Shneidman’s greatest questions: Where do you hurt and How can I help?

Shneidman’s greatest questions: Where do you hurt and How can I help?

After I had a meltdown in late 2005 and was slowly recovering in 2006, I was taking a psychometrics class at college to earn my psychology degree. Psychometrics is a fancy name for psychological testing and validating tests and assessments on various things. As I was recovering from a deep suicidal depression, I was curious to see if there were any measures on psychological pain in suicide. I wrote my first draft of the term paper with 20 some odd articles all doing various risk assessments and testing of suicide ideation but none of them dealt with psychological pain, which was what I was aiming for.

The professor tore my first draft apart and even, however vaguely, accused me of plagiarism. I wanted to get a good grade in this class because it would help my further advancement in psychology. I went back to the drawing board. I searched for pain and psychological pain in the library databank. About only 5 articles showed up, at the time. I am sure I was doing it wrong. I looked up the articles and found Shneidman and Holden. Dr. Holden was based out of Queen’s University in Canada. He came up with a psychache assessment that I found useful in my therapy. I kept that article and shared it with my therapist. Then I queried everything on Shneidman and hit the jackpot. His work was in psychache, psychological pain. I read everything I could on him and his followers. I saw my idol David Jobes’s early work on the Suicide Status Form. It wasn’t appealing to me at that time. I was more interested in the psychache of the matter.

I read Dr. Shneidman’s book, The Suicidal Mind. Holy crap! This was about “me”. I knew I had to read everything this guy wrote but it measured in the hundreds so I focused on what was available now. I tried to read his books that were solely written by him but they were few and outdated. He wrote many chapters. The two questions that I kept coming across were “where do you hurt” and “How can I help?” No one had ever asked me those questions all my years in therapy. Not even my current therapist at the time asked until I brought it up to her.

These questions were the basis of how he helped suicidal people over his career. He brought them other options for suicide by learning things about their predicament. Then he ranked them in order of importance. As he slowly worked with them, suicide became less of an option on the list, which was good. It didn’t mean their risk of attempting was any lower but they could see that it wasn’t something that had to do right then and there as there were other options. That is what suicide prevention is, finding other solutions to the problems someone is facing other than suicide. Sometimes it works, sometimes it doesn’t. There was a case in which Shneidman talked to a Hispanic male who attempted suicide by gun shot. He blew off half his face and needed multiple surgeries and was in intense pain from his injuries. Dr. Shneidman counseled this man until he was well enough to leave the hospital. They kept in touch but as time went on, the contact got fewer and fewer. The young man died by suicide by that method a few years later. It was a sad case. The importance of the story is that contact is useful even after the initial attempt has passed, be it with postcard or phone calls or text messages. This isn’t an entire protective factor but it can be. Some people who think of suicide and even go to plan it, get through their circumstances never to think about it again. Others make an attempt and it is a kind of “wake up” call and they never think about doing something like that again. Then you have the people that are chronically suicidal, who make multiple attempts. These are the people most at risk of ending their lives by their own hand. It is these people that need the most help and patience. This is where the framework CAMS (Collaborating, Assessment, and Managing Suicidality) comes in handy. Check out their website

Is it possible to be happy while being horribly suicidal?

Is it possible to be happy while being horribly suicidal?

Today while waiting for the bus, I was listening to my music. It wasn’t the normal playlist I usually listen to but I was playing all my songs in my music file. A few songs came on that I really love and I caught myself singing along and just feeling happy. It got me wondering what the hell was going on because the past few weeks I have been so suicidal. Hell, last Friday was my death date that I didn’t go through with and yet I still feel the urge to end my life. Yet here I was, singing along to the music like I didn’t have a care in the world.

I know people feel relieved once they make the decision to end their life. It’s like a burden is no longer on their shoulders. That the tasks that were impossible are now possible because things are going to end soon for them. I know this because I have felt it. I have gone through it. Yet somehow, some way, I have managed to survive the death dates and the horrible suicidal thoughts that have plagued me since I was young. My therapist calls me the exception to the rule. I some times call myself a coward for not going through with my plans. After all, I always keep my promises to other people but I never have been able to keep a promise to myself, and that include ending my life at some future date.

I wonder if I have finally lost my mind because I was happy this afternoon. How is it possible to feel joy and happiness after a suicidal episode? It didn’t last too long. Just for a few songs and then I started thinking about writing this blog because I think it’s important to talk about. Suicide claims over 40,000 lives each year in the US alone. Today happens to be “World Mental Health Day”. So I find it even more fitting to talk about suicide.

I’m not going to talk about statistics and data that I could bore you with about suicide. I have just my experience and knowledge that I have learned since studying about this epidemic the past 8 years. When I am not suicidal, I try to learn as much as I can about the treatments for it because it might help me through another episode. There is a lot of research out there. The top ones are CAMS, CBT, and DBT. I have given DBT a try and didn’t like it. That was more than 17 years ago and it has evolved just like CAMS has evolved over the last 25 years.

CAMS (Collaborating and Assessment of Managing Suicide) was developed by Dr. David Jobes and is by far, in my opinion, the best way to manage suicidal episodes. It is comprehensive, easy to administer and score, has a treatment plan, and doesn’t involve more paperwork than regular clinical administrative stuff. That is what I love about this tool. In it you use the forms called the Suicide Status Form to assess suicidal plans and also develop treatment strategies with the client instead of for the client. It’s a collaborative approach because everyone’s suicidal episode is not the same. What causes me to feel suicidal is not going to be the same for the next person.

Brief Cognitive Behavioral Therapy (CBT) has been shown to help those with suicidal thoughts and attempts. It can be used in conjunction with CAMS after assessment has been made. It’s important because this therapy helps with the cognition of suicide better than any other treatment. See the work of Craig Bryan for more information about this.

Despite my happiness lasting for a few moments in time today, I still feel a little content, which is better than I have felt the last few months. I don’t know why this has changed and I hope it’s not the bipolar in me shifting to mania. I always get worried when I am not depressed because it is what I am so used to. But I will take it. Tomorrow maybe totally different than today. Hell, tonight might be totally different than what I feel right now. But I don’t feel like taking my life today, and I think that is a good thing.

Twitter Rant: CAMS and Suicide

I wrote this at 0400 today. excuse the hashtags

Twitter rant CAMS and Suicide

I wonder if there will ever come a day when there isn’t a hierarchical relationship between client and clinician in the matters of #suicide. That clinician and client work together to deal with #suicide and all that it portends, without judgement, stigma, or fear. These are the musings I have at this hour. Anyone can be trained for suicide prevention but do they go with that training or own prejudices. I have seen that changing clinicians’ minds about how they deal with #suicide training doesn’t change their perception of it. The old stigma of “they’re going to do it anyways” so why bother helping them is prevalent. If it doesn’t change their perception of #suicide, why then bother spending hundreds of dollars for training if you aren’t going to use it?? Case in point, at the Menninger clinic, they had a CAMS study where the authors noted the clinicians resistance to this easy framework. Again, it was hierarchical, the clinician knows best, the client knows nothing, This truly needs to change if we are to prevent #suicides. CAMS was designed to work with all disciplines (SW, PhD, PsyD, MD, etc.) Yet these clinicians had their biases & stigma preventing an open mind. CAMS is unlike any other theory, is quick to learn, and has less paperwork. Along with the SSF, it really help deal with #suicidal clients. I might be biased for CAMS only because it saved my life and I think it is the most superior #suicide assessment out there. Here is my blog about #CAMS. #CAMS is also NOT a replacement or new treatment but a theory that working collaboratively helps someone who is #suicidal. my musings started when a therapist was complaining about the use of the CBT paperwork and stayed away from it in her practice. As a patient, I can totally understand why the CBT paperwork is so daunting. I never liked it and don’t think it is helpful but others have found it helpful. And you have the CBT nuts that swear by it. I just wonder if it is because that is all that they were trained to be like DBT therapists. You don’t have to change disciplines to work with #CAMS, after the assessments, the client will need that discipline for treatment. I still would love to replicate the study in the Boston area about therapists and their attitudes toward suicide and training. Final thoughts are that #suicide training is under utilized in this country and not mandated. when is that going to change??

my baby has left

My baby has left

I dropped off my baby (laptop) today as it would be pouring tomorrow. It did rain later in the evening but after I dropped off the package to FedEx, so I made good timing. I had lunch at my favorite place and then had coffee at Starbucks. I tried their new coffee, Sumantra Longberry. It was good and gave me some juice that I needed to write. After I wrote several pages in my journal, I decided to look at the roots story but didn’t have the mindset to do anything with it. I bookmarked it and left.

I got a little wet by the time I reached the station to go home. I caught the train and then got a text saying the buses were moderately delayed. Wonderful. I wanted to call my sister to pick me up but I didn’t want to bother her. So I waited. There were lines of people waiting so I decided to wait for the next bus as crowded buses give me anxiety. The next bus that came wasn’t as crowded, though the bus driver didn’t know where the stop at the station was. Made me nervous. Because there weren’t that many people on the bus, I made it to my stop quickly to go home. It was raining steadily by then. I never walked down the street so fast to avoid getting wet. I wasn’t carrying an umbrella. I hate carrying them. I probably will tomorrow, depends on how bad it rains. I have to go to Stop and Shop to pick up my father’s prescription. Damn jerk didn’t pick it up last week. Just hope my hip isn’t hurting like it is now.

I had therapy today and it went well. I like it when we talk about stuff that isn’t full of air. She is listening to me better than she has the past month and I like it. I guess telling her how I really feel has made a difference. She didn’t push seeing someone new today. I think we are going to try and work things out, which is good. We were talking about Corrective Emotion Experience, or something to that effect. I told her I will be willing to try that form of therapy. We also talked about structure and it will be the first day of catch up from the week and then on Wednesday more like a therapeutic day. She wanted to go once a week but I can’t imagine that to be helpful. All the suicide preventative people that I have talked to or listened to over the years, all seem to agree that twice a week is better than once. But she doesn’t want me to stop all together. I will only do that if she forces me to see someone else. With me catching up with Shneidman’s anodyne psychotherapy, I am learning tricks to help myself and then passing that on to my therapist via text messages. It’s hard to put his words in 160 characters but I am trying. The bottom line is trying to alleviate the press, perturbation, and pain that leads to suicide. We haven’t talked about my suicidality in the past three weeks because we are still sorting through what to do with therapy. It’s on “hold” for now. I talked a little about it today. It didn’t stress her out like I thought it would. She did listen rather than freak out. Progress. Today I thought about the Commitment to living paperwork but I have to be there to construct it. There is just only so much you can so over the phone. I suppose I can blog it and then we can talk about it and agree to it as oppose to signing it. I am just thinking outside the box. I think the biggest hurdle is going to be keeping track of the psychache when I am in physical pain. When my physical pain is low, it’s easier to do a psychache scale. But when I am really hurting, forget about it. It is very hard to distinguish psychological pain from physical when you have the heightened arousal of actual physical pain. I have been good about keeping it down and using Gabapentin more has decreased my pain tremendously, even though I have regained the five pounds I lost. There is nothing I can do about that. It’s just part of the side effects.

My therapist and I did discuss trying to find a CAMS therapist in this area. I have to get the nerve to tweet Jobes to see if he keeps track of such things. I know for CBASP there is a compilation of therapists on the website but, unfortunately, none are in my area. The closest person is in Rhode Island and that will be troublesome. I can look again. There might be more people trained in this area of psychotherapy. For CAMS, I personally know one of the consultants and am thinking of asking her rather than go through Jobes. Then I thought about it…would I see this therapist just because I am suicidal? That would be a pretty specific therapist to see just for a few weeks time. (CAMS can be useful in as little as 8 sessions.) I think I will do that and see where it gets me. The worse she can say is no, she can’t help me.