IOWA PSYCHOLOGICAL ASSOCIATION

Volume 1, Issue 1 Spring 2015 UNDERSTANDING DEPRESSION

From the president The Germanwings The Lethality of

Mass MurderSuicide Loneliness

Page 1 Page 2 Page 5

From the President Brenda Crawford, Ph.D.

In early August we experienced the death of actor and comedian

Robin Williams to an apparent suicide. Williams struggles with
Bipolar Disorder are relatively well known, as were his struggles
with alcohol and drug abuse spanning at least two decades. He
had commented in interviews that he often used his experiences
through his manic and depressive episodes to produce what we
as the public experienced as genius onscreen.

He was reportedly going through a severe depression at the time

of his death, according to his publicist. Sadly, his last Instagram
and Twitter posts were a birthday wish to his daughter, who
turned 25 two weeks ago, along with a picture of him with her
as a toddler.

I believe Mork and Mindy was likely the first non-cartoon I

ever watched on television. A friend of mine had commented
the same. I loved that show as a child and have fond memories
of watching it with my family. Ive always enjoyed Williams
work--on television, in his comedy, on film--and I was shocked
enough at the news that I assumed at first it must be an Internet
hoax that would be quickly quashed as rumor.

I was so terribly sad to discover that it was indeed true. As I was perusing the hundreds of articles that seemed to pop up
on the internet after the news broke, I came across one written by Dr. John Grohol, Psy.D., the founder and CEO of Psych
Central. He wrote: Suicide is an insidious choice due to the lies that depression tells us. When a person is suffering from
severe depression, as apparently Williams was, it can tell that person, Hey, youd be better off dead. Life isnt going to
get any better. And sadly, sometimes people listen. Even brilliant, accomplished individuals such as Robin Williams. There
was an almost immediate deluge of armchair psychologists pontificating on the Internet under such circumstances, and
with such a high profile individual, everyone is suddenly an expert about mental health issues, and more specifically,
depression.

Advancing Psychology as a Science and as a Profession Since 1949

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.
Generally, posts and articles were overwhelmingly supportive and focused on the needs for easier and more consistent
access to mental health care and the reduction of stigmas that prevent people from willingly accessing such care.
However, Ive also seen memes running on Facebook suggesting, the funniest man on Earth could not just think positive
and be healed. No amount of money or fame can fix it. I was immediately uncomfortable with what this meme was
suggesting. How hopeless does that sound? I work with depressed (and sometimes suicidal) people every day.

As a psychologist who spends a good deal of clinical time educating my clients about the benefits of therapies like CBT,
that are built on the philosophy that a person can indeed change ones thoughts and behaviors and be healed, it didnt sit
well with me. Still other posts (too many, Id argue) suggested that suicide is an action of a weak individual, its a selfish
decision, and results in a life that was a waste. Fox News anchor Shep Smith called Williams a coward.

These incidents suggest ignorance across much of the general public about what mental illness really is and how life-
threateningly miserable depression can really be. While it was simply a meme on Facebook, or the ignorant comments of a
TV personality, or the words of a Facebook friend, this is the ultimately the battle we as psychologists face.

Clients have asked my thoughts on Williams death. It was a topic of conversation at the commencement of many of my
sessions the day after his death was reported and continues to be a topic of conversation. These types of tragedies pique
interest, curiosity, and at times, immense fear for people.

If a very successful person like Robin Williams can still

succumb to the demons of depression, even with what would

Keep fighting
seem to be unlimited resources and opportunities for
multidisciplinary care at his disposal, can the battle ever be
won? Will it ever get better? I personally believe very strongly
that yes, it can. Its why I keep fighting the good fight and
encouraging my clients to do the same. Every. Single. Day.

the good fight." This is a prime opportunity for us to educate our public. We
need to talk about the various facets of mental illness and its
ability to be the great equalizer it knows no bounds and does
not care if you are an Oscar winner or homeless and we must
let our public know what psychologists do, how we can

help, and that what we do not only offers hope in times of darkness and despair, but can provide immeasurable amounts of
healing and connection when all might seem lost. Have you looked at the videos on our IPA website about educating the
public about what we do? I encourage you to do so. We are able to benefit from these resources and many others because
we have empowered ourselves by joining IPA, where our voices join to become one much louder, unified voice. Keep fighting
the good fight.

The Germanwings Mass MurderSuicide Shows

the Importance of Depression Intervention

Last Tuesday, 27-year-old co-pilot Andreas Lubitz deliberately crashed a Germanwings Airbus A320 jetliner into a
mountainside in the French Alps, killing 150 people. The planes captain, Patrick Sondenheimer, had stepped out of the
cockpit, during which time Lubitz locked the door and began the aircrafts lethal descent. Sondenheimer reportedly tried
to regain access to the cockpit using an axe, while Lubitz showed no emotion and spoke no words during the final moments
of his life. On the black box recording that also captured the terrified screams of passengers, Lubick can be heard breathing
normally.

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Theories of Lubitzs motives proliferated in the aftermath of the crash. Though Lubitz left no manifesto and made no
statement at any time as to the meaning of his actions, some are still convinced his was an act of terrorism.An ex-girlfriend
of Lubitzs has come forward to claim that the co-pilot fantasized about fame and notoriety, and must have become
distraught when he realized his dreams of a job at Lufthansa, the largest airline in Europe, were unlikely to come true.
Author Mark Ames, who has written a book on rage killings in the United States, has raised the possibility that Lubitzs
actions were those of a disgruntled employee, not unlike the postal shootings of the '80s and '90s. Its possible that all of
these elements factored into Lubitzs ultimately baffling decision to kill himself and over one hundred innocent people.
But underneath each of these themes runs another current, which continues to gain strength as the investigation wears
on: Lubitzs struggle with depression.

According to friends of the man, he suffered from a depressive episode of burnout in 2009, and was forced to withdraw
from pilot training as a result. Investigators searching Lubitzs home found several doctors notes attesting that he was
too ill to work, including one from the day of the crash; evidently none of these notes, one of which was torn up, had
been treated for suicidal tendencies before he got his pilots license.

There is little doubt that Lubitz was suffering intensely from depression at the time of his death, which may be of little
meaning to those devastated by the monstrous enormity of his final act. But Lubitz's case raises an important question:
Who are the people usually harmed by depression and is there any hope for intervention in cases of seemingly sudden and
inexplicable suicide?

In 2011, Danish filmmaker Lars von Trier released Melancholia, starring Kirsten Dunst as Justine, a deeply depressed
woman seemingly unmoved even as a rogue planet slings into collision with earth, destroying all life. The film received
mixed reviews, but even its most incisive critics, such as The New Yorkers Richard Brody, lauded its depiction of
depression: [T]he one true thing in Melancholia, Brody wrote in his review, is the depiction of Justines depression,
with her utter passivity and the blank look in her eyes.

Some 500 years prior to von Triers film, German artist Albrecht Drer created an engraving entitled Melancholia I. Its
scene seems a forbearer to von Triers film, with an impassive figure seated motionless, surrounded by unused instruments
and a rapidly depleting hourglass as a celestial disaster unfolds in the background. Time is running out, in other words,
and the engravings subject is too troubled to care.

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 In identifying cognitive turmoil with depression, Drer and von
Trier hit upon one of the chief signs of the illness. One of the
cardinal symptoms of Major Depressive Disorder is impairment
in concentration, Dr. Anthony Charuvastra, a voluntary clinical
assistant professor in the Department of Child and Adolescent
Psychiatry at NYU Langone Medical Center, told me. People
suffering MDD often describe this as slowed thinking,
indecisiveness, or trouble organizing thoughts.

Unlike sadness or sorrow, depression exerts a kind of downward

pressure on the mind, producing, in its most severe instances,
impairments in thought and judgment, which can manifest itself
in a variety of ways. A 2013 study of patients with HIV and
depression found, for example, that depression threatens an
individuals ability to enact effective coping responses, and
that ineffective coping, in turn, puts a person at risk for missing
single doses of medication or having - extended
Lorem Ipsum treatment
interruptions. Depression interferes with treatment
compliance in other illnesses, too.
Which is to say, taking care of yourself when depressed is not as
simple as it sounds, even when all medical
Author Elizabeth Stoker Bruenig

options are available. In Lubitzs case, every piece of the German healthcare system worked: He had access to treatment
and medication, and his doctors had identified his illness and that he should not be working, and had given him the resources
to make as much known to his employer. It was Lubitz himself who failed to make use of the options at his disposal, either
out of concern for his employmentnot an altogether rational consideration, given the alternative or simply because
depression, with all its attendant anxieties about worthlessness, failure, and futility, made pursuing healthy choices seem
pointless or impossible.

Depression, for me, is marked by lacking the energy needed to do any of the things that make life worth living, said Clark,
whose surname is omitted for privacy (as are the surnames of other sufferers of depression I interviewed), a 23-year-old
non-profit consultant from Virginia. In an interview, he recalled that at its worst times, I feel constantly fatigued and can
only wish that something outside of me will end my life already. Andrew, a 21-year-old Manhattanite who works in radio,
put it this way: You get trapped in your own head, sparring against yourself until suicide doesnt seem like a way out, it
seems like the only rational thing you can do.

Despite these effects, the victims of the vicissitudes of depression are vastly its own sufferers. People tend to largely
overestimate the amount of violent crime committed by people with mental illnesses and underestimate the rate at which
mentally ill people are victimized themselves. Lubitzs mass-murder-suicide is an extraordinary exception among depressed
people, and it is worth emphasizing that depressed people represent no special risk to others. But each suicide is its own
loss, whether or not others are harmed in the process. So how can we know who is at risk, and who is not?

Article Excerpted from Elizabeth Stoker Bruenig, Staff Writer from The New Republic March 30, 2015

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The 2nd Annual NAMI
IOWA Research
Dinner is Right
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Join NAMI on April 25th at the
Iowa State Historical Building for
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6:15 p.m. Presentations
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2 Hotel rooms for two nights
8 Passes to the VIP Party,
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NAMI IOWA, in conjunction with
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Riding the Emotional Roller
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To participate in this event,
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The Lethality of Loneliness
By Judith Schulevitz, The New Republic from May 13, 2013
Sometime in the late 50s, Frieda Fromm-Reichmann sat down to write an essay about
a subject that had been mostly overlooked by other psychoanalysts up to that point.
Even Freud had only touched on it in passing. She was not sure, she wrote, what inner
forces made her struggle with the problem of loneliness, though she had a notion. It
might have been the young female catatonic patient who began to communicate only
when Fromm-Reichmann asked her how lonely she was. She raised her hand with her
thumb lifted, the other four fingers bent toward her palm, Fromm-Reichmann wrote.
The thumb stood alone, isolated from the four hidden fingers. Fromm-Reichmann
responded gently, That lonely? And at that, the womans facial expression loosened
up as though in great relief and gratitude, and her fingers opened.
Fromm-Reichmann would later become world-famous as the dumpy little therapist
mistaken for a housekeeper by a new patient, a severely disturbed schizophrenic girl
named Joanne Greenberg. Fromm-Reichmann cured Greenberg, who had been deemed
incurable. Greenberg left the hospital, went to college, became a writer, and
immortalized her beloved analyst as Dr. Fried in the best-selling autobiographical
novel I Never Promised You a Rose Garden (later also a movie and a pop song). Among
analysts, Fromm-Reichmann, who had come to the United States from Germany to
escape Hitler, was known for insisting that no patient was too sick to be healed through
trust and intimacy. She figured that loneliness lay at the heart of nearly all mental
illness and that the lonely person was just about the most terrifying spectacle in the
world. She once chastised her fellow therapists for withdrawing from emotionally
unreachable patients rather than risk being contaminated by them. The uncanny
specter of loneliness touches on our own possibility of loneliness, she said. We
evade it and feel guilty.
Her 1959 essay, On Loneliness, is considered a founding document in a fast-growing
area of scientific research you might call loneliness studies. Over the past half-century,
academic psychologists have largely abandoned psychoanalysis and made themselves
over as biologists. And as they delve deeper into the workings of cells and nerves, they
are confirming that loneliness is as monstrous as Fromm-Reichmann said it was. It has
now been linked with a wide array of bodily ailments as well as the old mental ones.
In a way, these discoveries are as consequential as the germ theory of disease. Just as
we once knew that infectious diseases killed, but didnt know that germs spread them,
weve known intuitively that loneliness hastens death, but havent been able to explain
how. Psychobiologists can now show that loneliness sends misleading hormonal signals,
rejiggers the molecules on genes that govern behavior, and wrenches a slew of other
systems out of whack. They have proved that long-lasting loneliness not only makes
you sick; it can kill you. Emotional isolation is ranked as high a risk factor for mortality
as smoking. A partial list of the physical diseases thought to be caused or exacerbated
by loneliness would include Alzheimers, obesity, diabetes, high blood pressure, heart
disease, neurodegenerative diseases, and even cancertumors can metastasize faster
in lonely people.
The psychological definition of loneliness hasnt changed much since Fromm-
Reichmann laid it out. Real loneliness, as she called it, is not what the philosopher
Sren Kierkegaard characterized as the shut-upness and solitariness of the civilized.
Nor is real loneliness the happy solitude of the productive artist or the passing
irritation of being cooped up with the flu while all your friends go off on some
adventure. Its not being dissatisfied with your companion of the momentyour friend
or lover or even spouse unless you chronically find yourself in that situation, in which
case you may in fact be a lonely person. Fromm-Reichmann even distinguished real
loneliness from mourning, since the well-adjusted eventually get over that, and from
depression, which may be a symptom of loneliness but is rarely the cause. Loneliness,
she saidand this will surprise no oneis the want of intimacy.
Todays psychologists accept Fromm-Reichmanns inventory of all the things that
loneliness isnt and add a wrinkle she would surely have approved of. They insist that
loneliness must be seen as an interior, subjective experience, not an external,
5
objective condition. Loneliness is not synonymous with being alone, nor does being with others guarantee protection from
feelings of loneliness, writes John Cacioppo, the leading psychologist on the subject. Cacioppo privileges the emotion over
the social fact becauseremarkablyhes sure that its the feeling that wreaks havoc on the body and brain. Not everyone
agrees with him, of course. Another school of thought insists that loneliness is a failure of social networks. The lonely get
sicker than the non-lonely, because they dont have people to take care of them; they dont have social support.

To the degree that loneliness has been treated as a matter of public concern in the past, it has generally been seen as a
social problemthe product of an excessively conformist culture or of a breakdown in social norms. Nowadays, though,
loneliness is a public health crisis. The standard U.S. questionnaire, the UCLA Loneliness Scale, asks 20 questions that run
variations on the theme of closenessHow often do you feel close to people? and so on. As many as 30 percent of
Americans don't feel close to people at a given time.

Loneliness varies with age and poses a particular threat to the very old, quickening the rate at which their faculties decline
and cutting their lives shorter. But even among the not-so-old, loneliness is pervasive. In a survey published by the AARP in
2010, slightly more than one out of three adults 45 and over reported being chronically lonely (meaning theyve been lonely
for a long time). A decade earlier, only one out of five said that. With baby-boomers reaching retirement age at a rate of
10,000 a day, the number of lonely Americans will surely spike.

Obviously, the sicker lonely people get, the more care theyll need. This is true, and alarming, although as we learn more
about loneliness, well also be better able to treat it. But to me, whats most momentous about the new biology of loneliness
is that it offers concrete proof, obtained through the best empirical means, that the poets and bluesmen and movie directors
who for centuries have deplored the ravages of lonesomeness on both body and soul were right all along. As W. H. Auden
put it, We must love one another or die.

Who are the lonely? Theyre the outsiders: not just the elderly, but also the poor, the bullied, the different. Surveys confirm
that people who feel discriminated against are more likely to feel lonely than those who dont, even when they dont fall
into the categories above. Women are lonelier than men (though unmarried men are lonelier than unmarried women).
African Americans are lonelier than whites (though single African American women are less lonely than Hispanic and white
women). The less educated are lonelier than the better educated. The unemployed and the retired are lonelier than the
employed.

A key part of feeling lonely is feeling rejected, and that, it turns out, is the most damaging part. Psychologists discovered
this by, among other things, studying the experience of gay men during the first decade of the AIDS epidemic, when the
condition was knocking out their immune systems, and, as it seemed at first, only theirs. The nation ignored the crisis for
a while, then panicked. Soon, people all over the country were calling for gay men to be quarantined.
To psychologists trying to puzzle out how social experiences affect health, AIDS amounted to something of a natural
experiment, the chance to observe the effects of conditions so extreme that no ethical person would knowingly subject
another person to them. The disease came from a virusHIVthat was neutralizing all the usual defenses of a discrete group
of people who could be compared with each other and also with a control group of the uninfected. That allowed researchers
in a lab at UCLA to take on one of lifes biggest questions, which had become even more urgent as the disease laid waste
to thousands, then tens of thousands: Could social experiences explain why some people die faster than others?
In the mid-to late 80s, the UCLA lab obtained access to a long-term study of gay men who enrolled without knowing whether
they were infected with HIV. About half of them tested positive for the virus, and about a third of those agreed to let
researchers put their lives under a microscope, answering extensive questions about drug use, sexual behavior, attitudes
toward their own homosexuality, levels of emotional support, and so on. By 1993, around one-third of that group had
developed full-blown AIDS, and slightly more than a quarter had died.

Steven Cole was a young postdoctoral student in the lab itching to move beyond his fields mind-body split. At the time, he
told me, psychology was only just beginning to grasp how the physical world of our bodies gets remodeled by our psychic
and conceptual worlds. When the UCLA researchers started trying to figure out which social factors sped up the progress
of the disease, they tested obvious ones like socioeconomic status and levels of support. Curiously, though, being poor or
lacking family and friends didnt much change the rate at which an infected man would die of AIDS (although being in
mourning, as gay men often were those days, did seem to weaken an infected man's immune system).
It eventually occurred to Cole to try to imagine the world from a gay mans perspective. That wasnt easy for him: Im a
straight kid from the suburbs. I had stereotypes, but I didnt really know the reality of these peoples lives. Then he read
a book, Erving Goffmans Stigma: Notes on the Management of a Spoiled Identity, that tallies in detail the difficulties of
passing as someone else. He learned that the closeted man must police every piece of information known about him, live
in constant terror of exposure or blackmail, and impose sharp limits on intimacy, or at least friendship. It was like walking
around with a time-bomb, says Cole.

Cole figured that a man whod hide behind a false identity was probably more sensitive than others to the pain of rejection.
His temperament would be more tightly wound, and his stress-response system would be the kind that fires responses and
fires em harder. His heart would beat faster, stress hormones would flood his body, his tissues would swell up, and white
blood cells would swarm out to protect him against assault. If this state of inflamed arousal subsided quickly, it would be
harmless. But if the man stayed on high alert for years at a time, then his blood pressure would rise, and the part of his 6
immune system that fends off smaller, subtler threats, like viruses, would not do its job.
And he was right. The social experience that most reliably predicted whether an HIV-positive gay man would die quickly,
Cole found, was whether or not he was in the closet. Closeted men infected with HIV died an average of two to three
years earlier than out men. When Cole dosed AIDS-infected white blood cells with norepinephrine, a stress hormone, the
virus replicated itself three to ten times faster than it did in non-dosed cells. Cole mulled these results over for a long time,
but couldnt understand why we would have been built in such a way that loneliness would interfere with our ability to fend
off disease: Did God want us to die when we got stressed?The answer is no What He wanted is for us not to be alone. Or
rather, natural selection favored people who needed people. Humans are vastly more social than most other mammals,
even most primates, and to develop what neuroscientists call our social brain, we had to be good at cooperating.

Call for Papers

Summer Tip Issue

Editor Stewart Ehly (stewart-ehly@uiowa.edu) has released the schedule for the Summer
issue of TIP. Contributions are encouraged:
April 30-- Notice of intent to contribute
May 15-- First draft of materials
June 15Publication of summer issue

Dates to Remember

Mindfulness and Psychological Assessment in

Primary Care: Research, Integration and Practice
Start: April 10, 2015 8:00 AM (CDT)
End: April 11, 2015 (CDT)
Location: 812 University, Central College Maytag Student Center, Pella

Annual Membership Meeting

Start: April 10, 2015 5:00 PM - 5:00 PM
Location: Central College, Pella, Maytag Student Center

The Trust Sequence V: Hot Topics in Ethics and

Risk Management in Psychological Practice
When: June 06, 2015 8:00 AM - 4:30 PM
Location: Renaissance Savery Hotel, Des Moines

Fall Conference 2015

When: October 09, 2015 8:00 AM - 4:30 PM
Location: Scheman Center Ames, Iowa
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