Pop quiz - Parenting styles

What is the most effective parenting style?

A. Authoritarian

B. Permissive

C. Uninvolved

D. Authoritative

For more click here.

New York State has third lowest suicide rate in the US after New Jersey and Massachussetts.

 Based on recent data, the suicide rate in the United States is significantly higher than the homicide rate.

• Suicide Rate: In 2022, the age-adjusted suicide rate was 14.2 per 100,000 people.

• Homicide Rate: In 2023, the homicide rate was 5.9 per 100,000 people. Other data for 2023 shows a rate of 6.8 per 100,000 people.

In terms of total deaths, there are nearly two times as many suicides as homicides in the U.S. For example, in 2022, there were over 49,400 suicides compared to around 24,800 homicides.

In my career as a Psychiatric Social Worker I have done over 15,000 suicide evaluations most of them as a Psychiatric Assignment Officer in urban hospital emergency rooms.

Suicide rates vary greatly by region and other demographic characteristics. Men kill themselves three times more often than women but women attempt suicide three times more often than men. The reason for the discrepancy between suicide death rates is due to the means of the attempt. Men most often use guns while women use ODs and cutting.

New York State consistently has one of the lowest suicide rates in the United States. While the specific ranking can vary slightly depending on the year and the source of the data, New York is typically in the bottom three alongside states like New Jersey and Massachusetts.

For example, according to data from 2021, New York's suicide rate was 7.9 per 100,000 people, placing it among the lowest rates in the country. This is in stark contrast to states with the highest rates, such as Wyoming, Montana, and Alaska, which often have rates three to four times higher.

Suicide rates seem more influenced by the availability of social infrastructure than any other factor. When people are desperate do they have a place to turn? Is there help for what is distressing them so much that they would rather end their lives than go on living. New York, New Jersey, and Massachusetts have much better health and human services than other states.

Withdrawal symptoms from discontinuing antidepressants worse the longer they are taken

From PsyBlog 08/06/25

The longer a person takes antidepressants, the more likely they are to experience withdrawal symptoms when coming off them.

People who have taken them for more than two years are at a 10 times higher risk of experiencing withdrawal symptoms compared to short-term users (less than six months).

For long-term users, those symptoms are likely to be more severe and take longer to resolve.

Around half may suffer withdrawal symptoms when coming off antidepressants (although some think the true rate is nearer 15 percent).

Withdrawal symptoms include anxiety, dizziness, headaches, nausea, depression and suicidal thoughts.

It has been my experience after 56 years of practice as a psychiatric social worker that anti-depressant in some situations can be helpful but they are not a panacea for what too easily is diagnosed as "depression." There are many different types of depression and multiple factors that contribute to it. Studies show that in general counseling is more helpful in the long run than medications. In general anyone started on an anti- depressant should also obtain an evaluation of the depression by a qualified mental health clinician.

Themes from The Best American Science And Nature Writing 2024

The themes that have emerged for me from The Best American Science and Nature Writing 2024  are:

1. The earth is getting warmer and having negative consequences for the ecological balances which we humans have become accustomed to.
2. This climate warming is having negative consequences up to and ending in death for many living things.
3. A small group of under-supported scientists are studying what's happening and their findings are largely ignored or dismissed by the decision makers except in a few instances.
4. Science journalism is one way of informing and educating people about what is happening to them which is outside their level of awareness because the changes are insidious except when they culminate in catastrophic weather events.

Some observers have noted that because of these four things social anxiety and tension has risen contributing to political polarization and the rise of autocracies exemplified by the "strong man" leader who promises to "fix everything" and make people safe and more secure. This political solution is delusional because it doesn't address the underlying problem which is human caused climate change.

What will help? A correct diagnosis of the problem causing the rise in anxiety and plans that are effective in addressing the creation and maintenance of the problem. This requires cooperation, collaboration, and joint efforts around the planet. Isolation and nationalism will not help, but only maintain and increase the problem. There needs to be a shift from the emphasis on private wealth and profit to a sharing and creation of health giving commons. This is a huge shift in values especially in the richest country in the world, the US. What will bring this shift in values in the US population? The worsening of circumstances until people have to find a better way to live if they are to survive. And then a transformation into cooperative, collaborative, mutually satisfying democratic processes.

PS - The Best American Science and Nature Writing 2024 is the August 2024 selected read of the Allnonfiction Book Discussion Group. If you are interested in joining the Allnonfiction Book Discussion Group you can find more about it here.

Use of EHRs (Electronic Health Records)

Those of us with a more cynical sense of humor use to talk about "treating the chart". Treating the chart becomes more important as a means of complying with system expectations and requirements and often is used in measuring provider performance. This system is very dysfunctional and contributes to poorer patient care. As such, an argument might be made that the use of EHRs is unethical because of the skewed values and consequences for patient care.

When I reopened my private practice in May of 2024, I attempted to use the Simple Practice practice management system which includes their EHR templates. I quickly abandoned most of it because it seemed to interfere with my client care rather than enhance it. I went back to keeping my own notes on paper for the most part and sometimes computer based files which only I control and designed. The only thing I use it for now is billing.

https://mailchi.mp/openminds.com/daily-executive-briefing-4323228?e=f8bccd7a14

"most EHR systems weren’t built with the clinician in mind. They were built to get electronic billing information to payers and health plans and the results reflect those early designs. A study found that primary care practitioners spend more than 50% of their workday using their EHR—355 minutes (5.9 hours) of an 11.4 hour workday (see Primary Care Doctors Spend More Than 50% Of Workday On Documenting In The EHR). Of those 355 minutes, 75% were spent in the office during office hours and 25% were spent after hours. These data show that three tasks consume the most time: documentation (24%), reviewing chart notes (17%), and prescription refills and results management (16%)."

Teen suicide is on the decline, new federal data shows

From NPR on 08/04/25:

The new report shows that the prevalence of serious suicidal thoughts in 12-to-17-year-olds fell from nearly 13% in 2021 to 10% in 2024. And the prevalence of suicide attempts by teens also fell slightly — from 3.6% to 2.7%.
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The report also found that the share of teens with an episode of major depression in the past year fell during this time — from 21% to 15%. But only about 60% of teens with a recent episode of depression got treatment.

And 2.6 million teens still had thoughts of suicide in 2024, notes Hannah Wesolowski, chief of advocacy with the National Alliance on Mental Illness.

"That's 1 in 10 kids, which is still far too high in this country," she adds. "So we're making progress, but we're not making progress fast enough."

The report also found that 700,000 adolescents did attempt suicide in the past year.

Access to treatment is still very difficult for most families due to lack of providers, poor insurance coverage, high co-pays.

I would hypothesize that the suicide rate will continue to decline due to the heightened awareness of the negative impacts of smart phone social media addiction and the limiting of smart phones in schools.

Keep the faith. Stay strong. Be courageous. Tell the truth. Do the right thing. Focus on what matters in an age of cruelty in the US.

The following article was written and published on davidgmarkham.substack.com on 01/26/25. Not much has changed other than the national well being deteriorating further in the US.

A colleague wrote in part : “This has been an ugly week of multiple clients upset with the executive orders. The thing that continues to strike me is how der Trumpenfuhrer embodies the sum of all fears…..I spent two hours on Zoom today with crying people in the midst of the total meltdown of their lives, having lost jobs in the past several months and now worried about the ways in which the executive orders will effect them and the world. It was an ugly day.”

My reply is below:

It seems very important for therapists to support one another in what they are observing and experiencing. Vicarious trauma may be on the rise in our profession when therapists witness and describe days like the one you just had.

Psychopaths like pain. Inflicting pain is the point because it makes them feel powerful. Perhaps one of the most challenging things for therapists to observe and attempt to mitigate is cruelty and sadism.

In recent days not only is cruelty and sadism being perpetrated but it is being normalized with "pardons" that lift external constraints and restrictions and allows those so inclined to behave in further cruel and sadistic ways with impunity.

As I learned working on inpatient psych units and psych ed what works best with these behaviors is injections of Haldol and four point restraint with a skilled team trained to exert a "show of force". These tactics are used only after de-escalation techniques have failed.

After such interventions staff always met for a brief de-debriefing so that calm could be restored and confidence in maintaining safe order was reinforced.

As therapists we need to find ways to keep each other safe so we can keep our clients safe as best we can.

Remember, cruelty is not a byproduct of what is being perpetrated, but the cruelty is the point to dominate, coerce, and subjugate. It is important for us as MH professionals to confront it head on, lean into it, and mitigate it. Some of us will be harmed in the process, but in the end justice, compassion, dignity, and peace will be achieved.

Keep the faith. Stay strong. Be courageous, Do the right thing. Focus on what matters.