Tag: suicidality

Crashing

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

Crashing

I was supposed to see my psychiatrist today and cancelled late last night. I felt bad doing it but I was in too much pain from my outing with my friends and then I got another foot cramp. That settled it for me. I haven’t heard back from her, which probably means I need to email her again for another appointment time.

I am feeling really depressed today. I have been trying to stay in a good mood but today, the walls came down, hard. I just can’t stand being in pain for lengths of time. I know I have pain every day but this pain was around the clock, something I am not used to. And it was the same annoying pain. It never varied, which is why I needed to take my pain meds around the clock and if I didn’t, the pain would remind me to take it.

I think I was a little hypomanic and now I am crashing. I have no motivation to shower and I badly need one. I got away with brushing my teeth today but during the rinse cycle, damn back went into spasms. All I want to do is sleep but I am too restless to. I spent my checks on foolish things, but not really. The only thing that I bought on impulse was a messenger bag with a Pearl Jam logo on it. I have been wanting to get this bag for a while now and decided to get it. Now I am broke until my next pay period. I think I have enough left over to get a few prescriptions I might need during the month but that is all. I won’t be seeing my therapist this month. It’s just too much out of my budget. I did get my groceries. I knocked down the bill to less than $100 but I think when I added cold cuts it went up again. I tried. I won’t be trying my chicken and dumpling crockpot recipe until maybe next month.

I had therapy today. We talked about the crash. She agreed with me that it is a depression I am going through. I was really tired when we talked. She was worried about my back after I told her I had spasms while I was out last night, despite drinking water. I also told her I have no appetite. I am back to eating just one meal a day. Last night, I barely had anything to eat. All I had today was an egg burrito. I got heartburn afterwards because I haven’t been taking my heartburn pill all week. I haven’t taken any of my regular meds this week. I just don’t feel like taking meds. I will take my abilify and an Ativan so I don’t have side effects but that is all I will take. I just started taking the baclofen to try and ease the spasms. I really didn’t think the spasms in my foot last night were going to stop. It was terrible.

I have been thinking about how my therapist does things in regard to my suicidality. We will talk about it but we don’t really do anything about it. It’s like we know the elephant is in the room but we aren’t doing anything to make it go away. I often wonder why she doesn’t ask if I will be safe or have a safety plan in place when I start talking about suicide again and again. I know we do but sometimes I would like to be reminded about it.

Just in a Bitchy Mood

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

Just in a Bitchy Mood

I woke up early in the morning, like 0230 early. I was not happy. I only slept a few hours at that point. Then I go back to sleep about an hour later after I took some more Nyquil and Neurontin. I woke up around 1045 and I was hungover, most likely because of the Neurontin. All I wanted to do was sleep but I had my therapy appointment and I couldn’t blow it off. I got a call from my psychiatrist’s office. She had to reschedule my appointment for Friday. I don’t know why she didn’t call or email me. Now I am worried. I hope she didn’t have a setback. My only other explanation is the red tape the hospital has on coming back to work after being out for a while.

Because my sleep has been all fucked up, my tolerance has been extremely low. I was at Starbucks and the damn sun, which was reflecting off the building across the street, annoyed the crap out of me. It was just too damn bright. I wish the sun came with a dimmer switch sometimes. Then there was a girl that was talking silly to a boy in front of her. It just annoyed me. I just wanted her to shut up so I could listen to my music on my headphones. I really need to get noise cancelling headphones. I had a pair but they broke. I know Bose makes a pair of headsets that are noise cancelling but they are wicked expensive for my budget.

I had therapy today and we talked about things. I found out that she loves me sincerely but it’s not the kind of love like in a sexual relationship, which relieved my anxiety. I still don’t know why she loves me as I think I am unlovable. I asked her if she thought I was special and she goes into a tirade about stuff and I am like does that mean yes or no? She finally answered yes and then went on to explain that she doesn’t know where these questions come from. She still blames it on the trauma that I have been through. She brought up again the reason I don’t accept good feelings or reject good intentions is because of the complex PTSD that I have. I asked her if I have borderline traits and she said that I didn’t. I didn’t think that I did because I don’t have emotional dysregulation that borderline traits or borderline personality disorder have. I used to, but not anymore.

We also talked about my father and how narcissistic he is. I asked about narcissistic injury and she just didn’t explain it well. She basically told me to google it. I wanted to google it before writing this blog but I am not in the mood to google. I might do a separate blog about it. I also told her that I was nervous about the SSD review. I haven’t heard anything for a month now. And she hasn’t gotten any paperwork from them. Makes me think that my case is in limbo.

We talked briefly about my suicide thoughts. I told her I wanted to get some really lethal means and she was shocked about this. It was because of my crapping my pants last night that I have had enough of dealing with this. I haven’t told her about the voices telling me to do things. I’m hoping they will go away on their own. I just have a week until my MRI and then my stress level should level off. I haven’t been feeling paranoid or delusional. Just having voices talk to me all the time telling me to do things. And they are not my “normal voices”. If they were, then I wouldn’t be so worried. I hate hearing foreign voices. I know it’s because I am stressed. I have a lot on my mind. Having a fucked up sleep schedule is not helping either. Most of it has to do with having this stupid cold that I have. I wake up congested and not being able to breathe. It’s getting better but I am not quite well yet.

After therapy, I went to Starbucks. I used my cane because my leg has been bothering me. I am glad I did because on the way home, my thigh really started to hurt me. I haven’t done anything but walk, not too far though. I got my prescription from the pharmacy on the way home. One of them was stuck in limbo because of some computer glitch. My mother called to see where I was and when I told her, she said she wanted the paper. When I came home she said supper is what ever I want to make. I knew I should have ordered pizza and fries. Now I’ll probably have just a bowl of cereal.

Shneidman’s Psychache Theory

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mental disorders, mental illness, mood disorders, psychache, suicidality, suicide, writing

“From the view of psychological factors in suicide, the key element in every case is psychological pain; psychache. All affective states (such as rage, hostility, depression, shame, guilt, affectiveness, hopelessness, etc.) are relevant to suicide only as they relate to unbearable psychological pain. If, for example, feeling guilty or depressed or having a bad conscience or an overwhelming unconscious rage makes one suicidal, it does so because it is painful. No psychache, no suicide”. Edwin Shneidman, Suicide as Psychache p56

 

Psychache is the unbearable guilt, despair, hopelessness, shame, pain, depression, and press one feels when thinking about suicide. It is the corner stone of what this paper is about. The pain of the mind can cause constriction, a narrowing of view of things. It can also lead to perturbation (an unrest that causes one to feel like doing something to alleviate the uneasiness one feels) and also to press, which is also known as stress or the pressure and weight one feels under. The combination of these three things, press, perturbation, and psychache is what is known as the cubic model of suicide.

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The cubic model of suicide is a 1-5 rating of the three things I just mentioned. The higher the rating, the higher the likelihood of suicide. The worst rating is a 5-5-5 scenario and suicide will be imminent. It is important to rate these items when dealing with a suicidal person. It will validate what they are feeling and make them feel at ease in talking about what is causing them to feel so pressured and hurt to make them think of killing themselves.

When dealing with constriction, the dichotomous thinking that a) suicide is the only way out or b) things are always going to stay the same, it is important to always bring in more options to the person so they can see things differently. In his book Suicide as Psychache, Shneidman gives the example of a young pregnant woman who was thinking of killing herself with a handgun. She couldn’t have the baby so therefore in her mind, suicide was the only way out. After discussing several options with her (calling her parents, having the baby and giving it up for adoption, discussing the situation with the baby’s father, etc.), it was agreed that the woman would call the baby’s father. Suicide was no longer the number one item on the list. To prevent a mishap, Shneidman did take the gun away from the woman. An excellent example about means restriction.

In almost every suicidal thinking, there is some measure of lethality and perturbation. You can have high lethality and high perturbation, but you don’t always have high perturbation with high lethality. Perturbation, as described above, is very much like anxiety. It is a perturbed feeling that causes one to feel pressured to do something. Lethality is the doing something.

Also in every case of suicidal thinking is the frustrated needs that bring about the suicidal feelings.

ABATEMENT The need to submit passively; to belittle oneself

ACHIEVEMENT To accomplish something difficult; to overcome

AFFILIATION To adhere to a friend or group; to affiliate

AGGRESSION To overcome opposition forcefully; fight, attack

AUTONOMY To be independent and free; to shake off restraint

COUNTERACTION To make up for loss by retrieving; get even

DEFENDANCE To vindicate the self against criticism or blame

DEFERENCE To admire and support, praise emulate a superior

DOMINANCE To control, influence, and direct others; dominate

EXHIBITION To excite, fascinate, amuse, entertain others

HARMAVOIDANCE To avoid pain, injury, illness, and death

INVIOLACY To protect the self and one’s psychological space

NURTURANCE To feed, help console, protect, nurture another

ORDER To achieve organization and order among things and ideas

PLAY To act for fun; to seek pleasure for its own sake

REJECTION To exclude, banish, jilt, or expel another person

SENTIENCE To seek sensuous, creature-comfort experience

SHAME-AVOIDANCE To avoid humiliation and embarrassment

SUCCORANCE To have one’s needs gratified; to be loved

UNDERSTANDING To know answers; to know the hows and whys

These twenty needs are what Shneidman has called the essential ones when people are suicidal. Most of them are not all twenty but five or six as it pertains to the individual. “The prevention of suicide with a highly lethal person is then primarily a matter of addressing and partially alleviating those frustrated psychological needs that are driving that person to suicide. The rule is simple. Mollify the psychache”. (p53) Shneidman believed that these frustrated needs are what caused psychache.

I believe there should be another need, validation. Everyone needs to be validated in order to feel secure and feel okay. Without this, most people feel shamed and dumb, that what they are feeling or experiencing has no meaning or purpose. They may also feel empty and alone as no one understands what they are going through. This need when frustrated or thwarted can lead to suicide.

Shneidman, Edwin. Suicide as Psychache. 1993. Jason Aronson, Inc.

Recovery…what does it mean?

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

Recovery…what does it mean?

I keep hearing people talk about recovery and I am at a loss. Can someone enlighten me on what the hell it is? And what exactly are you recovering from?

I hear from suicide attempt survivors all the time this word. Do people who think about suicide really recover after they attempt? Because I keep wanting to try again and again. I haven’t made an attempt in years but I think about suicide constantly. Or is recovery just something that happens after you learn different coping mechanisms?

The reason I do a lot of suicide research is because I want to find something to help me. If I never looked for it, I wouldn’t have found CAMS and the SSF so useful. I have also found other assessment tools but nothing else worked. Traditional therapy didn’t work for me. I had to find a therapist that treated me as an equal and collaborate with me on what works and what doesn’t. It’s still an ongoing process as my suicidality gets worse during certain times of the year than others.

I don’t think I will ever recover from my mental illness. I think it will wax and wane, just like my suicidality, but it will never get better. I might find symptom relief through medication but even with medication, my depressions get the better of me. They are too severe and too frequent to really get relief from them. Medication has been proven useless with treating them. I am just left to suffer through them until they pass.

Then I have the physical pain that I deal with. I don’t think I will ever recover from that. It just seems to get worse during the temps of New England. My former PCP thought that I can just do something to make me feel better and things would be better. Wishful thinking. As much as I don’t want to be on meds, I know it’s my new way of life. It’s the only way I can survive. Otherwise, I think I would entertain the thoughts of killing myself, and by entertain, I mean attempt.