Today I got my bi-monthly journal of the American Association of Suicidology, Suicide and Life Threatening Behavior. My cousin came over and my mother said to him that I like reading that kind of material. I do but on another level, I feel embarrassed. I know I am taking it personally because it is personal. I attempted suicide many times over the years and each time I fail it is not only a failure, but it also is an embarrassment to my ego. I have the scars to show of the self injurious behavior I have had over the years. Again, an embarrassment of my illness. I don’t know why I feel this way. Or maybe shame is another reason I feel embarrassed. I don’t know. But it hurts. It hurts knowing that I failed and I am still here. I don’t know why it does but it hurts like hell. I have not told anyone about the shame that I feel other than my blog and maybe my therapist. There is so much I tell her that I sometimes forget if I tell her about the shame of living. I know people who have attempted don’t like to talk openly to the person in front of them about their story of attempt. I don’t think I can speak openly in front of a crowd of people and tell them I have attempted and failed and now I feel like a complete and utter failure. That I want to try again and succeed just to try to cheat death. But I have people that rely on me to be here and though I sometimes resent them for it and even hate them for it, I still continue living. I don’t enjoy living. It’s a constant struggle for me for one thing to another. It’s more of a hassle living than anything. Between the chronic pain that I feel physically to the chronic pain I feel emotionally, why bother? But I do because I don’t think I can ever again act on my feelings. I lost what is called lethality. And until I get it back, I am still going to be living this so called hell called life.
Category: Chronic pain
post 215
Been depressed today. I really didn’t want to do anything but I made a cake and watch game 6 of the ALDS red sox game. I really didn’t do much else. I tried typing up my paper that I wrote last night but I just don’t have the energy to do it. Maybe later.
The urges to cut have been back and forth today. I still have not injured myself. I think it will phase out once I get back to my normal routine with the hormone pills.
I am really pissed off that I can’t convert or burn Carrie Underwood’s CD Carnival Ride, so I have to purchase it again. I can’t even play it because of some license issue. I don’t remember where I bought it, I think I downloaded it at Walmart but I am not sure. This just sucks. More money for music. But I finally found the MP3 of “What hurts the most” so I am happy. I have been going crazy trying to find the Rascal Flatts CD or phone backup that had it. I knew I had it some place and I did. On my old hard drive that is as big as a paperback. I just got a tetrabyte hard drive and it’s like a cassette tape. Those that are older will know what that is. I don’t want to feel old by explaining what it is.
My left leg has been acting up and I just feel like overdosing to escape some where other than where I am at. I might just take some extra Neurontin tonight like I did last night. I just feel like if I don’t do something I am going to go crazy. I just feel so wound up and though I should just start cleaning my room or something I just am so overwhelmed by it that it makes me want to OD more. But I bear it and resist the urges to do so because the last thing I want is a 7 year old finding me in a coma or worse dead.
So yesterday I reformatted my tablet. Totally wiped it out to its original factory settings. In so doing so, I got rid of the encryption that I put on when I had to where I was working. Now I don’t have to. Problem is that I don’t remember what apps I had on there to replace. I know I had my facebook and twitter. Those are my essentials along with wordpress. It was sad that my Zipwhip app was not compatible anymore. My tablet is old as it still is running Android 3.2.1. My phone is running 4.2.1, which is I believe the “Jelly bean” Operating system. Android has funny names for the OS.
comparisons of psychological pain scales
Suicide attempts are the leading reason why people go to see a mental health professional. What does it mean after an attempt and will the person get the help they need. There are many assessments on risks but few deal with the psychological pain that is attached to the attempt. In my research I have found three clinicians that have developed assessments to help deal with this issue. They are Dr. David Jobes from Catholic University of America, Dr. Israel Orbach in Israel, and Dr. Ronald Holden from Queen’s university in Canada.
Dr. David Jobes wrote and developed what is known as a suicide status form and believes that by collaborating with the client, you can decrease the suicidality (Jobes, 2006; Jobes & Drozd, 2004; Michel & Jobes, 2011). The form consists of three parts: initial, tracking, and outcome. The initial form has the initial evaluation of suicidality, followed by a treatment plan agreed upon by both client and clinician, and then clinical notes such as axis I diagnosis, mood status and session outcome (follow up appt, discharge, or hospitalization). The tracking and outcome are similar in nature. Tracking follows the suicidality. This is used until suicidality is resolved. I base his study on research articles and the two books he has written on the subject.
Dr. Ronald Holden was able to validate his scale of psychache that has helped to focus treatment on psychological pain. This is a 13 item scale rated on a Likert rating of 1-5. The total number of points is 65. The higher the psychache, the higher risk of suicide. The first 9 items deal with the psychological underpinning of what is causing suicidal thinking. The last 4 items deal with the likelihood that this person will act on it. His work I base on his research article.
Israel Orbach (Orbach, Mandrusiak, Gilboa-Schectman, & Sirota, 2003; Orbach, Mikulincer, Sirota, & Gilboa-Schectman, 2003) also has a mental pain scale but has 44 items and cannot be used, in this author’s opinion, in the clinical setting but does have some merit in the initial evaluation of psychological pain. The overall score is intricate and complex as it breaks down the 44 items into quartiles. The study was very small, less than 50 participants and was broken down into two parts. I base his study on his research article.
These combined formed my contention that psychological pain is a causal factor in suicidal thinking.
Suicide status form:
This is a collaborative effort between client and therapist in understanding the reason why a person is suicidal. These forms, initial, tracking, and outcome, provide a base for which to form a treatment plan for working on decreasing suicidality. It was built on the theories of multiple clinicians in the field of suicidality. These clinicians are Shneidman (Shneidman, 1993), who focused on psychological pain, Beck, who focused on cognitive treatment of depression, Baumeister (Baumeister, 1990), escape theory in suicide as escape from self, Linehan (Linehan, Goodstein, Lars Nielson, & Chiles, 1983), reasons for living when you want to die, and Jobes (Jobes, 1995), tracking suicidality.
Dr. Jobes has developed an assessment tool and mangement for suicidality. This management includes the suicide status form (SSF) and uniquely tailors the treatment around individual needs. This is based on the client’s direct input into their treatment. This collaboration takes away the therapist as expert and puts the client in charge of treatment. This also makes things more comfortable and meaningful. Dr. Jobes believes that by tracking the course of treatment, there may be better outcomes and those that are suicidal do not go by the way side, meaning get lost in the system or are ignored after their treatment ends. In his seminal work (Jobes, 1995), he found that nearly half of those that reported to be stressed and suicidal responded to treatment. The other half either dropped out of treatment, got hospitalized, or remained chronically suicidal. This propelled him to develop the SSF to keep track of the suicidal clients and their outcome.
OMMP: Orbach and Mikulinger Mental Pain Scale.
This scale is a 44 item assessment that measures mental pain on nine factors ranging from irreversibility, loss of control, narcissist wounds, emotional flooding, freezing, self-estrangement, confusion, social distancing, and emptiness. These factors are what contributes to mental pain as explained by the authors (see Orbach et al, 2003). Items are scored on a Likert scale of 1-5. In my opinion, given the complexity of this assessment, it cannot be used for clinical use but does hold a valuable research tool.
Holden scale.
Dr. Holden’s psychache scale is a thirteen question self-report of items based upon Shneidman’s book, Suicide as Psychache (1993). Psychache is defined as despair, anguish, hopelessness, and psychological pain one feels. Each items are ranked on a 1-5 point scale ranging from never to always agree, neither, or from strongly disagree to strongly agree (Holden, Mehta, Cunningham, & McLeod, 2001). Scores are from thirteen to sixty-five. This scale is easy to use and can be used clinically, with the permission of the author to reproduce it. What I like about this scale is that it is user friendly, scores can be added quickly, and the tracking of suicide can be seen. With higher results, suicide is more likely to occur. The lower the score, the lower the risk of suicide.
These three assessments are comparatively the same but are just called different things. The main point of suicide ideation is to find out what is driving the person to think about suicide and to try and prevent it from happening. Ideally these scales should be used in the first session and the Holden and/or SSF used thereafter.
Baumeister, R. (1990). Suicide as Escape From Self. Psychological Review, 97(1), 90-113.
Holden, R. R., Mehta, K., Cunningham, E., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224-232.
Jobes, D. A. (1995). The challenge and the promise of clinical suicidology. Suicide and Life-Threatening Behavior, 25(4), 437-449.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Jobes, D. A., & Drozd, J. F. (2004). The CAMS approach to working with suicidal patients. Journal of Contemporary Psychotherapy, 34(1), 73-85.
Linehan, M., Goodstein, J., Lars Nielson, S., & Chiles, J. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51(2), 276-286.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.
Orbach, I., Mandrusiak, M., Gilboa-Schectman, E., & Sirota, P. (2003). Mental Pain and Its Relationship to Suicidality and Life Meaning. Suicide and Life-Threatening Behavior, 33(3), 231-241.
Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schectman, E. (2003). Mental Pain: A Multidimensional Operationalization and Definition. Suicide and Life-Threatening Behavior, 33(3), 219-230.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.
Copyright 2013 Collerone, G
suffering with a price
Today was a little better day without my nerve condition bothering me so much. I still feel pretty down.
I’ve been trying to work on my blog for the new thing that I am involved in and it’s tough editing my own work. I am to add in some questions but don’t know really where to begin. I feel like just drafting a whole other paper but I don’t want to start from scratch. Drafting this paper was a piece a cake the first go round. Editing it is a little more difficult.
I finally saw my therapist after not seeing her for a few months. I think I might be able to see her every Tuesday but I am not sure I can commit to that. I have a hard time waking up and getting the car from my sister’s work is a hassle. I then have to pick her up from work and sometimes I am too tired to drive back, even though it is a MUCH shorter distance than my therapist’s office. I had to give her my forms for my long term disability so I might see her next week so she doesn’t have to mail them out and I can send it in with the other stuff that they need. I’m seeing my psychiatrist next week so I will drop off the paperwork to her and my primary care as he is in the same facility. I don’t get to see him till the end of the month and I want them sent in ASAP.
I just looked over the paperwork and they have a section for vocational stuff. My psychiatrist isn’t involved in that kind of bullshit and neither is my therapist. Oh the hoops these idiots make you go through for a buck.
Been starting to feel suicidal again. I just keep thinking that I just have to die. I can’t go on living. Then today a video comes in that my niece wanted and she is overjoyed and tells me that she loves me so much. How am I to die knowing that she will be messed up if I die? It hurts too much to think about but yet it kills me to suffer the way I do all the time. I get no reprieve. No alleviation at any time. Sure I was able to drive 30 miles today to see my therapist but it cost me my back to be hurting and mentally I am still depressed and suicidal. We talked about this new group that I am hoping to get into. I don’t know, maybe it will help things. I know it will give me something to get out of the house but the group meets at the time of my therapy appt on Wednesdays. I know it’s not a big deal to reschedule my appt but it is to me. I hate it when the schedule gets messed around. Trying to find another time is not always that easy. But I still think that suicide is a way out of my misery. I don’t have to go to group or therapy. Just crush a teenager’s heart or two. I try not to think about stuff like that because it really brings into the picture of what suicide does to the family when you are gone. I keep thinking they will be alright but I know they won’t. People always keep reminding me of that and it kills me because it means I have to suffer longer. I just want my pain to stop. If I had cancer I know they wouldn’t want me suffering so why can’t they just understand it that way. That I had to be out of my misery because I hurt so much. But no one sees it my way.
You must be logged in to post a comment.