Tag: suicide

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.

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.

about my hiatus

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

About my hiatus

I have been in the hospital the past three months. I was not in a state where I could write a blog. I was doped up most of the time and barely knew what was going on around me. I was sick with renal failure, covid, and infection called C diff. I was barely eating so they had place an nasogastric tube down in my stomach for a bit. I don’t know how long this tube was place. I had taken a pic of it sometime in Sept. I missed how the season ended for my Sox. When I came home for a bit, I thought it was the end of Aug but it was the beginning of Oct. I was home for a week or so before going back to the hospital for psych. I spent four weeks in the hospital on the psych unit. I got really good care there. I learned my top surgery was postponed and I was very, very devastated. It was good that I was in the hospital because if I wasn’t, I probably would have ended my life right then. I was so angry and frustrated as I didn’t have answers and had to wait for them. I had no access to my phone so I didn’t have the usual supports I have when I am home. It was extremely frustrating. The staff tried to help me but all they could do was sympathize with me. There was only one LGBTIQQ staff person on the unit and even she couldn’t really understand my predicament.

I have an appointment next week with my pcp to get medically cleared for top surgery. I really hope this conversation goes well. It will be the first time meeting my new pcp as a fully conscious being. The first two times I met her, I was still in the confused, delusional state. All I could do when I met her was blink my eyes and nod yes or no.

I am having difficulty writing in a constant stream of consciousness. It has taken me two days to write three hundred words for this blog. My thoughts are still hard to write with everything that I have been through. It was really difficult in the hospital as I really lost the ability to write. Writing has always been a coping mechanism for me and when I couldn’t think to write, it hurt, literally. I would get these headaches that felt like my brain was being crushed. It literally hurt to think. I got several migraines while in the hospital. I would wake up around 0330-430 every morning with severe migraines. It was terrible. The trauma of everything I went through was very difficult to process. I had become catatonic at one point.

I am still feeling wicked depressed and anxious at times. I am off all pain meds and off my Ativan. It is weird not taking meds around the clock like I once did for years. Now I just take it a few times a day as I am taking my blood pressure med three times a day and take the Latuda at dinner time. It makes me tired and I often find that by 1900 I am sleepy. But that could be because I have been waking up before 0500 most mornings. I find it hard to get back to sleep with these early morning awakenings. I am so much clear headed now than I was in the middle of October. My memory is still not there on what transpired the six weeks I was on the medical floor of the hospital. I just have these weird dreams/delusions that sometimes intrude in my head. One day while in the psych ward, I was flooded with memories and couldn’t make sense of things at all. The anxiety it produced was terrifying. I was convinced I killed my mother and a bunch of weird shit around my house. Taylor Swift music got me through a lot of the anxiety but while in the psych ward, I didn’t have my music to calm me so it was very difficult to cope. Now that I am home and have music again and my laptop, I am coping so much better. I am reunited with my online friends again and it feels so good because I was missed so much. I have missed blogging so much. I regret that I didn’t write before now but it has been hard finding my writing voice again. It has been a real struggle.

In closing, I am going to try and write a blog a day like before, even if it is less than 500 words.

thirty years of therapy and what I have learned

by Midnight Demon, posted in blogging, Chronic pain, CRPS, depression, mood disorders, suicide

Thirty years of therapy and what I learned

I’ve been in therapy since I was 15. After 30 years and 15 therapists, I’ve called it quits. Not because I was cured because I couldn’t get the care I needed. Not all therapists are the same. And even if someone has the credentials I am looking for, doesn’t mean it will work out. I have seen social workers, psychologists (PhDs and PsyD), psychiatrists, and psych RN. The first 10 I saw within the first 10 years of starting therapy. Each therapist I saw didn’t last more than a year. One resident I saw lasted three years, till the end of her residency, but she moved on and I didn’t see her again. I tried DBT (Dialectical Behavioral Therapy), CBT (Cognitive Behavioral Therapy), and the various psychodynamic therapies out there.

My suicidal career took up talk for the last 10 years of therapy, maybe more as it got more serious and I didn’t want to live anymore. I started researching into the different treatment options and found very little to help myself. The therapist I was seeing at the time was stuck in her ways didn’t want to adapt to what I wanted her to do in therapy to help me. It was frustrating. Then I saw a PsyD with the credentials and I thought yes! This is going to work out finally. But it didn’t because she didn’t have empathy and couldn’t give me validation when I needed it the most.

What I learned from my research into suicidology is that the person needs to tell their story of why they are suicidal. It needs to be heard by an empathic person who validates why they are suicidal. They also should appear eager to listen and to know more about the person, their pain and suffering. To find out where it hurts and to try and heal it the best they can. I can go on about things like perturbation, lethality, constriction, and psychache but those are just words no one uses anymore.

Living with pain— physical or emotional— for years is a traumatic stressor. The experience of living with pain evokes many of the same responses that being subjected to abuse or neglect does. — Dr. Glenn Patrick Doyle

I came across this quote while scrolling through Twitter. Dammit this guy always posts something when I am in the feels. He is correct. Pain does have the same responses as being abused or neglected. I have suffered physical pain consistently 24/7/365 for the past twelve years. Each time my foot or ankle flared up, I had flashbacks of when my back gave out ten years prior. I had to go through a series of checklists to make sure it wasn’t happening again, each time, nearly every single day. Once I had a diagnosis for the pain the checklist checking stopped but the feelings of the trauma didn’t.

My therapist who I just stopped seeing, asked me what I was looking for in therapy. But I didn’t have the words. As I am reading the book Building a Therapeutic Alliance with the suicidal Patient, I am figuring out what I need in therapy. I knew she wasn’t able to give me what I need. I am not really sure what I need. I know I want someone to talk to tell my story to. For them to listen, empathically and compassionately to what I have to say about why I am suicidal and why it has become my only option left to me.