Depression And Suicide In SL Part 4 - Road to Recovery – Talking to Voice Restless © - Orchids Reports…

        Talking to the Two sides of … the Same Voice. Shadow and light are two sides of the same coin. One cannot exist without the other…

-Princess Zelda

There are two sides to all of us. We let the world see one side and one we don’t. Even the most open and honest one definitely has something … yes … something that you do not let the world see. You don’t lie but you do hide. The one who treats us, the physician, is also fallible. The person who rises out of those fallacies and sets out to help and the others, is one who has understood the true meaning of life. This is for all of you there who are doing so.

Professional Voice:

Orchids: Voice Restless in RL…

Voice: I'm a Clinical Neuropsychologist in training, hoping to get my degree somewhere in the coming year. I have always been fascinated by what is 'normal' and what is considered to be a 'psychiatric disorder', Where do you draw the line, when approximately 80% of the population comes into contact with a psychiatrist at least once in their lives? When are psychological problems 'normal' and when are they 'clinical'? And, more importantly, how can you help people when they suffer from psychological problems?

Orchids: Voice Restless in SL…

Voice: Here in SL I'm a carefree and fun-loving girl with a fascination for people and all their strange little habits and amazing minds. While I am quite the same in real life, I take it a step further than I do in SL.

Orchids: Much has been covered about depression in the earlier talks.  Is there anything else that we may have missed?

Voice: In general, there are 2 forms of depression that can be clinically diagnosed, and a few 'subcategories'.

The first is called 'dysthymia', and it is simply said a milder but more permanent form of depression. A lot of people underestimate this - it is however extremely draining and devastating to have to deal with loss of pleasure in life, depressed feelings and feeling of uselessness day in day out, sometimes for years at a time.

The well known form is depression, where a person has depressive episodes that last between 2 months and 6 months, is called Major Depressive Disorder. This is more generally more intense than dysthymia, and often goes hand in hand with suicidal thoughts / tendencies. Depressive episodes can be caused by an event, making it an 'reactive depression', or come from the inside, an 'internalized depression'.

Depressive episodes caused by seasonal changes are called Seasonal Affective Disorder.

Depressive episodes can also include psychotic symptoms, such as hearing voices or seeing things that aren't there. That's called a Psychotic Depression.

There's also a combination of the two - it's sometimes called 'Double Depression', though that is not an official diagnosis. This means that people suffering from this experience periods of deep depression, and suffer from mild depression between those periods.

People can also experience depression as a part of other mood or personality disorders. For example Bipolar Disorder, where periods of manic behaviour alternate with depressed episodes, and Borderline Personality, where people suffering from it can feel very unsure and worthless, thus causing depression.

Orchids: Thank you. I think that adds on to the pile of the various aspects of depression and the human mind.  Can you tell us about your experiences?

Voice: Usually it's the little things that make the biggest impressions. I did my first internship at a Psychiatric Hospital with severely ill elderly people. There was one man who had to stay in the isolation room for a few days after he was admitted, because he was suicidal. He felt utterly useless, failed as a human being. He was no longer in touch with his two daughters and thought he had failed as a father. The nursing staff is usually very busy, and there was no time to really sit down and talk with this man.

So I stayed after my work hours and sat down on the other side of the door. We talked, for over 3 hours. I asked him about his life, his family, and eventually he told me about his children, as well.

I told him a bit about my life, when he asked. I explained I understood how his daughters felt - my own mother is addicted to alcohol and no matter how much I love her, I cannot deal the pain it causes me. I made a point of telling him I was sure his daughters did love him and that his life had not been a waste. I'm not sure how much it helped, in the end, but he slept that night. For the first time since he got there, 3 days earlier, he slept, and I felt amazing to have been able to do that for someone.

Orchids: Yes, truly. It is difficult as a professional sometimes to give the time for that human touch and it must have given you immense peace. Do you feel that as a neuropsychologist, you contribute in SL in any manner?

Voice: To be honest, I think one of the most important things of being a psychologist is listening to people. I don't give advice often - I just listen and ask questions. Sometimes I offer new perspectives. For most people who are having a bad day, a bad breakup or a bad whatever, that is enough.

For people who actually suffer from a mental disorder, I'm not sure it is enough. It depends on how well they can deal with it themselves, how much therapy (if any) they have had, what point in their life they're at. There are so many factors to take into consideration.

The one thing I always try to do is educate people on mental disorders. I tell everyone not to be ashamed, not to feel like they're worthless or less than others because of it. You wouldn't treat someone with a physical disorder like that - why would you do it to someone with a different kind of disorder? I explain about the different disorders to people who ask, and I try and advise them honestly if they feel like they need professional help. That's all I can do in this virtual world.

Orchids: Your opinion on virtual worlds helping people with depression/suicidal tendencies....

Voice: I do think that, to a certain extent, people can be helped through virtual worlds. If you're looking for information or actual therapy, I think SL is seriously lacking, though. For that I wouldn't recommend it. The same goes for people who are very trusting or vulnerable - in this virtual world, they are easily and often taken advantage of.

However, people who are depressed or have suicidal thoughts / tendencies often feel disconnected from the world. They live inside their bubble of misery and can't see beyond that. Virtual worlds can help them to find people to talk to, share with, have meaningful friendships.

On the other hand, SL can be a lonely place when you don't know anyone here, and any sort of relationships here in SL don't tend to last long, though there are exceptions. I guess it really depends on the people you happen to meet, whether or not SL will help you with the feeling of being isolated.

Orchids: Do you think SL can substitute for RL counseling or is it just a temporary stop-gap before going RL?

Voice: Oh, it really depends on all those things I mentioned above. I think that, as a sort of 'refresher course' or peer support group, it can be very effective. You will need a good psychologist to guide the group, and make sure the group is going in the right direction.

However, I don't think it can ever replace face-to-face counseling. With a lot of different therapies, communication is key. You get homework assignments, you think about the big questions and you try and change an essential part of your make up. It's not easy, and I believe the anonymity of virtual worlds may cause people to drop out of those programs. The sad but true fact about therapy is that it is hard work; a psychologist isn't going to fix things for you - you are going to have to work up a sweat trying to fix them yourself.

Orchids: A comment on the television series (Lisa Kudrow one...) It deals with short web counseling sessions... Does it work in your opinion? Can something like that be done in SL?

Voice: Web counseling has, I think, the same 'problems' as SL counseling. The anonymity can give people the feeling of safety, being able to share and talk. On the other hand, the anonymity makes it easy to drop out. It's a difficult debate, and I think it really depends on both the therapist and the person needing help how it turns out.

Orchids: How do you deal when approached for help from someone who seems depressed / suicidal? Your Professional insight and layman’s advice..

Voice: I tell them I'm willing to listen and offer insights. I can give information, advise on what to do (sometimes, people really need RL help and I do tell them to go see their GP) and listen to their stories. When someone is suicidal, I do try and find out if they would really do it. Indicators that someone will go through with it are, amongst others, previous attempts and concrete plans.

But there is something people have to understand - I am in SL in my spare time. In my spare time, I am Voice; it's a time for me to relax. While I am more than happy to have deep friendships and share about myself and share in others lives, I do not have office hours here. I am who I am and what I am, but I don't like to feel obligated to help people - it's not a good feeling for myself and it's not a good feeling for others.

That's what I want to tell everyone who is approached by someone needing help. You are here to relax, first and foremost. It's is great if you want to help someone, and by all means, do so to the best of your abilities! However, make sure you set limits on what you are comfortable with and don't be afraid to tell people if you cannot handle their problems, if it becomes too much for you.

Other than that, I would say that people are actually depressed and / or suicidal, probably can't be helped by someone who is not a therapist. Research proves that people who suffer from depression are best helped by a combination of anti-depressants and cognitive behavioural therapy. You cannot provide that. Be sure to keep in mind your own limitations.

Orchids: That is an honest approach and the way it should be. If you do not keep limits for yourself, you are sure to burn out. How does one find out that one might be depressed/ have suicidal tendencies?

Voice: Depression can be very different in different people. One person feels tired, absolutely exhausted. Another may feel like nothing is fun, anymore. Some people cry all day, unable to stop. That is why I always recommend getting a diagnosis by a health care professional. Yes, there are lists of symptoms on the internet - but it's not as easy as it seems.

I think suicidal thoughts are easier to recognize - you find your mind wandering off, thinking about death, or less directly, maybe thinking about how the world would be different if you weren't there. Suicidal tendencies can be very sudden, or subconsciously express themselves. For example, you have no plans to commit suicide, but when you go to take an aspirin, you suddenly feel the urge to down the whole bottle. It can be quite startling, and if you have trouble repressing this urge, please, please go see your GP. He or she can help you find the right person to talk to.

Orchids: What is the most common age group?

Voice: Depression can strike in any age group.

Orchids: Are there gender differences in depression?

Voice: Depression has a distribution of about 50% women, 50% men.

Orchids: Postpartum Depression (PPD)……..

Voice: I haven't come across any, but they can definitely have suicidal tendencies. They can be people who have suffered from depression for longer periods of time, but it can also be their first depression. Women with PPD often feel overwhelmed with guilt about not being able to care for their newborn in the way they feel they should, which in turn contributes to the depression. The most important thing is to tell them, it's ok. This is where you are now, and it happens to a lot of people. It doesn't make you a bad person or a bad mother - it's something you need help with, and there's no need to feel ashamed or guilty about that. And again, please, please advise those women to go see their GP.

Orchids: Depression in later life………

Voice: Depression in later life is a tricky one. Elderly people can suffer from depression, just like anyone else.

However, it happens more than you'd think that people get depressed as they stop working. When you think about it, it makes sense - for, say, 50 years, your job was the reason you got up in the morning. It's often where you get the most social interaction and where you meet people. Your life can feel very empty without it, suddenly.

Also important to keep in mind that depression can be a symptom of other (age-related) illnesses, for example Parkinson’s Disease and Dementia. This makes the diagnosis harder to do for elderly people, but all the more important to get it right!

Orchids: What efforts are underway to improve treatment of depression?

Voice: The biochemical causes of depression are fairly well-researched. That means that neuroscientists know what happens in the brains of people who suffer from depression. With this knowledge, more and more research is done to improve anti-depressant drugs, work better.

There are, however, other therapies gaining ground fast. One of those is 'activation therapy'. People who are depressed are often unable to activate themselves, causing them to stay in bed all day, or hang on the couch. Activation therapy means getting people out and about again, helping them to break the habit of staying home all day.

Sport is also a great way to help with depression. The reactions sport causes in the brains, are similar to the effects of anti-depressants. And really, sport doesn't have to be the traditional gym-class. It can be walking, hiking, cycling or maybe even a team-sport, of people feel ready for that. This kind of treatment is quickly becoming more and more popular, mostly amongst people who don't respond well to medication or can't or don't want to use it, for whatever reasons.

Another fairly 'new one' is light therapy. At first it was thought light therapy would also have with Seasonal Affective Disorder, but it's been proven to help with 'normal' depression, as well. Using a daylight lamp for about 20 minutes in the morning has a positive effect on depression - I won't go into details, but I'm happy to provide articles for those who are interested.

Orchids: Can depression be resistant to treatment?

Voice: Yes, in rare cases it can be. When people are severely depressed, therapy is often hard to do, because people don't have the energy. They can feel very empty and passive. If medication doesn't help to relieve just enough to be able to start therapy, it makes for a very tough case.

In the psychiatric hospital where I did my first internship, they used Electro Convulsion Therapy (ECT, also known as Electroshock therapy) to treat treatment-resistant depression. Now I know this sounds scary, but the methods have come a long way since the scary stuff we see in movies. You can compare it to rebooting your computer when you have vague errors after it's been on too long. It resets all the processes, which often fixes the problem. That is what ECT does, basically. Resetting all the processes in the brain. It's seen as a last option, because ECT can cause minor memory loss, which is not desirable. Currently, there is a large study going on with medication which may protect against the memory loss.

Orchids: Have you seen incidents where an Avi was taken advantage of because of his/her depression?

Voice: Yes, I have. People who are depressed often crave human contact. If depression is combined with low self-esteem (which often is the case), people are willing to do things for others they really don't want to do, just to not lose that person. There are predators out there.

Orchids: What are the best resources in your knowledge for help for depression/suicide?

Voice: There's a lot of information out there in the internet. It's not always correct. Personally, for information about depression, I'd look it up in the Diagnostic and Statistical Manual of Mental Illness - the DSM; the book health care professionals use to diagnose mental disorders. A website I personally find pretty good and accurate is http://allpsych.com/disorders/index.html.

Information about suicide is harder to get - I'd recommend asking your GP or looking for personal stories, if that's what you're looking for. If you're looking for more scientific type of information, I found the Suicide Risk Assessment Guide very informative: http://www.mentalhealth.va.gov/docs/Suicide_Risk_Assessment_Guide.doc ‎

Of course, the best sources for information are also scientific articles. You can use Google scholar for that - it uses your keywords to search for scientific articles. Even if you can't always read them (you usually need licenses for that) you can always read the synopsis, which often gives a lot of information, as well.

Personal Voice:

Have you suffered from depression/suicidal thoughts or had somebody personal go through it? What did you do to overcome it?

Voice: I was diagnosed with Double Depression - dysthymia and major depressive disorder - at a very young age. I also suffered from panic attacks, Obsessive Compulsive Disorder and I have been suicidal; I have two suicide attempts in my past. I am now at a point in my life where I am very, very relieved both my attempts failed. Even though I still have bouts of depression occasionally, I do enjoy life, quite a lot.

Depression is partly hereditary and it's common in my family, as are other psychiatric disorders. I've found that for me, causes are mainly biological. Using anti-depressant medication has helped me a lot - I wouldn't have gotten where I am without it.

I've done practically all therapies that are available, and in the end, I learned one thing. Only you can help yourself. You know your body and mind like no other. You need to look at a therapy, critically, and decide what you can learn from is, what you can take home from it.

I know I have limited energy for certain periods of time and I make sure not to overwork myself. I try to be a little nicer than I usually am for myself, and give myself the rest and time I need to recover. I know that when I overwork myself, I am more vulnerable to depression, so I try not to. I set priorities and stick to them. It's taken me a while to learn how to do that, but it works very well for me.

Orchids: Have you felt overwhelmed anytime?

Voice: Gods, yes. I had panic attacks during my worst depressions, and I've been known to sit on the floor of a supermarket, crying my eyes out. Or in my kitchen floor, curled up into a ball. But hey - I made it through that, too! You are always stronger than you think - believe me on that.

Orchids: Has anything surprised you?

Voice: *smiles* No.

Orchids: What mistakes have you made?

Voice: I have lost sight of my own limits a few times. I tend to care for people a lot, and there is such a things as caring too much. That's why I would advise everyone to stay inside their comfort zone.

Orchids: How do you distinguish the one genuinely suffering from depression/suicidal feelings and the one who is just seeking validation or self pity?

Voice: I’m found that people who are depressed usually don't put themselves in the spotlight. They probably won't tell you how they are feeling, and when you ask them how they are, they'll usually just say 'Fine, thanks'. People who have suicidal feelings, thoughts or tendencies, don't often tell others about them. They can be afraid they'll be judged, or afraid to scare others. Also important that people tend to feel it's not 'really there' as long as they don't discuss it with others - suicidal feelings and thoughts can scare the person having them, as well!

Someone seeking validation, or wallowing in self-pity will generally search for attention. It's not foolproof, but that's usually how I distinguish. Keep in mind though, not everyone is the same. A person seeking validation can also be depressed.

Orchids: Can you give any encounters where you had to face such problems and how did you deal?

Voice: Sometimes, people just start sharing. I've had it happen a few times - out of the blue someone I hardly know tells me quite personal information. I tell them I don't feel comfortable. When they don't understand, make a scene or continue, I block them.

You have to protect yourself, at some point. Don't be ashamed of that!

Orchids: What would you like to tell the ones who have depression and are reading this?

Voice: Hang in there. I know how hard it is. I suffered through it. Find help - you cannot do this alone. Don't be ashamed - why would you be? You are not weak. You are not broken. You have an illness and you deserve treatment, just like any other person with an illness. You can make it. You a probably stronger than you could ever imagine. Ask for her. You are worth it.

Orchids says:

·         There are times when you feel the fight has gone out of you. Forget the 100…1000 reasons why it isn’t going to work…. Believe in the one reason that makes you think it will work…..

·         Iatrophobia, or fear of doctors… find out if you have it. Don’t let fear control you. There are good and bad ones just as there is light and dark in this world. You will find someone who takes it slow and understands your pace.

·         Compensate and appreciate him/her for their efforts in rising out of their own problems and attempting to help. How many of us actually ask that chair-sitting opinion –giver how their lives are going on?

*Please note that the information shared on the SL Enquirer and in this article are thoughts and opinions of Second Life residents and do not claim to be nor should be taken as certified or professional help. If you think that you may be depressed or feeling suicidal, professional help is need. You can reach out to your doctor or local church for resources that can help in your recovery process.