I saw this phrase in an article I was reading last week (sorry, I can’t remember the author) while preparing for last week’s blog on acceptance.  I thought it was kind of funny, if not a little corny, but even more funny was how it stayed with me during the week.  Every time I said the word “buts”, the phrase rang out, “Get off of your but.”  It helped me stop, take a second look at my thinking, and over the week, see how often I let myself off the hook so easily for acting positively on something I say is important to me.

Some of the things were little, like “I want to work out, but I don’t have time,” or “I want to eat healthy, but we don’t have anything good at home.”  Others were bigger, such as “I would love to go to Greece someday, but we could never afford it,” or “I wish I could be more like my colleague, but I’m just not as good a leader as she is.”  Every time I said the word “but,” it made me step out of my words and think – is this “but” an excuse or is this “but” my real choice?  Does it have to be all or nothing, can I do a little bit of exercise, or make some small step toward the desire?

Life is overwhelming and has a lot of limitations.  Money, food, time, energy are all finite resources.  How we choose to use them is really important and over time, ends up building to the significance of who we are and how we live our lives.  Each and every day we make so many decisions that it’s easy not to notice them.  One little decision does not seem to matter, but the decisions we make add up, and lead us to where we are.  I learned this week how easily I can get in the habit of derailing my valued actions by saying, “yes, but.”

So, I need to stop making excuses.  If I choose not to use my precious free time to work out, or if I choose to eat something not healthy, I need to own the decision.  And if I don’t have the money to go to Greece, I have to really ask myself how important that is to me.  If I really want to go to Greece, I can start saving and look for more the most affordable opportunities, perhaps forming a plan for the future.  “Buts” can come from many sources.  One type comes from pure laziness, BUT, others come from deeper places, like fear,  insecurity, sadness, helplessness, lack of control, or skill.  But, I am a victim if I let my world be ruled by my “buts,” which is why I liked this kitchy phrase.  It helped me step back and assess the truth of my assumptions and realize the comfortable pull of staying on our buts.

Last week’s blog contrasted the passive and avoidant experience of denial with acceptance, an active process of choice.  This week I’ve been thinking a lot more about these two experiences, and the complex relationship we humans have with our thoughts and feelings.  I see a lot of anxious people in my line of work, and tend to be a bit of one myself.  I am hardly in denial about things, as my anxious thoughts are quite active!  But these thoughts have the effect of controlling me and making me avoid things, just as denial can. When my mind tells me there is something to be afraid of (making a fool of myself in a presentation), it makes me want to run the other way (turn down the invitation to speak).  Though I’m not in denial, I still end up restricting my life through avoidance.  So this week, I decided to look a little closer at acceptance, to explore the paradox of how, at times, actually being less active in my thinking can lead to less avoidance in my behavior.

Cognitive fusion is a process that involves attaching a thought or feeling to an experience. Cognitive fusion is beneficial in many ways, like when we become interested in story lines in movies and books because we attach emotions to them, or we attach positive feelings to certain activities (hobbies) or people (our loved ones).  But when we fuse our negative thoughts with certain experiences, we begin to avoid those experiences.  So when I think of embarrassing myself through fears of public speaking, my fears are fused with the experience, and leads to avoidance.  

Ironically, the more we try to control thoughts and feelings, the more they tend to influence us in the long run in potentially harmful ways.  For example, have you ever tried to distract yourself from a unpleasant thoughts or feelings by binge watching or shopping?  Withdraw from certain people or opt out of certain activities because you don’t like the thoughts or feelings they bring up?  Have you tried blaming others, worrying, rehashing the past, fantasizing about “what if,” “if only,” or “why  me” in order to think your way away?  Or put substances in your body (ice cream, vodka, xanax) to get relief?  While they may have helped that day, what effect do they have over time?  Did the thoughts and feelings go away in the long run?  And what is the cost in terms of your health and vitality?

That is where acceptance comes into play.  Instead of trying to control our thoughts and feelings, we can “de-fuse” them.  If I think of giving a speech and get anxious, I can defuse this from the experience of being embarrassed and making a fool of myself.  By noticing my anxious feelings and accepting them, I can separate them from the outcome that leads me to avoid the experience and then in turn reinforces my feeling badly about myself.  

This type of acceptance involves developing a more compassionate relationship with our experiences.  As thoughts and feelings arise, the aim is not to control them by trying to stop them or change them, but to let them happen without letting them control us.  So I can be anxious, noticing my anxiety in how my hand shakes, how I feel a bit queezy in my stomach, but still go on and give the speech.  Who knows, the speech may go well.  I may embarrass myself or I may not, but I allow myself to be open to the new experience without making myself a prisoner of the past.  True acceptance is the ability to allow internal or external experience to occur instead of fighting them or trying to change them.  When we can accept our experience, we actually set ourselves free.

When we get some bad news or when something unpleasant happens, it’s normal to be in a state of disbelief.  After the shock begins to fade, our coping kicks in, and we begin to integrate and deal with the challenge we face.  But sometimes, unfortunately, people stay stuck, refusing to acknowledge an issue and along with it, its consequences.  This psychological state is known as denial, and in and of itself can create a host of problems.

Denial, as a long term strategy, is very problematic.  If we’re not able to acknowledge something, we’ll continue in a path that’s harmful to us, as well as block ourselves from doing anything to cope in the future.  If we deny our problem drinking or our smoking, we continue to do harm to our bodies, as well as prevent ourselves from getting the help we need to quit or even reduce the harm.  If we refuse to admit that we have an anger problem, we’ll not only hurt the people we love, but cut off from opportunities to repair the damage we’ve done and lose any chance to change our pattern to make things better in the future.

In the long term, reality always wins, no matter how we try to deny it.  And that’s why denial is so hard on relationships.  This aspect of denial is often overlooked when people in denial, or using denial’s close cousin, minimization, say, “it’s my body” or “it’s my decision,”  because it’s our loved ones that feel the responsibility and the consequences when we are in denial.  They worry, try to talk to us, and then feel helpless.  In  many ways when someone is in denial, it is the one who loves them who carries the burden of concern and fear.  And to make matters worse, a person minimizing or denying a problem will often react to the loved one’s efforts to help with blame.    It leaves a loved one with an unfortunate choice, continue to fight and confront, or go along with the denial, allowing it to continue in the effort to maintain peace.

It’s interesting to note that one of the biggest predictors of whether someone has a drug or alcohol problem is not the report of the person themselves, but if someone in their life has expressed concern about their behavior.  So please, if someone has the courage to express concern about you or a behavior you engage in, give it some thought.  We all have issues we prefer not to think about or acknowledge.  Being afraid and being stuck are part of being human.  But the difference between denial and acceptance is the key.  Denial is a passive response and with it is the avoidance of reality and then opportunities for coping.  While acceptance is an active process of making a choice to do what you can about the things you can control and accepting the things you cannot. Acceptance is a way of actively holding the truth rather than trying to run from it.

Most of us will face a situation in our lives where we feel helpless.  Whether it’s an unfortunate diagnosis for ourselves or loved one, an accident, or a traumatic event, when bad things happen it’s natural to be overwhelmed and become exhausted, feeling like every day of coping is like swimming alone against the current.  Personally, I have been feeling this way in response to my mother’s decline with her neurological degenerative disease.  Despite her best efforts at fighting the effects of Progressive Supranuclear Palsy, it breaks my heart to see her struggle to maintain her ability to swallow or speak even a single word at this point.  I had been feeling like we were both drowning.  Fortunately, I attended a conference in Phoenix this weekend, put on for patients and family members by the CurePSP Foundation.  What I received in terms of knowledge and connection has rejuvenated me, offering me support and resources, and a new perspective.  I share this with you this week in hope it might help someone else feeling beaten and helpless with their own struggle, whatever it may be, find a source of some empowerment.

Knowledge is indeed power.  While there is no cure to my mother’s illness, the series of lectures and presentations filled in many of the gaps I had, some I didn’t even know I had, in terms of understanding what was happening to her.  Some of the quirky behaviors I thought unique to my mother, I learned were actually not uncommon, and now understand why they happen.  In learning about the research of the cause of the disease, it relieved fears about heredity and the feeling she carried that she had somehow done something wrong to expose herself to the illness.  I came away with strategies for some of our challenges and a better sense of what to expect moving forward.  The knowledge I gained already is helping me to shift from helpless frustration to thinking about what I can do.  From little changes in how to interact with my mother to communicate more effectively, to resources that I became aware of, all the way up to the big picture of advocacy, I now have things I can do to help her, help me, and hopefully help others.  I can’t begin to describe the inspiration I got from the people I met, too far along in the disease to benefit from research, signing up to donate their brains for research when they pass.  Each expressed actual gratitude for the opportunity to do something beneficial.

The other incredible source of power I was able to tap into was the connection to others; a common humanity.  There was an immediate sense of intimacy when I walked in the room for the first time, seeing the wide eyed facial expressions (typical of the disease as a result of eye muscle issues), the canes, walkers, and wheelchairs, the bottles of liquid thickeners, and alarms going off to remind people of medication times.  I was able to hear the stories of many others with both similar and differing journeys.  It helped me actually appreciate that while my mother has had a long tragic decline, she has not had to endure hospitalizations from pneumonia or broken bones as many others had.  I felt a sense of gratitude, myself, at being able to share my accumulatd knowledge with daughters and sons whose parent was recently diagnosed.  I was also able to put the anonymous names of Board members on the CurePSP website together with faces, and hear stories of their own losses and motivations to serve.  I spoke with researchers, neurologists, social workers, and caregivers, all dedicated to understanding the illness, finding a cure, and improving the quality of life for themselves and others.

When struggling with a life changing event, it’s easy to become isolated and feel the burden is more than you can bare.  And it is true, because no one can do it alone.  We need others to help us stay afloat, to show us the way, and to follow behind us.  This weekend, thanks to the generosity of people who serve, people who study, people who donate, and people who share, I still feel the power of the raging current, but I have knowledge as a life preserver and others to float alongside with down the unpredictable bends in river.

Sad fact I learned: Dudley Moore, may his memory be for a blessing, died from complications of PSP.

What research shows is that sleep is actually a learned habit.  Our body develops sleep patterns that are easily disrupted with changes in schedules and stimulation.  Repeated nights spent worrying or tossing and turning in bed teaches the body to associate the bed with arousal and alertness.  To address the problem, we need to help our body “relearn” to associate the bed with relaxation and drowsiness.  Sleep experts refer to three types of “learning” that can help re-establish sleep patterns:  sleep hygiene, stimulus control, and sleep restriction.

Sleep hygiene involves creating a routine that will best enhance sleep.  Physically, we need to avoid caffeine 6 to 8 hours before our bedtime and avoid nicotine, which is also a stimulant.  Also avoid alcohol after dinner.  While alcohol can promote the onset of sleep, it often disrupts your natural sleep patterns, so you should avoid it up to 4 hours before you go to bed.  Regular exercise is really important to getting good sleep, but if done within two hours of bedtime, it can elevate your nervous system instead of relax it.   Your bedroom environment should be very dark, using dark out shades or eye masks can help, cool in temperature, and quiet.  White noise or earplugs are good for this problem.  Give yourself time to wind down before going to bed, and do the same routine each evening so that it becomes associated with sleep.  Avoid sleep medication.  Sleeping pills work only very temporarily and create sleep problems when used over time.  

Stimulus control involves the goal of reconnecting your bed with sleeping through learned association.  The bed should only be used for sleep and sexual activity:  no television, phone, computer use, or reading in the bedroom or in bed.  These activities, especially ones that involve a screen or stimulating material (yes, you Scandal fans) get in the way of associating relaxation with your bed.  Also, you should delay going to bed until you are sleepy.  If you don’t fall asleep relatively soon, get out of bed and return when you are drowsy.

Sleep restriction is also about training your body into patterns of healthy sleep.  It involves restricting the amount of time you spend in bed to the amount of time you currently spend actually asleep.  Research shows sleep restriction to be extremely effective for improving sleep, even though initially you may experience mild sleep deprivation as a result of the technique.  Sleep restriction involves calculating and keeping track of your sleep efficiency, which is the percentage of time you are actually asleep during the period of time you are trying to sleep.  For example, if you usually go to bed at 10 pm and wake up at 6 am, you are in bed for 8 hours.  Of this time, it takes you an hour to fall asleep, you wake for 30 minutes in the middle of the night and are up 30 minutes before you get up.  So, your actual sleep time is 6 hours of the actual 8 hours you are in bed, so the sleep efficiency is 75%.  Sleep restriction would mean reducing your time in bed by 2 hours.  You could either go to bed late, or get up earlier.  After sleep efficiency reaches 85% or greater, the time in bed can be increased in 15 to 20 minute blocks.  Time in bed is increased each week if you achieve 85% or greater.  The pattern is continued until efficiency starts to fall below 80% at which time you decrease sleep by 15 to 20 minute blocks.  You continue the process of increasing or decreasing sleep time by 15 to 20 minute blocks until sleep efficiency falls between 80 to 85% on a regular basis.  This is usually achieved in just a few weeks.

When people have sleep problems, the mere anxiety about sleep can be stimulating and make it difficult to get to sleep.  When you go to bed afraid of what the night will bring, you reinforce the wakefulness and alertness.  Before going to bed, try listening to a relaxing visualization that you can download from a meditation app, or just listen to soothing music.  You can listen to a classical music piece and pay attention to one instrument at a time.  This is mediation without having to even focus on meditation.  And if all else fails, try listening to a book on tape about a subject that doesn’t interest you. Personally, listening to tax advice tends to do the trick for me!

Before handing back a very challenging Spanish test, my daughter’s teacher gave them a handout entitled “Eight Reasons to Celebrate Mistakes.”  While my daughter and her classmates were not so amused, I, as her mother, appreciated the intention.  We live in a culture that values success and winning so much so that we lose sight of the process of learning and put tremendous pressure on ourselves to always be “right.”  When we put so much emphasis on avoiding mistakes, we lose sight of the learning and can become paralyzed, afraid to take any chances.

I wish we had a better word than “mistake.”  According to the dictionary, it means “an action or judgment that is misguided or wrong.”  I often wish we could call them “learning efforts” to avoid the judgment.  Especially when it comes to the bigger efforts of living, such as talking a new job, moving to a new place, or ending a relationship.  How often I hear people berate themselves for making such a “huge mistake,” discounting the courage of taking a chance and the experience obtained from trying something new.

So often we value and applaud “change” but set ourselves up by expecting that every change has to be for the better.  If things don’t work out as planned and hoped for, we often go beyond disappointment to the burden of shame.  How painful that is and often how unnecessary.  Sometimes we do make mistakes that require us to apologize or even feel guilty or ashamed, but these are situations that involve moral failures, or true lapses in our judgment, when we act on impulse or in a selfish manner.  These are the times we most certainly must make amends and acknowledge our error.  But I often see people generalize the notion of a mistake to a choice that was made with the best of intention.

In order to avoid mistakes of living, we would have to avoid taking any chances.  And the point of the hand out the teacher was trying to make was that learning happens through mistakes.  We try and we get feedback.  Feedback is how we learn not only Spanish, but also about ourselves.  It is the feedback that is the key to self awareness.  Sometimes we  try something new to see if we can expand our capacities, such as building the stamina to climb the mountain, or go to a group to learn how to tolerate the desire to drink.  And other times we try something new to see if it is a better fit for us, such as dating a new person or taking a job in a new environment.  Regardless of the outcome, which is seldom so black and white as being “right or wrong,”  we grow and change through the effort.  If we can avoid the embarrassment and the judgment, we can embrace the learning and the experience of expanding ourselves.

I love that the Spanish teacher walks her talk.  She gives the students a chance to re-submit their test with new answers.  The point is to use the feedback.  When we see the player score the touchdown or the musician accept the grammy, we only see the tip of the iceberg.  Ask anyone who has had success to tell you about the effort it took to get there and the non-successes it took along the way.  And then, after their moment of fame, they have to go out and start again, putting themselves out there with the chance that things won’t go as well the next time.  Learning to live with risk is the only way we can move forward.  So, instead of hanging our head in response to a mistake, why not celebrate the chance to learn?

I love texting and being able to shoot off an email late at night when it’s convenient for me, so I am truly not one of those anti-technology people  My iphone is almost always with me.  But as a person who also spends a lot of time analysing and working with communication, I have observed some real consequences that you might want to think about before you hit send.

Only 7% of human communication is through the content or words of our message, according to UCLA researcher Professor Albert Mehrabian.  The majority of communication is through sight and sound:  58% through body language and 35% through vocal tone, pitch, and emphasis.  Think about any sentence you can utter.  By using a smile or a scowl, a friendly tone or a sarcastic one, you can completely change the meaning.  This being the case, it is no wonder how often miscommunications happen with texts or emails.  It is truly a terrible way to create understanding and resolve an issue or settle a dispute.

In fact, I find that people often use these forms of communicating to, maybe without even realizing it, avoid resolution, or at least sabotage it.   By using email, we often say things we wouldn’t say face to face.  We don’t have to be in the presence of the person and deal with the response. We can protect ourselves from the other person’s distress, whether it’s anger, hurt, or strain in their voice.  When we type and send, we remain in control of the conversation.  While it feels powerful, it can also be a form of manipulation, especially if you don’t offer a follow up of a phone conversation or in person meeting to attend the other person’s point of view.

I often wonder if this is one of the factors contributing to our countries divide and people’s increasing sense of isolation.  When we can “say” things without consequence, limit actual dialog, and “share” a rant on facebook, we have no chance of finding common ground or creating understanding or at least connection.  In fact, when we express our anger by email without a follow up of conversation, it might feel good in the moment to tell someone off, but in reality, we leave ourselves in a place of victimhood.   It makes sense that over time a compounding of this victimhood could slowly erode our sense of connectedness and our capacity for intimacy and mutuality.  It takes courage to tell someone how you feel, especially when you are hurting.  But to do so in a vacuum robs you both of the profound grace and healing that reconciliation can create.  There is no substitute for hearing the words “sorry” and feeling arms around you in an embrace.

On the other hand, sending a text is so easy, it can create a false sense of connection and intimacy.  A woman I worked with was falling in love with a man she thought was so caring.  He texted her early each day to say good morning and throughout her day to say he was thinking of her.  But the truth was, when it came time to showing up for her when she needed help, a text was all he had to offer.  And he was offering it to more than just her, she came to find out!

I know that I personally have become lazy.  I use technology too often in place of conversation.  And in some cases, emails and texts do provide a great way to stay in touch and keep a connection with people I rarely can see, especially when we live in different parts of the country or world.  A clever phrase or aptly chosen emoji can bring a lot of humor into my day.  But we should all remind ourselves, that for anything nuanced, complex, or difficult to say, 7% is not using our full tool box for effective communication.  And if we find that we don’t want to say something in person, just as Thumper reminds us, we might best not say anything at all.

I came across a phrase this week that I wanted to share, as it describes an inspiring phenomena that I have been fortunate to witness, especially this past year.  The term is “post traumatic growth” and according to the research group who named it, it refers to a “positive change experienced as a result of a struggle with a major life crisis or a traumatic event.”  

According to the PTG researchers at the University of North Carolina, post traumatic growth tends to come in five general areas.  Some people who go through a major life crisis realize that opportunities emerge through the struggle, creating new possibilities that were not available before.  Some people find their relationships change, making them feel  closer to specific people and a greater sense of connection to others who are hurting.  A third area of change possible is an increased awareness of one’s own strength, developing a confidence from surviving something traumatic.  A fourth area is a greater appreciation for life in general, and a fifth is a deepening of spiritual awareness.  This shift is not necessarily in expected ways, as sometimes people experience a significant change in their belief systems as a consequence of a deepening spiritual awakening.

Distress and significant pain come with crises and unfortunately, few of us can avoid the inevitability of some type of major life event.  If we are living and loving we will face loss and random misfortunes that create physical and/or emotional chaos.  In no way is anyone implying that traumatic events are good, for I wish no one ever had to have have one.  But I have noticed and been tremendously moved in watching people come through a tragedy with new insight or skills that can have a positive effect in their lives.  I have witnessed friends suffer through cancer and treatment only to express deep emotional healing from the experience as it brought up many areas of their lives that needed attending to.  I am working with a woman who became homeless, literally having to sleep in her car in order to keep her cat.  She shocked me when she came in smiling, telling me that her back pain was much better since she was sleeping in an upright position, and that she in many ways hadn’t felt so good in a very long time.  She is going to get a special bed, she tells me, when she gets back to having a home.

Just as we can’t predict when a tragedy will occur, or how we will react to it, it makes me feel hopeful to know that suffering and growth are not mutually exclusive.  If I have to go through a horrible event, at least I can know that I can both suffer and experience positive change through the process.  As we support friends and family overcoming something difficult, it might help us to feel less helpless to know that people can and do experience positive transformation in a profoud way.

I like to think of Valentine’s Day as a celebration of love of all kinds.  Besides Eros, which means passionate love, Ancient Greek had three other words for love:  philia refers to the love of friendship, storge refers to familial love, and agape refers to selfless love or charity.  So even if you are not in a romantic relationship this year, take inventory of the love you do have and know that experiencing love is actually good for you.

It’s so important to remember that love comes in many forms.  This helps stave off the blues when you are not in a relationship and takes the pressure off of your romantic relationship if you are in one.  The happiest people report love of all kinds as being key – love of nature, love of learning, love of friends, and even a love for loving.  Incorporate love into your life.  Reach out to hug and hold hands with people. (This brings an instant mood boost.)  Look for opportunities to be playful with the people around you – laugh, dance, sing.  This tends to increase your connections and makes people feel closer.  Even something as simple as smiling at someone can make you both feel good.  Doing something kind for someone else and showing love is always the best way to ensure more love in your own life.  The more love you give, the more they you to receive.

Researchers lucky enough to be studying loving feelings have found many benefits.  Love actually creates happiness by causing the production of norepinephrine and dopamine in your brain leading to increased feelings of joy and pleasure.  Love helps boost self-esteem, leading to engaging in activities that contribute to better nutrition and decreases unhealthy lifestyle choices.  Feelings of love can lower the production of the stress hormone, cortisol.  In fact, love encourages your body to produce oxytocin, the “bonding” or “love” hormone that reduces overall stress, improves immune functioning, and decreases cell death and inflammation!

And don’t forget yourself.  It is hard for people to love you if you don’t feel you deserve it. Being able to receive love is an important part of psychological health.  Treat yourself like you would treat another person you are deeply in love with.  You are the best person to make you feel loved!

1-800-273-TALK (8255)  SUICIDE PREVENTION HELP LINE

Having worked in community mental health for three decades, I see a pattern each year.  Beginning in early February we get more calls and more people presenting with suicidal thinking.  Research shows that spring, rather than winter,  is the time that most people attempt suicide.  That is the bad news.  The good news is that people are coming to us for help.  Because of this important trend, I felt it important in this week’s post to share some information about suicide prevention.  Given that at any time approximately 25% of the population is suffering from depression, someone you know and love may be at risk.

According to Diane Sprice, the director of Suicide Prevention Services of the Central Coast, “The myth is that Christmas is the most high risk time for people to become suicidal, but it is actually springtime.”  Brice cites relationship troubles as the most frequent reason people call the suicide help line, followed by financial insecurity.  A Missouri hotline reported roughly 200 more calls on Valentine’s Day each year.  Once we get through the stress of winter, and the holiday, Brice says, “February comes and you’re supposed to be in love and you’re supposed to feel better…that’s when it gets really difficult for people, because of the expectation to feel better.”

For those who are lucky enough to have never experienced depression or suicidal thinking, it is very hard to understand why someone would think this way.  Especially when people externally seem to have success and so much to live for.  But depression has a way of distorting people’s thinking, bringing about a severe sense of hopelessness and despair that seems unending.  Thoughts of suicide are not a way of getting sympathy or attention, but a desire to end physical or emotional pain.  Most people who attempt suicide do not really want to die, they just don’t see any other way out of their suffering.  They actually convince themselves that others will be better off without their burden.

Only half of all Americans experiencing an episode of major depression receive treatment according to the National Alliance of Mental Illness.  They may be too hopeless, fear the stigma, or not have easy access to care.  The good news is, however, that 80 to 90% of people that seek treatment for depression are treated successfully using therapy and/or medication.  (This is what makes my work so rewarding!)  Therapy can help people find new ways to approach their problems and give people a sense of agency again while giving them a safe place to talk about their feelings.  Antidepressant medication can work on brain chemistry that has been affected by chronic stress or depression.

Some of the warning signs that someone is considering suicide are:  expressions of hopelessness, risk taking behavior, substance abuse, personality changes such as withdrawal, a lack of interest in the future, giving things away, lack of interest in future planning, and statements such as “you’d be better off without me.”  If you think someone is at risk, trust your instincts.  Talk with the person about your concerns, listening with empathy and a non-judgmental attitude.  Ask direct questions, such as if they have thoughts of hurting themselves and if they have a specific plan.  The more detailed the plan, the greater the risk.  Remove any means of carrying out the plan, such as medication, guns, or knives.  Never swear to secrecy or act in a punitive manner.  Even if the person resists, get professional help.  Remember and remind the person, suicidal thinking is a symptom of depression, not a personal failure.

Some Statistics:

• Suicide is the eighth leading cause of death in the United States, accounting for more than 1% of all deaths
• More years of life are lost to suicide than to any other single cause except heart disease and cancer
• 30,000 Americans die by suicide each year; an additional 500,000 Americans attempt suicide annually
• Suicide rates are highest in old age: 20% of the population and 40% of suicide victims are over 60. After age 75, the rate is three times higher than average, and among white men over 80, it is six times higher than average
• The highest suicide rates in the U.S. are among Whites, American Indians, and Alaska Natives
• Females attempt suicide three times more often than males, but males are 4 times more likely to die by suicide, as they tend to use more lethal methods such as firearms.
• An estimated quarter million people each year become suicide survivors.