Personality topics and theoretical frameworks

Teen Suicides

My relationship with suicide is longer than I would care to imagine. One of our dear family friends, an adult, took his life after several failed suicide attempts, which were explained as accidents to all of the young children who heard about them, even his own children. Those children were a few years older than I was, and I spent much of my younger years watching them struggle to find their places in this world, knowing that it had been too much for their father to handle. I worried, alongside my parents, their mother, and the other adults in our neighborhood, when the oldest child fell into a Goth crowd in high school, worried that his obsession with dark things signified something more, and that he would follow his father's example and take his life. He, and his younger siblings, all came through adolescence as well-adjusted as any other teenager, and I thought that my acquaintance with suicide had ended. What I had not counted on was that depression can be a very sneaky disease, and it does not always present its face to outside observers.

Kimberly, not her real name because of my respect for her family, which still mourns her, was a model teenager. Her mother died after years of struggle with breast cancer, unable to beat its third recurrence. Kimberly was the oldest child in her family of three, and the only one old enough to remember the years before her mother got sick. Her mother's first breast cancer diagnosis came almost immediately after the birth of her third child; a routine post-partum examination revealed a lump that turned out to be cancerous. Kimberly was seven at the time, and she took it upon herself to begin to care for her four-year-old brother and her infant brother, because her father was consumed with working to maintain health insurance and with trying to care for his wife. The first round of treatment was mild, in terms of cancer treatments. Kimberly's mother underwent a lumpectomy and chemotherapy, but soon regained her laughing and joyful demeanor, but the specter of the disease lurked there. No one was surprised by her second diagnosis. This time the doctor's were aggressive, performing a double-mastectomy, radiation, and debilitating chemotherapy. Though Kimberly was only nine at the time, she took on all the responsibilities of the household. However, she did it with a smile. She brought home straight A's, behaved perfectly at school, and cooked and cleaned at home. Everyone thought that she was a perfect child. She remained that perfect child throughout her mom's struggle through her third bought with cancer, and was a rock for her family when her mother died. By thirteen, Kimberly was the mom in the household, handling all of the family tasks, taking care of her younger brothers, and handling a full school schedule. She did it all with a smile, never betraying whatever she must have been feeling inside. The adults in her life failed her. Obviously, a child who had lived through the death of a parent and taken on the responsibilities of a household must have been experiencing a tremendous amount of stress, but no one looked past the smiles.

Her death came as a surprise to everyone. She had an argument with her father one morning before school. What the argument was about, no one knows. She stormed out of the kitchen, which was uncharacteristic for her, and slammed into her father's room. That is where he kept his pistol, but it never occurred to him that she was going for it. She shot herself once in the head, and the gunshot brought her father running from the kitchen, where he was putting together lunches for her and her brothers. She died almost instantly, her little brothers looking on as her father begged the 9-11 operator to have the paramedics hurry. The entire community was surprised. Almost all of the middle school attended her funeral, and the school district called in counselors from neighboring schools to help the students deal with their feelings. Like most of her friends, I felt somewhat responsible for her death. I took the smiles at face value, and never delved in to what must be under them. What Kimberly's death taught me is that all teenagers are at risk for suicide, and that any child who has experienced major turmoil and upset, needs to be periodically evaluated for suicidal ideation. Perhaps if someone had just taken the time to ask her if she had ever considered suicide, she would still be alive today. The world would be a richer place if she were still in it.

Problems with Job Stress, Sexual Harassment

My first real adult job was working for an answering service. The business was a small, independently-owned location. The owner was a very friendly man, who took steps to ensure that his workers were happy and satisfied. There were many smokers at the office, so he provided a smoking room for them, so that they could smoke and work. He arranged to bring in meals for his workers during busy times. He gave regular raises, and rewarded great work performance with bonuses and by rapidly promoting people in his small organization. In fact, he would have been the perfect boss, except for the fact that he was an unabashed sexual harasser. I call him an unabashed sexual harasser, because, when discussing his harassment of female workers, he discussed consulting his lawyer about sexual harassment and discovering that his business was small enough to fall outside of the purview of federal laws penalizing sexual harassment. While his workers would still be able to seek private remedies for his behavior, they would not be able to avail themselves of publicly available options, and, being low-wage workers, it was incredibly unlikely that they would actually bring suit as individuals.

My personal experience with the hostile environment came at the time of my first office meeting. We had office meetings approximately every six weeks, and I was hired immediately after one of those meetings, so I had been working in the office for over a month before the meeting. At first I thought the notice was a joke; after all, what type of office would hold its meeting at a "gentleman's club." However, everyone in the office was taking the notice seriously. In fact, two of my female coworkers were discussing the fact that they would be ordering rib eye steaks at the office meeting, because the strip club was famous for its wonderful steak meals. I knocked on my boss's office door, and, peeking my head in, asked him if our meeting was really at a strip club. He said yes, and looked surprised when I had a problem with it. I told him that I would not be attending a meeting at a strip club. In fifteen years, I was the first employee who refused to go to a strip club. He offered an alternative location: Hooters. When I told him that I would not be going to any sexually-oriented business for an office meeting, he reluctantly chose a local Mexican food restaurant.

From that moment, I became the go-to person in the office for sexual harassment. When he would grab or grope a female employee, they would come to me, and I would go with them into his office. I would instruct him that he was not to touch the employee in a sexual manner from that point forward. My boss, who could have fired me at any moment, seemed to regard my advocacy in an amused manner. He never once got angry with me. Moreover, once he was informed that his advances were unwelcome, he would stop sexual advances towards the female in question and move on to another employee. He never penalized any of us for speaking up to him; in fact, shortly after I accompanied a female coworker into his office to instruct him to stop fondling her, she was promoted to a supervisor position.

What that experience taught me is that sexual harassers are not necessarily the evil predators I envisioned before that work experience. My boss was not an evil man, and he did not condition future employment on tolerance of his advances. However, he was a relic, who considered women as sexual objects, rather than viewing women as individual people. Once he understood that his sexual advances would not be rewarded, he would stop the harassing behavior. That experience taught me that some cases of workplace harassment can be handled by individuals clearly defining their personal boundaries and refusing to bow to the intimidation. However, I am also aware that not all harassers are like my boss was.

Attitudes towards Homosexuality

I am confused about social attitudes towards homosexuality. I really have a hard time comprehending how anything that a consenting adult does with another consenting adult can be seen to have a negative impact on the rest of society. The whole gay marriage debate floors me, as well. As far as I am concerned, the issue of whether or not a state can legislate marriage based on its own definition of social mores was settled in Loving v. Virginia, when the Supreme Court declared that it was an Equal Protection violation to have anti-miscegenation statutes. Sex is clearly as much of an immutable characteristic as race, and it seems illogical to prevent people from entering into a legal relationship, such as marriage, on the basis of an immutable characteristic. However, attitudes about homosexuality very rarely seem rational. Instead, they seem to come from another, irrational place, where homosexuality stands as a symbol for some type of greater evil.

For example, opponents of same-sex marriage often talk about the traditional definition of marriage. They discuss the fact that marriage has traditionally been limited to pairs of one-male and one-female. However, these arguments ignore much of human history. First, marriage, as a legal relationship, is a fairly recent component of human experience. People have been coupling off for much longer than marriage has been an institution. These couples have included a wide variety of male-female and homosexual relationships. For example, in Greece, adult males were expected to take female wives in order to have children, but were permitted, even encouraged, to have young male lovers. While I cannot encourage pederasty, romantic and sexual relationships were encouraged between young women and adult men at the same time; there is an evolving age of consent that has made sexual relationships between adults and children taboo in much of the world, which did not exist in ancient times. The salient point is that romantic and sexual relationships between homosexual couples have historically received recognition. More importantly, marriage has not traditionally been what it is in modern America. Modern American marriages reflect a conscious choice of partner, by two willing adults. Until approximately two hundred years ago, the notion of romantic marriage was almost unknown, and marriages were based upon alliances between families. Moreover, throughout most of the Judeo-Christian tradition, which has shaped American concepts of marriage, marriage was a polygamous institution. To suggest that God intended marriage to be a relationship between one-man and one-woman ignores the evidence of marriage that is presented in the Bible, as well as extra-Biblical historical sources.

In fact, I find it difficult to understand Biblical arguments against same-sex marriage. The First Amendment clearly demands separation of church and state. While religious officials can perform marriage ceremonies, a couple is not considered legally married unless or until that couple has complied with a state's legal requirements for marriage. The United States recognizes marriages between divorced people, despite the fact that, for the majority of its existence as a religion, Christianity did not recognize the rights of divorced people to remarry. In fact, the Catholic Church still frowns upon divorce and has restrictions upon the recognition of marriages between divorced persons. To allow any religion to dictate the requirements for a civil arrangement seems so un-American, that it is difficult for me to understand how people could even suggest such a proposition. Because of that, I can only surmise that opponents of gay marriage think it will be a gateway to other things that they perceive as deviant or against the norm. They suggest that gay marriage will threaten the sanctity of marriage, maybe concerned that the already high rates of divorce, domestic violence, and adultery, and marriage-less cohabitation have weakened the institution to such a degree that one more blow may signal the end of marriage.

The Importance of Doctor-Patient Communication

My last visit to a primary care physician lasted less than five minutes with the doctor, though I was in the office for almost two hours. I waited in the waiting room for only about fifteen minutes, and was then shown into an examination room. A nurse came into the exam room, took my vital statistics, and asked me about the reason for my visit. When I explained that I had a sore throat and wanted to rule out both the flu and strep throat, the nurse left the room to get two tests. I waited another ten to fifteen minutes for her to return, and then she swabbed my throat and my nostrils, and then left with the tests. About fifteen minutes later, she returned to the room to tell me that I had tested positive for strep, but negative for the flu, and that the doctor would be in to see me. Another ten minutes passed before the doctor came into the room, confirmed my strep diagnosis, told me that she would be prescribing an antibiotic, and left the room. The doctor did not even examine my throat or ask about symptoms; all of that had been taken care of with her medical staff. About ten minutes later, a nurse came back into my room with my chart, which had the prescription attached to it. I went to the front desk, paid for my visit, and left the doctor's office. That type of visit to my doctor, whom I consider a good physician, is typical. Therefore, it comes as no surprise to me that there is a problem with doctor-patient communication.

I have never once been to see any type of doctor when I did not feel that time was of the essence. Every doctor I have ever seen has diagnosed me correctly, I assume, because I am healthy today, but not one of them has taken any time to examine other issues. Yes, they may ask a cursory question about whether or not I am experiencing any problems other than the reason for my visit, but they do so while making notes, writing prescriptions, or literally walking out of the exam room. I have not ever experienced a problem that I have not discussed with my doctors, but I can easily see how that could be a problem.

One of my uncles is on over 30 different medications. Not all of these medications are medically necessary; in fact, many of these medications have probably been improperly prescribed. He is a CPA, and he takes medication for ADHD, so that he can stay awake during tax season. He also takes sleeping pills, because the ADHD medicine makes him unable to sleep. Those are only two examples of the unnecessary medication that he takes. He also has a chronic health issue, diabetes. Despite these red-flags in his health history, which he dutifully reports at each doctor's visit, not one doctor has discussed the issue of prescription medicine abuse with him. I find this omission startling. How a relatively young man can be on over 30 different prescription medications each day without a medical professional taking the time to investigate how many of these medications are necessary startles me. In fact, when he relocated and found a new local doctor, that doctor simply looked at his existing medications and re-prescribed them without investigating whether or not any of them were necessary. Though I am not a medical professional, I think it must be dangerous for a person to take 30 different medications each day, especially for conditions that he does not have. What I cannot understand is why his doctors would fail to address that issue.

I think that the case of Michael Jackson is very illustrative. Obviously, my uncle did not have the same influence as Michael Jackson. However, his doctors probably experience much of the same pressure as Jackson's doctors experienced. Doctors are expected to provide a quick fix for their patients, and are given very little time to actually discuss patient's health issues. A doctor who fails to treat a patient's reported symptoms is likely to lose that patient. Therefore, it is not surprising that doctors do not always communicate with their patients.

Mood Disorders

With all of the pharmaceutical advertising marketed towards people suffering from depression, I have to admit that I find it difficult to differentiate where normal mood ranges become mood disorders. The commercials and depression inventories asking about depression seem to name characteristics that are within the normal range, especially if people have experienced life stressors. As a result, I think that I find depression a difficult concept to understand. After all, if all people experience some range of depression, and, furthermore, a pretty significant subset of society can expect to experience at least one episode of a major depressive disorder during his or her lifetime, is it accurate to consider depression a disorder? Is what society thinks of as depressive disorder merely a normal part of the human condition?

Moreover, I have often wondered about depression and the context of modern America. In modern American life, it is acceptable to have depression. A large number of my peers have been diagnosed with depression and are either currently taking, or have taken in the past, medication to deal with that disorder. It has made me wonder how much of depression is linked to being somewhat spoiled as Americans. Americans have an outlook on life that reflects the idea that life should make one happy. If one is not happy, then one works towards happiness. If that cannot be achieved, then people begin to look for root causes for that unhappiness. Science has reduced the root causes of most modern depression to a neurochemical imbalance, which can be adjusted with medications. However, if depression were merely a neurochemical imbalance, then it would seem that antidepressants would have the same impact on all people. All of the research that I have seen suggests that antidepressants are, in general, no more effective than talk therapy or behavior modification regimes that incorporate things like exercise, at treating clinical depression. All of this has really made me wonder about the role that expectation plays in depression.

I may have been misinformed, but I have heard statistics suggesting that the suicide rate among modern American teenage boys is higher than among the residents of concentration camps during World War II, female victims of rape as a war crime, and slaves in the American South. If depression is a genetic disorder, then the racial differences between these groups may help explain some of the gap, but, since mood disorders are thought to be triggered by stressors, one would expect to see elevated suicide rates in those groups. What would account for the differences? This is where I believe that expectation plays a huge role in depression. Modern American teenagers are told to believe that they can achieve anything. Even if they come from families with little or no emotional or psychological support, the overwhelming cultural message is still that American teenagers can achieve anything. However, disadvantaged children may see the doors of opportunity slamming shut on them, and see a disconnect between their reality and what they want to have happen. Perhaps that disappointment sets them up for depression. I am not certain. However, it does make it seem to me that depression may be a bit of a luxury. People who are unable to survive unless they get up every day, do what they have to do to survive, and repeat, may not have the time for introspection.

As a result, depression seems to be a bit of a luxury. Maybe the reason that I think that is that, as I understand it, a diagnosis of clinical depression usually requires that the depression not be situational. The people in the groups that I have previously described could all be exhibiting the same symptoms as a clinically depressed person, but may not merit the same diagnosis because one would expect anyone in those groups to be suffering from some depression. If there is no difference in groups, maybe the reality is that depression is simply part of the normal realm of human behavior, and is not, except in the most extreme cases, really a mood disorder at all.