Losses come in many forms, all of which can have a deep and profound psychological impact on those left behind. One important element of the grieving and healing process is finding a sense of closure. However, that sense is harder to find in some situations than others.

Decades ago, family therapist Pauline Boss, Ph. D., coined the term “ambiguous loss” to refer to a type of loss that lacks certainty, which can freeze the grieving process and prevent resolution. Ambiguous losses can be incredibly stressful, and only by recognizing them in ourselves and others can we find ways to cope and heal.

What is ambiguous loss?

Put simply, ambiguous loss is loss without closure, according to the Cleveland Clinic. Dr. Boss categorizes ambiguous loss into two main types:

• Type One ambiguous loss means a loved one is physically absent but psychologically present. The end of a relationship through a breakup or divorce is this type of ambiguous loss, as is loss of contact due to immigration. A Type One ambiguous loss also occurs when a person goes missing due to kidnapping, war, terrorism, or natural disaster.
• Type Two ambiguous loss is just the opposite: a loved one is physically present but psychologically absent. Usually, this is associated with cognitive disabilities and mental or physical illnesses that take away a loved one’s mind, such as Alzheimer’s disease, dementia, traumatic brain injury, addiction, or severe depression.

What makes both types of ambiguous loss difficult is the lack of closure. A confirmed physical death is certainly difficult, but that difficulty is concrete. The mind can process what happened, and there are rituals associated with it: the wake, the funeral, support from friends and family during a period of grieving, and so on. When a person is missing and presumed but not confirmed dead, or when they are physically present but unrecognizable, the sense of closure isn’t there.

Finding ways to cope with ambiguous loss

Coping with ambiguous loss means naming what has happened, recognizing it as a loss, finding meaning, and developing resilience. Dr. Boss has identified six pillars of coping with ambiguous loss:

• Finding meaning: making sense of the loss and finding a new purpose in life. For instance, some people who have experienced ambiguous losses channel their grief into advocacy,
• Adjusting mastery: recognizing your degree of control in the situation and learning to live with things beyond your control.
• Reconstructing identity: coming to understand your new identity following the ambiguous loss.
• Normalizing ambivalence: coming to terms with conflicted feelings, such as wishing for closure versus wishing for the person’s’ return.
• Revising attachment: carrying two contradictory ideas in your mind at the same time. “She may come back, or she may not.”
• Discovering new hope: finding a reason to carry on, often by helping others to avoid suffering the same ambiguous loss.

It’s critical for people who have suffered an ambiguous loss to get support and, when necessary, mental health treatment from a provider who has the right training and experience to help navigate these complex emotions. Ambiguous loss is, unfortunately, part of life, but with the right support system, it’s possible to develop resilience and find the resolve to keep moving forward.

Our law firm is honored to stand up for families

Unfortunately, the link between ambiguous loss and suicide is self-reinforcing. Suicide itself can cause a type of ambiguous loss: while someone who dies by suicide completion is definitively gone, losing someone to suicide can still create a psychological ambiguous loss because it’s so difficult to make sense of what happened. And experiencing ambiguous loss may increase the risk of suicide because someone who becomes frozen in the grieving process may become overwhelmed and unable to move on.

Ambiguous loss is one of several contributing factors to preventable deaths by suicide. If you have lost someone to suicide completion, we will listen to your story and explain your rights and options. Contact the Law Offices of Skip Simpson for a free, confidential consultation. We’re based in Texas but serve clients across the United States.

“Skip Simpson was my attorney regarding a mental health treatment team. I became the first person in the country to win a lawsuit against treaters who practiced recovered memories. That was 30 years ago. Skip was an amazing attorney for me and still is. He is the best in dealing with mental health issues. First a client, still a life long friend.”
— Laura P.
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SSRI activation in children and the misdiagnosis of Bipolar Disorder

Bipolar disorder is a devastating mental illness that affects over 5 million adult Americans every year. This mood disorder has been found to run in families, suggesting a possible genetic link and leaving children predisposed to what is often a violent onset of a manic or depressive episode. Many manic episodes require hospitalization, and the disorder’s extreme highs and lows are often the culprit for people losing jobs, relationships, homes and overall stability.

A misdiagnosis of bipolar, however, can be devastating. Medication can backfire. Diagnosis can be made too soon. While the adult and senior mentally ill population are at risk, children carrying a misdiagnosis are vulnerable brains in vulnerable bodies, and the medication they’re prescribed can do more harm than good. SSRI’s in particular can cause symptoms of hypomanic or manic states, leading to a bipolar diagnosis. This is called “SSRI-activation” and is not healthy for a child’s brain.

The Law Offices of Skip Simpson strives to protect the rights to proper care for mentally ill people, and we know how damaging a misdiagnosis can be, especially to children.

Diagnosing Bipolar Disorder

Bipolar disorder is actually somewhat difficult to diagnose correctly. Diagnostic criteria often involve noting the occurrences of episodes over a long period. These “episodes” are characterized by extreme “highs” and “lows” and usually come with a host of behaviors just as extreme, erratic and dangerous as their hosting moods. While lifelong and without a cure, bipolar disorder can thankfully be treated with medication and therapeutic methods.

In adults, bipolar disorder in one of its varying forms (as the disorder exists on a spectrum) typically reaches a full diagnosis in late adolescence into the mid-twenties. Due to a developing brain, it should be cautioned against to diagnose children with such a severe mental illness, though pediatric bipolar exists. Criteria fall into two categories, one for “manic” symptoms, and the other for “depressive” – the two “poles” of the illness. To be diagnosed, these two distinct mood states need to exist for certain lengths of time. These criteria are cited from the Juvenile Bipolar Research Foundation:

Symptoms of a Depressive Episode:

• Depressed mood most of the day, nearly every day
• Diminished interest in hobbies or activities
• Speech may become slow, delayed and even slurred
• Physical symptoms such as pain, hypersomnia or extreme fatigue
• Reoccurring thoughts of death or suicide
• These symptoms must occur every day for at least a week

Symptoms of a Manic Episode:

• At least one week of abnormal and persistent elevation in mood, including irritability.
• Decreased need for sleep
• Delusions of grandeur
• Potential psychotic symptoms-hallucinations and disconnect from reality
• Racing thoughts, sometimes to where a sufferer may feel like their head is “crowded” or “loud”
• Speaking so rapidly that others cannot understand them and speech may not even follow a coherent train of thought
• Inability to focus or sit still
• Excessive spending, substance abuse, irresponsible sexual activity or unsafe driving

Bipolar disorder is separated into Bipolar I and Bipolar II, based on the severity and duration of episodes. In addition, there are other criteria that must be met, making bipolar disorder something a professional should not diagnose lightly in a child.

The right medication for the wrong diagnosis

The absence of mania or hypomania is often overlooked when children complain of depressive symptoms and are prescribed selective serotonin reuptake inhibitors, or SSRI’s. Commonly known as antidepressants, when given to children they can relieve symptoms of unipolar depression. However, SSRI’s “activate” roughly 10% of children, meaning they can cause symptoms eerily similar to hypomania or mania. Irritability, fast speech, hyperactivity and even suicidal ideations can occur. Children with ADHD and anxiety are often given SSRI’s, and their “activated” effects can easily lead to a bipolar diagnosis.

Children with developmental disabilities are particularly at risk. Someone who is a “slow metabolizer” of SSRI’s will see problems even on the lowest dosage. Parents often panic when their child reacts to medications, or seems treatment resistant. Being the legal guardian, they can easily misdirect therapy and medication, sometimes demanding a higher dose for a child that seems unresponsive.

Medication should be carefully monitored, as should the child’s symptoms. Parents who believe their children are treatment resistant may simply not be treating the proper condition, such as ADHD or anxiety, which responds better to an atypical antipsychotic drug. Making “one change at a time” in a child’s medication is heavily stressed, according to Dr. Birmaher of the Western Psychiatric Institute and Clinic in Pittsburgh. The brain is a delicate instrument, and providers who switch multiple drugs at once are putting children at risk.

The risks of a misdiagnosis

Suicide in our youth is no new statistic. One suicide every five days is the current standing rate, a 40-year high, for suicide rates in children under 13. Medication may alleviate symptoms but can also put child patients at risk. In 2004, the FDA issued a public warning of an increased risk of suicidal thoughts or behavior in children being treated with SSRI’s. The SSRI’s reviewed included:

• Fluoxetine (Prozac)
• Zoloft
• Paxil
• Celexa
• Lexapro
• Luvox

The black box warning noted that children should be monitored closely. Bipolar disorder is often treated with a “cocktail” of medications. SSRI’s, mood stabilizers and antipsychotics are popular, and all carry warnings. Even so, the use of SSRI’s in children over 10 has increased considerably over time, and those medications persist in their popularity. We can take no chances when treating our youth for psychiatric conditions. We cannot afford to lose any more sisters, brothers, daughters, sons and friends.

We help protect their rights

Every child has the right to be treated with dignity and respect when addressing potential psychiatric concerns, and this includes adhering to the same strict evaluation that adults must endure to properly diagnose a serious mental illness. Combining therapy with medication and lifestyle changes can be particularly effective, whereas prescribing potentially dangerous medication for a condition that is, in fact, something else can be devastating.

If you or a loved one have suffered the terrible consequences of a child misdiagnosed and mistreated, contact us. We may help.

NBC News anchor Brian Williams has been suspended for six months without pay because of exaggerating stories regarding the potential danger he was in while reporting from disaster-afflicted regions. When it finally came to light remarks he had told were not accurate, some memory experts offered explanations other than deliberate misstatements by Mr. Williams. The possible argument made to justify his comments: the complexity of memory and how memory works.

Mr. Simpson, a lawyer well versed in the dangers of false memories, states “Mr. Williams, the NBC news department, and the nation all may believe Mr. Williams has deliberately lied when in fact Mr. Williams may simply have had confabulated memories. Confabulated memory is the production of fabricated, distorted or misinterpreted memories about oneself or his or her environment, without the conscious intention to deceive. I sincerely hope the possibility of a confabulated memory is carefully considered rather than a rush to condemn a good man.”   Simpson adds “there are techniques to employ to determine whether or not the Brian William’s comments are more likely confabulations or deliberate misstatements.   The pile on by other networks is self-serving and not informative. This entire William’s story can be one where the public is educated about the false memory controversy; a subject which major mental health organizations warned about in the 90’s.”

A mental health malpractice lawyer knows that false memories are a controversial issue and one that becomes a major cause for concern when people’s testimony of terrible crimes is used to secure a conviction in court. It is important to understand the complexities of false memories and the truth behind how memories work to develop a better understanding of why certain types of counseling may be problematic.

False Memories a Complex Subject

The Boston Globe reports on how memories change over time to create a story that makes sense based on your current world. Some experts believe that memories often provide false accounts of events that may have occurred, or provide “at best, semi-accurate records of what we experience.”

Research supports the theory that memory is fallible. Last year, a study published in the Journal of Neuroscience involved 17 participants looking at a computer screen at an object. The object was then moved to a different place in the same background. The participants were then asked to put the object back to where it had originally been, and they always put it closer to where it was in the second picture. This suggests the second picture had repealed the old one in their minds.

If the brain can create incorrect memories just by looking at different pictures, this means there is an even bigger risk that the brain will create false or incorrect memories when faced with explicit suggestions. This is part of what made Repressed Memory Therapy dangerous and is part of what makes theophostic counseling dangerous.

Repressed memory therapy (RMT) is a field of psychotherapy that assumes issues like insomnia, anxiety, bulimia and other related problems are caused by memories of child abuse that have been repressed. Techniques like hypnosis, guided imagery or other trance like states are used to help people “recover” their memories of abuse that their subconscious may have allegedly buried. In the last four decades however, repressed memory therapy was found to have caused many individuals to make false accusations of sexual and or satanic abuse that didn’t occur. RMT is not recommended by mental health professionals because of the risks of inadvertently planting false memories.

Theophostic counseling was developed in the 1990s and is also aimed at helping people to identify underlying causes of ongoing emotional pain and ongoing causes of current sins. The premise is that everyone is emotionally wounded because of lies the memory creates about past experiences and everyone must seek to have hearts and minds healed by Jesus. There are 14 principles of theophostic counseling, including finding renewal for the past to redeem the present.  However, many critics believe this process of dealing with past experiences is just a form of repressed memory therapy by another name.

If counselors use techniques like RMT or theophostic counseling and people falsely remember things like abuse, mental health counselors who participate in these widely-criticized forms of psychotherapy can sometimes be held liable for the consequences.

A psychiatric malpractice attorney at the Law Offices of Skip Simpson can help. Call (214) 618-8222 or visit http://www.skipsimpson.com to schedule a free case consultation.

For families of people who are in psychological pain, or who are suffering from what is called “psychache”—the hurt, anguish or overwhelming pain that can take hold in the mind— knowing when to contact a professional on a loved one’s behalf can be daunting. You may be unsure if it’s suicidal behavior, but you are constantly worried. A person, however, will usually show suicide warning signs long before seeing a psychologist, being admitted into a mental health facility or becoming an inpatient in a psychiatric hospital.

Experienced, compassionate Texas suicide lawyer Skip Simpson urges anyone who thinks they may have noticed even the slightest sign that a loved one may be suicidal to take action. Often, it doesn’t take much action to save a life—and to begin the process of ensuring that the person in danger gets help before deciding to take his or her own life. People who have jumped off a bridge in desperation but survived the fall have said they would not have leapt if they had received one smile from one person as they approached the railing. If a smile from a stranger can be that powerful in helping to keep a man who is in anguish over losing his job from choosing to end his life, or to prevent a woman overwhelmed by grief at the loss of her husband from deciding to kill herself, think what a loved one could do to help prevent a suicide.

Sometimes even close relatives will think their loved is not the type of person who could be suicidal. According to the National Suicide Prevention Lifeline there are certain suicidal thoughts and actions that men, women or adolescents with psychache may display, especially if they suffer from depression or other disorders linked to a risk of suicide:

• He reasons that he is a burden to others, feels trapped, has nothing to live for or wants to die.
• She says she has no reason to live, feels hopeless, is in unbearable pain or should just end it all.
• He is looking for ways to end his life, such as searching for poisons online or buying a gun.
• She is drinking more, using drugs excessively or engaging in risky activities.
• He is full of rage, acting recklessly or focused on seeking revenge.
• She seems agitated, anxious, and feeling there is no way out.
• He isolates himself from others and is withdrawn.
• She is not sleeping much or sleeping all the time.

• He has increasingly extreme mood swings.
• She has stopped going to work.
• He has stopped eating.

If you have a loved one who is showing signs of psychache and suicidal thoughts, act now. Here are several approaches the NSPL recommends that could help save someone’s life:

• Be direct. Talk openly and matter-of-factly about suicide.
• Be willing to listen. Allow them to express their feelings and accept those feelings.
• Don’t be judgmental or debate whether suicide is right or wrong. Don’t lecture on the value of life.
• Get involved. Become available. Show interest and support.
• Don’t dare him or her to do it.
• Don’t act shocked. This will put distance between you.
• Don’t be sworn to secrecy. Seek support.
• Offer hope that alternatives are available but do not offer glib reassurance.
• Take action. Remove means, such as guns or stockpiled pills.
• Get help from persons or agencies specializing in crisis intervention and suicide prevention.

Families of loved ones who attempted to commit suicide, who killed himself or took her own life in a mental health care facility or psychiatric hospital should also know that clinicians and hospital staff are often underpaid and stretched thin with their workload. Consequently patients are often watched only every 15 minutes, instead of at a higher level of observation, such as one-to-one or in line of sight of a hospital employee.

You have most likely come to this blog because someone you care about, or who is in your professional care, is in danger of committing suicide. Take action before anything happens.  If your loved one committed suicide or attempted suicide—whether as an inpatient, before being admitted to a hospital or emergency room, or after being released—you need a reliable, diligent suicide attorney. Call  Skip Simpson Attorneys and Counselors at 214-618-8222 or complete our online contact form. We understand what you are going through and can fight hard to pursue the compensation you and your family deserve.

A final note: Mr. Simpson rejects many more cases than he accepts. Not all attempted suicides are the result of incompetent care.  Mr. Simpson and the experts he retains distinguish the cases in which law suits are needed from those in which no law suit should be filed.

The Law Offices of Skip Simpson, 2591 Dallas Parkway, Suite 300 Frisco, Texas 75034