Of Suicidality

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.

sad and exhausted

Sad and exhausted

I was up in the wee hours of the morning. I had slept late and wasn’t really tired. I had finished the last of the casserole. I woke up and needed coffee. I had taken my morning meds and then went back to sleep for a couple of hours. I kind of planned the day of taking a shower, brushing my teeth, delivering the books to the Transgender Program, and then to Starbucks for coffee and lunch. I also planned on reading through my manuscript to see what else needed to be written.

The shower exhausted me. I had shaved and then I brushed my teeth. By the time I was in the shower, my back was flaring up. I had just finished washing my hair when I had to sit down. Cramps flooded my back and it was quite painful. I managed to get the bar of soap before sitting down so as I sat, I washed up. Drying off I nearly slipped in the shower stall. I managed okay then got dressed. I sat on my bed to rest and hydrate for a bit. I had no idea what I was going to wear. It was cool out but not quite cool enough for jeans. I decided on a button down shirt with my shorts. I then called a cab as I put my socks and shoes on. There was no way I was going to walk to my pcp’s office. I just didn’t have enough spoons for it.

The cab came. I put everything in my backpack and got in the cab. Traffic was bad. It normally takes like twenty minutes today took more than a half hour. I am glad I didn’t have an appointment or I would have been late. I dropped of the books and then ordered my drink and something to eat. I then walked to the Starbucks. There was a table free so I sat there and ate. After I ate, I tackled my manuscript. I got to like the 25th page and the printing was bad. The toner had already started to go and I didn’t notice it. Reading what I wrote stirred up some emotions and then I read the letter I sent my mother back in 2021. I got really sad. The pages were impossible to read so I called it off and then headed to the station. I got to the Square and picked up my meds that were ready. I thought about getting another coffee but it was past 3pm and I would be up late if I did so didn’t. I was exhausted and just wanted to go home. My nephew was in one of his moods as he didn’t even say hi to me when I greeted him. Whatever.

I thought about my mother all through the ride home. I was really sad. I still am sad. I am sad because my mom died and that I have no fucking clue where to go with my book. I couldn’t read what I wrote because there was a huge gap in the page. I am going to have to reprint the pages. I have a new toner that I haven’t installed yet. I’ve been lazy about it. People think writing a book is easy until they have to do it. I didn’t have pages to guide what I wrote so things just went on and then a new idea started and I was like WTF is going on here. I want to write more but I don’t know what I already wrote. I hate reading from a screen. I like pages in my hand to get something. This book is too important to me to just gloss over. I am going to try and see if Random House will publish it. No idea what is involved in the process. But I am half way where I want to be with 62 pages. I just need about 60-70 more to write. I’ll replace the toner in my printer sometime this weekend and then print out the 40 or so pages needed so I can read the rest of what I wrote. Hopefully it won’t hit me like a ton of bricks like it did today.

In a grumpy mood

I’m in the hospital. I’ve been here since Thursday. The depression and grief were just so overwhelming that I didn’t want to live anymore. So before things progressed to a bad place, I got evaluated. Sleep has been an issue so we are working on that while I am here.

I had a difficult night sleeping. For some reason dreams hurt my head and give me severe headaches. Not fun waking up to them. My foot also flared up (CRPS) around 0530 so I had to take pain meds. Then I was pretty much up and didn’t go back to sleep. My BP and heart rate were up this morning. I’m not surprised. I have been working with a friendly LGBTQ nurse the past few days. She had to give me my T shot today and they ordered it for the glut muscle. She was good. The only thing that hurt was the pinch of the needle.

I’ve had three cups of coffee today, all caffeinated. Has not helped my headache. Hoping tylenol will. I have been using diclofenac gel for my knees and it has helped so much. I haven’t been doing stairs so still not sure if that is a problem for me. At home, stairs would hurt my knees going down. Going up, not so much. I do stairs a lot when home because my room is above the living area.

I hope to be going out today for some fresh air. One of the MHS’s will be taking me. Depending on how well she knows the hospital, I might give some history. I did the last time I went out. It was cool for me to speak about it. When I leave, I want to take some pics of the current construction so I can remember how the Bulfinch is right now. I love that building so much. It was built by my favorite architect, Charles Bulfinch. He has a place in Rockport that I really would love to see. The place is I think 1.5 miles from the commuter rail stop, which is too far for me to walk right now. I might take an Uber if I go this summer.

I went to a webinar yesterday. CAMS care hosted Dr. Thomas Joiner and his theory of Interpersonal Theory of Suicide. It was very interesting. I learned a lot and got my wheels turning. I might write about his theory in a future blog. He is coming out with a new book in Jan/Feb and I can’t wait to read it.

There is another pt here who is trans. I am glad I got to meet them. I hope we can stay friends after the hospital.

I am tired. I hope today goes OK. Also hope this fog I am in dissipates. I am going to try sumatriptan to see if it helps this headache. Could be migraine activity as it has gone on for a few days now. I just feel shitty. I went outside and it is nice out. Hot but a dry heat. Not too humid.

paper where I wrote I’ll wait for you

Paper where I wrote I’ll wait for you

I am having a hard time sleeping. I am listening to Taylor to try and ease my heavy heart. Grief is hitting me hard. I am remembering stuff with my mother, mostly stuff from when I was little. The parties we used to have where we would have leftover chips and cake. It made a good breakfast while my mother was sleeping. She didn’t want us to eat that stuff but we did anyway. My mother was the one we did stuff with. My father never really had time for us because he was so selfish and narcissistic. My mother took us to church and to school. She also came to events at the school where we participated in. She didn’t come to my basketball games when I played my freshman year. It was not a good game usually as I sucked. Plus no one really gave me the ball to shoot it. I was bad at trying to take a shot under pressure. But I could do a layup pretty well.

I also remember the abuse my mother did to me. It happened when I was little and while I was in puberty. She saw changes and kept looking at me every time I showered or bathed. Even while I was an adult, living with her, I couldn’t be naked around her because she would look at my body. I felt so much shame and I think that is why I have a little of body dysmorphia. I hate the way my body is. I don’t like that I am overweight. Now that I don’t have breasts, I can clearly see my stomach that is huge and it bothers me. I am trying to lose weight. I haven’t the first clue how to actually do it. I am not a person that can eat salads and stuff like that. I am a meat eater. I will eat chicken and potatoes. I love making a chicken breast and roasting it. But getting back to the abuse, I was always criticized when I tried to go on a diet. My mother would not approve of it and be very snarky about it. My father called me fat and ugly all my life. It was very hard to lose weight when I felt like I had to live up my father calling me fat all the time. Every time we had dinner and I would fill my plate, he would say something about it. He was not a nice man.

So I had my parents give me an idea of what my body should or shouldn’t look like. I know I need to lose weight. But I don’t know how really. I have tried drinking Ensure during the days and then at night but I feel hungry. I need to have something solid in my stomach. I will usually have a turkey sandwich or just eat turkey breast or chicken breast and that will be my protein for the day. Sometimes I will make an egg. If I get up early later today I will try and make an egg sandwich.

I love how my chest is. I am still getting used to it as I really can’t believe the breasts are gone. I love it so much. I no longer have to wear baggy shirts to hide my chest. I can’t wait for the warmer weather so I can wear tank tops without worrying about whether my boobs are gonna show.

I feel sad about my mother’s passing. I feel like there should have been more time that she could have spent with us. But I guess it wasn’t meant to be. I feel cheated because my sisters had my mother at their birthdays and I didn’t. I got a phone call while she was in the hospital. A voicemail message, actually two of them. Then I didn’t get her card until two weeks after my birthday. I got no party with her. My sisters and nieces celebrated with me at the restaurant but it was so hard without my mother there on my birthday. I am upset about it. I never said anything about it before because I thought there would be another birthday with her. I was wrong. Cancer took her before we were ready to say goodbye to her. I am angry about this. I am sad and hurt, too. I got all these feelings rolled into one. I don’t know why the cancer showed up now. I knew it would eventually. She smoked a lot and I knew she caused damage to herself. I just wanted to have one more birthday with her. Now it is never going to happen.

I don’t know if I should stay up or go back to sleep. It’s almost 5am. It is usually the time I go back to sleep. The birds are chirping away, being annoying. They are cardinals. I think one of the is my father because he would be a pain in the ass in the morning especially if you didn’t answer his call right away. I am hungry and am thinking of making an egg sandwich. Haven’t decided if I want turkey or regular bacon in it. I have maple bacon that I haven’t opened yet. I love the smell of bacon. So good. My mother would make extra bacon when she made it. It was always too crispy for me and usually cold. I like eating the fat off the bacon. It is so good. I know it isn’t healthy but oh well. I don’t have it often. I usually like turkey bacon better than regular bacon. Less mess and easier clean up. I’ve been having turkey bacon with my burger that I make. It comes out so good. I love it.

My sister bought coffee creamer which is ok but it is sweet. I have to remember not to put sugar in the cup when I make my coffee. I am thinking of going downstairs to make something to eat and to have coffee.

I have decided that my trans memoir book is going to be in comic sans font. I find it more personal that way, though I keep going back to typewriter font, which I think is times new roman. I am not sure though. I don’t know. I need to write more about it and see what I have written so I don’t repeat myself. I will need to get an editor for the book. But I will worry about that when I have at least a hundred pages written. I want to have at least 200 pages with also resources for trans like the lifeline and other stuff. I think it will be important.