Preventing Suicide

Preventing Suicide

It is a very difficult topic to bring up. However, when someone talks about suicide or brings up concern for a loved one, it is important to take action and seek help quickly.

What is suicide: suicide means that someone ends their life on purpose. However, people who die by suicide or attempt suicide may not really want to end their life. Suicide may seem like the only way to deal with difficult feelings or situations.

Who does suicide affect: About 4000 Canadians die by suicide every year. Suicide is the second-most common cause of death among young people, but men in their forties and fifties have the highest rate of suicide.

While women are three to four times more likely to attempt suicide than men, men are three times more likely to die by suicide than women.

Suicide is a complicated issue. People who die by suicide or attempt suicide usually feel overwhelmed, hopeless, helpless, desperate, and alone. In some rare cases, people who experience psychosis (losing touch with reality) may hear voices that tell them to end their life.

Many different situations and experiences can lead someone to consider suicide. Known risk factors for suicide include:

• A previous suicide attempt;
• Family history of suicidal behaviour;
• A serious physical or mental illness;
• Problems with drugs or alcohol; a major loss, such as the death of a loved one, unemployment, or divorce;
• Social isolation or lack of a support network;
• Family violence;
• Access to the means of suicide.

While we often think of suicide in relation to depression, anxiety, and substance use problems, any mental illness may increase the risk of suicide. It’s also important to remember that suicide may not be related to any mental illness.

Warning Signs. Illustration by Elena.

What are the warning signs

Major warning signs of suicide spell IS PATH WARM:

I – Ideation: Thinking about suicide.

S – Substance use: Problems with drugs or alcohol.

P – Purposelessness: Feeling like there is no purpose in life or reason for living.

A – Anxiety: Feeling intense anxiety or feeling overwhelmed and unable to cope.

T – Trapped: Feeling trapped or feeling like there is no way out of a situation.

H – Hopelessness or Helplessness: Feeling no hope for the future, feeling like things will never get better.

W – Withdrawal: Avoiding family, friends, or activities.

A – Anger: feeling unreasonable anger.

R - Recklessness: Engaging in risky or harmful activities normally avoided.

M – Mood change: A significant and brusque change in mood.

How can I reduce the risk of suicide?

Though not all suicides con be prevented, some strategies can help reduce the risk. All of these factors are linked to well-being.

These strategies include:

• Seeking treatment, care and support for mental health concerns – and building a good relationship with a doctor or other health professionals.
• Building social support networks, such as family, friends, a peer support or support group, or connections with a cultural or faith community.
• Learning good coping skills to deal with problems, and trusting in coping abilities.
• When a person receives treatment for a mental illness, it can still take time for thoughts of suicide to become manageable and stop. Good treatment is very important, but it may not immediately eliminate the risk of suicide. It is important to stay connected with a care team, monitor for thoughts of suicide and seek extra help if it is needed. Community-based programs that help people manage stress or other daily challenges can also be very helpful.

What can I do if I experience thoughts of suicide?

Thoughts of suicide are distressing. It is important to talk about your experiences with your doctor, mental health care team, or any other person you trust. They can help you learn skills to cope and connect you to useful groups or resources. Some people find it helpful to schedule frequent appointments with care providers or request phone support. Other things that you can do include:

• Calling a crises telephone support line;
• Connecting with family, friends or a support group. It can be helpful to talk with others who have experienced thoughts of suicide to learn about their coping strategies.
• If you are in crisis and aren’t sure what to do, you can always call 911 or go to tour local emergency room.

Some people find a safety plan useful. A safety plan is a list of personal strategies to use if you thing you are at risk or hurting yourself or ending your life. You can create a plan on your own, with a loved ones, ot with your mental health care team. Your plan may include:

• Activities that calm you or take your mind off your thoughts;
• Your own reasons for living;
• Key people to call if you’re worried about your safety;
• Phone numbers for local crises or suicide prevention helplines;
• A list of safe places to go if you don’t feel safe at home.

How can I help a loved one?

If you are concerned about someone else, talk with them. Ask them directly if they are thinking about suicide. Talking about suicide won’t give them the idea. If someone is seriously considering suicide, they may be relieved that they can talk about it.

If someone you love says that they are thinking about ending their life, it is important to ask them if they have a plan. If they have a plan and intend to end their life soon, connect with crisis services or supports right away. Many areas have a crisis, distress, or suicide helpline, but you can always call 911 if you don’t know who to call. Stay with your loved one while you make the call, and don’t leave until the crisis line or emergency responders say that you can leave.

The two most important things you can do are listen and help the connect with mental health services.

Listening

Here are tips of talking with a loved one:

• Find a private place or let your loved one take as much time as they need.
• Take your loved one seriously and listen without judgement – their feelings are very real.
• Keep your word – don’t make promise you can’t keep or don’t intend to keep.
• Tell your loved one that they are important and that you care about them.

Supports

If your loved one already sees a doctor or other mental health service provider, it is important that they tell their service provider about any thoughts of suicide they may have been having. Depending on your relationship, you can offer to help – by helping your loved one schedule appointments or by taking them to their appointments, for example.

If your loved one doesn’t see a mental health service provider, you can give them the phone number for a local crisis line and encourage them to see their doctor. Your loved one may also be able to access services through their school, workplace, cultural, or faith community.

Supporting a loved one can be a difficult experience for anyone, so it’s important to take care of your own mental health during this time and seek support if you need it.

If you need more help

Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area.

Founded in 1918, the Canadian Mental Health Association (CMHA) is a national charity that helps maintain and improve mental health for all Canadians. As the nation-wide leader and champion for mental health, CMHA helps people access the community resources they need to build resilience and support recovery from mental illness.

Visit the CMHA website at cmha.ca. Mental Health For All!

Thoughts of suicide are distressing. It is important to talk about your experiences with your doctor, mental health care team, or any other person you trust. Illustration: © Megan Jorgensen.

Placing Math on a Timeline

Placing Math on a Timeline

The study of numbers has been both practical and sublime for millennia.

Without numbers it would be impossible to set a clock, keep score, or create a symphony. If numbers had not been needed the civilizations of ancient Mesopotamia, Egypt and China would not have felt it necessary to invent counting systems, which they then applied to their commerce and government. An early appreciation for the principles of geometry helped the Egyptians construct the pyramids and accurately record their boundaries.

By the sixth century, B.C., the Greeks took the practical math that they had learned from the Babylonians and Egyptians and ventured into more abstract investigations. The Greek philosopher Pythagoras and his disciples proposed a theorem, for instance, that showed the mathematical relationship among the three sides of a right triangle.  Another Greek, Euclid, was the first to suggest that geometry possessed a single set of logical rules. Archimedes laid the conceptual groundwork for integral calculus in the third century, B.C., and the celebrated astronomer, Ptolemy, played a leading role in developing trigonometry.

Developing Space Maths. Illustration by Elena.

The Romans largely contented themselves with the use of math in solving practical problems, but the more ethereal inquiries into the nature of numbers championed by the Greeks were taken up by Islamic thinkers in the 9th and 10th centuries. One of them, an astronomer named Muhammad ibn Musa al-Khwarizimi, laid many of the foundations for algebra.

Beginning in the 11th century, Islamic advances in mathematics gradually made their way into Europe. But it was not until the Renaissance in the 15th century that Europeans contributed to the breakthrough, with astronomers such as Nicolaus Copernicus, Galileo Galilei, and Johannes Kepler making major contributions.

Working independently, Sir Isaac Newton, an Englishman, and Baron Gotfried Wilhem von Leibniz invented calculus in the 1680s, which effectively ushered in the modern age of mathematics.

Following is a ready reference to many of the most commonly used mathematical concepts and operations.

An early appreciation for the principles of geometry helped the Egyptians construct the pyramids and accurately record their boundaries. Photo: © Megan Jorgensen.

Psychological Attraction

Psychological Attraction

Studies have been done to determine what men and women find desirable traits in the opposite sex. Across the world, gender differences were found. Apparently, men value youth and beauty, while women rate partners’ looks and age as relatively unimportant. Conversely, women place greater emphasis on wealth and status.

Theorists have explained the discrepancy in terms of evolution. Given the much larger and demanding involvement of the human female in procreation than the human male, “sperm is cheap” while “eggs are expensive”. Although offensively blunt and morally repugnant, ensuring reproductive fitness meant for the male to mate with as many partners as he possibly could, while the female had to find the one worthy male who would stick around, protect her and the offspring and provide sustenance and shelter. Thus, the different sexes would have evolved different mating success strategies.

Whether one believes the claim or not, it has been used to excuse cheating behaviour. For example, when award winning actress Sandra Bullock’s husband Jesse James committed adultery, his mistress tattoo model Bombshell McGee stated the evolutionary view to defend his actions.

Other psychological theories of attraction involve beauty. Female beauty has been more often objectified than male handsomeness. The pursuit of the perfect appearance led to suffering on many occasions. In the West, there are young women and teenage girls who starve themselves to attain the impossibly thin ideal. In some African nations, girls are force-fed fatty camel milk in order to fatten them up. Otherwise, they would be considered unattractive. In one disturbing documentary, unwilling children were beaten to ensure the fattening food consumption. The whole is made the more deplorable when an Ethiopian supermodel recalls how she was shunned in her homeland for her (natural) waif looks.

However, there is some universal agreement on what makes a mate beautiful. In global surveys, the main characteristics that came listed for women were skin (clear, smooth complexion) and waist-to-hip ratio. The waist-to-hip ratio is the circumference of the waist divided by the circumference of the hips at their largest. If the ratio falls between 0.7 and 0.9, then such women are rated as the more attractive ones to men. Again, evolutionists cite survival of the fittest. A potential mate with clear skin is more likely to be healthy, while a woman with a particular WtoH ratio is presumably neither pregnant nor unable to bear children.

Body type ideals also exhibit several gender differences. Consistently, men appear more confident about their own bodies and prefer a slightly bigger female body type than women, who tend to fall prey to self-doubt and think that a thinner shape is wanted than actually is. Both sexes like symmetric facial features.

Psychological attraction? Illustration : Megan Jorgensen.

Remembrance Day

Remembrance Day

Remembrance Day, also called Veterans Day, Poppy Day or Memorial Day is a memorial day observed in Canada since the end of the First World War to remember all the Canadians who died in the line of duty in the throes of war and peacekeeping efforts. This day was designated by King George V in 1919 to be observed on 11 November to recall the end of hostilities of World War I on that date in 1918. The memorial evolved out of Armistice Day, which was held on the grounds of Buckingham Palace in London. Remembrance Day in Quebec is also referred to as Jour du Souvenir.

In 1918, hostilities formally ended at the 11th hour of the 11th day of the 11th month, in accordance with the armistice signed by representatives of Germany and the Entente, even when the First World War officially ended with the signing of the Treaty of Versailles on 28 June 1919.

Since 1919, honoring the men and women who sacrificed their well-being to protect ours, the 11th hour of the 11th day of the 11th month is recognized in silence across Canada. In addition to parades and commemorations across cities and small towns, all Canadian flags on federal government buildings are flown at half-mast and schools across the country observe at least a moment of silence at 11 a.m.

Many people wear artificial poppies on their clothes in the weeks before Remembrance Day. The red remembrance poppy has become a familiar emblem of Remembrance Day due to the poem In Flanders Fields.

These poppies bloomed across some of the worst battlefields of Flanders, and their brilliant red colour became a symbol for the blood spilled in any war. On November 11, special church services are organized. These often include the playing of "The Last Post", a reading of the fourth verse of the 'Ode of Remembrance' and two minutes silence at 11:00 (or 11am). After the service, wreaths are laid at local war memorials.

The official Canadian national ceremonies are held at the National War Memorial in Ottawa. A service is held and wreaths are laid by armed services representatives. In May 2000 the remains of a Canadian soldier who died in France in World War I, but was never been identified, were laid in the Tomb of the Unknown Soldier at the National War Memorial.

Since then, people have laid poppies, letters and photographs on the tomb. Similar services and events are held throughout Canada. Some schools that are open on Remembrance Day hold special assemblies, lessons and presentations on armed conflicts and those who died in them.

The federal government recognizes Remembrance Day in the Holidays Act as a national holiday, but not all provinces treat it as a paid statutory holiday. Its status varies by province.

Remembrance Day is not a statutory holiday in Quebec, although corporations that are federally registered may make the day a full holiday, or instead, designate a provincially recognized holiday on a different day. When Remembrance Day falls on a Sunday or Saturday that is a non-working day, workers are entitled to a holiday with pay on the working day immediately preceding or following the general holiday.

In Flanders fields the poppies blow

Between the crosses, row on row,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below.

We are the Dead. Short days ago

We lived, felt dawn, saw sunset glow,

Loved and were loved, and now we lie

In Flanders fields.

Take up our quarrel with the foe:

To you from failing hands we throw

The torch; be yours to hold it high.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields.

Remembrance Day. The red remembrance poppy has become a familiar emblem of Remembrance Day due to the poem In Flanders Fields. Photo : © Megan Jorgensen.

Thank you, Veterans. Photo : © Megan Jorgensen.

Lest We Forget. Photo : © Megan Jorgensen.

Cenotaph in face of the Old City Hall in Toronto. Photo : © Megan Jorgensen.

Delirium

Delirium

Information for patients, family and friends. This text will help you to learn more about: What delirium is, its signs and symptoms, how can it be treated, how family and friends can help, where to find more information or resources.

What is delirium?

Delirium (dih-leer-ee-uhm) is a condition which causes a person to become confused in their thinking. It is a physical problem (a change in the body), not a psychological one (change in how the mind works).

Delirium usually starts over a few days and will often improve with treatment.

Delirium happens more often in those who already have dementia or depression, but it is different in these ways:

Delirium happens quickly and then can disappear. It can come and go at any time. This does not happen with dementia and depression.

Patients with delirium cannot focus their attention. This is different from patients with dementia or depression.

There are two types of delirium:

1. Hypoactive delirium happens most often in elderly patients. These patients are often mistaken for having depression or a form of dementia.

Patients with hypoactive delirium may:

• Move very slowly or not be active
• Not want to spend time with others
• Hesitate when speaking or not speak at all.

2. Hyperactive delirium is easier to recognize.

Patients with hyperactive delirium can:

• Be worried or afraid
• Be restless (not able to stay still or have trouble sleeping
• Repeat the same movements many times
• Experience hallucinations (seeing something or someone that is not really there)
• Experience delusions (believe something that is not true)
• At times, a patient can have both hyperactive and hypoactive symptoms.

What causes delirium?

Delirium can be caused by:

• A physical illness: Changes to body chemicals, dehydration (lack of water) or an infection, such as a urinary tract infection, could cause someone who is ill to become delirious.
• Medications: Some medicines used to treat illness or control pain may cause delirium.

Remember: Anyone can become delirious when ill.

What are the signs and symptoms of delirium? Here come common symptoms and signs:

Disorganized thinking: Saying things that are mixed up or do not make sense

Difficulty concentrating: Easily distracted or having difficulty following what is being said

Memory changes: Not able to remember names, places, dates, times or other important information

Hallucinating: Seeing or hearing things which are not real

Having delusions: Thinking or believing things which are not true or real

Feeling restless: Not able to stay still, trouble sleeping, climbing out of bed

Changing energy levels: Changes from being restless to being drowsy or sleepier than usual.

Other things to know about delirium

A person with delirium may not be able to understand when people are trying to help them. They may become irritated (angry) with hospital staff and family. They may start to think that everyone is against the, or are trying to harm them. Some delirious people may want to call the police to get help.

Delirium is like being in the middle of a very strange dream or nightmare. The difference is that the person with delirium is having these experiences while they are awake.

Can delirium be prevented? Illustration by Elena.

How can delirium be prevented?

Medicine has focus on patient safety preventing delirium from happening to any patient.

Doctors carefully screen (check) patients for factors that may cause delirium. They then address these factors early to help prevent it. These factors include:

• Hearing problems
• Vision problems
• Not enough water in the body (dehydration)
• Not being able to sleep or other sleep problems
• Dementia, depression or both
• Having trouble in thinking clearly – reasoning, remembering, judging; concentrating, understanding, expressing ideas
• Difficulty getting up and walking around
• The medications being taken
• History of alcohol or recreational drug use
• Chemical changes or imbalances in your body
• Low oxygen in your body
• Other health conditions or illnesses.

 How is delirium treated?

• The healthcare teams at hospital will create a safe environment for the patient and help them stay calm.
• They will look into the cause of the delirium based on the screening factors and symptoms. Many times, there is no single cause.
• They will then address the factors and symptoms. This could include: reviewing and changing medications, providing fluids, correcting chemical problems in the body, treating infections, treating low oxygen levels.

What can family and friends do to help?

Patients, family and friends can all help to prevent delirium. There are also many things that family members and friends can do to help someone who has delirium:

• Talk with the health care team about any signs of delirium you see developing in your loved one. Use the signs and symptoms described above to help you.
• Make sure your loved one always has their hearing aid, dentures, and glasses close by, if needed.
• Use a calm, soft voice speaking to your loved one or when speaking with others in the room.
• Place a soft light in the room at night so that your loved one will always know where they are. Before bringing in any electrical items, check with the healthcare team first. Keep the window curtains open to help your loved one know if it is daytime or nighttime.
• Remind your loved one where they are, what time it is, the date and the season. If possible, place a large sign in their room or write this information on a whiteboard. For example, you could write: “Today is Thursday, January 22, 2015. You are at Toronto General Hospital.” This will help them to stay connected.
• Gently reassure them that they are safe.
• Encourage your loved one to drink fluids, but check with the healthcare team first if they have any fluid restrictions. Feel free to bring their favourite foods from home, but check first with the health care team about any foods they should not eat.
• Make up a schedule of family and close friends who will stay with your loved one day and night so they will not be alone. This will help them feel more secure, less frightened and calm.
• Bring familiar photos into the room or play familiar music softly in the background.
• Limit the number of visitors who come to see your loved one until the delirium goes away.
• Make sure to look after yourself and get some rest and relaxation. Go out for short walks, remember to eat, and drink fluids to keep up your energy level.
• It is not easy to be with a delirious person, even though you may understand the problem. It may help to share your thoughts and feelings with someone. Feel free to speak with the health care team.
• Try not to become upset about the things your loved one with delirium may say. Delirious people are not themselves. In many cases, they will not remember what they said or did while delirious.

Preventing delirium in the hospital: Clocks and calendars may help patients stay oriented.

With the right kinds of treatments, the delirium should go away or be greatly reduced.

There are many healthcare professionals who can support and help you during this time. Please feel free to speak with your doctor or nurse and any other member of the team, including the Psychiatry service, spiritual care of social work.

Who can I talk to if I have more questions or any concerns?

The healthcare team can answer any questions or concerns you have about delirium. Many helpful websites, articles, books can help you find more information about delirium.

With the right kinds of treatments, the delirium should go away or be greatly reduced. Illustration: Megan Jorgensen.