Tag: psychiatry

finding care in the off hours

by Midnight Demon, posted in depression

Last night I was in the throws of pain again. But my thoughts didn’t immediately turn to darkness Like they normally do. I wrote an email to my pdoc about what has transpired during the week and that I haven’t been faithful in taking the increase in my mood stabilizer for reasons beyond my control. Mostly because I have been driving and I don’t want to be drowsy behind the wheel. I also asked her if there was a hotline number she knew of to call in times of distress. She gave me one.

This all lead me to thinking maybe I should have a blog about this important issue…finding care during the off hours. For most people in therapy, when they are in distress after hours their and before their next session is to seek help in the local ER. This can be costly, as copays have more than doubled to deter such visits. But for mental health, there should be an exception made as there is really no other place to go while in distress. I understand that the cost is higher because care is more urgent and is most likely is trying to ward off unnecessary visits. But when you are in crisis, how can that be unnecessary? For the mental health field, there are no urgent care centers to go to in distress. It’s either you see your therapist or go to the ER (Emergency room). There is no in between. SO what are you supposed to do when you are somewhat distressed and cannot wait till your next visit with your therapist?

There are self-soothing measures. You take a bath/shower, read, journal, brush your hair for 100 strokes, eat something, etc. But when all is said and done, and you still feel terrible, then what? Most therapists have some kind of plan in place, or should be able to give you a hotline number such as Lifeline 1800-273-8255 (US only) or the national hotline number 1800-784-2433 (US only). I have tried calling the Lifeline hotline but have never been patient enough to wait to get transferred to someone. The other number I have not tried. There is also a text # 20121 and you text 121help. I don’t know where I got that number from but when I tried it the other day, it didn’t work. I never got connected to anyone, but that might be because of the hour.

There are chat groups, I am told, where you can discuss suicidal feelings and not be “punished/banned” or turned away. Unfortunately, I do not have that URL to share as I have not looked into that chat room. But when you are in distress, are you really going to google something??

There is something called a Crisis Response Plan that I sometimes use when I am in distress. UNfortnately, the last few times I have been in distress, all of the self-help went out the window and I didn’t use anything. I just ruminated about what I was going to do. It’s not perfect trying to save your life when you feel like ending it. I was not in the frame of mind to seek help.

Therapists think that a suicidal person always calls for help when in crisis and that simply is not true. Most clients become impulsive, wants to get rid of the negative feelings NOW and are in my experience, not likely to reach for help.

For me, writing has helped but not everyone has that option to them. I will blog my distress and might be fortunate to have a few bloggers comment to show support or to chat. But that doesn’t happen all the time. Most of the it’s hit or miss. My frequent blog readers might not be online at the time of my post and so not get it.

Sunday I participated in a chat that was for crisis intervention and I learned that there was a crisis text chat available. The intervention was either through chat or text message. I am going to looking into using this the next time I am in distress or when my mood goes south. It’s not always easy to think of these thing when your mind is thinking of ending your life. To use a DBT term, you just cannot tolerate the distress because it is unbearable.

I have been trying to identify when I am in distress so that I can reach out for help but it’s not so easy. The last few time I have used distraction or music to help me out of the intolerable feelings. I also will write in my blog or my journal but it seems like all bets are off if I am in intolerable physical pain. Chronic pain mixed in with getting my menses and dealing with it has been difficult this past two weeks. The waiting for pain medication to kick in is sometimes not fast enough to deal with mentally.

I wish there was some help I could have regarding physical pain and lethality but there are few pain specialists that deal with mental health issues and fewer still, psychologists that deal with pain issues. Even crisis help lines don’t know hot to deal with physical pain that is behind suicidal ideation. In a perfect world, you would like to see someone that is well rounded in chronic health issues and suicidality. Unfortunately, I don’t think they exist or they may just be too far and in between to help the greater good.

When I was being evaluated at my local pain clinic, I saw a pain psychologist. His job was to help me deal with pain. But he didn’t offer me an real advise the first time meeting him. I would have to set up a series of sessions with him but unfortunately this happened when I lost my car and he is too far out to see. If I saw him with public transportation, it would be a two hour commute, both ways.

The hardest part of being alone with your thoughts is that you are left to your own devices before the next session or when office hours are available. I wish there could be urgent care centers that are specific to mental health issues. Because not all crisis needs to result in a hospitalization. Sometimes just talking with an understanding person is the best treatment mental health professionals can provide.

Don’t Feel Like Talking

by Midnight Demon, posted in depression, suicide attempt

Don’t feel like Talking

I have been reviewing in my mind the last few suicide “mini” attempts that I took over the past several months. I am wondering why I never called for help or called a friend. It wasn’t like I didn’t have a number for a friend I couldn’t call or a helpline or a chat person. I just was constricted into one way of thinking. I needed to escape and that was going to happen. It was my “only” way out. I think I slipped into Mr. Hyde and ran away from help. I couldn’t possibly think that someone would understand the amount of pain that I was in or understand that ending my life was the only way out of the mess that I was in. And it wasn’t truly a “mess”. I just wanted an out that I could count on.

My last attempt was last week. I wrote a blog about it and then fell asleep. While I slept off my drugs, at least three bloggers tried to get in touch with me through various ways. One of them found my personal email, which I am still wondering how in the world they got. I am glad I don’t have my cell phone listed anywhere or it probably would have been traced back to me. But since that happened, I have been scared to write. Scared because I don’t want the police showing up at my door. I have had that happen before and it wasn’t a pretty picture. It was terrible because even though I was in “protective custody” through EMS (the paramedics had already showed up and taken me to the hospital), the police and fire department didn’t know that so broke a window to get into my house. I was freaked out when I heard about this. My family was wicked worried about me. And that was all because I wrote an email to my psychiatrist. My writing has gotten me into trouble. So now I am scared that it will again. I have dissociative episodes. I barely remember sending the blog that night. I don’t even remember what I said, other than taking pills.

I don’t want to stop blogging. It has been a lifeline for me. But I also realize that I need to be more aware of my thoughts and feelings to stop the hurt before I take something lethal. Luckily, I only took a few pills. I didn’t take a bottle. But the question remains, why didn’t I feel like talking to someone before I took them??

I know of suicide prevention. I know of suicide assessments. So why didn’t I use them? I am not beating myself up here. I am just trying to understand what went on inside my head so that I can do something the next time this happens. All that I come up with is that I didn’t want to go to the hospital again. If I paged my psych and told her I wanted to take my life, I don’t think she would let me off the phone unless I had a plan with her to go to the ER. So that option is out. Luckily, through this recent episode, I found a fellow survivor that I can email. I hope that I can email her and talk freely about what I am feeling and what I want to do. That is if I feel like talking. That is the key…talking. To know one’s story. I feel like such a hypocrite because I wrote a book, published it, and then tried to take my life afterwards. Some survivor I am. I am totally unstable and I don’t think I will ever be stable. I told my therapist today, that if I had the chance, I would try again. I am just tired of living. SO DAMNED TIRED. I have nothing keeping me here. My protective factors are minimal. I don’t even know if they exist anymore. I mean, I love my family a little bit but I don’t feel connected to them in anyway. I just feel like I am this stranger that comes out of my room and says hi every now and then. I hardly go out anymore. My life is meaningless.

My therapist is so excited about my book that she doesn’t even want to read my blog anymore. Though my blog readership has hit an all time high lately. I should be proud of that. But I don’t feel it. I don’t feel anything. I am not interested in anything. I got my journal of Suicide and Life threatening behavior today and it didn’t even excite me. One of my favorite suicidologists wrote a paper in it. I should have been all over it but I wasn’t. I had no interest in what the article was about. I am too depressed to care about anything. And I don’t even talk to my therapist anymore. All she wants to talk about it my fricken book. I am done talking about my book. It just depresses me. And I don’t know why. I should be on cloud nine right now but I am not. Maybe I should go back on an anti-depressant. But I am so sensitive to them, they just make me sick. I hate this anhedonia I have been feeling. I hate that worse than the psychache that I have been feeling. I mean, how many times can your heart break and nobody know? Because depression is an invisible illness. No one sees it. No one else feels it. It’s all inside you. And no one feels like talking about it.

time and patience

by Midnight Demon, posted in blogging, mood disorders

Last night I was in excruciating pain. It was terrible. I emailed my psychiatrist that I was done. If my PCP wants me to jump hula hoops he has another thing coming. I am not buying into it anymore. I no longer care what is causing my pain. I know what helps my pain and that should be all that matters. He isn’t questioning my blood pressure medication. Why the hell is he giving me a hard time about my pain medication. I am sick of it. After last night, I swore to myself this was it. It’s the weekend so I can’t do a thing about it. My foot still hurts so I won’t be going out like I had wanted to. It probably would hurt me anyways.

I know I posted a lot yesterday and last night. I got the writing bug back so please forgive me. I have to express myself the best way I know how, by writing.

The President of the AAS posted an article about how the mental health care in the UK is going down the tubes. It’s been going down the tubes in the US for some time now. I know, I have been apart of the system. The hospitalizations don’t care about stabilizing you they just care if you aren’t going to hurt yourself when you leave. And then it is up to incompetent clinicians who don’t know how to deal with suicide and suicide ideation. Most don’t want to change their practice to the new system. Some won’t even attend a seminar about it. I think it has to be mandatory, statewide or they cannot renew their license. That is what I think. If they were to get into a program of CAMS or use the SSF I think there would be a lot less suicides out there for people that want help and this way here they won’t be turned down. But I don’t think there are enough clinicians to do the job. Graduate programs only have a minimum of five or six slots per year. That is a very small number for new clinicians. I also think there should be incentives to work with the population that most needs it. It’s all about triage. But can triage really work in the mental health system? Who is to say that the quiet kid in the corner who is hurting is not the worse off than the one screaming at the top of his lungs because voices are telling him they are going to kill him. I don’t have all the answers. But for those that want help should have priority over those that don’t want help. But unfortunately, those that don’t want help are truly the ones that need it the most. Those are the ones that will end up killing themselves. There is no easy balance. Everyone’s needs are different. And if you shy away from that person, you leave a bad impression about being cared for in that person’s mind.

In my case, if I stopped going to a therapist every time they left me, I would not be here. Sure, when that therapist left it gave me a bad taste in my mouth. But I knew I needed help and so I sought it out. Not every therapist is right for every person. Sometimes you have to go through several to find the one you can talk to the most and won’t be so judgmental, or feel like they are. It took me 11 therapists to find the one that I have been with for more than a decade now. It just takes time and patience to find that right one.

A day at Starbucks

by Midnight Demon, posted in blogging, depression

I’m at Starbucks drinking my Isla Flores. I don’t know what I am going to do when they get rid of this coffee. I like it more than West Java and it is from the same island (Indonesia). It is really hot today so I am glad they have the A/C cranking in here. It’s going to reach 95 degrees today. I don’t like heat. It drives me crazy. There have been studies done on suicide that state that intolerable heat causes suicide, or makes it more prone to suicidality. I know because there have been times I have thought more about suicide on hot days than I have on cold.

I have an appointment with my psychiatrist today. I don’t know if I am going to tell her about my plans. I don’t want to risk going into the hospital. Though for the first time in a long time, I didn’t wake up with doom on my mind today. I slept pretty good. That is the first time I slept through the night without waking up at some early time. I still have my menses and cramps, that are driving me crazy, especially on this hot day. I want to go into a pool and get wet today but that is not going to happen. I’ll just take a shower when I get home to cool off.

I am glad I brought my laptop to Sbux today. I like writing outside of my room. I might work on my book today. I haven’t worked on it in so long. I added double space and it is now 48 pages. I guess that is a good number to start with. There are some things that I’m editing as I go along.

Despite lowering the dose of my antipsychotic medication, I have not had any delusions or bad voices. The voices will ramp up at night to keep me talking by asking questions of my day or come in when I am resting. I hate that. I try to ignore them but they get so insistent. Sometimes it is just questioning how my day is going; other times they question every decision I am making. Why am I taking this bus over that bus, why am ordering this food over that food. You sure you want to do that rather than this. Or they tell me that I am doing everything wrong, some times including breathing. Like is there a correct way to breathe? Seriously. Half the time you are not even aware of it so WTF. Or they ask me why I am doing something, like just now they asked me why I put my sock in my sock and I reply that I don’t want to lose the other sock. I found this method has worked to keeping my pairs of socks together. Less mismatching.

It is like a sauna in my room right now. The ceiling fan is just moving hot air around. While I was at my psychiatrist appointment, I wanted to do a psychache scale. I no longer write the graphs in my journal as right now it just wastes paper as I don’t use it. So I look on my phone. I don’t have it in my files. I check my dropbox files and my google drive, NA-DA. I am pissed. I hate not having my files when I want them!! So now I have to place these documents and the SSF on my drives because I don’t have them. It would be nice to have them in an emergency. Like when I was in the hospital and they needed a safety plan for me to be discharged. I didn’t have my crisis response plan (CRP; see this blog for what it looks like) in my journal because it was a new journal. I didn’t have it written out in a word doc so I had to rummage through my PDF’s looking for it on my phone/tablet. Then I had to write it all out, substituting what my therapist and I came up with the generics of it. That was fun because I had to rush. But what truly pissed me off was that they didn’t even want a copy of the damn thing. They just wanted to make sure that I had one. So sometimes the CRP is useful in hospitalizations and sometimes it is not.