Saturday, October 17, 2009

#Depression #Suicide #Health #WOC #Mentalillness: I knew s/he was crazy, but...

I often get asked what the Telltale Signs of Depression are and I usually say, Google or WebMD?

Since I deal with diverse populations, Google and WebMD are often NOT our BFF's. When explaining to diverse groups there are plenty of "yes, buts" or "what ifs" after even the listing all the Telltale Signs from the DSM-IV revised by a Nobel Laureate in Medicine!

In this written piece, I am relaying and translating the societal and cultural nuances so that mostly everyone can be on the same page for depression and suicide. While knowing the basis of the mental illness through listing the symptoms, it is just as important that these symptoms are understood fully even the variations in behavior that are witness, so that all have a positive mental health diagnosis and prognosis! Everyone deserves equity and parity in mental health care and everyone needs full understanding and education on what is known and treated in serious mental illnesses like depression and suicide.

First, below is the listed symptom of depression from WebMD that was obtained by the National Institutes of Mental Health:

What are symptoms of depression?

According to the National Institute of Mental Health, symptoms of depression
may include the following:

  • difficulty concentrating, remembering details, and making decisions
  • fatigue and decreased energy
  • feelings of guilt, worthlessness, and/or helplessness
  • feelings of hopelessness and/or pessimism
  • insomnia, early-morning wakefulness, or excessive sleeping
  • irritability, restlessness
  • loss of interest in activities or hobbies once pleasurable, including sex
  • overeating or appetite loss
  • persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
  • persistent sad, anxious, or "empty" feelings
  • thoughts of suicide, suicide attempts

Are there warning signs of suicide with depression?

Depression carries a high risk of suicide. Anybody who expresses suicidal
thoughts or intentions should be taken very, very seriously. Do not hesitate to
call your local suicide hotline immediately. Call 1-800-SUICIDE
(1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) -- or the deaf hotline at

Warning signs of suicide with depression include:

  • a sudden switch from being very sad to being very calm or appearing to be happy
  • always talking or thinking about death
  • clinical depression (deep sadness, loss of interest, trouble sleeping and eating) that gets worse
  • having a "death wish," tempting fate by taking risks that could lead to death, like driving through red lights
  • losing interest in things one used to care about
  • making comments about being hopeless, helpless, or worthless
  • putting affairs in order, tying up loose ends, changing a will
  • saying things like "It would be better if I wasn't here" or "I want out"
  • talking about suicide (killing one's self)
  • visiting or calling people one cares about

Remember, if you or someone you know is demonstrating any of the above
warning signs of suicide with depression, either call your local suicide hot
line, contact a mental health professional right away, or go to the emergency
room for immediate treatment.

Suicide Warning Signs

by Kevin Caruso

If you or someone you know exhibits several of the suicide warning signs listed below, immediate action is required, so please read the information on the home page of this website and take action. Thank you.

Suicide Warning Signs:

  • Appearing depressed or sad most of the time; (Untreated depression is the number one cause for suicide.)
  • Talking or writing about death or suicide.
  • Withdrawing from family and friends.
  • Feeling hopeless.
  • Feeling helpless.
  • Feeling strong anger or rage.
  • Feeling trapped -- like there is no way out of a situation.
  • Experiencing dramatic mood changes.
  • Abusing drugs or alcohol.
  • Exhibiting a change in personality.
  • Acting impulsively.
  • Losing interest in most activities.
  • Experiencing a change in sleeping habits.
  • Experiencing a change in eating habits.
  • Losing interest in most activities.
  • Performing poorly at work or in school.
  • Giving away prized possessions.
  • Writing a will.
  • Feeling excessive guilt or shame.
  • Acting recklessly.

It should be noted that some people who die by suicide do not show any suicide warning signs.

But about 75 percent of those who die by suicide do exhibit some suicide warning signs, so we need to be aware of what the suicide warning signs are and try to spot them in people. If we do see someone exhibiting suicide warning signs, we need to do everything that we can to help them.

If you or someone you know exhibits several of the suicide warning signs listed above, immediate action is required, so please read the information on the home page of this website and take action.

Always take suicide warning signs seriously.

Thank you,

Kevin Caruso

I am translating these symptoms for the African American community because many people have come to me wondering if there is a way to identify or tell, or if there was anything thing they could do to stop any suicide. My cursory view of this list shows the lack of cultural competency in mental health, and thereby can cause burgeoning symptoms in African Americans. While it is clear that not ALL of these symptoms are manifested and there are variations between individuals, these are the main kinds of "cultural nuanced symptoms" that someone who is depressed often displays. It is NOT like someone who is depressed makes an "ACTIVE" choice to have display these symptoms, rather it is likely the wrong choice or inaccurate choice--it is like the person thought it was a good idea at the time or the thought never occur to him/her that the idea was illogical. At this time, I will not be listing what to do to manage these symptoms, but, one is more than welcome to visit one of The Ari | af | ya Universe's brands: Sistah Mental Health and Wellness or GYM Right-H/W Coaching and Events to learn self-managements.

The other issue is I organized this "Translation Navigator" so that we are all on the same page. I mean no disrespect to those who understand this information, but seriously, looking at the mental health disparities, something MUST be done for the lack of cultural incompetence described in my symptom review. I have chosen to do develop this written piece which I also will place on the Crazy Black Woman blog under a more marketable and racy title. This written piece needs to be used complementary to your professional health care provider and does not supplant or supersede your treatment plan with a licensed provider. Nor does it counteract against the written reference material.

Here it goes:

The inability to concentrate often resembles forgetfulness--but everyday forgetting important tasks, like missing due dates for bills, or forgetting to call key people like doctors. It is not the casual forgetfulness of losing keys or dementia like forgetting where you are--like Alzheimer's--that is very different! This forgetfulness is like after have a profound conversation with the depressed person (more like an argument) and they forget to pay the cable bill, still... Mainly forget to do important tasks.

Being fatigued or decreased energy means if the depressed person exercises every day at 12 PM, then they stop and do not do it for a month because they complain of fatigued or exhaustion or "I'm tired"--then it probably a depression. It is the dramatic shift in routine over a month that this symptom resembles.

Feelings of guilt, worthlessness and/or helplessness are often not articulated or said and generally men do not state this. If men say anything it resembles blame of any perceivable target--often you! Generally, depressed women complain, then blame. Shortly, I will explain what that looks like because it is a manifestation of depression as a disorder.

Hopelessness and/or pessimism often looks like "commentary" that teenagers provide whenever you make comments. For example, when you say, "Let's go to the Beach, it is a nice sunny day!", a depressed individual would say rapidly, "Why to get burned by the sun!"

Insomnia or excessive sleeping: I have not been privy to insomnia due to depression, but I have slept all day for several days without being sick. Like I would choose to sleep vs choosing to exercise, or go to a fun social activity.

Irritability or restlessness: Irritability often looks like whining and snapping at whatever you say. You could just say "BOO" and the depressed person combined with the feeling of guilt would bite your head off for saying "BOO"... The restlessness is often combined with the forgetfulness. Watch when they cook. Tell the depressed person to make Koolaid/punch and s/he will get flustered by making a simple recipe... And remember, the behavior is not sporadic; it is consistent over a month or two.

Lost of interest in activities once pleasurable, includes sex: This particular symptom I have witnessed and experienced its combination with the forgetfulness, the fatigue, the guilt the pessimism and the excessive sleeping symptoms. It could be any activity that you know your loved one enjoys. One of mine was going to the movies. I was very much into science fiction and reading the latest trailers and previews. Then, my loved ones would ask, "Hey, let's go to the MOVIES" and I would say I did not want to go. I had no reason why and one would have to twist my arm to make me go. The other issue is when it is several activities once enjoyed as a tradition and the activities no longer want to be done for unknown reasons! Such as your depressed loved one and you enjoy having fries and shakes after a heavy workout, it is your ritual, and for no reason, the depressed individual refuses to go--not because s/he took a new nutrition class, but just s/he does not want it... Remember, the behavior must be consistent over a month and is not sporadic!

Changes in eating behavior: I have witnessed and experienced overeating. I may have done some forms of appetite loss, unrealized. But, I have overeating junk food more than not eaten at all... What a depressed individual does when s/he overeats is a lot of carbs: breads, cakes and sugar! Apparently, the medical aspects of depression feeds off of glucose in the brain, the full mechanism is unknown. Moreover, the meal is one time of day--all day and does not stop until sleep! Alternatively, what a depressed person looks like when his/her appetite loss is s/he has failed to go grocery shopping and all that is left is something indistinguishable, often the depressed person is living off of something bizarre like gum or rationalizes vitamin supplements have nutrition. Most of the symptoms mesh with each other, so this one is combined with forgetfulness, inability making decisions, helplessness and hopelessness. Moreover very little eating can cause the insomnia...

Persistent malaise: A depressed person complains all the time about physical issues and when s/he chooses to see a primary care physician, knowing that the ache and pain is in his/her mind is currently discouraged due to lawsuits. Laboratory tests and manifestations cannot convince the depressed person of his/her ailment. Remember this is another symptom that meshes itself with other symptoms, so if this one is see, the other ones are seen... I have experienced this one with the fatigue, guilt, hopelessness, irritability and lost of interest in activities symptoms.

Persistent negative thoughts: A depressed person complains about "nobody likes me" or any absolute statements: NEVER, ALWAYS, NOBODY, EVERYBODY. AND often you also see judgmental with accusations types of comments: "You should's" and "You must's". The empty feelings look like "listlessness" or lack of response--especially when you ask a simple question like "How are you going today". A depressed person will respond with a shrug or say "I don't know" on a consistent basis. Remember, this type of symptom is meshed with the other ones... The thing is this one is a trigger: meaning when you start hearing them frequently is when your antenna needs to be raised!!!

Thoughts of suicide: When the comment gets made, it needs to be taken seriously. Whether or not there is a plan, that will be discussed later, no games can be made or discounting it. By that time, depressed people have actually intensely rationalized and thought about it, so now they are beginning to vocalize it... It is the process of the disease of depression. Literally, the brain is damaging itself due to the aforementioned symptoms. It is thought that all the symptoms meshed together overload the system and crashes the brain--like a hard drive. But there are other organs attempting to save the body at the same time: i.e. the heart, the muscles, the stomach, the liver and the kidneys, plus many others to override the "self-destruct" button... Remember, this behavior is not night and day or sporadic, does not lessen the impact though, so watch this behavior closely.

So please permit me to use some creative license and combine some of the warning signs to suicide from WebMD and

There are some key spots that MUST be watched and vigilant with someone suffering from depression, especially as it relates to suicide! I cannot stress this enough if you love this person, this is NOT about "Dr. Gina" being crazy, this is about me going into thoughts of suicide and generally these thoughts resemble the below discussion. Also, these are the telltale signs. This IS what you look for so that you can do "if you could have done anything differently..." The way to think about this is the splinter in the tiger. The tiger by itself is a lethal fighting animal, but when there is a splinter, they writhe in pain and while you might think "it is not a big deal", it is to the tiger and usually it will kill itself or gnaw off its paw to minimize the pain... However, if you do notice key suicide warning signs, you need to include a professionally licensed provider for any intervention. But laws vary from state to state, and no one can be hospitalized against his/her consent. I am only pointing out the suicide symptoms, as usual my disclaimer is this is completely complementary and suggestive of any professional statements, it cannot be used to diagnose, supplant or used contrary to any professionally licensed provider's treatment or medical orders. In fact the information presented here has not been verifiable so you must use it at your own risk and it is for casual informational purposes only!

Sudden switch from very sad (depressed) to calm/appearing happy: While obviously stated, often this looks like the depressed person has found "resolution" to his/her problem--usually it is committing suicide--like the game show buzzer--EHHHN--inaccurate conclusion here. So, if you notice this behavior with your loved one, ASK what his/her wants are? Asking this question is also called a question of autonomy. The point of this question is had they made a definitive decision--you will get an answer to this question no matter what the answer is... If s/he flies off the handle or shuts you out, that answers your question. If s/he actually tells you what is going on, then you may have to make your own decisions, which does NOT include yelling at him/her.

Always talking and writing about death. Generally, we think of this "Gothic paraphernalia", like always wearing black like a vampire... But really, making this culturally relevant for African Americans, this symptom looks like wanting to be that "gangster" or "thug", with the guns, listening to "gangsta rap" or "thuggish" music and actually believing it is real. And the discussion looks like dark and dreary kind of lifestyle, such as robbing people, misogyny, prostitution, etc. This symptom meshes with another symptom as described later.

Clinical depression as described in the above section.

Having a "death wish"--taking unnecessary risks: In the African American community, these symptoms appear to resemble anything! Running red lights is unsafe for any African American in the United States, so that would not be something we would manifest. But carrying a gun into a club saying we are protecting ourselves is an "unnecessary risk"... The death wishes we have is getting involved in very dangerous activities known to ruin our lives and are self-destructive--which leads us to our next symptom

Substance abuse: Alcohol is a depressant, and some illegal substances, like marijuana and methamphetamine make irrational thoughts worse. Many people in our community abuse substances to self-medicate from their depression. It is a self-destructive habit. This is probably one of the single elements that is seen more in the African American community than others. The symptom looks over and above the normal consumption of substance abuse--a functional alcoholic or smoker, etc. And substance abuse treatment differs from depression treatment, while the two are intertwined inexplicably, first the addiction is treated then the mental health issue...

Acting impulsively: One of my signature ones! Usually I would run to go somewhere or act like I was running away when I was younger, living with my parents. My folks were not astute enough to pick up that was a suicidal symptom, so, without treatment, this one can precipitate to a worse outcome, like a suicide attempt--which I did. Since this discussion is about depression, acting impulsively is doing something without thinking about it and letting the chips fall where they land--meaning if the depressed person dies, that will be where the chips land... The depression symptoms you often see meshed with this suicide warning sign are guilt and hopelessness.

Poor performance in school and work: Young people often have failing grades and it is known they are able to do the work. For adults, it accounts for missed days of work, lack of follow through and missed deadlines. The depression symptoms you often see meshed with this suicide warning sign are lack of concentration, fatigue and excessive sleeping.

Putting affairs in order, tying up loose ends, writing/changing a will, giving away prized possessions: So many depressed African Americans feel they do not have anything, so changing wills is infrequent occurrence. Moreover, I have not seen or experienced giving away prized possessions freely. I gather this suicide warning sign resembles vandalism or destruction of property. The depressed person's thinking is "Since I have nothing to lose (hopelessness) and everyone thinks I am worthless (guilt, worthlessness), I will vandalize this property by graffiti or I will destroy this property by stealing/thievery of key items". What makes this illogical thinking occur in a depressed person is putting the affairs in order or tying up loose ends... What makes this a suicidal warning sign is the risk of arrest involved along with the depression symptoms and other suicidal warning signs like substance abuse or a death wish.

Feeling strong anger or rage: It has been told to me that depression is anger turned in on myself. The anger I have had and still have is due to unresolved hurts and pains done to me or experiencing what I perceive as a traumatic event. Some people casually say, "This is what is called life, deal with it"--is a destructive comment to make to clinically depressed individual, it is what will tip them over to just thinking about suicide to actually committing suicide. The heartless comment often is misconstrued to a depressed person who is already having inaccurate gross conclusions in thought and the comment causes the person who is incapable to articulate his/her feelings to only verify his/her self-worth with the depression symptoms. What you see is either the first suicidal warning sign of "listlessness" or "empty" feelings or you see an anger/rage unloading, often with crying. What causes this anger? I have a blog on anger as it is written from my bipolar POV. When I realized I was very anger or enraged, I had to develop an action plan to remove myself from the event so that my brain was not damaged by my negative thoughts. I also include several other activities and if you would like to know more, you would have to join Sistah Mental Health and Wellness -- the premier online social media site for diverse women:!

Remember, it should be noted that some people who commit suicide do not show ANY warning signs. So, loved ones may still feel, "I knew s/he was crazy, but..." And if you actively see these symptoms and want to help him/her, judgment does not help them, professionally licensed provider can! A few pastors have qualifications for professional mental health care and it does not only include prayer or telling one to just be saved! Many professionally licensed providers lack cultural sensitivity and could look "crazy" to you! Finding the what works for you, navigating the mental health care system, implementing mental health and wellness goals for you and your loved ones is very important! If that is something that interests you and you are a diverse woman, please feel free to join us at Sistah Mental Health and Wellness! We await your presence, today!