March Madness; April Fools
Consider the title. Both terms indicate we are now in a season marked by much fun and frivolity. But both terms also suggest a darker side of this season as well: they hint at a time of loss of normal self controls, which can make this season one of considerable unrecognized dangers as well.
Many cultures recognize and sanction the loosening of our restraints in early Spring. In the U.S., Mardi Gras is perhaps the most vivid example of raucous behaviors, including wild costumes and dancing, laced with ample doses of imbibing and licentious behaviors. Germans, characteristically(at least in popular imagination) staid and predictable, celebrate the end of Fasching at this time with days of permissible loss of restraint. Holi in India is celebrated with vividly colored costumes, throwing colored water, dirt and balloons at others, and even gals kissing selected guys. On Purim, in March, the rabbis have instructed us to drink to such an extent that we can no longer differentiate the good guy in the Purim story(Mordechai) from the evil one(Haman), an alcohol binge otherwise prohibited the rest of the year(I know of no one who adheres to this command). And, of course, on April Fools Day we may prank and humiliate our friends in a fashion that would be wholly infantile and unsocialized at other times.
March, unfortunately, also marks the beginning of the season of suicide in the Northern hemisphere. Most of us intuitively think of the dark and cold winter as the prompter of suicidal behaviors, but in fact the winter has the lowest incidence of these tragic occurences. Suicide likewise is most frequent in the respective spring and summer months in the Southern hemisphere. Numerous factors have been posited for this recurring phenomenon, but most experts would link the increase in spring and summer suicide rates to the lengthening of the hours of sunlight during these months. Other factors, including seasonal variations in temperatures, fatty acids, and neuropeptides have also been hypothesized. No matter what the proximate factors may be, this marks a time of increased vulnerability to taking one’s life. In March, savvy psychiatrists need to be especially vigilant in monitoring their patients for these self destructive behaviors.
Suicide, however, is also but the mirror image of homicide: Both are supremely violent behaviors, the latter against others, the former against oneself . Both are marked by the same decrease in the breakdown product of serotonin, an antidepressant neurotransmitter, found in the cerebrospinal fluid. It is therefore not surprising that homicide and violence also find their first of two peaks in the spring, the second peak being in autumn.
While not a scientific survey, it is nonetheless instructive to ponder the headline violence linked to our current season, beginning with the recent Brussels terroristic murders. Other notable violence linked to spring have been the Columbine shootings(April 20), the homicidal/suicidal flight of Germanwings Captain Lubitz(March 24), and the executions in the West Bank mosque of many Muslim worshippers on Purim of 1994(February 25). Indeed, the Purim story itself, likely based on an ancient Persian rituals tied to what was essentially Mardi Gras season of the time and recorded in the wonderfully crafted Biblical novella, Esther, is replete with planned violence(against Mordechai and the Persian Jews), hangings(of Haman and his sons), and mass murders (of enemy Persians) .
I would now draw attention to a significant and often unrecognized effect of the spring season on psychiatric patients, specifically those suffering depression. This mood disorder can present in a number of different ways. It may appear as episodes of pure depression separated by periods of normal moods, as classical Bipolar Disorder in which the individual suffers depressive episodes distinct from manic ones(including euphoria, decreased need for sleep, excessive energy and exuberance), or mixed episodes wherein depressive and and manic or hypomanic symptoms are intermixed like a kneaded bread. It turns out that individuals suffering a Bipolar or mixed depression are the population most likely to suffer seasonal winter depressions. They are also, however, susceptible to getting manic or hypomanic symptoms in the spring. These energized spring states pose special dangers for suicidal and violent acts. Yet, these hyper-aroused and hyper-energetic states, sometimes mixed with depression, can be hard to detect, even for accomplished psychiatrists, let alone for primary care physicians who, in fact, treat a full 70 percent of psychiatric patients, especially those with depression.
The increase in self- and other-directed violence during this season may not be limited to diagnosed depressed or manic individuals.
Personally, I was a painful and bereaved witness to the seasonal unsettling of the mental faculties of a dear colleague, who spent three chaotic days taunting his family and associates with suicide threats and fleeing multiple scenes before finally overdosing virtually on his employees’ doorstep. It took place in March, 1978.
If we think about it, it should come as no surprise that increasing or decreasing sunlight should affect us as much as I’ve described. All life, after all, is permeable to the environment on our planet. Life was created on Earth, and interacts with all of its unique characteristics and forces. We are also reactive, for instance, to negative(calming) and positive(agitating) ions in the air, ultraviolet light(sun damage), altitude(sickness and increased risk for suicide), and numerous other environmental stimuli with penetrate our biological systems. Many of these have yet to be studied adequately, but their effects are more considerable than we generally appreciate.
The take-home leson is this: Springtime is a seaon of fun and freedom, but it is also an unsettled season. The sunlight is changing rapidly, the weather is unsettled, and, for whatever cause, our abilities to control our violent impulses weaken considerably at this time as well. This loss of self control has been both socialized and, to an extent, harnessed through sanctioned social and religious rituals.
Whether we consider ourselves, psychiatric patients, or the general population, springtime and pre-spring should signal caution to us all. Be on the lookout for any increased violence, for suicidal statements, or for sudden aroused states in previously depressed and lethargic family members and associates. Physicians, especially those in primary care, need, too, to be extra cautious in evaluating their patients. If energized individuals also use alcohol or drugs, or are adolescents, populations whose controls are already compromised even before the vernal equinox, we need to be especially vigilant to monitor their behaviors and bring them to treatment before violence ensues.
Awareness of March madness will help us from becoming April fools.
Consider the title. Both terms indicate we are now in a season marked by much fun and frivolity. But both terms also suggest a darker side of this season as well: they hint at a time of loss of normal self controls, which can make this season one of considerable unrecognized dangers as well.
Many cultures recognize and sanction the loosening of our restraints in early Spring. In the U.S., Mardi Gras is perhaps the most vivid example of raucous behaviors, including wild costumes and dancing, laced with ample doses of imbibing and licentious behaviors. Germans, characteristically(at least in popular imagination) staid and predictable, celebrate the end of Fasching at this time with days of permissible loss of restraint. Holi in India is celebrated with vividly colored costumes, throwing colored water, dirt and balloons at others, and even gals kissing selected guys. On Purim, in March, the rabbis have instructed us to drink to such an extent that we can no longer differentiate the good guy in the Purim story(Mordechai) from the evil one(Haman), an alcohol binge otherwise prohibited the rest of the year(I know of no one who adheres to this command). And, of course, on April Fools Day we may prank and humiliate our friends in a fashion that would be wholly infantile and unsocialized at other times.
March, unfortunately, also marks the beginning of the season of suicide in the Northern hemisphere. Most of us intuitively think of the dark and cold winter as the prompter of suicidal behaviors, but in fact the winter has the lowest incidence of these tragic occurences. Suicide likewise is most frequent in the respective spring and summer months in the Southern hemisphere. Numerous factors have been posited for this recurring phenomenon, but most experts would link the increase in spring and summer suicide rates to the lengthening of the hours of sunlight during these months. Other factors, including seasonal variations in temperatures, fatty acids, and neuropeptides have also been hypothesized. No matter what the proximate factors may be, this marks a time of increased vulnerability to taking one’s life. In March, savvy psychiatrists need to be especially vigilant in monitoring their patients for these self destructive behaviors.
Suicide, however, is also but the mirror image of homicide: Both are supremely violent behaviors, the latter against others, the former against oneself . Both are marked by the same decrease in the breakdown product of serotonin, an antidepressant neurotransmitter, found in the cerebrospinal fluid. It is therefore not surprising that homicide and violence also find their first of two peaks in the spring, the second peak being in autumn.
While not a scientific survey, it is nonetheless instructive to ponder the headline violence linked to our current season, beginning with the recent Brussels terroristic murders. Other notable violence linked to spring have been the Columbine shootings(April 20), the homicidal/suicidal flight of Germanwings Captain Lubitz(March 24), and the executions in the West Bank mosque of many Muslim worshippers on Purim of 1994(February 25). Indeed, the Purim story itself, likely based on an ancient Persian rituals tied to what was essentially Mardi Gras season of the time and recorded in the wonderfully crafted Biblical novella, Esther, is replete with planned violence(against Mordechai and the Persian Jews), hangings(of Haman and his sons), and mass murders (of enemy Persians) .
I would now draw attention to a significant and often unrecognized effect of the spring season on psychiatric patients, specifically those suffering depression. This mood disorder can present in a number of different ways. It may appear as episodes of pure depression separated by periods of normal moods, as classical Bipolar Disorder in which the individual suffers depressive episodes distinct from manic ones(including euphoria, decreased need for sleep, excessive energy and exuberance), or mixed episodes wherein depressive and and manic or hypomanic symptoms are intermixed like a kneaded bread. It turns out that individuals suffering a Bipolar or mixed depression are the population most likely to suffer seasonal winter depressions. They are also, however, susceptible to getting manic or hypomanic symptoms in the spring. These energized spring states pose special dangers for suicidal and violent acts. Yet, these hyper-aroused and hyper-energetic states, sometimes mixed with depression, can be hard to detect, even for accomplished psychiatrists, let alone for primary care physicians who, in fact, treat a full 70 percent of psychiatric patients, especially those with depression.
The increase in self- and other-directed violence during this season may not be limited to diagnosed depressed or manic individuals.
Personally, I was a painful and bereaved witness to the seasonal unsettling of the mental faculties of a dear colleague, who spent three chaotic days taunting his family and associates with suicide threats and fleeing multiple scenes before finally overdosing virtually on his employees’ doorstep. It took place in March, 1978.
If we think about it, it should come as no surprise that increasing or decreasing sunlight should affect us as much as I’ve described. All life, after all, is permeable to the environment on our planet. Life was created on Earth, and interacts with all of its unique characteristics and forces. We are also reactive, for instance, to negative(calming) and positive(agitating) ions in the air, ultraviolet light(sun damage), altitude(sickness and increased risk for suicide), and numerous other environmental stimuli with penetrate our biological systems. Many of these have yet to be studied adequately, but their effects are more considerable than we generally appreciate.
The take-home leson is this: Springtime is a seaon of fun and freedom, but it is also an unsettled season. The sunlight is changing rapidly, the weather is unsettled, and, for whatever cause, our abilities to control our violent impulses weaken considerably at this time as well. This loss of self control has been both socialized and, to an extent, harnessed through sanctioned social and religious rituals.
Whether we consider ourselves, psychiatric patients, or the general population, springtime and pre-spring should signal caution to us all. Be on the lookout for any increased violence, for suicidal statements, or for sudden aroused states in previously depressed and lethargic family members and associates. Physicians, especially those in primary care, need, too, to be extra cautious in evaluating their patients. If energized individuals also use alcohol or drugs, or are adolescents, populations whose controls are already compromised even before the vernal equinox, we need to be especially vigilant to monitor their behaviors and bring them to treatment before violence ensues.
Awareness of March madness will help us from becoming April fools.
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