Tag: psychache

Saturday Blog 27: Struggle with Suicide and Bereavement of Others

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

Saturday Blog 27: Struggle with Suicide and Bereavement of Others

I will never again go to the Square on a Saturday! I got stranded there because there were no buses to take me home. I waited two hours and Twitter was no help in finding out why or the public transportation system for that matter. I had gotten a text saying severe delays due to traffic but not that there would be no service to the Square. I was so pissed. I hadn’t eaten anything but a bag of chips so was starving when I came home. I was lucky my sister was home and could pick me up. Then I got a migraine that just made things worse. So I am writing this blog a little later than usual because of the migraine.

I watched this video about “Life after Suicide”. It really made me think about the people I would be leaving behind and the affect it would have on my “kids”. It also made me feel grateful that I can talk about my suicidal feelings with my therapist and psychiatrist, openly and honestly. I think that if I kept those feelings to myself, I would probably act on it. It helps to hear my therapist say that she would be devastated if I went through with my thoughts. I don’t know how my psych would feel. Probably the same as I have known her for over twenty years. The thing is, I don’t want to live. I had made a decision with myself when I was young to take my life so I wouldn’t be old. Here it is twenty plus years later and I still struggle with suicide. It’s like it gets bashed around, deeply thought about, planned, and just never happens. I haven’t made a suicide attempt since I was eighteen and then I spent two and half months in a psych unit at the local hospital. I had met a psychiatric resident who believed in me and we worked together for three years. It was the most stable relationship I ever had with a professional, aside from my current therapist. I was still in and out of psych hospitals. When I was first hospitalized, I was damned if I was going to end up like the people around me. I was in a lot of psychological pain that I wanted it to end. Even though that pain has subsided somewhat, I still think about suicide. I now suffer chronic physical pain and it keeps the thoughts swirling around in my head.

In the video, the woman who talks throughout it says that you need to talk about suicide. In London, they have a place called the Maytree where suicidal people can stay for up to five days to deal with their crises. It is run by none other than a suicide attempt survivor. I have no idea if a place like that exists in the US. I know in my town, there is something called a residential place that is similar to what they were talking about. It was so long ago, I forget the criteria for going there. I know you had to be a part of the Department of Mental Health system to go to it. I was so ill then. I didn’t stay at the place. It was run down and dirty looking, nothing like the Maytree. But it was an alternative to the hospital. I don’t know if they exist anymore with budget cuts to the mental health system. They closed so many psych units in the last twenty years. Even the world famous McLean Hospital isn’t what it used to be.

Also in the video, there is a segment with Dr. Rory O’Connor (person that I got the video from) that talks about entrapment and how a suicidal person often feels trapped and feels the need to escape. This is often true. I feel trapped because of the guilt I would place on others by my death. I die and others feel hurt. In the meantime, I am left to deal with my own suffering that no one else can feel. How is that fair? And don’t dare tell me life is unfair. I know that already, I live with it every single day. I pissed and crapped my pants today and didn’t know it so don’t bother telling me that life is unfair. Another misery that I have to deal with and don’t want to. Dealing with the physical pain is one thing; it’s quite another to deal with your bodily functions not working right.

Throughout the video, I thought about my friends David and Melinda, who lost their significant others by suicide. David lost his fiancé almost six months ago. His fiancé was my friend Chris. I had felt guilty about his death because I am so involved with suicide prevention and yet I never reached out to Chris. I never knew the demons he was facing. He was always a stand up guy and looking at him, you never knew he was depressed. He hid it well. We will never know what made him take his life. David has been open about his grief on FB and it has been one of the reasons why I am still here. The grief he feels is so palpable it hurts to watch him go through it. Chris was the first friend of mine to die by suicide. I have had other friends die, but not like this. It is a unique death that no one can understand or make sense out of.

Review: Development and Prelim Validation of a Scale of Psychache

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

Review: Development and Preliminary Validation of a Scale of Psychache
Holden, Mehta, Cunningham, and Mcleod, 2001 Canadian Journal of Behavioural Science

Suicide kills more people in a year than auto accidents and cancer combined. It is currently, the tenth leading cause of death in the United States. What can be done about this? Researchers in Canada have developed and validated a scale to detect the suffering associated with suicide. This suffering is called psychache. It is the unbearable pain, intolerable despair, guilt, angst, and anguish one feels when contemplating suicide. This is based on Shneidman’s work, “Psychache as Suicide”. He is the father of suicidology and believed that if one does not have psychache, one will not die by suicide.

This seminal paper by Holden et. al, is fantastic. It gets to the heart of suffering people and can also be used as a gauge of whether treatment is decreasing psychache or not being helpful. In my experience using this scale, I have found it helpful. It really states what the therapist needs to know to help the client work on the issues surrounding suicidal ideation. The scale is easy to administer and doesn’t take long to tally up the numbers in a session to give a numerical value to psychache. The higher the number, the more likely the client is thinking about dying by suicide. The lower the number, the lower the risk.

In this paper, the authors did two studies. One to measure the validity of the scale and the other to cross validate the study using the same sample. In addition to the Psychache Scale, the following measures in the first study were given, in order, the Beck Hopelessness Scale (Beck et. al 1974), the Unusual Thinking Scale (Mazmanian et. al. 1987), Reasons for Attempting Suicide Scale (Holden et. al 1998), and the Suicidal Manifestations Questionnaire (Johns and Holden, 1997). There were 294 participants, mostly women (76%). Of these, 197 reported suicide ideation at some point in their lives, 46 thought about suicide in the past four weeks, and 30 participants reported at least one suicide attempt in their life with 21 attempting within the previous five years and 8 reporting multiple attempts. The mean age was 19.1 years (SD 1.6). No racial or ethnic data were collected.

The study found that the psychache scale appears to be reliable and valid in measuring deep psychological pain. It also seemed to be effective in weeding out those that are suicide attempters versus non-attempters.

The second study focused on the childhood abuse exclusively on the women. It was found that the scale was reliable and replicated the previous study in determining psychache.

The Psychache Scale is a thirteen item self report written to be responded on 5 point scales ranging from either never to always or from strongly agree to strongly disagree. It was originally longer than thirteen items but after trimming down the essence of psychache, the scale was finally brought to be a thirteen item report.

What I love about the scale is that it is very easy to spot suicidality. From my own self-report, I have found that the first 9 items focused on my psychological well-being. If the number was great or at its max, I was doing poorly. The last four items dealt with suicidality. It, in my opinion, states how imminent suicide is on the client’s mind. Taken together as a whole, you can monitor treatment goals and see if that decreases the numbers. The lowest to score on the item is thirteen. The highest sixty-five. My interpretation of the scale is that if the number is lower than the medium (33), the person is not in danger, unless the last four items equal a twenty, which I doubt will happen. It will depend on the measurements of the items to determine suicidality. The items themselves will provide clues to the client’s mental state. See the article to see the items.

Can’t Die Without Explanations

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

“One can’t die without explanations”. Fyodor Dostoevsky p 513, the Idiot

This statement struck me tonight, in more ways than one. I think, this is the purpose of Hyde, to explain my death to people so they know of my suffering. I am very tired at the moment. I just woke up from a short nap and now I am in pain because I almost fell while getting up off the toilet. I lost my balance and fortunately, sat back down, but harder than I would have liked. My left knee didn’t like it much. I woke up with it hurting me. But once I started moving, the pain went away. Mysteriously as it came. Until I nearly lost my balance. Weird.

My back is hurting and I don’t like it. I can barely sit up. I keep thinking about death. I don’t want to live anymore. I know I have said these things time and time again, but it’s true. I don’t know what I am going to do when my date comes in the next few weeks and I am left all alone with my thoughts. If I don’t kill myself, it will be a defeat. If I try, at least I can say I tried. I won’t know if I succeed if I don’t try.

The quote is from a character in the Idiot, Ippolit, who has consumption (TB or Tuberculosis) and is in the last stages of the disease before death. He has been given just three weeks to live and keeps on telling people that he must tell his “confessions” before he dies. I feel the same way, though I don’t feel there is anything to confess. I have not done anything wrong. I just feel like a lowly human being that deserves to die. I am tired of the mental anguish I suffer day in and day out. I am tired of my physical pain that prevents me from working and “having a life worth living”. Today I drove and it cost me pain in my ankle. I don’t know why. I always feel this pain while driving/sitting for too long. It is a pain that starts at my ankle bone and goes into my foot. The pain is like a wrap that no one can see but I feel. They say it’s the peroneous tendon that is inflamed causing this pain. If you look at the skeletal structure of this tendon, you can clearly see how it goes from the ankle to the three damn toes of the foot. That is where I have most of my pain. The last three metatarsals in my foot. It haunts me like it does now. And I am in severe pain.

Aside from my transgender issues which will never be resolved, I have body image issues that are distorted. I am ugly, yet people have told me I am handsome and sometimes, cute. I don’t feel this way. I feel like I am very ugly that I will break a camera or mirror if I look into it long enough. I have a negative self-image. I can’t stand the way I look or how my body feels. I have a self-loathing so deeply ingrained in me that I doubt my therapist can ever get to the bottom of it. Having breasts is just one of the reasons I self-loathe. I cannot stand myself. I really want to die. I don’t want to breathe anymore. It hurts to breathe. I tell my psychiatrist this and she doesn’t think too much of it, about the hurting to breathe. But then, there is nothing she can really do about it. I am not in distress. My skin color isn’t blue. I am oxygenating very well. There are no obvious signs that there is a weight on my chest, unless you count the things that are there (breast tissue). But every woman has them and they don’t cause interference with breathing. No, I am not saying there is something pathologically wrong with me. I know that this heaviness is this depression that I feel. It makes everything heavier than what it should be. Probably why my knee hurts. It can no longer carry the weight that I have put on since my last hospitalization. I have tried to lose this weight but it is difficult. I eat the wrong things. But I eat the things that make me happy, like cheeseburgers, bacon, and ring dings. Not all the time. Just once a month when I get paid and can afford these things.

These things taste good when I am feeling up to eating them. Lately, my taste buds have failed me and nothing tastes good. I eat only because I need to, though I don’t enjoy it like I once did. Nothing brings me joy or pleasure. Used to be that I have a mocha from Starbucks and that made me happy. Now it just tastes like sugar and I don’t even taste the espresso like I used to. I feel like I am wasting my money on this drink. Maybe it’s time to try espresso by itself, but I am a creature of habit. I order the same thing all the time. It’s hard to break from that.

Today I was thinking about my diagnosis. Used to be that I had recurrent major depression, with psychotic features, NOS. Now I am depressed but it’s not under the same classification. Not that I need to know what it is. I don’t really care, but I would like to know if it is a bipolar depression that I am suffering. I had highs a few months ago, back in February. Those were lovely, though a bit terrifying. I am not used to feeling up. I am used to feeling down all the time. And this time I have hit an all time low. I think about death constantly and when I am not, I am dreaming of funerals and wakes. I often wonder, if I do have a wake, who will show up. I doubt I will get the same sympathy as a friend of mine who died from diabetes. People who die by suicide don’t get the same sympathy as other who die by illnesses. But that is a debate for another day.

My explanation of my death is this, I am tired of hurting, both physically and mentally. Physically, my pain is well controlled, though I still hurt every day causing me to be on medication to control it. Mentally, there is no medication for me. Sure I take my mood stabilizer and anti-psychotic pill to ease those symptoms caused by the bipolar and psychosis that I have. But it doesn’t help the mental pain, the psychache, the deep down to the bone ache that no one can see or feel. I have been struggling with this ache since I was 8 years old. I am tired of fighting it every single day. 32 years is a long time to be fighting something that no one else can feel or see or measure even. There is no test that my pdoc can give to see where it lives, where it abides. Sure, I know there are measures out there but no one uses them. My therapist has stopped using the psychache scale. I have even stopped using the psychache scale, not because it wasn’t effective, but because it just was a number that couldn’t be brought down. It was up and it stayed up, until my crisis was over. This time, I don’t think my crisis is going to be over. Hell, I don’t think I am going to last that long period. What the hell am I waiting for?? Why can’t I go through with it tonight. Fear. And that I don’t want my family to find my body. It will be hard to be dead by suicide. Harder still and more traumatic to find my body. I don’t have a place I can go to end my life. And that is really sad. So I just sit here and complain about why I cannot go on living knowing I can’t take my life because I have no place to end it. And that is the funny thing about my therapist and psychiatrist. They have never asked me how I am going to do it, where, when. I just tell them I am suicidal and they just leave it at that. They never know what my plan truly is.

Sunday Blog 4

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

Sunday Blog 4

I had a crappy night sleeping again. I woke up around midnight and didn’t go back to sleep till around 4. I hated it. Then my phone decided it was going to beep every few minutes after nine. It was stupid text messages from the T saying that this and that bus was running late. I don’t fucking care. I am not using the system today! But there is no way to stop the messages from coming in, unless you totally want to stop the service. And I don’t want that because I need to know if my bus or train is delayed when I need to use it.

Since getting up late, I have been doing nothing but eating. I had some pop tarts for breakfast and then I had a steak for lunch, two hours later. I haven’t eaten anything heavy, just some cookies and pasta salad but I feel empty. I don’t know if it’s emotional eating or what, but I hate it. The steak I had was a decent size piece. And I ate it all. It was very good. Now my brother in law is calling asking if I want some of his pork. I declined, politely.

I didn’t think I was going to blog today because I am so sleepy. Sundays are really my down days because I don’t usually have anything planned. I filled my med box for the week. I also got my Otterbox but can’t figure out how to get the sucker open to put my phone in it. It is really annoying me. I think I got the sucker on right. It is the right case and the buttons work so I am happy. Now I can relax on dropping my phone, accidently of course.

I realized last night that I never finished the review of the psychache scale that I started. I guess I really dropped the ball on it because I even forgot what the name of the document is called. I don’t know when I will get back to it.

Yesterday, I put up some lyrics about how I was feeling at the moment. The song was by Blake Shelton and the song was called “Don’t make me”. One of the lines was something like “If I am gone, I’m gone that’s that”. I normally write these on Twitter because I don’t get any back lash. Instead I wrote it on Facebook and OMG the responses were so serious. Fucking A. It was like I was writing a goodbye note or something. I hate it when people don’t get lyrics. Course, no one listens to the music I listen to, so it’s no wonder they are clueless. Just pisses me off when I have to explain things.

It’s like when my psychiatrist wanted me to write some code about my midnight writings to her. She felt that might help ease her anxiety about my darkness. But honestly, I am never aware of what I am writing in that state of mind. I am most of the time in a dissociated state. And really wonder if it really happened when I wake up the next day. There is no way I can put in a code word because I am not “with it” to do it. I know that she would like that but I am not there. And now I have to keep my phone on in case she does call me when she reads my writings. I hardly shut it off anyways, but it would be nice to shut it off once in a while. Like this morning so I wasn’t interrupted with text messages! There is a “blocking” feature on my phone but I am not sure how it works. I can set it up, in theory, to let only certain people call. I probably need a tutorial on it from the Sprint store so I don’t mess it up. It would suck if I blocked the wrong people, like my psychiatrist or therapist!

Ankle has been hurting today so I have not been in the best of moods. I am so tired of dealing with pain all the time. Normally, I can handle it. But when my sleep is off, I am more sensitive to it and it messes with my mood. It’s just another thing that I just can’t handle. It’s just an annoying kind of pain today, nothing that I haven’t experienced before. It is just annoying the crap out of me because I haven’t done anything to really warrant it hurting me. I have been sleeping most of the day so I don’t understand what its problem is.

My therapist still wants me to see her. I am going to try and take my sister’s car Tuesday after my father’s doc appointment and go to her office. It all depends on if my sister needs the car or not. I am hoping not.