Jan 06

What’s the difference between clinical depression and just having ‘sad mood’ (sadness) or ‘feeling blue’? This often-asked question is often asked and sometimes, it may indeed be hard to tell whether there are already signs of depression if someone has been feeling depressed for some time.

To try clarify this question to some extent, feel free to undergo the online test on my website, or watch the nice TED video clip below about the topic. If you feel like it, just add your experiences or observations in the comments below – maybe they can be of help for others asking themselves similar questions.

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Oct 31

Today, I stumbled upon this little video on the web, and thought I’d like to share it with you. Even though I feel it banalizes the problems in life to an extent – it invites to contemplate, and that alone certainly doesn’t hurt… ūüėČ

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Feb 19

‘And meanwhile, in Thailand…’ – it feels like looking back into how mental health issues were dealt with 100+ years ago in Europe.

Thailand is very backward with respect to public information regarding mental illness and its treatment and training for mental health providers. The highest degree in psychology in Thailand is a bachelor degree, and psychotherapy in general is not been heard of, let alone being an integral part in modern health (or at least mental health) treatment.

What happens is that many people, especially in the countryside, are locked up or chained by their relatives or other people in their villages. They are called ‘baa’ (crazy) and are often considered as obsessed by ghosts or demons. Sometimes, the village head or ‘healers’ will involve some amateurish form of electro shock therapy which causes memory loss or more serious neurological damage. If mental patients are lucky and a medical doctor or even psychiatrist is in reach, treatment usually only consists of dropping pills, but there is no psychotherapy, no counseling, no social work.

And if all of that wasn’t enough, the well-hyped ’30 Baht [1 USD] healthcare scheme’ introduced by former PM Thaksin Shinawatra led to most of the better doctors leaving the (low-paid) countryside and now working in the highly paid private hospitals servicing foreigners.

Also, there is very little personnel trained in geriatric mental health care. With an aging population and growing numbers of patients afflicted with age related dementia, one may well call this a health care crisis.

Expats are in a somewhat better position, as they can afford to seek professional psychotherapeutic or counseling support from well-trained Westerners. Thai psychiatrists, even if Western-trained, are often sticking to medication as only means of treatment, and many of them also lack of understanding Western culture and mindsets.

“According to the Department of Mental Health’s survey, conducted 4 years ago, less than one percent or 400,000 Thais aged between 15-59 years are suffering from various type of psychotic disorders. The most common type of mental illness suffered by 70 percent of Thais with a mental disorder is Schizophrenia”

These numbers sound highly implausible and illustrate the very limited quality of mental health research (and consequently, treatment) in Thailand. Let us hope that the new focus of the Department of Mental Health to avoid maltreatment of mental health patients is only a first step of many necessary changes in policies and education of the public just as well as the professionals already working in the field.

More on the campaign: http://tannetwork.tv/tan/ViewData.aspx?DataID=1052726

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Jan 17

For a long time, the brain of an adult was considered as a rigidly fixed, hard-wired organ. The latest scientific findings, however, show just the opposite, proving not only something that Buddhists have always known, but also illustrating why psychotherapy ‘works’ ‚Ķ and that many of our weaknesses might actually be more changeable than we had dared to hope.

One of the most fascinating areas of research in neurobiology is the one dealing with the so-called ‘neuroplasticity’, or ‘neural plasticity’. This term refers to the ability of synapses, nerve cells or entire areas of the brain to change and adapt depending on their use. Depending on the neural system referred to, it may also be called ‘synaptic plasticity’ or ‘cortical plasticity’. The basis for the discovery of the adaptability of the brain and nerve cells was the research of psychologist Donald O. Hebb (1904-1985).

Researchers at the University of Zurich showed for example that for someone who experienced a right humerus fracture and was restricted to use only his left hand, striking anatomical changes could be proven in specific brain areas after just 16 days: the thickness of several sections of the left brain hemisphere was reduced, while parts of the right hemisphere compensating for the injury increased in size. Also, the fine motor skills of the compensating hand had improved significantly.

Simple, but amazing results in tests confirm that even the basic act of imagination can enlarge areas of the human brain: brain researcher Pascual-Leone, for instance, asked volunteers to practice a simple piano piece and then analyzed the motor areas of their cerebral cortex. He found that the area which is responsible for controlling the finger movements had increased in size. So it appears that the popular comparison by teachers to see the brain as a muscle is actually not that far-fetched: if certain areas of our brain are continuously used and ‘exercised’, they seem to develop – and our skills and the information that can be stored in these cerebral areas will increase accordingly.

In another experiment, the subjects should just imagine to play the piano piece for a certain amount of time. The astonishing result: exactly the same areas of the brain had been found changing as in the volunteers who had actually practicioned the piece on the piano. So just by thinking or by mental training alone – by an activation of the involved neural circuits -, physiological changes of the brain can apparently be stimulated.
Quite an amazing story in this context is the one of painter Esref Armagan, who has been blind from birth. Nevertheless, he is able to create realistic images of buildings and landscapes that he knows only from descriptions. Although the visual areas of his brain had never received an external visual stimulus, the associated brain areas are as active as the ones of someone who can see: just by the descriptions of the objects he later paints on paper, his brain is recognizing mental images.

Mere imagination can seemingly have enourmous effects on our brain, and actually we already know such effects from psychotherapy : it’s range of methods allows to ‘try’ new behaviors and mental concepts in the client’s imaginagion or the therapeutic practice. Later on, they can ultimately be implemented in the life ‘out there’. Piece by piece, old and hindering concepts of thinking are replaced by others that can make us happier, more confident and help us to achieve our personal goals and needs in more successful ways than before. It explains why psychotherapy can achieve supportive effects even with severe mental illnesses and neurological disorders.

To Buddhists experienced in meditation, all this will not sound new at all: if someone is able to concentrate on one thought for a long time, negative thoughts can gradually be overcome. By overcoming those thoughts that cause mental suffering, however, a physiological and permanent adaptation of the brain circuits may be achieved that had caused these negative thoughts before. What can be achieved by the external and professional guidance of a trained psychotherapist, Buddhist monks can reach only by themselves through years of meditation practice.

Therapeutic effects of neuroplasticity have been documented after strokes, in pain treatment, in autism, for symptoms of paralysis, learning difficulties, phantom pain and many more (many of which are mentioned in detail in the videos and the bibliography linked below). Just as epigenetics, neuroplasticity seems to be an evolutionary factor by which humans can gradually adapt to the demands of the environment they live in.

Resources and links:

The Brain That Changes Itself – short documentary: Canadian psychiatrist and psychotherapist Norman Doidge about the adaptability of the human brain.

Neuroplasticity and Rehabilitation   by Sarah A. Raskin
The Brain That Changes Itself   by Norman Doidge
The Mind and the Brain: Neuroplasticity and the Power of Mental Force   by Sharon Begley
Books about Neurobiology   (german)

(Sources: N. Langer et.al, Effects of limb immobilization on brain plasticity in: Neurology, Jan 17, 2012;
Image sources: psychofonie.ch, persoenlichkeits-blog.de)

Blog entry first released in 08/2010 in german language (‘Neuroplastizit√§t’); continuously updated, last update: Jan 18, 2012)

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Jan 12

A test checking for traits of the following personality disorders has just been put online:

  • Psychopathy / Antisocial Personality Disorder
  • Narcissistic Personality Disorder
  • Histrionic Personality Disorder

Even among professionals, there is confusion about the meanings and differences between psychopathy, sociopathy, antisocial and histrionic personality disorder, and much more so amongst persons who sense problems in their relation to others but need orientation on where these problems might derive from. This test tries to assist in checking for traits of each of these disorders separately and then giving separate results for each of them.


To achieve as accurate results as possible, this self-assessment combines screening methods based on the Hare Psychopathy Checklist (used in contemporary research and clinical practice to assess psychopathy) and clinical markers for narcissistic personalities and histrionic personality disorder according to the diagnostic manuals DSM-IV and ICD-10. The test thus has a relatively high potential to achieve reliable results even when done over the Internet – however, it has to be mentioned that particularly for the personality disorders tested, the quality of the result might be lower if the person doesn’t answer honestly or is delusional, both parameters that are actually potential traits of a psychopathic or antisocial personality.

(Image source: 2.bp.blogspot.com)

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Jan 05

Photo src: thetastingnote.com

Viagra, the popular anti-impotence drug, may stop working for many patients after 2 years, the results of a study suggest.

Dr. Rizk El-Galley of the University of Alabama at Birmingham and colleagues interviewed 151 men who had filled prescriptions for Viagra. Overall, 74% reported that 25 milligrams (mg) to 100 mg of the drug enabled them to initiate and maintain erections sufficient for intercourse.

The improvement rate ranged from 50% for patients with impotence caused by diabetes, to 78% for those with no specified reason for impotence, to 100% for those with suspected leakage in their veins.

3 years later, the investigators re-interviewed 82 of the men, of whom 43 were still using the drug. Sixteen of those 43 (37%) said they had needed to increase the dose by 50 mg to achieve an adequate erection. It had taken between 1 and 18 months for the treatment to lose its effects. There was no correlation between the need to increase the dose and frequency of use.

‘In general, 81% of patients who were still receiving treatment were satisfied, and 92% were able to achieve and maintain erections sufficient for sexual intercourse in more than 50% of attempts,’ El-Galley and colleagues wrote in The Journal of Urology.

Of the 39 patients who had stopped taking Viagra, 28 had initially reported a good response. Fourteen of those patients who stopped said the drug no longer worked, and six said they had regained the ability to have spontaneous erections.

There is notable disappointment about the fading powers of the ‘blue miracle pill’ in the professional world. ‘According to my observations, Viagra only helps half of all patients with erectile dysfunction caused by physical factors’, P. Derahshani, head of the urology department of the K√∂lner Klinik am Ring (Cologne, BRD) reports. A potential health-risk lies in the fact that for patients showing habituation effects, the dose can only be rised by the ones who have previously used 25 or 50mg, while for doses above 100mg, the risk of side effects such as circulatory weakness, nausea or headaches increases remarkably.

No substitute for psychotherapy or sex therapy

“One should not forget that Viagra is only indicated for erectile dysfunction for those men whose potency problems have physical causes,” the Viennese urologist Werner Reiter of the impotence clinic at the Vienna General Hospital said in an interview with the “S√ľddeutsche” (SZ). Especially in older men who smoke a lot and suffer from high blood pressure or heart disease, Viagra often loses its effect after prolonged dosing. In men with stable health, on the other hand, there is rarely a (physiological) habituation effect.
“If the impotence is caused by mental factors, Viagra will just cover up the first symptoms for a while,” warns Reiter. For long term success, these patients could only be helped with psychotherapy or sex therapy.

Health risks often underestimated

Fatally, many men ignore or underestimate the risk of self-medication. But an alarming number of 40 percent of the men who visit a doctor because of erection problems, suffer from arteriosclerosis of the coronary arteries (which may, but is not always the cause of erectile dysfunction). Impotence ‘may nevertheless be a sign of a disease or an incipient disease. However, to simply cover up symptoms and to look away from the real causes, has never worked out on the long run, neither in medicine nor in psychotherapy,” says sex therapist Karl F. Stifter. It is important to keep the whole person in mind, which in this case would mean to check for physiological causes of the erectile dysfunction before considering any medication.

Underestimated by many men is the risk of suffering a heart attack. Like most drugs that interfere with the blood circulation of the body, Viagra & Co. involve special risks for patients (sometimes unknowingly!) suffering from heart conditions. In particular, patients who are taking nitroglycerin or blood pressure lowering drugs, which also relax the smooth muscles, may not take the pills to avoid potentializing their effects. Together with medications containing nitrate (eg for angina pectoris), the drug may lead to a fatal drop in blood pressure and heart diseases in men with circulatory failure. An examination by a physician is therefore absolutely necessarily before taking them.

In fact, no other medications are responsible for as many deaths due to negligent use as the new “erection helpers”. Worldwide, 616 deaths after taking Viagra were reported during the first 3 years after its introduction alone. The easy availability of the tablets over the Internet or on the black market poses a big problem, because they are extremely inviting for self-medication, and there is a relatively high risk to purchase harmful imitations. The ‘copycat’ market of the tablets, mainly India and China, is hard to control, with all the associated risks for the end user. Often enough the tablets are also not only taken at a far too young age, but also abused as kind of a ‘lifestyle drug’, completely ignoring the impact on the cardiovascular system – and probably also the production of our endogenuous ‘drugs’ that help to build and maintain an erection, as the study mentioned above could indicate.

So there is reason to expect a massive increase of the number of ‘Viagra Veterans’ during the next years who suffer from what I’d call ‘multisystemic erectile dysfunction’: psychogenic erectile dysfunction by men who furtheron developed organically caused erectile dysfunction either from resistance against the drug or by underproduction of endogenous drugs from longterm use of the supplementary drugs). These men may well find themselves suck in a dead end once they reach an age (or have to deal with side effects of physical illnesses) involving a natural decrease of the erectile function without many remaining options to treat their impotence.
It has been proved that in the vast majority of men under the age of 50, erection problems are caused psychologically – but even (and especially) at a higher age, a medical examination is necessary before starting to take medication. If there is no clear evidence for a physical cause, in the interest of one’s health (and perhaps also to keep the “Viagra trump card” for more difficult times), it is recommended to seek counsel from a sex therapist or psychotherapist rather than to reflexively grab one of the readily available “blue pills”.

(Sources: Reuters.com; Rizk El-Galley et.al., “Long-Term Efficiacy of Sildenafil and Tachyphylaxis Effect” in: The Journal of Urology – September 2001 (Vol. 166, Issue 3, Pages 927-931); Image source: creakyeasel.com)

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Dec 31

To a high extent, the work of a psychotherapist consists of the treatment of the various forms of depression, so I’ve always tried to improve my understanding of this particular form of mental disorder – and of its most extreme form, the idea to commit suicide. So I’ve continuously gathered data on suicide – here you will find a compendium of the information I found, a sort of overview of the currently known facts and figures on this subject.


It is estimated one million people a year die by suicide, which equals about one every 40 seconds – but that number may actually be even significantly higher, since the official numbers released by many countries are too low. Suicide thus contributes at least 1.5 percent of the global deaths and is the tenth leading cause of death. In 2006, 140,000 people had taken their lives, that equals 11.1 per 100,000 people. People under 25 years of age are most vulnerable (there was no significan change compared with previous years), and the elderly (where a significant decline in suicides was found).

Trends in some OECD countries, graph: OECD

Regional differences: within Europe, the rates in the northern countries are generally slightly higher than in the southern ones. An effect of latitude on the suicide rate was found in Japan, suggesting an influence of the daily duration of sunshine. Nevertheless, other countries can have significantly different rates of suicide compared to Japan at the same latitudes, like Great Britain or Hungary for example. Suicide is a significant problem in the former Soviet states, and more than 30 percent of suicides worldwide occur in China, where 3.6 percent of all deaths are attributed to suicide.
Regarding the impact of light/solar radiation by correlating the suicide rate with the number of hours of sunshine a day, a seasonal clustering of cases of suicides could be proved in 2011 in a study by the Medical University of Vienna that was published in the journal “Comprehensive Psychiatry”.

Particularl attention deserves South Korea where in recent years, the suicide rates have increased drastically, namely by 172% to 21.5 per 100,000. The number of suicides by men has almost tripled from 12 per 100,000 (1990) to 32 per 100,000. With 13 of 100,000, the suicide rate among women is also the highest. The OECD attributes the rise in suicides on the economic decline, dwindling social integration and the disintegration of traditional family bonds. But it may be doubted whether this is really something that extraordinary compared to Mexico (+43%), Japan (+32%) and Portugal (+9%), which also reported an increase in the suicide rate. In Hungary, the suicide rate has declined by 41 percent, but the country, with 21 suicides per 100,000, is still second only to South Korea. Finland’s numbers are also above average with a high suicide rate of 18, followed by France (14.2), Switzerland (14), Poland (13.2) and Austria (12.6, 27/100,000 in men, in women 10/100,000). Germany, where the number of suicides compared to 1990 decreased by 37 percent, with 9.1 in the lower third. Apart from Great Britain (6.1) and Mexico (3.1) the situation appears on the Mediterranean people to do well. In Spain (6.3) and Italy (4.8), far fewer people kill themselves than in other OECD countries. And the Greeks are drawn the least to commit suicide: here, just 2.8 per 100,000 kill themselves

Conflicting data on the so-called happiness research was revealed by a remarkable study analyzing the correlations between life satisfaction and suicidal tendencies. In a comparison with the average satisfaction of people according to the “World Values ‚Äč‚ÄčSurvey” and the suicide rates according to the WHO, the suicide rate is not only very high in the Scandinavian countries in spite of their high satisfaction but also in Iceland, Ireland, Switzerland, Canada or the U.S. The conclusion of the study was that the relation between high life satisfaction and high suicide rates was independent of harsh winters, religious and cultural differences in different countries (more)

One possible explanation for this ostensible contradiction could be that in an environment where many other people are ‘happy’, own discontent, own suffering is felt more strongly. If there is also despair of beign able to achieve a change, certain personality types may see suicide as a way out.

A few more details about Austria: in Salzburg, the Crisis Intervention Center (‘Kriseninterventions-Zentrum’; of others, I don’t have any data) recorded a significant increase in patients in their teens in 2010. In Austria, about twice as many people die by their own hand than after traffic accidents every year. In 2002, 1.551 chose to commit suicide, including 50 children and adolescents aged ten to 20 years. Self-injuries in children are also on the rise. At the whole of Austria, the suicide rate of the early 1960’s has risen sharply until the mid-1980’s – to 24 suicides per 100,000 of the population. Since then, the rate decreased and it is now (as already mentioned above), at 13 per 100,000 per year. This equals about 1,300 suicides per year.

However, there are growing doubts within the Austrian scientific community as to the accuracy of these statistics, and I want to outline them a bit further to help you, the reader, understnad the underlying problems of suicide studies: fewer and fewer autopsies are performed as in Austria, which decreases the possibility to distinguish suicides from natural deaths. Thus, in countries with the highest autopsy rates as in the Baltic states or Hungary, the suicide rates are generally higher than in countries with low autopsy rates. Similarly, in countries where autopsy rates are declining, at the same time there are also increasingly fewer registered suicides (Source: Archives of General Psychiatry 2011 (Link). So with statistics like these, there is always reason to question whether such statistics can be trusted at all.

More gender-related details: is in the developed countries, the gender ratio of suicides is roughly 2-4 (men) : 1 (women) and seems to be increasing. Asian countries show a smaller ratio, but it seems to be increasing as well. Only China has more women than men dying from suicide.

Risk factors for suicide

Among the many factors that may raise the risk of suicide, the most important known ones currently seem to be:

  • male gender (OECD: 17.6 per 100,000 males, 5.2 for women)
  • a history of self harm
  • psychiatric disorders and / or
  • Alkohol-/Medikamentenmissbrauch
  • upbringing and education
  • suicide depictions in the media
  • smoking

Genetics and Neurobiology

Autopsies of suicide victims showed changes in central neurotransmission functions, such as the serotonin system (mood-regulating hormones). Low cholesterol concentrations are associated with higher suicide risk, but the risk is greater if the lower cholesterol level was reached with diets rather than by using statins. The authors suppose that this may stem from the fact that dieting people have a higher risk of mental problems, but so far, there was no corroborating evidence for this theory. Furthermore, family histories of suicide at least double the risk for girls and women. Although the evidence is scanty here as well, a number of researchers suggest that high levels of aggressive behaviors and impulsiveness may also be associated with an increased risk of suicide. Especially in young boys, suicide rates increase over the years of their growing up, while a higher suicide risk because of hereditary components was primarily detected on the maternal side.

Professional guilds

Suicide rates are higher among non-workers (unemployed, retired etc.) than among employed persons/professionals. Higher rates are also partly linked to mental illness, which in turn has a connection with unemployment.

Among the professionals, however, some groups show an increased risk: medical practitioners have a high risk in most countries, and doctors (and related jobs in the health professions) generally have the highest risk. Nurses also have a high risk. Particularly in these groups, the easy access to venoms seems to be an important factor influencing the high rates. Anesthesiologists are particularly vulnerable among physicians because narcotic drugs are used in many suicides. Several other high-risk professions are dentists, pharmacists, veterinarians and farmers.

Age Groups, Ethnicity, ..and Seasons

In most countries, suicide rates are highest amongst elder people, however, in the past 50 years, the rates among the younger population has increased as well, especially in men. Suicides are committed most frequently in spring, especially among men as well. People born during spring or early summer have an increased risk of suicide, especially women. Americans of European descent have higher suicide rates than Americans of Latin American or African origin, with this difference increasingly leveling out amongst young African Americans due to the increased suicide rate among young African Americans slowly. Indigenous groups such as Aborigines in Australia and Native Americans also have higher suicide rates, possibly due to cultural, social exclusion and greater alcohol abuse.

Suicide Methods

Quite generally, men prefer more violent means of suicide (for example, by strangulation or shooting themselves), and women ‘softer’ forms (self-poisoning), which is probably the explanation for the sharp difference in successful suicides between men and women (see above) and the suicide attempts that both sexes undergo in about equal rates. Different cultures show different preferences in methods, in South Asia for example, women typically burn themselves. Access to specific methods could be the factor that finally leads to putting suicidal thoughts into action. In the U.S., firearms are used for by far the most suicides, with the risk of using them for this purpose being the highest where guns are found in households. In the rural areas of many developing countries, the ingestion of pesticides is the most common method, which reflects the toxicity, easy availability and the lack of storage. At up to 30 percent of suicides worldwide, pesticides are involved.

Comorbidities und Connections with Mental Disorders

Mental health problems are a major factor in suicides. It is believed that of about 90 percent of people who kill themselves, they suffered from a kind of psychiatric disorder. Depression increases the risk to the 15- to 20-fold, and about 4% of patients suffering from depression die by suicide – but only about 20-30% of depression are recognized (!). But even for those, in most cases many years are passing to the correct diagnosis, and then, still, less than 50% of the diagnosed patients ever starts looking for a psychotherapy and/or receives pure pharmacological support. This means that most people suffer on a chronical basis, but don’t search – or can’t find – adequate help.

Clinical signs of suicide where depression was involved, are patients with previous self-harm, hopelessness and suicidal tendencies. About 10-15% of patients with bipolar disorder die by suicide, but the risk is highest at the beginning of the disease. About 5% of schizophrenia patients also die by suicide. Alcohol abuse, anorexia, attention deficit-hyperactivity disorder (ADHD) and body dysmorphic disorder (KDS) all increase the risk of suicide. Especially the last example explains in part why the risk increases in women after breast-enlarging surgeries.

Physical health also plays a role, but with some strange results. Surprisingly, people with higher body mass index (BMI) have a significantly greater risk of depression, however, their risk of suicide is lower (15% decrease in suicide risk per 5 kg per square meter of body surface area increase in BMI). The reasons for this are unknown. Cancers, particularly of the head and neck, HIV / AIDS, multiple sclerosis, epilepsy and several other diseases also increase the risk of suicide.

Other factors that increase the risk of suicide include physical abuse and sexual abuse over the childhood, or events that affect the entire population (such as natural disasters or the deaths of celebrities). After the death of Diana, the Princess of Wales, in 1997, the suicide rate rose by 17%, most clearly in her age group. War involvements reduce suicide rates, possibly due to the social cohesion that is generated in the communities. People who have suffered a loss by suicide, are themselves at increased risk, and suicide clusters may occur in communities or through Internet contacts. The authors add: ‘A significant proportion of the evidence shows that certain types of media that report on or present suicidal behavior, may influence suicidal behavior and self-harm in the general population.’

A ‘hot potato’ in the psychiatric community are recent studies showing that even antidepressants can induce suicidal thoughts not only in adolescents, but also in adults. I already posted a few articles related to these studies in this blog.

(Sources for the aforementioned numbers: Health at a Glance 2009: OECD Indicators; MedAustria)

Suicide und Self-Injury

In addition to rising suicide rates, there is also an increase in self-harm among young people, as pedagogues report in many Western countries. The reasons for this may be traumatic experiences in early childhood. The brain has a high plasticity and very vulnerable to external factors during this stage of development. Serious diseases, sexual abuse, neglect and lack of communication in bringing up – often caused by hours in front of the television or computer games – are also considered to be significant risk factors for later suicide attempts. They may also cause children and adolescents to harm themselves physically. Burned skin from cigarettes or scratches from knifes or razor blades must be understood as a cry for help.

While in 1950, only 40% of people who attempted suicides were under 45 according to the WHO, we were already at 55% in 2004. A reason for depression occurring at earlier stages of life might be the earlier onset of puberty and the decaying of family structures. If there is healthy communication within the family, and if common concerns and problems can be expressed and discussed, it is much easier for young people to overcome a crisis.

(Source: Der Standard, 06/2004)

How can suicided be prevented?

Suicide preventionThe claim to be able to prevent suicides would be a difficult one to fulfill because of the large number of factors that are involved until it actually comes to a suicide attempt. Strategies could be aimed at high-risk groups or trying to reduce the risks for the population as a whole. Firstly, any person with depression should be checked for suicide risk by professionals specifically asking about suicidal thoughts and plans. This shows the importance of specific training and sensitivity of physicians who are often enough the only ‘professionals’ many depressive persons might have contact to at the first place. Studies from the Nordic countries show a decline in suicide rates by 20 to 30% after general practitioners were trained to recognize depression properly and to help patients to get appropriate therapy (psychotherapy and supportive pharmaceutical measures).

In cases of high or imminent suicide risk, immediate action is necessary, including vigilance and monitoring of those affected, possibly through hospitalization. In addition, potential tools that may be used for suicide attempts have to be removed and an aggressive treatment of the associated psychiatric disorder be initiated.

A restriction of access to potentially lethal substances or tools can indeed help to prevent suicides. The introduction of security cameras on bridges and increased control of firearms, as well as the safer storage of pesticides and poisons (especially in rural areas of developing countries) has been proven to significantly reduce the risks. Education programs to improve the mental well-being as well as stricter control of the media reporting of suicides could also have preventive effects. On the objection that persons who wish to commit suicide would find ways and means to realize their goal in any case it may come as a surprise that for example when switching from toxic coal gas to non-toxic North Sea gas in the UK, the suicide numbers declined dramatically, while, for example in Japan right after the release of two films that were romantically idealizing the issue of suicide, the corresponding numbers increased significantly. Helsinki had the world’s highest suicide rate in the 90s and was able to cut it to 18 per 100,000 through prevention programs.

Because on the internet – in addition to advice and instructions for suicide in ‘suicide forums’ – a new trend had been detected in Japan to arrange collective suicides online, the government of South Korea (which had recently suffered the world’s largest increase of suicides, see above) will block related Internet sites, and there are also plans to make it more difficult to find information about suicide on Internet portals by blocking specific keywords such as suicide, ‘how can I die’, ‘collective suicide’, ‘suicide techniques’ and others. In addition the government plans to create a legal basis for the police to request the personal information of Internet users from their service providers who promote suicide or offer advice to persons willing to undergo suicide.

The challenges to prevent suicides in developing countries requires special attention, as most of the suicide-related research is done in developed countries, while the highest suicide rates are in fact found in developing countries. On nation-wide measures it is also worth mentioning that after a recent meta-analysis of randomized studies ([1], [2]) had suggested that the risk of death and suicide in people with mood disorders receiving lithium has been reduced by 60 percent, researchers have brought up the idea of adding small doses of Lithium to tap water.

Family members and the social environment in general also have an essential role. Relatives may be the first ones who can notice that someone might isolate himself or is depressed. It is of utmost importance to recognize these signs (see article about presuicidal syndrome) and to talk to the affected person about it. Nevertheless, the options and means of family members and friends are often limited – it is therefore important to involve external help (a psychotherapist, counselor, psychiatrist or at least a family doctor) if one feels overwhelmed or feels no longer able to reach the person.

Treatment of Depression

That psychological treatment can prevent a suicide in many cases is a well known fact that has been proven in numerous studies. The World Health Report 2001 already reported, quoting several studies, that some mental disorders may be chronic and of long duration, but that with proper treatment, those suffering from mental disorders can now lead a productive life and participate in their communities. Up to 60% of people suffering from severe depression can get well with the right combination of psychotherapy and antidepressants. I’ve written a detailed article on this topic in the publications section of my German-language website, which specifically describes and comments the latest standards for the treatment of depression.

(Further sources: APA, AZ, Der Standard 03.06.04, The Lancet Vol. 373, Issue 9672, p.1372-1381, 18 April 2009, Telepolis [1], see also links to sources right within the article.
This blog entry was first published in 12/2009; continuously updated as soon as I get aware of new facts. Last updated: 12/2012).

more blog articles about suicide


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Dec 29

Interesting figures have recently been published by the British Home Office: statistics show that young men suffer just as much as women from ‘abuse’ by their partners – at least if forms of emotional violence like harassment or bullying are considered as forms of abuse as well.

Probably because men are usually feeling less self-confident at the beginning of a relationship, especially in the younger age group of 20-24 years a surplus of female violence (6.4% versus 5.4% male) can be found, while in higher age groups, both ratios are increasingly aligning. For 2007/2008, 2.2% of interviewed women of all ages reported about experiences of mild or severe physical violence by their partners, but for men, the value wasn’t much lower with 2.0%. However, the study also found that women are more commonly abused and have to experience more severe and repeated physical abuse. Looking at the quality of the data available to researchers, a report on violence against men of the German Federal Ministry for Family Affairs from 2004 and a study by the Criminology Research Institute of Niedersachsen (Germany) conducted similar results for Germany with both reporting that the available data on violence is hardly sufficient to allow reliable conclusions about gender-based violence since domestic violence perpetrated by female partners is still considered a taboo by women, but also men – and social workers.

'Smitten - Engaged - Battered'
Controversial poster that depicted fathers as potential perpetrators of violence, funded by the Austrian Ministry of Women in 2008

In general, there seems to be a growing awareness process regarding the issue of female violence (including domestic violence). In England, for instance, male-specific charities have already been criticizing for some years that while in England and Wales there are a total of nearly 500 women’s shelters to escape from domestic problems and to obtain advice, but only 7 comparable facilities for men. Organisations and research dealing with women’s specific concerns are equipped with significant financial and media resources, while the ones dealing with men’s issues often have to fight for their financial survival every year. The shame of many men to get help for domestic violence underscores the public image (but also the statistics of many counseling services, which are often managed by women) that the perpetrators are usually men, while women are the victims of psychological and physical violence.

Related links and articles:

(Blog entry first posted in German language (‘Weibliche Gewalt – Ein Tabuthema’) in 02/2009; last update: 12/2011)

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Dec 29

Today, I stumbled upon an impressive and moving interview with the survivor of a suicide attempt that was published in a newspaper article in September 2000. In a state of presuicidal constriction / presuicidal syndrome, Kevin Hines jumped of the Golden Gate Bridge and survived this jump only by extremely fortunate circumstances .

Photo © Seattle Times

Bild © Seattle Times

Today he can talk about it and works in a helping profession (nurse). In his spare time, he tries to inform and educate others about the importance of an accurate and professional medical and psychotherapeutic treatment of mental illness. ‘I’d feel lucky if with my horrific experience, I can just keep only one person from taking his own life,’ he says in the NZZ interview with G. Sachse. Indeed, during the (time-limited) course of a presuicidal syndrome that may define one of the worst stages of depression but also of paranoid delusions, the way the affected person perceives, experiences and thinks about what is going on may be much different than under normal circumstances, and it may also be linked differently than usual with one’s emotions and behavior. At the end, the affected person may see no other way out than to take his/her own life. Only after the abating of the syndrome, other options can be perceived and imagined again – that is why in times of crisis it is so vital to seek professional help right away (eg by doing an emergency-call, calling in for a crisis appointment at a psychotherapist, vitising a psychiatric clinic etc.) just to overcome the most difficult time. At least, friends or other acquaintances should be called up – the idea is to “play for time”, to aim at getting over this barely endurable phase by all means, at least to get through until the next morning. If, unexpectedly, you as the suffering person would still not feel better at that time, you should contact a trusted physician. Consider, however, that for periods of serious depression, it is actually recommended to consult a qualified psychiatrist or psychotherapist, even if it has not yet already come to suicidal thoughts, or if these thoughts have already subsided – to avoid them from coming up again by treating the underlying depression.

In conversations with clients who have dealt with phases of suicidal constriction, they repeatedly confirmed how happy they were about having ‘survived’ the critical phase once they had stabilized again and how lucky they felt that they didn’t end their life before. Sometimes, they had experienced completely unexpected positive events in the time since their deepest phases of depression, but more generally, their life had taken a positive turn since they had continued with their psychotherapy, an upturn that was not forseeable.¬†“Give life a chance” – this common slogan (that is usually used in a different context) shouldn’t be forgotten especially in the phases of life where it apparently can’t get any lower.¬† As we know from economic sciences, it is systemically inherent that after a low point, it can only go upwards again. What could be worse in life than a stage in which there doesn’t seem to be any way out other than death? As paradoxical as it may sound, after successfully having weathered the worst hours of a particular night, life will most probably already feel at least an iota better the next morning. Talking to someone (especially one with a person who is professionally trained to assist in difficult phases of life), it is usually possible to develop completely new perspectives, perspectives that can give life a positive turn on a long-term scale.

To avoid being misunderstood: this is certainly not always an easy or quick process – but properly accompanied and instructed, the majority of people succeed at the end.

Further information:

Depression – Mythen und Fakten rund um eine ‘Zeitkrankheit’ (Artikel R.L.Fellner; german language)
Vier Sekunden bis zum Aufprall (NZZ Interview mit Kevin Hines 2009; german)
Lethal Beauty РA jumper [..] makes a new life  (San Francisco Chronicle 2005)
(Blog entry first published in German language (‘Gedanken eines Suizidversuch-√úberlebenden’) in 03/2009, published on English website: 12/2011)

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Dec 27

Many clients tell me of difficulties finding the right relationship partner. Of course such problems almost always have psychological reasons – in one way or another, these persons sabotaged themselves, they suffer from forms of social anxiety or (in my experience, this is the most common reason) have low self-esteem.

The issues around dating, attraction and sexual attraction have inspired researchers and artists since the beginnings of mankind. Under this – rather ironic – article headline, I will summarize the results of relevant studies and research – and continuously expand and update this collection as soon as there are new findings.

But beware: I’ll not guarantee for the plausibility – or especially success – of any of these hints! ūüėČ

Attractiveness and mate selection

  • “Attractive bodies and faces are symmetrical” – when selecting a partner, we jump on aesthetic impressions indicating a good state of health and fitness, including reproductional capabilities (Source).
  • People with symmetrical physique receive more positive attention when dancing and during mate selection” (source)
  • Women without ideal measurements are stronger, tougher and more resistant to crises” – in Western countries, women with a greater waist-hip ratio than 0.7 are considered to be less attractive than in other world regions, but better prepared for times of crisis (Sources: [1, 2, 3])
  • Estrogen makes women’s faces look more attractive.’ –¬† during their fertile days, the faces of women obviously look more attractive (Source)
  • Women tend to be selected if they are beautiful, men are more likely to be selected if they act dominantly‘ – this actually refers to political elections, but then, maybe not .. if you consider the other research results mentioned in this blog entry (source)
  • Beauty makes insecure.‘ – this, and that attractive men and women usually find it more difficult to find partners than averagely attractive people, would be a possible conclusion from the so-called ‘sidewalk experiment’ by James Dubbs u. Neil Stokes (‘Beauty is Power: The Use of Space on the Sidewalk’, 1975): on a sidewalk, pedestrians altered their walking direction more often to give space to men rather than for a woman, for 2 people rather than for just 1, and for pretty than for¬† unattractive women. Their theory was that attractiveness, group size and gender are signals of power which involves territorial claims causing the aforementioned evasive behavior (Source).
  • Other attributes for attractiveness will be judged based on attractiveness of the clothing‘ – attractively dressed subjects were judged as more competent and social than non-attractively-dressed individuals, and, as the researchers suspected, probably as physically more attractive as well (source).
  • Taller men are sexually and socially better off than shorter ones. ‘ – men seem to have their greatest difficulties when dealing with strong, attractive and wealthy competitors, but the taller they are, the less of a role these attributes play in dealing with them. Little men tend to be most jealous. In women, however, the taller and shorter ones are more jealous than the ones of average size. Average-sized women are most shaken by tall and socially dominant rivals just as by other women’s¬† persuasiveness (link)
  • women prefer older men, older men prefer younger women.’ – a possible explanation for the biological causes of this phenomenon was provided by a study that found that women with a four-year-older partner, and men with a six years younger partner show the greatest reproductive success (source).
  • Man perhaps lost his body hair because it was sexy to the opposite sex.’ – new hope for bald people? (source)
  • Results of an econometric analysis of online dating behavior showed that men who reported that they were in search of a long-term relationship achieved much more success in online dating than those who were merely out on an affair. For men, the appearance of women is of outstanding importance; for women, the man’s income is of utmost importance: the richer the man, the more emails he receives. Income increases the attractiveness of a woman for men as well, but only up to a certain height. [..] Men are attracted by female students, artists, musicians, veterinarians, and celebrities, and they avoid secretaries, retired women and women who work in the military or the police. Women prefer soldiers, policemen and firemen as well as lawyers and financial experts in a management position, but they avoid laborers, actors, students [..]. The data analysis of about 30,000 users also revealed that men have significant drawbacks when they are short. For women, obesity is fatal. That’s probably why many online daters ‘adjust’ these parameters relatively often: male online daters are slightly taller than the average man while the typical female online dater is 10 kg lighter than its real counterpart. In the book Freakonomics in which the results can be read in detail, the authors described their findings, obtained by mathematical methods, as follows: ‘In the world of online dating, a head full of blond hair has about the same worth for a woman as a college degree.’
  • “‘Nasty’ men not only get most women, but also the most beautiful ones.” – in most studies on this subject, these men showed distinctive combinations of narcissism, Machiavellianism and psychopathy (Sources: [1], [2], [3])
  • Men should not act as if they were ‘carried away’: uncertainty about the feelings of the opponent increases his/her attractiveness (Source: E. et.al in Whitchurch: “Uncertainty Can Increase Romantic Attraction”, Psychological Science, 01/2011).


  • ‘The mere presence of a woman increases the testosterone levels’ – regardless of her appearance, the testosterone levels in men sitting in the same room as a woman increased by 8% within 300 seconds (Sources: [1],[2])
  • The frequency of female orgasms increases with the income of their partner ‘ – sex with wealthy or powerful men probably feels more exciting by women because it may help to obtain access to wealth and power, or to keep this access up (Sources: [1], [2], [3])
    Addendum 04/2010: a counter study was published that shows different results.
  • The more attractive women consider themselves to be, the greater demands they make on their sexual partners – in men, this correlation doesn’t exist, which could mean that they are less picky or less inclined to enter into permanent relations aiming at reproduction (Sources: [1], [2])
  • (indirect) relationship between voice and sexual activity’ – volunteers with a voice perceived as attractive had about equally long fingers on both hands (reference to the context of attractiveness by symmetry, see above), their first sex at a younger age, more sexual partners and more affairs (Sources: [1], [2])
  • Women respond differently to male body odor.’ – their brains can differ normal male perspiration from perspiration resulting from sexual arousal (Source)
  • Women’s tears put off men and reduce their testosterone level. (Source: Shani Gelstein et.al, “Human tears contain a chemosignal” in: Science 01/2011, DOI: 10.1126/science.1198331)

Family / Children / Fertility

  • ‘Correlation between wealth and reproductive success‘: a British study found higher reproductive success for wealthy men; in women, the number of children declines with increasing education and income (Source)

(First published in German language (‘Wissenschaftliche Aufriss-Tipps’) in 01/2008; continuously updated. Last update: 12/2011)

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