Tag: psychache

Of Suicidality

by Midnight Demon, posted in blogging, depression, mood disorders, psychache, suicidality, suicide, suicide attempt

Of suicidality

Since my last therapy session, I have been thinking about my suicidal career and how it relates to my identity as a trans person. My therapist is under the impression that it is my insurance hindering me from seeking another therapist and I told her, no. It is my suicidality. She seemed incredulous about this. So I wrote to her and told to contact at least 5 therapists and ask them if they would take on a suicidal client and see what she gets. I doubt she will do this.

I also told her in the message that I would like to continue talking about this because it is central and I think that I can heal if I talk about how I didn’t have the words to speak about being a boy all these years. In my first few years of therapy, it was difficult because I was also an active cutter. One therapist tried to push DBT on me and failed. I resisted. In one of the exercises she gave me was to think about cutting and note how many times I thought about it. It was over like 20 times a day I thought about it and it made me worse thinking about it this. I felt really bad about myself. I didn’t have much hope about this new therapy. This was back in the early 2000s, before I found a stable therapist. By then, my cutting had somewhat stopped. It didn’t provide the release it once did. Instead, I just became suicidal. It was extremely painful. I was hurting very bad. My psychache was off the scale. My therapist became my only source of support and hope. I was seeing her maybe three times a week but I still just eluded to how I was feeling. In looking back, she really didn’t have a strong sense of redirecting me when I went off course and that was a downfall of our therapy. It went on like this for years and I just became more and more suicidal. I didn’t know what was making me so suicidal. I just knew I was.

The pain of living not as my true self was literally killing me. I hated my body and myself. I actually loathed myself in ways I never thought of. I hated my face. I was convinced I was ugly and fat. My father had called me “facia bruta” (ugly face) for so long that I believed him. I had things on my chest telling me every day that I was not a man. I had periods that made me suicidal every month. The hormonal aspect of it was terrible before I was able to stop them. It literally was like a switch went off when I started bleeding and I was ok again. But before then I was in suicidal hell. All I thought about was killing myself and I had such pressure to do so. I usually ended up going in the hospital for a couple of weeks but that never helped me. It would keep me safe from myself but they never cared to work on why I was suicidal. It was to be dealt with on the outpatient therapist.

My last two hospitalizations I tried to get as much as I could out of them. I knew I was still suicidal and might be for some time. I have been suicidal for nearly forty years. It is a tough habit to break. That is why I want to talk about it in therapy. Being the wrong gender for so long really was painful. It took me a few years to even say the word without breaking down and crying. It didn’t relieve me of my suicidal thoughts though.

I remember I was first suicidal when I was just eight years old. I didn’t tell anyone but it felt like the right thing for me. At that age, I had all or nothing thinking and thought that if I couldn’t be a boy, then I should die. There were hardly any gender clinics in the 80s and I think there was just one doctor at the Children’s Hospital that did gender affirming care. I grew older and my suicidality got worse. I became a planner. I would set dates. I truly had a suicidal mind when it was active. The blinders would go on and that was all that I could see was my death. I still get that way sometimes. It just made sense at the time for me that it was the thing to do. I had planned my death right before my tenth birthday. I wanted to kill myself on my birthday. But my mother was throwing me this big party and as my birthday is near Christmas, I wanted to see what presents I got. I never acted on my feelings until a few months later when I got into an argument with my mother over something. I had talked about being suicidal to my childhood best friend. He wanted me to get help but I felt like I was crazy if I did. I didn’t get help until I was fifteen, after I made some scratches on my wrist in an attempt to end it. But there was more than just being in the wrong body that was causing me to be suicidal at the time. I had a lot of trauma in my family to process and most of it went unprocessed as the therapist was more interested in trying to stop me from cutting.

My suicidality, body image, and being transgender are all tied together. For years, I hated myself because I wasn’t my true self. I know the past couple of years, my suicidality took a life on its own. I think that was partly due to the misgendering and use of my deadname at home. I felt like I was still a girl in my mother’s eyes no matter how much facial hair I had. Being me was difficult and now that I have had top surgery and am my true self where my mind and body are congruent, is still tough. I don’t have bottom dysphoria, thank god. I can never have a prostate gland to make my penis work the way a cis man does. But then, I have never really liked the thought of having one.

I tried conveying to my therapist about how intertwined the suicidality and being trans is but I don’t think she got it. I have been wanting to be dead a long time now and even though I might not have a suicidal mind now, I still feel suicide is an option for me. The trouble is, the past four years so I have no filter between being suicidal and being safe. I used to plan dates. Now I don’t. I just act on my feelings and that is dangerous according to my therapist. I’ve felt like I have put it off so many times that I might as well act on it. I’ve always held on to Dr. Paul Quinnett’s thinking of giving yourself time between the actions and thoughts. Suicidal thoughts and feelings can happen in a matter of minutes and sometimes, depending on method, acting can be fatal. But giving yourself space between the action and thoughts gives you time to think on the matter. I’ve always give myself a few weeks time, sometimes, a month or more, when planning my death. Then when the date came, if I didn’t feel like acting on it, I didn’t have to. And most times, the feelings had passed and so did my thoughts to act. Sometimes I was in a better place mentally. I might still be depressed but not enough to want to end my life. I honestly wonder if I will ever not be suicidal while being my true self.

I have talked about my suicidality openly on social media and throughout my blog. Sometimes it triggered a well visit from police which I didn’t like. I had gone through some dissociative periods where I would write the most suicidal things and then wake up the next morning, wondering if it was a dream. Often I would send an email to my then psychiatrist, who would call me in the morning and I often had no idea what she was talking about until I read the sent message. I often felt alone late at night with my feelings and would text or email my psych team about them so I would feel less alone. This just created worry and sometimes hospitalization, or at least a trip to the ED. I am thankful that period of my suicidality has passed. My ideation is often triggered by any distress, real or imagined, and often goes to the planning stage. I no longer have a filter between my thoughts and planning. Usually there is some space between them as it takes a while to come up with a plan. For right now, I know what my method is so I just go right to planning when I feel suicidal. I will pick a date and then when that day comes, if I am feeling suicidal, I will act but most times I don’t. I have been working with my therapist about trying to put some kind of buffer between thought and planning as it has become an almost “automatic” thought. And planning usually calms me down as it gives me an option for my distress. I am trying to come up with another plan when my planning is active. It hasn’t been easy. I am thankful I can be frank with my therapist when I am suicidal and not be automatically hospitalized for my thinking/ideation. It is still a fear of mine when talking about this stuff but I try to inform her as much as I can. I was taught nearly thirty years ago to keep the thoughts to myself. I was hospitalized at the time and my stay was becoming long. I basically had to keep the thoughts to myself or there was no hope of leaving the hospital. This was still before DBT and CBT were the main forms of keeping suicidal ideation at bay. Today there is brief CBT that was formulated by researcher/clinician Dr. Craig Bryan. DBT (dialectical behavior therapy) was created by Dr. Marsha Linehan. Both of these therapies along with CAMS (collaborating, assessing, and managing of suicide) has been studied extensively to combat suicidal ideation. I love CAMS as it speaks to me and I feel really helps me focus on why I am suicidal. It is based on the works of the father of suicidology, Dr. Edwin Shneidman as well as other researchers. CAMS is easy to administer and rate within a session. And because it is collaborative, the client/patient has a say in what their treatment is. That is the focus of CAMS, it takes the client as expert rather than the therapist. This is often lacking in the mental health field. There is such a paternalistic approach to suicidal behavior. It makes it difficult to talk about and there is always the fear of suicidal people being labeled as “crazy”.

I believe Dr. Shneidman was correct in saying that suicidal ideation is due to psychache, the psychological pain of the mind. His book, The Suicidal Mind, resonated with me deeply. He talked about constriction of the mind where there are blinders and the suicidal person can only see suicide as an option. He also talks about things called lethality, perturbation, and press. He formulated a suicide cubic model of perturbation, press, and psychache that I find useful in gaging my own suicidal thoughts and where I am in whether I need crisis management or just an extra therapy session. I felt like Dr, Shneidman was on the mark. I am glad that CAMS took into account his work and includes a measurement of psychological pain. As Dr. Shneidman has stated, no psychache, no suicide.

paper where I wrote I’ll wait for you

by Midnight Demon, posted in blogging, depression, mood disorders, PTSD, recurrent major depressive disorder

Paper where I wrote I’ll wait for you

I am having a hard time sleeping. I am listening to Taylor to try and ease my heavy heart. Grief is hitting me hard. I am remembering stuff with my mother, mostly stuff from when I was little. The parties we used to have where we would have leftover chips and cake. It made a good breakfast while my mother was sleeping. She didn’t want us to eat that stuff but we did anyway. My mother was the one we did stuff with. My father never really had time for us because he was so selfish and narcissistic. My mother took us to church and to school. She also came to events at the school where we participated in. She didn’t come to my basketball games when I played my freshman year. It was not a good game usually as I sucked. Plus no one really gave me the ball to shoot it. I was bad at trying to take a shot under pressure. But I could do a layup pretty well.

I also remember the abuse my mother did to me. It happened when I was little and while I was in puberty. She saw changes and kept looking at me every time I showered or bathed. Even while I was an adult, living with her, I couldn’t be naked around her because she would look at my body. I felt so much shame and I think that is why I have a little of body dysmorphia. I hate the way my body is. I don’t like that I am overweight. Now that I don’t have breasts, I can clearly see my stomach that is huge and it bothers me. I am trying to lose weight. I haven’t the first clue how to actually do it. I am not a person that can eat salads and stuff like that. I am a meat eater. I will eat chicken and potatoes. I love making a chicken breast and roasting it. But getting back to the abuse, I was always criticized when I tried to go on a diet. My mother would not approve of it and be very snarky about it. My father called me fat and ugly all my life. It was very hard to lose weight when I felt like I had to live up my father calling me fat all the time. Every time we had dinner and I would fill my plate, he would say something about it. He was not a nice man.

So I had my parents give me an idea of what my body should or shouldn’t look like. I know I need to lose weight. But I don’t know how really. I have tried drinking Ensure during the days and then at night but I feel hungry. I need to have something solid in my stomach. I will usually have a turkey sandwich or just eat turkey breast or chicken breast and that will be my protein for the day. Sometimes I will make an egg. If I get up early later today I will try and make an egg sandwich.

I love how my chest is. I am still getting used to it as I really can’t believe the breasts are gone. I love it so much. I no longer have to wear baggy shirts to hide my chest. I can’t wait for the warmer weather so I can wear tank tops without worrying about whether my boobs are gonna show.

I feel sad about my mother’s passing. I feel like there should have been more time that she could have spent with us. But I guess it wasn’t meant to be. I feel cheated because my sisters had my mother at their birthdays and I didn’t. I got a phone call while she was in the hospital. A voicemail message, actually two of them. Then I didn’t get her card until two weeks after my birthday. I got no party with her. My sisters and nieces celebrated with me at the restaurant but it was so hard without my mother there on my birthday. I am upset about it. I never said anything about it before because I thought there would be another birthday with her. I was wrong. Cancer took her before we were ready to say goodbye to her. I am angry about this. I am sad and hurt, too. I got all these feelings rolled into one. I don’t know why the cancer showed up now. I knew it would eventually. She smoked a lot and I knew she caused damage to herself. I just wanted to have one more birthday with her. Now it is never going to happen.

I don’t know if I should stay up or go back to sleep. It’s almost 5am. It is usually the time I go back to sleep. The birds are chirping away, being annoying. They are cardinals. I think one of the is my father because he would be a pain in the ass in the morning especially if you didn’t answer his call right away. I am hungry and am thinking of making an egg sandwich. Haven’t decided if I want turkey or regular bacon in it. I have maple bacon that I haven’t opened yet. I love the smell of bacon. So good. My mother would make extra bacon when she made it. It was always too crispy for me and usually cold. I like eating the fat off the bacon. It is so good. I know it isn’t healthy but oh well. I don’t have it often. I usually like turkey bacon better than regular bacon. Less mess and easier clean up. I’ve been having turkey bacon with my burger that I make. It comes out so good. I love it.

My sister bought coffee creamer which is ok but it is sweet. I have to remember not to put sugar in the cup when I make my coffee. I am thinking of going downstairs to make something to eat and to have coffee.

I have decided that my trans memoir book is going to be in comic sans font. I find it more personal that way, though I keep going back to typewriter font, which I think is times new roman. I am not sure though. I don’t know. I need to write more about it and see what I have written so I don’t repeat myself. I will need to get an editor for the book. But I will worry about that when I have at least a hundred pages written. I want to have at least 200 pages with also resources for trans like the lifeline and other stuff. I think it will be important.

Sunday Musings

by Midnight Demon, posted in blogging, depression, mental illness, mood disorders, psychache

Sunday musings

I am still reading Linehan’s memoir. I am learning more about DBT this second go round than I did the first time I read it. I seem to be more accepting of DBT as I am realizing that there is evidence DBT works with highly suicidal individuals. The trouble is, it take a lot of work as there is so much to learn. The two takeaways I am getting from this second reading is the two skills radical acceptance and STOP. STOP stands for stop, take a step back, observe, proceed carefully. I am finding I need to practice this skill as otherwise I get angry and nothing gets accomplished. I also need to radically accept that I have depression and trauma issues.

I woke up late this morning. I didn’t get up till after 12. I kept getting severe headaches, like migraines. They would go away if I just stayed still. It happened three times after my alarm went off to take my morning meds. I thought I would have to take a migraine medication to get rid of it but it seems to have gone away on its own. I had started getting these kinds of headaches while in the hospital. I thought they had gone away but the last two nights they have come back.

My cousin texted me this morning saying that Ohio State has made it to the playoffs and they are playing Georgia. That is going to be a tough matchup. Georgia just won yesterday. They killed LSU by a big number. This is what I love about college football games, they score big numbers.

I am thinking about mailing out a card that I wrote out and then getting pizza for my late lunch/early dinner. Problem is that I have no energy to get moving and I know if I force myself to do it, I will have to take a lot of breaks to go around the block. I found my sunglasses but I still am unable to find my transition glasses. I have no idea where they went to. I know if I find the case, I will find them. I hate when I misplace things. It drives me crazy.

I miss baseball. It doesn’t look like the Sox are going to sign Xander Bogaerts. I just hope he doesn’t end up on the Yankees. I still don’t know if JBJ is still with the team. I watched a baseball game while I was in the hospital and he was playing for the Blue Jays. I don’t know if this is true or not. I will be sad if it is. I have no clue how the season ended because I was so sick in the hospital.

Yesterday, I listened to Taylor Swift’s 1989 album. Today I am listening to Rob Thomas’s Someday on repeat. I love this song so much.

I am feeling suicidal. Nothing really happened in the last half hour or so. I just feel like ending my life. I see no good in it. I have imagined how I would do it two different ways. I won’t act on it, though I do want to. I just don’t want to end up back in the hospital. There is no guarantee I will end up back on the same unit I was in. I could end up somewhere else. That keeps me from going to the ER. I know I spent a few days in the psych ER before I was transferred to the unit I was in. I don’t know how long I was there as I wasn’t myself. I was in a confused state. I don’t remember if I had my phone or not. If I did, I know I wasn’t using it. I was much too paranoid about it. I am working through the feelings of distress I am feeling. I am distracting myself by writing about them. I have therapy tomorrow and will tell my therapist about this. I want to die so bad that it is almost like nothing else matters to me, not even top surgery. I have hit a new low in my life. I try to keep telling myself life will be different when I have the surgery but will it? I thought about going back to college while in the hospital after I recovered from surgery. It seems impossible right now but I want to make an effort in the next couple of years to earning my degree. I want to finish it at UMass Boston. Trying to make goals helps defend against the darkness, least for a little while.

I am feeling worthless right now. My psychache is high. I am a little perturbed and my press is at least a three. I spoke how I wrote the book Darkness Always Wins while I was in the hospital. I was and still am in a dark place. I don’t know if I am going to recover from this episode of depression. Meds have made little improvement to how I feel. I know realistically, it could be a year or more before I recover. It is the way recurrent depression is. I don’t buy that I have bipolar disorder. My depressions are too dark and stay dark for periods that are much more similar to major depression. I really think I am misdiagnosed. Fortunately, the treatment is the same: antidepressant therapy. I need to take an antipsychotic because I am prone to hearing voices otherwise. I have done well with Latuda, though it is causing some dystonia for me.

I just read a blog that I wrote a more than a few years ago about Shneidman’s psychache theory. I was trying to think about it while in the hospital. I remembered the three P’s, press, perturbation, and psychache. A 5-5-5 indicates imminent suicide. I was a 5-5-5 in the hospital at times. I tried to remember the psychache scale by Ronald Holden. I couldn’t remember his name or if I had it on my blog for staff to look up. My memory has been so much affected by what I have been through.

I had dinner with my family tonight. It helped a little being around them but at one point I wanted to tell my sister I needed to go back to the hospital. I just couldn’t bring myself to tell her though so I kept quiet. I will talk more about this with my therapist tomorrow morning. I really feel like shit. It is like the song going down in flames, “Falling into this, again.”

about my hiatus

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

About my hiatus

I have been in the hospital the past three months. I was not in a state where I could write a blog. I was doped up most of the time and barely knew what was going on around me. I was sick with renal failure, covid, and infection called C diff. I was barely eating so they had place an nasogastric tube down in my stomach for a bit. I don’t know how long this tube was place. I had taken a pic of it sometime in Sept. I missed how the season ended for my Sox. When I came home for a bit, I thought it was the end of Aug but it was the beginning of Oct. I was home for a week or so before going back to the hospital for psych. I spent four weeks in the hospital on the psych unit. I got really good care there. I learned my top surgery was postponed and I was very, very devastated. It was good that I was in the hospital because if I wasn’t, I probably would have ended my life right then. I was so angry and frustrated as I didn’t have answers and had to wait for them. I had no access to my phone so I didn’t have the usual supports I have when I am home. It was extremely frustrating. The staff tried to help me but all they could do was sympathize with me. There was only one LGBTIQQ staff person on the unit and even she couldn’t really understand my predicament.

I have an appointment next week with my pcp to get medically cleared for top surgery. I really hope this conversation goes well. It will be the first time meeting my new pcp as a fully conscious being. The first two times I met her, I was still in the confused, delusional state. All I could do when I met her was blink my eyes and nod yes or no.

I am having difficulty writing in a constant stream of consciousness. It has taken me two days to write three hundred words for this blog. My thoughts are still hard to write with everything that I have been through. It was really difficult in the hospital as I really lost the ability to write. Writing has always been a coping mechanism for me and when I couldn’t think to write, it hurt, literally. I would get these headaches that felt like my brain was being crushed. It literally hurt to think. I got several migraines while in the hospital. I would wake up around 0330-430 every morning with severe migraines. It was terrible. The trauma of everything I went through was very difficult to process. I had become catatonic at one point.

I am still feeling wicked depressed and anxious at times. I am off all pain meds and off my Ativan. It is weird not taking meds around the clock like I once did for years. Now I just take it a few times a day as I am taking my blood pressure med three times a day and take the Latuda at dinner time. It makes me tired and I often find that by 1900 I am sleepy. But that could be because I have been waking up before 0500 most mornings. I find it hard to get back to sleep with these early morning awakenings. I am so much clear headed now than I was in the middle of October. My memory is still not there on what transpired the six weeks I was on the medical floor of the hospital. I just have these weird dreams/delusions that sometimes intrude in my head. One day while in the psych ward, I was flooded with memories and couldn’t make sense of things at all. The anxiety it produced was terrifying. I was convinced I killed my mother and a bunch of weird shit around my house. Taylor Swift music got me through a lot of the anxiety but while in the psych ward, I didn’t have my music to calm me so it was very difficult to cope. Now that I am home and have music again and my laptop, I am coping so much better. I am reunited with my online friends again and it feels so good because I was missed so much. I have missed blogging so much. I regret that I didn’t write before now but it has been hard finding my writing voice again. It has been a real struggle.

In closing, I am going to try and write a blog a day like before, even if it is less than 500 words.