I have been depressed for the past few days and my coping skills are not working. Because of this I thought about cutting my wrist but instead I mixed my meds up a bit and slept. I guess you can say that I was a drunk because all I did in the morning was stumble around.
I didn’t plan on doing this I just couldn’t cope with the pain of living anymore. I needed an escape and I needed it badly. I know I could have called my psychiatrist or therapist but most likely they would have said go to the ER. The ER is useless. You wait for hours to be seen because more urgent cases take precedent and because you are not actively doing anything to harm yourself you just are forced to sit and wait. Then when you get put into a room you are searched, made to give a urine sample and might have blood drawn if they think you need to be admitted. Or you might have blood drawn anyways if you overdosed like I did last night. I couldn’t help it. I wanted to cut really bad and I knew that if I did and I needed stitched I would be screwed. Least with OD’g you don’t leave scars. I didn’t OD with the plan to kill myself. I just wanted an escape for a few hours as things have been shitty the past few days. I told my sister that I wanted to be a man. She asked if me if I was sure. I started to break down. Obviously I wasn’t that obvious to my family. I was just a tomboy that never grew out of it. Except tomboys don’t usually wear men’s clothes all the time. This has been the most difficult conversation that I have had in a long time, since I came out as being gay. I refuse to use the word lesbian because I am a male not a female.
I want to be able to tell my family this year because I will be going to a clinic soon as I get the guts to call to make an appointment. I don’t want to start the hormones and then questioning me why I have facial hair. I have a little facial hair now but it’s kind of stupid looking because there is a space in the middle of it.
I just want to be myself. I don’t want to hurt anyone. The only person getting hurt is me because I can’t be who I am. That is why I want to cut, want to OD, want to kill myself. Though I still feel like it would be better to bury me as their “daughter” than as their “son”. My parents are of the old generation. They don’t understand things of today. Much less gender identity disorder or being transgender. Right now I guess you can say that I am just a crossdresser except my damn boobs get in the way of that. How I loathe my boobs. It is one part that I hate the most. I want to look at my chest and see nothing but my pectoral muscles, not breast material.
The biggest question so far that I have had since coming out as transgender is when am I going to have surgery. Are you kidding me? Let me get used to being freely who I am first!! Let me try the hormones first and see how they work. I hate to think of surgery before hormone replacement and most surgeons won’t do it unless you truly have been living as the opposite sex for some time. It is not an easy thing to go through. And mentally it messes with you big time.
I know this road I have been on is the right now. My sister was worried that it is going to mess with my depression. What she doesn’t realize is that part of my depression is not being who I truly am.
Tag: psychological pain
Ten Faces
April 2008 Poster for the 41st Annual American Association of Suicidology conference
Abstract: I have written this paper to talk about my experience with suicide and how the works of Dr. Shneidman has helped me to find the words to the dark demons that are below the surface. This paper also talks about how I think more clinicians need to focus on the psychological pain their clients feel when suicide begins to look like the only answer to their problem. I hope that by sharing my experiences and introduce the works of David Jobes that there are assessments that are out there even if they do not fit the category of validity.
Presentation:
I began my research into suicide and psychache in the spring of 2006 while taking a psychological testing class. My assigned term paper topic was psychometric assessments or psychological tests which interested me. I chose the subject of suicide assessment/risk because of my past experiences; I had barely survived another severe episode of depression the previous winter. Despite my clouded thinking, I had carefully planned my own death. Researching this paper would reveal what the so-called experts knew about these destructive, echoing thoughts I’d suffered from and what kind of assessments and/or treatments my therapist could potentially offer me during these terrible bouts.
What I found astonished me. Despite finding over thirty articles about assessments and risk factors, not one focused on assessment of psychological pain, or, as Dr. Edwin Shneidman refers to it, psychache. In an article by Ramsay and Newman (2005) states that most mental health providers have little standardized training in treating suicidal patients during clinical graduate work, and, are equally lacking during continuing education. I also found, not surprisingly, that some clinicians, once they realize their client is or has been suicidal, opt to transfer care to another professional, especially after a suicide attempt (Ramsay & Newman, 2005). In another article by O’Carroll et al.(1996), I was dismayed to read that there is no standard definition of what it means to be suicidal.
But the intent of this paper is not to review the literature of the past twenty-years. This paper is to talk about what Dr. Shneidman calls the “human stuffy of emotions, the words of a suicidal person” (1996, p. 6). It is to focus on the three P’s of suicide: “perturbation, press, and psychache”.
In 2004, my illness permitted me a break in the gloom; I gained some insight into my suicidal thoughts. I imagined writing a book about my experiences, hoping it would help someone. Alas, that book was already written, and was entitled The Suicidal Mind by Dr. Edwin Shneidman (1996). Finding this book made me feel discouraged. My therapist encouraged me to write my book based on
personal experience rather than from a clinical perspective. I didn’t go back to Dr. Shneidman’s book or work until a year and a half later, when I was taking that psych testing class.
The terms psychache, constriction, perturbation, and press are vital components of suicidal thinking. The cubic model Shneidman(1995) writes about is the best indication, in my opinion, of how likely someone might commit suicide. When pain, perturbation, and press, the three P’s, are at their highest level, individuals are much more likely to feel trapped. Thus they feel there is no way out. Suicide then becomes the answer they seek to end their pain and their life.
Although I heartily agree that assessments of the lethality of suicidal ideation are important, the one element that has been frequently overlooked is the psychological pain that the individual is feeling. What I have learned is that there needs to be an assessment of psychological pain whenever a client is feeling suicidal or having suicidal thoughts. A good analogy is the following: Think of a time when you had to go to the emergency room because of a physical ache, maybe abdominal pain or a severe headache. One of the tools the clinician might use is a scale to rate your physical pain from 1-10 with 10 being severe. Some emergency rooms have drawings of ten faces with varying expressions of discomfort that children and non-English speaking patients can utilize to evaluate their pain. No such scale exists
in the psych world. Even most psychiatric emergency services at major hospitals do not ask about mental pain. That is what I find so striking about Dr. Shneidman. By asking, “Where do you hurt”, the three P’s of suicide, perturbation, press, and mental pain can be assessed and taken into account of how likely a suicide attempt might occur.
Current research studies by Holden et al. (Flamenbaum & Holden, 2007; Holden, Mehta, Cunningham, & McLeod, 2001) at Queen’s University in Ontario are validating a pain scale that I think is efficacious, especially in times of crisis, and possibly life saving. From my experience of those darkest moments, there are no words for the depth of pain that I feel. Holden and Mehta’s scale (2001)can help communicate how much pain the client is feeling. This scale is essentially a self-report of psychache, enabling the clinician to quantify psychological pain. It can also determine whether that pain is the driving force for a potential suicide attempt. This scale is, in my opinion, the best measure to pinpoint all three aspects of perturbation, pain, and press. As Dr. Shneidman points out, the best source of understanding suicide is through the “words of the suicidal person” (1996, p. 6).
Once the level of pain has been determined, assessment can be tracked through the work of David Jobes described in his latest book, Managing Suicidal Risk (2006). He uses the continuum of
initial interpretation, tracking, and outcome to manage a suicidal client. These forms are called the Suicide Status Form (SSF). These forms have gone through the process of refining to become efficient and use of ease in managing suicidality (Jobes, 1995, 2006; Jobes & Drozd, 2004; Jobes et al., 2004). He stresses that he will do all he can to prevent his client from fulfilling their plan, and he offers the client a more positive way of dealing with these thoughts. Through his work, he facilitates the client managing his or her own treatment, collaborating on what will effectively decrease suicidal thoughts and impulses.
I hope that someday these tools become more widely available to those that want to help the suicidal clients, even if they have not been empirically tested. As Dr. Shneidman once said, “relevance has precedence over precision, and that ‘validity’ does not exhaust the category of ‘usefulness’”(1999, p. 287).
References:
Flamenbaum, R., & Holden, R. R. (2007). Psychache as a Mediator in the Relationship Between Perfectionism and Suicidality. Journal of Counseling Psychology, 54(1), 51-61.
Holden, R. R., Mehta, K., Cunningham, E., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224-232.
Jobes, D. A. (1995). The challenge and the promise of clinical suicidology. Suicide and Life-Threatening Behavior, 25(4), 437-449.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Jobes, D. A., & Drozd, J. F. (2004). The CAMS approach to working with suicidal patients. Journal of Contemporary Psychotherapy, 34(1), 73-85.
Jobes, D. A., Nelson, K. N., Peterson, E. M., Pentiuc, D., Downing, V., Francini, K., et al. (2004). Describing suicidality: An investigation of qualitative SSF responses. Suicide and Life-Threatening Behavior, 34(2), 99-112.
O’Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996). Beyond the Tower of Babel: A Nomenclature for Suicidology. Suicide and Life-Threatening Behavior, 26(3), 237-252.
Ramsay, J. R., & Newman, C. F. (2005). After the Attempt: Maintaining the Therapeutic Alliance Following a Patient’s Suicide Attempt. Suicide and Life-Threatening Behavior, 35(4), 413-424.
Shneidman, E. S. (1995). Suicide as Psychache: A Clinical Approach to Self-Destructive Behavior: Rowman & Littlefield Publishers, Inc.
Shneidman, E. S. (1996). The Suicidal Mind: Oxford University Press.
Shneidman, E. S. (1999). The Psychological Pain Assessment Scale. Suicide and Life-Threatening Behavior, 29(4), 287-294.
copyright 2008 collerone, g
a bad day
Been in a funk the past two days. I have ben really down because of the condition I have called CES, or Cauda Equina Syndrome. I have had to bladder accidents that have cut my mood to shreds. Then in my dreariness, I told one of my sisters that I wanted to be Mike. She was supportive but didn’t understand that the reason why I have been so miserable is because of being in the wrong body. I cried myself to sleep last night only to wake up at two o’clock in the morning. I didn’t fall back asleep until six thirty. I hate the disrupted sleep.
Now that she knows, I feel relieved but I have the urge to cut really bad. I hate myself and want relief. The only way I have been able to do that in the past is by cutting. But I am afraid that once I start, I won’t be able to stop. I took some meds to help calm me down but they have not kicked in yet. I have been up since nine thirty and really just don’t want to do anything. I just want to sleep but I am not. I played some online poker and lost a big amount of chips. Not a big deal as it’s not real money. I can always get it back or buy more chips.
I have been playing on the computer most of the morning trying to get rid of the awfulness that I feel. But nothing is working. I’m looking at razors and bandages. I am imagining how it will feel and if I will need stitches. That will suck as I will most likely be hospitalized. I should pack a bag just in case so my family knows what I need. I know I have a lot of writing to do but right now I just can’t do it. I don’t have the energy. I really want to go off on a person in the CESSG group for being a whinebag. She is complaining about everything that is wrong with her life. I hate people like that. Most of it has NOTHING to do with CES and that bothers me.
I still want to end my life. Nothing has changed my plans for my date with death. I have to have this just so that I can live. Surprisingly it is a national day of something. I forget what it was but it was pretty funny. I really have to decide what I want to do today to harm myself. I feel like I deserve it. The pain that I feel is intense and I can’t bear it too much longer, though I am trying. Though any time I talk about suicide or cutting pain is usually involved. It’s not a physical type of pain. Just a kind of heartache that won’t go away.
I am happy that I am transitioning but it’s hard as hell. One of my aunts suggested I say a Hail Mary ten times a day. I have been out of the Catholic church for years and the only way for me to remember the word is to look them up. I am not going to do that because I do not believe in prayer. I am not a religious person in the least. I wish people would just listen to me and not have too much to say other than they understand. Is that too much to ask. Most people when they open up to issues like I am describing just need an ear to vent out their frustration and maybe a shoulder to cry on. They don’t need their problem fixed or delegated to someone else. They just need support to get through that moment of time they are in distress.
more on transitioning
I started the day with an unusual abundance of energy. I felt like I could face the world and was ready to take it on. That was until I had my therapy session and all bits went to hell. I didn’t want to do anything. I just wanted to curl up in bed and not do anything.
After session I felt a little better after talking about my TG stuff. This stuff is really complicated and I feel very alone with it though people around me are very supportive of it. I am trying to get used to the pronouns and the medical issues I am having. See I go to one place and only my psychiatrist knows my issues right now because I am a “beginner”. I have not told my PCP or any other of my many other care providers. Not like they would turn me away, or they might to another “qualified” individual. I just feel that right now since I am spotting I need to see someone. I got my periods stopped by birth control pills and trust me having to take female hormones to stop my menses kills me enough. But having to explain it without crying my eyes out that is another matter. Not to mention that among my many care providers they all read each other’s notes except my psychiatrist so if I tell one, the others are going to know except I am not there yet. I don’t want it in my medical file that I am a transgendered individual or that I have gender identity disorder yet. I just am not there as sometimes it takes so much emotion that all I do is cry over it as I talk about. I guess part of it is because I hate myself so much that I just want no part of my body. I can deal with the facial hair but I cannot deal with my breasts or my reproductive system. Those are the two things I hate most about myself. I just wish I had the money to get the operation to get rid of both. To look down and not see breasts would make me happy. To actually see hair on my chest would be wonderful and not the little stubs I have now. I truly hate myself for being in the wrong body.
And this is why I am suicidal. This is why I want to end my life. I hope that by the time my date comes around I am half way to the other side or else I just end things and let things be. My parents can bury me as their daughter instead of their son. because it hurts too much to be not who I really am meant to be.
midnightdemons7 
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