Category: psychache

Of suicidality

Since my last therapy session, I have been thinking about my suicidal career and how it relates to my identity as a trans person. My therapist is under the impression that it is my insurance hindering me from seeking another therapist and I told her, no. It is my suicidality. She seemed incredulous about this. So I wrote to her and told to contact at least 5 therapists and ask them if they would take on a suicidal client and see what she gets. I doubt she will do this.

I also told her in the message that I would like to continue talking about this because it is central and I think that I can heal if I talk about how I didn’t have the words to speak about being a boy all these years. In my first few years of therapy, it was difficult because I was also an active cutter. One therapist tried to push DBT on me and failed. I resisted. In one of the exercises she gave me was to think about cutting and note how many times I thought about it. It was over like 20 times a day I thought about it and it made me worse thinking about it this. I felt really bad about myself. I didn’t have much hope about this new therapy. This was back in the early 2000s, before I found a stable therapist. By then, my cutting had somewhat stopped. It didn’t provide the release it once did. Instead, I just became suicidal. It was extremely painful. I was hurting very bad. My psychache was off the scale. My therapist became my only source of support and hope. I was seeing her maybe three times a week but I still just eluded to how I was feeling. In looking back, she really didn’t have a strong sense of redirecting me when I went off course and that was a downfall of our therapy. It went on like this for years and I just became more and more suicidal. I didn’t know what was making me so suicidal. I just knew I was.

The pain of living not as my true self was literally killing me. I hated my body and myself. I actually loathed myself in ways I never thought of. I hated my face. I was convinced I was ugly and fat. My father had called me “facia bruta” (ugly face) for so long that I believed him. I had things on my chest telling me every day that I was not a man. I had periods that made me suicidal every month. The hormonal aspect of it was terrible before I was able to stop them. It literally was like a switch went off when I started bleeding and I was ok again. But before then I was in suicidal hell. All I thought about was killing myself and I had such pressure to do so. I usually ended up going in the hospital for a couple of weeks but that never helped me. It would keep me safe from myself but they never cared to work on why I was suicidal. It was to be dealt with on the outpatient therapist.

My last two hospitalizations I tried to get as much as I could out of them. I knew I was still suicidal and might be for some time. I have been suicidal for nearly forty years. It is a tough habit to break. That is why I want to talk about it in therapy. Being the wrong gender for so long really was painful. It took me a few years to even say the word without breaking down and crying. It didn’t relieve me of my suicidal thoughts though.

I remember I was first suicidal when I was just eight years old. I didn’t tell anyone but it felt like the right thing for me. At that age, I had all or nothing thinking and thought that if I couldn’t be a boy, then I should die. There were hardly any gender clinics in the 80s and I think there was just one doctor at the Children’s Hospital that did gender affirming care. I grew older and my suicidality got worse. I became a planner. I would set dates. I truly had a suicidal mind when it was active. The blinders would go on and that was all that I could see was my death. I still get that way sometimes. It just made sense at the time for me that it was the thing to do. I had planned my death right before my tenth birthday. I wanted to kill myself on my birthday. But my mother was throwing me this big party and as my birthday is near Christmas, I wanted to see what presents I got. I never acted on my feelings until a few months later when I got into an argument with my mother over something. I had talked about being suicidal to my childhood best friend. He wanted me to get help but I felt like I was crazy if I did. I didn’t get help until I was fifteen, after I made some scratches on my wrist in an attempt to end it. But there was more than just being in the wrong body that was causing me to be suicidal at the time. I had a lot of trauma in my family to process and most of it went unprocessed as the therapist was more interested in trying to stop me from cutting.

My suicidality, body image, and being transgender are all tied together. For years, I hated myself because I wasn’t my true self. I know the past couple of years, my suicidality took a life on its own. I think that was partly due to the misgendering and use of my deadname at home. I felt like I was still a girl in my mother’s eyes no matter how much facial hair I had. Being me was difficult and now that I have had top surgery and am my true self where my mind and body are congruent, is still tough. I don’t have bottom dysphoria, thank god. I can never have a prostate gland to make my penis work the way a cis man does. But then, I have never really liked the thought of having one.

I tried conveying to my therapist about how intertwined the suicidality and being trans is but I don’t think she got it. I have been wanting to be dead a long time now and even though I might not have a suicidal mind now, I still feel suicide is an option for me. The trouble is, the past four years so I have no filter between being suicidal and being safe. I used to plan dates. Now I don’t. I just act on my feelings and that is dangerous according to my therapist. I’ve felt like I have put it off so many times that I might as well act on it. I’ve always held on to Dr. Paul Quinnett’s thinking of giving yourself time between the actions and thoughts. Suicidal thoughts and feelings can happen in a matter of minutes and sometimes, depending on method, acting can be fatal. But giving yourself space between the action and thoughts gives you time to think on the matter. I’ve always give myself a few weeks time, sometimes, a month or more, when planning my death. Then when the date came, if I didn’t feel like acting on it, I didn’t have to. And most times, the feelings had passed and so did my thoughts to act. Sometimes I was in a better place mentally. I might still be depressed but not enough to want to end my life. I honestly wonder if I will ever not be suicidal while being my true self.

I have talked about my suicidality openly on social media and throughout my blog. Sometimes it triggered a well visit from police which I didn’t like. I had gone through some dissociative periods where I would write the most suicidal things and then wake up the next morning, wondering if it was a dream. Often I would send an email to my then psychiatrist, who would call me in the morning and I often had no idea what she was talking about until I read the sent message. I often felt alone late at night with my feelings and would text or email my psych team about them so I would feel less alone. This just created worry and sometimes hospitalization, or at least a trip to the ED. I am thankful that period of my suicidality has passed. My ideation is often triggered by any distress, real or imagined, and often goes to the planning stage. I no longer have a filter between my thoughts and planning. Usually there is some space between them as it takes a while to come up with a plan. For right now, I know what my method is so I just go right to planning when I feel suicidal. I will pick a date and then when that day comes, if I am feeling suicidal, I will act but most times I don’t. I have been working with my therapist about trying to put some kind of buffer between thought and planning as it has become an almost “automatic” thought. And planning usually calms me down as it gives me an option for my distress. I am trying to come up with another plan when my planning is active. It hasn’t been easy. I am thankful I can be frank with my therapist when I am suicidal and not be automatically hospitalized for my thinking/ideation. It is still a fear of mine when talking about this stuff but I try to inform her as much as I can. I was taught nearly thirty years ago to keep the thoughts to myself. I was hospitalized at the time and my stay was becoming long. I basically had to keep the thoughts to myself or there was no hope of leaving the hospital. This was still before DBT and CBT were the main forms of keeping suicidal ideation at bay. Today there is brief CBT that was formulated by researcher/clinician Dr. Craig Bryan. DBT (dialectical behavior therapy) was created by Dr. Marsha Linehan. Both of these therapies along with CAMS (collaborating, assessing, and managing of suicide) has been studied extensively to combat suicidal ideation. I love CAMS as it speaks to me and I feel really helps me focus on why I am suicidal. It is based on the works of the father of suicidology, Dr. Edwin Shneidman as well as other researchers. CAMS is easy to administer and rate within a session. And because it is collaborative, the client/patient has a say in what their treatment is. That is the focus of CAMS, it takes the client as expert rather than the therapist. This is often lacking in the mental health field. There is such a paternalistic approach to suicidal behavior. It makes it difficult to talk about and there is always the fear of suicidal people being labeled as “crazy”.

I believe Dr. Shneidman was correct in saying that suicidal ideation is due to psychache, the psychological pain of the mind. His book, The Suicidal Mind, resonated with me deeply. He talked about constriction of the mind where there are blinders and the suicidal person can only see suicide as an option. He also talks about things called lethality, perturbation, and press. He formulated a suicide cubic model of perturbation, press, and psychache that I find useful in gaging my own suicidal thoughts and where I am in whether I need crisis management or just an extra therapy session. I felt like Dr, Shneidman was on the mark. I am glad that CAMS took into account his work and includes a measurement of psychological pain. As Dr. Shneidman has stated, no psychache, no suicide.