Tag: psychiatry

what to call this

by Midnight Demon, posted in mental disorders, mental illness, mood disorders, psychache, suicide, suicide attempt

“…Our best route to understanding suicide is not through the study of the structure of the brain, nor the study of the social statistics, nor the study of mental diseases, but directly though the stuffy of human emotions described in plain English, in the words of the suicidal person.” (emphasis added)
– Edwin Shneidman, The Suicidal Mind

This statement is very true. How else would you know what lurks in the heart of a suicidal person. I have been there many times. My last episode of depression, if you want to call it that, almost caused me to end my life on Nov 5, 2005. Ten years ago around that time, I was in another severe major depressive episode and tried to take my life then. I didn’t want to suffer any more and decided to end my life on the anniversary of that day, to finish what I had started.
I don’t know what brought me to that point. I first started coming up with this plan some time in August 2005. I had wanted to go in the hospital around Labor Day as my mood was bleak and I felt a need to escape life for a while. I felt I needed to be in an environment that was safe and supportive. I had finally made plans to take off work and go in. I was then in a psychotherapy group. I had told the group leader that I wouldn’t be in for a couple of weeks because I was going in the hospital. The hospital has always been my escape. It was my way of re-cooperating, and a way of recharging my batteries so to speak. But this “professional” thought that I didn’t need to be in the hospital, that I could do this on my own. He thought an admission to the hospital would be more harmful to my pride than saving my life. But he had not clue how dark my thoughts were or how suicidal I was at that moment. Nor did he realize how much “psychache” I was in. He said the words that my “dark side” needed. For the first time in my life, I gave in to it. I was back to living a double life again, one that was deeply full of mental pain and misery that wanted nothing more to do with life and I living life by going to work, school and being ‘happy”. All the while, I was planning my death. I had heard on one of my favorite crime shows that the migraine medicine I was taking could cause cardiac arrest if taken in high doses. A ninety-day supply was all that I needed and I did have that. I no longer wanted to live after that day. If I couldn’t go in the hospital, what other option was there for me?

Looking back, I started to see my collapse. By the end of September, I had my date, my method, and my intent. All that was left to do was to “quit” therapy, get my affairs in order, write a will, and then, maybe, leave a note. I remember going to my classes and sketching all that I had to do before November. It was a month before I was to do it and if all went well, it would work. I had given myself a month to not only think this through, but also to give me time in case I wanted to back out. I had done this many times. During my adolescence, I had read Paul Quinnett’s Suicide: The Forever Decision. He described giving some time between the method and going ahead with it. On many occasions, it worked. But I knew that I was going to go ahead with my plans even if I did “feel better”. I had no rescue plan nor did I want to be rescued. I knew how I was going to do this for quite some time. I had been perfecting this plan for ten long years and finally; this was going to be my last episode of depression. I was no longer going to suffer anymore. No more pain, it was finally going to end.
At this time, with all this planning, I was getting bored in therapy. I no longer had anything worth telling my therapist about. I sure wasn’t going to tell her how suicidal I was. I certainly did not want to be forced to go in the hospital again and wreck my plans. I was making it look like I was “ok” and doing well so that when I would tell her I was taking the last few weeks off in October, she wouldn’t suspect anything. I came up with a game over the course of therapy that I liked to play. The game is called 20 questions, she could ask any question she wanted and I had to answer it, honestly. I am usually an honest person and on the spot, it would be difficult for me to come up with something bogus. I sat there that day and wanted nothing more than to leave but we had at least ½ hr to go. She is a stickler for keeping exactly fifty minutes, each session. We started playing my game and the first question she asked was “what is really, really, really, going on?” I remember I thought it was funny and laughed. Here I was portraying to be this highly functional person, all the while, stuck in such despair and constriction that all I could think about was Novemeber 5th. This was going to be my last depressive episode and I was determined to see it through. But I was shocked that she asked that question. I asked what she was talking about, she told me something that one of her supervisors had stressed during her training: it’s the highly functional depressed person that you need to look out for to be the most suicidal. I didn’t confess to her that day what was running through my mind. My body was still going through shockwaves about what to do. I felt like I had been caught with my pants down or something. I don’t know how I got out of that session without telling her then what was going through my head. I think I passed the question. I felt like I was walking a tight rope after that. The next session, I told her about my plans for November.

She then asked all the “right” questions. She assessed that I was highly suicidal, at high risk. But I didn’t think that I was. My thinking was “rational” even though I now realize that it was completely irrational.

It was now the second week in October and she was begging me to another way out of this mess. I told her that there wasn’t and in my clouded mind, I seriously thought she was going to let me leave so that I could kill myself. The sad thing is that I thought all of this was completely rational. All my thoughts made sense to me. I was in so much pain that I dissociated just to commit suicide. A different “ego state” had taken over as the rest of me just could not tolerate the “psychache” any longer. This episode had made me closer to my therapist than anyone in my life. I know that if she didn’t ask me that one stupid question, I wouldn’t be here today. For the next few months, we had contracts and increased sessions. We worked intensely on getting me to see that there could be another way out. I ended up going to a partial program for a couple weeks in November and then again in December. I was to turn thirty and I really did not want to see it happen. I didn’t see much of a future. All I saw was pain and misery that I so desperately wanted to end. I felt I was back to living in an abyss. I wore the pain like a heavy coat that no one saw. She thinks that it is some kind of miracle that I am alive and that I am a very resilient and “special” person. I don’t see myself as such and I doubt I ever will.

Even though I did not attempt suicide, I still went through a “post suicide” depression. I lost my appetite and had many physical symptoms of depression. I had stopped taking my medication, all of them, at this point. I just didn’t see the point. Some time in December, when the pain of living was wll beyond my breaking point, I went back to pharmacotherapy. This has helped to stabilize my mood for the last few months. I have been trying to sort out where I went wrong. One thing I noticed was that I had stopped writing my feelings, any feelings, in my journal. My journals had gaps of several weeks between entries. I was once an avid, daily journal writer. When I did write it would be a brief synopisis of the events of the day or weeks in between the last entry. No feelings, just events that had taken place. I had also stopped writing letters to my therapist. These letters would often speak of what was “really” going on.
I didn’t think much of my writing. I looked back on my previous entries from a few years ago. It is much different from what I write today. Looking over the past year’s journal entries, most of them have to do with “rushing” to do things. I gave my therapist a journal from 2001. Every page is written about the agony of my soul. It was therapeutic to write such despair. It listed my deepest, darkest, morbid thoughts, and feelings that the outside world hardly knew. Sadly, it also made me more depressed, as it was my “proof” that things couldn’t get better.
The entries leading up to my plan in November had nothing about the agony, the despair, and the anguish that was driving me to think about and execute my plan of ending my life.
I don’t know when I stopped writing. I think most of it happened before the breakup of my last girlfriend. She had made fun of what I wrote, as if my pain was a joke, something to be laughed at. I also grew tired of writing every day about my “psychache” and not feeling much change. I think a part of me felt that as long as I was writing something, even if no feelings were present, it was better than not writing at all. I always liked to record my events of daily living. However, when I stopped writing of my pain and thus ignored it, the more the dark side began to control me. It had no outlet, no way of showing itself. It then began using my subconsciousness to express itself. If I wasn’t actively thinking about suicide, my “other side” was planning and scheming on ways to commit the act. That is why I saw nothing wrong with my plan. The blinders came on and held on tight to the idea that the world would be better off without me. My “kids” (nieces and nephew) would be fine without me, my therapist would be ok, some how, and I really didn’t care much about what my friends would think. I couldn’t think about that. During what would be my last few weeks, a couple friends from out of state called me. I saw it as a way of God telling me that I was still important to these people, even if I felt completely worthless and didn’t deserve to live.
According to one study of Joiner et al, there are long-term beneficial effects that has shown writing about personal experiences can possibly have protective functions in that it reduces impulsive and maladaptive problem solving. It also can allow for more effective emotion regulation (both of which skills are key aspects of psychotherapy for suicidal patients (Joiner, Walker, Rudd, & Jobes, 1999). This protective function that I had used so well in the moments of my early years of therapy and throughout the course of late adolescence and early adulthood, I was no longer using. My feelings were not being recorded, at all. I chose instead not to feel and make myself as busy as possible with work and school, but mostly work.

For most of October through December 2005, I felt like I was living in a black cloud that was always around yet no one really ever saw. I felt so lifeless inside. It was so black. I truly was in an abyss. I was going down in flames and this time, I wanted it to be the last. Somehow, my therapist was able to get the blinders to open a little bit. I have a niece that was less than a year old. She is a cutie and when she saw me during this time, she gave me a look like as if to say, “Where have you been?” There was a period where I didn’t see her for a couple weeks because of working late. When I did see her, she “smacked” me almost as if she were saying, “Where were you?” Her older sister, who is almost like my own daughter, hugs me, kisses me, and tells me she misses me when she doesn’t see me often. I truly have no idea why I believed that they would be ok; I knew that they would be so heartbroken that their favorite aunt would no longer be around. I think it just helped me to rationalize my ultimate escape plan and make me go through with it without consequence. If I did stop and think about them and how it would make them feel, the protective factors Joiner et al talks about would have prevented me from executing my plan. I did not want that to happen this time. I wanted to die and I was going to do it.

Earlier this year (2005), I lost my cat, Stone. She was the closest thing to having a real child in my life. She was abused as a kitten and I had gotten her out of hiding. She trusted me. She would scratch other people and even the kids, if they got too close, but not me. I lived with my sister for a couple of years and during that time; I helped to make sure she was safe and gave her the affection that she needed. I miss her everyday. She died at the young age of six of renal failure. I felt she was the only “person” in my life to love me unconditionally. When she died, a part of me did too. I never felt a loss as great as this. That little fur ball captured my heart and soul and there was nothing I could do to help her live a long life. I have grieved a little. I still struggle with her loss.

Some days are better than others are. I would like to have a new cat but my living situation doesn’t allow it. This semester, I am taking psychological testing. Our term paper has to do with a testing element. Suicide assessment has always been an area where I am deeply curious and fascinated. I envy those people who actually are able to end their lives. They are no longer suffering emotional turmoil, no more psychache. I started the research a few months ago and was amazed to find that there isn’t a standardized method of training someone to be a suicide risk assessor. I remember in August of 2003, I had discovered that if I told of my dark thoughts, it helped. I guess you can say it was a catharsis. There is a paper written by Walker et al that looked into that theory (Walker, Joiner, & Rudd, 2001). But if I were to do that, I would have to attempt suicide and my therapist doesn’t want me to do that. We have talked about why I want to end my life. My theory is that if I try my plan and succeed, I was meant to die. If I failed, then I did deserve to live. The outcome is purely fate. I think I have a very lethal means of ending my life, but there is still the risk that I could live, end up a vegetable, or die. Those are the risks. Will it be cathartic? I feel I won’t know until I try. I have given my therapist my word that I wouldn’t try and that is the ONLY thing keeping me alive today is my friggin word. I am a gentleman, honest and true to my word. I don’t believe in lies and deceit. That only causes more trouble and a dishonest life.

My word. The fabric holds together my soul like the collagen that holds skin cells together. How many times have I broken it? Not many. To myself, I have broken more times than I can count. But in giving it to another person, it is as solid as a rock, most of the times anyways. When the blinders came off, I felt used. My therapist had used my word against me. She knew that if I gave her my word, I would keep it all costs. I was and still am at times very angry with her. I am not sure if it is justified or not. She kept me alive the only way she knew how. I hate her for it. I don’t want to live this life and yet she is allowing me to suffer, sometimes in silence, sometimes outspoken. I have tried to end therapy in the last few months because I cannot seem to face her. I think that is because she keeps reminding me of how close I was to death. I don’t feel like I was. I never attempted to go through with my plans so it doesn’t feel like it was an actual attempt. Just very strong thoughts and planning that never happened.

After being stabilized on meds for a month, my mood improved for the better. The contentment that I felt back in October 2004 came back. For the first time since then, I began to plan my future. I started looking at grad schools again and Rascal Flatts’ “Feels like today” and “I’m Moving On” held their significance in my life again. My kids were more precious to me.

The contentment started to fizzle the beginning of July 2006. It’s now the beginning of August and the psychache has returned. I am not writing. I am barely talking in therapy. I have so much to say yet can’t be bothered by talking about how I feel. I don’t see the point. I want to end therapy but as my therapist reminded me the other day, that will surely be a death sentence. I know that it is only a matter of time before the perturbation increases and I won’t be able to handle the pain of living anymore. I had put in safeguards when I was feeling well and could see things more clearly. The constriction that I feel right now is starting to cloud my judgment.

During my research, I had found some helpful tools. One is a psychache scale by R. Holden and Mehta. The other is the suicide status form by David Jobes et al. I have been using the psychache scale to monitor the ache. When I first started back in May, the score was high but as the weeks progressed, it got low. I can’t really make out what it means, as there is no standardization of what the scores mean. For a good measure, I gave the scale to an online support group to see what their psychache was. The lowest I got was a 20 and my score was well over 40. Most of these people suffer from chronic physical pain, not depression. I know that there have been studies where chronic pain contributes to depression, but that is a small percentage. I wanted to include these people in my research because I know they often get excluded because of their medical condition or because they are on pain medications.

Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and
routinizing the assessment of suicidality in outpatient practice. Professional
Psychology: Research and Practice, 30(5), 447-453.

Walker, R. L., Joiner, T. E., & Rudd, M. D. (2001). The course of post-crisis suicidal symptoms: How and for whom is suicide “cathartic”? Suicide and Life-
Threatening Behavior, 31(2), 144-152.

Up and Down, Up and Down

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

Depression affects millions of people. It does not discriminate. It is a hidden illness as the signs are not always obvious. Lethargy, fatigue, loss of interest, loss of pleasurable things and activities are common. Personal hygiene is another common dysfunction that is not really discussed outside a clinician’s office. They may not shower every day or even brush their teeth.
I have suffered from depression most of my life and it’s only been over the past few years that my hygiene has suffered. I don’t shower every day. I barely brush my teeth. I don’t use deodorants unless I remember to. I might brush my teeth once every few days, though it’s not because I’m lazy. It’s mostly because I don’t care at times or because my post nasal drip (PND) causes me to gag and be nauseous. Because there have been many mornings where I am gagging and puking, I have gotten in the habit of not brushing my teeth every day or brushing later in the day when my stomach settles. Most days I really just forget because it just isn’t a priority for me. The PND has also gone on for years and I can say that it has caused me to feel bad about myself because I can’t take care of my teeth. Both my parents have dentures and that is the last thing that I want but when you feel so low, you don’t want to do anything. Even less so when you feel sick to your stomach. So I try to brush before bed and get in that habit but it is not easy. I have become easily distracted so if I go to the bathroom and do my business, I might not remember to brush. Sometimes I will if my mouth feels yucky. I think a lot of people with this condition don’t take care of themselves but are too embarrassed to admit they don’t take care of their oral hygiene. It is the same with personal hygiene.
I just don’t think about this anymore mostly because I know I will end up losing my teeth if I don’t. I have even stopped going to the dentist for fear of being reprimanded. I feel bad about my hygiene habits. Bust most days you only have enough spoons to do one or two things for the day. If showering and brushing your teeth are those two things, that doesn’t leave much for the rest of the day. I’m lucky that some days I go out and get my coffee at Starbucks. Usually that means no shower. Which leaves you with one spoon. Spoon theory (https://midnightdemons7.wordpress.com/2012/08/08/spoon-theory-explained/) is the equivalent of the amount of energy people have that do not have a chronic medical or mental condition that affect daily activities. Most people can take a shower, brush their teeth, get dressed, and then go out into the world to do what they have to do. This is not so with someone with a chronic health condition, being physical or mental. For those of us with chronic illness, it is not that easy. What used to take me 20 minutes now takes 40 or more, depending on how much pain or energy I have.
For me, it takes about 30 minutes to get dressed only because it is difficult for me to decide what to wear. What color jeans, socks, shirt or what kind of jeans I want to wear. Indecision is the biggest problem with me. I have too many and I can’t just chose one. I guess it could be worse. I could just be trying on clothes and take them off like some people do.

Building a Therapeutic Alliance

by Midnight Demon, posted in mental disorders, mental illness, mood disorders, suicide, suicide attempt

Building a Therapeutic Alliance with the Suicidal Patient. Eds: Konrad Michel and David Jobes

This book is a work of genius among the top suicidologists in the U.S. and Europe. The editors actually want to help suicidal people get better and try to make their life worth living. Like most of Drs. David Jobes and Konrad Michal work, they have done an excellent review of the literature and made the book easy to read without a lot of psychological jargon.  This book should be used as a handbook for anyone dealing with suicidal individuals.  As someone who has been through many suicidal episodes with many different therapists, this book is groundbreaking.  It lists his classic work of CAMS (collaborating and managing suicidality) which is a tried and true way of dealing with lethal suicidality in an outpatient setting. The other evidence based therapists will enhance therapy around this work.

The Chapters are broken down easy enough and progress from good to bad in my opinion, of the treatments that work.  The conclusion was brilliant by Dr. Jobes. He has stated with clarity the hardships that are faced with suicidality such as the IRB approvals for research, clinicians wanting to work with this population, and the need to try and keep these people in therapy.

The brilliance surrounding this book is the alliance part of it. Without a therapeutic alliance, you cannot have a good report with a therapist and the therapist cannot have a good report with the client. The essential element is having a good working relationship that builds on trust and collaboration. The therapist must want to know the client’s story in a non-judgmental, non-criticizing way. By listening to this story, the therapist engages the client and the client feels validated and understood. This is a central element to helping any client in psychotherapy, in any discipline.

This book covers most of the therapeutic disciplines and how it relates to treating someone with suicidal ideation. It also offers empirical evidence that supports treatment of suicidal individuals, from psychodynamic to cognitive therapies.

I believe this book should be read by every graduate student and post graduate in the mental health field. This book can also augment education for those that are already in the field and practicing psychology or psychiatry.

what do you say

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

I have been asked to write about what you say to a person who has just attempted suicide. The answers are many but there is a song that I have in mind, another one by the Fray, that I think helps to explain it if only I can get the words out. You try and be supportive and not be a smart ass with things like I’ll kill you if you try this again. It is one of the WORST thing you can say to the person. Being there and hearing the person’s story of why they did what they did will be invaluable. It might even prevent another attempt. If this was a one time deal, the person will say this was the stupidest thing I ever did in my life and may not try again. If this was not and the attempter says, how could I be so stupid that this really was going to work, that they seem harder on themselves because they survived or are wicked PISSED OFF they did survive, there is a likely chance they will attempt again and again until they succeed. I know this from experience. I first overdosed when I was sixteen, April 12, 1992. I remember the day as if it was yesterday. I had carefully planned out my pills, the day, how I was going to do it. I even went to confession the day before (I was a practicing Catholic at the time) and went to church on this sunny Sunday. It was my Aunt’s birthday and I knew that the house would be all to myself. All I had to do was wait for it to be. I knew by the time I got home from church, my family would be heading over to Somerville and be down my grandmother’s house celebrating my aunt’s day of birth, not knowing meanwhile back home I was planning on ending my life. Except it didn’t work. I got wicked sick, puked everywhere, my eyes were dilated for days. And when I woke up Monday morning, I WAS FRICKEN PISSED OFF like no tomorrow. To my dissatisfaction, I went to school in a very pissed off mood. I couldn’t tell anyone what I had done nor could I tell them why I was so pissed off.  There was one person I did tell. It was not the school nurse or a friend but my therapist at the time, a social worker who a month or so before told me she was leaving the state and I would have to find someone else to take care of my mental health needs. I don’t remember what happened too much the day after, I was still drugged up and out of it but I remember being so mad at everyone, most of all myself for failing. I then fell into one of the worse depression of my life. This got really bad. I didn’t go into the hospital as I said I was never going to do it again and all the lying it took to avoid being in the hospital because I just was so PISSED and was not going to get help. The hell with the help. It failed me and I was really really angry. This therapist was my third and I figured strike three was called and I was out. I later did go into the hospital that year, in the summer. I lost another twenty pounds, had no appetite, thoughts on killing myself were great, I felt like the biggest asshole on the planet because I failed to kill myself and that kind of pain is hard to describe. You have no idea what failure is until you try and take your life and fail at it. It hurts and that is what I was feeling. This big hurt that no one knew because who would want to know how much it hurt to fail at killing yourself when you thought things out so perfectly, or you thought you did. Nobody knew I had done what I did and when I did it was met with over concern and I was left feeling more like a burden than I ever did before the attempt.  I also felt like who would listen to me. I was a pretty good student and who would believe that I was having problems holding things together after my parents had a massive argument that ultimately ended their marriage.  I felt that I should have been smart enough to sort through this all by myself.

 I remember that day the phone just kept on ringing. I couldn’t understand why. Didn’t the world know this was my day to end things? I’m not sure if the phone constantly ringing was a good or bad sign. It was my best friend wanting to play and I was half in the bag so to speak so there was no chance of me leaving the confines of my house to play ball. But I wonder if the panic of what I was doing forced me to throw up all that I had taken. I remember right before falling asleep that this was it, I was going to sleep for the last time. YEA RIGHT…

There have been at least ten times I have tried to end my life. Unfortunately, I don’t always remember what was happening with me when I was just about to take my life. I do remember and it is still the case today, that most of my attempts have been planned attempts and not an impulsive one which most are. I did have an impulse the first time I truly wanted to die as I was digging with a pair of scissors to draw out a vein and die that way but that was a lot harder than it seemed. I was introduced to the self-harm of cutting which can also look like suicide attempts, especially when the cuts are deep enough to cause stitches.  Though I am a former self-harmer, that is not the subject of this paper and will defer commenting on this for now.

The reason I had first cut was because I had wanted to die. I had tremendous stress with a parent that day and the day after and I just snapped. All I could think about was death. Up until this time, I was the perfect student in my high school freshman year. I was getting all A’s and nearly had a perfect attendance record. After this blowout, and that I put mildly, I didn’t care too much about anything. My grades slipped and my attendance faltered. I entered therapy and discovered more than what I bargained for. My psyche was exposed and I could not let anyone in on the hurt I was feeling.  I had grown up with the what goes on in the house stays in the house.   I just wanted the pain to end and so I had cut to end it. Fortunately, I wasn’t a good cutter and all I did was cause scratches on my wrist.  It wouldn’t be until a year later that I would take my first serious suicide attempt.

Like my pain that I tried to hide, I also kept my scars that were visible, hidden. Today they are a reminder of how bad things were and that I survived. I know it may sound strange but they are truly what saved me from attempting more serious attempts at my life.  Planning an attempt is not as easy as it sounds but it is what has kept me going. It is my escape hatch and though a lot of researchers have written about suicide as an escape, it truly can be as well as I know it to be. I have thought of many plans but have not acted on any since before 2001.  That makes over a decade of planning yet no action. You might think that I have been lucky but in 2005 I came close to acting on my plan. Things were going pretty sucky for me emotionally and I was still struggling with my nerve injury. Chronic pain and depression do not mix.  Seemed that both like to feed off one another and I was swimming in both physical and mental anguish. I could barely keep above water so created this wonderful plan, set a date, and all I had to do was get my affairs in order by Nov 5th, 2005. Except the one thing I was counting on, fooling my therapist in thinking I was “well”, failed horribly.  The way she recounts it today and is always be aware of someone making an effort at feeling good. This is true. The moment someone in a deep depression like I was in suddenly starts to feel better is the crucial time to ask about suicidality.  The reason being is that this provides the sufferer that they are no longer going to suffer. The so called “warning signs” of suicide can be just that, feeling better after a deep depression and suddenly giving away possessions.  With people with suicide careers such as mine these warning signs are not so subtle to the outside observer. Even a trained professional could miss them. I was under siege with suicidal thoughts yet no one knew until the day my therapist asked what was really, really, going on.  If not for her insight into my care, I probably would not be here today writing this for you to know. It is important to realize that the attempter does not want people to find out about their plan, especially when they have been thwarted many times in the past with hospitalizations after hospitalizations. Statistically, I should not be here yet as my therapist points out, I am the exception. Why I do not know. But holding my thoughts to myself was my haven. I thought carefully about my plan  every day and that brought me some reprieve from my pain.

Constant vigilance is key after someone attempts suicide.  If they are intent on ending their lives, they will try and try again until they succeed. If the suicide was a “wake up call”, and if they truly get the help they need at this time, they may not try again. But these types of preventions are not always sound. What holds true for one may not hold true for another. The biggest thing to worry about with attempters is the amount of guilt and sense of failure after the attempt that makes another attempt all that more eminent.

As mentioned earlier, hearing the person’s story is the most important thing you can do after or before an attempt. Just listening without being judgmental and criticizing can be important for the person and might be just the thing to prevent another attempt that will succeed. There is a book called building a therapeutic alliance with a suicidal patient by Konrad Michel and David Jobes, two of the foremost suicidologists in the world. They have written an awesome account of how to build an alliance with a suicidal person. It should be the textbook guide to anyone in the mental health field. It gives case studies of clients and the therapist’s reaction, good and bad. That is crucial to see how one person can be understanding and helpful and another not so helpful. If you are reading this and are a mental health professional, I STRONGLY urge you to get this book. I have studied the works on David Jobes for several years now, you might even call me a professional stalker as all I do is do a literature search on him at least every month to find out what new study he has done with his works on collaborating and managing suicide (CAMS). In this works, the SSF (Suicide Status Form) is the key element to help a survivor or someone who is about to attempt suicide to help work through their issues on why they think ending their life is the key to solve their problems.  But without knowing the story behind the pain, no one will be able to help this person that has just attempted to end their life.

My story mentioned above, and you can see how much pain I was in that caused me to think ending my life was the answer. While being in this bubble of hopelessness and despair, no good feelings can penetrate it. I guess that is why my therapist crossed the boundaries and told me she cared and when she started crying, I knew that to be the true. Hearing the person tell you why they are thinking about ending their life is so essential to saving that life.  To reassure this person that they are not a burden, not a bother, not a dipstick is the most important thing you can do to try and help bring some hope and ease the pain. There is really nothing more than you can do to help this person in need of help but just knowing you are there and that you are not going to leave or think less of them can help save this person from making another attempt. I have been through some very close attempts. One attempt was medically serious and I was forced in the hospital for three months because a previous therapist (who was more than pissed off at me) was so very certain I was going to try again. And I would have had I not given myself some time to heal while under the hospital’s care. I was in a very dark place and there was no other way out of my abyss other than suicide. I had tried all the medications, and they didn’t help me. I tried therapy for years and it didn’t help me. Still after all this time and energy of trying to plan the end of my life I still try and hold on to some hope that there will be a better tomorrow. Sometimes there is and sometimes things are just the same. This hurts. Knowing day after day that there is no way out other than suicide is a very lonely place. A place that is filled with hurt. I had tried and I failed again. There is no greater pain than that.

Today I read on facebook a quote, “when you fail, you learn from the mistakes you made and it motivates you to work even harder.—Natalie Gulbis

This is the worst thing you can say to someone who has just attempted suicide and is hell bent on suicide like I was. Yes, I have learned from my mistakes, I have learned not to trust people, especially mental health professionals, to speak of telling them of my suicidal plans because they will try and stop me from achieving those ends. I honestly have no idea how my therapist can deal with me sometimes because I am hell bent on ending my life and she I think lives in a fairy tale world where suicide doesn’t exist so when I tell her, the answer is always a NO. But then, could it really be a yes? If all therapists were to green light their client’s suicide there would be no hope for prevention. But therapy still is supposed to help those in need and yet after more than 15 yrs in therapy with different modalities, I still remain depressed and suicidal. Though I might get a respite every now and then it is far and too in between to really count and I have learned not to hold on to it because that usually means a big downfall and another hospitalization.

Now I find myself writing about every attempt I have made in my life and the consequences of those actions.  I don’t know if that is what people want to read about but I write about the aftermath and how it felt after each failed attempt.  Maybe I have just given up on trying to attempt again and that is why it has been so long since I have. True I feel like the biggest failure in the world knowing this but how can I not. This is deeply personal talking about the lowest point in my life and wanting to end it all and then by some grace, still be forced to live on afterwards because of some kind of divine intervention. Of the many attempts I have tried, only 1 was medically serious to warrant a hospitalization. The others were not so serious but did lead me to hospitalizations. Since the age of sixteen I have had close to 30 hospitalizations. Most have been involuntary as I posed a danger to myself and it is law to hospitalize for that reason. I just wonder why I have survived this long. Am I suicidal if I don’t attempt and just plan? We can go into the whole what makes a person a suicidal ideator vs. an attempter but most would agreed prevention lies in before the attempt not after. We hear stories about suicides and their survivors but what you don’t hear at all is about the attempter that survived. These truly are the ones that need the most attention to but because their world is so private no one really knows. Unless someone survives a shotgun wound or immolation or hanging attempt, you often don’t see the scars of attempters. True those that slice their wrist leave scars but most do survive to eventually tell their tale. There are countless overdoses every year that get under reported or if successful get ruled as accidental poisonings rather than suicides mostly to either spare the family the “shame” or because there was no clear indication that the poisoning was intentional. Most people believe that unless there is a suicide note, it is not a suicide because he or she wouldn’t do that. I would say that the majority of people who attempt and fail feel too ashamed to admit what they have done and so cover their asses by saying it was an accident or just a foolish impulse but for those that succeed we will never know.

Talking about an attempt is difficult for the survivor. They really need support after the attempt, to know that they matter and are not a burden to their friends and family. I know not all family members are supportive when it comes to mental illness and when someone they love and care about just tried to take their life, fear of losing them overtakes the care and compassion that they might feel.  I know with my family I did not have that kind of support but then I felt like a burden to most of my family because I had this illness I could not control that was causing me to feel like the scum of the earth. If you are reading this and truly want to help someone after and attempt, whether it be a friend, coworker, or family member, do not shy away from them. Let them know how much you mean to them and look them in the eye when you do. There is a lyric from Sugarland’s song Just make me believe that says “if you look in my eyes and tell me we’re going to be alright, if you promise never to leave, you just might make me believe.” This person feels so out of it they do not want to come back to the land of the living and the shame of what they have done and the guilt is killing them in ways the attempt never did before. If they thought that killing themselves was the answer, they may now know that it is not.  If the attempt caused an injury, that will be harder to deal with. Not only have they failed to kill themselves properly, they injured themselves without taking that into consideration. That will be hard. Words like saying they have their whole life in front of them will only make them feel worse or that they were “lucky” to survive. I still don’t feel lucky to have survived my attempts. I still feel ashamed of myself and worse like the biggest failure in the world.