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Lloyd I. Sederer, MD

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I Hear You: Responding to Cries for Emotional Help

Posted: 01/18/12 08:42 AM ET

Cries for emotional help come in all forms. We witness these cries in ways direct and indirect: from outright requests to help me stay alive to the less direct but no less obvious self-starvation of anorexia or leaving empty pill bottles or illegal drugs in plain sight.

We recently witnessed a modern-age cry for help when Sinead O'Connor declared on Twitter: "does any1 know a psychiatrist in dublin or wicklow who could urgently see me today please? im really un-well... and in danger." Why a celebrity needs Twitter to find a psychiatrist is beyond me. Sure, we can all quip about how hard it is to get an appointment with a doctor, but I suspect that is not what this was about.

Nor can I know since I am not personally familiar with this celebrity, her medical community or resources, or for that matter her state of mind when she turned to such a ubiquitous form of social media for help. But as a psychiatrist I understand how people reach out in ways that we need to listen to: The ultimate fear is that they will find no one there, which is the saddest situation of all. Suicide, as has been said, is not just the product of hopelessness; it is the result of believing that you are all alone, with no one to turn to and no means of exiting from the psychic pain that is crushing your soul.

Mental or emotional pain hurts no less than physical pain. In some ways, mental anguish can be more unbearable because it is often laced with several horrible additives. The first is a common tendency for a person to blame themselves for the condition they are in: They feel guilt, shame, a failure for not having willed themselves better. In addition, there is stigma: The way that people with mental disorders are shunned, castigated and marginalized as if that person is a low-life who needs "to get a life." External injury is thus added to personal agony and self-blame. Topping it all off, there is no broken bone, tumor or infection to point to that explains what's causing the pain. This can create upheaval in a person's sense of self as they search for a way of comprehending what does not have the same explanatory power as do the myriad of conditions that appear visibly on the body, or by blood or imaging tests, or by looking at cells under a microscope.

The Australians launched a social media campaign a few years ago called "R-U-OK?". The Aussies suggested something far more personal and meaningful than waiting for someone to arrive at an emergency room after an overdose or sending a distress signal by email, Twitter, Facebook or some other channel in our rapidly-expanding universe of social media. If you see someone in emotional distress or displaying the consequences of psychological problems (such as social isolation, compromised work performance, poor self-care), they urged to reach out to that person: Ask, R-U-OK? and then sit back and listen non-judgmentally and support the part of that person that wants to live, to love and to be connected to their family, friends and work community. It is there, I assure you, but often buried under hurt and disappointment and hopelessness.

Don't be afraid of saying the wrong thing. Saying nothing, letting somebody stew in their psychic pain, is far more likely to result in something unfortunate happening than is offering a kind word and support for taking what steps are needed to begin to change a situation or treat a problem. When no one asks, when no one notices, cries for help generally escalate -- and not only by tweeting.

Human behavior is purposeful. We do things for a reason. Sometimes that reason (or reasons) is obvious and sometimes not. Behavior is "crazy" only until we understand it, then it is not crazy anymore. Self-destructive behavior happens for a number of reasons, including a need to communicate with others how bad the pain and loneliness is.

You may not be able to answer a celebrity's Twitter cry. But you can listen for cries for help from those you love, from friends and from co-workers. You can answer their cries for help. If not, who knows where or how the cry will next appear?

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.

Visit Dr. Sederer's website (www.askdrlloyd.com) for questions you want answered, reviews, commentary and stories.

For more by Lloyd I. Sederer, MD, click here.

For more on mental health, click here.