Friday, October 30, 2015

The Healthy Secret of Music and Rage

At one of the PowerMusic classes I teach, a student asked me “How can I safely experience rage?”  It’s a great question.

You could visit an anger bar.

You could enroll in a specialized mixed martial arts program, such as Pugilistic Offensive Warriors, where Veterans with post-traumatic stress therapeutically beat the hell out of each other.

The idea here is to express the anger you feel – in relative safety – and let it go.  Much better to not stuff those explosive rage-full emotions back down inside and drag them around where they might leak out at the wrong moment.

Freud’s case for depression as anger turned inward may be a good one.  When I was a kid the range of “acceptable” emotions in our house was very narrow.  Anger and grief, for example, weren’t allowed.

The only acceptable way I could express big emotion was at the piano.  Using music, I could express – and experience – the entire emotional spectrum, but my built-up anger kept on leaking out where it shouldn’t.

You’ve probably met men like me: passive-aggressive, master of sarcasm, always ready with a snarky remark or backhand compliment.  It was ugly but that was all I knew.  That was my “normal” back then.

Fast forward to my early thirties and psychotherapy.  Fast forward again to my early fifties: regular practice to unpack my lifetime of pent-up rage.  How?  Do I smash things and hurt people?  Do I binge on adrenalin?  Do I meditate?  Pray?

None of those.  Destructive rage isn’t socially acceptable, and meditation and prayer come only AFTER my rage is gone.

The Secret of Music and Rage

Would you be surprised to learn you and I can experience rage safely and fully using a drum?  Or headphones?  Alternatively, free-stylin’ with our homies?

All true.

Here’s the magic of why we would want to do that: your very own secret rage unravels to music the same way as mine.  We humans are hardwired like that.

Freestyle Your Rage

Hip-hop (rap) is just about as full of rage as any music can get.  It needs to be.  It’s a safe way to put anger into words and then back those words with a powerful beat.  And you don’t have to be Nicki, Eminem or Ludacris to do this for yourself.

When you’re steamed, surf to the website called wikiloops where you’ll find tons of beats minus vocals.  Choose your favorite genre, click Play, and freestyle-rap your anger away.  Forget about the rhyme and lock in on the rhythm of just a few words you can repeat.

Let’s break that down.

Think: what gets your knickers really twisted?  Phrases like “road rage,” or “medical terms” repeated out loud – like you mean it, people! – and in rhythm can sometimes be enough to unpack my rage.

“Road rage” and “medical terms” were two gems from my PowerMusic class of homeless folks at last week’s freestyle.  Others: “stupid people,” “robots,” “insensitive bitches,” “people don’t see me,” and “government.”  After an hour rapping that stuff to a heavy beat, all of us were grinnin’ and definitely NOT feelin’ rage.

Are you getting this?

Pound Rage Out

Don’t have a drum?  Be the drum!  Sit in a sturdy chair with your feet flat on the floor.  With your left hand, slap the top of your left leg near the knee.  Then do the same thing on the right.  Repeat it in a constant rhythmic beat: left, right, left, right, left right, etc.  Hard to keep a steady beat?  Find and slap along with a wikiloops track.

Now, just like in freestyle, think about the stuff that gets you good and angry.  Really angry. Let that s**t take over your entire soul.  Keep your rhythmic slap steady.  Really angry now?  Slap harder.  If you want to, shout some words or nonsense syllables it to the beat.  Try as hard as you can to hold on to the angry, raging craziness inside you while you beat that steady rhythmic slap with your hands on your legs.  You’ll know you’re finished when you can’t dial up the anger any more.

Listen With Your Rage

As powerful as a drum and/or freestyle may be, they’re not for everyone.  The analytical judgment-based part of my brain still makes me drag my feet, even on new musical experiences that might be good for me!  Fortunately, there are other ways.

Thanks to the Internet, it’s easy to dial up rage music.  Dare yourself to uncover music that’s outside your current anger envelope.  If you’ve never listened to Metallica or Rage Against the Machine, this would be a good time.  If mainstream hip-hop is already your thang, take it further with Hot 97 where you can hear the latest and edgiest new artists.  Take the deepest dive you can into the madness of music fully endowed with rage.  Build a two- or three-song playlist that really does it for you.

With your headphones (not ear buds, please!) and a quiet, non-mobile place to sit (please don’t do this in the car!), close the door on the world and spin up your rage playlist.  Give yourself the OK to think rage and anger – bring up the stuff that has festered for a while and let the angry vengeful ragged power of the music wash it away.  The more fully you can feel your anger, the more profoundly that feeling can flow through you…and out of you.

A Little Less Rage, A Lot More Love

That snarky person I was back in the day has given way to a different sort of person now.  Sure, I still have anger, but I don’t have as many anger issues now that I’ve made a musical practice out of rage on purpose.  Science has been able to prove there’s a thin line between love and hate and the more hate I release the more I choose love.

Try a little music to let go of that rage you feel.  You deserve it.

Thursday, October 22, 2015

Depressed? You’re in Great Company. Here’s Why….

I’m chronically depressed.

It’s a diagnosis…but it’s not a disease.

Did you know that October is National Depression Education and Awareness Month?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), my diagnosis means that, in the opinion of psychiatrists, I have four or more of the following symptoms that have lasted for more than two weeks:

• Body: Fatigue, body aches, significant change in appetite, sleep disturbance

• Mind: Racing thoughts, negative thinking, negative self-concept, suicidal thoughts

• Mood: Sadness, despair, guilt, lack of self-worth, hopelessness, irritability

• Social: Loss of interest in social interaction, lack of desire in activities, withdrawal from others, loss of sex drive

You may recall times in your life when you’ve experienced symptoms like these. There may be good reasons for them, too. But that doesn’t mean you’re mentally ill or have a disease!

When my Mom died after a long illness, I didn’t grieve right away. After a year or so, when I finally did begin to feel her loss, those grief emotions hung around me for a long time. They are supposed to; that’s how it works! Losing a parent is a life experience that deserves prolonged grief.

When I faced my own suicidal thoughts during a very dramatic and intense period of my life, those feelings stayed with me for many months. They are supposed to! I still make an almost-daily decision to keep breathing. Facing my own desire to kill myself, but deciding not to, is a life experience that demands deep emotions. No other way to handle it.

Sure, I used anti-depressants, and I’m glad I did so with a great psychiatrist and an educated awareness and understanding. I also stopped using them cold turkey after about a year when my feelings of being an experimental lab rat ran counter to my desire to fully experience the emotions and fully process them.

More recently, on the advice of a naturopathic physician, I tried using melatonin. The chemical reaction I had after only a week got me literally screaming into my pillow. I stopped that experiment cold turkey, too.

Perhaps it serves the medical and psychiatric communities to label me with a mental illness. But there’s no scientific test for depression, and no evidence that it is a disease. All that science can do for depression is treat the symptoms, often with drugs that carry a suicide warning as well as highly unpredictable effects folks like me probably don’t want. Getting to the root cause of depression has so far eluded the scientific and medical research community.

So what do I do?

These days when I get depressed, I recognize the symptoms as I would an old friend. I welcome the opportunity to identify the source of what I feel. If it is unprocessed grief, I grieve. If it is “anger turned inwards,” I rage. If it is loss, fear, aimlessness…whatever…I give myself the time and care of fully experiencing the loss, fear or aimlessness. I do this where it’s safe for me and safe for others – raging on the highway isn’t safe! – and I do this until I’ve fully felt the symptoms depression brings to me.

To fully feel the symptoms of depression in safety for myself and with compassion for the safety of others around me is a good practice.

To fully feel those symptoms is not masking them by meditating, praying or doing anything to change them.

Sometimes I cry; sometimes I keen (like when I was screaming into my pillow on melatonin). Sometimes I rage -- but without breaking things and hurting people! Sometimes the symptoms are so intense that it makes my entire body quake – I’ve learned that these kinds of tremors can be very healing.

When I’ve fully experienced the symptoms, they leave me. That process can take minutes or months, depending on the intensity of the life experience that triggered the symptoms.

How do I do this?

Full experience of emotion, for me, happens when I bring those symptomatic emotions to music.

Music lubricates the experience of my depressing emotions. Music allows me to experience the symptoms and the feelings that go with them in a very personal and healthful way.

Whatever the DSM wants to claim about me, I don’t feel that my practice is a sign of mental illness. To me it feels like I’ve found a way to give myself proper care – care that drugs and therapy don’t give me.

If you are experiencing depression, I hope you can use my story. I hope it will inspire you to try a different approach to meeting the symptoms you experience. Without stigma and without fear.

Some experts feel that symptoms of depression open a doorway to the human psyche – the soul. I’ve walked through that “chronically depressed” doorway many times in my life. With all that practice, I’ve gotten better at it. I’d like to think you would join me there.

Tuesday, September 8, 2015

Worried a Friend Might Be Suicidal? Here's How to Help

It’s World Suicide Prevention Day today: September 10 2015.
It might seem like a morbid subject, but there’s a happy ending. I promise.

A few years ago on a beautiful spring morning, I got the call no one wants. Through her tears, my best friend’s wife told me that my lifelong buddy was dead…he had set himself on fire. She witnessed it, as did his parents and two of his three kids.

I didn’t know then that I might have been the one to save him.

I want to be very honest and direct: I’ve chosen not to take my own life – it’s a choice I make often.
Just last week I was mountain biking on the rim of the Rio Grande Canyon near Taos New Mexico. It’s spectacular: flat mesa with this huge rift cut through it. The drop-off to the river is several hundred feet in many places. I chose not to jump. I’d rather continue to live – to see what happens the next moment, and the next. Breathing, for me, is better than not breathing.

There are people alive in the world that I love, and who love me. I feel confident that not jumping was – and is – still my best choice.

Thanks to two long-term studies, researchers have learned that social connectedness – not necessarily “relationship” but simply having a robust network of friends – can significantly reduce the risk of suicide for both men and women.

Life’s hard – no question about that. Friends – not the digital kind, but real, live, in-person friends – can make it seem less difficult. Those studies show that those friendships can literally be lifelines.

Here’s how I might have helped my buddy choose to keep breathing.

Ask about risk for suicide or harm
Sure, it’s a hard question: “Are you feeling suicidal?” Or: “Are you thinking about hurting yourself?” I wish I’d known to ask my friend how he was feeling and what he was thinking. It’s such a simple question, but it might have saved his life. Role play that question with friends who care for you…it will seem more natural if you ever need to ask it for real.

Listen – and don’t be judgmental
To listen and not judge is hard. It’s even harder to bite your tongue and NOT try to intervene in a crisis. Just don’t; it’s more effective to listen. Look into your friend’s eyes and LISTEN. The next step is about what you CAN do…but only after your friend or acquaintance stops talking.

Give reassurance
This is when you can talk. What you say right then is ONLY about being supportive and empathetic. If you know your friend well, give them love and support – a hug even. If you are barely acquainted, offer your friendship: “I’m here for you, whatever that might mean. I would miss you if you were gone.” You aren’t going to fix anything, but you can offer encouragement and information: “It’s fairly common to consider suicide, but it’s much less common to actually do it, and I want you to keep breathing. I enjoy our friendship.” If you want other ideas about what to say, email me!

Encourage appropriate professional help
There are lots of qualified professionals who deal with suicide every day. You don’t have to be one to effectively and confidently encourage your friend to connect with any of them. Calling 9-1-1 is a great first step. The National Suicide Prevention Hotline is another: 1-800-273-TALK. You could suggest that your friend call 2-1-1 and ask for a referral to a qualified suicide therapist.

Encourage self-help or other support strategies
Again, in spite of what many people believe, suicide isn’t always a mental illness. Your friend’s well being is important to you – if you make sure they feel and know that, your encouragement will be genuine and received that way, too. There are many ways to give self-care and tons of resources for doing so, from yoga and mindfulness practices to self-care using music. Religious folks appreciate the fellowship of church, and although that may not be working for them at the moment, perhaps a change of venue would be welcome – maybe invite them to your church with you. Be creative when you offer options!

This simple five-step process is something you can learn and do. It’s not hard – remember to role-play! – and it’s effective. Want to know more? You can take a free short course, taught by Mental Health First Aid, in many places in the United States.

So here’s the good news I promised.

Yeah: I’m still alive. But it gets better.

While the suicide statistics are dire, as you and I work to build authentic connections with people that we love, we lower the potential for those peoples’ desire to take their own lives. As the message of how to do that spreads, all of us become more connected and more capable to offer empathy to each other – and to others we don’t know.

Isn’t that good news? It’s the kind of awareness that feels good to me. If you do this even once, I guarantee it will feel good for you, too. Tell me your story! The world is listening.

Wednesday, July 15, 2015

The Suicide Spectrum

The Jumper ~ R Noelle
"The friend who holds your hand and says the wrong thing is made of dearer stuff than the one who stays away." ~ Barbara Kingsolver, quoted in The Sun, February 2007

Somewhere between taking one’s own life when everything seems completely without hope – call that “hopeless suicide” – and “assisted suicide” there is a conversation waiting to happen.  This post is meant to spark that conversation.
So many Veterans appear to choose suicide from the perspective of having nothing left to live for – no meaning in life and too many issues, whether physical or emotional or practical – so ending it all appears as the best option. Non-Veterans also face this choice, including my grandfather (whom I never knew) and my best friend (whom I knew well) and me. This is “hopeless suicide.”
It’s also a fact that there’s growing awareness and advocacy for “assisted suicide” as a humane way to end one’s life when reasonable expectations for recovery simply don’t exist.
There’s some crossover, too: “officer-assisted suicide” is, ironically, a fairly reasonable way for some people to end their lives. These days, all one has to do is show up in a public place acting crazy and brandishing a toy gun and the police will take you out.
And what about the protest suicides that are popular in Asian countries? Monks have set themselves on fire for a long time to call awareness to conditions they abhor and can’t change. That’s considered honorable.
Finally, what if suicide is a better alternative in the moment of crisis? The Jumper (hat tip to R Noelle for the image shown above) depicts one person's choice to leap from the World Trade Center rather than die during its collapse.
Which of these forms of suicide does society want to prevent? It’s fine to pass laws to add more behavioral healthcare professionals to the rolls of caring professionals, or pass laws to permit more assisted suicides, but laws alone aren’t going to resolve the questions that reside along the suicide spectrum.

Hopeless Suicide

Let’s start with the big one: unless you are the one contemplating taking your own life, you are an outsider. Even as close as my friends and family were to me when I was thinking seriously about killing myself, none of them – and I mean NONE of them – knew what was really going on with me, and I made sure to keep it that way. Yes: I was in therapy, and I even told my therapist what I was thinking, but that wasn’t the reason I didn’t take my own life. I didn’t share that reason with anyone, and at the decision point, it wasn’t about reasons anyway. Something else takes over at that moment, and that something has nothing to do with reason and sanity.
So who are “we” (the outsiders) to say we know best about some random suicidal person’s wellbeing? Doesn’t matter if we are parents, close friends, spouses or co-workers of one who’s suicidal – what right do we have to interfere? For most practical purposes, by the time I was at my decision point, it was too late for outside intervention. I suspect that’s the case for many others, too.
I’ve been through a couple of trainings that help non-clinical non-professional folks like me know how to recognize suicidal tendencies in others and begin the process of intervention to stop a potential suicide from becoming a real one. Both programs were good, but as good as they were, I believe both programs operate at a point that’s too late to do much. Prolonging the act is really all we can hope for when a person is obviously suicidal; much more work is required to turn a suicidal individual into a non-suicidal individual. I choose life every day, but that consistent choice to live came hard to me.
The time to intervene in someone else’s suicide comes way before they are ready to take their own life, perhaps even before they consider it as an option.
Think about this: do you have any authentic human relationships? The kind that battle buddies have in military combat. The kind where you would give your own life to save your friend’s life without a moment’s hesitation. If you have THAT kind of friendship with one or more people, you are blessed. I believe this is the kind of authentic human connection that saves lives, too.
Are you a good mentor? Have you ever volunteered to truly put someone else’s success ahead of your own, stand beside them as they struggle, encourage and coach when necessary, answer the phone in the middle of the night, be the big sister or big brother they never had, allow them to reach their full potential? If not, try it. If you achieve success as a mentor, you will have done two important things: 1) you will have modeled an authentic friendship, and 2) you will have empowered one more person to do the same and become a friend or mentor for someone else in turn. Pay it forward.
We must guard against the complacency of assuming that another law, or another program, or another donation to a humanitarian cause, or another Sunday in church is making the difference for folks thinking about suicide. It’s not. What DOES make the difference is authentic human connection, whether that’s the in form of a real friendship, or being a mentor, or being an authentic spouse or authentic partner. We can’t make the mistake of assuming our relationships are OK just being on cruise control; if we do that, it’s too late to intervene when suicide becomes an option.
There’s research that indicates an authentic relationship is the best intervention for hopeless suicide. If you really want to prevent hopeless suicide, work on the relationships in your life. Make certain they are authentic. Those relationships might save YOUR life some day.

Assisted Suicide

The conversation about assisted suicide is easier for most of us. But think about this: if it was YOU with a chronic, painful health condition from which there was no prognosis of recovery, would you want to ride it out until your “natural” death, even if that meant great emotional and financial stress to those you love as well as your own suffering? I can understand the reasonableness behind choosing assisted suicide.
I can also understand the reasonableness behind officer-assisted suicide. Although perceptions are changing rapidly thanks to racial tensions in the United States, society has had less trouble with a peace officer taking out a crazy person brandishing a gun than society would have had with that same person taking their own life. Now that society is confronting the issue of killings by peace officers, perceptions are changing. Society is demanding a higher level of accountability from its peace officers, which seems to anticipate an expected drop in the numbers of officer-assisted suicides.
The bottom line, however, is that a reasonable, rational person in possession of their own faculties and “of sound mind” may still choose to end their own life, even with the cooperation and consent of those closest to them – their family and friends. Whether a person in that situation runs in front of a train or gets a lethal injection or threatens some police officer doesn’t really matter, does it? One way or another, someone who wants to die – maybe even needs to die – is going to figure out a way to do so, and there’s a poignant beauty in this paradox that states such as Oregon recognize by legally protecting a person’s right to assisted suicide. Isn’t this a humane treatment?

The Questions

The challenge for everyone who cares about the issue of suicide is to embrace the paradox of life and death. Both are necessary parts of being human.
In spite of the overwhelming evidence that all of us are going to die n our society, there’s an implication that death is somehow “bad” and life is “good.” What would happen if society could put aside its judgment on life and death for long enough to talk about it objectively? Could this provide an opening for a more enlightened conversation about the value of a good life and the value of a good death?
Are you aware of the resources available to a person who, facing his or her own death, seeks a transition that has great meaning and great authenticity? The resources are out there, and they range from religious counseling to psychological counseling to all sorts of New Age modalities for approaching one’s own end of life. It’s a very moving field of endeavor, and it seems that the people who engage in facilitating the mental and emotional transition from life to death have been given short shrift in the conversations about suicide. Perhaps they stay hidden because the perceptions of society in general are often hostile to these workers, especially regarding suicide.
That’s the big question of course. Society feels it is somehow necessarily humane to prolong life and anathema to assist death. “Thou shalt not kill” runs deep in American ethics. No matter what, suicide in any form is killing, and disconnecting from a deeply held belief in the sanctity of life is difficult work. But it is possible to put one’s beliefs on the shelf during discourse, hear the various points of view, and perhaps even evolve more effective policy without compromising one’s individual ethics. For example, isn’t “thou shalt not kill oneself” versus “thou shalt not kill anyone else” a reasonable distinction for dialogue? I’m not ready to pass laws that remove penalties for murder, for example, but I’d be willing to hear a wider discussion of permissible humane choices at end of life.
I’d also be willing to entertain a wider discussion of permissible choices at the end of hope. Many humanitarian organizations claim to serve people who have reached the end of hope, but taking a step out of homelessness and addiction, for example, is often a process that homeless addicts don’t survive without friends and mentors.
Perhaps these questions, if we could at least talk about them, might help bring society closer to preventing suicide. After all, isn’t it society that has failed the individuals who take their own life? Isn’t it incumbent on all of us to be the friend to a person who feels the death grip of hopelessness, for whatever reason? If we aren’t willing to live like we value life itself and act to preserve that value, what purpose do we have to live at all?

Tuesday, June 2, 2015

Music in Your Face for PTSD Awareness Month

There’s monotony about most “healing music” out there: it’s peaceful, serene and well, quite boring ... to me.
Yes, it’s relaxing, Yes, it’s all about alpha wave, right brain transformative experience. And let's be honest: yes, it SELLS.
But is that what we really need?
One of the hardest lessons I’ve learned in therapy is that stuffing the feelings I don’t want is destructive to my psyche and wellbeing. Before therapy, I was too good at doing that: keep a stiff upper lip; suck it up; forge ahead. But all that suppression wasn’t good for me.
Instead of that approach, it wasn’t until I learned to practice feeling emotions fully – in safety and with support – that I started to really transform. Everything up to that point was no better than using sticky tape and baling wire on an open wound.
Back to that mesmerizing music…
"Music has charms to soothe a savage breast,” wrote William Congreve in “The Mourning Bride” in 1697. There’s an enduring beauty to that phrase, and music certainly does have such power. But what’s not often remembered is the type of music Congreve must have imagined in his day.
Popular secular music in the early 18th Century was quite unlike music in the 21st Century. Back in Congreve’s day, unless you were in church, you’d hear a sackbut, a lute, possibly a hand drum and maybe some sort of whistle, accompanied by the sort of low, bowed string instrument that would become a modern cello. Hardly a peaceful orchestra, as anyone who’s actually heard an ancient sackbut can tell you. This sort of music is sometimes used in Shakespearian plays.
Perhaps Congreve was thinking more of the early vocal music just beginning to make its way out of the church into secular society – and there is some hauntingly beautiful late Renaissance vocal music out there. Henry Purcell’s compositions are great examples, and they are enchanting when performed by a modern orchestra. They must have been stunning in Congreve’s day, too, played on the best instruments available, which weren’t anything to write home about – by this time, Stradivarius would have made only a few dozen violins. Musicologists might debate the soothing values of Purcell’s most sublime works versus modern “healing” music but there’s an “apples to oranges” problem with doing so that pits the musical hoi polloi against, well, everyone else… and there goes any soothing effect.
One thing musical healers tend to forget is the psychotherapeutic fact that stuffing your troubles multiples their bad effects. Before one can get to any sort of soothing experience, it’s absolutely essential to let go of the traumatic stuff – the stuff that’s making you anxious, upset, depressed, whatever-the-feeling-that’s-not-what-you-want.
Playing a didgeridoo and Tibetan bowl for me when I’m all hopped up on posttraumatic stress is like adding kerosene to a fire. Not soothing. I understand the alpha wave science, but I don’t want to hear it at that moment. Instead, I need some heavy or def metal – Alice in Chains or Metallica – to help me feel the “bad” stuff fully.
So when I’m in that ugly place, I tend to reach for music that supports the ugly feelings I have. Those feelings – and the music I need – can be quite savage, so I make sure to use headphones so I can turn it up LOUD and listen in a safe place where I won’t hurt myself or anyone else (that is, NOT in the car or on my bike or in any other situation that requires me to split attention between the rage/anxiety/depression I’m feeling and the need to operate potentially dangerous equipment).
And then I listen to that sort of music until I no longer feel the rage/anxiety/depression of whatever triggered me. This speeds up the process of “getting it out” while preventing my acting out any of the feelings I don’t want in a destructive way.
ONLY then am I ready for something soothing.
I feel it’s a huge mistake to confront rage with “healing” music. At that moment, it does the rager no good to be met with some crystal-crunching anthem, and it could actually put the ragee in danger. I know: if someone gets in my face with “all there is is love” when what I’m actually feeling at that moment is anything but loved or loving, there’s going to be trouble.
Think about it: if you want to work out, you need physical support and pump-you-up music. When you are in the mood, you spin a sexy playlist. Eventually, your workout (or love-making) are over, and only then is it time for a different kind of music. So why wouldn’t you support feelings of rage/anxiety/depression with compatible music – for you – that lets you feel that stuff fully?
To recap:
1.     When traumatically stressed, use music to feel it fully in a safe place;
2.     Listen and feel that stuff until you can’t feel it any more;
THEN (and only then):
3.     Give yourself a “healing” music bath using whatever music brings you down easy.
Try it. Write and let me know how it goes.
And spread the word: June is PTS awareness month and every one of us needs to know how to use music to intervene – it’s easy and powerful.

Wednesday, May 20, 2015

Doing Something vs Doing Something Effective About Suicide

We all want to know that what we do is effective, right?
What can we effectively do about suicide? 
We can vote for politicians to “do the right thing” which normally means that THEY vote to spend more of OUR money … in the War on Poverty, or the War on Drugs, or government education … or suicide… 
We can learn the skills to intervene when someone we encounter seems to be at risk for hurting themselves or taking their own life. 
We can give to a charity that “does something” about humanitarian issues like suicide in hopes that we’ve picked the best organization that will make the biggest difference with our money… 
We can re-learn the interpersonal skills that give us authentic human connections with our family and friends and co-workers – connections that can intervene when the stresses of daily life grip us. 
We can assume that “something is being done” by behavioral health care professionals and try to ignore the fact that more people are taking their own lives today than ever before…
We can take a realistic, reasoned and educated look at our own communities and the organizations in them to learn which initiatives REALLY reduce suicide and why, then begin to replicate those efforts.
It is no longer enough to assume that “something is being done” about suicide when so much effort and money has already been spent without results. It’s no longer enough to assume that our favorite humanitarian organizations are able to get out in front of suicide. And it’s certainly high time we understood that government is NOT about doing what it right because government, while it is good at making and enforcing laws, has a decades-long expensive track record of failure at effectively getting out in front on humanitarian issues.
If you have a friend or family member who’s depressed, stressed and anxious, what are you doing to intervene? Is it working? If not, there are resources available to you – such as The QPR Institute and Mental Health First Aid – that will help you be more effective. If so, teach your family and friends how to do what you do.
That would be doing something effective…for a change.

Thursday, May 7, 2015

Is Technology Undermining “Veterans First?”

We all know that patience with the VA wore thin long ago. One of the many remarkable results of that impatience is that Vietnam Veterans of San Diego created what is now known as Veterans Village of San Diego rather than wait for the VA to get its own act together and truly serve homeless drug-addicted combat Veterans. Fortunately, Veterans Village of San Diego has shown by example what can be done when Veterans truly come first.

Doubtless there are many remarkable individuals serving the VA, but it’s a shame that the VA’s own computer systems limit the effectiveness of the individuals working there. Part of my life was spent as an IT systems analyst, and I would like to offer insight and suggestions from my own experience of the Veterans Administration San Diego Healthcare System (VASDHS) over the last few months, seen from the point of view of a friend who is a disabled Veteran.

One example:

How is it that medical procedures at VASDHS can be cancelled last minute without notification to transportation services? My friend was told he had lost transportation privileges because a van came to pick him up for a procedure that had been cancelled. The cancellation computer failed to advise the transportation computer, which made more work the human beings serving the Veteran as well as the Veteran himself. That’s not putting Veterans first.

Another example:

Why is it that my Veteran friend can be called to an urgent appointment with less than 24 hours’ notice, requiring him to arrange his own transportation, only to wait hours for that care to be given after arriving on time as demanded? That doesn’t seem to be putting Veterans first.

Yet another:

How can the VA computer system cancel all transportation contracts for disabled Veterans without first checking to see if those Veterans have appointments on the books? This happened today at the VASDHS, and it put a number of excellent VA staffers into damage control mode. How can that be putting Veterans first?


A Veteran trying to respond to chain yanking in any of these examples is told to call the “Primary Care Call Center.” The capable caring call center crew has only one way to put Veterans first: send an email message to the proper Primary Care provider. In this open-ended system, there is no guarantee that the Veteran will get a response, and the system is useless in some cases since the only response window offered by the call center is “two to three working days.” A disabled Veteran without transportation who must be at appointments with less than 24 hours to respond doesn’t have two to three working days. In this case, the only thing that is being put first is an open-ended broken system with no accountability programmed into it.

Some suggestions, free for the taking:

A)   Most industry-standard call center software has escalation capabilities that facilitate human intervention when necessary. It’s not hard to implement such features, nor is it hard to find capable managers and team members to use them effectively. Even the most backward third-world call centers can do this; let’s make it a part of putting Veterans first here in San Diego, and soon. An in-place escalation process would have smoothed out the response to today’s transportation cancellation issues.

B)   Require human review of computer-determined actions with a potential negative impact on ten or more Veterans. A human being could easily apply the brakes before such automatic actions become a train wreck. This could have prevented today’s transportation snafu, and would also help keep transportation from being wasted on cancelled appointments. Ultimately, the underlying deficiency in the computer systems must be corrected; until they are, let’s put Veterans – not computer systems – first.
C)   Require human review of all computer-initiated appointment notifications where a Veteran is given less than 24 hours to arrive for care to make sure that the communication to the Veteran is clear and that any questions the Veteran has can be answered during the notification process. This may mean that the automated notification system won’t work in some cases; until that’s done, let’s put Veterans first.
It seems obvious that the human capital needed to implement these suggestions is available; I witnessed it today doing damage control and it seems obvious that excellent staff would be much happier re-deployed out in front of a problem rather than reacting to the fallout from one. It also seems obvious that if a third-party civilian like myself – and I’m not a rocket scientist – can notice such things, they must already be painfully obvious to many others.

How about it, VASDHS? Doable?