Category: suicide

moments 2

by Midnight Demon, posted in blogging, suicide, transgender

Moments

There have been many moments where I find myself thinking about suicide and moments where I wanted to act upon them very badly. Right now is one of those moments. I am suffering under a heavy coat of depression caused by physical pain and now mental pain because my body has gone back into female mode and I have my menses again. I wish I could say that I like it but I don’t. It kills me when I get it. I just feel so empty and despairing and there is no one I can talk to about it. I know I should seriously just end my life and leave people wondering why because that will be easier than trying to tell them I killed myself because I am in the wrong body. Even though I have tried to explain myself to a couple of people I still get called the “proper” pronoun and gender pronoun given this biological body. I must be crazy thinking that I am a male. And it hurts. I am hurting because I cannot get away from my menses. They can put a man on the moon yet they cannot stop this hurt. WTF. I was hoping it was just spotting but the true colors came out as I went to the bathroom just a few minutes ago. Just lovely. Here I am trying to finish my book and now I got to deal with this? I really just want to die. It’s bad enough that I have pain, physical pain that is so putting me over the top. But no one believes me when I tell them I want to be a male. My psychiatrist that I have known forever still calls me a “her”. I don’t tell her it bothers me because I am afraid that I will break down. I have never stood up for myself. Even when my father called me “his daughter”, I wanted to scream at him that I was really his son. I took a lot of meds tonight to deal with my pain, this was before my little trip to the bathroom. I am starting to feel the effects of the pain meds and muscle relaxers. Moments like these I wish I took too much. But I can’t risk having my mother or sister find my body in that state. It would devastate them to no end. Not like my death won’t do that to them anyways, but it’s better to remember me some other way. I am a transgender and that is why I want to die. I don’t think anyone can help me with this. I am too far gone. I am too far developed. But if only my menses could be stopped permanently would I not think about suicide all the time. Meds are kicking in really fast so I will end here. And unfortunately, I know that I will wake up tomorrow. That is truly a pity. I don’t want to wake up tomorrow or any other day. My life revolves around stuff that I don’t want it to be. Now I have to keep track of the bleeding and when it started and I just don’t want to. I just want to die. I just don’t want to exist anymore. Why is that so hard for anyone to understand that I would be better off dead. My psychiatrist would want me to call her right now but it’s 1 o’clock in the morning and I don’t want to bother her with my mundane argument. We have had these go rounds before and they usually, almost always, result in me going to the hospital for more mundane treatment. Moments like this, I wish there was a switch that could just end my life. And poof I will be gone…

dark clouds circling upon me

by Midnight Demon, posted in blogging, psychache, suicide

I just got finished reading some more of Touched with Fire. I keep reading this book and wondering, is this me? Because the descriptions of the melancholy and the mixed states could be more like me than I have been letting on. I am not saying I need to be on more medication or anything but wow, I never thought I was truly bipolar until I read this book again.

I came across my favorite quote from Tolstoy, “I myself did not know what I wanted. I was afraid of life, I struggled to get rid of it, and yet I hoped for something from it”. I think that is going to be the first line of my book, if I can get it approved. I don’t know how to do that but I will figure it out.

Funny how I wrote a hopeful blog about seeing my future and now all I see are dark clouds circling me. I am tired. I am in pain. My foot is hurting me as if there is no tomorrow. I have taken my meds but they have not kicked in quite yet. I want to end my life because I just cannot go on this way. This heaviness in my chest must cease if I am to survive. I am sure that if I see my doctor he will tell me that I must lose weight. But it is not a visible weight that you can see that is on me. It is to the left of my sternum, under my ribs that I feel this pressure just above my heart. It stifles my lungs. I have to force air in and out to keep myself breathing otherwise I fear I will stop and suffocation is no way to die. It is a painful way to die. I don’t know when the heaviness began. It seems to have reared its ugly head when I was reading about my melancholy and my mixed states. Now I am flooded with emotion that no one else can feel. It is a powerful feeling to write when you feel you are dying. Maybe I have another diagnosis called hypochondria. But this weight is too much to bear. It bored down on you like a heaviness you just cannot explain. Its tightness wraps around your heart and tries to squish it. My whole left side feels weak. I am too tired to fight it. If it is going to kill me, let it be quickly. But maybe the heaviness is trying to stifle the thousand wounds that have been inflicted upon my heart. Either way it is very unbearable and despairing and frightening. I know it is not a sign of a heart attack because I would not be so lucky to die of that. I am not sweaty. I am not short of breath. I just have a 100 pound weight on my chest that no one can see. And I am afraid should it be long continued it will kill me.

thinking of my future is so not me

by Midnight Demon, posted in blogging, chronic physical pain, depression, mood disorders, psychache, suicide, suicide attempt

You know, I never really thought ahead with time before. I found that if I did it overwhelmed me too much so I always stuck with today or the hour or sometimes the minute because I had to. But now with this book that is turning into my baby, I am finding myself looking forward to the future more. Totally a weird sensation. I am not saying this makes me less depressed. It makes me a little less suicidal or have suicidal thoughts that float more rather than linger.

Today I have been in a weird space. I had a good session with my therapist and for some reason it put me in a good mood. Now I am wondering if I am hypomanic because I am in a good mood and have been up since 5. Things with the hypomania can spiral out of control quickly so if I am not my usual pessimistic self I tend to worry.

My writing friend said that I should write about this weird sensation but I am finding it difficult to because it is so not like me to think about the future. Usually my future is pitch black. I don’t have one. I know everyone does, but for a LONG time I just didn’t. Thinking about the future brought worry and anxiety. I had to get through today first and that was always difficult enough so I stopped thinking about future things. I still think that I can get my degree and my doctorate and be the therapist that I want to be. I know that I don’t want to be old and gray though, too. I have Alzheimer’s on both sides of my family so I know there is a good chance that I might get it. I already am having trouble with memory. I often write things and I forget that I write them. I don’t know if it is the dark side or just another part of me that was in the moment and I had these ideas. I am sure when I look back on this post, I am going to be like WTF, I wrote this?? That is so unlike me! And it is and that is what is weird.

My friend also thought that I don’t reward myself because of my suicidality. I have been suicidal for so long that I don’t think I can look past a month at a time without fearing losing my life. It’s like I am a Klingon and wake up every morning asking is this the day I am going to die? People don’t understand this. I know my family would be watching me like a hawk if they had any clue just how suicidal I have been the past few months. And the past two days I have felt like I have been in an alternate reality or something because thinking of my future is so not me. But this book that I am writing and sort of slaving over has given me a different perspective. I want to see this book published. I want to see this book successful. If I sell 100 copies, I will be happy, least for a little while. But I didn’t go on disability to be a successful writer. The bad stuff is still under the surface. I was re-reading “Touched with Fire” and came across a quote from Hugo Wolf “I appear at times merry and in good heart, talk too, before others quite reasonably and it looks as if I felt, too. God knows how well within my skin, yet the soul maintains its deathly sleep and the heart bleeds from a thousand wounds”. This is so true of me. I appear to be merry, cheerful, happy to the outside world but inside I am tormented and my heart bleeds. Nothing can stop the bleeding. I thought that working on this book would help the ache, and it has to some degree but it is still there. I might not be feeling it 100% of the time, all the time, but it is still there. I can’t deny it anymore than I can deny my foot pain that also is my nemesis. I am my own worst enemy. But today I can say that I am more a friend.

commitment to living

by Midnight Demon, posted in depression, mood disorders, suicide, suicide attempt

Seeing as I have been suicidal the past few weeks, sometimes intensely, other times not so much, I thought I would talk about the dreaded “no suicide contract”. In an article by Rudd, Mandrusiak, and Joiner (2008), the authors describe that there is no empirical data that proves a contract is a deterrent to suicide anymore than say pinky swearing (my words not the authors). In these times where suicide rates are going up rather than down, it is important to have something in place so that the therapist and client feels comfortable sharing the suicidal feelings without always resorting to hospitalization. The authors in this article promote a “commitment to living statement” as way to facilitate 1) identifying roles, obligations, and expectations of both clinician and client, 2) communicate openly and honestly about all aspects of treatment including talk of suicide, and 3) identify emergency services usage when client cannot contain the agreement.

This agreement seems to me as a good way to start any conversation of suicide but it also feels like it is an informal consent contract. It doesn’t really focus on a suicidal behavior tracking plan like the Suicide Status Form. All it does is explicitly states that the client make a commitment to living.

I was reading this because I thought it was a unique contract but now I am thinking that it is not. It does however, give the clinician and client a time focused treatment plan that I think all therapists should have with their clients so that if something is not working, it can be changed so it does work. In my experience, I think that this would be helpful for my therapy but I think it might be too late for that as we are no longer seeing one another face to face and this contract requires a handwritten statement to be made.

My therapist and I have reached another impasse and I think sometimes that having a break is beneficial. It gives me time to think things over. I also think that if I had the inclination, I would bring this article up again with her and see what she thinks of it to help my suicidal tendencies. But I am not sure about the whole commitment to living aspect of it. It does seem to me that something needs to give and she needs a piece of mind that doesn’t include me telling her I want to kill myself every week. The biggest thing on the commitment statement is that it allows for goals to be set. In my twelve or so years of being with the same therapist, I don’t think we ever have set one goal in treatment. Usually I was the one to come up with a treatment plan on how I wanted to be treated. That was fine until I ran out of gas and ideas. But what would setting a goal after all this time be like? I don’t know as I have not really thought about it. My therapist doesn’t give me homework, other than possibly blogging about something she has in mind for me to work on. We generally have an unspoken agreement that I will call her should I think about acting on my thoughts to harm myself. The most I have done is text her, a lot, to let her know I am having a hard time with my thoughts. Usually this happens during the long weekend when either she is away or when we have a long few days between sessions due to the weekend or holidays. I try not to text her so much but she seems to like me keeping her in the loop so I do it to sort of please her. Plus it tells her that I am still alive so that eases her anxiety a little.

An example of the Commitment to Treatment Statement is the following:

I, ________, agree to make a commitment to the treatment process. I understand that this means that I have agreed to be actively involved in all aspects of treatment including:
1) Attending sessions (or letting my therapist know when I can’t make it
2) Setting goals
3) Voicing my opinions, thoughts, and feelings honestly and openly with my therapist, whether positive or negative but most importantly my negative feelings
4) Being actively involved during sessions
5) Completing homework assignments
6) Taking medications as prescribed
7) Experimenting with new behaviors and new ways of doing things
8) Implementing my crisis response plan when needed
I also understand and acknowledge that, to a large degree, a successful treatment outcome depends on the amount of energy and effort I make. If I feel like treatment is not working, I agree to discuss this with my therapist and attempt to come to a common understanding as to what the problems are and identify potential solutions. In short, I agree to make a commitment to living. This will apply for the next ____ months at which time it will be reviewed and modified.
Signed_____
Date_____
Witness____

To me, as I have said before, this looks more like a basic agreement contract to therapy than it does for specifically suicidal thinking/behavior. The reason I bring it up is because most clinical therapist do not have such specific language in their agreement and I think it is important to work together in treatment. A client should always have a say in treatment, no matter if it is in psychotherapy or medicine. With a little modification of the wording, this statement can be used in any clinical scenario. It is basic and to the point. Clients should be active in the care but sometimes that is just not possible. I mean if you have a throat infection, you are not going to argue with your doctor about treatment. You will want the antibiotics so that the infection doesn’t spread and you get sicker (if it is a bacterial infection to begin with). But it gets trickier with something complex as say diabetes. This blog doesn’t deal with that so I won’t say anything further about it. Just know that you should always advocate for your say in treatment and ask questions about why you are being placed on medication or physical therapy or whatever your doctor prescribes.

Basically, I have to agree that this commitment to treatment statement (CTS) is better than a “no suicide” contract because it (CTS) allows open discussion and collaboration of treatment whereas the no suicide contract will just state that the client will not kill him/herself.

The second part of the CTS agreement is the Crisis response plan (CRP). It states:

When thinking about suicide, I agree to do the following:

Step 1: Try to identify my thoughts and specifically what’s upsetting me
Step 2: Write out and review more reasonable responses to my suicidal thoughts
Step 3: Do things that help you feel better for at least 30 mins (examples can include, trying to sleep, play internet games, brush hair 100 times, write in a journal, listen to music, etc)
Step 4: Repeat all of the above
Step 5: if thoughts continue, get specific and I find myself preparing to do something, I will call XXX @ 555-555-5555 or suicide hotline
Step 6: if I cannot reach above I will call my therapist or psychiatrist
Step 7: if I am still feeling suicidal and I don’t feel like I can control my behavior, I go to the ER or call 911 (or whatever the local emergency line is for your country).

Either plan is effective even though neither have been empirically tested. The CRP I have used in my treatment and I have found it useful. During one of my recent hospital stays, I actually gave out the CRP to other patients hoping they would benefit from its usefulness.