what to call this

“…Our best route to understanding suicide is not through the study of the structure of the brain, nor the study of the social statistics, nor the study of mental diseases, but directly though the stuffy of human emotions described in plain English, in the words of the suicidal person.” (emphasis added)
– Edwin Shneidman, The Suicidal Mind

This statement is very true. How else would you know what lurks in the heart of a suicidal person. I have been there many times. My last episode of depression, if you want to call it that, almost caused me to end my life on Nov 5, 2005. Ten years ago around that time, I was in another severe major depressive episode and tried to take my life then. I didn’t want to suffer any more and decided to end my life on the anniversary of that day, to finish what I had started.
I don’t know what brought me to that point. I first started coming up with this plan some time in August 2005. I had wanted to go in the hospital around Labor Day as my mood was bleak and I felt a need to escape life for a while. I felt I needed to be in an environment that was safe and supportive. I had finally made plans to take off work and go in. I was then in a psychotherapy group. I had told the group leader that I wouldn’t be in for a couple of weeks because I was going in the hospital. The hospital has always been my escape. It was my way of re-cooperating, and a way of recharging my batteries so to speak. But this “professional” thought that I didn’t need to be in the hospital, that I could do this on my own. He thought an admission to the hospital would be more harmful to my pride than saving my life. But he had not clue how dark my thoughts were or how suicidal I was at that moment. Nor did he realize how much “psychache” I was in. He said the words that my “dark side” needed. For the first time in my life, I gave in to it. I was back to living a double life again, one that was deeply full of mental pain and misery that wanted nothing more to do with life and I living life by going to work, school and being ‘happy”. All the while, I was planning my death. I had heard on one of my favorite crime shows that the migraine medicine I was taking could cause cardiac arrest if taken in high doses. A ninety-day supply was all that I needed and I did have that. I no longer wanted to live after that day. If I couldn’t go in the hospital, what other option was there for me?

Looking back, I started to see my collapse. By the end of September, I had my date, my method, and my intent. All that was left to do was to “quit” therapy, get my affairs in order, write a will, and then, maybe, leave a note. I remember going to my classes and sketching all that I had to do before November. It was a month before I was to do it and if all went well, it would work. I had given myself a month to not only think this through, but also to give me time in case I wanted to back out. I had done this many times. During my adolescence, I had read Paul Quinnett’s Suicide: The Forever Decision. He described giving some time between the method and going ahead with it. On many occasions, it worked. But I knew that I was going to go ahead with my plans even if I did “feel better”. I had no rescue plan nor did I want to be rescued. I knew how I was going to do this for quite some time. I had been perfecting this plan for ten long years and finally; this was going to be my last episode of depression. I was no longer going to suffer anymore. No more pain, it was finally going to end.
At this time, with all this planning, I was getting bored in therapy. I no longer had anything worth telling my therapist about. I sure wasn’t going to tell her how suicidal I was. I certainly did not want to be forced to go in the hospital again and wreck my plans. I was making it look like I was “ok” and doing well so that when I would tell her I was taking the last few weeks off in October, she wouldn’t suspect anything. I came up with a game over the course of therapy that I liked to play. The game is called 20 questions, she could ask any question she wanted and I had to answer it, honestly. I am usually an honest person and on the spot, it would be difficult for me to come up with something bogus. I sat there that day and wanted nothing more than to leave but we had at least ½ hr to go. She is a stickler for keeping exactly fifty minutes, each session. We started playing my game and the first question she asked was “what is really, really, really, going on?” I remember I thought it was funny and laughed. Here I was portraying to be this highly functional person, all the while, stuck in such despair and constriction that all I could think about was Novemeber 5th. This was going to be my last depressive episode and I was determined to see it through. But I was shocked that she asked that question. I asked what she was talking about, she told me something that one of her supervisors had stressed during her training: it’s the highly functional depressed person that you need to look out for to be the most suicidal. I didn’t confess to her that day what was running through my mind. My body was still going through shockwaves about what to do. I felt like I had been caught with my pants down or something. I don’t know how I got out of that session without telling her then what was going through my head. I think I passed the question. I felt like I was walking a tight rope after that. The next session, I told her about my plans for November.

She then asked all the “right” questions. She assessed that I was highly suicidal, at high risk. But I didn’t think that I was. My thinking was “rational” even though I now realize that it was completely irrational.

It was now the second week in October and she was begging me to another way out of this mess. I told her that there wasn’t and in my clouded mind, I seriously thought she was going to let me leave so that I could kill myself. The sad thing is that I thought all of this was completely rational. All my thoughts made sense to me. I was in so much pain that I dissociated just to commit suicide. A different “ego state” had taken over as the rest of me just could not tolerate the “psychache” any longer. This episode had made me closer to my therapist than anyone in my life. I know that if she didn’t ask me that one stupid question, I wouldn’t be here today. For the next few months, we had contracts and increased sessions. We worked intensely on getting me to see that there could be another way out. I ended up going to a partial program for a couple weeks in November and then again in December. I was to turn thirty and I really did not want to see it happen. I didn’t see much of a future. All I saw was pain and misery that I so desperately wanted to end. I felt I was back to living in an abyss. I wore the pain like a heavy coat that no one saw. She thinks that it is some kind of miracle that I am alive and that I am a very resilient and “special” person. I don’t see myself as such and I doubt I ever will.

Even though I did not attempt suicide, I still went through a “post suicide” depression. I lost my appetite and had many physical symptoms of depression. I had stopped taking my medication, all of them, at this point. I just didn’t see the point. Some time in December, when the pain of living was wll beyond my breaking point, I went back to pharmacotherapy. This has helped to stabilize my mood for the last few months. I have been trying to sort out where I went wrong. One thing I noticed was that I had stopped writing my feelings, any feelings, in my journal. My journals had gaps of several weeks between entries. I was once an avid, daily journal writer. When I did write it would be a brief synopisis of the events of the day or weeks in between the last entry. No feelings, just events that had taken place. I had also stopped writing letters to my therapist. These letters would often speak of what was “really” going on.
I didn’t think much of my writing. I looked back on my previous entries from a few years ago. It is much different from what I write today. Looking over the past year’s journal entries, most of them have to do with “rushing” to do things. I gave my therapist a journal from 2001. Every page is written about the agony of my soul. It was therapeutic to write such despair. It listed my deepest, darkest, morbid thoughts, and feelings that the outside world hardly knew. Sadly, it also made me more depressed, as it was my “proof” that things couldn’t get better.
The entries leading up to my plan in November had nothing about the agony, the despair, and the anguish that was driving me to think about and execute my plan of ending my life.
I don’t know when I stopped writing. I think most of it happened before the breakup of my last girlfriend. She had made fun of what I wrote, as if my pain was a joke, something to be laughed at. I also grew tired of writing every day about my “psychache” and not feeling much change. I think a part of me felt that as long as I was writing something, even if no feelings were present, it was better than not writing at all. I always liked to record my events of daily living. However, when I stopped writing of my pain and thus ignored it, the more the dark side began to control me. It had no outlet, no way of showing itself. It then began using my subconsciousness to express itself. If I wasn’t actively thinking about suicide, my “other side” was planning and scheming on ways to commit the act. That is why I saw nothing wrong with my plan. The blinders came on and held on tight to the idea that the world would be better off without me. My “kids” (nieces and nephew) would be fine without me, my therapist would be ok, some how, and I really didn’t care much about what my friends would think. I couldn’t think about that. During what would be my last few weeks, a couple friends from out of state called me. I saw it as a way of God telling me that I was still important to these people, even if I felt completely worthless and didn’t deserve to live.
According to one study of Joiner et al, there are long-term beneficial effects that has shown writing about personal experiences can possibly have protective functions in that it reduces impulsive and maladaptive problem solving. It also can allow for more effective emotion regulation (both of which skills are key aspects of psychotherapy for suicidal patients (Joiner, Walker, Rudd, & Jobes, 1999). This protective function that I had used so well in the moments of my early years of therapy and throughout the course of late adolescence and early adulthood, I was no longer using. My feelings were not being recorded, at all. I chose instead not to feel and make myself as busy as possible with work and school, but mostly work.

For most of October through December 2005, I felt like I was living in a black cloud that was always around yet no one really ever saw. I felt so lifeless inside. It was so black. I truly was in an abyss. I was going down in flames and this time, I wanted it to be the last. Somehow, my therapist was able to get the blinders to open a little bit. I have a niece that was less than a year old. She is a cutie and when she saw me during this time, she gave me a look like as if to say, “Where have you been?” There was a period where I didn’t see her for a couple weeks because of working late. When I did see her, she “smacked” me almost as if she were saying, “Where were you?” Her older sister, who is almost like my own daughter, hugs me, kisses me, and tells me she misses me when she doesn’t see me often. I truly have no idea why I believed that they would be ok; I knew that they would be so heartbroken that their favorite aunt would no longer be around. I think it just helped me to rationalize my ultimate escape plan and make me go through with it without consequence. If I did stop and think about them and how it would make them feel, the protective factors Joiner et al talks about would have prevented me from executing my plan. I did not want that to happen this time. I wanted to die and I was going to do it.

Earlier this year (2005), I lost my cat, Stone. She was the closest thing to having a real child in my life. She was abused as a kitten and I had gotten her out of hiding. She trusted me. She would scratch other people and even the kids, if they got too close, but not me. I lived with my sister for a couple of years and during that time; I helped to make sure she was safe and gave her the affection that she needed. I miss her everyday. She died at the young age of six of renal failure. I felt she was the only “person” in my life to love me unconditionally. When she died, a part of me did too. I never felt a loss as great as this. That little fur ball captured my heart and soul and there was nothing I could do to help her live a long life. I have grieved a little. I still struggle with her loss.

Some days are better than others are. I would like to have a new cat but my living situation doesn’t allow it. This semester, I am taking psychological testing. Our term paper has to do with a testing element. Suicide assessment has always been an area where I am deeply curious and fascinated. I envy those people who actually are able to end their lives. They are no longer suffering emotional turmoil, no more psychache. I started the research a few months ago and was amazed to find that there isn’t a standardized method of training someone to be a suicide risk assessor. I remember in August of 2003, I had discovered that if I told of my dark thoughts, it helped. I guess you can say it was a catharsis. There is a paper written by Walker et al that looked into that theory (Walker, Joiner, & Rudd, 2001). But if I were to do that, I would have to attempt suicide and my therapist doesn’t want me to do that. We have talked about why I want to end my life. My theory is that if I try my plan and succeed, I was meant to die. If I failed, then I did deserve to live. The outcome is purely fate. I think I have a very lethal means of ending my life, but there is still the risk that I could live, end up a vegetable, or die. Those are the risks. Will it be cathartic? I feel I won’t know until I try. I have given my therapist my word that I wouldn’t try and that is the ONLY thing keeping me alive today is my friggin word. I am a gentleman, honest and true to my word. I don’t believe in lies and deceit. That only causes more trouble and a dishonest life.

My word. The fabric holds together my soul like the collagen that holds skin cells together. How many times have I broken it? Not many. To myself, I have broken more times than I can count. But in giving it to another person, it is as solid as a rock, most of the times anyways. When the blinders came off, I felt used. My therapist had used my word against me. She knew that if I gave her my word, I would keep it all costs. I was and still am at times very angry with her. I am not sure if it is justified or not. She kept me alive the only way she knew how. I hate her for it. I don’t want to live this life and yet she is allowing me to suffer, sometimes in silence, sometimes outspoken. I have tried to end therapy in the last few months because I cannot seem to face her. I think that is because she keeps reminding me of how close I was to death. I don’t feel like I was. I never attempted to go through with my plans so it doesn’t feel like it was an actual attempt. Just very strong thoughts and planning that never happened.

After being stabilized on meds for a month, my mood improved for the better. The contentment that I felt back in October 2004 came back. For the first time since then, I began to plan my future. I started looking at grad schools again and Rascal Flatts’ “Feels like today” and “I’m Moving On” held their significance in my life again. My kids were more precious to me.

The contentment started to fizzle the beginning of July 2006. It’s now the beginning of August and the psychache has returned. I am not writing. I am barely talking in therapy. I have so much to say yet can’t be bothered by talking about how I feel. I don’t see the point. I want to end therapy but as my therapist reminded me the other day, that will surely be a death sentence. I know that it is only a matter of time before the perturbation increases and I won’t be able to handle the pain of living anymore. I had put in safeguards when I was feeling well and could see things more clearly. The constriction that I feel right now is starting to cloud my judgment.

During my research, I had found some helpful tools. One is a psychache scale by R. Holden and Mehta. The other is the suicide status form by David Jobes et al. I have been using the psychache scale to monitor the ache. When I first started back in May, the score was high but as the weeks progressed, it got low. I can’t really make out what it means, as there is no standardization of what the scores mean. For a good measure, I gave the scale to an online support group to see what their psychache was. The lowest I got was a 20 and my score was well over 40. Most of these people suffer from chronic physical pain, not depression. I know that there have been studies where chronic pain contributes to depression, but that is a small percentage. I wanted to include these people in my research because I know they often get excluded because of their medical condition or because they are on pain medications.

Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and
routinizing the assessment of suicidality in outpatient practice. Professional
Psychology: Research and Practice, 30(5), 447-453.

Walker, R. L., Joiner, T. E., & Rudd, M. D. (2001). The course of post-crisis suicidal symptoms: How and for whom is suicide “cathartic”? Suicide and Life-
Threatening Behavior, 31(2), 144-152.