Panic might be triggered by signals from your bones

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Them bones do more than you give them credit for.

Them bones do more than you give them credit for. (Camilo Jimenez via Unsplash/)

In a stressful situation, your hands may sweat and your heart may pound. But a new paper published Thursday in Cell Metabolism suggests that a less obvious organ—your skeletal system—is what starts the fight-or-flight response that gets you out of harm’s way.

“It’s a revolutionary study,” says Ernestina Schipani, a medical doctor and professor of orthopaedic science at the University of Michigan who was not involved in the new research. The paper, she says, completely changes our understanding of the sympathetic nervous system—the “fight-or-flight” response—by demonstrating that bone is “critically important” to its function.

Until now, Schipani says, she and the rest of the scientific community thought it was adrenaline, a well-known hormone produced by the adrenal glands located above the kidneys, that kickstarted fight-or-flight. But according to this new research in lab mice, an acute stress response is impossible without a hormone called osteocalcin—which, as its name suggests, is made by bones.

Julian Berger, a genetics PhD candidate at Columbia University and the study’s first author, says that when his team inhibited osteocalcin production in mice and then exposed them to a stressor, like the odor of fox urine, they didn’t seem appropriately fazed. “It’s almost like someone is mugging you and you ignore them and take out a Snickers bar,” he says.

If you’re surprised that bones can produce a hormone that impacts the nervous system, you’re not alone. Little more than a decade ago, scientists thought that bones were pretty much exactly what they look like at first glance: hollow tubes made of calcium designed to hold the rest of our bodies up. But as this new study demonstrates, our skeletons can actually change the way we react to the world around us.

The researchers weren’t necessarily looking to uncover osteocalcin’s role in getting us amped up; they were just trying to figure out the conditions under which bones produced it. Once they realized acute stress was the key trigger, they decided to investigate exactly what part osteocalcin plays in a moment of panic.

They found that when the skeletons of their rodent test subjects released osteocalcin, it “turned off” the parasympathetic nervous system, also known as the “rest-and-digest” nervous system. It’s active when things are normal, prompting your body to go on with its day-to-day processing. When things aren’t normal—when you get mugged, for instance—the sympathetic nervous system kicks into gear instead, diverting energy toward (theoretically) life-saving actions.

Adrenalin is still an important part of the process, as is the hormone cortisol so often associated with stress. They activate and sustain the fight-or-flight response of the sympathetic nervous system. But this can only happen after osteocalcin turns the parasympathetic nervous system off. “When you have a car, you need to press the gas pedal and take your foot off the brake at the same time,” Berger says.

The findings might help explain why we have bones at all. At only 509 million years old or so, internal skeletons are “a relatively late piece of the evolutionary toolkit,” says Berger. There’s no way to know what the animal kingdom would look like if we’d never shed our shells and armoured scales in favor of shoulders, knees, and toes. But figuring out why vertebrates shifted to relying on internal strength could help reveal how skeletons affect our health and well-being. Although several theories about the function of bone exist, this study lends more credence to one idea: that animals evolved them as protection against predators. Previous studies into the role of osteocalcin have found it improves memory, helps you run better, and allows your body to take in more fast energy in the form of glucose.

If you look at what osteocalcin does and what adrenaline does, says Schipani, there seems to be a lot of overlap. After all, adrenaline is also involved in the release of glucose, increases your heart rate, and makes a bunch of other contributions to the fight-or-flight reflex.

Future research will have to figure out the exact chemical mechanisms by which all these substances combine to power our brawls and evasive maneuvers (and, more often than not, our panicked stammers during awkward conversations). For now, all we know is that bones are likely part of the equation. So take a moment to appreciate your body’s weird and intricate system of calcium tubes—they do a lot more than just hold up your squishy bits.

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A denim fix that’s better than a patch

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If you cherish your jeans, you want to keep them wearable as long as possible.

If you cherish your jeans, you want to keep them wearable as long as possible. (Ricardo Gomez Angel via Unsplash/)

There’s a particular sick stomach lurch that happens when you rip a favorite pair of jeans, not unlike the feeling of losing a beloved pet or fumbling a fragile family heirloom. For many of us, the denim we live in becomes an inextricable part of our lives.

But a tear doesn’t have to mean tears. In recent years, a handful of pros have gained online acclaim by showing that it’s possible to re-weave denim, thereby healing a rip instead of just patching it.

“Pretty much anything can be fixed,” says Kattya Torres, owner of New York City-based Denim Therapy. Torres’ company has become famous among jean lovers for seamlessly repairing even the most dramatic rips. “It’s like a puzzle. I have had jeans come in here that look, honestly, like a g-string, and we’re able to reconstruct it.”

While you may not want to attempt that level of denim surgery right away, it’s possible to pull off some smaller patch jobs from the comfort of your own home.

Jean therapy for beginners

“Denim is extremely forgiving. It hides a lot of imperfection,” Torres says. That’s good news for those of us without access to the signature Colour Match system pioneered by Denim Therapy, or the specialized industrial sewing machines touted by companies like San Francisco-based Self Edge. But if you’re willing to tolerate some imperfection, you can do a passable job with some basic supplies and a standard sewing machine (or, if you don’t have a sewing machine, with a lot of patience).

Ripped knees and crotch blowouts are the two most common types of repairs Torres sees, and both are within reach of the home re-weaver.

“The most important part of the reweaving process is the color match,” says Torres. “And you know, no denim is truly blue.” She suggests taking your jeans with you to the fabric store so you can get the best thread color for the job. Look carefully at the area around the tear—depending on the aging or dye patterns, it may be a different color than the jeans overall.

You might feel tempted to buy heavy thread to make your fix as strong as possible, but Torres says you’re actually better off going with something lightweight. A common beginner’s mistake is reinforcing a repair so much that new tears form along the edge of the patched spot. Avoid this by grabbing some ordinary cotton sewing thread.

What you’ll need:

  • Lightweight thread
  • Fabric for backing (either scrap material or something you can iron on)
  • Pins
  • Sewing machine
  • Tailor’s chalk (optional)

How to reweave your jeans

On the left: torn jeans with backing pinned into place. On the right: the sturdy, finished repair.

On the left: torn jeans with backing pinned into place. On the right: the sturdy, finished repair. (Amelia Urry/)

1. Clean up the area around the tear as much as possible. Trim off all loose threads and be careful not to stretch the tear open any more. Instead, try to bring the edges together, keeping the opening as small as it can be.

2. Prepare your backing. If you’re using an iron-on patch, turn the jeans inside out and cut the patch so it covers 1-2 inches outside the tear. If you’re using fabric, hold the material behind the hole and pin it in place, making sure to fasten any irregular tatters of denim to the fabric. Take your time with this step—it’s critical to have good, solid backing on the inside, Torres advises.

3. Iron or sew around the edge of the patch to fasten the backing to the denim. If you’re sewing, don’t worry too much about making straight lines—these seams will likely be covered over when you start reweaving. But do make sure any loose bits of denim are firmly sewed down over the patch, so they won’t bunch up and form unsightly lumps in the next step.

4. Thread your sewing machine with the color you picked out. If you have never done this before, take time to read the instructions. There are no shortcuts on the road to success—believe me, I’ve tried.

Zig-zag over the damaged area and just keep going until your problems are gone. Alright, well, not all your problems, unfortunately, just the massive hole in your jeans.

Zig-zag over the damaged area and just keep going until your problems are gone. Alright, well, not all your problems, unfortunately, just the massive hole in your jeans. (Amelia Urry/)

5. Line up the area you are going to be sewing over. “Follow the grain of the denim,” Torres says. That can take some practice, so she suggests sketching a few lines in tailor’s chalk to help you stay oriented to the direction of the weave.

6. Moving slowly but smoothly, begin sewing over the damaged area. Advance an inch or two past the edge of the tear and then reverse the machine to zig-zag back over the patch. Stay wide—you should cover the full breadth of the tear with the first couple zags, then keep going back over the area as new stitches fill in the tear.

7. Don’t stop. “It’s like a magic eraser,” Torres says. “You just keep going until you don’t see the damage.” Be careful not to sew pocket linings into the new material. Be warned: The inside of the jeans may look like a mess, but the outside should start to look smoother and more consistent.

Preventative patching can keep your jeans going strong

To make your jeans last as long as possible, it’s best to address small tears and weak spots as soon as they appear, rather than letting them fray into a serious problem. For these smaller areas, you might not need to reweave anything—a simple patch might buy you more time with intact jeans.

You can use any fabric for this, including spare scraps of denim or iron-on material. Cut the patch just an inch or two wider than the weak area, and apply it to the inside of the jeans.

If you’re sewing on a patch, you can make your stitches nearly invisible from the outside by returning your needle through the same hole (or as close as you can get) that it came out of. The stitches will be visible from the inside, but there will be almost no hint of thread on the outside.

More than just a piece of fabric

“Everything has a story,” Torres says. Many customers will bring their jeans in, along with their own particular tale of love and loss. “We realize we’re not just working on a piece of denim.”

As specialized repair services like tailors and cobblers are disappearing in many cities, denim repair may be an exception. New businesses are popping up across the U.S., including mail-in services like Denim Surgeon or DenimRepair.com for people who don’t live in busy coastal cities.

“The demand is always there,” Torres says. “It doesn’t have to be a very high-end pair of jeans either. It could be an inexpensive pair you’ve picked up 10-15 years ago, and it’s shaped to your body—you don’t want to let go of it.”

A good fix should last about as long as the jeans did before they tore, she says. And if you care for your denim carefully, there’s no reason you can’t keep repairing the material over time. Contrary to some popular opinions, Torres says you should wash your jeans when they get dirty, since dirt can abrade the fabric, but whatever you do, don’t put them in the dryer!

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The EPA’s roll back of the Clean Water Act could impact drinking water for millions of Americans

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Small streams could be in danger

Small streams could be in danger (Joao Branco/Unsplash/)

The Trump Administration just announced yet another blow to the country’s environmental protections. On Thursday, officials from the EPA and the U.S. Army Corps of Engineers repealed an Obama administration update to the 1972 Clean Water Act, which had expanded protection to wetlands and streams that are disconnected from navigable rivers. “They’re effectively sending us back 30 years in our protections of U.S. waters,” says Peter Gleick, co-founder of the Pacific Institute and a MacArthur “genius” Fellowship winner for his work as a climate and water scientist.

The 2015 rule has broadened the definition of “waters of the United States,” which allowed the EPA to regulate pollutants in a much greater proportion of waterways than before. Dry washes and streams may only flow intermittently, but according to an EPA report they make up about 59 percent of streams in the U.S. and 81 percent of those in the Southwest. Another EPA report, which supported the 2015 rule, reviewed more than 1,200 studies on small streams and wetlands and found that they’re critical to the health of downstream rivers: “There is ample evidence that many wetlands and open waters located outside of riparian areas and floodplains, even when lacking surface water connections, provide physical, chemical, and biological functions that could affect the integrity of downstream waters.” And yet, many of these waters now have no protection under federal law.

The original definition of “waters of the United States” mainly covered large rivers, their tributaries, and adjacent wetlands. The Clean Water Act requires industrial and municipal polluters discharging to these rivers to obtain permits from the EPA and the 2015 update expanded those regulations to include smaller streams and wetlands. Thursday’s repeal will soon be followed by a rule change, and the replacement text would basically revert to the ’70s-level protections. Officials have stated that the change would remove a current “regulatory patchwork”—the 2015 update only applies to 22 states, Washington D.C. and U.S. territories because other states have challenged the rule in court. In a press release, EPA Administrator Andrew Wheeler said redefining “water of the United States” would “provide greater regulatory certainty for farmers, landowners, home builders, and developers nationwide.”

But despite whatever uncertainty there may have been, the 2015 update was enacted for a reason: the streams and wetlands that aren’t flowing into or right next to major rivers are still crucial for wildlife and humans. Drinking water for one in three people in the lower 48 comes from same waters that just lost their federal protection in the repeal, as PopSci has reported previously. “The weakening that we’re seeing today is really serious—It’s really cutting protection for drinking water for a lot of Americans,” says Gleick. “A lot of our groundwater resources and a lot of our surface water resources are now going to be vulnerable to far more pollution.”

The 2015 rule also regulated pesticides and nutrients leaching from many farmers’ fields—a diffuse but cumulatively significant source of pollution. In the Mississippi basin, for example, the pollutants from numerous farms that trickle into small streams and wetlands eventually flow into the river and then into the Gulf of Mexico, says Gleick. This impacts water quality and leads to the growth of massive algal blooms and fish die offs. “Some farmers would have had to get permits to discharge pollutants into the streams and wetlands,” says Gleick. But now that requirement has been lifted, and our waters will suffer for it.

Overall, says Gleick, “We can expect more pollution in our waterways, more threats to drinking water supplies, more court cases, and more confusion about where this country ought to go on environmental protection.”

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With thousands missing and displaced after Dorian, the Bahamas may soon get hit by a tropical storm

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Recovery efforts on these northern Bahamian islands have only just begun, and many small villages have not yet received aid, according to the Associated Press. Dorian’s 180 mph sustained winds caused an estimated $7 billion of damage. The storm killed dozens, and search and rescue teams are still looking for approximately 1,300 missing people. Officials expect the death toll to rise.



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A ban on flavored vaping products could help signal to teens that vaping isn’t as safe as they think

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Many products featured on this site were editorially chosen. Popular Science may receive financial compensation for products purchased through this site.

Copyright © 2019 Popular Science. A Bonnier Corporation Company. All rights reserved. Reproduction in whole or in part without permission is prohibited.



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This distant world is a lot like Earth, but you wouldn’t want to live there

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An artistic representation of the exoplanet K2-18b.

An artistic representation of the exoplanet K2-18b. (Alex Boersma/)

If you could pack a hot air balloon onto an interstellar spaceship and travel 110 light years to a certain planet orbiting a dim star in the constellation Leo, you’d have an experience not entirely unlike ballooning on Earth. The temperature, pressure, and moist air could feel quite pleasant, though you’d need an oxygen mask—and possibly an umbrella.

“It could happen that you get rained upon,” says Björn Benneke, an exoplanet researcher at the University of Montreal.

Telescopes hunting for flickering, wobbling stars have located more than 4,000 potential exoplanets in recent decades, some of which orbit in the not-too-cold, not-too-hot zone around their host star where water would have a shot at staying liquid. Others have even been found to harbor actual molecules of H2O. The exoplanet K2-18b, however, is the first to check both boxes, according to two studies published this week. Unfortunately, a few other decidedly unearth-like characteristics make K2018b an improbable home for life as we know it. But the discovery represents an important step toward finding planets we might actually consider hospitable.

“It’s the closest we have come to detecting some kind of environment similar to the Earth,” says Benneke, who leads one of the two teams studying the planet.

Everything scientists know about this alien world comes from the way it interacts with its star. The Kepler mission first spotted the star’s dimming in 2015, and follow-up observations with the Spitzer space telescope confirmed presence of a planet twice as large as Earth in 2017. A different instrument then weighed the planet by measuring the star’s wobble, finding it to be about eight times heavier than Earth. Another three years of observations with the Hubble Space Telescope managed to capture eight more flickers of light, leading to this week’s descriptions of the planet’s atmosphere.

The key to studying the atmosphere of a planet you can’t really see is to measure how big it looks using different kinds of light. A purely rocky planet with no atmosphere would perfectly block all colors, while each type of molecule in an atmosphere blocks only particular wavelengths. The atmosphere looks opaque in that variety of light, and the planet looks bigger against the background star. K2-18b, for instance, swells when viewed in the type of light blocked by water.

“This is basically direct evidence that there is water vapor in the atmosphere,” says Benneke, whose research was published online this week, but has not yet been peer reviewed.

Another group of scientists, whose results appeared Wednesday in Nature Astronomy, came to the same conclusion using the same data. While they can’t say whether the planet has a wet or arid climate—their models forecast between 0.01 and 50 percent humidity—they say the odds of a random statistical coincidence are lower than 1 in 2,000.

But if any future explorers do find themselves floating through K2-18b’s atmosphere, they shouldn’t attempt to land. The planet’s size and weight make it rather wispy by terrestrial standards—almost all hydrogen gas with little to no solid matter for alien creepers to crawl over. While our solar system lacks a true analog, Benneke suggests that a mini Neptune might serve as a better mental image than a supersized Earth. “I would not expect any Earth-like life because of the absence of the surface,” he adds.

K2-18b’s skies may be even more familiar than the mere presence of water suggests. Benneke’s analysis detected slight amounts of light being blocked—making the planet look slightly thicker—at all wavelengths. Since the planet’s low density rules out a surface, he interprets this obstruction as a side effect of the water. “The most likely explanation is that this is actually a cloud deck of liquid water droplets very similar to the Earth,” he says. “It’s quite likely that there’s even rain.”

The other team, however, isn’t quite ready to start issuing exoplanet weather forecasts. “Our models are fully consistent with clouds,” writes Ingo Waldmann, an astronomer at University College London who worked on the Nature Astronomy analysis, in an email, “but we cannot conclusively say clouds are there or not until [we get James Webb Space Telescope] observations.” He and his colleagues checked the observations against models of both cloudy and non-cloudy atmospheres, and found that neither was a significantly better fit than the other.

In addition to lacking a surface, K2-18b also orbits a star quite different from our sun. As a small dwarf, it shines nearly 40 times less brightly, and its cooler temperature makes it more red than yellow. That’s no problem in terms of providing energy—the planet orbits much closer than Earth does, making a lap in about a month, so it gets similar warmth—but the star’s frequent flares likely bath the planet in ultraviolet radiation. UV flares aren’t necessarily a deal breaker for life, but they don’t make living easy.

The real significance of studying more exoplanets with atmospheres like K2-18b, Benneke says, is that they help answer major questions about how stars shape their planets, such as how much dwarf stars destroy the thin atmospheres around more life-friendly, rocky worlds. K2-18b’s thick atmosphere is impervious to such stellar activity, but the techniques used to study it will be invaluable as more powerful telescopes secede Hubble in the near future.

“In the overall storyline of humanity finding life across the universe,” Benneke says, “this is maybe the furthest we have come so far.”

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Stir it up with these next-level woks

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This easy-to-use, non-stick wok is a great way to test your aptitude for stir-fry if you’re a beginner cook (or just beginning to try Chinese cooking). It’s dishwasher and oven safe, made out of lightweight aluminum with a non-stick coating, and can be used for regular forms of sautéing, simmering, or poaching. Please note: Non-stick pans won’t be as durable as our other options, and won’t stand up to very high heat. If your favorite Chinese dishes are sauce heavy Americanized staples like General Tso’s Chicken, this will work fine. Otherwise, save up for carbon steel or a cast iron wok.



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Why some experts are trying to redefine suicide

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A movement is building to define suicidality as a condition in its own right.

A movement is building to define suicidality as a condition in its own right. (Noah Silliman/Unsplash/)

One night in her Nashville apartment, Bre Banks read a comment from her boyfriend on Facebook. They were in a shaky spell, and his words seemed proof she would lose him. She put her laptop down on the couch and headed to the bedroom to cry. “My legs seized up, and I fell,” she recalled. With her knees and forehead pressing into the carpet, she heard a voice that said, “Slit your wrists, slit your wrists.” She saw herself in the bathtub with the blood flowing. She was terrified that if she moved she would die.

Banks, then 25, was a disciplined graduate student with a job and close friends and had no psychiatric history. “I had never considered suicide an option,” she says. But for the next three days, she couldn’t sleep while the voice and disturbing images persisted. After seeing a therapist, she decided to teach herself techniques from dialectical behavior therapy, one of the few treatments shown to reduce suicidality. The voices and images came back over the next few months, but eventually faded. Eight years later, Banks now evaluates suicide prevention programs across Tennessee as a manager at the large mental health provider Centerstone’s research institute, and she and the same boyfriend just celebrated their 10th anniversary.

In the public imagination, suicide is often understood as the end of a torturous decline caused by depression or another mental illness. But clinicians and researchers know that suicidal crises frequently come on rapidly, escalating from impulse to action within a day, hours, or just minutes. Many also point to the fact that they may strike people like Banks, who are otherwise in good mental health.

That understanding is one reason a movement is building to define suicidality as a condition in its own right. Most recently, researchers from Mount Sinai Beth Israel and Florida State University have agreed to collaborate on a joint proposal for a new diagnosis in the next Diagnostic Statistical Manual of Mental Disorders (DSM), a handbook published by the American Psychiatric Association. The criteria include familiar symptoms of depression, but these symptoms occur in an acute state that is not currently obvious to clinicians. Proponents say it could spur more research and make it easier for suicidal patients to get the care they need.

Some have expressed skepticism. “Far too many diagnoses in psychiatry come and go,” said George Makari, a Weill Cornell Medicine psychiatrist and historian of psychiatry. The idea that suicidality may not be a symptom of something else—a mood or personality disorder—is novel. “If they’re making the claim that we’ve been seeing this upside down for a long time,” he said, “that’s fascinating.”

Suicide rates have been rising sharply since 1999, figures from the Centers for Disease Control and Prevention (CDC) show. More than half of those who take their lives do not have a known mental health condition. There is also no established way to pinpoint when a patient is in immediate danger. “You cannot rely on people telling you when they are or are not suicidal,” said Igor Galynker, a professor of psychiatry at Icahn School of Medicine in New York.

Research backs that up: A 2019 meta-analysis of 71 studies conducted around the globe found that about 60 percent of people who died by suicide had denied having suicidal thoughts when asked by a psychiatrist or general practitioner. Here in the U.S., a 2016 study examined data from four health systems that use standardized questionnaires in primary care and specialty clinics. (The questionnaires ask whether the patient has experienced “thoughts that you would be better off dead or of hurting yourself in some way.”) Although the answers did predict future suicide attempts to some extent, there were plenty of false negatives. Thirty-nine percent of the suicide attempts and 36 percent of the suicide deaths occurred among patients who had responded “not at all” to the key question. In another study, about a quarter of the suicide attempts were made by people who reported zero suicidal thoughts.

It’s easy to assume they were lying, but that’s not quite true. Greg Simon, a psychiatrist and investigator at Kaiser Permanente Washington in Seattle, who led the 2016 study, was involved in a follow-up study based on interviews with 26 people who had made attempts after denying any suicidal thoughts on the standard questionnaire. The interviews revealed that some people had lied, he said. But they also revealed people who had provided “aspirational” responses—they were trying not to have suicidal thoughts—and people who had experienced no suicidal thinking whatsoever. (Among the latter group, alcohol often factored into their attempts.) None of them woke up that morning with a plan to die that day.

For his part, Galynker determined long ago—after he lost a patient who took him by surprise—that he couldn’t rely on patient reports. In 2007, he set out to develop a set of symptoms that would help pinpoint imminent suicide—even if the patient didn’t report suicidal thinking. “We hypothesized that the pre-suicidal state leading to suicidal action was short-lived, kind of like pulling a gun trigger,” he said. In 2009, he called it “suicide trigger state.” Over dozens of research papers, he explored various symptoms as predictors, developing checklists and then testing how well they predicted future behavior. While these checklists are still new, they are being used to screen for suicidal risk among high school students in Moscow, Russia, and among hospital patients in Chicago.

In 2017, Galynker coined the term “suicide crisis syndrome.” People with this syndrome feel trapped, though they might not think of death per se. They may be flooded with misery and unable to think clearly. Certain thoughts, like Banks’ images and voices, return repeatedly, no matter how much they are resisted. They may experience mood swings or overwhelming emotional pain.

At Florida State University, Thomas Joiner, the author of several books on suicide and the editor of a suicide journal, outlined his own criteria for a quick-onset suicide crisis, which he calls “acute suicidal affective disturbance.” This describes rapidly escalating plans for suicide over hours or days—faster than clinicians may expect. The key difference is that Joiner includes reports of suicidal thinking as an essential criterion.

The pair teamed up more than two years ago when the first paper describing both of their diagnoses appeared. Together, the two researchers envision a new DSM suicide diagnosis with two sub-types, one with thoughts of suicide, and one without. Before this diagnosis is approved for the DSM, however, the researchers may need to show more conclusively that the phenomenon they describe isn’t a symptom of depression or another mental illness, and that their methods of screening for it are effective.

Psychiatrist Michael First at Columbia University, who presided over earlier revisions of the DSM, sees a suicide-specific diagnosis as an “appealing idea.” If the melding of Galynker’s and Joiner’s formulations worked well and proved to be accurate, First said, “then it would clearly be very useful to have it.”


Clinicians currently struggle with little guidance on how to identify imminent risk or make sense of suicides that seem to come out of the blue.

Nearly once a week, attending psychiatrist Dmitriy Gekhman at Mount Sinai Beth Israel sees a patient who has attempted suicide and is hard to classify, though he must find a relevant code for each patient’s chart. “You kind of go through the history and everything, and they’re not depressed. They don’t meet the criteria for depression, they don’t meet criteria for bipolar disorder, and they don’t have a personality disorder,” he said. “We just discharged somebody this week who that happened to, and we still have somebody on the unit now.”

If a diagnosis based on Galynker’s and Joiner’s research were put in place, it would put the patient’s doctors on notice that the patient is a risk for suicide with rapid onset. Over time, it’s possible that clinicians and even teachers and parents would become better at seeing the signs. The diagnosis, Joiner explained, is a “warning sign for the future.”

Detroit’s Henry Ford Health System provides a glimpse of how suicide prevention might evolve. At Henry Ford, suicide is considered its own mental health category, not primarily a symptom of depression. In 2002, the health system began a series of initiatives and reduced patient suicide rates a dramatic 80 percent over the next seven years.

The staff at Henry Ford discovered that from 2000 to 2010, only half of patients who died by suicide had received a mental health diagnosis, closely matching current national statistics. This could be undiagnosed illness, “but I think a lot of people don’t meet the criteria,” said Brian Ahmedani, who directs the health system’s Center for Health Policy & Health Services Research.

Henry Ford screens everyone with questionnaires asking about suicidal thoughts, a practice the Joint Commission, which certifies health care organizations, started recommending in 2016. But in its behavioral health units, the risk assessment focuses on triggers, such as a job loss. Ahmedani says that patients in the highest risk percentile usually have a number of triggers: chronic pain, opioid use, and insomnia, for example. Because assessing the many possible combinations can be difficult, Henry Ford uses artificial intelligence to analyze electronic medical records, helping clinicians who may not have time to catch a perfect storm before it’s already too late. Veterans are a high-risk group, so the Veterans Affairs (VA) has begun using these algorithms too.

Currently, suicidal people are often prescribed antidepressants. However, other than lithium, most often used to treat people with bipolar disorder, there’s little evidence that medication prevents suicide, Ahmedani observed. New VA clinical guidelines also support short-term infusions of a drug called ketamine.

Henry Ford offers treatments specific to suicide: identifying triggers and coping mechanisms, for example. It also offers cognitive behavioral therapy and dialectical behavior therapy, the treatment that helped Banks. Patients are encouraged to develop a safety plan that includes removing guns or painkillers from the home, and an idea of who they might call under duress.

David Covington, a suicide prevention activist, said, “we used to think that if you treat addiction, the mental health will get better, and the other side thought if you treat mental health, the addiction will get better. Now we say you have to treat both.” Similarly, a person might need treatment for both suicide and depression.

The new diagnosis, more fundamentally, could change who we think might be driven to the extreme of a suicide attempt. Psychiatrists still refer to suicide attempts with a short buildup as “impulsive,” but Joiner’s team disputes that these are impulsive people. Megan Rogers, a Ph.D. candidate who works with Joiner, sees outpatients at the university clinic. She recalls one who “within hours would go from no risk to high risk” but had what she describes as a “conscientious and vigilant,” rather than impulsive, personality.

Still, some question whether a new diagnosis would actually benefit patients. For one thing, it isn’t clear how such a diagnosis would influence treatment—or whether it would save lives. “There is simply no value in a prediction that cannot lead to an effective preventative measure,” writes psychiatrist Matthew Large in a 2018 paper evaluating suicide assessment approaches generally. More people could land in hospital psychiatric care, or be kept longer than they desire, he said. And “while it is generally assumed that hospitalization can prevent suicide, this has never been demonstrated empirically.” In fact, suicide rates are high among recently discharged patients and some say hospitalization can make things worse.

Galynker agrees that hospitalization is not necessarily the answer and is looking at new treatment methods. In the meantime, the diagnosis might communicate the higher risk to insurance companies, explained Lisa Cohen, a professor of psychiatry at Icahn School of Medicine and co-author with Galynker, giving patients better access to treatment options.

Psychiatrists who make decisions about hospitalization say they would appreciate more science to guide them. “It would be incredibly helpful to have a very clear indication that someone is at higher risk,” observed Julie Holland, who once presided over a psychiatric emergency room at Bellevue Hospital in New York. A close look at the buildup to a crisis would be invaluable. “We do that when somebody’s heart stops, or when somebody’s heart is imminently stopping,” said Chicago psychiatrist Leo Weinstein, who teaches at Northwestern University. “Making the unstable state a diagnostic entity in its own right,” like ventricular fibrillation or congestive heart failure, he says, “is crucially important.”


Temma Ehrenfeld is a writer and ghostwriter in New York drawn to philosophy and psychiatry. Her most recent book is “Morgan: The Wizard of Kew Gardens.”

This article was originally published on Undark.

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