Tag: psychache

Mental and Physical Pain

by Midnight Demon, posted in cauda equina syndrome, CES, Chronic pain, chronic physical pain, depression, mood disorders, psychache, suicide, writing

I’m up in pain and listening to Casey James. I love his music and guitar playing. I think the guitar is the best instrument to listen to when you are in a bad mood. It just does something to the brain. Or maybe I just like it because I like it.

So I am in pain tonight because I did too much today. Can’t do stuff that a normal person can do like go up and downstairs, put a bookcase together and then carry it up the stairs even though it wasn’t that heavy. I plan on getting a bigger one, maybe a six shelved case. That ought to be able to get my stuff off the floor. Right now my new book case is half full and I haven’t even really started putting stuff in it yet. My “bible” of suicidology books doesn’t fit in it so I am going to have to put it in the bookcase in the hallway.

I wish I could do things that I used to be able to do without pain. My left foot feels like it is being stabbed repeatedly. In addition to being stabbed, it also feels like it is going to snap if I move it the wrong way. Oh the joys of nerve pain. Always changing. It never is the same night after night. Makes it interesting and then when you go to the doc you have to explain to them that the pain has changed. No you no longer have a barbed wire across your ankle, you just have a constant drilling feeling. Sometimes I think the doctors think you make this stuff up just to get drugs but without the drugs, I would be a suicidal nightmare. It is bad enough that I want to cut. But that I because of another issue.
My back is aching like I did manual labor for hours. I can still move but I know I will probably be a little stiff tomorrow. I will do some of my exercises to loosen up the tight muscles before getting out of bed tomorrow. That is all that I can do to prevent a relapse. If it hurts too much I can always drug myself to obviation.

I thought that would happen by now but I still have some words left in me that I have to get out before succumbing to pharmacology. I am hoping tomorrow I get my hair cut. It is getting pretty long and I don’t like it long. I especially don’t like it when I have wisps of hair sticking out of my ball cap and glasses. It is driving me crazy but my cousin has assured me that tomorrow afternoon he will cut it, though he didn’t call tonight to confirm.

Did I tell you that my foot hurts? My ankle is having weird pains and my leg just is on fire? I can’t win tonight. Why am I in pain other than the fact that I did too much today? Why does doing too much bother me? No it’s not because I am fat and lazy. Its because I have been left with a nerve condition known as Cauda Equina Syndrome, CES for short. It’s when the horse’s tail part of your nerves get disrupted because of a trauma or disc material gets embedded in it. In my case I had this syndrome twice due to a disc rupturing. I have had four back surgeries, 2 at different levels. If I had them closer together I might have needed a fusion and then I would be permanently out of work forever. Right now I am out of work on disability. Mostly because of mental reasons. I also suffer from mental illness as I constantly want to kill myself every day for this reason or that but I am forbidden to do it. I just can’t muster enough courage to end my life. I constantly wish I was dead just so I wouldn’t have to deal with my physical or mental pain. Right now I am just dealing with the physical. But throw in some mental pain and I am ready to be committed and that is no fun.

I wish I had normal control of the lower part of my body again. But I don’t think it is ever going to happen. If anything this pain reminds me that 12 years ago I messed up my back due to a chiropractor. She adjusted my spine and my disc responded by exploding. It left me with something called foot drop and I have been in trouble with my left foot/ankle/leg since then. I get tired easily. I can’t walk long distances like I used to. My foot will just become weak the more I try to use it. It sucks. And I am only 37 years old. I don’t know how I got to be this old but I know I won’t make it to be 38…

why i think about suicide

by Midnight Demon, posted in Chronic pain, chronic physical pain, depression, mental disorders, mental illness, mood disorders, physical pain, suicide, suicide attempt, transgender

Suicide is the ultimate escape. The place you can go to when all seems and feels hopeless. I often think about killing myself at least twice a day or more if I am feeling really hurt and hopeless. Pain is another reason I think about suicide. Pain can be either physical or mental for me. Mostly these days it’s mental. I do not like myself. I loathe myself to the degree I would rather be dead than live this way. I hate the way I look. I hate the way my body is. I am ugly and disgusting and no one can tell me otherwise. My therapist says that I have a form of body dysmorphic disorder because I loathe myself so much. It’s just another reason to kill myself. Another reason to end my life.
Yet despite all this loathing and self-hating and pain, I’m still alive. I’ve come up with a date to end my life. I have decided that 38 years of living is long enough, or close to it anyways. I try not to think about it I try to think of now and live but its just too damn hard when you have to force yourself to breathe everyday. Sure the lungs work automatically but to actually breathe freely without this elephant sitting on your chest, that is what I am talking about. I used to say weight on the chest but what is that exactly. Not very accurate visually. Unless you have been to a gym and know what a weight is and looks like, most people don’t know. An elephant is easier to visualize and imagine better.
Right now I am at a café in a bookstore in Harvard Square. I bet no one knows that I am suicidal. They just see a guy writing in a notebook, drinking a lime soda. That what kills me. The invisibility of it all. These thoughts are mine and mine alone, unless I speak of it like I am doing now. No one knows. No friend or family member knows except my therapist and psychiatrist. Sometimes guilt will make me not want to commit suicide. I feel bad because I have worked with these caregivers for more than a decade. MY psychiatrist I have worked with for almost two decades. Yet I don’t but do care how they will react to my suicide. Will their attitudes change? Will they refuse to see other clients who are suicidal? Most will.
My therapist keeps saying I am the exception not the rule. But I am tired of living in constant misery. Misery that only the blog world knows about. I can’t share my misery with others because I have become so ingrained to keep it to myself. I keep it to myself so as not to worry my friends and family members. They wouldn’t understand anyways. My family is not one of openness. I am not blaming them for how I turned out. I don’t blame anyone but myself for my suicidal thoughts. It’s my fault. Maybe if I got help sooner I wouldn’t be this way but that is doubtful, it took me twelve years of therapy to realize what the root of my suicidality was. I was suicidal since I was eight years old. It wasn’t because I was abused (although I have been by multiple family members) but not at that ago. Suicide just came to me at that ago and has been with me ever since. I didn’t like myself back then anymore than I do now. But it was because of reasons I had not thought of. Reasons I could not articulate like I can now as an adult. I realized I was a girl and I didn’t like it. I developed into one an hated it. But I couldn’t say anything to anyone, not even my best friend from childhood because back then you just didn’t say what you felt or what you thought. I would have fallen on deaf ears and it’s not like psychiatry/psychology is like it is now. I have always felt like an outcast and coming out as a “boy” would have further set me into outcast land.
Just like when I thought I was a homosexual, I thought of killing myself. I felt like I was severely psychotic liking another woman. Again I didn’t say anything to anybody, not even my therapist at the time because I was fearful of being committed to the hospital. I already had a few by this point. But I met a fellow inpatient that showed me it was ok to be gay and I’m grateful for that.
My therapist now does what she can for helping me accept being a transgender but part of me always wonders whether one day she will have me committed for these thoughts. And I don’t mean the suicidal ones.
Why am I not in the hospital if I am chronically suicidal? Because I’m not “actively” suicidal. If I was in imminent danger to myself, like I was going to do it right this second, at this very moment, I would be hospitalized, probably against my will.
But at this stage I just feel like my telling my providers I’m suicidal is like me crying wolf. I’ve said this so many times I don’t really think anyone believes I will act on it. Hell I don’t even feel like I will act on it. I want so much to die and though I have made active plans to kill myself, I am still here. I have not attempted in several years now. At this point I wish it could be just a wish that I could be granted at anytime. I sometimes wish I lived in the times of the Ancient Greeks where if you constantly asked for permission, eventually you were granted permission and “allowed” to kill yourself with hemlock. Now the governments of most societies say it’s all part of mental illness and every life should be saved. Now do you see why I am not vocal on my suicide thoughts. I have to keep them secret for fear of commitment. But a hospital stay is not what I need. Being six feet under and pushing up daisies is what I desire. That is truly what I want.
Somehow between my last “attempt” seven years ago, I lost my lethality. I lost the will to truly die. Even though I wish to be dead on a constant basis, don’t get me wrong, I have no will so to speak to truly act on my thoughts anymore. I lost the intensity of my constriction, my narrow minded thinking. Because of this I am still alive though I desperately wish I was dead.

coping skills not working

by Midnight Demon, posted in depression, mood disorders, psychache, suicide, suicide attempt, transgender, writing

I have been depressed for the past few days and my coping skills are not working. Because of this I thought about cutting my wrist but instead I mixed my meds up a bit and slept. I guess you can say that I was a drunk because all I did in the morning was stumble around.
I didn’t plan on doing this I just couldn’t cope with the pain of living anymore. I needed an escape and I needed it badly. I know I could have called my psychiatrist or therapist but most likely they would have said go to the ER. The ER is useless. You wait for hours to be seen because more urgent cases take precedent and because you are not actively doing anything to harm yourself you just are forced to sit and wait. Then when you get put into a room you are searched, made to give a urine sample and might have blood drawn if they think you need to be admitted. Or you might have blood drawn anyways if you overdosed like I did last night. I couldn’t help it. I wanted to cut really bad and I knew that if I did and I needed stitched I would be screwed. Least with OD’g you don’t leave scars. I didn’t OD with the plan to kill myself. I just wanted an escape for a few hours as things have been shitty the past few days. I told my sister that I wanted to be a man. She asked if me if I was sure. I started to break down. Obviously I wasn’t that obvious to my family. I was just a tomboy that never grew out of it. Except tomboys don’t usually wear men’s clothes all the time. This has been the most difficult conversation that I have had in a long time, since I came out as being gay. I refuse to use the word lesbian because I am a male not a female.
I want to be able to tell my family this year because I will be going to a clinic soon as I get the guts to call to make an appointment. I don’t want to start the hormones and then questioning me why I have facial hair. I have a little facial hair now but it’s kind of stupid looking because there is a space in the middle of it.
I just want to be myself. I don’t want to hurt anyone. The only person getting hurt is me because I can’t be who I am. That is why I want to cut, want to OD, want to kill myself. Though I still feel like it would be better to bury me as their “daughter” than as their “son”. My parents are of the old generation. They don’t understand things of today. Much less gender identity disorder or being transgender. Right now I guess you can say that I am just a crossdresser except my damn boobs get in the way of that. How I loathe my boobs. It is one part that I hate the most. I want to look at my chest and see nothing but my pectoral muscles, not breast material.
The biggest question so far that I have had since coming out as transgender is when am I going to have surgery. Are you kidding me? Let me get used to being freely who I am first!! Let me try the hormones first and see how they work. I hate to think of surgery before hormone replacement and most surgeons won’t do it unless you truly have been living as the opposite sex for some time. It is not an easy thing to go through. And mentally it messes with you big time.
I know this road I have been on is the right now. My sister was worried that it is going to mess with my depression. What she doesn’t realize is that part of my depression is not being who I truly am.

Ten Faces

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

April 2008 Poster for the 41st Annual American Association of Suicidology conference

Abstract: I have written this paper to talk about my experience with suicide and how the works of Dr. Shneidman has helped me to find the words to the dark demons that are below the surface. This paper also talks about how I think more clinicians need to focus on the psychological pain their clients feel when suicide begins to look like the only answer to their problem. I hope that by sharing my experiences and introduce the works of David Jobes that there are assessments that are out there even if they do not fit the category of validity.

Presentation:

I began my research into suicide and psychache in the spring of 2006 while taking a psychological testing class. My assigned term paper topic was psychometric assessments or psychological tests which interested me. I chose the subject of suicide assessment/risk because of my past experiences; I had barely survived another severe episode of depression the previous winter. Despite my clouded thinking, I had carefully planned my own death. Researching this paper would reveal what the so-called experts knew about these destructive, echoing thoughts I’d suffered from and what kind of assessments and/or treatments my therapist could potentially offer me during these terrible bouts.

What I found astonished me. Despite finding over thirty articles about assessments and risk factors, not one focused on assessment of psychological pain, or, as Dr. Edwin Shneidman refers to it, psychache. In an article by Ramsay and Newman (2005) states that most mental health providers have little standardized training in treating suicidal patients during clinical graduate work, and, are equally lacking during continuing education. I also found, not surprisingly, that some clinicians, once they realize their client is or has been suicidal, opt to transfer care to another professional, especially after a suicide attempt (Ramsay & Newman, 2005). In another article by O’Carroll et al.(1996), I was dismayed to read that there is no standard definition of what it means to be suicidal.

But the intent of this paper is not to review the literature of the past twenty-years. This paper is to talk about what Dr. Shneidman calls the “human stuffy of emotions, the words of a suicidal person” (1996, p. 6). It is to focus on the three P’s of suicide: “perturbation, press, and psychache”.

In 2004, my illness permitted me a break in the gloom; I gained some insight into my suicidal thoughts. I imagined writing a book about my experiences, hoping it would help someone. Alas, that book was already written, and was entitled The Suicidal Mind by Dr. Edwin Shneidman (1996). Finding this book made me feel discouraged. My therapist encouraged me to write my book based on

personal experience rather than from a clinical perspective. I didn’t go back to Dr. Shneidman’s book or work until a year and a half later, when I was taking that psych testing class.

The terms psychache, constriction, perturbation, and press are vital components of suicidal thinking. The cubic model Shneidman(1995) writes about is the best indication, in my opinion, of how likely someone might commit suicide. When pain, perturbation, and press, the three P’s, are at their highest level, individuals are much more likely to feel trapped. Thus they feel there is no way out. Suicide then becomes the answer they seek to end their pain and their life.

Although I heartily agree that assessments of the lethality of suicidal ideation are important, the one element that has been frequently overlooked is the psychological pain that the individual is feeling. What I have learned is that there needs to be an assessment of psychological pain whenever a client is feeling suicidal or having suicidal thoughts. A good analogy is the following: Think of a time when you had to go to the emergency room because of a physical ache, maybe abdominal pain or a severe headache. One of the tools the clinician might use is a scale to rate your physical pain from 1-10 with 10 being severe. Some emergency rooms have drawings of ten faces with varying expressions of discomfort that children and non-English speaking patients can utilize to evaluate their pain. No such scale exists

in the psych world. Even most psychiatric emergency services at major hospitals do not ask about mental pain. That is what I find so striking about Dr. Shneidman. By asking, “Where do you hurt”, the three P’s of suicide, perturbation, press, and mental pain can be assessed and taken into account of how likely a suicide attempt might occur.

Current research studies by Holden et al. (Flamenbaum & Holden, 2007; Holden, Mehta, Cunningham, & McLeod, 2001) at Queen’s University in Ontario are validating a pain scale that I think is efficacious, especially in times of crisis, and possibly life saving. From my experience of those darkest moments, there are no words for the depth of pain that I feel. Holden and Mehta’s scale (2001)can help communicate how much pain the client is feeling. This scale is essentially a self-report of psychache, enabling the clinician to quantify psychological pain. It can also determine whether that pain is the driving force for a potential suicide attempt. This scale is, in my opinion, the best measure to pinpoint all three aspects of perturbation, pain, and press. As Dr. Shneidman points out, the best source of understanding suicide is through the “words of the suicidal person” (1996, p. 6).

Once the level of pain has been determined, assessment can be tracked through the work of David Jobes described in his latest book, Managing Suicidal Risk (2006). He uses the continuum of

initial interpretation, tracking, and outcome to manage a suicidal client. These forms are called the Suicide Status Form (SSF). These forms have gone through the process of refining to become efficient and use of ease in managing suicidality (Jobes, 1995, 2006; Jobes & Drozd, 2004; Jobes et al., 2004). He stresses that he will do all he can to prevent his client from fulfilling their plan, and he offers the client a more positive way of dealing with these thoughts. Through his work, he facilitates the client managing his or her own treatment, collaborating on what will effectively decrease suicidal thoughts and impulses.

I hope that someday these tools become more widely available to those that want to help the suicidal clients, even if they have not been empirically tested. As Dr. Shneidman once said, “relevance has precedence over precision, and that ‘validity’ does not exhaust the category of ‘usefulness’”(1999, p. 287).

References:

Flamenbaum, R., & Holden, R. R. (2007). Psychache as a Mediator in the Relationship Between Perfectionism and Suicidality. Journal of Counseling Psychology, 54(1), 51-61.

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.

Jobes, D. A., Nelson, K. N., Peterson, E. M., Pentiuc, D., Downing, V., Francini, K., et al. (2004). Describing suicidality: An investigation of qualitative SSF responses. Suicide and Life-Threatening Behavior, 34(2), 99-112.

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.

Ramsay, J. R., & Newman, C. F. (2005). After the Attempt: Maintaining the Therapeutic Alliance Following a Patient’s Suicide Attempt. Suicide and Life-Threatening Behavior, 35(4), 413-424.

Shneidman, E. S. (1995). Suicide as Psychache: A Clinical Approach to Self-Destructive Behavior: Rowman & Littlefield Publishers, Inc.

Shneidman, E. S. (1996). The Suicidal Mind: Oxford University Press.

Shneidman, E. S. (1999). The Psychological Pain Assessment Scale. Suicide and Life-Threatening Behavior, 29(4), 287-294.

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