Tag: David Jobes

NP idiot

by Midnight Demon, posted in Bipolar Disorder, blogging, Chronic pain, chronic physical pain, CRPS, depression, mood disorders, suicide

I had an appt with a nurse practitioner that apparently got her license from a cracker jack box or maybe the Boston Globe. She was insistent on me having plantar fasciitis even though my PT ruled it out but didn’t I read the newspaper, not a medical journal, saying that plantar fasciitis is the new back pain?? Are you fricken serious? I didn’t know reporters had their medical degree. Also pissed me off that she thought unilaterally and bilaterally were the same. Ugh!!!!! I had to literally fight for an MRI. She wanted an xray and didn’t even ordered that right as they xrays the outer part of my ankle not the inner where the damn lump is!!! I am so frustrated. I got to call radiology to see if I can have the MRI sooner than next week and during daylight hours. I might go to a different site. Ugh!! Oh and she was telling me the same damn things to do my PT has been telling me. Guess she was deaf on that part.

Oh and the kicker was that she walked in asking if I was having surgery. When I said no, she said you aren’t having gender reassignment surgery? And then she got all concerned and crap like she never had a transgender patient before. Omg I am not a specimen for your study!!! I got very upset by this behavior. I mean, shit. Seriously? I emailed my psychiatrist to ask her what to do. I want to file a report on her as I think what she did was inappropriate. I mean, hell, I was seeing her for foot pain, not a transgender issue! I am so pissed. I hate that she was so dismissive about what I was telling her about being in physical therapy and then dismissing what my PT said about me not having plantar fasciitis. She just wasn’t hearing me and I am glad she ordered the MRI. I already got a report on the X-Ray and surprise, nothing was revealed except for some spurs that have been there for a while.

I had a webinar when I came home on CAMS, the Collaborative Assessment and Management of Suicidality. OMG It was like having Dr. David Jobes in my room! It was awesome. I love him so much and have so much respect for him. He basically covered all that I know about CAMS. I love the new research he is doing. Sadly, one of the trials had two suicides. It is a risk but sadly not something you want to see. I wish I could share this with my current therapist but he is so anti-CAMS it isn’t funny. He just thinks talking about things is the answer. I know it is my fault in keeping him but fuck, there aren’t a lot of therapists taking new clients AND wanting to deal with chronic suicidality! I had one therapist not call me back in the Harvard area. I tried out of my comfort zone and that hit me in the ass with a don’t come back. I wish someone was dealing with suicidality in clients rather than just passing them off. If I could sprinkle some of Jobes’s kindness and humanity I would. It isn’t something I take lightly. I have been in the model of what he teaches and want to spread it around but hell, some therapists like the one I was seeing before my current one, was adamant about learning something new. In her words, she wasn’t a suicidologist so she didn’t have to learn it so what that said to me was if she had another client that was suicidal, she was NOT using CAMS/SSF with them. It makes me sad that there is this level of what you think a therapist should be and the reality is they just don’t exist. I don’t know why people become therapists if they aren’t willing to deal with the hard issue of suicide. I don’t know, maybe I have it backwards.

I saw a sign at my PCP’s office that they are moving location, and it is not even within their building. It is a building like 4 blocks over from the train station. I can’t walk there. Maybe on a good day, but those days have been so rare lately that I seriously doubt if I am sick, I will be able to make it. I think there is another way of going there. I just have to find out if the shuttle from another train station still goes by there, and where that stop is as the last time I was in that area, there was construction which had the sidewalk blocked off. This sucks because it adds to my commute and worse, no Starbucks, LOL

I just wrote a thread on Twitter and I am going to paste it here. I think it is important:

“I’ve been thinking about the @UniteSurvivors webinar with @lab_jobes and what he was saying about drivers (what drives ppl to suicide) and how those with lived experience can help. It took me to all the times the past 2 years I’ve been in horrible suicidal depressions/states, mostly due to my chronic pain. Dr. Jobes talked about a “life worth living”. Frankly I don’t even have a day worth living but somehow I am still here. I don’t want to be. I am in a chronic pain flare right now. My thoughts instantly go to suicide because it feels like my bones are being crushed and I am being stabbed in my ankle. How do you survive this while being suicidal? Frankly I don’t have a clue. It is probably because I don’t have lethal means near me when I flare (whether consciously or subconsciously I am not sure). I don’t have a large dose of meds by my bedside or knives. I don’t own a gun, though I sometimes wish I did. Guess these small measures have kept me here. My blog where I can write to Express myself. Have online connections to my support group which is invaluable. Different time zones are a life saver. B/c when it is 3 am, no one is up Boston time. I’ve learned to do this not through a therapist or hospitalization but mostly on my own. And having my psychiatrist email at 2 am is handy. Thank you Dr. Dave for CAMS and the SSF. It combines my thoughts of suicides to practical practice. I know I wouldn’t be here without it. I should add I am an autodidact suicidologist.”

I just read what I wrote and though some of it doesn’t make sense, I didn’t want to fix it because the essence of what I am saying is there. Anyways, that is all I have for today. There is a huge thunderstorm happening right now and I want to publish this before I lose power, if that should happen. Go SOX!!!!!

My Thoughts on Zero Suicide as a Person with Lived Experience

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

My thoughts about Zero Suicide as a person with Lived Experience

There has been a lot of talk on Twitter about Zero Suicide and it’s mission to reduce the suicide rate to zero, because 1 is just too many. At first, I was appalled that clinicians think that is possible. I for one think that it is outrageous because there is always going to be someone who dies by suicide. Maybe not in their organization but outside their organization. But then I learned that it’s not an individual’s practice but an organization or health system that strives to achieve this goal. They have trainings and meeting with those in the suicidology world.

Something kept bugging me about this. I kept quiet because I didn’t want to anger those that are for it, though I think there are a few blogs that I wrote about it before I understood the mission. While talking to a friend that is a suicide loss survivor, the bells went off. She said that it goes against Shneidman’s questions, where do you hurt and how can I help?

I am a big supporter of Dr. David Jobes work with his framework called CAMS (Collaborating, Assessment, and Management of Suicidality). I don’t know if Dr. Jobes trains these Zero Suicide clinicians. And even if they are trained, I am not sure it will be used. Most clinicians have the attitude that their skills on suicide risk are good enough when it could be faulty. Worse, they go through the training yet don’t use what they are taught. That drives me up the wall. Why bother going to a training (unless it’s a mandatory thing) if you aren’t going to take away from it?

I really think CAMS is a tried and true framework to prevent suicide based on my experience of using it in my former therapy. I also used the Suicide Status Form. Unfortunately, my therapist did not want training in CAMS and we drifted apart, thus ending our relationship. We did, while we worked together, use the initial and tracking forms but unfortunately, we never got to the outcome form. She wasn’t committed enough to see it through and that kind of pissed me off. Every time I had a suicidal episode, she just wanted to know one question on the form, The one thing that would help me no longer feel suicidal. It is an open ended statement where the client fills in their thoughts on the matter. Unfortunately, I could never come up with a satisfactory answer as I really didn’t know the reason for my suicidality. I just wanted to die and that was that. I wrote a blog about CAMS if you would like more information about how it is formed and the use of the Suicide Status Form.

I went on the website for Zero Suicide but could not seem to find the specific training that they went through. From what I gathered on Twitter from their live tweets, some of it is CAMS and some of it is using risk factors for suicide. Unfortunately, risk factors alone are not predictive of a suicide attempt. CBT has been useful in reducing suicide attempts but not all clinicians are trained in this modality. The book by Craig Bryan on CBT for preventing suicide attempts is a good book to learn more about it. I also wrote a review on the book that you can see here.
The other thing that gets me is that no where among Zero Suicide is there talk of a person’s psychological pain. There are measures, if you look for it. Dr. Holden at Queen University in Canada has created a scale to measure what Dr. Shneidman calls psychache. See my review on the research article for more information. I think it is a good psychometric to gauge a person’s level of suicidality and pain, which ultimately leads to thoughts of suicide. This must be included in any talk of preventing or intervention of suicide and also postvention, should a suicide attempt occur.

My final thoughts of Zero Suicide is that it is a novel idea but as Dr. Shneidman says, “How many suicides do you want, and I say I don’t want any, but I want there to be the freedom to do it. I study suicide but I am not pro-suicide. I’m for suicide prevention.” I share his sentiments. I do not like the talk of “suicide is not an option”. To me, that is hindering free will. I do hope the rate of suicides goes down, but the way that health care and mental health are going, I think there will be more before it lowers, especially among the chronic pain patient population.

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

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mood disorders, suicide, suicide attempt

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 https://cams-care.com/?pgnc=1

Is it possible to be happy while being horribly suicidal?

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

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.