Category: Bipolar Disorder

Shneidman’s Psychache Theory

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mental disorders, mental illness, mood disorders, psychache, suicidality, suicide, writing

“From the view of psychological factors in suicide, the key element in every case is psychological pain; psychache. All affective states (such as rage, hostility, depression, shame, guilt, affectiveness, hopelessness, etc.) are relevant to suicide only as they relate to unbearable psychological pain. If, for example, feeling guilty or depressed or having a bad conscience or an overwhelming unconscious rage makes one suicidal, it does so because it is painful. No psychache, no suicide”. Edwin Shneidman, Suicide as Psychache p56

 

Psychache is the unbearable guilt, despair, hopelessness, shame, pain, depression, and press one feels when thinking about suicide. It is the corner stone of what this paper is about. The pain of the mind can cause constriction, a narrowing of view of things. It can also lead to perturbation (an unrest that causes one to feel like doing something to alleviate the uneasiness one feels) and also to press, which is also known as stress or the pressure and weight one feels under. The combination of these three things, press, perturbation, and psychache is what is known as the cubic model of suicide.

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The cubic model of suicide is a 1-5 rating of the three things I just mentioned. The higher the rating, the higher the likelihood of suicide. The worst rating is a 5-5-5 scenario and suicide will be imminent. It is important to rate these items when dealing with a suicidal person. It will validate what they are feeling and make them feel at ease in talking about what is causing them to feel so pressured and hurt to make them think of killing themselves.

When dealing with constriction, the dichotomous thinking that a) suicide is the only way out or b) things are always going to stay the same, it is important to always bring in more options to the person so they can see things differently. In his book Suicide as Psychache, Shneidman gives the example of a young pregnant woman who was thinking of killing herself with a handgun. She couldn’t have the baby so therefore in her mind, suicide was the only way out. After discussing several options with her (calling her parents, having the baby and giving it up for adoption, discussing the situation with the baby’s father, etc.), it was agreed that the woman would call the baby’s father. Suicide was no longer the number one item on the list. To prevent a mishap, Shneidman did take the gun away from the woman. An excellent example about means restriction.

In almost every suicidal thinking, there is some measure of lethality and perturbation. You can have high lethality and high perturbation, but you don’t always have high perturbation with high lethality. Perturbation, as described above, is very much like anxiety. It is a perturbed feeling that causes one to feel pressured to do something. Lethality is the doing something.

Also in every case of suicidal thinking is the frustrated needs that bring about the suicidal feelings.

ABATEMENT The need to submit passively; to belittle oneself

ACHIEVEMENT To accomplish something difficult; to overcome

AFFILIATION To adhere to a friend or group; to affiliate

AGGRESSION To overcome opposition forcefully; fight, attack

AUTONOMY To be independent and free; to shake off restraint

COUNTERACTION To make up for loss by retrieving; get even

DEFENDANCE To vindicate the self against criticism or blame

DEFERENCE To admire and support, praise emulate a superior

DOMINANCE To control, influence, and direct others; dominate

EXHIBITION To excite, fascinate, amuse, entertain others

HARMAVOIDANCE To avoid pain, injury, illness, and death

INVIOLACY To protect the self and one’s psychological space

NURTURANCE To feed, help console, protect, nurture another

ORDER To achieve organization and order among things and ideas

PLAY To act for fun; to seek pleasure for its own sake

REJECTION To exclude, banish, jilt, or expel another person

SENTIENCE To seek sensuous, creature-comfort experience

SHAME-AVOIDANCE To avoid humiliation and embarrassment

SUCCORANCE To have one’s needs gratified; to be loved

UNDERSTANDING To know answers; to know the hows and whys

These twenty needs are what Shneidman has called the essential ones when people are suicidal. Most of them are not all twenty but five or six as it pertains to the individual. “The prevention of suicide with a highly lethal person is then primarily a matter of addressing and partially alleviating those frustrated psychological needs that are driving that person to suicide. The rule is simple. Mollify the psychache”. (p53) Shneidman believed that these frustrated needs are what caused psychache.

I believe there should be another need, validation. Everyone needs to be validated in order to feel secure and feel okay. Without this, most people feel shamed and dumb, that what they are feeling or experiencing has no meaning or purpose. They may also feel empty and alone as no one understands what they are going through. This need when frustrated or thwarted can lead to suicide.

Shneidman, Edwin. Suicide as Psychache. 1993. Jason Aronson, Inc.

Recovery…what does it mean?

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide, suicide attempt

Recovery…what does it mean?

I keep hearing people talk about recovery and I am at a loss. Can someone enlighten me on what the hell it is? And what exactly are you recovering from?

I hear from suicide attempt survivors all the time this word. Do people who think about suicide really recover after they attempt? Because I keep wanting to try again and again. I haven’t made an attempt in years but I think about suicide constantly. Or is recovery just something that happens after you learn different coping mechanisms?

The reason I do a lot of suicide research is because I want to find something to help me. If I never looked for it, I wouldn’t have found CAMS and the SSF so useful. I have also found other assessment tools but nothing else worked. Traditional therapy didn’t work for me. I had to find a therapist that treated me as an equal and collaborate with me on what works and what doesn’t. It’s still an ongoing process as my suicidality gets worse during certain times of the year than others.

I don’t think I will ever recover from my mental illness. I think it will wax and wane, just like my suicidality, but it will never get better. I might find symptom relief through medication but even with medication, my depressions get the better of me. They are too severe and too frequent to really get relief from them. Medication has been proven useless with treating them. I am just left to suffer through them until they pass.

Then I have the physical pain that I deal with. I don’t think I will ever recover from that. It just seems to get worse during the temps of New England. My former PCP thought that I can just do something to make me feel better and things would be better. Wishful thinking. As much as I don’t want to be on meds, I know it’s my new way of life. It’s the only way I can survive. Otherwise, I think I would entertain the thoughts of killing myself, and by entertain, I mean attempt.

Rambling 567

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders

My day started off rough. I kept on waking up every few hours during the night but somehow managed to stay in bed till 10. I woke up at 0500. All I remember is having a bowl of cereal and answering a friend’s email. I think I went back to sleep as I don’t remember what happened after that.

A couple of my blogger friends are having a difficult time right now. I wish there was more I could do to help them other than being there for them. It’s so hard because they are so far away from me.

I made biscuits and heated up some gravy. It was my lunch. I then made my delicious coffee that tastes like milk chocolate. I am so glad I was able to get another bag of this coffee. It’s called Brazil Sertaozhino. This is the second kind of Brazil coffee made from small lots that I like. I have three different kinds of coffee, not counting the bunch my therapist gave me from Hawaii. I still don’t know if it will be good for the French press I have. I have to ask my niece if fine coffee grounds will work with it. The coffee grounds that I use are course grounds, a different grinding process.

I went up and down the stairs a few times and that aggravated my leg. Then my sister called to babysit and I am hurting really bad. Seems going down the stairs hurt more than going up. I couldn’t use my cane as I was carrying my laptop and my coffee down the stairs.

I don’t know how but I got a bunch of shit (lint and other things) in my bed. I don’t understand how this happened as I was wearing slippers the whole time I was in my kitchen and in my room. I was so pissed off. I need to clear my bed off so I can change the sheets. I have been removing one item or two a day. I told myself that I wasn’t going to allow stuff to accumulate on my bed the last time I changed my sheets. HA, I am funny. I might as well as said I was going to win the lottery that day.

I miss my therapist and it’s only been a few days since I last talked to her. She is only gone for a week. I have been writing letters to her. I wasn’t going to because I write these very long letters and she never has time to read them. I try to keep them short and to the point but it never seems to work out. The writing helps to let her know what is going on while she is gone because what I have to say doesn’t fit in a text message.

One of my favorite country artist is coming out with a new album. She used to belong to the duo Sugarland. I miss that duo so much it hurts. And I feel really sad when I hear Lady Antebellum’s music. They broke up a few months ago. Their lead singers, Hillary Scott and Charles Kelley have decided to go solo. Their last recorded song was “I did with you”. It was recommended by YouTube and I just cried when I heard it. I think I was just emotional that day because I haven’t cried since hearing it again and again. It still makes me sad when I hear it because I know I am not going to hear anymore music from this group. Kelley has a few songs out but I refuse to listen to him because it just hurts. I am still not over the breakup.

I want to thank my readers. I just passed the 55,000 views on my blog. I wouldn’t have become successful in the three years since writing this thing without your support. I know most of you don’t always comment or leave feedback but that is okay. I am glad people read my blog every day. It means a lot to me. My top blog is still Knackered, a Short Story about CES. My second is Analysis of a Song: How to save a life. I don’t know what my third one is.

I emailed my psychiatrist late last night to tell her how things were going and also to let her know when my MRI was scheduled. It’s in two weeks but I think I will try and move it up. I can’t stand being in pain that affects my walking. It’s bad enough I can’t walk that far because of my stupid ankle but to have my upper leg also bother me, NO. I don’t think so. I will really gain a lot of weight as all I have been doing lately is eating with little outside walking. I have been trying to limit what I eat but that doesn’t always work out because of my cravings. I blame my psych meds for these cravings, which usually involve carbs. Tonight I plan on having steak but I am still full from eating biscuits so we’ll see. I know my mother won’t touch the steak because she doesn’t like it. More for me! It’s not a huge piece, just perfect for one person. I would love to have it on the grill but I don’t know how to operate it. My sister never showed me and I think the grill has been put away for the winter anyways. I just broil it. It comes out just as good that way, too.

I was going to go to Starbucks today to write my psychache paper but it doesn’t look like I am. I haven’t showered in days. And I refuse to go out unless I shower. So I just haven’t gone out. Plus I am babysitting so I really can’t go out. It’s also very cold out, which explains why my spine has been aching, especially my sacrum (lowest part of the backbone). It’s kind of funny, but if I push on a certain part right before my butt, I will pee. It’s like a pee button. I haven’t told any of my doctors this because I am afraid. I try to avoid touching that area as much as possible. I know my nerves are damaged in that area. Another indication that I am fubar.

I spent at least 15 minutes on the phone with my father’s doctor to get him a refill for one of his medications. I was told that he would only get a month’s supply unless my father sees the doc. What fucking bullshit. So I had to cancel one of my Amazon orders so I can have money for Zipcar to take him to this appointment. I still haven’t figured out what I am going to tell my father when I show up with a car to take him to his doc’s appointment. I hate his doc but I have been unable to find another PCP in Boston that will take him. I have to make phone calls and I hate making them, mostly because I hate being put on hold.

I don’t like that his PCP holds his medications hostage to an appointment with him. These meds are for his heart and liver so I don’t understand the reasoning behind it. These aren’t even scheduled or controlled medications. It just drives me crazy because I am the one that has to put the effort into transportation to and from his appointment as well as stay with him when the doc is often behind. It doesn’t do my PTSD any favors staying two to three hours with my father, let me tell you.

Sunday Blog 27-Dec-15

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders

Sunday Blog 27-Dec-15

I had a busy day. My groceries came soon after I woke up from a weird dream. I put them all away and then had breakfast. My back has been sore most of the day because of the damn rain and the temp dropping more than 10 degrees. It’s not really painful just an ache that won’t go away.

I got mail. My DVDs that I ordered came in so tonight I will be watching It’s a Wonderful Life. I also got a letter from my neurosurgeon’s office telling me when my MRI is. It’s two weeks from now. I am not happy about this. I think I will call and see if I can be seen at another location. They have quite a few at the hospital I go to.

My prescription was ready to be picked up and I went because I wanted chips. I didn’t order them with my groceries. I usually don’t order junk food unless I am craving it or think of it. But today while watching the game, I wanted something to munch on. The game went sour so I decided to have a beer. Then the game really sucked. I threw away the beer and went upstairs to my room.

I haven’t had time today to read or write. I honestly don’t know where the six hours have gone to. My ankle is killing me, probably because I have been going up and down the stairs all day. My sister called me after the groceries were put away to tell me I had presents. There were two gifts that I didn’t open. I got a Sox umbrella and a nice comfy bathrobe. It will come in handy after showering. I really like this gift as I never had a bathrobe before, not a nice one anyway. I had a hospital one but that was it.

I can’t believe that in two weeks my therapist and I have been seeing each other for fifteen years. I also can’t believe it’s been fifteen years that I have had CES, cauda equina syndrome. I have had it twice in my life. The first time was fifteen years ago, second, nine years ago. The third is pending.

I checked the Powerball. No one won. I still have another chance to win, if I remember to play. My brother-in-law gave me some scratch tickets for my birthday. I won six bucks. I will cash it in and get a few quick picks for the Powerball and Mega Millions. That pot is over 117 million bucks. It would be sweet to win that. I used to play my own numbers but they never came out and I never got a number or two. So now I just do quick picks.

I am very tired. I am going to try and have an easy night. I hope I get to sleep at a decent hour. I still have to fill my pill box for the week. I also need to shower but will wait till my ankle calms down some. I don’t have any plans for the week as my therapist is on vacation. I just have to see my father Thursday. The rest of the week is up to me. I want to go to Starbucks tomorrow so I can write this paper about psychache. I have been thinking about it the last few days but nothing concrete has come of it. I have an opening quote from the book but I still don’t have a beginning sentence. I hope to have it done by the end of the week.