Category: suicidality

An Open Discussion About Suicidal Thoughts and Chronic Pain

by Midnight Demon, posted in Bipolar Disorder, blogging, Chronic pain, chronic physical pain, depression, mental disorders, mental illness, mood disorders, psychache, psychosis, suicidality, suicide, suicide attempt

An Open Discussion About Suicidal Thoughts and Chronic Pain

For the past twenty-four hours, I have been in a suicidal quandary. Last night I was in severe pain for the umpteenth time in a row. I had wanted to go to sleep but my ankle said, nope, not yet. I got really angry because I so wanted to sleep. It was past midnight. I had finished watching the ball game. I had winded down. I was ready for sleep. But pain said no and because it was the third or fourth night in a row that this happened, I was fed up. I wanted to kill myself. I felt there was no other way to escape.

My pain is well managed. All I had to do was take two pills to quiet the pain down and then drift off to sleep. I took the pills and waited for the throbbing to stop. Within an hour, it did but my brain didn’t. I was still pissed and suicidal that I just wanted to give up. I went over the plan I had been thinking about the past few months, wondering if it would work or not. A doctor friend told me it would be painful but I knew that. I also know that it would be at least 2-6 hours for the pills to work. That is a lot of time.

My friend understands about the chronic pain that I have because she also suffers from it as well. Unfortunately, she doesn’t have adequate pain meds like I do. I am not planning on ending my life with my pain meds. Far from it. If the area that I wanted to hang myself wasn’t fenced off, I would go there and do the deed. But it’s fenced off and I am not a good climber.

It doesn’t matter what kind of pain you are in, physical or mental. It still makes you want to end your life. Unfortunately, I have both so I am in a pickle. I have the raw end of the deal. I write about my suffering because I hope that it will help someone. I am not feeling hopeless. Just disgusted that I have to rely on pills every single day to give me relief from my pain, either it be my pain meds or my psych meds. Recently, I have been psychotic and that opened up a big kettle of worms. I thought I would have to go back to the hospital but my mother became sick and needed care so I couldn’t go. I had to be treated as an outpatient and take my care more seriously because my mother needed me.

I know the devastation I will bring to my family should I die, not only my family but to those around me. I talk about taking my life on this blog a lot because it helps to write about it. Doesn’t make me feel less suicidal but it helps with the feelings of not being able to do anything about it. Last night I was close to killing myself and if I had a clear plan, I probably wouldn’t be writing this right now. I don’t know if another hospitalization is in my future. I have grown hopeless about that kind of treatment because there is no treatment in the hospital anymore. The mental health professionals and insurance companies just think that a few days in a locked ward is enough to reset your thinking and make you think you have a life worth living. It’s a big crock. For some it is helpful but for those with chronic illness like me, unless you get treatment, actual therapy, it is just a waste of time.

I am not saying I have the answers to the mental health system because it is different in every state, and that is not the purpose of this blog post. But talking about suicide is similar to everyone who experiences it. People are literally dying because they don’t want to be in pain anymore. They don’t want the stigma that means having to take a pill to control that pain is causing them. Sometimes the stigma is greater than the treatment of the pain. Every day I wonder if I am an addict and will my meds be taken away from me because my pain is controlled with meds. I know that if any doctor takes these pain meds away from me, they might as well be signing my death certificate.

You can say that I can’t have it both ways but I am so tired of not having a life because of pain. I can’t walk like I used to. Just walking a few blocks brings me horrible pain. Last night I washed dishes and I think that is what set off my ankle pain. For the ten minutes it took me to wash four dishes and two cups. I can’t drive long distances because my ankle will act up on me. I never know what sets off my pain. And the docs aren’t sure what is causing my pain. Some kind of pain syndrome but they are not sure what. My quality of life sucks because I can’t go to family functions and things because my pain limits me. I test the boundaries every day and I am rewarded with pain. Then add mental illness on top of that and it’s not a pretty picture. Sure I was depressed and suicidal BEFORE I had chronic pain. But I also was able to hold down two jobs that I somewhat enjoyed.

I am not trying to boo-hoo my life. I just hate the way I live and I just don’t want to live anymore. It’s too painful, both physically and mentally.

Major shopping done and the suicidality from last night

by Midnight Demon, posted in Bipolar Disorder, blogging, Chronic pain, chronic physical pain, mental disorders, mental illness, mood disorders, physical pain, psychache, psychosis, suicidality, suicide

Major shopping done and the suicidality from last night

I got my monthly groceries today. I just finished putting everything away that needed to be put away. The breads I left out for my mother to deal with as the refrigerator needs some shuffling. I am not good at that. I am disappointed they didn’t have my hot dogs and one of the 12 pks I ordered, they decided to give me two 2L bottles. I rather they just give me a credit. I should have sent them back with the guy. But oh well. I have my diet soda that I drink. It’ll come in handy on these hot days.

I must have spent 15 minutes shopping at Walmart and walked out with $66 worth of clothes. It was all the shorts that I needed for the summer as I was wearing out the jean shorts I kept on wearing. I figure it will last me three years at least. That was the last time I went clothes shopping. I hate shopping for clothes. If something doesn’t catch my eye right away, I don’t get it. There were clothes I wanted to get but they didn’t have my size. I was disappointed.

After shopping at Walmart, I went to my therapy appointment. We talked about last night. I am glad that I didn’t email my psychiatrist at like 2 am. I know I would have received a phone call this morning if I did. I was not in good space. My ankle is starting to throb but it was nothing like last night. I still feel like I should be dead. I told my therapist I had every intention to cancel our appointments for next week but she wouldn’t have one word of it. I also told her I felt like texting her but I didn’t feel like it because I knew we would end up talking about it. She told me I could text her any time, day or night. That is good and all but it sucks when you don’t get a response back. I didn’t tell her this.

Our conversation was all over the place. Whenever there was a break, she brought us back to the suicidality. She wanted to know more about it. I really don’t remember much, though I still remember feeling suicidal. I think if I had a solid plan, I probably would have executed it today, regardless of the consequences. I woke up really groggy as I didn’t go to sleep till well after 0200. I did text my therapist around 0211 so I was still up at that time. I just said I was in a “dangerous mood”. I really didn’t want to get up but I couldn’t forfeit the Zipcar. It was well past the time I could cancel it so I forced myself up. I was so sleepy that I didn’t even get myself coffee before leaving Boston. I was half way to my therapist’s location when I realized I didn’t get coffee as I was getting sleepy on the road. I am so glad there is a Starbucks near her office that I always go to. I also got something to eat as I was getting hungry.

I should probably email my psychiatrist and let her know what happened last night and that I am still feeling suicidal. It was very difficult NOT to do something last night as I just was fed up with being in pain all the time, night after night after night. I wish it was close to 2000 so I could take my meds and go to bed. I am so fricken tired. I tried taking a nap before the groceries got here but some idiot from South Carolina called me and woke me up. It was a sign because it was close to when my delivery was scheduled to be delivered. So I never got my nap. I so could use a coffee but I don’t want to fuck up my sleep further.

There was hardly any traffic on the way home, thank goodness. I had enough time to make a run to my house to drop off my shopping bags and then return the car. I am glad I have a location near my house that is within walking distance. There is another location near me but it’s up a hill and I don’t do hills. If I could, I wouldn’t be disabled. My ankle already didn’t like the walk back home but I took my pain meds to quiet it down.

This is why I don’t understand why I got so suicidal last night. It’s not like I don’t have meds for my pain. I do and they work, though taking them before the pain is bad has always been a challenge. I could just take them and within minutes my pain can climb or it could be two hours after I take the meds and then my pain shoots up. There is no rhyme or reason to what brings me pain. The slightest movement seems to make it explode and for some reason, it hurts threefold when I lay down versus when I am sitting up. But I can’t sleep while sitting. It hurts my back and neck being in that position all the time. I have tried to use a pillow and sleep but I always turn over on my side and sleep, sometimes with the sitting pillow as a back support or it ends up on the floor.

I told my therapist about the anger that I was feeling last night when the pain happened to get out of control. I really wanted to punch a wall. I was so done. I have no idea what will happen tonight if my pain returns when I try and sleep. I know part of the reason is because I thought I took my pain meds but I didn’t. I usually take them either before my night meds or after but because I was watching the game last night, things kind of didn’t follow my routine. I also now realize that I was on my feet more because I washed dishes before going up to bed. That could have been why the pain was so intense last night. I did them because my mother would flip if I left them for her in the morning.

I feel really sad that I got so suicidal last night and didn’t act on my feelings even though they were really strong. I think if the voices were not controlled I probably wouldn’t have stayed safe. I don’t know what I would do as most of my medication is three feet from me and I don’t think my foot would have allowed the journey, no matter how suicidal I was. I knew things would be better in the morning (even though technically it was morning) but I couldn’t see it. I had to do something and ended up doing nothing. I feel like a failure.

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.

Quote of the Day 29 Nov 2015

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

Suicide in theory should never come as a total surprise if one knew enough about the intimate inner life over the entire course of the individual’s psychological history.–Edwin Shneidman, Definition of Suicide