A Special Blog Post

This is my 500th blog post. I wanted it to be memorable. And it will be, I hope, to me anyways.

I thought I would talk about David Jobes. He is my idol in the field of suicidology. I talk a lot about his work on my blog because I want to spread the word that there are treatment plans and assessment scales available for those who are suicidal. It took twenty-five years for this to happen. It might not catch on like DBT (Dialectical Behavior Therapy) did for borderline personality disorder but I am hoping that through my blog, someone has at least an inkling about it.

His work is CAMS: the Collaborating Assessment and Managing of Suicide. It is a framework that allows the suicidal patient/client to work with the therapist in his or her treatment plan. By working together, therapist and client, it is hoped that suicidal thinking will decrease enough so a completed suicide is avoided. This does not mean that the suicidal thinking will go away completely. Nor does it totally prevent a suicide. During one of his talks, he spoke of a clinician in Texas that followed the CAMS and the assessment tool, SSF (suicide Status Form) to the letter with one of his suicidal clients. The client ended up killing himself. The clinician did everything that he could. But sometimes, there is still the risk.

The SSF is a seven page form that uses an initial, tracking, and outcome form to monitor and assess suicidality. It is based on the work of several clinicians. I won’t go into great detail about this because you can find out more in Dr. Jobes’s book, Managing Suicidal Risk. The link it to the Amazon website where you can purchase it. I would love to post the SSF one day but I would be violating copyrights, though in the book you can make copies of the form. I just can’t do it electronically, yet.

The wonderful thing about this form is that it is a self report about the client’s thinking about suicide and also has clinical information in the end so that both client and clinician fill it out to assess and document the suicide risk. It doesn’t take more than 10-15 minutes to fill it out (might take longer if the person has trouble understanding reading and writing English or has a disability that prevents that from happening, such as dyslexia). It is individualized for the client and that is a huge thing Jobes tries to do. It is not a fit all in one box, so to speak. It should broaden the thinking of the client and clinician to help bring together and work together to prevent the client from committing suicide. In the SSF, it talks about reasons for living and dying, assess psychological pain, hopelessness, the need to escape, and also asks the question, what would make you not kill yourself? I have used this form in my therapy sessions and that is the first question my therapist asks me when I am in the throws of a suicidal crisis, which happens more times than not for various reasons.
Mostly it has been my word that has kept me alive and I do hate myself for it at times. I have told my therapist that I would keep myself safe and I have, though sometimes, I overmedicate to do so.

Background information of Jobes is that he is a professor at the Catholic University of America and also has a private practice in the Washington, D.C. He has written in at least a half dozen books (some of which I own, if I could afford it I would own all) and countless research articles relating to his work and also to the field of suicidology. He not only write about his work but also about the legality and ethical matters of dealing with a suicidal client.

Paranoid troubles continue

I have been having a facial migraine all day. One side of my face is numb and tingling. I have had them before. They usually are caused by bright sunny days and being overtired. I have been up since very early this morning. I wanted to get my editing done on my book and get to Starbucks early to get a seat. I got there around eight-thirty this morning as I was up at seven. I got the migraine when I came home. I guess I am stressing about this book a little bit.

I’m getting tied up in the details and when I asked a friend about quoting she said it’s different than quoting for a paper or article. CRAP. I have to find out if I can use this information with consent or half my book goes bye-bye. Not helping my migraine today.

Then today as I was looking for my migraine medicine, I realized I have two packages of old birth control patches that I am never going to use. I called the pharmacy to find out what to do with them and they tell me to call my city for medication dump. Well, it’s too late now to call. I was annoyed because I was on hold for like five minutes but it felt longer than that because of this damn migraine. I just feel pressure all around me and I just can’t get a hold of myself. I hate feeling out of control. I don’t know what effect the migraine med and my anti-psychotic pill will have so I don’t want to mix the two right now. I just have to ride it out and I can’t tolerate it. I feel like I am being pulled into different directions. It’s not even eight o’clock yet and I am ready for bed, which I might do but am afraid I will wake up early in the morning again, but this time at two or three o’clock. I can’t win no matter how hard I try with sleep. My days of sleeping for more than 7 hrs straight are over.

It’s a terrible feeling being watched by an unknown entity. Thankfully the voices aren’t chiming in with banter or I would really be losing it. Not that I would harm myself, just feel like I need to be back in the hospital again or something for fear of losing control. Maybe this book is just too much for me. I am starting to have second thoughts about it. I already feel like it will suck anyways. My therapist keeps trying to tell me that my book will be good like my blog is but my blog is different. I can write what I want to without being censored, per se. And I can quote pretty well to promote that things are not my ideas, least I hope that comes across. Maybe I am just worrying about nothing. My friend wants me to contact my idol about his stuff and the Aeschi model that I wrote. I just have to find it and make it in a document that is readable to him and pray he has time to read it and consent and then me not have a heart attack if he says yea or nay. This is the big leagues and I don’t want to fuck up on my first book. I would be utterly devastated if I got sued or something for what I wrote. I am like totally paranoid, and possibly with good reason. I wish I had my therapy appointment tomorrow but I don’t. I had to cancel because I am seeing my PCP. My monthly pain management appointment. I know he just is going to comment about my weight again. I put on a few pounds while I was in the hospital, I know I did. I haven’t weighed myself because I am too scared. I hate myself for it but sometimes I have no control over my eating. I sometimes eat when I feel it and other times I don’t eat at all because I have no appetite. Such is the struggle with depression. You would think a medical professional would know this but they don’t. They just want you in their set guidelines of a healthy weight, which is ridiculous. Technically I should be 125, at the most, and I haven’t weighed that much since high school. Medication is to blame and my back and ankle issues. It’s hard to exercise when it hurts. I try to push through it but it always backfires on me. Like today after I came home, my sister asked me to pick up my niece. It was a good walk from my house and now I am hurting because of the hills in my area. I don’t do inclinations too well with my bad ankle and there was no other way to get to my house without going downhill, unless I wanted to walk another three blocks or so. I know I shouldn’t be complaining because other people have it worse than I do with CES. But being in chronic pain every day changes you. For two and half years I have had pain nearly every single day, all day on some level. It gets worse at night, part of the reason I wake up in the middle of the night. My doctor calls this “inactivity” while I call it trying to sleep!! Sometimes I really think he doesn’t get it when he says he does. Did I also mention that he stresses me out going to see him? I never know what new thing he will come up with about my ankle pain or what kind of doctor he will refer me to next. I won’t go. I am tired of seeing new doctors and they always tell me the same thing, nothing is wrong with my foot or they don’t know why I am having pain as there is nothing wrong with my foot/ankle. I have seen them all and I am DONE. I just want my pain medication and just send me on my merry way. The end.

feeling uneasy

Been having a rough few days. Psychosis has not let up but I have so far avoided going in the hospital. I just can’t go in for material reasons. My baby (laptop) is on its way back to me and today because my mother is deaf, missed the doorbell. Now I have to wait till Monday to get it back. If I got my laptop today, I would have made a plan to go in the hospital on Monday. Now, no such luck. I really need the break. I am having command auditory hallucinations (AH) and those are really difficult to deal with in an outpatient setting. But my psychiatrist didn’t seem too concerned, though I really downplayed the severity of the AH. I still am wicked paranoid and can’t shake the feeling that I am being watched.

The day did not bode well for me because I woke up in severe ankle pain. I was close to cancelling my appointment with my psych today but I knew that if I did, I would have a hard time getting another appointment. And if I did go in the hospital, I would have a hard time getting discharged if I don’t have an appointment. Sometimes you need to have the follow up appointment with your therapist and psychiatrist before they can consider discharge. I am not hoping to stay too long in the hospital but I can be there up to fourteen days. I also stressed to my psychiatrist that I wanted to watch the Sox game today so I couldn’t go in. She joked but she knew I was serious. She knows that if I was really feeling bad, a baseball game wouldn’t matter to me.

Other than trying to write and keep up with this blog, I am having a wicked hard time with my other writing. I have been journaling because I am watched less and don’t feel that the voices can read my thoughts as much. I feel like I am getting behind though there is no official deadline or something to do my writing. I haven’t tried editing since last Saturday when I got overwhelmed. I can’t really think straight with the additional meds and have been getting agitated easily so I have been staying away from my book. I really thought editing would be easy but it is not. I gave myself a goal of publishing it by Oct 15th but now it is looking more like the end of Oct/early November. I really need to decide the order of my chapters but I need to wait till this psychotic episode passes. I got an email from my friend in Scotland who says he will be purchasing many copies so he and his family can read it. I know that I will be successful the first month or so and that is all that I am hoping for. I figure at least fifty or so copies will be sold. But I could be wrong. It could be more. But I don’t want to really count my chickens before they hatch. And I really don’t want to think about the implications of losing my disability if I am really successful. But I will worry about that when and if things come to that.

I still am depressed. I tried to be cheerful when I saw my psychiatrist but I just didn’t have it in me. I just felt flat. It hurt to really think what I wanted to say. I really wanted to give her the low down but feared I wouldn’t leave the office without an escort to the ER. Now I am kind of scared of what the weekend might hold for me if I can’t get on top of this. I know that if I go to the local psych ER I will get admitted, even if I just want to talk with someone. I have packed a bag just in case I go in. I just feel so uneasy. I am really shocked that my pdoc didn’t really encourage me going in the hospital, but then she usually leaves it up to me to make those kind of decisions.

psychosis and songs

I was chatting with a fellow blogger tonight about various things and one of the topics that came up was measures to fix the mental health system. 1) there needs to be more funding to keep existing programs open. 2) needs to be a better crisis response across all state hospitals or city hospitals so that people do not resort to suicide because they got left behind. People have the notion that inpatient hospitalizations are a cure all for all types of psychiatric ailments but what they don’t realize is that treatment hardly exists behind closed doors. Sure medication is dispensed but what is needed is therapy on the floors more than what the nursing staff can provide.

I have been struggling the past few days with psychosis and am wondering if I should be in the hospital. I was able to get a hold of my psychiatrist and she allowed me to take my old go to antipsychotic med that I like when nothing else seems to work. I just took it and I hope that it stops this song that is playing like a broken record in my head. The song is sirens by Pearl Jam. It is striking a chord with me a little too well and is “talking” to me, telling me that I should die. I don’t understand why this is happening, though it seems to be the course after every dissociative episode I face. I become purely psychotic after losing time.

I still am under black clouds. Listening to music is helping. I just wish the feeling like nothing would stop. And I still have the heaviness in my chest. The psychache is in full gear. I guess that is why the song is telling me to kill myself.