What Happens In Vegas Stays In Vegas

I got stuck in traffic, all alone, just me and NPR, talk radio. There's a story on about the suicide rate in Las Vegas. I didn't know it was higher than the rest of the country-- is that surprising? Oh, but for people who leave, the rate goes down, and for people who enter, the rate goes up. It's like something's in the water there (or maybe in some other substances?)

From today's Las Vegas Sun reporter Marshall Allen writes--

The study, which will be published in the December edition of the peer-reviewed journal Social Science & Medicine, challenges one of the common attitudes about suicide in Las Vegas, Wray said. There’s a general resistance by Las Vegas leaders to admit the extent of the problem, he said, and suicide prevention is “not at the top of anyone’s agenda.”

“Given the magnitude of the problem, one can argue it should be,” he said.

The study does not answer the Las Vegas version of the chicken and egg conundrum: Are suicidal people attracted to Las Vegas, or does something about the city lead people to kill themselves?

The scenarios that explain the high rate of suicides in Las Vegas vary and need further research, Wray said.

“One would be ‘gambler despair’ — someone visits Las Vegas, bets his house away and decides to end it all,” he said. “Another would be that those predisposed to suicide disproportionately choose Las Vegas to reside or visit. And, finally, there may be a ‘contagion’ effect where people are emulating the suicides of others ... Some people may be going there intent on self-destruction.”

Wray said the evidence points to something about Las Vegas that causes more suicides. The finding that suicide risk remains high in Las Vegas while there are declines in other counties suggests there could be something harmful about the city, Wray said. He also noted the finding that the risk of suicide is reduced when people leave Las Vegas.

“If suicide was really about the people, it seems they would take their suicide risk with them,” he said. Experts have speculated that problems with addiction to gambling and drugs and alcohol, lack of mental health resources and rapid growth also may contribute to the suicide problem.

An Adventure A Day Has Kept ClinkShrink Away

Oh dear. I really have been negligent. Dinah has been working hard to carry on Shrink Rap single-handedly---and done a smart job of it too---while I've been frittering my time away hanging from rocks. But more about that later.

So here is my post. Late, short, but better than nothing.

So I've been hearing a lot lately that I may be rather crazy, or at least lacking in good judgment, for my newest hobby. Dinah has suggested that I could use it as the starting point for a blog post, and I think that's a good idea.

For the past couple months I've been off rock climbing. It's something I've always wanted to try but couldn't convince my friends to try with me. Unfortunately, for the kind of climbing I do you actually do need a friend to go with you to hold the end of the rope. And the friend has to be someone you trust completely. Given that Dinah refused, repeatedly, to hold the end of my rope it took me a while to try this hobby. Now that I've done it, I'm hooked.

So how does this relate to psychiatry? Wow, there are a lot of take-off points here. I could talk about the difference between intelligence and judgment. I could talk about issues related to trust and how you choose the people you trust. Or---and this is my preference---you could talk about risk-taking behaviors in general.

My prison patients are risk-takers. They grab opportunities to make a quick buck, get revenge, blow off steam or just blow up. The problem with my patients' risk-taking behavior is that it gets them into trouble with the law.

I rarely see pro-social risk-takers because they channel their proclivities in ways that are either beneficial for them or at least don't injure others. Pro-social risk takers are people who start businesses, explore new countries, try to set new world records or who 'boldly go where no man has gone before'. They are the adventurers and visionaries.

Why do these folks fall into one category versus the other? And what makes people risk-takers?

I think there are three things that interact here: inheritance or biology, environment (including things like socioeconomic status and resources) and individual life events or experience.

Risk-taking is a character or personality trait that exists in everyone across a continuum, like extroversion or neuroticism. People are more or less risk-taking and open to new experience. There's a biological basis for many personality traits, and risk taking does seem to be heritable. Risk-taking or sensation-seeking tendencies may co-exist with impulsivity, but not always. Non-impulsive risk-takers take the time to plan their risks---to take reasonable precautions or safety measures and to weigh out the odds (or in the case of rock-climbing, make sure the rope is anchored soundly) to maximize the chance of success. If you've grown up in a disadvantaged neighborhood where the school drinking fountains are laced with lead, you're more likely to be an impulsive risk-taker (or one of my patients). Thus, environmental factors can influence the way an inherited trait is expressed.

The third and final way is through life experience. You can imagine all the life-changing events that could influence risk-taking behavior---watching the market crash, for example, is probably putting a damper on some economic risk-taking right now. Similarly, someone who is given a diagnosis of a terminal illness might decide to uncharacteristically go on a round-the-world trip. You get the drift.

As far as my risk-taking is concerned, it's basically just for the fun of it. Thanks for bearing with me, my fellow Shrink Rappers.

And thanks for the pic.

Roy: Quotes seen around the blogs

girl MD: "i've already had one cup this morning, but there's no such thing as too much coffee."

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shrinkette: "I've made a rule here: 'No medical advice is given on this site.' But suppose that a commenter says: 'To taper a med, do A, B, and C.' Does that violate my rule? Should I delete the comment?"

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bioethics: "Truth is an important component of the fiduciary responsibility of the physician to his or her patient. But as with the physician's prescription of a medication for treatment of a patient's illness, the maximum dose is not often the appropriate dose to prescribe, should the dose of truth administered to a patient be titrated too? "

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blogborygmi: "If I were a fat pediatrician, I might be a little reluctant to counsel a fat child, myself, because, you know, little kids can't abstract like adults can."

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mind hacks: "Transcranial magnetic stimulation (TMS) is a technique whereby magnetic fields are used to temporarily alter the function of the brain by inducing an electrical current in the brain tissue. ... Much weaker magnetic fields (about the strength of a loudspeaker) ... have also been used to induce unusual experiences by stimulating the temporal lobes ... A new project called Open-rTMS aims to develop this latter type of system (actually, generally not referred to as TMS in the neuroscience literature) and publish the plans and software online. They're currently looking for people to sign up to the mailing list and kick the project off, so if you're looking for a way to alter your state of consciousness with magnets, this might be your chance."

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rebel doctor: "On-line poker is a dangerous and seductive mistress. I fight her allure (usually unsuccessfully) every night."

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john grohol: "I have not been able to see either of these [reality TV] shows since I don’t have access to that channel, but the premise of both is disturbing. I’m also troubled by the idea that there are likely psychologists working as consultants in designing the shows and the experiments."