Tag: suicidal ideation

Of Suicidality

by Midnight Demon, posted in blogging, depression, mood disorders, psychache, suicidality, suicide, suicide attempt

Of suicidality

Since my last therapy session, I have been thinking about my suicidal career and how it relates to my identity as a trans person. My therapist is under the impression that it is my insurance hindering me from seeking another therapist and I told her, no. It is my suicidality. She seemed incredulous about this. So I wrote to her and told to contact at least 5 therapists and ask them if they would take on a suicidal client and see what she gets. I doubt she will do this.

I also told her in the message that I would like to continue talking about this because it is central and I think that I can heal if I talk about how I didn’t have the words to speak about being a boy all these years. In my first few years of therapy, it was difficult because I was also an active cutter. One therapist tried to push DBT on me and failed. I resisted. In one of the exercises she gave me was to think about cutting and note how many times I thought about it. It was over like 20 times a day I thought about it and it made me worse thinking about it this. I felt really bad about myself. I didn’t have much hope about this new therapy. This was back in the early 2000s, before I found a stable therapist. By then, my cutting had somewhat stopped. It didn’t provide the release it once did. Instead, I just became suicidal. It was extremely painful. I was hurting very bad. My psychache was off the scale. My therapist became my only source of support and hope. I was seeing her maybe three times a week but I still just eluded to how I was feeling. In looking back, she really didn’t have a strong sense of redirecting me when I went off course and that was a downfall of our therapy. It went on like this for years and I just became more and more suicidal. I didn’t know what was making me so suicidal. I just knew I was.

The pain of living not as my true self was literally killing me. I hated my body and myself. I actually loathed myself in ways I never thought of. I hated my face. I was convinced I was ugly and fat. My father had called me “facia bruta” (ugly face) for so long that I believed him. I had things on my chest telling me every day that I was not a man. I had periods that made me suicidal every month. The hormonal aspect of it was terrible before I was able to stop them. It literally was like a switch went off when I started bleeding and I was ok again. But before then I was in suicidal hell. All I thought about was killing myself and I had such pressure to do so. I usually ended up going in the hospital for a couple of weeks but that never helped me. It would keep me safe from myself but they never cared to work on why I was suicidal. It was to be dealt with on the outpatient therapist.

My last two hospitalizations I tried to get as much as I could out of them. I knew I was still suicidal and might be for some time. I have been suicidal for nearly forty years. It is a tough habit to break. That is why I want to talk about it in therapy. Being the wrong gender for so long really was painful. It took me a few years to even say the word without breaking down and crying. It didn’t relieve me of my suicidal thoughts though.

I remember I was first suicidal when I was just eight years old. I didn’t tell anyone but it felt like the right thing for me. At that age, I had all or nothing thinking and thought that if I couldn’t be a boy, then I should die. There were hardly any gender clinics in the 80s and I think there was just one doctor at the Children’s Hospital that did gender affirming care. I grew older and my suicidality got worse. I became a planner. I would set dates. I truly had a suicidal mind when it was active. The blinders would go on and that was all that I could see was my death. I still get that way sometimes. It just made sense at the time for me that it was the thing to do. I had planned my death right before my tenth birthday. I wanted to kill myself on my birthday. But my mother was throwing me this big party and as my birthday is near Christmas, I wanted to see what presents I got. I never acted on my feelings until a few months later when I got into an argument with my mother over something. I had talked about being suicidal to my childhood best friend. He wanted me to get help but I felt like I was crazy if I did. I didn’t get help until I was fifteen, after I made some scratches on my wrist in an attempt to end it. But there was more than just being in the wrong body that was causing me to be suicidal at the time. I had a lot of trauma in my family to process and most of it went unprocessed as the therapist was more interested in trying to stop me from cutting.

My suicidality, body image, and being transgender are all tied together. For years, I hated myself because I wasn’t my true self. I know the past couple of years, my suicidality took a life on its own. I think that was partly due to the misgendering and use of my deadname at home. I felt like I was still a girl in my mother’s eyes no matter how much facial hair I had. Being me was difficult and now that I have had top surgery and am my true self where my mind and body are congruent, is still tough. I don’t have bottom dysphoria, thank god. I can never have a prostate gland to make my penis work the way a cis man does. But then, I have never really liked the thought of having one.

I tried conveying to my therapist about how intertwined the suicidality and being trans is but I don’t think she got it. I have been wanting to be dead a long time now and even though I might not have a suicidal mind now, I still feel suicide is an option for me. The trouble is, the past four years so I have no filter between being suicidal and being safe. I used to plan dates. Now I don’t. I just act on my feelings and that is dangerous according to my therapist. I’ve felt like I have put it off so many times that I might as well act on it. I’ve always held on to Dr. Paul Quinnett’s thinking of giving yourself time between the actions and thoughts. Suicidal thoughts and feelings can happen in a matter of minutes and sometimes, depending on method, acting can be fatal. But giving yourself space between the action and thoughts gives you time to think on the matter. I’ve always give myself a few weeks time, sometimes, a month or more, when planning my death. Then when the date came, if I didn’t feel like acting on it, I didn’t have to. And most times, the feelings had passed and so did my thoughts to act. Sometimes I was in a better place mentally. I might still be depressed but not enough to want to end my life. I honestly wonder if I will ever not be suicidal while being my true self.

I have talked about my suicidality openly on social media and throughout my blog. Sometimes it triggered a well visit from police which I didn’t like. I had gone through some dissociative periods where I would write the most suicidal things and then wake up the next morning, wondering if it was a dream. Often I would send an email to my then psychiatrist, who would call me in the morning and I often had no idea what she was talking about until I read the sent message. I often felt alone late at night with my feelings and would text or email my psych team about them so I would feel less alone. This just created worry and sometimes hospitalization, or at least a trip to the ED. I am thankful that period of my suicidality has passed. My ideation is often triggered by any distress, real or imagined, and often goes to the planning stage. I no longer have a filter between my thoughts and planning. Usually there is some space between them as it takes a while to come up with a plan. For right now, I know what my method is so I just go right to planning when I feel suicidal. I will pick a date and then when that day comes, if I am feeling suicidal, I will act but most times I don’t. I have been working with my therapist about trying to put some kind of buffer between thought and planning as it has become an almost “automatic” thought. And planning usually calms me down as it gives me an option for my distress. I am trying to come up with another plan when my planning is active. It hasn’t been easy. I am thankful I can be frank with my therapist when I am suicidal and not be automatically hospitalized for my thinking/ideation. It is still a fear of mine when talking about this stuff but I try to inform her as much as I can. I was taught nearly thirty years ago to keep the thoughts to myself. I was hospitalized at the time and my stay was becoming long. I basically had to keep the thoughts to myself or there was no hope of leaving the hospital. This was still before DBT and CBT were the main forms of keeping suicidal ideation at bay. Today there is brief CBT that was formulated by researcher/clinician Dr. Craig Bryan. DBT (dialectical behavior therapy) was created by Dr. Marsha Linehan. Both of these therapies along with CAMS (collaborating, assessing, and managing of suicide) has been studied extensively to combat suicidal ideation. I love CAMS as it speaks to me and I feel really helps me focus on why I am suicidal. It is based on the works of the father of suicidology, Dr. Edwin Shneidman as well as other researchers. CAMS is easy to administer and rate within a session. And because it is collaborative, the client/patient has a say in what their treatment is. That is the focus of CAMS, it takes the client as expert rather than the therapist. This is often lacking in the mental health field. There is such a paternalistic approach to suicidal behavior. It makes it difficult to talk about and there is always the fear of suicidal people being labeled as “crazy”.

I believe Dr. Shneidman was correct in saying that suicidal ideation is due to psychache, the psychological pain of the mind. His book, The Suicidal Mind, resonated with me deeply. He talked about constriction of the mind where there are blinders and the suicidal person can only see suicide as an option. He also talks about things called lethality, perturbation, and press. He formulated a suicide cubic model of perturbation, press, and psychache that I find useful in gaging my own suicidal thoughts and where I am in whether I need crisis management or just an extra therapy session. I felt like Dr, Shneidman was on the mark. I am glad that CAMS took into account his work and includes a measurement of psychological pain. As Dr. Shneidman has stated, no psychache, no suicide.

Identities that shape us

by Midnight Demon, posted in blogging, depression, PTSD, suicidality, suicide, suicide attempt survivor, transgender

I had a good discussion with my therapist about how last session brought up how much I was a boy and developed as a girl. It was really confusing and I didn’t have anyone to talk to about it. The only person who I knew that was a man and dressed as a woman was the leader of the BAGLY support group. She was always surrounded by young males so I never had a chance for a one to one conversation with her. I think if I came out sooner, my life wouldn’t have been so painful. My therapist pointed out that she thinks I identify as being depressed and suicidal. She is right. But being depressed as well as being suicidal is transient. I have other states of being throughout the day. It comes down to my thoughts that go into the feelings that go into the behavior. All are connected in a triad. CBT can break the cycle. I told my therapist today what I thought about a year ago when I was back to my senses. I had a medically serious suicide attempt and I was pissed I was still alive. I didn’t tell her I thought my chance of surviving weren’t that great. The only thing keeping me in this world was having top surgery. It was what kept me going. It was crucial I identify more as a man than anything else in my life. As long as I had those things on my chest, I was not a man and it was literally killing me.

My therapist and I talked briefly about my parents. I know my father would never see me as his son. I don’t even think he would have accepted I liked women. My mother was a little more open but not by much. I will never know if she saw me as her son because she was dying or because her mental state was affected. I know when I came home from the hospital she still used the wrong pronouns. At that point, I didn’t care enough to correct her. It bothered me but there was nothing I could do about it. She wasn’t going to change. It took a lot just to have her call me G.

I like to think the suicidal stuff is behind me but I know it isn’t. It will always be an option for me. I’ve been suicidal since I was eight and even though I am more congruent with my thoughts, I have a shitload of trauma to deal with that could easily make me suicidal again. I learned today that even though I have a suicidal career, I can still change it to something else. It is going to take a lot of work though. As Dr. Doyle says, 1% is better than 0. I’ll be continuing to write about my midnight demons in this blog. It is the one thing that keeps me sane. And I hope that if you have found my blog because you are suicidal, there is hope. Things do change. It took a year for me but I’m not completely out of woods and that is ok. You are here now and I hope you stay.

Review: Critical Suicidology

by Midnight Demon, posted in suicidality, suicide, suicide attempt

Book Review Critical Suicidology

Critical Suicidology Edited by Jennifer White, Ian Marsh, Michael J. Kral, and Jonathan Morris

This book comprehensively talks about suicide and suicidology. It asks where suicidology is going and how to do the research needed to understand it better. I have broken down this review with a sum of the chapters in the book. The first chapter talks about suicidology and what is meant by the term. It also talks about defining suicide research. Nomenclature was discussed and I thought about the tower of babel paper written by O’Carroll (O’Carroll, Berman et al. 1996). Agree with author that you cannot diagnose suicidality like this paper and later Silverman points out (Silverman 2006). It is too fluid and changes on sometimes an hourly basis. The complexity of suicide and suicide ideation varies between individuals. I was also disappointed that Dr. Julie Cerel’s work on suicide survivors was not mentioned despite being published at the time of the book. There was mention that at least 7 people are affected by suicide which Cerel’s research disputes. According to her research, as many as 125 people can be affected by one single suicide. Bereavement research is not mentioned.

Chapter two was a bit confusing as it gave grounds for quantitative research but then changed gears and wanted qualitative research as the “best”. Author appears a little disgruntled that the editor of the leading US based suicide journal, Suicide and Life Threatening Behavior, seems to say one thing but do another. They looked at a few years of studies and found most of them were quantitative yet the editor wanted qualitative. It goes back and forth. At the end, the author sides more on mixed studies (qual and quant) analyses.

Chapter three is about Indigenous youth. This is a special population that needs more attention. Prevention efforts should be what the youth is needing rather than someone else. A power struggle of whether the intervention needs community support or individual support is discussed.

Chapter four talks about youth in general. It was a hard chapter to read as it reminded me of my past struggles.

Chapter five discusses women and how they were expected to care for others and shamed which caused them to be depressed or they were abused. Help seeking was encouraged but some women were shamed further so was not good help. It’s true that men are at greater risk of dying by suicide than women as they often choose more lethal methods. Women have less lethal suicide attempts and gender norms need to be included in the character of women who attempt or self-harm.

Chapter six talked about narrative therapy of suicide survivor loss. Interesting to learn of narrative therapy and that someone got their PhD in suicidology. The narratives of a bereaved survivor were touching. Very sad.

Chapter seven deals with collaborative care, no us/them directive. No diagnosis to prevent stigmatization in treatment. Like that they use whole person rather than diagnosis to treat suicidal ideation and behaviors. Works of Jobes, Lenaars discussed.

Chapter eight is a lived experience chapter written by someone with BPD and how positive psychology helped her. Interesting but thought author was talking around in circles. Kept saying she had recurrent suicidality but then would talk about lived experience and being an academic.

Chapter nine talks about social violence and hate that cause suicide rather than individualize a person’s suicide. Solidarity helps to mitigate when a person dies by suicide. An interesting chapter.

Chapter ten talks about youth suicide among queer identities. How gay men are attributed in film to be sad and suicidal to forming the identity of lesbian/gay/bi. Confusing as fuck with the verbiage.

Chapter eleven discusses poetry in facing suicide survivors. Interesting chapter about how words can convey feelings.

Chapter twelve is about Inuit suicide and how it was high before prevention programs took hold in the community. Best treatment was at the community level rather than individual involvement. Youth suicide decreased when there were peer support and increased when peer support networks weren’t available. Brilliant example of how a sense of belongingness can help to decrease suicide.

Chapter thirteen talks about reimagining youth suicide. Goes back and forth about chapters throughout the book and other research.

Overall, a very important book to have if you are serious about suicidology.

O’Carroll, P. W., et al. (1996). “Beyond the Tower of Babel: A Nomenclature for Suicidology.” Suicide and Life-Threatening Behavior 26(3): 237-252.

              Suicidology finds itself confused and stagnated for lack of a standard nomenclature.  This paper proposes a nomenclature for suicide-related behavior in the hope of improving the clarity and precision of communications, advancing suicidological research and knowledge, and improving the efficacy of clinical interventions.

Silverman, M. M. (2006). “the language of suicide.” suicide and life threatening behavior 36(5): 519-532.

Sunday Musings

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

Sunday musings

I am still reading Linehan’s memoir. I am learning more about DBT this second go round than I did the first time I read it. I seem to be more accepting of DBT as I am realizing that there is evidence DBT works with highly suicidal individuals. The trouble is, it take a lot of work as there is so much to learn. The two takeaways I am getting from this second reading is the two skills radical acceptance and STOP. STOP stands for stop, take a step back, observe, proceed carefully. I am finding I need to practice this skill as otherwise I get angry and nothing gets accomplished. I also need to radically accept that I have depression and trauma issues.

I woke up late this morning. I didn’t get up till after 12. I kept getting severe headaches, like migraines. They would go away if I just stayed still. It happened three times after my alarm went off to take my morning meds. I thought I would have to take a migraine medication to get rid of it but it seems to have gone away on its own. I had started getting these kinds of headaches while in the hospital. I thought they had gone away but the last two nights they have come back.

My cousin texted me this morning saying that Ohio State has made it to the playoffs and they are playing Georgia. That is going to be a tough matchup. Georgia just won yesterday. They killed LSU by a big number. This is what I love about college football games, they score big numbers.

I am thinking about mailing out a card that I wrote out and then getting pizza for my late lunch/early dinner. Problem is that I have no energy to get moving and I know if I force myself to do it, I will have to take a lot of breaks to go around the block. I found my sunglasses but I still am unable to find my transition glasses. I have no idea where they went to. I know if I find the case, I will find them. I hate when I misplace things. It drives me crazy.

I miss baseball. It doesn’t look like the Sox are going to sign Xander Bogaerts. I just hope he doesn’t end up on the Yankees. I still don’t know if JBJ is still with the team. I watched a baseball game while I was in the hospital and he was playing for the Blue Jays. I don’t know if this is true or not. I will be sad if it is. I have no clue how the season ended because I was so sick in the hospital.

Yesterday, I listened to Taylor Swift’s 1989 album. Today I am listening to Rob Thomas’s Someday on repeat. I love this song so much.

I am feeling suicidal. Nothing really happened in the last half hour or so. I just feel like ending my life. I see no good in it. I have imagined how I would do it two different ways. I won’t act on it, though I do want to. I just don’t want to end up back in the hospital. There is no guarantee I will end up back on the same unit I was in. I could end up somewhere else. That keeps me from going to the ER. I know I spent a few days in the psych ER before I was transferred to the unit I was in. I don’t know how long I was there as I wasn’t myself. I was in a confused state. I don’t remember if I had my phone or not. If I did, I know I wasn’t using it. I was much too paranoid about it. I am working through the feelings of distress I am feeling. I am distracting myself by writing about them. I have therapy tomorrow and will tell my therapist about this. I want to die so bad that it is almost like nothing else matters to me, not even top surgery. I have hit a new low in my life. I try to keep telling myself life will be different when I have the surgery but will it? I thought about going back to college while in the hospital after I recovered from surgery. It seems impossible right now but I want to make an effort in the next couple of years to earning my degree. I want to finish it at UMass Boston. Trying to make goals helps defend against the darkness, least for a little while.

I am feeling worthless right now. My psychache is high. I am a little perturbed and my press is at least a three. I spoke how I wrote the book Darkness Always Wins while I was in the hospital. I was and still am in a dark place. I don’t know if I am going to recover from this episode of depression. Meds have made little improvement to how I feel. I know realistically, it could be a year or more before I recover. It is the way recurrent depression is. I don’t buy that I have bipolar disorder. My depressions are too dark and stay dark for periods that are much more similar to major depression. I really think I am misdiagnosed. Fortunately, the treatment is the same: antidepressant therapy. I need to take an antipsychotic because I am prone to hearing voices otherwise. I have done well with Latuda, though it is causing some dystonia for me.

I just read a blog that I wrote a more than a few years ago about Shneidman’s psychache theory. I was trying to think about it while in the hospital. I remembered the three P’s, press, perturbation, and psychache. A 5-5-5 indicates imminent suicide. I was a 5-5-5 in the hospital at times. I tried to remember the psychache scale by Ronald Holden. I couldn’t remember his name or if I had it on my blog for staff to look up. My memory has been so much affected by what I have been through.

I had dinner with my family tonight. It helped a little being around them but at one point I wanted to tell my sister I needed to go back to the hospital. I just couldn’t bring myself to tell her though so I kept quiet. I will talk more about this with my therapist tomorrow morning. I really feel like shit. It is like the song going down in flames, “Falling into this, again.”