ASAD: Acute Suicidal Affective Disturbance
I read the above article with interest. One of my Twitter buddies shared it with me and wanted my opinion on it. I think that it is right on queue and I hope that Dr. Joiner eventually sees this as a diagnosis. But I worry that if the stigma of suicide is not dealt with, it might just be an admitting diagnosis and thus cause more harm than good.
According to the criteria lined out, I meet this diagnosis, though at this time, I am unable to rule out whether a medical condition or conditions exclude the diagnosis. There have been many a times that while I am in excruciating pain, this condition is activated and I am acutely suicidal. The only thing that has saved me from actually making an attempt on my life is that I physically cannot walk and have refused to kill myself in my own home. Then in the morning (most of these attacks have occurred in the midnight hours), I no longer feel so suicidal.
It used to be that what I would call a “switch” would be activated and I would be suicidal until I fell asleep. Now I know that it’s this disturbance that occurs and it makes sense to me. But in every suicidal occurrence that has happened over the past two years, it has been because of physical pain or some kind of dissociative state brought on by physical pain. Very rarely has it occurred solely with psychache or psychological pain. Granted not every episode is psychache free and physical pain free. I will have what Shneidman calls the three Ps, Psychache, Perturbation, and Press as well as physical pain that causes me to be severely suicidal. These nights, I swear to myself I will end my life the next day when I can walk again. Fortunately, I don’t feel as suicidal the next day because I had a few hours or more of respite from these kinds of pain and perturbation. That isn’t to say that I won’t be activated the next night or come up with a suicidal plan to end my life the following day. These plans are usually a few weeks away to give me time to think things over and essentially put off today what can be done tomorrow. These plans have also given me time to work through my feelings and usually by the time that date comes, I no longer feel suicidal enough to go ahead with the plan.
Suicidality is a tricky business and not everyone’s suicidality is the same. What triggers my suicidality might not trigger someone else’s. There are mitigating factors that might be similar in nature like the criteria states but I would love to see the data in the context of ruling this a diagnosis. Just because I find this disturbance fits my suicidality, doesn’t mean that it will someone else’s and that is the difficulty with the nomenclature I think Joiner talks about in his article.