The Forgotten Patients
Robert Langreth and Rebecca Ruiz, 09.03.10, 09:00 AM EDT
Forbes Asia Magazine dated September 13, 2010
The mental health industry ignores the 35,000 people a year who commit suicide. A few researchers are trying to change that.
Alexsandra Wixom started experiencing uncontrollable bouts of sadness when she was 15. "I was emotionally off. I cried all the time," recalls the Seattle-area resident, who is now 25. Her mood swings eventually became so wild the former honors student had to quit going to high school. Over the next eight years she saw a psychiatrist every other week. Her doctors tried everything from Zoloft to mood stabilizers to heavy-duty antipsychotics, but none of them helped for long.
By her late teens visions of suicide started floating through her mind. In one nightmare she was a character in a videogame and lay bleeding at the top of a castle and wanted to die. On her 21st birthday in December 2005 the urges became so intense that Wixom checked herself into a hospital for a week. Her second hospitalization came in early 2007, when, while grocery shopping, she was struck with a desire to die. A month later she ended up in the hospital a third time after tripling her daily cocktail of psychiatric drugs in hopes of poisoning herself.
Her behavior might have escalated until it reached a tragic end. But after her last hospitalization Wixom was referred to University of Washington psychologist Marsha Linehan, one of a handful of researchers who specialize in suicidal patients. Linehan diagnosed her with borderline personality disorder, an extreme inability to regulate moods, and prescribed a type of counseling called dialectical behavior therapy.
Wixom spent the next year in group and individual sessions learning practical skills to manage her emotions so that they didn't spiral out of control. They included distress tolerance techniques like plunging her head into ice water, devising ways to distract herself when bad thoughts arose and learning not to leap to the conclusion that one bad day implies a life of misery. She has not been hospitalized since. "DBT is the best thing in the world. It changed my life," says Wixom, who got married halfway through therapy and is raising two daughters, ages 10 months and 2 years. Now with a high school diploma and an associate's degree, she is pursuing a career in online marketing. "Nobody in my boat should be without this."
Few suicidal patients get such good treatment. Roughly 35,000 Americans commit suicide each year--more than die from prostate cancer or Parkinson's disease. Another 1.1 million make attempts, while 8 million have suicidal thoughts. Among those aged 15 to 25 it is the third leading cause of death. Yet researchers know astonishingly little about how to treat people who contemplate killing themselves. The subject has been so roundly ignored that the 900-page bible of U.S. psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, offers no advice for doctors on how to assess suicide risk.
Fear, logistics, low research funding and more risk than reward for drug companies all conspire to make suicide the neglected disease. The National Institutes of Health is spending a paltry $40 million in 2010 studying suicide, versus $3.1 billion for research on aids, which kills half the number of Americans. (Another government agency spends $48 million on hotlines and prevention.) Therapists often don't want to treat suicidal patients, and university clinical study review boards are skittish about studying them, says the University of Washington's Linehan.