Tag: suicide attempt

Why Do I Need Therapy?

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

Why do I Need Therapy?

I woke up from oblivion and asked myself, why do I need therapy? I think I am doing it more out of obligation than for help. Sure, it’s nice to talk to someone every week. I just don’t know if I should continue or not. I know that I will feel a certain kind of loneliness without therapy. I have been doing this for fifteen years now. I still wonder if me paying her to talk is worth it. I feel really worthless and guilty for some reason. My head is foggy from the medication and I need to take my psych meds before I go loopy again. Withdrawal from oxcarbazepine is not pleasant as I found out on Wednesday.

Sure, therapy has helped me with things and stuff but do I need it? Can I stop therapy and be okay. I have my blog to write my feelings down and vent. Course, it is not the same as venting to someone on the phone or in person. Lately, we have been trying to work on self-care. I have never done that before. I have taken “mental health” days off work, more than I should have. I just couldn’t handle it and my therapist kept pushing me to take some time off of work. But then I was working 50-60 hours a week. I miss being well enough to work that many hours. In the end I was working either 20-32 hours and I was a 40 hour employee. I had to use my earned time to get 40 hours. Within weeks, my bank of time ran out and so did my job. I was deemed disabled and unable to do my job by some committee that I have no idea who was involved in. And I certainly wasn’t invited to share my experience with these people. But there went my job that I have been working in for 14 years. My psychiatrist thinks that there is no way I can work a job anymore with my back situation. That was kind of reassuring for me. And my therapist thinks the same way..

I know mentally I have been up and down and all around. My therapist knew that I was going to oblivion tonight and though she was concerned, didn’t really try to stop me. She didn’t like what I was doing, but she knew I needed an escape. I slept really hard, a good seven hours straight. Now I am foggy as hell and kind of hungry. I don’t know if I should have the yummy red velvet pop tarts or Oreo’s thin golden cookies. I am a sucker for sugar cookies.

I knew my oblivion was not going to be permanent and my therapist knew that. I have texted her what I was doing all weekend. I deleted the messages on my phone in case I really didn’t wake up or tried to go to the bathroom and fell down the stairs. That was my only fear. The password on my phone is easy. It’s my niece’s birthday and my sister knows this. She knows because I told her when my niece wanted to use my phone for games. Unfortunately, I have had to delete the games because my phone is out of fucking memory. I have 16 GB and it’s all used up. I had to also delete the FB app because it was taking up a good chunk of memory. I use my web browser on my phone to check FB now.

I feel like I am obligated to be in therapy because I owe my therapist money. Though, if you think about it, the more I see her, the more I have to pay. Thing is, I don’t think I am being “analyzed” when we talk. I know things are harder on the phone than in person. I get that. But shouldn’t my words be scrutinized? I am just thinking out loud here, throwing my thoughts on this computer screen. Sure, we talked about Hyde and the dealings he is making and we talk about my suicidality but really don’t have a plan. We just go by my word that I won’t kill myself. I am not saying I need a new therapist. I am just wondering if I truly need to talk to someone every week.

I am not saying that I am stable enough to be without therapy. I just wonder if I am just wasting her time and my own by talking. She gets that I have been injured by father’s narcissism and we try to work through that, course it goes in one ear and out the other sometimes. I just can’t retain what she says because it hits me a certain way and I can’t deal with it at that moment. I do a lot of self-reflection after therapy so I write down what we talked about and such. I had started to keep a notebook of what we talked about but this week I didn’t keep notes because of my damn narcissistic father. All we talked about was his medical needs and how stupid he is about understanding what is going on at times. Sometimes he gets things and sometimes he is out to lunch. I don’t understand why I have to tell her the details of my father’s dilemma. It just takes up so much of our time that we don’t talk about anything else.

I feel like the only reason I keep going is because I am obligated some how to talk to her. I don’t know why I feel like this. It’s like I have to humor her to stay in therapy. We talk more like we are friends than a professional relationship. I am not saying this is wrong or anything. Sometimes I like this and other times I feel like we are doing something wrong. Lately we have been talking about self-care, something we have never really talked about in the whole 15 years we have been talking. My taking the Neurontin was part of self-care because I really needed sleep and to zone out. It might have been in excess but the dose that I took I knew it wasn’t lethal. If I had taken say my trileptal at that dose, it might have been a different story.

I am Dumb

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

My ex got in touch with me tonight. She still hasn’t told me what she wants. She just keeps asking how I am. I refuse to answer. She has lost the right to know how I feel. She changed her Facebook profile. I don’t know if she has done this to get in touch with me or if there is another reason. Frankly, I could care less.

As much as I didn’t want to do it, I did some research on the subject I am looking for on Google. I got some interesting results. And it makes me sick and more depressed. I have been trying to write a story about narcissism NOT using my father as an example but that is proving to be impossible. Every example that I have read tonight points toward him and his ways. I will say that my therapist is wrong about narcissistic injury. You can only have that type of injury if you are narcissistic and I am definitely not. I did one of the online test and scored very low. The test even called me humble, something that I know my father is not. He is a cunning bastard. From what I gather from multiple sources is that there is no getting around this personality. You are best to leave the person. Oh, how I would LOVE to do that. I would do it in a heartbeat and not look back.

What I learned is that the narcissist is incapable of love. I knew this on some level but it was confirmed tonight. I am unloveable and have been for quite some time. I don’t believe anyone that says they love me because my father lies so much. He only says it now because he is a despicable person and thinks he is being truthful. That is his way of showing he “cares” but he could give two shits. He has no feeling for us, my sisters and I, in reality. It’s all in his mind and as long as you go along with it, all is hunky dory. That is why I don’t argue with him, even though it angers me so. I have learned not to show my anger, least not to him or anyone else I care about. Hell, I don’t even show it to my therapist though she provokes me sometimes.

My therapist says she cares and that she loves me. My psychiatrist I know cares but I shield it off, especially when my suicidality is at its peak. It’s too dangerous to have these people care for a moron like me. I am nothing and always will be. I am good for nothing. This has been instilled in me since I was young and continues to this day because of the cunning ways of my father. He is not a dad by any means. He is a sperm donor to me. I am never right. I am always wrong. And that is the way it living under the roof of a narcissist.

I am wasting more money on books next week. One of them is called “rethinking Narcissism” by Craig Malkin. I figure I might as well read it to further poison myself. I doubt it will change my thinking of myself. My therapist and psych have tried for years. But it’s all a sham. My father would say that I am crazy for seeking help, if he knew. Hell, he did tell me to kill myself, so I do have his permission to do so. If I wasn’t afraid of heights, the Tobin might be my way out. But I have other plans. I always have other plans. It’s what I do. I plan my death all the time. So in moments when I feel like acting, there just has to be a time and place to act on it. I haven’t been successful as I wouldn’t be writing this if I was. I am a loser at killing myself. I always seem to tell someone important to me that I am going to do it and then they thwart me from going through with it. I am dumb, just like my father says I am.

I haven’t eaten much the last few days. I wish I could say that it was on purpose but I just have no appetite. Today I ate a little better but small meals. A sandwich here, soup there. I just don’t feel like eating. Sometimes I feel like I don’t deserve to eat. I kind of know when a depression is coming because my appetite because scarce. But I have enough fat so I am not worrying about being underweight. I might be malnourished but that is a matter of debate. Most people think that because you are overweight, you are well-nourished. I wish that were true but it’s not. I hardly eat what I am supposed to. Sugar and fat is my diet mostly, hence my composition. But this article isn’t about weighty matters.

Article Review: Working with Suicidal Clients

by Midnight Demon, posted in Bipolar Disorder, depression, mood disorders, suicide, suicide attempt

Article Review: Working with Suicidal Clients

I have to say that this article was not what I expected. It was an overview to the special issue the journal Cognitive and Behavioral Practice was having. The authors of the article described briefly what each article was about, which left me looking for more articles to add to my collection. But the take away message was that suicidal clients are to be treated as individuals and not as a “one size fits all” treatment modality.

Cognitive therapy has been moving up in the suicide chain as being helpful to suicide clients (Jobes, 2015 presentation AAS). DBT is also as it has helped a lot of clients with borderline personality disorder.

I found it interesting that there was a safety planning section. I googled it to try and learn more and there was a website for it. I downloaded the form as well as the training manual. It might come in useful in my therapy. I didn’t need the article to get to the form. It is similar to many other planning tools used by cognitive therapists. The thing I don’t like about it is that it is a sheet of paper that can get lost or misplaced. It also has the potential of not being used if the client is not near the paper when a crisis is at hand (e.g., at school versus at home). The author for the brief article has stated that therapists are slowly moving away from “no harm” contracts and moving toward safety planning. The reason being that “no harm” contracts have not been shown to be effective and may increase the likelihood of suicide. Also, simply making a promise not to kill yourself doesn’t really hold up well legally.

Ellis, T.E. and Goldston, David B. Working with Suicidal Clients: Not Business as Usual. Cognitive and Behavioral Practice (2012) 19: 205-208

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.