the incredible burden of healthcare costs that have become out of control and unsustainable. It is time for action; actually, we are way into the process of an entrenched pattern of more and more of our GDP being targeted at healthcare costs. We need to adopt a new cultural understanding of how critically important it is for folks to adopt a new lifestyle that is healthy and prevents the onset of chronic diseases. We know how to do that and we need to get on with the business of public policy change, positive change within the healthcare industry, and a reorientation of peoples understanding about disease prevention. Without shifts in how people live their lives and how they view their health, we are setting up an unnecessary toxic and lethal endpoint.

The main point we want to make here is that perhaps 70% or more of all chronic disease is related to lifestyle factors that we have control over; lifestyle Medicine initiatives target needed changes in our daily activities in order to prevent and reverse the epidemics of cancer, diabetes, heart disease, dementia and all the rest.

 References

·        Cannizzaro, Joseph: ‘Answers for the 4A epidemic, healing for kids with autism, ADHD, asthma, and allergies,’Siloam Publishing, 2012.

·        Centers for Disease Control and Prevention, National Center for Health statistics, CDC.gov, 2017.

·        Davis, Brenda: ‘Kick diabetes essentials: the diet and lifestyle guide,’ Book publishing Company, 2019

·        Frates, Beth et al.: lifestyle medicine handbook, an introduction to the power of healthy habits, Healthy Learning, 2019.

·        Greger, Michael and Stone, Gene: ‘ How Not to Die,’ Flatiron Books, 2015.

·        Hughes, K. et al., ‘The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis, The Lancet Public Health, 2017.

·        Monnat, S.M. and Chandler, R.F.: ‘The long-term physical health consequences of adverse childhood experiences.’ The Sociological Quarterly, 2015.

·        Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. WR Morb Mortal Wkly Rep. ePub: 21 December 2018.

·        Zahler, William A: ‘Health, inertia, and information: why are we sick?’ Create Space and KDP, paperback and Kindle editions, March 2018.

·        Zahler, William A: ‘Synergy and the Dynamics of Lifestyle Change’, Create Space and KDP, published January 2019.

William Zahler, MSW, DipACLM

November 2019

Mortality and Homicide

Culture and Mortality, Part 3: Homicide

This is the third of four articles about Culture and Mortality

Here we have another interesting, complex, and important topic area concerning our culture and the loss of life. We have seen and are continuing to see a series of so- called ‘mass shootings’ that are perpetrated by men, many of whom are mentally ill and who lack an intact sense of impulse control, moral conscience, and ability to reason in a sensible way. ‘Hate Crimes’, another fairly recent term, are defined by the FBI as a ’criminal offense against a person or property motivated in whole or in part by an offender's bias against a race, religion, disability, sexual orientation, ethnicity, gender, or gender identity.’

Researchers have identified three types of lethal violence:

·       Homicide related to other criminal activities: involves organized criminal groups or other criminal acts

·       Interpersonal homicide is perpetrated by intimate partners/family or relating to other interpersonal homicide

·       Socio-political homicide is related to social prejudice or to other socio-political agendas

Unfortunately, in our culture ‘Hate Crimes’ are all too common; hate is obviously not a healthy emotion and it is a mental health issue that is destructive to one’s internal emotional state, to the community, and to any number of interpersonal relationships. An interesting and important psychosocial issue has to do with what interacting and complex factors contribute to the genesis of these intense and destructive emotions.

There were 14,123 murder victims in the United States in 2018. It is very important to understand that in many of these cases, perhaps most, the perpetrator left behind rather clear signs that they were a threat. So, a very important part of the instigation to aggression has to do with blatant verbal threats, hostile interpersonal interactions, collecting lethal weapons, a history of poor impulse control and other clear antisocial behaviors.; some of this acting out is made obvious in social media. After the hostile, murderous act, investigators encounter family members, fellow students and others who confirm their concern about the perpetrator. So, one of the things that we need to work on within our communities is to identify these potential perpetrators early on, in an attempt to prevent further homicidal acts. In a culture that is relativistic in many ways, it is increasingly difficult for folks to discern what is acceptable, and what is not. In a culture where we are ambivalent about and normalize many asocial behaviors, there is a good deal of confusion about boundaries. We are making some headway in terms of identifying potential perpetrators with slogans like: ‘If you see something, say something.’ The whole issue of how we orient a community to take action in these cases is worthy of further study. When someone speaks in a bizarre manner, threatens the life of others, or otherwise threatens the community, we need to take action and there needs to be policies and agencies available that can intervene promptly and effectively to stop these people

Overly liberal policies and intentions can get people killed. Some of this is the same mentality that fails to hold criminals accountable in so-called ‘Sanctuary Cities.’ These sorts of behaviors by city officials feed the whole relativistic movement that normalizes all sorts of aberrant behavior. Not only is this sort of thing contrary to common sense, but it adds an unnecessary level of unpredictability and lethality to the cultural mix.

The perpetrators of homicide may have serious mental health issues like paranoid schizophrenia, antisocial personality disorder, clinically significant depression, as well as a history of problematic interpersonal relationships. At some level they are also suicidal, knowing that there is a good chance they will be killed as law enforcement authorities mobilize a response to their criminal actions. Substance abuse of all sorts can be a factor in many these cases and this should not be down- played as many of the drugs of abuse alter brain function dramatically and negatively.

Terrorism is obviously a significant part of the homicide issue, but the motives have to do with toxic ideologies that propel the terrorists to launch efforts to exterminate their perceived enemies. These terrorists feel quite justified, based on their sick ideologies, to train children to be of a similar mindset. So, this is highly organized, purposeful homicide. It may involve flying airplanes into buildings, setting off explosives, running down people with vehicles, and using any variety of weapons to carry out their hostile acts. The actions of terrorists have become an ingrained aspect of our culture and has instilled a potent threat to our survival; it reinforces our sense of vulnerability and adds to the long list of cultural challenges that contribute to emotional turmoil. And, the results of terrorist attacks are a major input to Post Traumatic Stress Disorder (PTSD).

School shootings: Children exposed to violence, crime, and abuse are more likely to abuse drugs and alcohol, suffer from depression, anxiety, and posttraumatic stress disorder. They may fail or have difficulties in school, and engage in criminal activity.

 The data from five decades of school shootings shows the most typical age for a school killer is 16 or 17 and these perpetrators are highly likely to be male. The attacks are not often "indiscriminate", but are more usually an "escalation of a dispute" or a gang-related incident.

A database, going back to 1970, shows there were more incidents and more deaths in 2018 than any other year on record from gun violence in schools.

So, here is a 10-year review of school shooting statistics in America:

·       2008, 11 school shootings, 16 killed, 28 injured

·       2009, seven school shootings, three killed, 12 injured

·       2010, 12 school shootings, eight killed, 14 injured

·       2011, seven school shootings, five killed, 12 injured

·       2012, 12 school shootings, 43 killed, 16 injured

·       2013, 26 school shootings, 18 killed, 33 injured

·       2014, 37 school shootings, 17 killed, 35 injured

·       2015, 21 school shootings, 21 killed, 41 injured

·       2016, 15 school shootings, nine killed, 26 injured

·       2017, nine school shootings, 15 killed, 26 injured

·       2018 (YTD- as of July, 2018), 22 school shootings, 40 killed, 66 injured.

Mass Shootings: According to the Gun Violence Archive, a nonprofit that tracks shootings in the US, 373 people died from mass shootings in 2018 and 1,346 others were injured. Although it is important to recognize that most people suffering from a mental illness are not dangerous, for those persons at risk for violence due to mental illness, suicidal thoughts, or feelings of desperation, mental health treatment can often prevent gun violence. Policies and programs that identify and provide treatment for all persons suffering from a mental illness, need to be a national priority. The mental health community must take the lead in advocating for community-based collaborative problem-solving models to address the prevention of gun violence. It is also important to note that many mass shooters are also suicidal, are willing to give up their lives as they murder others. Many of the shooters left a blueprint for their alleged actions on social media. And, most of the shooters planned and prepared the act; many spent almost 2 years planning their attack. Unfortunately, in the majority the cases people who see signs of trouble before the mass shooting often do not call police.

Several other profile issues include being male, being single, divorced or separated and most had concerning behavior’ in common like abuse, harassment, bullying and sometimes violence. 35% of mass shooters have been convicted of a crime as an adult and history of or acting in an abusive, harassing or an oppressive way. More than half of these shooters discussed the idea of committing the violent act with someone else!

References:

·        Mohler, R. Albert: ‘Culture shift: the battle for the moral heart of America,’ Multnomah Books, 2011, Chapter 13.

·        United Nations office on drugs and crime, Global study on homicide, publish online, July 2019.

www.statista.com

·        Zahler, William A.: ‘Health, Inertia and Information: Why are we sick?’ Create Space and KDP, published 2018. Chapter 8.

·        Zahler, William A: ‘Synergy and the Dynamics of Lifestyle Change’, Create Space and KDP, published January 2019, Chapter 8.

William Zahler, MSW, DipACLM

November 2019

Culture and Mortality: Suicide

Culture and Mortality, Part 2: Suicide

This is the second of four articles about Culture and Mortality

Yes, the statistics on the rising rates of suicide in the United States are very concerning. It appears to me that we learn the same lessons over and over and over again. Without a moral compass, we are in trouble, big trouble.

We are in a culture that is often confusing, hyperactive, and without boundaries. As a result of this, many of our citizens are searching diligently for meaning in life, for a way to eliminate alcohol and other drugs from their life, and for a way to dampen their depression. Many of these folks have lost hope, and find themselves entertaining ideas about self-destruction; as I have said elsewhere, rehearsing a suicide plan is a hugely destructive place to be. This group of people lack self- efficacy, a sense of being in control and being capable of functioning successfully. They also have a deficient sense of well-being, of happiness. In many cases they are lonely; interestingly loneliness is an all too common negative mood state; some authors believe that it is a cultural epidemic involving not only loneliness but also isolation and alienation. Up to 40% of adults in the United States report feeling that way.

You may not know that physicians have among the highest rates of depression and suicide of any group; more than one doctor a day kills themselves. Overall, suicide rates in the USA have increased by 25% in the past 20 years. This is not a sign of a healthy culture, it is a sign of desperation, sickness, psychopathology, and hopelessness.

Risk factors/ etiology for Suicide include:

·       Depression is a key risk factor for suicide. Suicide often stems from a deep feeling of hopelessness. The inability to see solutions to problems or to cope with challenging life circumstances may lead people to see taking their own lives as the only solution to what may really be a temporary situation; and most survivors of suicide attempts go on to live full, rewarding lives. Dopamine is the neurotransmitter pathway to pleasure and may be interrupted in folks with depression. This, clinically significant depression, is without question, the most common reason people die by suicide.

·        Psychosis: Evil inner voices often command self-destruction for reasons that are difficult to understand. Psychosis is much harder to mask than depression, and can arguably be even more tragic. The worldwide incidence of schizophrenia is 1 percent and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, are often derailed. Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be treated for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission until the voices lose their commanding power and until the associated delusions lose their potency.

·       Substance abuse (Addiction):  Although many addiction treatment programs will not accept clients with recent suicidal behavior, up to 40% of patients seeking treatment for substance dependence report a history of suicide attempts. Several predisposing and precipitating risk factors such as marital and interpersonal relationship disruption, occupational and financial stressors, recent heavy substance use and intoxication as well as a history of previous suicide attempts and sexual abuse combine in an additive fashion with personality traits and mental illnesses to intensify risk for suicidal behavior in addiction patients. Major depression, bipolar disorder, borderline personality disorder and post-traumatic stress disorder are especially associated with suicidal behavior in people with addictive disorders.

·       Chronic pain (CP). Studies indicate that suicide ideation, suicide attempts, and suicide completions are commonly found in chronic pain populations. In addition, a number of controlled studies about suicide completion rates indicated that CP may be a suicide risk factor. Finally, a review of known suicide risk factors from other populations indicated that CP populations commonly exhibit other suicide risk factors. Psychiatric examiners should consider CP to be a potential suicide risk factor.

·        A family history of suicide

·        A prior suicide gesture that is often a sign of impulsivity.

·        Made a mistake: This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems, is education.

·       Impulsiveness often plays a role among adolescents who take their life. If a person deemed at risk due to any of the above risk factors exhibits sudden mood changes—even a suddenly upbeat mood—or completely new behaviors, they may be actively suicidal. Those who speak about being a burden to others, having no reason to live, feeling trapped or in unbearable pain may also be contemplating suicide.  Often related to drugs and alcohol, some people become foolish and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is often genuine, but whether or not they'll ever attempt suicide again is unpredictable.

·       A cry for help. and don't know how else to get it. These people don't usually want to die but do want to alert those around them that something is seriously wrong. They often don't believe they will die, frequently choosing methods they don't think can kill them in order to call attention to their challenges, but they are sometimes tragically misinformed. For instance, a young teenage girl suffering genuine angst because she feels lonely or has gotten into a devastating fight with her parents, may swallow a bottle of Tylenol—not realizing that in high enough doses it can be lethal.

·       A philosophical reason to die. These people aren't depressed, psychotic, maudlin, or crying out for help. They're trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. This is a reasoned decision that may be prompted by a painful terminal illness where there is no hope of reprieve.

·       Stress: we see that a number of successful suicides were related to acute stress in a person who may have poor coping skills, a co-existing depression, and a history of troublesome relationships. This person may have abruptly lost their job, have been rejected in a critical relationship, or may otherwise have had a financial setback, an ego insult, or a narcissistic affront that is highly anxiety producing. Stress-related diseases have been increasing for decades; these include heart disease, hypertension, obesity, diabetes, addiction, anxiety and depression.

·       Perpetrators in mass shootings are not only homicidal, but clearly have some level of awareness that they will lose their lives in the process. They are suicidal.

·       Suicide Contagion is an increase in suicide attempts and completed suicides following exposure to a suicide in the media or one’s personal circle. The suicide of a prominent celebrity or a member of a specific community, such as the military or an elementary school, have been shown to correlate with a rise in suicides. Although many studies have reported the correlation, they cannot conclude that exposure caused the elevated rates. Those who are especially susceptible to suicide contagion, also referred to as copycat suicide, include adolescents, people who already struggle with suicidal thoughts, and people with mental health conditions such as depression, bipolar disorder, and post-traumatic stress disorder.

So, How do we engender hopefulness and a sense of well-being in all age groups … in an increasingly complex world?

References:

·        Fishbain DA: ‘The Association of chronic pain and suicide,’ Seminars in clinical neuro- psychiatry, [01 Jul 1999, 4(3):221-227]

·        Mohler, R. Albert: ‘Culture shift: the battle for the moral heart of America,’ Multnomah Books, 2011, Chapter 13.

·        Ornish, Dean and Ornish, Anne ‘UnDo It: how simple lifestyle changes can reverse most chronic diseases,’, Ballantine Books, 2019.’

·        Yuodelis-Flores C and Ries, RK: ‘Addiction and suicide: A review.’ The American Journal on Addictions, [02 Feb 2015, 24(2):98-104]

·        Zahler, William A.: ‘Health, Inertia and Information: Why are we sick?’ Create Space and KDP, published 2018. Chapter 8.

·        Zahler, William A: ‘Synergy and the Dynamics of Lifestyle Change’, Create Space and KDP, published January 2019,  Chapter 8.

William Zahler, MSW, ACLM

November 2019