Tag: psychache

ASAD: Acute Suicidal Affective Disturbance

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide, suicide attempt

ASAD: Acute Suicidal Affective Disturbance

http://www.mdedge.com/clinicalpsychiatrynews/article/100017/depression/aas-acute-suicidal-affective-disturbance-proposed

I read the above article with interest. One of my Twitter buddies shared it with me and wanted my opinion on it. I think that it is right on queue and I hope that Dr. Joiner eventually sees this as a diagnosis. But I worry that if the stigma of suicide is not dealt with, it might just be an admitting diagnosis and thus cause more harm than good.

According to the criteria lined out, I meet this diagnosis, though at this time, I am unable to rule out whether a medical condition or conditions exclude the diagnosis. There have been many a times that while I am in excruciating pain, this condition is activated and I am acutely suicidal. The only thing that has saved me from actually making an attempt on my life is that I physically cannot walk and have refused to kill myself in my own home. Then in the morning (most of these attacks have occurred in the midnight hours), I no longer feel so suicidal.

It used to be that what I would call a “switch” would be activated and I would be suicidal until I fell asleep. Now I know that it’s this disturbance that occurs and it makes sense to me. But in every suicidal occurrence that has happened over the past two years, it has been because of physical pain or some kind of dissociative state brought on by physical pain. Very rarely has it occurred solely with psychache or psychological pain. Granted not every episode is psychache free and physical pain free. I will have what Shneidman calls the three Ps, Psychache, Perturbation, and Press as well as physical pain that causes me to be severely suicidal. These nights, I swear to myself I will end my life the next day when I can walk again. Fortunately, I don’t feel as suicidal the next day because I had a few hours or more of respite from these kinds of pain and perturbation. That isn’t to say that I won’t be activated the next night or come up with a suicidal plan to end my life the following day. These plans are usually a few weeks away to give me time to think things over and essentially put off today what can be done tomorrow. These plans have also given me time to work through my feelings and usually by the time that date comes, I no longer feel suicidal enough to go ahead with the plan.

Suicidality is a tricky business and not everyone’s suicidality is the same. What triggers my suicidality might not trigger someone else’s. There are mitigating factors that might be similar in nature like the criteria states but I would love to see the data in the context of ruling this a diagnosis. Just because I find this disturbance fits my suicidality, doesn’t mean that it will someone else’s and that is the difficulty with the nomenclature I think Joiner talks about in his article.

a depressing blog

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

A depressing blog

***Warning may contain suicidal ideation so if you feel like you are a fucking hero, do not read. I am writing to vent my feelings not ACT on them.***

This morning when I woke up, my hip was in awful pain. I figured it was because of the way I slept and took a pain pill. Then I went back to sleep only to wake up a few hours later to my med alarm beeping. I had to take my blood pressure medication, which I didn’t take yesterday because I woke up too late. I couldn’t miss two days in a row so I got up gingerly. My hip and ankle fought me in protest. Happy Monday to me.

I have been in a dark mood. My mood is low, only made lower because a couple of friends of mine hit the guilt button today. I made a cake and they wanted some. Problem is they are on the Cape and I am not. How I was to get them my cake was the problem. So it got eaten and they got mad. I greedily had the cake for breakfast as I made my coffee. There is one slice left, which I will have for dessert or lunch. I haven’t decided. I don’t even care if I eat real food today. I am in a rotten mood.

One of my bloggers, who I love, commented on a password protected blog. I know she means well and all but it got me angry. I wasn’t angry at her, but myself. I have failed myself, some how some way and the only way to rectify this is to end my life. Then I was going through Twitter as I am sorting through this anger I am feeling, and lo and behold a psych article is published saying placebo pills help pain when the person knowingly knows this. WTF. You mean to tell me I need to take a sugar pill for my pain? Hold the phone. I will take the last week of my birth control pills (those are sugar pills) and see if they help the intractable pain that I feel every fucking night. Fucking idiots. I wish it was that fucking simple.

This study enraged me to no end. It’s just the fuel that the idiotic DEA and senators need to stop manufacturing life saving opioid medication to those in need. Here just take a sugar pill and you will be fine. I really don’t want to be around when that shit hits the fan. This further exasperates the idea that the pain is all in your head mentality. Even as we speak my ankle is throbbing pretty darn good. It must be in my head that is making it that way after all this time. After all, there is nothing structurally wrong with my ankle. It’s picture perfect, minus a little swelling here or there. And I need to live for this bullshit? For what? Why must I endure more pain and agony every day/night? I will try the sugar pill experiment and let you know how it goes, though.

My mother called a little while ago. She wanted to know if I was going out. No, I am not going out. Why she asked. I didn’t have the time or patience to tell her that I am in a rotten mood and that my colon might explode after all the stuff I had to take to go to the bathroom. That I felt like killing myself and that I just want to be left alone. That my ankle and hip were competing in pain and they haven’t decided which one was going to win today. So I just said because I am not going out in my irritated voice. She got off the phone.

And now the tears have started for whatever reason. I just feel so damn rotten. I know the grief of my father is in there somewhere. I woke up with him on my mind this morning. I still find it strange that I haven’t heard from him and then I realize why and it hurts. Doesn’t help that I painfully went through my April blogs documenting his death as well as my horrible depression that I am still in. I might not have the physical symptoms of depression anymore but I still have the mental. I don’t think I am ever going to recover from this episode. It has gone on for far too long. Just another nail in my coffin.

I had texted my therapist at noon asking for a session if it was possible. I got no response so I just texted her saying forget it, I will just deal with her tomorrow. I get to see her in person and give her my cake that I made over the weekend. I will be getting a Zipcar to see her. This will make the third week in a row that I have seen her on a Tuesday. I just hope my hip is better by tomorrow and I can walk without pain. It will suck if I have to cancel the reservation. I have decided to have her fill out the paperwork for my LTD as one of my diagnoses for disability is depression. It says physician to be filled out but she is one of my attending clinicians so if they don’t like it too damn bad. My physician doesn’t know me from Adam and I can’t let her fuck this up. It’s too important.

I really wish you could just end your life by wishing for death. It would be so much easier than having to plan your death out, make suicide notes to try and comfort those left behind. To answer the “why” you leave behind. I wish I didn’t cause people pain when I leave but I must leave. I can’t go on suffering mentally and physically anymore. It’s too exhausting. It’s not today or tomorrow. It will be within a month or so, unless the sugar pills help me.

Psychache Unreal

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders

Psychache unreal

I was listening to a few of my favorite songs and then psychache hit. Psychache is the emotional pain that you feel when basically every thing sucks. I was thinking about my father, the Sox, and other stuff and the psychache just became unbearable. I feel like I should take something for it but there is nothing for me to take. Pain meds, even Tylenol, are useless. Doesn’t help that my ankle is throbbing. Nothing like it was last night but I just noticed that it’s swollen and painful. Not a good sign.

I hate when my heart feels like it is being torn apart. It’s the worse feeling in the world. I had a temporary break when some things on Twitter and Facebook made me laugh. One was about a great dane that was trying to escape his house through his skylight. The picture was really funny. The second one was about Pavlov. It was a psych joke that really had me busting out laughing. I don’t remember how the joke went. I am never good at remembering jokes. I usually tell them in the wrong order.

I don’t really know why I am hurting so badly. Sure the sox season is over and I am still grieving for my father. I just feel like that has been old news for a while and why should it be bothering me tonight? I have been thinking of suicide again. While I was typing up my previous blog, I read about the treatment for BDD (body dysmorphic disorder). The article said that CBT is effective in treatment in most patients. Great. Another thing for me to have CBT. There is a book on it but I don’t plan on getting it because I just ordered one for managing chronic pain. I will have three books on CBT, all on various conditions. I don’t really believe I have BDD. Maybe some symptoms of it but not the full disorder. One of the examples they gave was about a person who felt there nose was crooked and people were staring at them. I don’t feel that way. I just think I am ugly and every body knows this. They know I am fat because I am definitely not skinny by any means.

Growing up, I was always compared to my cousins who were thin. They always said to me, why don’t you be like so and so. I couldn’t because my father kept calling me fat so I felt like I had a reputation and permission to be fat. I couldn’t let him down. And because he called me ugly all the time, I just assumed every body else thought so too because he was my world.

I had a surprise when I came home today. I found out I had leaked urine in my pants. I stunk really bad. I was so embarrassed. I changed and felt immediately down. I guess my mood has been sinking since then. It’s so tough because I never know when I am full and lately between all the meds I have been taking, it’s been hard to pee some times or know when I am full. Plus I haven’t been drinking too much so that just makes things harder and stinkyer. It’s because of my nerve injury that I don’t have a sense of my bladder like I used to. I lost it back when I got it the second time around 10 years ago. I always feel a loss of dignity when this happens. You would think that after 10 years I would be used to it by now but I am not. It still hurts my pride. It makes me feel ashamed. It really sucks.

Is it possible to be happy while being horribly suicidal?

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide, suicide attempt

Is it possible to be happy while being horribly suicidal?

Today while waiting for the bus, I was listening to my music. It wasn’t the normal playlist I usually listen to but I was playing all my songs in my music file. A few songs came on that I really love and I caught myself singing along and just feeling happy. It got me wondering what the hell was going on because the past few weeks I have been so suicidal. Hell, last Friday was my death date that I didn’t go through with and yet I still feel the urge to end my life. Yet here I was, singing along to the music like I didn’t have a care in the world.

I know people feel relieved once they make the decision to end their life. It’s like a burden is no longer on their shoulders. That the tasks that were impossible are now possible because things are going to end soon for them. I know this because I have felt it. I have gone through it. Yet somehow, some way, I have managed to survive the death dates and the horrible suicidal thoughts that have plagued me since I was young. My therapist calls me the exception to the rule. I some times call myself a coward for not going through with my plans. After all, I always keep my promises to other people but I never have been able to keep a promise to myself, and that include ending my life at some future date.

I wonder if I have finally lost my mind because I was happy this afternoon. How is it possible to feel joy and happiness after a suicidal episode? It didn’t last too long. Just for a few songs and then I started thinking about writing this blog because I think it’s important to talk about. Suicide claims over 40,000 lives each year in the US alone. Today happens to be “World Mental Health Day”. So I find it even more fitting to talk about suicide.

I’m not going to talk about statistics and data that I could bore you with about suicide. I have just my experience and knowledge that I have learned since studying about this epidemic the past 8 years. When I am not suicidal, I try to learn as much as I can about the treatments for it because it might help me through another episode. There is a lot of research out there. The top ones are CAMS, CBT, and DBT. I have given DBT a try and didn’t like it. That was more than 17 years ago and it has evolved just like CAMS has evolved over the last 25 years.

CAMS (Collaborating and Assessment of Managing Suicide) was developed by Dr. David Jobes and is by far, in my opinion, the best way to manage suicidal episodes. It is comprehensive, easy to administer and score, has a treatment plan, and doesn’t involve more paperwork than regular clinical administrative stuff. That is what I love about this tool. In it you use the forms called the Suicide Status Form to assess suicidal plans and also develop treatment strategies with the client instead of for the client. It’s a collaborative approach because everyone’s suicidal episode is not the same. What causes me to feel suicidal is not going to be the same for the next person.

Brief Cognitive Behavioral Therapy (CBT) has been shown to help those with suicidal thoughts and attempts. It can be used in conjunction with CAMS after assessment has been made. It’s important because this therapy helps with the cognition of suicide better than any other treatment. See the work of Craig Bryan for more information about this.

Despite my happiness lasting for a few moments in time today, I still feel a little content, which is better than I have felt the last few months. I don’t know why this has changed and I hope it’s not the bipolar in me shifting to mania. I always get worried when I am not depressed because it is what I am so used to. But I will take it. Tomorrow maybe totally different than today. Hell, tonight might be totally different than what I feel right now. But I don’t feel like taking my life today, and I think that is a good thing.