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Anthony Bourdain, Kate Spade, and the Fallacy of Success and Happiness

On Tuesday morning, fashion designer Kate Spade committed suicide. A few days later, on Friday afternoon in Strasbourg, France, chef Anthony Bourdain committed suicide.

What stands out both Spade's and Bourdain's death is the fact that they represented, for many, what seemed to be success and happiness. Spade had sold her eponymous handbag collection in 2007, had a husband and a teenage daughter, and had swept up every fashion award humanly possible, and then some.

Likewise, Bourdain was a giant in his field, working up the ranks in the kitchen to becoming a talented chef, a widely read author, and achieving the pinnacle of his success in televised food documentaries that flung him to perilous corners of the Earth, first through No Reservations and then through Parts Unknown.

Beneath that sheen of success and happiness, however, there was depressiondeep, unsettling, tumultuous depression that rocked both Spade and Bourdain, ultimately leading them to commit suicide.

That's a huge problem within the mental health community right now, which is reeling from the fact that not only did two well-liked, highly followed celebrities with strong fan following potentially spark a suicide contagion, but also a report out from the Centers for Disease Control that proves what we've suspected: Suicide rates are spiking in every state in America, with about half of states seeing levels skyrocketing 30 percent more than previously reported.

One of the most astonishing facts reported in the CDC's Morbidity and Mortality Weekly Report is the fact that 54 percent of people who committed suicide had previously unknown mental health issues. Only after they died did loved ones figure out that there were issues beneath their outward facade.

"The first thing is that even people who have a lot of support are not immune to mental health issues behind the scenes," Lauren Appio, a psychologist with a private practice in Manhattan who is trained in dealing with patients dealing with suicide ideation and depression, told The Daily Beast. "They might say, 'I have it all. Why can't I be satisfied, be content, move past this?"

Appio said that the misconception that people who "have it all" can't have depression or be dealing with mental health issues often works against patients as well, wondering why they are incapable of being happy if they have a dream family and relationship, a job others lust after, and all the perks of fame and success.

That's the wrong way to think about it. While many equate suicide with those who have struggled with mental illness for years or dealt with substance abuse and have had an established history of trying to deal with their inner demons. But Appio said that those most at risk of suicide ideation are often the very people who don't have such a history.

That said, Appio stressed that there are warning signs. She said they almost always told someone about the issues they were dealing with: talking about wanting to die and kill themselves, researching methods of suicide online, and expressing hopelessness, feeling trapped or like a burden on others.

But a potential obstacle might be those who are close to the patient and might not understand why success and "having it all" doesn't mean happiness. "People might unintentionally invalidate them by asking, 'What's wrong? Why don't you snap out of it?'"

And that invalidation can be extremely dangerous in putting a person towards the path of suicide.

Dr. Waguih William IsHak is a professor of psychiatry at Cedars-Sinai in Los Angeles agreed that people who might seem like they are successful and happy are at risk of hiding depression, and can be so good at it that they don't pique concern from even those closest to them.

What can be especially frightening is the point at which a depressed person has internally made the decision to commit suicide, and reach a sense of relief.

"So many people don't see it [suicide] coming because they [eventual victims] seem to be in such a good mood and so relieved," IsHak said. "It's a scary thing."

That makes the science of trying to understand when a person is most at risk of committing suicide essential. Yet, because of stigma, science funding, and the complex psychology behind suicide, it's been one of the least funded and understood mechanisms of our neuroscience.

In fact, IsHak called suicide neuroscience and our understanding of it "underdeveloped." "We've looked at biochemicals, and we have some ideas, but a lot of the studies don't have anything reliable to show."

One potential area of promise is Brodmann Area 25, a part of the cerebral cortex in the brain that has shown some linkage with depression and suicide. In people who are depressed and are considering suicide, some preliminary research seems to suggest that there is low metabolic activity in the area, with low oxygen rates and glucose. IsHak cautioned the research is early and that what we know about Brodmann Area 25 can hardly be used for prediction. But it's a start.

Some work in this arena has been done, and to great effect. Kelly Posner at Columbia University helped establish the Columbia-Suicide Severity Rating Scale, a series of questions that can be asked of anyone and has proven remarkably effective in preventing suicide and helping to treat depression.

But its not enough. Perhaps the biggest obstacle towards treating suicide as the public health issue it is is the fact that there is no federally funded program, particularly focused on the most vulnerable population of adults.

"Suicide research has not become a national priority, and it should," Is Hak said. "It would open the door to using biomarkers and brain imaging to study people at risk of suicide.

The important thing to understand, according to experts, is that those who might seem happy, who might seem fortunate, who might not seem to have a reason to be anything but lucky are not immune to mental health struggles. For those wondering about Bourdain and Spade's suicides, the question is often why. But the truth is complex and one that is lodged deep within their now silenced memory and mind. That they were successful did not preclude them from angst and pain, the type that pushed them over the edge into suicide; in fact, that contrast of their outward success and seemingly perfect life from the turmoil they dealt within themselves might have driven them to feel even more out of touch, hopeless, and isolated.

"We all know people like this, if we're not them ourselves," Appio noted. "We live in a culture where we're motivated to hide and suppress our suffering in the name of seeming fine. There's a pressure to persevere and be positive.

"It's possible for people to hide," she said. "But those warning signs slip through. That we we have to look out for."

If you or a loved one are struggling with suicidal thoughts, please reach out to the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

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Radical new approach to schizophrenia treatment begins trial

Exclusive: as evidence emerges that schizophrenia could be an immune system disease, two-year trial will use antibody drug currently used for MS

British scientists have begun testing a radically new approach to treating schizophrenia based on emerging evidence that it could be a disease of the immune system.

The first patient, a 33-year old man who developed schizophrenia after moving to London from Cameroon a decade ago, was treated at Kings College Hospital in London on Thursday, marking the start of one of the most ambitious trials to date on the biology of the illness and how to treat it.

During the next two years, 30 patients will receive monthly infusions of an antibody drug currently used to treat multiple sclerosis (MS), which the team hopes will target the root causes of schizophrenia in a far more fundamental way than current therapies.

The trial builds on more than a decades work by Oliver Howes, a professor of molecular psychiatry at the MRC London Institute of Medical Sciences and a consultant psychiatrist at the Maudsley Hospital in south London. Howess team is one of several worldwide to have uncovered evidence that abnormalities in immune activity in the brain may lie at the heart of the illness for some patients, at least.

In the past, weve always thought of the mind and the body being separate, but its just not like that, said Howes. The mind and body interact constantly and the immune system is no different. Its about changing the way we think about mental illnesses.

Recent work by Howes and colleagues found that in the earliest stages of schizophrenia, people experience a surge in the number and activity of immune cells in the brain. As well as fighting infection, these cells, called microglia, have a gardening role, pruning unwanted connections between neurons. But in schizophrenia patients, the pruning appears to become more aggressive, leading to vital connections being lost.

We studied people in that [initial] phase of the illness and saw microglial changes, said Howes. It shows that its something [happening] very early on and seems to be driving the illness.

The most extensive pruning appears to occur in the frontal cortex, the brains master control centre, and also the auditory regions, which could explain why patients often hear voices. The frontal cortex indirectly controls the brains levels of dopamine a surge in this brain chemical is thought to explain the delusions and paranoia experienced by those with schizophrenia.

Nearly all existing medications work by blocking dopamine, which can bring psychotic symptoms under control, but fail to protect the brains basic architecture from damage.

The current drugs are based on 1950s technology; they all still work in exactly the same way, said Howes. They are only able to target the delusion side of things. Its like getting a sledgehammer and squashing it down.

Microglial cells, outlined in green stain, have thin processes that reach out around brain cells, stained in red. Photograph: Bloomfield et al

There is a growing appreciation that other, perhaps less well-known, symptoms associated with schizophrenia memory and cognitive problems, and lack of motivation can have an equally profound impact on patients, and existing drugs do little to help this side of the disease. Its typically [these other] symptoms that are the most disabling, said Toby Pillinger, a psychiatrist and Kings College London researcher involved in the study.

The latest trial, a collaboration between MRC scientists and Kings College London, involves treating patients with a monoclonal antibody drug, called Natalizumab, that is already licensed for MS. In MS, the brains immune cells go awry by attacking a different aspect of the brains wiring. And although the diseases manifest in very different ways, apparent parallels in the underlying biology raise the possibility that the MS drug might help schizophrenia patients.

The drug works by targeting microglia and restricting their movement around the brain, which scientists hope could prevent the over-pruning of vital connections. In doing so, it could potentially address the diseases full spectrum of symptoms.

The first participant, Leopold Fotso, 33, received his first dose of treatment on Thursday. Fotso, who lives in south London after moving from Cameroon in 2007, was diagnosed with schizophrenia four years ago. He has been admitted to hospital several times with psychotic episodes. His illness also forced him to abandon his studies in accountancy which he had moved to the UK to pursue and his part-time kitchen job.

Leopold Fotso undergoes the first treatment of a new therapy for schizophrenia. Photograph: Teri Pengilley for the Guardian

He currently has monthly injections of an antipsychotic drug, and his condition is now stable. He feels on the way to being himself again and is looking to slowly start working again. Its quite hard, he said.

At some time during their life about 1 in 100 people will suffer an episode of schizophrenia. In the UK, about 220,000 people are being treated for the condition by the NHS at any one time.

In total, in this first trial, 60 patients will be treated for three months, attending clinic once a month for hour-long infusions half will receive the antibody, half a placebo. The patients symptoms will be tracked and, along with 30 healthy volunteers, they will be given a series of brain scans, cognitive assessments and tests of immune activity. The hope is that, even if symptoms do not improve, the study should also answer fundamental questions about the role of the immune system in the illness.

Belinda Lennox, senior clinical lecturer in psychiatry at the University of Oxford, whose work also focuses on the role of the immune system in schizophrenia, said the concept behind the latest study was exciting although at a very experimental stage. Theres a lot of emerging evidence that the immune system is going wrong [in schizophrenia], she said. If reducing inflammation acts to improve psychosis in this study it will open a new range of treatment possibilities, which is very exciting for the field, and desperately needed.

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