Death and suicide on the web

A friend pointed me to an article (found via a post at Think Christian) titled, "The Web Is The Worst Place to Grieve." The article, published in a conservative-libertarian magazine, describes several examples of real and feigned suicides that have been blogged on the web.   Blogging had made possible public suicide notes.  The article is a good reminder of the dark side of Web 2.0 whose opportunities and possibilities I've explored here in the past (see posts in Blogging category).

I'm an intellectual stalker!

One of the URMC colleagues with whom I previously talked about blogging, asked me about mindmapping today (see my mapping posts). Because she has sequentially hit upon a couple of my key interests, she questioned whether she's an "intellectual stalker"--a phrase I thought was just hilarious. Part of what tickles me about the phrase and concept, is that "intellectual stalking" is what the blogosphere is all about! RSS is the übertool of the intellectual stalker, allowing a person to obsessively track the thoughts and experiences of another. Best of all--it's anonymous and free! Thank you to my colleague for this great phrase!

Blogging out in the open: Response to post from Wynne Center Board

Some of the members of the Wynne Center for Family Research board read my blog post from yesterday about my presentation to the Board.  When I saw them today their response was quite positive--lots of comments (and humor) about it.  This brings me back to some of my initial posts about blogging in a professional setting (see Blogging out in the open in a clinical setting and How clinicians learn: Web 2.0 Opportunities?).   I'm now at the point of being pretty open about it where I work, and I continue to see it as a useful way for developing ideas, connecting with others with similar interests, and disseminating information to and dialogue with front-line clinicians and trainees.

Presentation to Board of Wynne Center for Family Research

I presented at the Wynne Center for Family Research (WCFR) board meeting today. I presented about our clinical services and about my work in suicide risk assessment, including how it grew out of experiences with suicidal patients in couples and families. The Center board and the faculty of the WCFR were present.

The Board is unbelievable--a real dream team for family systems fans:

Barbara Fiese, Ph.D., Syracuse University
Nadine Kaslow, Ph.D., Emory University
William Pinsof, Ph.D., Northwestern University
Harry Reis, Ph.D., University of Rochester (Liaison)
Frederick S. Wamboldt, M.D., National Jewish Medical Center
Karen Weihs, M.D., University of Arizona

Given the stature and brilliance of this audience, I was both nervous and eager to get their feedback about our clinical service and about the work that has grown out of it. Here are my notes, and some reflections, from the discussion that followed my presentation:

-- One board member shared an experience she had many years ago working with a prominent family therapist as her supervisor. She recounted the following experience:
She worked with the family of an adolescent who had attempted suicide. She wanted to do a suicide risk assessment as part of her session with the family. Her supervisor, at first, discouraged her because it wasn't "systemic." She persisted and ultimately prevailed by offering to do a suicide assessment for each person present (not just the child) and to invite others present to provide input on the others' assessment! The supervisor allowed this as sufficiently systemic.

Reflection: This is a fascinating story that highlights the tension inherent in melding an activity that has traditionally been part of an individualistic medical model with a family systems view of people, their problems, and their strengths. I think few family therapy supervisors nowadays would advise against suicide risk assessment. Suicide risk assessment is taught (with a range of how much) in every family therapy training program. But I'm not sure if we've developed a lot further in terms of the actual how-to. My impression is that most of the time, there continues to be a one-dimensional linear approach to training suicide assessment that implicitly assumes individual therapy and interviewing.

-- Other thoughts:  One key to resolving the potential tension is to think about suicide as residing in a family system. This view goes beyond thinking about family members a "collateral informants", which is how family involvement is often described in the suicide literature. Instead, we need to develop conceptual AND CLINICAL models for assessing risk through the lens of interactions, relationships, roles, and family myths. For example, how does the hopeless that registers in the individual grow out of family roles and interactions...or from a strength-based approach how might shifts in the family give greater hope to the individual experiencing suicidality.  It is not that this is never talked about, it's just that the focus on individual psychopathology and personality often overshadows this dimension--and perhaps more so than with other behaviors we assess and intervene with because the act of suicide is ultimately unilateral and done when alone.

-- One member asked about me "sharing" what I'm working on. This is an important question to me on several levels:

  1. Blog. This blog is one mechanism I'm using to share thoughts and discoveries.

  2. Planned publications. I am on the cusp of conducting an evaluation of my risk assessment workshop and plan to publish the results. I am also working on another publication in which I'm collaborating with two faculty members of the Deaf-Wellness Center.

  3. Career Direction. If what I'm doing turns out to be helpful to clinicians and to families, I want to share it widely. That brings up interesting questions about how I spend my time professionally. Given the range of my interests (in terms of content (peds primary care, suicide) and professional activities (teaching, writing, clinical work), it is hard to know the right direction. A career in research is appealing in ways it hasn't been in the past. This is probably a dilemma many of my readers (especially those in academia) are familiar with. I'll be focusing on discerning this over the next year or so.

-- After I talked about this blog, a board member recommended using it as a way of helping to disseminate science to general audience. I have done this a little (such as here), but could probably do more.

-- A board member suggested that, in light of how heavy it is to focus on suicide (an adverse outcome), it would be advisable for our clinical service to also gather stories and data about positive outcomes of family therapy. This is a perceptive and appreciated comment because prevention of a bad outcome does have a peculiar emotional tone for an individual or group. I named this blog "Commitment to living" in part to cast this work in a positive direction. This comment is a good reminder to do that kind of thing in many ways also at a system level.

All of that in 30 minutes! I appreciated the opportunity to consult with such bright and experienced senior experts in our field.

CTL to Healthcare Professional Mindmappers: Delurk!

Gaelen O'Connell over at Mindjet contacted me to ask if I knew of other healthcare professionals who are use or write about mindmapping.   I thought it was a good question.  I couldn't think of anyone, but realized that if there were others out there, I would love to connect.    So..if there are any other healthcare professionals with an interest in mapping out there, leave a comment on this post or email me separately.  Thanks for the question, Gaelen!  

CTL censored in China

Thanks to a post by Dr. X, I discovered that this blog is banned in China--at least according to the Great Firewall of China, a site that purports to test any URL to see if it is blocked in China.    I'm interested to know how sites make the blacklist.  That there must be a keyword algorithm or something like that for censoring site--if so, I guess "suicide" or "risk" is on that list.

CTL added to PsychNews

Commitment to Living has been added as a news source to PsychNews, a site that aggregates psychology news from a range of sources.   PsychNews has a nice-looking interface and plans to offer RSS syndication soon, which will be good for those who want a breadth of psych news coverage in a single feed.

Related posts:  Commitment to Living featured on PsychSplash

More blogging to come at URMC?

I was invited to an informal, coffee-cart conversation about blogging in a medical center.  A person in our organization wants to develop a group blog around the interest area of Community Health.

A few reflections on this conversation, which took place on Friday.

  1. We spent a fair amount of time on definitional ambiguities around the word "blog." I had never realized that the word can evoke lots of different images in people's minds. At different points, it morphed between meaning "anything RSS," "Web 2.0," "collaborative Internet", and "discussion board." That happens with any word (I say "chair" and think of this and you might think of this), but it is especially true of word describing emerging concepts.

  2. I became aware of how personal my blog is to me, and how much I resist efforts to legislate aspects of it. I didn't like ideas that entailed requiring people to commit to post once a week or something like that.  I'm sure corporate blogs do something like that, but for a blog that is about idea development, I think the frequency should match the idea generation and can't be forced.

  3. I had never thought before about how to get "buy-in" from people to blog. My recommendations to those involved in this project was that the only way to cultivate bloggers is to get people reading blogs first. Get them understanding RSS and some of the benefits to blogging (including in clinical or academic communities) from a reader's standpoint. I think it's hard to imagine why spending time writing posts would be useful to oneself or others until you've seen it in action.

  4. My other thought about "buy in" is that you have show people how any project that will require time and effort will promote their careers, not just promote a concept.  For faculty, it's about intellectual development.  You'd have to show and provide examples of how writing thoughts that are still under-development to a wide audience can be helpful.

  5. I found myself thinking a lot about (and mentioning to my colleagues in our discussion) the Merlin Mann's quote that I have referenced here before, in which he describes a blog as "only incidentally a publishing system...At its heart, your blog represents the evolving expression of your most passionately held ideas..."

  6. Web 2.0 is all the rage right now.  Articles like this one in InfoWorld talk about the growth of vendors who are trying to profit from this. There are a lot of ways leaders can go wrong when trying to jump on the Web 2.0 bandwagon. These 23 steps for learning Web 2.0 have gotten a lot of attention lately. Seems like a thoughtful approach, perhaps a prerequisite "course" for anyone interested in how a particular institution might benefit from the new web.

  7. It's important to consider which tool is right for which purpose. Blogs are great for pushing content to interested audiences, wikis for collaboration on specific projects, etc. When is it best to use multiple individual blogs and when is it better (as I think they're going to try here) to have one blog with multiple contributors?  My personal preference as a consumer is for the individual blog because part of my interest is watching the creative process take shape in an individual over time.  But maybe that's just the clinician in me.

It was fun to be part of the discussion at this early stage.  I'm excited to see where the initiative goes.

43 Folders post on blogging ideas and thoughts

In my previous post, I explained how I described what professional idea blogs (and are not) to my colleagues. Merlin Mann at 43 Folders has a nice post on Blogs: Watching passionate thoughts evolve (in public). In it he, offers a nice description of a new-blogger's experience, and this advice to bloggers:

"Remember that your blog is only incidentally a publishing system or a public website. At its heart, your blog represents the evolving expression of your most passionately held ideas. It’s a conversation you’re holding up with the world and with yourself — a place where you can watch your own thoughts take different shapes and occasionally surprise you with where they end up…"

Blogging out in the open in a clinical setting

Roy from Shrink Rap’s commented on my post about Web 2.0 opportunities that he has "not EVEN mentioned to anyone about our psychiatry podcast." That surprised me, given how significant his web presence is. But that was certainly true of my blog until a couple of weeks ago, when I finally "decloaked" my blog to my colleagues.

I decloaked during a presentation to our group that focuses on evidence-based practice. This group includes several key leaders in our department. I was giving a progress update about my work toward our shared goal of improving the training and documentation tools for suicide risk assessment, documentation, and response. Thankfully, the project is progressing, and I had several steps forward to present. On the mindmap I was using to present, (as I've noted in a previous post, I use MindManager for presentationg), I reported progress on steps forward that I had previously committed to, then added a bubble reporting the development of this blog (along with a link to it).

I introduced it with some trepidation. By way of disclaimer, I started by recognizing that the image some think of when they hear the word "blog" (if they think of anything) is a "navel-gazing, exhibitionist teenager" sharing stories about weekend parties and rants about parents. I explained that blogs have evolved in many professional and academic circles as a way of journaling ideas and sharing emerging trends with like-minded people. I showed some sample posts and sample comments. I referred people to the About this blog page if they wanted to learn more about what I'm up to with this experiment.

The response was mostly positive--probably best described as a mixture of amusement and curiosity. No one was openly critical, and some of my colleagues thought it was pretty cool. There was one appropriate and constructive question raised about liability issues for me (what if someone follows my clinical advice and something goes wrong), but no other public comments. One colleague later comment that she had never read a blog before, and I suspect that was true for many people in the room.

Being out in the open feels good, although it has already changed the way I think about my blog. I don't think the change is good or bad, but it does change my mindset to think that my colleagues and superiors might read what I write here. Then again, they might not!

How clinicians learn: Web 2.0 Opportunities?

A thoughtful colleague of mine observed yesterday that, although there is a range of ways clinicians get clinical information about suicide (articles, workshops, books, practice manuals), a lot of clinical learning takes place informally--by doing the work and by talking with other clinicians. That is probably especially true for the busiest front-line clinicians.

I later reflected about what this could mean in terms of Web 2.0 opportunities to change clinician behavior. First, the narrative, personal feel of blogs might appeal to clinicians in a way that practice manuals and official websites don't.   Second, the conversational opportunities of wiki (Wiki in wikipedia, Using Wiki in Education), RSS feeds, podcasts, and other Web 2.0 venues also have potential to reach people in a fresh way.

Would a front-line clinician who does not regularly read research journals subscribe to a weekly 10 minute podcast conversation between a suicide researcher and a clinician who works with high-risk patients? Maybe. It's mostly an empirical question at this point, but there are several experiments going on in the field, some of which are on my blogroll.