Let’s Talk About Self-Injury

Imagine that you are a fourteen-year-old who has a history of parental abuse or neglect, is struggling at school, has few friends and is vulnerable to peer pressure. You are in frequent conflict with your parents. Some of your friends are known to intentionally harm themselves and say that they find relief in doing so. Do you have the skills to manage intense emotions? If you do the same by cutting your arms and legs, is it a cry for help, or a precursor to suicide?

What would lead someone to harm themselves? These are people who have problems regulating emotions. They don’t know how to cope with intense or overwhelming emotions and find relief through damaging their skin. It is most common among adolescents with an onset around age 13 or 14 and increases as they reach older adolescence up to age 17. It offers a temporary escape from intolerable feelings. The intent is survival rather than death.

How does creating pain by hurting your body help someone who is already in psychological pain? The self-injury may provide a distraction for someone who is better able to tolerate physical pain than emotional pain. It may give them a sense of control over their feelings. It is an attempt to express internal feelings in an external way. It may communicate intense emotions to the outside world. And it may serve as punishment for perceived faults.

Most people who harm themselves are not doing so for attention or making a cry for help. They typically wear long sleeves or long pants to hide the scars or cuts.

Self-injury is the deliberate destruction of body tissue without suicidal intent. It is listed in the DSM 5 as a diagnostic disorder. Its criteria are five or more days of self-inflicted harm over the course of one year without suicidal intent and, the individual was motivated by seeking relief from a negative state, resolving an interpersonal difficulty, or achieving a positive state.

However, a spectrum of behavior exists from self-injury on one end progressing to suicide attempts on the end. Self-injury is a strong predictor of future suicide attempts. It is important not to assume that someone who harms their body wants to kill themselves, but keep in mind that there is increased risk for suicide.

The goal of therapy is to help clients learn to tolerate uncomfortable feelings and find healthier means of managing overwhelming emotions. They can benefit from learning to control impulses. Increasing family and social support is a buffer against these intense states. Research shows that strong parental bonds can differentiate those who think about suicide from those who actually attempt suicide.

If you know someone who self-injures don’t panic or become angry. Although this behavior is alarming, understand that this is someone who is struggling emotionally. Ask them what you can do to help them from injuring themselves. Realize that this is a coping strategy, not a weapon against you. Model healthier coping skills. It is a treatable condition.

Advertisements

Can Mental Health Treatment Prevent Mass Shootings?

19-year-old Nikolas Cruz opened fire on a Florida high school on Valentine’s Day, 2018. He killed 17 people. In an attempt to understand why this occurred, and how to prevent it in the future, many focus the debate on lack of gun control and mental illness. Could mental health treatment have prevented this?

Nikolas Cruz participated in mental health treatment, but we don’t know what type of treatment he received. He stopped his treatment for unknown reasons. He is described as having had “emotional problems” since childhood, a quick temper and anger problems. These often led to property destruction, odd behavior toward other students in school, and expulsion from school. The expulsion was related to fighting and/or carrying a knife in school. It was said that he struggled with grief or depression related to the death of his mother who died in November from pneumonia. The couple who took him in after his mother died said they did not see any warning signs. They thought he was doing well at his new school and was working hard to get his high school diploma.

Would Cruz have committed mass murder if he had the right kind of treatment, or if he had continued treatment?

It is my opinion that mental health treatment will only minimally stop mass shootings. Research demonstrates that mental illness is not a predictor of violence. There is some association between mental illness and violence, but the association is weak. One study, from Annals of Epidemiology, states “evidence is clear that the large majority of people with mental disorders do not engage in violence against others, and that most violent behavior is due to factors other than mental illness.” Anger is a problem for people with and without mental illness. Anger can be, but isn’t always, a component of mental illness. Also, many people with anger issues do not have a mental illness. According to the American Psychiatric Association, “mass shootings by people with serious mental illness represent 1% of all gun homicides each year.” Counseling can be helpful toward anger management, but only for people who are motivated for change.

It has been said that President Trump revoked former President Obama’s executive order barring mentally ill persons from gun purchases. Congress did revoke regulations preventing some people from purchasing a gun, but it was already limited in scope. People prevented from purchasing a gun have been determined by a court to have marked mental illness who are a danger to themselves or others; or lack the mental capacity to manage their own affairs; who has been declared insane by a court in a criminal case; and those people who are found incompetent to stand trial or found not guilty by reason of lack of mental responsibility. This is a very narrow subset of mentally ill people and would not apply to the vast majority of people who commit homicide.

The mental health system in America is broken. Treatment is not readily available to those who need it, particularly in rural areas. More than 50% of Americans who suffer from a mental illness do not receive treatment. High cost, limited health insurance, resistance and stigma are all barriers to help.

President Trump has said when someone is obviously disturbed they should be reported to authorities. Fair enough, but police officers rely on mental health providers to assess dangerousness and place people in the most appropriate level of care. Multiple levels of care include outpatient, intensive outpatient treatment, partial hospitalization, inpatient hospitalization, and residential. Persons with mental health disorders should be provided with health care which is the least restrictive. The aim is to preserve the patient’s dignity, rights and freedoms as much as possible. One is not easily or quickly committed to seclusion or restraint for their own or other’s safety. Most states have a 72-hour period in which an assessment is completed for emergencies. Once the 72-hour hold is lifted, patients can request a discharge. Or, if the hospital team believes it is necessary, they will start the commitment process. This process begins after a threat to self or others has been substantiated. It is not a highly effective prevention measure.

It is critically important to institute an action plan against shootings. The number of mass shootings is increasing. A national organization that tracks school threats says there are 10 threats a day on average. After the Parkland, Florida incident there have been about 50 threats a day on average.

When assessing potential lethality, professionals ask if the patient has access to weapons. If they are deemed dangerous, they take action to limit access to weapons. That’s a first step in decreasing risk. In the case of mass shooters, gun control is the first line of defense.

So what else can we do to prevent violence? Adopt and teach emotion regulation skills. Emotion regulations are measures taken by an individual to monitor, evaluate and modify intense emotional reactions. Deficits of emotion regulation are linked to depression, anxiety, substance abuse and other conditions. Improving emotion regulation skills can serve as violence prevention. For example, one skill is to accept and tolerate negative emotions. I would like to see these skills modeled by adults and taught across all levels of education.

Perhaps if Nikolas Cruz practiced emotion regulation skills he would have found healthy ways of expressing his anger and grief.

What People in Opioid Addiction Recovery Want You to Know

Chances are you either know someone with a substance abuse problem, or have a problem yourself. According to the National Survey on Drug Use and Health (NSDUH), 21.5 million Americans (aged 12 and older) battled a substance use disorder in 2014. There are more than 23 million Americans in recovery from addiction to alcohol and other drugs.

Addiction, by definition, involves negative consequences to the person’s life. It is often devastating to families and friends. It’s often said that addiction is a family disease. That means that everyone in the family is affected by one member’s addiction. Addiction affects the stability of the home, the unity of the family, mental and physical health, and the overall family dynamic.

They desperately want the addiction to stop. Once a person who misuses alcohol or drugs starts a recovery process, the family is greatly relieved.

A person who becomes dependent upon an Opioid, such as heroin or prescription pain killers, has special challenges in recovery. By mid to late stage Opioid addiction their fear of withdrawal has caused them to act in ways they would never have otherwise behaved. In recovery, they may suffer intense guilt over their behavior. They want the support and trust of their family but can’t be fully open about their recovery because the family may have certain assumptions about recovery.

I talked with a group of Opioid dependent people in recovery who discussed their families’ assumptions. Here’s what their family members and loved ones want to believe about the recovering person:

1. Recovery is a decision, not a process.

2. The addiction is in the past and they are “all better now.”

3. They will never slip.

4. All of their days are sunny. They should be grateful and have a positive attitude.

5. If they were really motivated, they wouldn’t need medication for Opioid addiction.

The recovering addict wants to reestablish relationships with their family and don’t want to disappoint them. They may hide their true feelings from family. But if they could be really honest about their recovery they would say the following:

1. I’m not always happy. My life is infinitely improved in recovery and I have every reason to be happy. But I struggle with depression, anxiety and feelings of worthlessness. The underlying issues that contributed to my addiction are not gone simply because I stopped using substances.

2. I miss the drug’s warm blanket that numbed my pain, gave me energy and euphoria, and provided a distraction from life’s stress.

3. I still have cravings from time to time. I am perpetually on guard against relapsing.

4. I feel judged by my past. I am often misunderstood. For example, when I excuse myself from your presence, am tired, or behave badly, it is not evidence that I am getting high.

5. I may never have used a needle or heroin. Your assumptions, based on media sensationalism, may be wrong.

6. MAT (Medication Assisted Treatment) such as Methadone or Suboxone is the gold standard of treatment for Opioid dependency.

7. I’m tired of having to explain that MAT is not substituting one drug for another.

8. I’m not interested in tapering off my medication. I may choose to stay on MAT indefinitely. I have a chronic lifelong disease and will never be cured.

9. It’s not over. Although I’m drug free, the damage done can take years to repair.

Recovery support groups are a safe place for members to share their innermost thoughts and feelings. They are understood by others who have walked a similar path. But sharing their recovery journey with family members can be healing to the entire unit.

Can you ever again return to normal? With treatment, both the addict and family members can go on to live full, happy, and productive lives.

He Very Strongly Said He Was Innocent

Rob Porter, a White House staff secretary, is in the news this week. All White House staff are subject to a background check before being granted security clearance. The FBI knew of Porter’s domestic assault after interviewing his ex-wives and having access to police reports and a 2010 Order of Protection. The FBI passed this information to John Kelly who allowed Porter access to classified information in spite of this knowledge. This poses a risk of blackmail to the office.

He resigned after domestic violence charges toward his two ex-wives came under scrutiny after months on the job. Porter called the allegations “outrageous” and “simply false.” President Trump wanted to believe him. Trump made a statement “remember Rob Porter says he’s innocent and I think you have to remember that. He said very strongly yesterday that he’s innocent so you have to talk to him about that.”

Chief of staff, John Kelly, initially made a statement describing Porter as “a man of true integrity.” But after viewing photographs of Porter’s assault Kelly said he was shocked by the allegations. Why wasn’t he shocked when he first learned of the assaults? Porter was described as having kicked, choked and punched his first wife. He would throw her down on a soft surface, shake her, and rub an elbow or knee into her. His second wife stated that Porter dragged her naked and wet from the shower to yell at her. He dismissed these women’s words but was “shocked” upon seeing a photograph of one of the women with a black eye. Seeing is believing, but a testimony and criminal records are not believed?

Trump has a history of defending men who are alleged to have abused women, including himself. For example, Corey Lewandowski, his election campaign manager, who faced a misdemeanor battery charge after an altercation with a female reporter. And he defended Roger Ailes, Fox news producer amid sexual harassment allegations. And Fox news host Bill O’Reilly was described as “a good person. I don’t think Bill did anything wrong.” And Roy Moore, a candidate for the US Senate who lost the election after numerous allegations of sexual misconduct with underaged girls was supported by Trump. “He said he didn’t do it.” What he has not done is defend the victims of sexual or physical assault.

Trump and Kelly believe every individual deserves the right to defend their reputation. True enough. But they don’t have a right to ignore or deny facts of history. When Trump asked “Is there no such thing any longer as Due Process?” he is referring to the presumption of innocence. In the case of Porter, he had due process in 2010 and was deemed dangerous when a judge granted an Order of Protection to his first wife.

There are not two sides to the issue of domestic assault. Domestic assault, whether it is physical, sexual, emotional, or economic, is a crime and should be treated as such. The White House sent the message that domestic violence should be covered up, perpetrators should be shielded and protected from accountability, and victims are not to be believed.

But he’s a good employee. Trump defended Porter saying “He did a very good job. We wish him well, he worked very hard. It’s a tough time for him. We hope he has a wonderful career and he will have a great career ahead of him.” As a perpetrator of domestic assault, he should not have a job that is risk sensitive. I also wish Porter well. It is my hope that he participates in a batterers education program and changes his thinking and behavior. I hope he addresses his need for power and control over women. As in his case, the cycle of abuse continues from one victim to another without intervention and treatment.

The stakes are high. Domestic assault is an epidemic. Three women are murdered every day by a current or formal partner in the US. Seventy percent of women worldwide will experience physical and/or sexual abuse by an intimate partner during their lifetimes. One in seven men have been victims of severe physical violence by an intimate partner in their lifetime. It is not to be denied or minimized just because you want to believe in the accused’s innocence.

Strongly stating that you are innocent, does not necessarily make it so.

Love (Usually) Wins over Heartache (Eventually)

Women who have experienced the pain of childbirth may say they’ll never do it again. Some people (more women than men) who divorce resolve never to marry again. Pet owners who experience the anguish of their pet’s death may grieve as intensely as losing a close family member. They may be hesitant to make another lifelong commitment to a furry being. But more often than not, love wins over heartache. In spite of the pain and heartache we allow ourselves to love again.

Do we forget the pain of our previous losses? Some people believe that time heals all wounds and that our memories of pain soften with time. Not necessarily so. Time alone doesn’t always heal your psychological wounds. Time is not medicine.

It is a myth that women are biologically programmed to forget the pain of childbirth. It hasn’t been forgotten, but the happiness and burst of oxytocin of cradling a baby colors the memory of the preceding pain. This is known as the halo effect. Over time, many women report labor and birth pain as less severe than they originally thought. But women who reported they had “the worst pain imaginable” continue to report that five years later. It could be that no matter how painful childbirth is, some women feel that the unconditional love and wonderful experiences with their child make childbirth worth the hours of pain.

If you have experienced the pain of divorce, you know how devastating it is to lose your best friend and see your future hopes and dreams disappear. Yet, many people try it again. Sixty-four percent of men had remarried in 2013, compared with 52 percent of women. Optimism alone doesn’t make for a happy remarriage. Sixty percent of second marriages end in divorce. Seventy-three percent of third marriages end in divorce. Professional counseling in the first marriage may save later heartache.

My husband and I lost Bingo, our eight-year-old Cavalier King Charles Spaniel, this week. Bingo had struggled with congestive heart failure and a respiratory illness until we made the difficult decision to facilitate his passing. As you can imagine, we are devastated to lose the company of this sweet, although neurotically anxious, boy. Would we do it again? It is too soon to tell, but if our past is an indicator of the future, we will open our hearts and adopt again.

Rather than throw in the towel and declare that we’ll never face heartache again, we need to heal, then assess whether the risk outweighs the costs.

How do we heal? Social support is critical to healing. Rely on your friends for comfort. Friends offered hugs and invitations to talk. I posted news of Bingo’s death on Facebook and received countless acknowledgments of my grief. Each hug and gesture of support made me feel warm and fuzzy. In fact, hugs ward off stress and protect the immune system. This makes me less susceptible to depression and anxiety. One study of hugs found that both perceived social support and more frequent hugs reduced the risk of infection and less severe illness symptoms. Hugs also lower blood pressure, alleviate fears around death and dying, improve heart health and decrease feelings of loneliness. One friend emailed me a group of photos of human/animal hugs that also gave me warm and fuzzy feelings, prompting a healing effect.

Once sufficiently, but not perfectly, healed, assess whether you are ready to take the risk of love again. Love is all about taking risks. Peter McWilliams said: “It is a risk to love. What if it doesn’t work out? Ah, but what if it does?” It’s your choice.

 

How Much is a Little Girl Worth?

In September 2016, Rachel Denhollander was the first woman to make a public allegation of sexual assault against former USA Gymnastics (USA Gymnastics) and Michigan State University (MSU) team doctor Larry Nassar. Nassar was accused of sexually abusing more than 140 children and young women. He was sentenced to 40-175 years in prison on seven counts of criminal sexual conduct in the first degree. He is already serving 60 years in prison on child pornography charges and awaits sentencing on three more counts of criminal sexual conduct in the first degree. 169 survivors and family members were allowed to give victim impact statements in court.

Denhollander made a powerful statement about the long and frustrating process of seeking an end to the abuse and justice to be served. In making a case for a long prison sentence, she asked the judge to consider “How much is a little girl worth? How much is a young woman worth?”. She pled for the maximum sentence and the fullest weight of the law to be used to protect another innocent child from sexual assault. Children are worth every protection the law can offer.

She described Nassar as a hardened and determined sexual predator. She was sexually assaulted by him over a 16-year period under the guise of medical treatment. Nassar groomed her for the purpose of his sexual gain. He found satisfaction in the suffering of his victims, some girls as young as six years old. He gained the trust of their parent, sometimes performing sexual violation with a parent in the room.

What was particularly upsetting in her testimony was the ability of others to minimize, deny and fail to act on behalf of victims. Four other victims prior to her allegation had described his behavior and penetration and their belief that they had been assaulted, in detail, to three different athletic departments at MSU. It was reported to MSU’s head gymnastics coach, to a track coach and to multiple athletic trainers and supervisors years prior to Denhollander’s contact with Nassar. Some of the trainers and people in positions of authority had been told of the abuse and were silenced. USAG was burying reports of sexual assault instead of reporting them. This led to a culture of abuse against children without fear of being caught. The USAG allowed Nassar to “treat” these girls in their own beds without having a medical license in the state of Texas.

Denhollander is angry. MSU responded to allegations with press releases saying that there was no cover-up because no one who heard the reports of assaults believed that Nassar was committing abuse. They didn’t know, because no one believed. And because no one believed, victims were silenced, intimidated, repeatedly told it was medical treatment and forced to return to Nassar for continued assault. Authorities said the allegations of assault didn’t count because it wasn’t told to the right person. They imply that the right person is the one who has authority to fire the alleged perpetrator.

As a result of this case, The US Olympic Committee has ordered the entire USA Gymnastics board to resign by January 31. Two MSU officials have quit. MSU athletic director stepped down following reports that the school knew of the abuse claims but failed to take action. These bodies are required to examine their plans for combating abuse.

So, who has the duty to protect children? Who is the right person to file a report? What is the right way to handle sexual assault allegations?

I am a mental health professional who is mandated to report allegations of abuse to our state department of child welfare. But everyone has a duty to protect children. Everyone is morally and ethically mandated to protect vulnerable people by nature of being a responsible world citizen. It is never an easy task to place a call for fear of negative consequences. However, it is not your role to be judge and jury as to the validity of an allegation. You are only called upon to place the call. Once you place a call, a case worker will assess whether the allegation is reportable according to their guidelines. If so, a police report is made and an investigation is held. They will deem the allegation founded, or unfounded, and take appropriate steps to ensure the safety of the child.

Here’s the wrong way to handle an allegation. Don’t ignore it and hope it will go away. Don’t deny the allegation and assume that the victim is confused, making it up, or the allegation lacks proof. Don’t honor your own belief that bringing forth the allegation will cause further harm to the victim, and therefore hide the report. Don’t assign malicious intent to the victim, believing them to be wanting attention, or seeking financial gain. Don’t hide behind the idea that there is fault on both sides, and the victim must have wanted it or contributed to it on some level. And don’t assume that children are resilient and no long harm has been done. Victims will have lifetime scars.

“How much is a little girl worth? How much is a young woman worth?” These are questions that you alone answer when you suspect or learn of abuse. Do your part in protecting children.

How To Cope with Divorce

As a marriage counselor, I’m asked if couples are really helped by therapy. The truth in my practice is that I don’t know. I have not performed outcome studies. My perception of the outcome is skewed because couples who seek my help are motivated. Couples who have predetermined they want a divorce don’t often present themselves in my office. I’ve seen marriages that appeared emotionally dead, spring to life. I’ve also seen marriages that appeared quite healthy, choose to divorce. I cannot predict with certainty which couples will buckle down and adopt suggested changes or practice the assigned techniques. I’d like to believe that the majority of couples I’ve counseled improve their skills and stay together, but I don’t know what happens after they stop sessions.

I had written a column in May of 2015 titled “Is It Time to Move On?” In it I laid out indications that it is time to move on from an unsatisfying job or marriage. Bottom line reasons follow:

When the situation consistently causes more pain than joy.

When you feel angry and resentful more days than not.

When you have made yourself small to accommodate an intolerable situation.

When the situation is killing your spirit – causing depression, anxiety or medical illness.

When you act against your core values and lose respect for yourself.

When you have tried everything to fix the situation, and there are no options left.

When you have exhausted your options and turn to irresponsible activities like the use of alcohol or drugs to numb yourself.

When you feel abused by the situation.

If the answer to one of these is resoundingly yes, you would likely be happier if you divorce. If you determine that you should move on, you may still lack the emotional where-with-all to do so.

Divorce is a traumatic event. Some traumas do not heal with time. It has been said, “Time heals all wounds.” Rose Kennedy does not agree. “The wounds remain. In time, the mind, protecting its sanity, covers them with scar tissue, and the pain lessens. But it is never gone”. The truth is that some things that happen to us will never heal. Relational brokenness is no less significant than physical brokenness. We may never be quite the same.

It is unfortunate that we are forced to make significant life decisions when in our most vulnerable state. Friends may recommend you find an aggressive attorney, your family may determine that your once loved partner and valued in-law is an abusive person. Your friends take sides, some leaving you alone and lonely. Divorce can be ugly for couples who fight over children or finances. If the soured relationship isn’t enough cause for depression, a long and protracted divorce could cause PTSD (Post Traumatic Stress Disorder) symptoms in which you are left embittered and seething with revenge.

So here’s what I recommend to people in this vulnerable state. Start with your values and make your desired outcomes secondary. Reflect on what is important to you and how you want to carry yourself through the process. For example, you may aspire to be fair, to be kind, to be brave, and to seek the benefit of all involved. Meditate on these qualities frequently so that when you make difficult decisions in a settlement, you can be proud of your choices and the manner in which you carried yourself. Let the details take shape around your aspirations.

Fairy Tales Are Not For the Homeless

I have to admit that I look forward to the fairy tale wedding of Prince Harry and American actor Meghan Markle. I remember watching the wedding of Charles, Prince of Wales, and Lady Diana Spencer in 1981. Their marriage was the “wedding of the century.” It was watched by a global TV audience of 750 million people. We later grieved Diana’s death and enjoyed seeing her young sons grow into men. And, we can take pride in a British-American union. One of our own is becoming a princess. Let’s face it, American women are a bit envious of the English and their hats. When the Queen wears a hat, dress code etiquette states that all women wear hats for formal events.

A fairy tale extravaganza doesn’t happen magically. I’m reading that Windsor Castle prefers that guests and tourists not rub elbows with the homeless and potential panhandlers. It was suggested that vagrants and their belongings be “dealt with” before the wedding. This has stirred up controversy over the root causes of homelessness and the most effective methods of addressing the problem. Rather than sweep the homeless under the rug there should be public policy designed to improve the life and health of the homeless.

I get it. There may be safety concerns. And it is difficult to enjoy a party in the presence of suffering or smelly people. But to hustle them off the streets and out of sight seems morally wrong.

It is made easier to subjugate groups of people whom we deem different from us. It is a human trait to divide people into Us and Them, ingroup and out group, our kind and the others. We do it with remarkable speed. It is hardwired into our brains.

How do we stop making these dichotomies? One way is through prolonged contact. If we rub shoulders often with people who are different from us, long enough, our similarities start to outweigh differences. Another way is to make the implicit explicit, by identifying our biases through reflection. A third way is a cognitive tool called perspective taking. Imagine being them. Would your feet hurt if you walked in their shoes?

I was a youth minister in Cabrini Green housing projects of Chicago for several years in the early 1980’s. In 1981, Mayor Jane Byrne flattened the Us/Them dichotomy by moving into this low income housing where approximately 9% of the residents were employed. Mayor Byrne walked in the resident’s shoes. She demonstrated a commitment to safety and reform. By moving in she brought civic attention and city services to the buildings. I saw immediate change to the building that she inhabited. The grounds were cleaned of debris, flowers planted, elevators repaired, and security was increased. Her husband coached the local sports teams. I was pleased to see her walk from the projects to work. The experiment only lasted three weeks. And unfortunately, funds dried up when she lost her bid for reelection. Many people thought it was a political stunt, but I admire her investment in addressing a social problem. There was no sustainable change but I appreciated the effort.

Perhaps the Royals of England could learn a lesson here. They could rub shoulders with people who lack stable housing. They can reflect on their biases. And they should walk in their shoes. As a result, public policy is formed.

Ask the Opioid Dependent Patient, Not Law Enforcement, About Incidences of Opioid Overdoses

The Dubuque, IA Telegraph Herald recently featured a news article by Alicia Yager entitled “Law Enforcement Divided on Overdose Intervention.” In it, she references Richard Jones’, the sheriff of opioid-ravaged Butler County in Ohio, refusing to equip his deputies with Narcan. He believes requiring deputies to administer Narcan puts them in danger and the cost of repeatedly treating people with Narcan are “sucking the taxpayers dry.” “All we’re doing is reviving them. We’re not curing them.” Opponents of Narcan believe it has no lasting impact on the death toll.

Nearby sheriff Robert Leahy of Clermont County in Ohio says “from my personal experience it is right thing to do.” The nasal spray makes it simple to administer, it’s not a major burden to track and maintain supplies and that it’s a natural extension of our mission to serve and protect. Leahy further states “no matter what their plight is and how they got to where they are, it’s not for us as law enforcement to decide whether they live or die.”

Ms. Yager then cites local law enforcement leaders in the tri-state area of Wisconsin, Illinois and Iowa, who are happy to include Narcan in their tool box to help people who might otherwise die. The Dubuque County sheriff’s department and Dubuque police department in Iowa carry Narcan. According to Dubuque Drug Task Force statistics, there were 15 opioid-related overdoses with four resulting in death. Those figures are an improvement from 2016 which had 28 overdoses and nine deaths. Dubuque police chief said he is aware of three instances of reviving an overdose victim since July of 2017, when they began carrying Narcan. Officers in Jo Daviess County in Illinois don’t carry Narcan yet but will do so as part of a state wide mandate. Grant County in Wisconsin doesn’t see a need for Narcan yet and have only used it once. Although they don’t see the effects of an opioid epidemic, they are happy for the opportunity to administer it if needed.

But here’s the thing. Law enforcement is not in a position to know how many fatal or near fatal overdoses occur within their jurisdiction. We can’t rely on their statistics for an accurate count of how many people have nearly died.

Why? Given the legal consequences of possession of an illicit substance, people who are in trouble will resist calling for help, unless absolutely necessary. In spite of Good Samaritan laws, in which there are to be no arrests for someone who tries to save a life, drug users are suspicious. They will try to handle the overdose without intervention from paramedics or law officers. With increased distribution of Narcan to the public, we may see fewer reported overdoses and more people being saved by a peer or family member.

Additionally, in cases of fatal overdose deaths, families may choose privacy over public stigmas. The death certificate may list cause of death as respiratory failure and not opiate overdose. These deaths may not get counted in statistics. Stigma, such as perpetuated by Richard Jones in Butler County, Ohio, prevents people from openly sharing that a loved one died of the disease of addiction. There is no such stigma of a family member dying of cancer.

In Yager’s column, she references a fear of violence from someone who has been revived with Narcan. Sheriff Jones said that people can be combative when they come to, and “an officer bent over giving Narcan could get a brick to the head.” This language is unnecessarily inflammatory and sensational. It is true that an opiate dependent person who is revived with Narcan will wake to pain. Narcan works by stopping the overflow of opiates to receptors leaving them with no opiates in their system and inducing withdrawal symptoms. However, they are no more likely than any other patient in pain to react with aggression. Officers are trained in tactics of restraints and will surely remove any nearby bricks that could cause harm to themselves.

When Jones says “All we’re doing is reviving them, we’re not curing them” he is correct. Narcan is a tool to keep people alive. It is not treatment. Law enforcement is not expected to provide treatment. Their purpose is to serve and protect, even if it takes 20 uses of Narcan to protect them. He also says Narcan has no lasting impact on the death toll. This may also be correct and some statisticians believe the epidemic will get worse over the next six years. But even one more day of life to a loved one is precious. Can you look into the eyes of a grieving parent and justify withholding Narcan because it would have no lasting impact on the death toll? Of course not.

So where do we turn for more accurate figures? To the patients who are dependent upon opioids themselves. I did an informal survey of opioid dependent people in this tri-state area two years ago and repeated it last week. In 2015 I surveyed a group of ten people who were in drug treatment for addiction to opioids (heroin or pain killers). Among these ten people, they had experienced eleven overdoses. When asked how many overdoses they had witnessed or known of among their peer group, they counted more than sixty. When asked how many of those overdoses resulted in death, they counted twenty-two.

Last week I again surveyed a group of seven people who are in treatment for an opioid dependence. Six people had experienced a total of eleven overdoses. When asked how many overdoses they had known of among their peers, they counted eighty-four. Among those eighty-four overdoses, thirty-two had died as a result of the overdose.

Admittedly, this is not a scientific study but it does indicate that patients are better informed than law enforcement officials. News columns that look to law enforcement to understand the nature and extent of an opioid crisis can mislead the public. It is important for law enforcement to be equipped with Narcan, but it is imperative for patients to have Narcan and easy access to treatment.

Are You an Impostor?

Papotia Reginald Wright, of Brooklyn, New York, said that he was proud of his 25 years in the Army. He served as a Special Forces Green Beret. He told stories of his military days including one where a person cut out his kidney. He was living with one kidney. When in uniform he was an impressive Green Beret. Wright became a well-respected military figure in his community. He founded an organization in Brooklyn to help veterans. However, his personal history wasn’t true. He was recently exposed as an impostor. One veteran who worked for this organization said he was “played for a frigging fool” after learning that Wright was a fraud. To add insult to injury, Wright was behind on rent for the organization.

There are legal consequences for this kind of deceit. Wright is being investigated for possible violations of the Stolen Valor Act. The Stolen Valor Act states that fraudulent claims about military service is subject to a fine, imprisonment up to a year or both.

We’d all like to be someone else from time to time. We fantasize of a life where we’re rich, famous, or a hero. We may embellish our accomplishments and stretch the truth on occasion in an effort to impress. Imposters not only embellish their traits. They are pathological liars.

Pathological liars suffer from a mental illness or personality disorder. The lies bring attention to the person and make the person or situation look better. One probable cause for pathological lying is low self esteem. The person is trying to make themselves feel better about themselves in terms of their accomplishments. It is a rare condition that affects a small percentage of people.

On the flip side, it is more common to have a fear of being found out to be an impostor. The impostor phenomenon was developed in 1978 by psychologists Clance and Imes. In spite of being competent, one is convinced that they are frauds and do not deserve the success they have achieved. Common signs that someone feels like an impostor are perfectionism, excessive work hours, undermining achievements, fear of failure and discounting praise. Examples are “I feel like a fake,” “I just got lucky,” “They’re going to find me out.”

70% of people feel like an imposter at times. It is particularly common among high-achievers. When severe, people who experience this condition are subject to anxiety, stress, low self-confidence, depression and shame. This condition robs you of the satisfaction that comes from your accomplishments.

So what can you do? Accept that you have some role in your success. If your condition is severe, seek psychotherapy.