Sunday, October 10, 2010

Wow, My Father and I Actually Agree on Something

I haven't written in awhile but I decided to write about this because it happens so rarely. I've been discussing this idea with my dad for a couple of years now; that the Western industrialized nations are going to experience a shift in their stature in the world in several ways that primarily boil down to a lower standard of living for a much smaller population. The Eastern nations (China, India and eventually Africa) on the other hand will experience a boom as they come into the 21st Century and beyond, for a younger and larger population, leaving their own mark on history.

I spoke with my dad on the phone today and he said "I heard a program on WHRO TV and thought of our many conversations on this subject and how I disagreed with you. After listening to the program I am now inclined to see that a lot of your points were quite valid." So I decided to listen to the taped program at the Miller Center given by Jack Goldstone The New Population Bomb: The Four Megatrends That Will Change the World ( and I understand why my father agrees with me now.

This is not the first time my father has agreed with me on some thought or opinion. In fact it's been happening more and more recently, but our past history contains lots and lots of heated arguments.

Wednesday, August 18, 2010

A More Balanced Approach to the Reporting of Suicide in the Media

If you live in Massachusetts, particularly eastern Mass., you've probably been watching TV, listening to the radio or reading the same news stories I have about the "alleged Craigslist killer", Phillip Markoff, ending his life by suicide.

I'd like to extend my condolences to the families and friends of Julissa Brisman, Megan MicAllister and Phillip Markoff. They have suffered terrible losses and are experiencing a kind of pain that most of us will never know. Some of their friends and family will be at a loss as to how to support them during this time. I'd like to offer some suggestions:
  • Keep in contact through regular phone calls, visits or emails
  • Give emotional support through listening and talking (mostly listening)
  • Offer to give practical support, such as helping to do the shopping, cook dinner, carpool, etc.
  • Just be around

I've given a lot of thought to the reporting of this suicide because there's been reporting of every detail of the actual act including photographs leaked to the media of the crime scene. It's very troubling to view, listen to and read since I know there are people, including young people, who may be contemplating suicide who are also seeing and hearing the same information. The constant repetition of this story for days without additional helpful information for those viewers, readers and listeners who may be contemplating suicide is a disservice to them and their families and friends. The helpful information that should also be reported in stories involving suicide should include: the facts of suicide; the warning signs of suicide; where someone who is contemplating suicide can call to find help; and what resources there are in the community for the family and friends who are dealing with the loss of a loved one due to suicide.

For instance in Massachusetts:
  • There is a Statewide Emergency Services Program for psychiatric emergencies. The Statewide toll free phone number is 1-877-382-1609 and you enter your zip code to get the phone number for the local provider that serves your area.
  • There is a National Suicide Prevention Lifeline 1-800-273-8255 that will connect you with the crisis center nearest you (
  • The American Foundation for Suicide Prevention ( and The Samaritans of Boston ( have support groups services and a survivor to survivor network for families and friends who have lost a loved one to suicide.

I came across this website on mental health reporting in the media and it has a very helpful tip sheet on reporting on suicide.

Tips for Reporting on Suicide

Copycat/ Suicide Contagion is real. Research shows that the incidence of suicide increases following news coverage of suicide. The following guidelines are suggested to minimize copycat attempts:

  • Refrain from using photographs of grieving relatives and friends when a suicide has occurred. Photographs might encourage someone contemplating suicide to act as a way to get attention or get back at someone, creating a dangerous copycat effect. Youth are especially vulnerable to these effects.
  • Do not report the method or place of suicide in detail. Exposure to suicide methods, including photographs, can encourage imitation among vulnerable individuals.
  • Do not portray suicide as a heroic or romantic result of a single event or cause. This obscures the long and painful process that results in completing suicide. Over 90 percent of suicide victims have a significant psychiatric illness at the time of their death.
  • Always include information about crisis intervention services in the area and a referral phone number.
  • Do not use suicide in headlines, even when they take place in public. This unnecessarily dramatizes the event and shifts the focus from the tragic loss of life. There are exceptions, as in the term “suicide bomber” when reporting on terrorist activities.

Facts About Mental Illness and Suicide

The great majority of people who experience a mental illness do not die by suicide. However, of those who die from suicide, more than 90 percent have a diagnosable mental disorder.

People who die by suicide are frequently experiencing undiagnosed, undertreated, or untreated depression.

Worldwide, suicide is among the three leading causes of death among people aged 15 to 44.

  • An estimated 2-15 % of persons who have been diagnosed with major depression die by suicide. Suicide risk is highest in depressed individuals who feel hopeless about the future, those who have just been discharged from the hospital, those who have a family history of suicide and those who have made a suicide attempt in the past.
  • An estimated 3-20% of persons who have been diagnosed with bipolar disorder die by suicide. Hopelessness, recent hospital discharge, family history, and prior suicide attempts all raise the risk of suicide in these individuals.
  • An estimated 6-15% of persons diagnosed with schizophrenia die by suicide. Suicide is the leading cause of premature death in those diagnosed with schizophrenia. Between 75 and 95% of these individuals are male.
  • Also at high risk are individuals who suffer from depression at the same time as another mental illness. Specifically, the presence of substance abuse, anxiety disorders, schizophrenia and bipolar disorder put those with depression at greater risk for suicide.
  • People with personality disorders are approximately three times as likely to die by suicide than those without. Between 25 and 50% of these individuals also have a substance abuse disorder or major depressive disorder.

To Find out the Warning Signs of Suicide Check Out these Links:

The American Foundation for Suicide Prevention (

National Suicide Prevention Lifeline 1-800-273-8255 (

You can check out these links for a sampling of the coverage and background in the case.

CraigslistKiller Phillip Markoff - articles and videos (Fox 25 News Boston)

DA To Investigate Markoff Suicide In 'Craigslist' Case (WCVB TV Channel 5

Sheriff defends jail after Markoff suicide (

Friday, August 6, 2010

Please do not disturb, migraine zone

I'm writing this post for a blog carnival for August on headaches. For eight years I kept a daily diary of my symptoms for the migraines and neuropathy: what I ate, how much sleep I got, what the weather was like, what I did for exercise, what else I did for the day (volunteer activity if any), etc. Then at the end of the month I would summarize the number of migraines, the number of days I had the severe tinnitus, the number of days I had neuropathy in the left side of my head hand and foot. This summary was done on a spread sheet. Then near the end of the eighth year a thought came to me to check to see if there were any trends in all of this time and I graphed it by month over the eight years. The only trend I saw was that it was just plain consistent whether I did nothing at all or was very active (that's relative of course), that the migraines and the neuropathic pain didn't change at all.

I realized at this point that this really depressed me. After a couple of days of thinking about it I decided to stop tracking all this information and just do what I wanted to do, within reason of course, and stop waiting for something else to happen. I was not going to wait for there to be a cure or for the pain to dissipate on it's own. I had to get on with my life as best as I could. I can't say this was a revelation, it was more like a realization that I had to figure out some way of coping with all of this and get some sort of life back. Realizing it was not going to be the life I had also depressed me and this took some time to deal with.

It's very humbling when something happens to you, beyond your control, that forces you to change your life; change your career, change your outlook and probably change other aspects of your life you don't even know about yet at this point. This happened to me. I had to give up a career as a successful CPA because I wasn't able to perform most of those duties due to my cognitive impairment and chronic pain. I really loved this career because of the people I worked with, the clientele, the variety and the constant learning. I love to learn.

I started to volunteer as much as I could at different places trying to figure out what I would do next - what job skills could I still do and not do so I could find the appropriate job/career and start that new chapter of my life. I worked with an occupational therapist who helped me immensely with breaking down the tasks so I could do them without taxing my brain and tackle my concentration and distraction problems. We also figured out by trial and error what work environment would be better for me.

I didn't give up on my mind/body program principles of pacing myself, practicing mindfulness and redirecting my negative thoughts. I still use these to help me get through each and every day.

I am now working part-time and that may all be that I will be able to work but that's okay. I'm working at something I love again, something new but uses my intellect to the extent that I can use it and I'm around lots of people again and learning new things which I love to do. Life is good.

Monday, July 5, 2010

Why doesn't hindsight really benefit us?

It's July 5, 2010, I'm trying to stay cool on this hot summer day and I'm listening to Charlie Rose on PBS. He's discussing the state of the economy in the world with Thomas L. Friedman, an economist, and the statement that "we don't seem to learn from the mistakes of our grandfathers" is spoken by Mr. Friedman and it gets me thinking about that thought in particular. Why doesn't hindsight really benefit us? Why is the expression hindsight is 20/20 just that, an expression? I don't think I have the answer but I'd love for people to help figure this one out. It would sure increase everyone's standard of living and offer peacefulness if we weren't fighting wars that we can't afford, in more ways than one, all the time.

It does seem that we, as humans, can't seem to admit we're wrong or that we're making the same mistakes our fathers or grandfathers have made until we have the benefit of hindsight. And even with that benefit of hindsight we still repeat the same mistakes in future generations. Why is that? Why can't we learn from these mistakes? What is it all about Alfie?

I know I suffer from this on occasion, just like everyone else, but now I try very hard to not fall into this pattern and over the years I've done better and better. I know that I take more time to think about decisions before actually making them. I actually weigh the pros and cons. When I was younger I pretty much went with my gut instinct and although I have survived and thrived for the most part, some of those decisions were so wrong that when I look back on them now I wonder "what was I thinking?" and the obvious answer is I wasn't thinking at all, I was reacting. Reacting to what? Reacting to what I thought was going to be a lost opportunity or what I thought was going to be a good opportunity but what actually turned out to be bad opportunity or dead end. And yet if I had children (which I don't) they would be doomed to repeat many of the same mistakes I made and for the same reasons which wouldn't become apparent, yet again until some time passed. There's that hindsight again.

You notice the animal kingdom doesn't have this problem or do they? They do repeat patterns over and over again and maybe this is what's happening to us, a pattern that we're doomed to repeat over and over again. Birds migrate back and forth to the same spots even if their lives will be in danger. The same is true with a lot of other animals that are very territorial.

It would be very disappointing to think that with our supposed increased level of brain function and advanced ability to reason that we are still reduced to repeating the same self-defeating patterns of the animal kingdom. I would hope that we as humans could have evolved beyond that much, don't you think so?

Well I'd love to hear your thought.

Sunday, June 6, 2010

My Cats

The reason why I'm writing this blog post is I'm listening and sort of watching Cats on the Ovation channel. I went to the musical many many years ago in Boston and really enjoyed it. I started to think of all the cats I've had over my lifetime to date.

I have four cats at the moment. I usually only have two at any one time. I've had cats my entire life, well since I was seven years old. I actually wanted a dog but both my parents had dogs as children and decided we would have cats. I've never pursued the reasons why and don't need to now. One thing I've found as I get older is that I don't have to have all the answers to all the questions that come up.

Anyway all my present cats were adopted as adult cats. Before this I had started out with kittens that people gave me. I started to adopt adult cats when after my cats had died of old age I went looking for a couple of kittens and I saw all the adult cats that needed a home. I adopted Hobbs and Goober when they were five and four years old, they are now 15 and 14 years old. Hobbs is black with white like he's wearing a tuxedo with white spats on his front paws. Goober is all black. They are not related but raised together and at times barely civil to each other. I've come home many days to globs of cat hair on the floor. Hobbs is the bully of the two. Hobbs doesn't meow he squeaks. He also loves to eat and never misses a meal even when he doesn't feel well. His second favorite activity is sleeping. He gets the blue ribbon for couch potato. Goober was not a social cat when I got him, he didn't like to be petted but he loved to play. It took a year of patiently working with him to be able to pick him up without his growling and also letting me pet him. Now he comes to me for attention and will sleep next to me if it's not too crowded.

I was taking a friend to pick out a young cat to adopt for herself since her apartment building had just allowed one cat per unit. We went to the Animal Rescue League of Boston and the MSPCA Angel in Boston and she found a younger version of Goober to adopt at the Animal Rescue League.

At the MSPCA I came across two nine year old long-haired females that were in a separate room and they were so sweet and friendly. I read their story of having an owner with Alzheimer's and having to be given up because their owner had to be transferred to a nursing home. By the way they were shaved because their owner hadn't groomed them and their fur became very matted. Then I saw their names Thelma and Louise and that they had been there for almost three months already. My heart was tugged so hard that I couldn't leave without adopting them. Louise is definitely part Maine Coon cat and quite large but Thelma is probably not because she's your average size cat. They are definitely sisters according to the MSPCA staff. The MSPCA voluteers and staff were so excited to have someone adopt Thelma and Louise. Apparently there were favorites of everyone.

When I got Thelma and Louise home I kept them in a separate room from Hobbs and Goober for about two weeks so they could get used to the smells and sounds. Occasionally I would let them see each other when the door was opened so they could get used to the idea of each other. Then the day came to let them meet. I let Thelma and Louise out of their room so they could explore the rest of the house and meet Hobbs and Goober.

Well the first meeting was quite interesting. It turned out that Thelma is the bold one and won't put up with any bull from Hobbs and Goober and she put them on notice right away by hissing at Hobbs and hitting Goober on the head. Were they ever surprised. Louise on the other hand was altogether either frightened still or nonplussed. Hobbs and Goober came up to her and Goober hissed and growled at her and she just sat there like she heard nothing or didn't care. I've never seen a cat act like that.

Now that it's been three years since I adopted Thelma and Louise, I can safely say that Louise was nonplussed. Because when push comes to shove she does stand her ground and growl but it takes a lot for her to feel that she has to. Usually she just turns and walk away like its such a bother. Louise is another blue ribbon couch potato. Her favorite activity is sleeping.

Thelma and Goober are the hyper vigilant type, always on alert and ready to go. They follow the sun, up at dawn and asleep at dusk. Oh and they nap in-between but they are still quite active for their age.

In the beginning as their long-hair coat grew back in I began brushing it and noticed two things, Thelma was obsessed with keeping herself clean and Louise never took a bath (that I saw). So after the winter I decided to take them to the groomer at the local pet shop so Louise could get a bath, which it turned out she did need. The groomer told me she has never had a cat sit still like Louise did when being groomed. And especially when being bathed in the sink! She took a picture of my very wet cat just sitting natural in the sink. If I find it I'll post it to the blog. Anyway after being taken for another bath six months later, low and behold Louise starts to clean herself finally. So now they just get trimmed from long-hair to short-hair during the summer months.

I don't know if I would have four cats again, it gets expensive but I love these kitties. I don't regret adopting Thelma and Louise at all. They have helped mellow out Hobbs and Goober and
and they love to be loved. Louise loves to be near me all the time including when I'm on the computer so I put a cat bet next to the laptop so she'll stop walking on the keyboard. Thelma is my shadow. Anytime I get up and go anywhere she is there and I have to watch my step. Even Goober appreciates them now because Hobbs picks on Louise sometimes and not him all the time.

I really enjoy having these cats and I know they love living with me.

Sunday, May 16, 2010

What can I say about Dementia?

My mother has dementia. I think the first time I knew something was wrong with her was when one day she asked me what I wanted for Christmas about a dozen times or more. After the first time I showed her a pair of fleece slippers from LL Bean and even gave her the page out of their catalog so she could order it. Then with the catalog page in her hand, she kept asking me what I wanted for Christmas. It was so unnerving. I turned to my dad and asked when did this start. It was a shock to him too.

It was probably the change in her routine that contributed to this episode. She probably didn't remember my home that well since I hadn't live in it that long. They only visited me once a year and I also did likewise. We live 500 miles apart so it's not like we can get together whenever we want.

My mom probably had been hiding what was going on for awhile, who knows how long. This is another illness, like mental illness, that people hide their symptoms because they don't know what to think or are afraid of what it means. Her case is as classified as early onset (before age 65 and in her case closer to age 60).

Getting my mom to go see a doctor to find out what was going on was very difficult. She refused for close to a year. Then finally we get her to a doctor who turns out to be a quack and affirms to her she's perfectly fine except for the mild diabetes and high cholesterol. The mini mental exam they give is such a joke. By the time someone fails this test, it's too late to start effective treatment to slow the progression of the disease and improve the quality of life for the parent or spouse. This test should not be relied on. If you can believe it, the doctor didn't seem to take my concerns and examples into account. In fact, it seemed that since she passed the mini mental test, he was satisfied that nothing even remotely like dementia or alzheimer's was present.

Of course my dad was satisfied with this pronouncement but I wasn't. I was glad she was getting treatment for her mild diabetes and high cholesterol but I was the still concerned that her mental status was being overlooked.

Flash forward a year and my mom is starting to get lost driving home. My dad has to call the police to help locate her so he or them get her to follow them home. Even at this point my dad is in denial that anything is wrong with her mental status.

Where am I going with this? Dementia and Alzheimer's are debilitating and cruel diseases. What I mean by cruel is that they destroy the mind before they destroy the body. So the family experiences the death of their loved one twice. Watching their loved one disappear, little by little day by day, month by month, year by year. It's not all bad. I've had some wonderful moments with my mom. There are fewer moments now because there's far less of her there than there has been.

I cried a lot in the beginning, sometimes at the strangest times. I could be driving to work or watching a tv show and the tears would just begin to flow and I could't stop. I haven't cried as much lately and I'm not sure why. Am I used to the idea that I'm losing her, that she's dying before my eyes? I doubt it. It's probably that it's been going on almost 12 years and I don't know when the end will be. Not that anyone knows when the end will come. I think it's because I have to be strong for my dad who's started the grieving process recently. It's so hard for him to realize that she is going before him and he'll be without her. How will he manage? That's why I cry now, because of the pain it's causing him.

Sunday, May 9, 2010

Guilt and it's not anyone's fault

I teach a NAMI Family to Family education course every fall. The course meets for 12 weekly 2 1/2 hr classes and the course is always full (20 participants). One of the goals of the course is to let family members know that mental illness is not their fault, that they need not have any guilt. To let go of that guilt they feel.

Try telling that to any mother from any culture and you' might be blue in the face before they let go of that guilt. Even though they come to understand that mental illness is partly genetic predisposition in nature, a biological process, they still view it as they gave their child those genes that are part of the cause, as if that it's their fault. No one has a choice in which genes they pass on to future generations. (At least not yet.) IT IS NOT ANYONE'S FAULT!

If only mothers (and fathers and siblings) could realize that it's more important to deal with the reality that their loved one has a treatable illness that is the fault of no one. People are born with all kinds of predispositions to illnesses such type 1 diabetes or muscular dystrophy and we don't blame them for this. It's the unfortunate luck of different combinations of different genes that are either on or off. We are just beginning to understand how this happens.

The important message I'm trying to get across to mothers (and all other caregivers) is to focus on the present and future and assist their loved one in how to effectively manage their mental illness so they can live a productive and happy life just as anyone else would. Don't dwell on the past that can't be changed; just accept it and move on. The sooner you do this, the sooner you learn everything you can about the illness and treatments and services available so your loved one can too and be on the road of recovery, a lifelong journey for many.

If you get stuck in the past your loved one is likely to also. What's the expression, "like mother like...."

This is all meant in the most loving and understanding way from a sibling who became the caregiver in her family. Happy Mother's Day.

Thursday, April 29, 2010

May is Mental Health Month

I co-hosted a WeGo Health Webinar on Wednesday April 28th with Amy Kiel and the focus was May is Mental Health Month. Here is the link to some tips, tools and suggestions on how you can get involved . So how will I be getting involved?

I'll be exhibiting at a corporate health fair and displaying lots of helpful information on mental health and recovery and the support and education programs of NAMI Massachusetts. I always try to interact with people who come by and I'm often successful in finding out why they are getting literature and if they have any questions I can answer in person.

I'll be participating in the weekly Tuesday Mental Health and Social Media Twitter chats which I really enjoy. I'm always so invigorated after the chat, having discussed and shared thoughts about mental health topics with like minded people from Canada, England and Australia as well as across the U.S. Join the conversation on Tuesdays at 10pm EDT For other time zones use this to convert to your time zone.

I'll be tweeting and posting daily Facebook status updates about mental health facts, dispelling myths and telling how mental illness affects the entire family. I'm hoping that the followers and friends of NAMI Massachusetts and my personal Facebook friends will retweet/copy them into their status so we can raise awareness and reduce stigma. As a unified voice I hope we'll make a significant impact.

As Volunteer Coordinator for NAMI Massachusetts I'll be participating in the NAMIWalks Massachusetts: Changing Minds One Step at a Time on May 15th at Artesani Park, along the Charles River This Walk is such a fun experience, and yes a lot of work, but still lots of fun. It's wonderful to be around thousands of families, friends and so on, celebrating that mental illness is just like any other illness and that there's no shame or guilt associated with it - at least for those precious few hours. It's very empowering for most walkers and volunteers to participate.

I've pulled together as many Mental Health events in the state of Massachusetts as I could find and put them together in a calendar on our website I'll keep adding to the calendar as I find more events and programs. If you know of one please email me the info at There's a lot of good stuff going on around Children's (May 2nd-8th) and Older American's (May 23rd-29th) mental health so I hope people will take the time to check them out.

I'll be moderating a workshop at the Suicide Prevention Conference in Marlboro, MA and also helping out at the NAMI Massachusetts Exhibit table.

I'm sure there'll be more I'll add to my list and I'll keep you posted.

So please use me as your inspiration to get involved. I hope to see in your comments what you did to honor or celebrate May is Mental Health Month.

Sunday, April 4, 2010

What do the words mental illness mean?

I've been thinking about this question lately because I saw someone say on twitter that there isn't much stigma now. There are many others, including myself, who disagree with that tweet. So I started to think about what the words "mental illness" meant to people.

My first thought was to try to explain what mental illness is and this is difficult, because although recently there have been some advances in research, there is still no one gene or causal factor that medical science can point to and say this is what causes mental illness. Current thinking is that it's a three pronged chain reaction; a genetic predisposition; a stressful trigger or traumatic event; and lack of early identification/intervention with effective treatment. There is usually a delay of approximately ten years between onset of symptoms and illness identification followed by effective treatment.

The last prong of the chain reaction could be and possibly even the illness itself be prevented if there was early identification of symptoms followed by effective treatment.

What's the reason for the delay? One reason for it is due to the lack of knowledge about what the warning signs are on the part of parents, medical professionals, education professionals and religious personnel, anyone who has personal contact with a child or adult, but especially a child or adolescent. Another reason for it is outdated ideas about mental illness; thinking it's a weakness of personal character, thinking it's a result of poor parenting, even thinking that it's the person fault for not following their god or is being punished for some alleged sin. Yet another reason is cultural; there is shame in most cultures associated with having mental illness. The person who has the illness is kept away from others out of sight and isn't allowed to participate in life the same as others.

Does that last one sound familiar? It should, even here in the U.S., because we're a melting pot of cultures, this has effected how mental illness has been treated. Those with mental illness were kept at home (inside) until their illness was so severe that they were placed in an asylum or some people call them mental institutions for the rest of their life. Some institutions were nice if your family could afford it but almost all were absolutely awful beyond belief because they focused on containment and restraint. I don't want to get into any more details you can investigate that on your own. You should know that there are people with mental illness who are kept at home away from everyone even today in 2010, here in Massachusetts. That's such a sad statement.

Regardless of what the reasons are, education is something we can all participate in, something we can start doing today to solve the third prong of the chain reaction. We don't have to be scientists or mental health professionals. They should be doing their jobs in research and treatment. So my recommendations are as follows and these are not new or original ideas.

Ask that all public and private educational personnel (yes including staff) be required to receive some basic education about mental illness and what the procedures should be when someone either displays symptoms or talks about symptoms of mental illness. Any health class would include a discussion about mental health since they are connected.

Ask that all medical professionals be required to receive more mental health education in medical school and stay up-to-date for licensure. Since more and more primary care physicians are prescribing medications for mental illness they should also have up-to-date knowledge on the subject.

All mental health professionals should be required to maintain up-to-date mental health knowledge as part of their licensure. There are professionals with outdated knowledge who should not be treating people with mental illness.

Ask that all police, armed services, justice system and correction system personnel be required to receive in depth education and training about mental illness. (Ideally people with mental illness should be diverted to treatment at the earliest point of contact.) We don't want the jails and prisons to become the next mental institutions for our future children. What does that say about our commitment as a nation, to the most vulnerable in our care.

The Federal and State governments can and should, in conjunction with nonprofit organizations (and there are many), launch an in depth and long-term mental health education campaign about what mental illness is and what it isn’t and that there’s no shame in seeking treatment. This campaign would have to use a multi-media approach to reach all audiences, young and old, and all cultures. Early identification and treatment is most effective just as in any other illness. Education and early identification and treatment would cut long-term health care costs tremendously. This should be a no-brainer.

The following is for use as an informational guide not a tool for diagnosis which needs to be performed by a licensed and trained mental health professional. First seek out the expertise of your primary care physician and then he/she can refer you or your loved one to a mental health professional if required.

Warning Signs of Possible Mental Illness:
Sitting and doing nothing; rocking or pacing
Friendlessness; abnormal self-centeredness
Dropping out of activities; decline in academic/athletic performance
Inappropriate hiding
Loss of interest in once pleasurable activities
Frequent or sustained crying for no apparent reason
Expressions of hopelessness; extreme pessimism about everything
Excessive fatigue or sleepiness, or persistent insomnia
Inability to concentrate or cope with minor problems
Irrational statements and/or peculiar use of words
Excessive fears or suspicions
Bursts of emotion unrelated or out of proportion to the situation
Hostility from a person formerly passive and compliant
Indifference in important situations
Apparent inability to cry or express joy
Inappropriate laughter
Unexplained severe anxiety or fearfulness
Changes in eating habits; gorging, purging, starving
Hyperactivity or inactivity or both
Deterioration in personal hygiene or grooming
Extreme washing, checking, or counting
Noticeable or rapid weight gain or loss
Hair pulling or other forms of self-mutilation
Unusual involvement in automobile accidents
Drug or alcohol abuse
Forgetfulness or loss of valuable possessions
Frequent moves or hitchhiking trips; running away
Bizarre behavior; skipping, staring, or strange posturing
Extensive, sustained hoarding
Excessive sensitivity to noises, light, clothing, or smells
Obsession with and collection of guns, knives, explosives, etc.
Violence directed towards objects, animals, others, or self
Reports of hearing voices or seeing sights unknown to others
Beliefs that are obviously contrary to fact
Delusions of grandeur or persecution (paranoia)
Suicide ideation