I hate what my life has become. I don’t shower regularly. I don’t brush my teeth every day like I am supposed to. I just hate being this glob of a person. I miss working though I can’t anymore because it hurts too much physically. Plus it was causing me to have severe suicidal thoughts every day, sometimes every hour. But it at least provided distraction from being miserable. I have tried to do what is right but I just don’t care any more. I have given up trying to live a life. I don’t go out anymore unless I have to. I barely make it to my psychiatrist’s appointments. I have a hard time waking up in the morning. And though it’s easier to get it out of the way in the morning, it sometimes sucks because I will have nothing else to do for the day. I write about my miserable life in hoping that someone will take solace in knowing they are not alone in what they are feeling but I feel alone because I no longer have people contact. I know I should probably join a group therapy group or something to get me out of the house but I just can’t think of it and I do nothing. I try and read but my attention span is just not there. I try and play my Facebook games but they bore me now and frustrate me. I should probably clean my room but I have no energy to get out of bed. I keep my laptop on my bed at all times because I need its accessibility for my thoughts. I journal pages and pages of things that run through my head of a day of nothingness. It really sucks being disabled.
Category: psychache
today’s therapy session
Like every Tuesday afternoon, I had therapy with a crazy therapist. Today she really annoyed the crap out of me because she wanted to know what was inhibiting me from seeking help. I had asked her why I was in therapy. I don’t feel like I need therapy anymore yet I am chronically suicidal and depressed at times. I constantly think of ending my life. I don’t know why I asked her this. It started a fight as she got into one of her raves and it killed me hearing her listing all the reasons I need therapy. Made me sound like a big psycho. I just feel like I am wasting her time. I feel like I am a worthless loser who just is never going to get better.
I told her I told my sister I wanted to be Mike. I thought she was going to have a breakdown. She got so happy and said that I am making progress. But then I told her the downfall of it. I overdosed most of the weekend to escape from the pain I was feeling and I don’t mean the chronic physical pain I normally deal with. I was just overwhelmed with everything I didn’t want to face the world. SO I didn’t. I drugged myself to oblivion. I honestly don’t remember much about this past weekend. I know I wrote four blogs in one day. I don’t even remember what they were about. I totally checked out in my own way. I think I dissociated. It was the most painful experience I ever had and the weird part of it all was that my sister was accepting of it. She was ok with me being Mike but she told me the unpleasant side of things with my mother and my other sister and that I just couldn’t face. That was what I felt so painful. I just wanted to check out. I couldn’t stand myself for saying something. I was completely mentally exhausted from the conversation with my sister. I couldn’t and still can’t really do much of anything but stare out into space. Not working doesn’t help. I have no place I can go to get away from my feelings or from myself. I no longer have the luxury of losing myself in a pile of samples. SO I did some self harming. I checked out by taking a bunch of pills to deal with the pain of coming out as a transgender.
I told my therapist all this. She was happy but not really that I had checked out most of the weekend. But I didn’t cut like I had wanted to. I knew that if I did there would be no stopping me. I wouldn’t stop. It would be like cocaine, once I started I wouldn’t be able to stop. I would need to cut more and more to get the feeling of nothing. Those that cut know what I am talking about.
The end of the session my therapist got tearful and I’m not sure why. I think she was happy I was progressing along with the transgender stuff but I am not sure. I know two months ago I wouldn’t even think about it. But seeing as I set a date on killing myself, I want to see how far along I can go with this transgender transitioning. If I can progress toward it maybe I won’t have to kill myself, but that is no guarantee that I will not kill myself sooner. I still have thoughts and urges of hanging myself. I hope that I don’t but you never know.
coping skills not working
I have been depressed for the past few days and my coping skills are not working. Because of this I thought about cutting my wrist but instead I mixed my meds up a bit and slept. I guess you can say that I was a drunk because all I did in the morning was stumble around.
I didn’t plan on doing this I just couldn’t cope with the pain of living anymore. I needed an escape and I needed it badly. I know I could have called my psychiatrist or therapist but most likely they would have said go to the ER. The ER is useless. You wait for hours to be seen because more urgent cases take precedent and because you are not actively doing anything to harm yourself you just are forced to sit and wait. Then when you get put into a room you are searched, made to give a urine sample and might have blood drawn if they think you need to be admitted. Or you might have blood drawn anyways if you overdosed like I did last night. I couldn’t help it. I wanted to cut really bad and I knew that if I did and I needed stitched I would be screwed. Least with OD’g you don’t leave scars. I didn’t OD with the plan to kill myself. I just wanted an escape for a few hours as things have been shitty the past few days. I told my sister that I wanted to be a man. She asked if me if I was sure. I started to break down. Obviously I wasn’t that obvious to my family. I was just a tomboy that never grew out of it. Except tomboys don’t usually wear men’s clothes all the time. This has been the most difficult conversation that I have had in a long time, since I came out as being gay. I refuse to use the word lesbian because I am a male not a female.
I want to be able to tell my family this year because I will be going to a clinic soon as I get the guts to call to make an appointment. I don’t want to start the hormones and then questioning me why I have facial hair. I have a little facial hair now but it’s kind of stupid looking because there is a space in the middle of it.
I just want to be myself. I don’t want to hurt anyone. The only person getting hurt is me because I can’t be who I am. That is why I want to cut, want to OD, want to kill myself. Though I still feel like it would be better to bury me as their “daughter” than as their “son”. My parents are of the old generation. They don’t understand things of today. Much less gender identity disorder or being transgender. Right now I guess you can say that I am just a crossdresser except my damn boobs get in the way of that. How I loathe my boobs. It is one part that I hate the most. I want to look at my chest and see nothing but my pectoral muscles, not breast material.
The biggest question so far that I have had since coming out as transgender is when am I going to have surgery. Are you kidding me? Let me get used to being freely who I am first!! Let me try the hormones first and see how they work. I hate to think of surgery before hormone replacement and most surgeons won’t do it unless you truly have been living as the opposite sex for some time. It is not an easy thing to go through. And mentally it messes with you big time.
I know this road I have been on is the right now. My sister was worried that it is going to mess with my depression. What she doesn’t realize is that part of my depression is not being who I truly am.
Ten Faces
April 2008 Poster for the 41st Annual American Association of Suicidology conference
Abstract: I have written this paper to talk about my experience with suicide and how the works of Dr. Shneidman has helped me to find the words to the dark demons that are below the surface. This paper also talks about how I think more clinicians need to focus on the psychological pain their clients feel when suicide begins to look like the only answer to their problem. I hope that by sharing my experiences and introduce the works of David Jobes that there are assessments that are out there even if they do not fit the category of validity.
Presentation:
I began my research into suicide and psychache in the spring of 2006 while taking a psychological testing class. My assigned term paper topic was psychometric assessments or psychological tests which interested me. I chose the subject of suicide assessment/risk because of my past experiences; I had barely survived another severe episode of depression the previous winter. Despite my clouded thinking, I had carefully planned my own death. Researching this paper would reveal what the so-called experts knew about these destructive, echoing thoughts I’d suffered from and what kind of assessments and/or treatments my therapist could potentially offer me during these terrible bouts.
What I found astonished me. Despite finding over thirty articles about assessments and risk factors, not one focused on assessment of psychological pain, or, as Dr. Edwin Shneidman refers to it, psychache. In an article by Ramsay and Newman (2005) states that most mental health providers have little standardized training in treating suicidal patients during clinical graduate work, and, are equally lacking during continuing education. I also found, not surprisingly, that some clinicians, once they realize their client is or has been suicidal, opt to transfer care to another professional, especially after a suicide attempt (Ramsay & Newman, 2005). In another article by O’Carroll et al.(1996), I was dismayed to read that there is no standard definition of what it means to be suicidal.
But the intent of this paper is not to review the literature of the past twenty-years. This paper is to talk about what Dr. Shneidman calls the “human stuffy of emotions, the words of a suicidal person” (1996, p. 6). It is to focus on the three P’s of suicide: “perturbation, press, and psychache”.
In 2004, my illness permitted me a break in the gloom; I gained some insight into my suicidal thoughts. I imagined writing a book about my experiences, hoping it would help someone. Alas, that book was already written, and was entitled The Suicidal Mind by Dr. Edwin Shneidman (1996). Finding this book made me feel discouraged. My therapist encouraged me to write my book based on
personal experience rather than from a clinical perspective. I didn’t go back to Dr. Shneidman’s book or work until a year and a half later, when I was taking that psych testing class.
The terms psychache, constriction, perturbation, and press are vital components of suicidal thinking. The cubic model Shneidman(1995) writes about is the best indication, in my opinion, of how likely someone might commit suicide. When pain, perturbation, and press, the three P’s, are at their highest level, individuals are much more likely to feel trapped. Thus they feel there is no way out. Suicide then becomes the answer they seek to end their pain and their life.
Although I heartily agree that assessments of the lethality of suicidal ideation are important, the one element that has been frequently overlooked is the psychological pain that the individual is feeling. What I have learned is that there needs to be an assessment of psychological pain whenever a client is feeling suicidal or having suicidal thoughts. A good analogy is the following: Think of a time when you had to go to the emergency room because of a physical ache, maybe abdominal pain or a severe headache. One of the tools the clinician might use is a scale to rate your physical pain from 1-10 with 10 being severe. Some emergency rooms have drawings of ten faces with varying expressions of discomfort that children and non-English speaking patients can utilize to evaluate their pain. No such scale exists
in the psych world. Even most psychiatric emergency services at major hospitals do not ask about mental pain. That is what I find so striking about Dr. Shneidman. By asking, “Where do you hurt”, the three P’s of suicide, perturbation, press, and mental pain can be assessed and taken into account of how likely a suicide attempt might occur.
Current research studies by Holden et al. (Flamenbaum & Holden, 2007; Holden, Mehta, Cunningham, & McLeod, 2001) at Queen’s University in Ontario are validating a pain scale that I think is efficacious, especially in times of crisis, and possibly life saving. From my experience of those darkest moments, there are no words for the depth of pain that I feel. Holden and Mehta’s scale (2001)can help communicate how much pain the client is feeling. This scale is essentially a self-report of psychache, enabling the clinician to quantify psychological pain. It can also determine whether that pain is the driving force for a potential suicide attempt. This scale is, in my opinion, the best measure to pinpoint all three aspects of perturbation, pain, and press. As Dr. Shneidman points out, the best source of understanding suicide is through the “words of the suicidal person” (1996, p. 6).
Once the level of pain has been determined, assessment can be tracked through the work of David Jobes described in his latest book, Managing Suicidal Risk (2006). He uses the continuum of
initial interpretation, tracking, and outcome to manage a suicidal client. These forms are called the Suicide Status Form (SSF). These forms have gone through the process of refining to become efficient and use of ease in managing suicidality (Jobes, 1995, 2006; Jobes & Drozd, 2004; Jobes et al., 2004). He stresses that he will do all he can to prevent his client from fulfilling their plan, and he offers the client a more positive way of dealing with these thoughts. Through his work, he facilitates the client managing his or her own treatment, collaborating on what will effectively decrease suicidal thoughts and impulses.
I hope that someday these tools become more widely available to those that want to help the suicidal clients, even if they have not been empirically tested. As Dr. Shneidman once said, “relevance has precedence over precision, and that ‘validity’ does not exhaust the category of ‘usefulness’”(1999, p. 287).
References:
Flamenbaum, R., & Holden, R. R. (2007). Psychache as a Mediator in the Relationship Between Perfectionism and Suicidality. Journal of Counseling Psychology, 54(1), 51-61.
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.
Jobes, D. A., Nelson, K. N., Peterson, E. M., Pentiuc, D., Downing, V., Francini, K., et al. (2004). Describing suicidality: An investigation of qualitative SSF responses. Suicide and Life-Threatening Behavior, 34(2), 99-112.
O’Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996). Beyond the Tower of Babel: A Nomenclature for Suicidology. Suicide and Life-Threatening Behavior, 26(3), 237-252.
Ramsay, J. R., & Newman, C. F. (2005). After the Attempt: Maintaining the Therapeutic Alliance Following a Patient’s Suicide Attempt. Suicide and Life-Threatening Behavior, 35(4), 413-424.
Shneidman, E. S. (1995). Suicide as Psychache: A Clinical Approach to Self-Destructive Behavior: Rowman & Littlefield Publishers, Inc.
Shneidman, E. S. (1996). The Suicidal Mind: Oxford University Press.
Shneidman, E. S. (1999). The Psychological Pain Assessment Scale. Suicide and Life-Threatening Behavior, 29(4), 287-294.
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