Tag: mental illness

comparisons of psychological pain scales

by Midnight Demon, posted in Chronic pain, mental disorders, mental illness, mood disorders, psychache, suicide, suicide attempt

Suicide attempts are the leading reason why people go to see a mental health professional. What does it mean after an attempt and will the person get the help they need. There are many assessments on risks but few deal with the psychological pain that is attached to the attempt. In my research I have found three clinicians that have developed assessments to help deal with this issue. They are Dr. David Jobes from Catholic University of America, Dr. Israel Orbach in Israel, and Dr. Ronald Holden from Queen’s university in Canada.

Dr. David Jobes wrote and developed what is known as a suicide status form and believes that by collaborating with the client, you can decrease the suicidality (Jobes, 2006; Jobes & Drozd, 2004; Michel & Jobes, 2011). The form consists of three parts: initial, tracking, and outcome. The initial form has the initial evaluation of suicidality, followed by a treatment plan agreed upon by both client and clinician, and then clinical notes such as axis I diagnosis, mood status and session outcome (follow up appt, discharge, or hospitalization). The tracking and outcome are similar in nature. Tracking follows the suicidality. This is used until suicidality is resolved. I base his study on research articles and the two books he has written on the subject.

Dr. Ronald Holden was able to validate his scale of psychache that has helped to focus treatment on psychological pain. This is a 13 item scale rated on a Likert rating of 1-5. The total number of points is 65. The higher the psychache, the higher risk of suicide. The first 9 items deal with the psychological underpinning of what is causing suicidal thinking. The last 4 items deal with the likelihood that this person will act on it. His work I base on his research article.

Israel Orbach (Orbach, Mandrusiak, Gilboa-Schectman, & Sirota, 2003; Orbach, Mikulincer, Sirota, & Gilboa-Schectman, 2003) also has a mental pain scale but has 44 items and cannot be used, in this author’s opinion, in the clinical setting but does have some merit in the initial evaluation of psychological pain. The overall score is intricate and complex as it breaks down the 44 items into quartiles. The study was very small, less than 50 participants and was broken down into two parts. I base his study on his research article.

These combined formed my contention that psychological pain is a causal factor in suicidal thinking.

Suicide status form:
This is a collaborative effort between client and therapist in understanding the reason why a person is suicidal. These forms, initial, tracking, and outcome, provide a base for which to form a treatment plan for working on decreasing suicidality. It was built on the theories of multiple clinicians in the field of suicidality. These clinicians are Shneidman (Shneidman, 1993), who focused on psychological pain, Beck, who focused on cognitive treatment of depression, Baumeister (Baumeister, 1990), escape theory in suicide as escape from self, Linehan (Linehan, Goodstein, Lars Nielson, & Chiles, 1983), reasons for living when you want to die, and Jobes (Jobes, 1995), tracking suicidality.

Dr. Jobes has developed an assessment tool and mangement for suicidality. This management includes the suicide status form (SSF) and uniquely tailors the treatment around individual needs. This is based on the client’s direct input into their treatment. This collaboration takes away the therapist as expert and puts the client in charge of treatment. This also makes things more comfortable and meaningful. Dr. Jobes believes that by tracking the course of treatment, there may be better outcomes and those that are suicidal do not go by the way side, meaning get lost in the system or are ignored after their treatment ends. In his seminal work (Jobes, 1995), he found that nearly half of those that reported to be stressed and suicidal responded to treatment. The other half either dropped out of treatment, got hospitalized, or remained chronically suicidal. This propelled him to develop the SSF to keep track of the suicidal clients and their outcome.

OMMP: Orbach and Mikulinger Mental Pain Scale.
This scale is a 44 item assessment that measures mental pain on nine factors ranging from irreversibility, loss of control, narcissist wounds, emotional flooding, freezing, self-estrangement, confusion, social distancing, and emptiness. These factors are what contributes to mental pain as explained by the authors (see Orbach et al, 2003). Items are scored on a Likert scale of 1-5. In my opinion, given the complexity of this assessment, it cannot be used for clinical use but does hold a valuable research tool.

Holden scale.
Dr. Holden’s psychache scale is a thirteen question self-report of items based upon Shneidman’s book, Suicide as Psychache (1993). Psychache is defined as despair, anguish, hopelessness, and psychological pain one feels. Each items are ranked on a 1-5 point scale ranging from never to always agree, neither, or from strongly disagree to strongly agree (Holden, Mehta, Cunningham, & McLeod, 2001). Scores are from thirteen to sixty-five. This scale is easy to use and can be used clinically, with the permission of the author to reproduce it. What I like about this scale is that it is user friendly, scores can be added quickly, and the tracking of suicide can be seen. With higher results, suicide is more likely to occur. The lower the score, the lower the risk of suicide.

These three assessments are comparatively the same but are just called different things. The main point of suicide ideation is to find out what is driving the person to think about suicide and to try and prevent it from happening. Ideally these scales should be used in the first session and the Holden and/or SSF used thereafter.

Baumeister, R. (1990). Suicide as Escape From Self. Psychological Review, 97(1), 90-113.
Holden, R. R., Mehta, K., Cunningham, E., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224-232.
Jobes, D. A. (1995). The challenge and the promise of clinical suicidology. Suicide and Life-Threatening Behavior, 25(4), 437-449.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Jobes, D. A., & Drozd, J. F. (2004). The CAMS approach to working with suicidal patients. Journal of Contemporary Psychotherapy, 34(1), 73-85.
Linehan, M., Goodstein, J., Lars Nielson, S., & Chiles, J. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51(2), 276-286.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.
Orbach, I., Mandrusiak, M., Gilboa-Schectman, E., & Sirota, P. (2003). Mental Pain and Its Relationship to Suicidality and Life Meaning. Suicide and Life-Threatening Behavior, 33(3), 231-241.
Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schectman, E. (2003). Mental Pain: A Multidimensional Operationalization and Definition. Suicide and Life-Threatening Behavior, 33(3), 219-230.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.

Copyright 2013 Collerone, G

urges

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

***WARNING MIGHT BE TRIGGERING TO SOME PEOPLE***

Past few days have been rough. I have been humiliated by my nerve condition, in so much pain I couldn’t sit long enough to watch the Superbowl, and today I get hit with nerve pain in my ass that almost made me want to pass out again. All this has left me wanting to do something self-destructive.

I was talking with my therapist about this week’s events and a sudden urge to cut emerged without warning and staring at me from across my bed room was a new razor. I could almost feel the pain and feel the blood as it dripped down my arm. I need to cut so bad it feels like nothing will take its place until I do. I am starting to get obsessed with it. But I don’t have my supplies ready, though they could be in an instant if I tried. I don’t want to start something I can’t finish and cutting would do that for me. It would start out as something small and then I could go deeper and deeper until the bleeding went a little out of control. I would be happy for a little while and maybe for longer than that. I am trying to distract myself from it by writing but it’s only feeding the feelings of self-infliction that I want to do. I am guessing this is how a junkie feels needing their next fix. I want it so bad but the ramifications and consequences will not be good for me. I haven’t cut in almost ten years. So in some respects, you can say I have been “sober” all that length of time. And if I cut I will lose my “sobriety”. I don’t know what will happen. I might cut and be turned off like it happened the last time I cut or it might turn on the flood gates and I will become a “junkie” always looking for the next fix.

Why do I want to cut? Because I cannot tolerate the intensity of my psychache, the psychological pain, the despair, frustration, perturbation, worthlessness, and guilt that I am feeling. I have tried listening to music but I just cannot turn out the sound of my pain. It sucks hurting this much and no one knowing. I wish I could say why I feel like this but I don’t know why. I just do. I know part of the reason I want to cut is because of the fact I cannot kill myself. Cutting is a way for me to express my emotions without hurting anyone but me. And I am fine with that even if others are not. People do not want this to happen to me but I can’t stop the thoughts. They are weighing on me like a barge on my chest.

suffering with a price

by Midnight Demon, posted in Chronic pain, depression, mood disorders, suicide, suicide attempt, writing

Today was a little better day without my nerve condition bothering me so much. I still feel pretty down.

I’ve been trying to work on my blog for the new thing that I am involved in and it’s tough editing my own work. I am to add in some questions but don’t know really where to begin. I feel like just drafting a whole other paper but I don’t want to start from scratch. Drafting this paper was a piece a cake the first go round. Editing it is a little more difficult.

I finally saw my therapist after not seeing her for a few months. I think I might be able to see her every Tuesday but I am not sure I can commit to that. I have a hard time waking up and getting the car from my sister’s work is a hassle. I then have to pick her up from work and sometimes I am too tired to drive back, even though it is a MUCH shorter distance than my therapist’s office. I had to give her my forms for my long term disability so I might see her next week so she doesn’t have to mail them out and I can send it in with the other stuff that they need. I’m seeing my psychiatrist next week so I will drop off the paperwork to her and my primary care as he is in the same facility. I don’t get to see him till the end of the month and I want them sent in ASAP.

I just looked over the paperwork and they have a section for vocational stuff. My psychiatrist isn’t involved in that kind of bullshit and neither is my therapist. Oh the hoops these idiots make you go through for a buck.

Been starting to feel suicidal again. I just keep thinking that I just have to die. I can’t go on living. Then today a video comes in that my niece wanted and she is overjoyed and tells me that she loves me so much. How am I to die knowing that she will be messed up if I die? It hurts too much to think about but yet it kills me to suffer the way I do all the time. I get no reprieve. No alleviation at any time. Sure I was able to drive 30 miles today to see my therapist but it cost me my back to be hurting and mentally I am still depressed and suicidal. We talked about this new group that I am hoping to get into. I don’t know, maybe it will help things. I know it will give me something to get out of the house but the group meets at the time of my therapy appt on Wednesdays. I know it’s not a big deal to reschedule my appt but it is to me. I hate it when the schedule gets messed around. Trying to find another time is not always that easy. But I still think that suicide is a way out of my misery. I don’t have to go to group or therapy. Just crush a teenager’s heart or two. I try not to think about stuff like that because it really brings into the picture of what suicide does to the family when you are gone. I keep thinking they will be alright but I know they won’t. People always keep reminding me of that and it kills me because it means I have to suffer longer. I just want my pain to stop. If I had cancer I know they wouldn’t want me suffering so why can’t they just understand it that way. That I had to be out of my misery because I hurt so much. But no one sees it my way.

had enough

by Midnight Demon, posted in cauda equina syndrome, CES, Chronic pain, chronic physical pain, physical pain, suicide

Today was interesting and bad. It was interesting because for the first time, I was at Starbucks and there was a mentally ill guy there just ranting on all the customers, mumbling something and he was asked to leave but didn’t. he just took his jacket off and told the guy next to him this is going to get interesting for the next 30 mins. The manager of the store decided to call the cops. I was in the middle of an email and said god only knows what as all this was going on and left the store. I wasn’t hanging around to find out what this guy had up his sleeve.

I had ordered a plain latte to try it out. Never again. It was so plain, LOL. I went across the street and had lunch at McD’s. I really wanted a big Mac. Then decided to go home so hell can start. I had to go to the bathroom by the time I got home. Because my nerve condition affects my bowels, it’s hard to go sometimes and today was the mother load. I felt like I was trying to push out a tuba but only rabbit turds came out. The hardness caused some bleeding and I thought great, I’m bleeding from the front and back now as I still have my fucking menses till god knows when! My mother decides she has to go so I had to hurry up. I ended up getting stuff everywhere, rushing so my mother doesn’t end up peeing herself. I never had a day like today. And it still is wicked humiliating to me. The psychache just too much. I just am so numb, well emotionally. Right now my feet are doing a cramping dance because they are cold despite warm socks. I just hate that I can’t go to the bathroom like I did before all this CES (Cauda Equina Syndrome) entered my life. I feel really bad because I NEVER had shit on the bathroom floor before but there must have been some stuff there after I wiped and I didn’t know so when I got up it fell on the floor. Luckily my mother didn’t notice it or I would have said I stepped in dog shit (even though clearly there was no shit on my shoes). I just want to die from embarrassment.

To say that today has been a shitty day is an understatement. But this is the life I live now. My nerves no longer tell me where my stool is. Half the time I go pee and hear plunk. My biggest fear is when I have loose stool. That is when I really have no control. The hardest part is that I wanted to tell someone but I had no one to really tell. I belong to a support group and could have gone there but lately all my post there have been negative and I know they would have understood but I just feel like a burden to them because I need their support sometimes too much lately. And it’s not like I can explain it to my family. They would freak out and I know there would be that awkward day where my mother would ask if I shit myself today because she thinks it’s being supportive. But it’s not. I hate telling her anything about my condition. She blames me for having my surgery, even though it was an emergency. I had no choice. It was either surgery or never walk again. The second time I didn’t tell them why. It was because I was losing control of my bladder. I also had wicked bad leg pain. My surgeon was surprised I was still able to walk with the disc material in my spine where it shouldn’t be. I still have the pics on my private Facebook page to show my fellow CESers the material. Normally you can’t get that stuff but because I worked in the path dept at the time, I knew who to talk to about getting it. I wanted to see for myself what it looked like. This was only for my second diagnosis. My first one I missed the disc by a few days. It’s like having a trophy but also a reminder of what these buggers can do when they get wrapped up in your nerves when they shouldn’t. I had one disc fragment embedded in my L3 nerve for a few days. I lost use of my left leg and it took months of rehab to get it back. Too bad it didn’t help my foot drop on the same side. I never learned to walk correctly or if I did, it was only when I was a fatigued that I would not. It’s so hard knowing now that I am not working whether being stationary is helping or not. I know I did a lot of walking today and it felt good but now I am paying the price with cramps in my feet.