When Tamika talks about becoming a mother, you can hear how it rewrote her sense of identity. But when her daughter Allegra was later diagnosed with severe depression and psychosis, that identity began to unravel—and reveal something much deeper. Behind the scenes of her family's history was an untreated illness that had already shaped the shoreline: schizoaffective disorder.

This episode dives into the space where psychosis meets mood disorder, where reality and emotion overlap in ways that can feel impossible to untangle.

In this Mental Margins segment, we share bonus content and confront a critical question with Jack Register from episode 106: Why do we treat mental health crises differently than physical ones?

If someone has a diabetic episode behind the wheel, we rush in with the jaws of life, pull them from the wreckage, and never question their willpower. Yet when a person spirals into suicidality or psychosis, society often steps back—expecting them to "help themselves" before we decide they're worth saving.

This conversation dives into the systemic contradictions at the heart of mental health care:

• The Power and Peril of Diagnosis – Labels like "narcissist" or "histrionic" are tossed around in pop culture as if they're harmless, when in fact DSM and ICD diagnoses can alter the entire trajectory of someone's life.

• The Hidden Penalties of Honesty – Military members, law enforcement officers, licensed professionals, and those with security clearances risk losing their livelihoods if they disclose certain conditions. Stigma isn't just social—it's structural.

• The Critical Window of 13 to 24 – The age when schizophrenia, bipolar disorder, and major depression most often emerge—just as young adults are stepping into independence. A diagnosis at this stage can reroute college, housing, and even financial aid, sometimes more drastically than a felony conviction.

• A Godson's Story – A brilliant 19-year-old with schizophrenia, once bound for Ivy League scholarships, now cycles through homelessness, suicide attempts, and a chaotic care system that changes his medication with each insurance shift—each "fix" spiraling him further from stability.

At the heart of this reflection is a haunting metaphor: an emotional car accident. When the crash comes, we too often stand at the roadside, unsure if we're allowed to intervene—when what's needed is decisive, lifesaving action.

The DSM-5 and ICD-11 both emphasize that mental disorders are defined not only by symptoms but by their impact on functioning and social participation. Yet history shows us how easily labels can be weaponized—from Benjamin Rush's early 19th-century medical pathologizing of "moral" failings to today's casual pop-psychology shorthand of "toxic" or "narcissistic."

This segment underscores the moral tension in diagnosis: clinical categories can validate care, but they can also exclude, penalize, or silence those already most vulnerable.

In the end, the question remains: If we would pull a stranger from the wreckage of a car without hesitation, why do we hesitate when the crash is invisible, when it is of the mind?

A breakdown of episode 106

In this episode, we explore the aftermath of mental health crises through personal stories and expert insight. Featuring voices of Tamika Christy, Jack Register, and Ashley Holder, the discussion delves into grief after suicide loss, the challenges within mental health systems, and the emotional toll on caregivers and first responders. We also examine how trauma ripples through communities and the evolving ways we memorialize those we've lost online.

• Grief and Suicide Loss: Author Tamika Christy shares her experience after losing a loved one to suicide, confronting stigma and complicated emotions. The conversation highlights how a suicide's impact ripples outward – one study estimates 135 people are exposed to each suicide death– and how social media profiles of the deceased often serve as "digital gravestones" where friends and family post tributes. Tamika reflects on navigating insensitive questions (like "Do you feel better now that she's gone?") and the journey of healing from trauma as both a loved one and caregiver.

• Mental Health Systems & Reforms: Jack Register (licensed clinical social worker and mental health advocate) discusses systemic responses to mental illness. He breaks down the rollout of the new 988 Suicide & Crisis Lifeline, which in its first year received about 4 million calls, texts, and chats – a 33% increase from the previous year – and improved answer times to ~35 seconds on average. Jack notes ongoing challenges for 988, including uneven funding and public awareness gaps. The episode also examines California's controversial CARE Court program: a new civil court system that lets judges order treatment plans (medication, therapy, housing) for individuals with severe untreated psychotic illnesses like schizophrenia. Governor Newsom touts CARE Court as a "care-first" solution to help people before they become dangerous to self or others, but disability rights groups argue it violates civil liberties by forcing treatment and potentially fast-tracking noncompliant patients into conservatorships (loss of autonomy). Jack helps unpack this legal framework and the debate between public safety and personal rights.

• Caregiver Trauma & First Responder Perspectives: Ashley Holder, a first responder and trauma survivor, speaks to the emotional toll of responding to crises and caring for those with severe mental illness. She highlights the often overlooked suicide risk in serious mental health conditions – for instance, individuals with psychotic depression have a higher likelihood of suicide than those with non-psychotic depression, and research shows about 34% of patients with schizoaffective disorder (which combines mood disorder and psychosis) have attempted suicide in the past. Ashley and Jack discuss initiatives like Crisis Intervention Team (CIT) training for police, a 40-hour de-escalation program now adopted by over 2,700 communities nationwide, designed to improve law enforcement responses to people in mental health crisis instead of relying on force. Ashley also opens up about the mental health struggles among first responders themselves – notes that firefighters and law enforcement officers are now more likely to die by suicide than in the line of duty, due to chronic exposure to trauma and stress. The segment underscores the need for peer support, training (like CIT), and systemic change to support both those in crisis and the professionals who help them.

• Golden Gate Bridge Survivor Regrets – All 29 people who survived a Golden Gate Bridge suicide attempt later "regretted their decision as soon as they jumped." (Mental Health First Aid training stat, reported by TeacherToolkit, 2022).

• Spanish Flu & Suicide Rates – U.S. suicide rates dropped ~24% during the 1918–20 influenza pandemic and then rebounded ~12% higher in the decade after (Chan et al., Prim Care Companion CNS Disord., 2021). This "pulling-together" effect during crises echoes Durkheim's theory of social cohesion.

• DSM-5 vs. ICD-11 Definitions – Schizoaffective disorder in DSM-5 requires meeting criteria for schizophrenia plus a mood disorder, including at least 2 weeks of psychosis without mood symptoms (to distinguish from depression with psychotic features). ICD-11 takes a cross-sectional approach: the diagnosis is made only when full criteria for schizophrenia and a moderate/severe mood episode are present concurrently (for ≥4 weeks). Psychotic depression is defined as a major depressive episode accompanied by delusions or hallucinations ("mood-congruent" or "mood-incongruent" per DSM-5 specifier).

• 988 Crisis Lifeline Performance – In its first year (July 2022–July 2023), the 988 Lifeline answered ~4 million contacts (calls, chats, texts), 33% more than the previous year's volume. Average response speeds improved (most contacts in ~30–40 seconds). However, the system faces challenges: many centers rely on short-term federal funds and need sustained state support, public awareness is still growing (only ~63% of Americans knew about 988 by mid-2023), and some callers remain wary due to privacy concerns and confusion with 911. (Source: Colleen DeGuzman, KFF Health News, 2023).

• CARE Court (California) – The Community Assistance, Recovery, and Empowerment (CARE) Court is a new California law (enacted 2022) creating a civil court process for certain individuals with schizophrenia or other psychotic disorders. It enables family, clinicians, or first responders to petition a court to mandate a 12- to 24-month care plan (mental health treatment and housing). Supporters, including Gov. Gavin Newsom, argue it's a "no one left behind" approach to get help for those who are homeless or declining due to severe mental illness. Critics (e.g. Disability Rights California, ACLU) warn that it erodes civil rights, forcing treatment on people who may not consent and potentially leading to conservatorship if they refuse to comply. Legal challenges claim CARE Court violates due process and may not address the root problem (the shortage of voluntary treatment options).

• "Digital Gravestones" & Social Media Grief – Personal social media accounts often turn into digital memorials after someone dies. For example, Facebook allows "Memorialized" profiles (with a Remembering banner) where friends and family continue to post memories and condolences. By 2021, experts noted our online accounts "may become like our digital gravestones" – enduring virtual monuments to our lives. This trend raises new questions about managing one's "digital legacy" and the role of social platforms in the grieving process (e.g. legacy contacts, auto-delete settings, etc.). (David R. Polgar, BuiltIn, 2021).

• Suicide's Ripple Effect – According to a 2018 study (Cerel et al., published in Suicide and Life-Threatening Behavior), each suicide leaves behind a wide circle of people in its wake. On average 135 individuals are exposed (knew the person who died) and about 1 in 5 of those report that the loss had a devastating or life-altering impact on them. This updated figure ("not six") underscores that the reach of a suicide loss extends far beyond immediate family – including friends, coworkers, classmates, clinicians, and community members who may also need support.

• Psychotic Disorders & Suicide Risk – Major depression with psychotic features and schizoaffective disorder carry elevated suicide risk. Patients who have experienced psychotic depression have a higher likelihood of future relapse and suicidal behavior than those with non-psychotic depression. For schizoaffective disorder, which combines mood disturbance and schizophrenia-like symptoms, studies indicate roughly 34% of patients have attempted suicide at least once. (By comparison, about 5–10% of those with pure schizophrenia die by suicide over a lifetime, and ~20% attempt, according to psychiatric research.) Careful risk assessment and integrated treatment (addressing both psychosis and mood symptoms) are crucial for these diagnoses.

• CIT – Crisis Intervention Team Training – CIT is a specialized 40-hour training program for law enforcement officers on responding to mental health crises. Launched in Memphis in 1988, the "Memphis Model" CIT program has now been adopted by over 2,700 communities across the U.S.. CIT training equips police to recognize psychiatric distress, de-escalate situations, and divert individuals to treatment instead of jail when safe to do so. Research shows CIT-trained officers use force less often and more effectively connect people to mental health services. (Sources: NAMI, 2020; Dupont et al., 2007).

• First Responders & Trauma – First responders (police, firefighters, EMS, 911 dispatchers) experience frequent trauma and high stress, which has led to disproportionate suicide rates in these professions. A 2021 CDC report noted that law enforcement officers and firefighters are more likely to die by suicide than in the line of duty. In addition, EMS providers have a 1.4 times higher suicide risk than the general public. Studies have found elevated rates of PTSD (e.g. ~1 in 5 dispatchers) and depression in these jobs. These findings have spurred initiatives like the Helping Emergency Responders Overcome (HERO) Act in the U.S., aiming to establish better tracking of first responder suicides and expand mental health resources (peer support, counseling) to this workforce.

Mental Health Rewritten, created by the OWLS Education Company, in collaboration with the Ummah Collective Group is hosted, written and produced by me, Dominic Lawson

Executive Producers Kenda Lawson and Dr. Whitney Howzell

Cover art was created by Alexandria Eddings of Art Life Connections.

Some music was provided by DJ Krate Digga of the Mighty SoundChampz Crew

In this special reflection, Dominic steps away from the usual storytelling format to speak directly with listeners. After the powerful response to Episode 105, where we shared Nia's story, Dominic opens up about the impact that episode had on his own mental health—and why Mental Health Rewritten exists in the first place.

He shares the outpouring of messages from listeners who connected deeply with Nia's journey, and how those words of gratitude also brought a heavy reminder: that even in telling these stories, healing is not linear. The weight of these conversations can stir up personal emotions, and sometimes, stepping back is necessary.

Dominic talks honestly about his brief hiatus, the importance of decompressing, and how he rediscovered a grounding practice—flying drones—that has helped him regulate, reset, and return with clarity. It's a reminder that even storytellers and advocates need space to breathe.

As he prepares to launch Episode 106, Dominic invites listeners to continue walking with him on this journey. Expect more moments of check-ins, reflections, and honest conversations about mental health—not as side notes, but as part of the process itself.

The call from the sheriff's office. The Netflix notification from Baja. The 3 a.m. plea for a room. Each detail reads like a breadcrumb trail—fragile, almost surreal—marking the chaos of a loved one's unraveling. What happens when systems meant to protect instead withhold? When family becomes both the lifeline and the witness to an impending collapse?

This Mental Margin segment pulls us into that liminal space between presence and absence, where silence from a loved one becomes unbearable, and news delivered at the doorstep turns final.

This preview sets the scene for our upcoming full episode of Mental Health Rewritten, releasing September 19th.

This Mental Margins bonus segment expands on Episode 105: Rewriting the Conversation Around Suicide.

In the full episode, we heard Ashley-Lauren Elrod's powerful story of surviving prolonged suicidal ideation. Here, Tina Aggarwal offers additional commentary that did not make it into the main release—breaking down the complex, overlapping forces that can drive someone toward a suicide attempt.

Tina emphasizes a critical truth: suicidality is never the result of a single factor. Instead, it emerges from a combination of influences—mental illness, racial trauma, childhood sexual trauma, chronic health challenges, isolation, and substance use. She describes how these stressors accumulate over time, leading to months of persistent suicidal thoughts before a person reaches a breaking point.

Her most haunting insight is the metaphor of the hijacked mind: when suicidality reaches its peak, the brain enters a trance-like state where the individual feels pulled toward one singular mission—ending their life. At that stage, intervention is nearly impossible, which is why communities must act long before someone reaches this point of no return.

This bonus reflection underscores the urgency of early intervention and compassion, reminding us that suicide prevention is not just about crisis response—it's about recognizing the warning signs and creating safety long before the mind is hijacked.

👉 If you or someone you know is struggling with suicidal thoughts, dial 988 in the U.S. for the Suicide & Crisis Lifeline. You are not alone, and help is available.

In this segement of Mental Margins, we share two perspectives on the hidden weight of high-functioning pain.

First, trauma therapist Denise D. Moore shares a testimonial and reflects on dismantling the "strong Black woman" stereotype—reminding us that while not every story ends with a cure, every story can still carry meaning.

Then, from Episode 105: Rewriting the Conversation Around Suicide, we check in with Nia—the friend who remembers every birthday, keeps the group chat alive, and always shows up for everyone else. From the outside, she's the glue holding her circle together. Inside, she's carrying storms she's never named.

In this week's Mental Margin, we step back from the noise and dig deep into Major Depressive Disorder (MDD)—not just as a diagnosis, but as a lived experience. With over 700,000 lives lost to suicide annually, understanding MDD isn't just clinical—it's critical.

We explore how Major Depressive Disorder manifests beyond sadness: in executive dysfunction, in physical exhaustion, in a feeling of cognitive suffocation.

In this episode of Mental Health Rewritten, we tackle the subject of suicidal ideation with care, nuance, and urgency. Through a combination of real survivor stories, fictionalized scenes, clinical insight, and historical framing, host Dominic Lawson guides listeners through what it means to live on the edge of despair — and what it takes to survive it.

We hear the stories of:

Nia, a high-functioning professional whose emotional unraveling is invisible until it's too late.

Ashley-Lauren, a survivor navigating abuse, chronic illness, and a suicide attempt that ultimately catalyzed her healing.

Sean, a veteran who faced combat trauma, alcoholism, and stigma in the military before becoming a suicide awareness trainer.

Vernon, a comedian whose laughter masks a legacy of trauma dating back to childhood — and who now saves lives one conversation at a time.

Clinician Tina offers expert insight on how we understand suicidal ideation, the brain's escape mechanisms, and the ripple effects of silence. The episode reframes suicide not as a selfish act, but as a signal — one we must learn to recognize with compassion, not judgment.

The Diathesis-Stress Model as a framework for understanding breakdowns under compounded trauma

The language of suicide and why shifting from "committed suicide" to "died by suicide" matters

The invisibility of high-functioning depression and what it means to check on the "strong" ones

The interplay of PTSD, survivor's guilt, and stigma within veteran communities

The power of disruption — how a call, a laugh, or a knock at the door can save a life

The legacy of silence, especially in BIPOC and male communities, where vulnerability is often punished or pathologized

Mental Health Rewritten, created by the OWLS Education Company, in collaboration with theUmmah Collective Group is hosted, written and produced by me, Dominic Lawson

Executive Producers Kenda Lawson and Dr. Whitney Howzell

Cover art was created by Alexandria Eddings of Art Life Connections.

Some music was provided by DJ Krate Digga of the Mighty SoundChampz Crew

World Health Organization. (2021). Suicide worldwide in 2019: Global health estimates. Geneva: WHO.

World Health Organization. (2021). Suicide: Key facts.

American Foundation for Suicide Prevention. (n.d.). Recommended language about suicide.

National Alliance on Mental Illness. (n.d.). Suicide.

Centers for Disease Control and Prevention (CDC). (1999). Historical Statistics on Suicide in the U.S., 1900–1999.

Liu, Y. (2004). Macroeconomic conditions and suicide rates in the United States. American Journal of Public Health, 94(5), 768–773.

Nock, M. K., Borges, G., Bromet, E. J., et al. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry, 192(2), 98–105.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). Washington, DC

Ingram, R. E., & Luxton, D. D. (2005). Vulnerability-Stress Models. In B. L. Hankin & J. R. Z. Abela (Eds.), Development of Psychopathology: A Vulnerability-Stress Perspective (pp. 32–46). SAGE Publications.

U.S. Department of Veterans Affairs. (2023). 2023 National Veteran Suicide Prevention Annual Report.

U.S. Department of Veterans Affairs. (n.d.). REACH VET: Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment.

O'Reilly, K. B. (2018, Oct). How AI is helping detect and prevent suicide. American Medical Association (AMA).

Gafni, M. & Baum, G. (2024, Feb 28). Former Meta employee kills wife, twin sons, self in San Mateo. Mercury News.

Campbell, J. C., et al. (2003). Risk factors for femicide in abusive relationships: Results from a multisite case control study. American Journal of Public Health, 93(7), 1089–1097.

If you or someone you know is struggling with suicidal thoughts, you are not alone. Help is available.

988 Suicide & Crisis Lifeline (USA) – Call or text 988 any time, day or night https://988lifeline.org

Veterans Crisis Line – Call 988, then press 1 https://www.veteranscrisisline.net

Crisis Text Line – Text HOME to 741741 https://www.crisistextline.org

The Trevor Project (LGBTQ+ youth support) – Call 1-866-488-7386 or text START to 678678 https://www.thetrevorproject.org

National Alliance on Mental Illness (NAMI) – https://www.nami.org/help