Tag: mental illness

Grief

by Midnight Demon, posted in depression, medical, suicide

Been struggling the past few days. I have been thinking of my friend in South Africa who is struggling right now with grief from the loss of his best friend and soul mate. His blog details the pain he is going through and it made me think of my own grief I have with the life I used to have. Of being able to walk without pain, life without taking any meds other than for psych, and being able to work without worry. Now I have no job, walking is no longer possible for long distances and yet I still think I can do it if only if I try harder. I tried for more than a year working two jobs that were physically and mentally exhausting. I went from working 60 hrs a week to nothing in 16 months. Now I don’t know if I can ever work again because soon as I get stressed or the pain levels get too high, I have a psychotic break and develop delusions that I believe are real. Like cutting my leg, I know it will not cure anything yet I can’t help but feel there is a foreign body in it causing the swelling and if only that swelling was cut open, I will be healed. But no doctor believes me. They just tell me to take my little pink pill to quiet the voices down and suddenly the delusions become just that and I realize just how fricken crazy I am. I know one day I will give in to the internal hell I face every day and try and open my leg up to see what is inside this lump on my leg. It is the cause of my grief, of my suffering this raised bump that some days you can’t see and others you can.  My friend has a different kind of grief but I know he suffers the same way I do with this bloody nerve condition we share. It has robbed us of our sanity, our livelihood, and our dignity. It bothers us more than we let on to people because we have to put a brave front on all the time and minimize just how bad the pain really is.

The other night I was contemplating ending my life in a few days time. I know I can really do it. I have the equipment and all that is needed is just a time and place. I know that I can really do it but do I want to leave my friends and family, who I know will be better off without me than with me living? I am tired of struggling every day, of breathing in and out and knowing nothing will change. My contentment period has expired and I want to expire too. I don’t understand why I should go on living when all I do is suffer. People have told me I am a good writer but so far it has not paid the bills and let me live a life that I can call my own. I just have trouble with the fact that I am so miserable. I am a negative person. I cannot be a positive when I do not see the light of day. Yet I just continue to stick around because my friend in SA needs me, my nieces and nephew need me, my therapist needs me.  I feel like such a hypocrite when I am trying to prevent suicides when the only one I am truly trying to prevent is my own. I read about suicide day and night and realize that I don’t know how I survived all the attempts I made over the years.  Reading about suicide makes me realize that statistically I should be dead. Yet I am not. Grief has frozen my heart to love again, and this nerve condition takes every ounce of strength not to throw in the towel after each day. I would love to work again and walk around the block without hurting. But that is no longer possible. I walk with an AFO (Ankle Foot Orthotic) and it is my help aid and my hindrance. People see that I am disabled. It has taken me a year to come to this conclusion and it sucks. Realizing you are disabled is no happy feat. It makes you wonder when you ever will be normal again and after 11 yrs of dealing with the pain and agony of nerve pain, I called UNCLE. I had enough. My friend, bless him, still keeps the fight to support his family and his friend’s son. He gets around in a wheelchair. He has more pain than I ever would dream of but the difference is that his is controlled better than mine. The US frowns upon narcotic use and so I am limited in my pain relief. I only take it when I have pain that is an 8 or higher and days when it is on the cusp of being an 8, I try to stick it out. I don’t do this because I like to be in pain. I do this because the stigma around pain medication makes me. My family doesn’t understand the difference between addiction and dependence. Actually few people do unless properly educated or if they also suffer from chronic pain. I can tell you I don’t misuse my meds. I don’t take it to feel high or to change the way I feel psychologically. I don’t take more than what I am supposed to unless I am close to being in a suicidal rage because my pain is up there and I can’t take it any longer. This means I am not addicted to it. I can go a few days without taking it, but barely longer than that. I can’t say I am dependent on it because on days I don’t take it I don’t notice being sick or worse than what I normally feel. I am chronically exhausted by pain and mental anguish that I hardly notice if I am dependent on the drug. My mind doesn’t think, oh I have not taken any pain meds today so why don’t I take it for the hell of it. I just don’t think that way. Some people do and that is a tragedy. And those are the people I am mad at because they ruin me getting the help I need from pain management doctors. If these doctors truly were able to help me with this and take care of my pain, I probably would NOT have had to file restrictions at work and then be out of work because those restrictions were not accepted by my employment.  That is why I am out of work, because I can’t walk around the lab anymore. It is like a huge city block and walking around and around for eight hours just about killed me. Hell after four hours I was ready to collapse in pain and sometimes I did. I’d have to leave in the middle of my shift because the pain got so bad or I had to rely on my coworkers to bring me work because I couldn’t get up off the chair and get it myself.  It was at times humiliating to be in that kind of pain and not have anything to take for it and then go home and suffer all night long. The hours I lost losing sleep were many.  I would get some relief after a few hours sleep but then it would be time for me to go to work my next shift. I sometimes would call out if I felt I didn’t get enough sleep. You can’t be dealing with a person’s lab values and have no sleep that could cost them their life because I am too sleepy to pay attention. What is worse I could not take any pain meds while working so I had to suffer through my shift without any relief. It sucked big time but I had to be alert in my duties. I had to stay sharp.  As much as I sometimes hated my job, I do miss it. I miss some of the people I have developed close relationships with over the years I worked there. I miss the routine of work. This is my grief and it hurts like hell

is suicide caused by psychological pain

by Midnight Demon, posted in suicide attempt

Since 1949, Edwin Shneidman has done extensive research in the field of suicidology.  He began his research by looking at suicide notes in the coroner’s office in Los Angeles (Shneidman, 1996).  During his intensive research, he came up with the term, “psychache” to refer to the mental pain, which, when intense, makes life so horrible and horrendous, that the sufferer can only think about suicide as the only option out of his/her misery.

Psychache can be defined as “hurt, anguish, soreness, aching, psychological pain in the psyche, the mind (Shneidman, 1996).”  Risk factors associated with suicide are only relevant as far as they can relate to psychache (Shneidman, 1993, 2005).  Dr. Shneidman believes that the true cause of anyone’s thoughts of killing themselves derive from this “psychache.”

During my research for this paper, I concluded that literature concerning the cause for individuals to resort to suicide is sadly lacking.  Most of the assessment scales for determining suicide risk focus on basically, two concepts as proposed by Rosenberg  (1999), action based and affective based interventions. 

Action-based interventions can include items such as a “no suicide” contract, increase sessions or phone check-ins, and, if appropriate, hospitalization. 

Affective based interventions focus on feeling and thoughts that are behind the suicidal ideation. 

Attempts have been made by several researchers for implementing a framework for something close to a “standard” for treatment care that is not determined by litigation (Brown, Jones, Betts, & Wu, 2003; Joiner & Rudd, 2000; Joiner, Walker, Rudd, & Jobes, 1999; Kral & Sakinofsky, 1994; Rosenberg, 1999; Rudd, 1998; Rudd, Joiner, Jobes, & King, 1999; Sommers-Flanagan, Rothman, & Schenkler, 2000; Walker, Joiner, & Rudd, 2001).  Discussion of litigation is not the objective of this paper, so if the reader is interested, Brown et al (2003) would be the work to which one is referred.

The frameworks provided by these researchers have provided many useful scales in determining risk and lethality of suicide, but do not include the assessment of psychological pain.  In Range and Knott’s (1997) analysis of twenty assessment instruments, not one of the twenty examined includes an assessment of psychological pain.  One reason for this is the subjectivity on the individual’s emotions, thoughts, mental state, and experience (Kral & Sakinofsky, 1994).  According to Kral and Sakinofsky (1994), suicidologists are in general agreement that “predicting suicide for a given individual is that, like many human states, the suicidal state has a temporal, fluctuating dimension”.  They propose that the evaluation of psychache experience, the psychological state of the suicidal person, is the key to accurate risk assessment.

Psychache is subjective.  A person is not going to feel the exactly the same way for any length of time.  However, if the level of perturbation (mental anguish) increases in intensity for too long, the individual is going to feel a need to escape from the anguish and despair by any means necessary, including by not existing any more.  If suicide is seen as the only option, the only form of escape, lethality of a suicide attempt is high risk.  Kral and Sakinofsky (1994) have stated that treatment of perturbation will reduce lethality and treatment of lethality ideation will reduce perturbation as these two states can feed off one another (Kral & Sakinofsky, 1994). 

A scale to the assessment of suicide risk would be to have a scale of the person’s needs and current psychological pain.  Dr. Shneidman believes, as do I, that when psychache is intense, perturbation is intolerable, and one or more psychological needs are thwarted or blocked, suicide is seen as the only option of relieving the psychache (Shneidman, 1999).  He has based these needs on described by Henry Murray’s (1938) Explorations in Personality. Shneidman has developed 20 psychological needs.  These needs are weighted and the total sum is 100 (see table 1 for an example).

Table 1

 

Murray Need Form

­­­­­­­­­­­­­­­­­­­­­­­_______________________________________________________________________
Subject: ____________________Sex: _______Age: ______Rater:________Date:_______

­­­­­­­­­­­­­­­­­­­­­­­_______________________________________________________________________

_____   ABATEMENT          The need to submit passively; to belittle oneself.

_____  ACHIEVEMENT      To accomplish something difficult; to overcome.

_____  AFFILIATION         To adhere to a friend or group; to affiliate.

_____  AGGRESSION         To overcome opposition forcefully; fight, attack.

_____  AUTONOMY           To be independent and free; to shake off restraint.

_____  COUNTERACTION                       To make up for loss by retrieving; get even

_____  DEFENDANCE        To vindicate the self against criticism or blame

_____  DEFERENCE           To admire and support, praise emulate a superior

_____  DOMINANCE          To control, influence, and direct others; dominate

_____  EXHIBITION           To excite, fascinate, amuse, entertain others

_____  HARMAVOIDANCE          To avoid pain, injury, illness, and death.

_____  INVIOLACY                        To protect the self and one’s psychological space.

_____  NURTURANCE       To feed, help console, protect, nurture another.

_____  ORDER                     To achieve organization and order among things and ideas

_____  PLAY                                    To act for fun; to seek pleasure for its own sake.

_____  REJECTION             To exclude, banish, jilt, or expel another person.

_____  SENTIENCE             To seek sensuous, creature-comfort experience.

_____  SHAME-AVOIDANCE       To avoid humiliation and embarrassment

_____  SUCCORANCE       To have one’s needs gratified; to be loved

_____  UNDERSTANDING                        To know answers; to know the hows and whys.

100

(Shneidman, 1999; used with permission)
References:

 

Brown, G. S., Jones, E. R., Betts, E., & Wu, J. (2003). Improving suicide risk assessment in a managed care environment. Crisis, 24(2), 49-55.

Joiner, T. E., & Rudd, M. D. (2000). Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. Journal of Counseling and Clinical Psychology, 68(5), 909-916.

Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and routinizing the assessment of suicidality in outpatient practice. Professional Psychology: Research and Practice, 30(5), 447-453.

Kral, M. J., & Sakinofsky, I. (1994). Clinical model for suicide risk assessment. Death Studies, 18, 311-326.

Murray, H. A. (1938). Explorations in personality. New York: Oxford University Press.

Range, L. M., & Knott, E. C. (1997). Twenty suicide assessment instruments: Evaluation and recommendations. Death Studies, 21(1), 25-58.

Rosenberg, J. I. (1999). Suicide prevention: An integrated training model using affective and action-based interventions. Professional Psychology: Research and Practice, 30(1), 83-87.

Rudd, M. D. (1998). An integrative conceptual and organizational framework for treating suicidal behavior. Psychotherapy, 35(3), 346-360.

Rudd, M. D., Joiner, T. E., Jobes, D. A., & King, C. A. (1999). The outpatient treatment of suicidality: An integration of science and recognition of its limitations. Professional Psychology: Research and Practice, 30(5), 437-446.

Shneidman, E. (1996). The suicidal mind: Oxford University Press.

Shneidman, E. S. (1993). Commentary: Suicide as psychache. Journal of Nervous and Mental Disease, 181, 147-149.

Shneidman, E. S. (1996). Suicide as psychache.New York and London: New York University Press.

Shneidman, E. S. (1999). The psychological pain assessment scale. Suicide and Life-Threatening Behavior, 29(4), 287-294.

Shneidman, E. S. (2005). How I read. Suicide and Life-Threatening Behavior, 35(2), 117-120.

Sommers-Flanagan, J., Rothman, M., & Schenkler, R. (2000). Training psychologists to become competent suicide assessment interviewers: Commentary on Rosenberg’s(1999) suicide prevention. Professional Psychology: Research and Practice, 31(1), 99-100.

Walker, R. L., Joiner, T. E., & Rudd, M. D. (2001). The course of post-crisis suicidal symptoms: How and for whom is suicide “cathartic”? Suicide and Life-Threatening Behavior, 31(2), 144-152.

Copyright 2013, Collerone, G

suicide paper, V1

by Midnight Demon, posted in suicide attempt

“You will not fail to see that I am suffering under a depression of spirits which will [not fail to] ruin me should it be long continued” -Edgar Allan Poe {{Jamison, 1993 #18}.    

Depression, left untreated, eventually leads to suicide.  In the United States, suicide is the 11th leading cause of death, accounting for approximately 30,000 deaths with an age adjusted rate of 10.7 per 100,000 persons (Gaynes et al., 2004).  Most clinicians have seen suicidal patients throughout their careers.  Researchers have reported that professional psychologists has a 1:5 or 1:7 chance of losing a client to suicide; for psychologist trainees, a 1:6 ratio has been reported.  To date, there is no known formalized training program for beginning or experienced clinicians designed to teach suicide assessment skills, nor is there a recognized model for treating suicidal thoughts and feelings in a systematic way (Rosenberg, 1999).  Furthermore, the current literature fails to accurately define what it meant by “suicide ideation” or “suicide attempt”.  O’Carroll et al describes in their research how one clinician can say to the other that they have hospitalized a client due to suicide attempt.  The other clinician often wonders what that means.  Does that mean the client actively attempted deliberate self-harm warranting medical attention, attempted self-harm but did not warrant medical attention, or ideated a plan for an attempt and was intent on acting on that plan.  Eg pg 238 on senate asking the question and responding.  Reasons for intent, how many came to the hospital how many didn’t, how many died.  Basic terms are not uniform among clinicians (O’Carroll et al., 1996). 

David Rudd has provided a conceptual framework based on clinical summaries and assessment tasks consistent with existing standards of care but not dependent on psychotherapeutic orientation.  This framework is divided into three categories: practical skills, self-image, and interpersonal relationship (Rudd, 1998). 

One of the essential goals to achieve treatment success is to emphasize psychodynamic approaches to developmental issues and the therapeutic relationship.  A strong therapeutic alliance is essential to positive outcome treatment with a depressed client (Klein et al., 2003).

Several studies have noted a difference between single and multiple attempters (Joiner & Rudd, 2000; Joiner, Walker, Rudd, & Jobes, 1999; Rudd, Joiner, Jobes, & King, 1999; Walker, Joiner, & Rudd, 2001).  It has been postulated that previous suicide attempts sensitize one to subsequent suicide-related thoughts and behaviors.  These individuals with a history of multiple attempts display behavioral and cognitive styles distinct from those of non-multiple attempters. There is also evidence that crisis intensity is related to negative life events for non-multiple attempters but not for multiple attempters (Walker et al., 2001). These same authors have stated that clients fall into three types of groups when assessing suicidality: suicide ideators, single attempters, and multiple attempters (Joiner et al., 1999).

The difference between them is the elevated risk in multiple attempters because of type, chronicity, and severity of psychopathology.  The authors also go on to define seven domains of factors in assessing suicide risk.  These are:

1. Previous suicidal behavior

2. Nature of current suicidal symptoms

3. Precipitant stressors

4. General symptomatic presentation, including hopelessness

5. Impulsivity and self-control

6. Other dispositions (e.g. history of abuse, environmental factors, substance abuse, etc)

7. Protective factors (e.g. suicidal writing, social support)

A history of previous suicidal behavior is an important domain for risk assessment.

In addition to these domains, the authors have narrowed down two main factors to summarize suicidal symptomatology risk: “resolved plans and preparation” and “suicidal desire and ideation”.

     Resolved plans and preparation is defined as the following symptoms: a sense of courage to make and attempt, a sense of competence to make an attempt, availability of means to and opportunity for attempt, specificity of plan for attempt, preparations for attempt (seeking gun, pills, etc), duration of suicidal ideation, and intensity of suicidal ideation.  Their view is that if the client shows such symptoms, they are in pernicious, moderate risk.

     The suicidal desire and ideation factor defines the following symptoms: reasons for living, wish to die, frequency of ideation, wish not to live, passive attempt, desire for attempt, expectancy of attempt, lack of deterrents to attempt, and talk of death and/or suicide.  These symptoms are clinically noteworthy but are considered minimal risk, unless the client has had previous suicidal attempts (Joiner et al., 1999).

References:

Gaynes, N. B., West, S. L., Ford, C. A., Frame, P. S., Klein, J., & Lohr, K. (2004). Screening for suicide risk in adults: A summary of the evidence for the United States preventative services task force. Annuals of Internal Medicine, 140(10), 822-835.

Jamison, K. R. (1993). Touched with fire.New York: Free Press Paperbacks. p.18

Joiner, T. E., & Rudd, M. D. (2000). Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. Journal of Counseling and Clinical Psychology, 68(5), 909-916.

Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and routinizing the assessment of suicidality in outpatient practice. Professional Psychology: Research and Practice, 30(5), 447-453.

Klein, D. N., Santiago, N., Vivian, D., Schwartz, J. E., Vosisano, C., Blalock, J., et al. (2003). Therapeutic alliance in depression treatment: Controlling for prior change and patient characteristics. Journal of Counseling and Clinical Psychology, 71, 997-1006.

O’Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996). Beyond the tower of babel: A nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26(3), 237-252.

Rosenberg, J. I. (1999). Suicide prevention: An integrated training model using affective and action-based interventions. Professional Psychology: Research and Practice, 30(1), 83-87.

Rudd, M. D. (1998). An integrative conceptual and organizational framework for treating suicidal behavior. Psychotherapy, 35(3), 346-360.

Rudd, M. D., Joiner, T. E., Jobes, D. A., & King, C. A. (1999). The outpatient treatment of suicidality: An integration of science and recognition of its limitations. Professional Psychology: Research and Practice, 30(5), 437-446.

Walker, R. L., Joiner, T. E., & Rudd, M. D. (2001). The course of post-crisis suicidal symptoms: How and for whom is suicide “cathartic”? Suicide and Life-Threatening Behavior, 31(2), 144-152.

hail to the shower

by Midnight Demon, posted in suicide attempt

8-30-12

I live in a depressed state most of the time. It takes me a long time to get dressed and make decisions about what to wear, from the socks, to the pants/ shorts, shirt, etc. but the most annoying thing that I always have to psych myself up for is a shower. It should be an easy decision but because I have to stand longer than I should, it is painful. It actually exhausts me, both physically and mentally instead of being invigorating. I rarely love taking a shower. I have such a bad association to it because it makes me exhausted and then afterwards I just want to crawl back in bed. It takes too much energy sometimes just to put clothes back on. It takes all I have out of me. I hardly ever think that it is a good thing to be exhausted after showering but I find that I am and I have grown to despise it. I don’t know when it happened it just did. Maybe because it just takes so much energy to shower. I don’t even stay in long, ten minutes tops, yet it still robs me of the energy for the day. Though this isn’t the case always. Sometimes if I take it a night it wakes me up and then I am up all hours of the night. It really is mind boggling how a shower affects me. You know you need to do it because of good hygiene and all but sometimes I just want to stay away from it because it bothers me so much. I usually try and take a shower every 3-4 days or so. I do this because my mother is always bitching about the water bill so that further causes me to wait until I am raunchy and smelly before I go. It is better in the winter time because the summer sucks. I sweat and you have to take a shower more just to get the stuff off you. I am lucky my hair is short and I don’t go out much because it gets greasy looking and once it starts itching I know I have no choice but to shower. I know you might think that this is silly but it really gives me anxiety.

I guess my pain meds have kicked in enough for me to try and shower. It will do one of two things, either wake me up or tire me out…

This time it tired me out. I took a three hour nap, which has been my norm the past few days. I think my meds may have something to do with it because within an hour or taking them I feel really sleepy.
On another note, I have been having strong urges to cut my leg the past 24 hrs. It sucks because I really think there will be a benefit to it while the medical professionals do not. It’s like an infection that needs debridement and I just feel that if I take the junk out, my leg will no longer be swollen anymore. My rational self still thinks this is a way bad idea. I know it probably is true but I hate being in pain all the time. So the question becomes, to cut or not to cut…