Category: mental illness

school worries

by Midnight Demon, posted in depression, mental disorders, mental illness, mood disorders, psychache, psychosis

Just got the notice that my state refund was redirected to the state university towards the money I owe. Now with the close to $900 I will pay off the entirety of what I owe and be free to hopefully enter class in the summer. Though I am a long way from actually going there right now. I just learned I got to get readmitted and it has to go through a review process. I know my transcripts hasn’t been great at the school, but working two jobs and going to school was tough. I was lucky to get a B or even a C. Though I have more W’s than I do actual grades. I also have a couple of incompletes that are now F’s so I know my GPA sucks right now. I feel really rotten as it is and summer is a long time away from now. I have until the middle of April to sign up for this class I want to take. I really, really want to take this class. It is the history of psychology and is only offered over the summer. It is a summer long course and is upper level. I will have my work cut out for me because it will also be my first online course. I’m now starting to chicken out. Plus it really won’t matter if I go through with my plans for the end of the week.

The typical worries I have is what if I don’t get accepted back? What am I going to do? I really want to go back to this university as it will suck to start over somewhere else. I know the professors in the psych department so know what it’s like. I won’t have that advantage at another school. Plus I can take my time this go round because I won’t be bothered with the demands of work. The hard part is going to be paying for it as loans are out of the question. I’ll have to save some money every month and be on a strict budget to go back.

The whole process is kind of freaking me out. If I don’t get accepted I have to go to another school. If I survive this week and don’t do what I want to do. Maybe school is too soon after this mental breakdown I have been experiencing. But then, the reason I left school was because I had a breakdown. I just couldn’t handle school and work and became psychotic. But now I will just have school to focus on. Maybe I will excel maybe I will just be as overwhelmed and it won’t happen like I plan. Nothing happens like I plan it to go. I will be a fool to say that everything goes right for me but it doesn’t.

exciting article

by Midnight Demon, posted in depression, mental disorders, mental illness, mood disorders, psychache, psychosis, suicide, suicide attempt

Just read an interesting article about the Collaborating and Management of Suicidality (CAMS). I can’t believe this theory is 25 years old. It is gaining more acceptance as time goes on as more countries are using it as a treatment modality in suicidal people. It is a clinical intervention that is used as a collaboration between client and therapist in the treatment and care of a suicidal person. I find it one of the best out there and it is the best because it can be used across the disciplines in the mental health field.

I will be writing more about this. I write a lot about Jobes, the creator of CAMS and the SSF (suicide status form). He is the most brilliant person I have ever met. The fact that this is going to electronic way I think will be used across mediums and will be easier to deliver. Most clinicians have gone the electronic way but not all. This makes me want to go back to school and get my degree.

Farkle and buses

by Midnight Demon, posted in depression, mental disorders, mental illness, mood disorders, physical pain, psychache, psychosis, writing

Nothing interesting going on today. I went to see my therapist and psychiatrist. My therapist and I talked about my current delusion/paranoia: the 6 die and the crowding on the bus. I play a game called Farkle and it is a dice game that is played on my phone or computer. Don’t really know the object of the game other than to collect as many points without Farkling, which is when you don’t get the one or five die. Lately my delusion has been focused on the 6 die thinking it just wants to kill my game. I become paranoid every time I get a 6 thinking game over. But usually that is not the case. Irrational I know but when you are delusional, you can’t be rational.

The crowding on the bus situation is my true paranoia. I HATE it when people start crowding up the entrance doors and I literally begin to panic and have anxiety. I just get so paranoid that these people that are standing are going to go flying because the bus had to come to a sudden stop or some jerk cuts the bus off. The worse is when strollers get on the bus and take up seating for people. One time there were three strollers and they weren’t the small kind. I am talking about the heavy duty ass big wheelers that take up 3 adults just to fit a small tyke that swallows it whole. DRIVES ME NUTS. It blocks the aisle where people want to get off or on and then I am left usually without a seat at my designated disability seat because these mini cars are now in my way. I will not go out because of this paranoia some days. I just can’t stand to see the aisle clogged up with people or strollers. It just makes me really anxious.

Because I spent a good time out today, my ankle is really sore. I am finding that even the smallest of activities have flared it up. The pain is bone crushing. This is the lateral malleolus or the bone that sticks out at your ankle. The pain is so intense, especially when I stand. I know all the more reason that I should lose weight but when you can’t fricken walk right, all you can do is restrict your caloric intake and that is difficult to do. I have been trying for weeks to stick to a diet but I have been failing completely. I just can’t help it. I like to eat. I have been trying to control the cravings but it is so difficult. If I want Chinese, I’ll have it. If I want pizza, I order it (I like plain cheese so it’s not too bad). Today I thought about Thai food but decided against it as after my appt with my psychiatrist I just wanted to go home. I thought about making manwich. I haven’t had that in sooo long. So tomorrow I will make that. I bought the lean meat. Only problem is that I am the only one that likes it. I usually end up eating it all. Another item of food I cannot resist. It is just sooo good!!

comparisons of psychological pain scales

by Midnight Demon, posted in Chronic pain, mental disorders, mental illness, mood disorders, psychache, suicide, suicide attempt

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