Death, Where Is Thy Sting?

In 2014, the suicide rate in the United States was 13 per 100,000 people, the highest recorded rate in 28 years. Over that year, 43,000 Americans killed themselves. The U.S. suicide rate also rose 24% over the 15 previous years (1999-2014), with the rise correlated to the period’s severe economic slump.


I am getting ready to enter a five day stretch of work, during which time I will spend fifteen hours in mental health clinics, up to seven hours in probate court related evaluations, and thirty seven hours doing telepsychiatry consults in emergency rooms around South Carolina. If past history is any predictor of future trends, which it always is, then many of those hours in clinic and ED will be spent assessing suicide risk. 

Threatening to commit suicide can be a cry for help, a manipulation to control an estranged spouse, a last ditch effort to control debilitating anxiety, the only perceived way out of a drug addiction, or a gamble that one might be admitted to a secure hospital when one has no where else to go. It may also be, unfortunately, the successful ending of one’s life by one’s own hand. 

We see various forms of threats. Let’s me say right off the bat that ALL threats should be taken seriously. ALL. 

There are teens who cut themselves. Although some folks do indeed cut themselves seriously enough to to die, most of these self-identified cutters do so to control anger, stem impulsive and destructive urges, or to “just feel something”. 

There are others who have suicidal ideation, real thoughts about dying, without any specific plan or intent or mean to carry out the threat. 

Other groups have suicidal ideation, specific plans, and means to carry out those plans. These are often considered gestures if they involve non-lethal methods such as swallowing a small amount of household cleaner, burning oneself, or trying to drown oneself in the bathtub. Again, some of these gestures can be inadvertently lethal, such as when a preteen decides to take a whole bottle of a “safe” household drug like Tylenol, shuts down her liver and dies. 

Then there are the more serious attempts, such as overdose with a lethal amount of an antidepressant (one week’s worth of some such pills is enough to cause death), hanging (still one of the most common methods used in jails), and self inflicted gunshot wounds. I have seen patients who tried to hang themselves and succeeded only in causing anoxia severe enough to cause permanent brain damage. I have also seen a police officer, well trained in the use of guns, attempt to kill himself by pulling the trigger of a shotgun with his toe, only to have miscalculated the kick of the weapon, blowing his face off but leaving him very much alive. 

The most serious of suicide attempts, the ones who succeed, often give you clues to the act before they carry it out, but manage to succeed anyway. They are often middle aged to elderly men, divorced or widowed, with medical problems, a history of depression, substance abuse, taking antidepressants and who have made some contact with a healthcare provider within days of killing themselves. These men are disconcerting, because they are often resigned to the fact that they are going to die, are relieved and even happy about it, are firm in their convictions and plans, and are very likely to be successful. I have seen some of them leave all the bills paid, the financial and other documents neatly organized on desk or disk drive, and have a letter, will, and other documents laid out for easy discovery by their grieving families. 

Who kills themselves the most? 


For every one completed suicide, there are about twenty five attempts. Often, these are women using overdoses, cutting or other attempts. Men tend to use guns, although women are catching up to them in that department. Firearms account for almost fifty per cent of all suicides. White males accounted for seven of ten completed suicides in 2014, and middle aged to elderly men are still the most at risk group of them all. 

Women attempt suicide three times more often than men.

Men die of suicide 3.5 times more often then women.

Obviously, suicide attempts and completions are still a huge problem in the United States. 

Suicide is the tenth leading cause of death in South Carolina, where I practice psychiatry. On average, one person dies by suicide in this state every 11.5 hours. Our telepsychiatry shifts cover eighteen hours per day. 

The rate of 15.13 suicides per 100,000 people is higher than the national rate of 12.93. 

I will go into this long working stretch knowing that the odds are stacked against us, but that we can make a difference if we listen, intervene, and try to catch those who feel that suicide is the only way out. 

If you or someone you know is suicidal, please seek help through your local emergency room, through your doctor, or by calling the National Suicide Prevention Lifeline at 1-800-273-8255.

What’s It All (Really) About, Alfie?

I am sick to death of the misinformation, the lies, the bogus rules and regulations, the demagoguery, the trumped up charges, the turning of a blind eye. I am sick of people, all kinds of people, who hide behind the cloak of righteousness but are wearing no clothes. I loathe the ones who hide behind their religion, walking stiffly and piously behind the cross as if it were a Sherman tank protecting them from bell tower snipers. I scoff at the ones who point to academic degrees or ancestral pedigrees and nod knowingly, as if those pieces of paper give their opinions and ideas any more weight than those of the butcher, the baker, or the candlestick maker. 

I am sick to death of all of us, ALL of us, writing and rewriting the rule book of life as if it were a movie script. 

What’s it all about? 

We need rules, they say, harsh and punitive and enforceable and ironclad. 

We are guaranteed our religious freedom by the constitution of the United States, they say out of one corner of their venomous mouths, while spitting at the ones worshipping differently, out of the other side. 

We need to keep our citizenry safe! Our children! Our wives! Our homes and businesses! 

There is only one marriage between a woman and a man, they say. There is no room for love in the interpretation of the Bible and its inspired Word. Excuse me? Have you read the Bible? Really? If they had their way, sexual orientation would be a mandatory 100 level college class, not a descriptive idea. 

And politics. My God, don’t get me started on politics this year. This fall will be hell, do you hear me, HELL, for this country and its democracy. Is anything about politics, which by the way means the work of the people for those they represent, aimed toward serving constituents anymore? Is it about making life better for all of us? Or is it about showmanship and money and power and influence and fifth grade epithets and character assassination? Will we survive this election cycle in the United States? Yes, we will. Will be be a stronger country, ready to lead the free world? No, I assert, we will not. 

Education, money, influence, family history, grandfathering, and legacy claiming. All tools of the modern day elite to oppress those who DO NOT HAVE. 

What’s it all about, really? In this day and age, what is it all about? 

It is about nothing more than fear, my friends. 

Fear that the future will be worse then the present which for us is worse than the past. 

Fear that the ones in charge will not look like me, act like me or think like me. 

Fear that I will be forgotten. 

Fear that I will be used, abused, and even killed. 

Fear mongering is the new consensus building. 

There is a grand illusion of equality in this country. 

There is a Pollyanna sense of safety in this country.

There is a false sense that we are TOO BIG TO FAIL. 

We are passing laws about bathrooms, when we should be much more concerned about BACK ROOMS,  where the deals are made. 

What to do, what to do? 

One man’s opinion.

Reform government so that laws that protect ALL and strive for the success and wellbeing of ALL are actually written, debated, and voted upon. 

Set rules and regulations and reasonable precautions that protect ALL of us from the harms that we know full well exist in today’s world. 

Understand, fully understand, that we live in a very pluralistic world, and there there IS no going back. 

Develop and promote expectations for decorum, reasonable behavior, and positive, productive human interaction. 

For violators of ANY of the above, develop protocols for swift, terrible, and very serious punishment. Allow no quarter for those who would stall with millions of dollars and hundreds of hours in court after court, appealing and dodging and dancing around the improperly dotted i or the uncrossed t. 

Make America great again?

No, no, no.

America, and much of the rest of the global village, has always been great. 

We have simply lost our will to stand up for the afflicted,  champion the oppressed, reward hard work, acknowledge the worth of the ideas of our citizenry, and get back to the fundamental values and tenets that have allowed us to coexist on this planet for this long. 

We must put our heads together and figure out what it’s all about, before it’s too late. 


Pride goeth before a fall. 


: a feeling that you respect yourself and deserve to be respected by other people

: a feeling that you are more important or better than other people

: a feeling of happiness that you get when you or someone you know does something good, difficult, etc.


Photo credit: Katherine Oliver Birkbeck

We have all had reasons to be proud. 

We grow up, graduate high school, then maybe college, then maybe professional school. We learn a skill, a trade, a profession, gain experience and take it out in the big wide world and find that we are really proficient at something. Reason to be proud, no doubt.

We buy that car we’ve always wanted, or that house, or that boat. We’re proud when people comment on our physical possessions. 

We take care of our bodies, age well, stay in shape, work out, wear nice clothes, get our hair done, wear shiny jewelry. We are proud of how we look. 

We are proud of our work record, our involvement in our church, our community activities or our political dealings. We “run on our record” in so many ways as the years roll by. 

I think Webster may have been thinking about all of these with that first definition above. We accomplish things, learn things, do things,  possess things that help us respect ourselves, and then we expect that respect to be forthcoming from others. All well and good, within reasonable boundaries. 

We cross over into that second definition when things get just a little out of hand. When we think that we are better then others, that we are more fortunate, that we deserve more, that we are more special than others, that we have a higher purpose or place then they do. This kind of pride can swell and fester and putrify and lead us to the brink of destruction, sometimes giving us that last little nudge, that gentle push, that sends us over the edge into the dark abyss of narcissism from which there is no voluntary turning back. 

Now, I have made my fair share of mistakes. 

Some of them have been tiny ones, almost unseen. Some have been known only to me and God. Some of them have been more public and visible and embarrassing. Some have been big, so big that I will rethink them from time to time, and probably will for the rest of my life. 

My mistakes, collectively, may have diminished my ability to feel proud of myself sometimes.

However, nothing has shaken my pride in one thing, actually three people, who I love and care about very much. 

My daughters have grown to be the kind of young women that I can truly be proud of. 

They were all good children, no doubt, energetic and funny and creative and spunky and playful. 

They all grew and branched out into different areas of interest, activities and circles of friends. 

They all finished college, persevering through good times and bad to complete this milestone. 

They now are blossoming even further as adults. 

They teach little children (a job I hold in very high esteem, as they literally shape our future in their classrooms every day). 

They give others the opportunity to grow and learn.

They sing, and dance, and act, and create.

They have pets!

They (or at least she, for now!) have children of their own, something that still amazes me every day.

They love and learn and live and they are making their marks upon this broken world, which gives me great hope that one day it will be whole again.

This kind of pride, this sense that my children are very special and wonderful and lovely and gifts to the world they live in, surely will go before a fall. 

A fall in my hurt and disappointment in myself, because I know I have been a small part of creating three wonderful lives that matter. 

A fall in my anxiety about the craziness of this world, because I know that the generation that follows mine is smart and strong and willing to figure it all out.

A fall in my constant sense of worry (if you are a parent, this needs no explanation), because I know that even though they don’t need me in quite the same way they always used to, they are fully capable of taking care of themselves. 

Yes, this third kind of pride is marvelous. 

It makes all the hurt and pain and doubt and fear fade into the background, and leaves room for nothing but bright hope and joy and celebration.

I love you, girls. 

Swimming Upstream, or….

How many of you have spent an afternoon floating down a river? If you haven’t made this sunlit trip,  I highly recommend it. 

My experience with this activity was a lot of fun. It was a social activity with family, it was on a lovely sunny day, it was in a river that was quite low (so I never feared that this foray into the rapids and sluices would be my last) and it was easy to just enjoy. We rode a rickety, clattering bus, loaded with people and gear, to the launching point well upstream of our parking spot. We dragged or carried our kayaks down the ramp to the water, a wonderful spot in the shade of a bridge overpass. We slogged into shallow water, trying our best to hold boat and booze and hats and other gear, and then, slipping and teetering and laughing all the way, we somehow ended up floating, silently slipping into the already moving clear current. 

The next few hours were really, really nice. Sun dappled water. Greenery everywhere. Something new around every bend. Places that were so shallow that the more weighty of us had to portage to get to the next cool, deep pool. Cows. Yeah, cows. That part was really cool. One straight run terminated in a very small but exciting rapids that we all had to negotiate to move on down the river. There was no thinking about it. In true Master Yoda fashion, there was no try, only do. We were never in any danger, but the rapid acceleration and feeling of being shot out of a small water cannon made the pulse rise. The other hysterical part of shooting those rapids was the fact that there was a campsite of Deliverence-esque people on the other side. I kept listening for banjo music and watching the treeline high above us for the glint of a rifle barrel. 

Navigating the increasingly harrowing river of digital technology is something that most, but not all, of us have a good deal of experience with. 

I think with many people who love what they love and cannot see any possible way to love new things that do not have a cathode ray tube, belt drive or vacuum tube, it is a daunting proposition indeed. Those folks,and you may be among them, are basically swimming up stream. They are trying, half heartedly, to put in well downstream, paddle like mad to get back upstream to the place they parked their Edsels, but it is a lost cause they know it. The current, even at its shallowest, shadiest, most placid point, is simply too strong to fight for very long. The digital river, as all rivers, flows inexorably to the sea. 

We now have at our fingertips hundreds of thousands of books, magazines and newspapers, blogs like this one, transcripts of speeches, and a multitude of other digitized print material. We can access, by buying or streaming, millions of songs and performances of all kinds. We can watch television shows from the time there were television shows, plus thousands of Oscar winning movies and serials and documentaries. We can listen to audiobooks and attend classes at the finest colleges and universities, all by clicking, tapping and swiping. 

It is like trying to drink from a firehose. If one insists on fighting it, taking it all in, missing nothing, one will surely drown. You can try to swim upstream in the digital river, but the 1s and 0s will swirl around you, eddying and deepening until they fill your lungs and you gasp for air for the last time. 

Now, all is not lost, and a watery grave of code does not have to be the end of you. 

Just like preparing to launch oneself into a river to enjoy the afternoon sun, one can prepare to enter the digital world and really enjoy the journey.

First, wear good shoes. Just like the sharp rocks that lurk just under the inviting water, there are pitfalls in the digital space that will snag you if you let them. Educate yourself. Read. Learn. Know what is on the seedy bottom of the twenty first century stream. Viruses, phishing, identity theft, and scams of all types wait on the bottom like whiskered catfish. There are bottom feeders everywhere in this new cyber world. 

Put in at a safe place. You wouldn’t start your journey down a river by launching yourself off the highest falls you could find. Start in the shallows. Read a digital book. Buy a song or two. Download a movie or a television show. Get the hang  of how it’s done. 

Slowly explore deeper waters. Learn how to access whole seasons of your favorite shows. Find out how to borrow digital books instead of buying them. Decide if buying music is still for you, or if a subscription streaming service better suits your needs. 

Be excited, carefully so, about what is around the next bend. Once you get the hang of this music and book and movie thing,  you’re going to see augmented reality, virtual reality, and self driving cars in the next decade. Exciting? Heck yes! Scary? Heck yes! 

Explore new things that make your pulse quicken. Learn how to take a virtual course in Chinese culture, how to be a part of a storm chasing team, or how to cook Indian food. It’s all out there, and so much more. It’s easy to find and even easier to take advantage of. You just simply have to put your oar in the water and paddle. 

My advice to those of you who are still put off by this brave new world, frightened that things are not what they used to be and appear to never be going back? 

You have all the time in the world. The river keeps moving, but that is the scary AND the reassuring part. It should keep moving for a very long time to come. 

Don’t swim upstream.

Get in, pop a cold one, raise your face to the sun, and float. 


Don’t forget the sunscreen. 


My thoughts today, dear readers, come from many places. They are in a way an extension of the thoughts I was having when I wrote about who you would like to be, in a recent blog post. I hope I can convey them succinctly and cogently. Please let me know if I hit that mark or if I don’t. Writers always want to improve. 

Trina and I took a wonderful trip to Germany last week, with visits to several castles and other areas in Munich proper as well as the broader area of Bavaria. I have also been listening to podcasts, hanging out on Facebook and Twitter, and reading. 

One of the broad, prevailing themes that keeps coming up for me lately is the concept of branding. 

We toured the Residenz Munich, a place that was both fascinating and underwhelming at the same time. One its many hallways held row upon row of people, men and women, with fancy names and fancier titles, many of whom had died over a thousand years ago. The emphasis was not upon the person,  but usually upon the title. The status, social and political, of each person in the hall was prominent. Their branding as leaders of their time was indelible after a Millenium. 

Another day trip took us to the foothills of the German Alps, where we visited two of Ludwig II’s castles. The jewel  that is Schloss Linderhof was a magnificent, gleaming country residence in an idyllic setting, where the Fairytale King spent two weeks out of a month on many occasions. On the outside, the house, grounds, gardens, fountains, pools, and snow-capped mountains in the background made for a truly lovely and pleasant setting. Then, one went in to see a lavish, over-the-top cacophony of color, crystal, swans, vases, meeting rooms, beds and canopies that at first looked regal indeed, then by the end of the brief walking tour became garish carnival parodies of themselves. I could see staying for days on the grounds, but I would have trouble spending even one full night in the porcelain confines of Linderhof. That castle was the only one that the Swan King would finish before his untimely death under suspicious circumstances.

Schloss Neuschwanstein was a bit better, again looking exactly like the inspiration that it was for the castle at Disneyland. Rising up from a steep elevation, it looks down upon an absolutely stunning vista of lakes, villages and mountains. It’s is the quintessential castle, which is exactly what the monarch wished it to be. Outside, it is a living tribute to the Middle Ages. Inside, it is a tangible tribute in wood, stone and fabric to the works of Richard Wagner. This magnificent castle even has a carefully constructed grotto within the building itself, a bizarre intermezzo in the walking tour of the grounds. 

Ludwig II once told his governess that he wanted to forever remain a mystery to himself and to everyone else. He spent all of his money on lavishness beyond comprehension, then kept himself isolated and aloof. He appeared to brand himself as a classical King, one who did not want to give up any of his power over Bavaria to the larger German state, but who knew that his magical style could not survive in the changing world of government. Even years after his death, his monuments to consumption, finery, and having the absolute best of everything do nothing to better explain his untimely death at age forty, by drowning, in mysterious circumstances. His brand now lives on in tour busses, picture posters, and plates of schnitzel in the restaurant that perches just below his most monumental castle. I’m quite sure he would be appalled, yet flattered, by the present day commotion.

Of course, the Monarchs and other rulers of old are not the only ones who have wanted to brand themselves. 

Look on any social media outlet nowadays and you can see an odd transition taking place in real time. 

Companies, easily recognizable brands, are advertising on Facebook, Twitter and Instagram as “people”, telling stores, having opinions, and making “friends”. These are ads, makes no mistake about that, but they are ads of the warm fuzzy kind that pull at your heartstrings and suck you in. 

Individuals, fearing that they are losing relevance and being lost in the chatter, are now turning themselves into brands. I have several friends who sing, write, create and dispense information. They do these things very well in fact. They are all trying in their own way to create an easily distinguished and recognizable brand of their own. Anything less that that nowadays, and one faces being lost in a cacophony of Internet noise only rivaled by the visual loudness of the peacocks and swans of Ludwig II’s castles. 

Seeing all of this from centuries ago, and now in our own time, makes me feel very odd. I do not want to run to the highest peak and isolate myself, like Ludwig did, and yet I do not want to market myself in ways that feel unnatural. I want to be heard, but I don’t want to sell out. 

I want to have less stuff.

I want to do more things, have more experiences. 

I want to help more people, even if that means the few people right in front of me in my clinic tomorrow. 

I want to leave a legacy of grace, gentility and benevolence. 

I know full well that I cannot control the world nor any of the people in it. I will not try. 

I would shun exhibitionism, amassed wealth, and influence.

I would like to live on by passing on ideas, kindnesses, and care.

I don’t think I need to turn myself into a brand to do that and be happy when I die.

What do you think, my friends?

Is branding good? 

Do you feel that you need to establish yourself as a recognizable brand to make a difference in this world?

That Guy (or Gal)

Who do you want to be, really? 

Do you want to be the person known for his work ethic, his energy, his stamina, his grace under pressure? 

Do you want to be the lady who makes the awesome cakes?

Do you want to be the only person in your circle who can ride a unicycle?

Do you want to be the person that others go to when they have a gut-busting secret that they just have to share with someone else?

Do you want to be the one with the fantastic sense of style?

Do you want to be the leader, the one everyone else follows?

Do you want to be the mover and shaker?

Do you want to be the innovator?

Do you want to be the destroyer?

Do you want to be the healer?

Do you want to be a friend?

Do you want to be a lover?

Do you want to be the one who’s always traveling?

Do you want to be the one who throws the most awesome parties?

Do you want to be the one they call Mom?

Do you want to be the one they call first?

Do you want to be the first to arrive and the last to leave?

Do you want to be the one who comforts others?

Do you want to be the one who always knows?

Do you want to be passionate?

Do you want to be strong?

Do you want to be tender?

Get out there.

Be that guy.

Be that gal.


Time Out

We are all caught on a treadmill of expectations. 

We have obligations to work, spouse, kids, church, friends. 

We love to watch TV, listen to music, read books and magazines, surf the Internet, email, text, talk, write, paint, remodel, clean, shop, eat, and socialize.

We sometimes even need to sleep. 

Add it all up. Numbers don’t lie, do they?

Most of our waking and sleeping hours are spoken for. We make some of these choices about how those hours are spent. Others are made for us, usually with our tacit approval. 

I would submit to you that we also need time to learn, think, train, assimilate, absorb, plan, assess, dream, commit, network and care. 

The main problem is, if we don’t schedule the time for this, and I mean hard schedule it, on your calendar, taking up a block of time, it will never happen. 

You must put yourself in time out. 

I mean it. 

Go into the corner (whatever that space is for you) and put your nose to the wall and block everything else out. Give yourself time for yourself. 

Think. Dream. Plan. Scheme. 

Because if you don’t take the time to do this, and you’re never sure where you’re headed, any old road will take you there. 

Don’t let the treadmill win. 

Get off.