Tag: suicide attempt

thinking of my future is so not me

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

You know, I never really thought ahead with time before. I found that if I did it overwhelmed me too much so I always stuck with today or the hour or sometimes the minute because I had to. But now with this book that is turning into my baby, I am finding myself looking forward to the future more. Totally a weird sensation. I am not saying this makes me less depressed. It makes me a little less suicidal or have suicidal thoughts that float more rather than linger.

Today I have been in a weird space. I had a good session with my therapist and for some reason it put me in a good mood. Now I am wondering if I am hypomanic because I am in a good mood and have been up since 5. Things with the hypomania can spiral out of control quickly so if I am not my usual pessimistic self I tend to worry.

My writing friend said that I should write about this weird sensation but I am finding it difficult to because it is so not like me to think about the future. Usually my future is pitch black. I don’t have one. I know everyone does, but for a LONG time I just didn’t. Thinking about the future brought worry and anxiety. I had to get through today first and that was always difficult enough so I stopped thinking about future things. I still think that I can get my degree and my doctorate and be the therapist that I want to be. I know that I don’t want to be old and gray though, too. I have Alzheimer’s on both sides of my family so I know there is a good chance that I might get it. I already am having trouble with memory. I often write things and I forget that I write them. I don’t know if it is the dark side or just another part of me that was in the moment and I had these ideas. I am sure when I look back on this post, I am going to be like WTF, I wrote this?? That is so unlike me! And it is and that is what is weird.

My friend also thought that I don’t reward myself because of my suicidality. I have been suicidal for so long that I don’t think I can look past a month at a time without fearing losing my life. It’s like I am a Klingon and wake up every morning asking is this the day I am going to die? People don’t understand this. I know my family would be watching me like a hawk if they had any clue just how suicidal I have been the past few months. And the past two days I have felt like I have been in an alternate reality or something because thinking of my future is so not me. But this book that I am writing and sort of slaving over has given me a different perspective. I want to see this book published. I want to see this book successful. If I sell 100 copies, I will be happy, least for a little while. But I didn’t go on disability to be a successful writer. The bad stuff is still under the surface. I was re-reading “Touched with Fire” and came across a quote from Hugo Wolf “I appear at times merry and in good heart, talk too, before others quite reasonably and it looks as if I felt, too. God knows how well within my skin, yet the soul maintains its deathly sleep and the heart bleeds from a thousand wounds”. This is so true of me. I appear to be merry, cheerful, happy to the outside world but inside I am tormented and my heart bleeds. Nothing can stop the bleeding. I thought that working on this book would help the ache, and it has to some degree but it is still there. I might not be feeling it 100% of the time, all the time, but it is still there. I can’t deny it anymore than I can deny my foot pain that also is my nemesis. I am my own worst enemy. But today I can say that I am more a friend.

commitment to living

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

Seeing as I have been suicidal the past few weeks, sometimes intensely, other times not so much, I thought I would talk about the dreaded “no suicide contract”. In an article by Rudd, Mandrusiak, and Joiner (2008), the authors describe that there is no empirical data that proves a contract is a deterrent to suicide anymore than say pinky swearing (my words not the authors). In these times where suicide rates are going up rather than down, it is important to have something in place so that the therapist and client feels comfortable sharing the suicidal feelings without always resorting to hospitalization. The authors in this article promote a “commitment to living statement” as way to facilitate 1) identifying roles, obligations, and expectations of both clinician and client, 2) communicate openly and honestly about all aspects of treatment including talk of suicide, and 3) identify emergency services usage when client cannot contain the agreement.

This agreement seems to me as a good way to start any conversation of suicide but it also feels like it is an informal consent contract. It doesn’t really focus on a suicidal behavior tracking plan like the Suicide Status Form. All it does is explicitly states that the client make a commitment to living.

I was reading this because I thought it was a unique contract but now I am thinking that it is not. It does however, give the clinician and client a time focused treatment plan that I think all therapists should have with their clients so that if something is not working, it can be changed so it does work. In my experience, I think that this would be helpful for my therapy but I think it might be too late for that as we are no longer seeing one another face to face and this contract requires a handwritten statement to be made.

My therapist and I have reached another impasse and I think sometimes that having a break is beneficial. It gives me time to think things over. I also think that if I had the inclination, I would bring this article up again with her and see what she thinks of it to help my suicidal tendencies. But I am not sure about the whole commitment to living aspect of it. It does seem to me that something needs to give and she needs a piece of mind that doesn’t include me telling her I want to kill myself every week. The biggest thing on the commitment statement is that it allows for goals to be set. In my twelve or so years of being with the same therapist, I don’t think we ever have set one goal in treatment. Usually I was the one to come up with a treatment plan on how I wanted to be treated. That was fine until I ran out of gas and ideas. But what would setting a goal after all this time be like? I don’t know as I have not really thought about it. My therapist doesn’t give me homework, other than possibly blogging about something she has in mind for me to work on. We generally have an unspoken agreement that I will call her should I think about acting on my thoughts to harm myself. The most I have done is text her, a lot, to let her know I am having a hard time with my thoughts. Usually this happens during the long weekend when either she is away or when we have a long few days between sessions due to the weekend or holidays. I try not to text her so much but she seems to like me keeping her in the loop so I do it to sort of please her. Plus it tells her that I am still alive so that eases her anxiety a little.

An example of the Commitment to Treatment Statement is the following:

I, ________, agree to make a commitment to the treatment process. I understand that this means that I have agreed to be actively involved in all aspects of treatment including:
1) Attending sessions (or letting my therapist know when I can’t make it
2) Setting goals
3) Voicing my opinions, thoughts, and feelings honestly and openly with my therapist, whether positive or negative but most importantly my negative feelings
4) Being actively involved during sessions
5) Completing homework assignments
6) Taking medications as prescribed
7) Experimenting with new behaviors and new ways of doing things
8) Implementing my crisis response plan when needed
I also understand and acknowledge that, to a large degree, a successful treatment outcome depends on the amount of energy and effort I make. If I feel like treatment is not working, I agree to discuss this with my therapist and attempt to come to a common understanding as to what the problems are and identify potential solutions. In short, I agree to make a commitment to living. This will apply for the next ____ months at which time it will be reviewed and modified.
Signed_____
Date_____
Witness____

To me, as I have said before, this looks more like a basic agreement contract to therapy than it does for specifically suicidal thinking/behavior. The reason I bring it up is because most clinical therapist do not have such specific language in their agreement and I think it is important to work together in treatment. A client should always have a say in treatment, no matter if it is in psychotherapy or medicine. With a little modification of the wording, this statement can be used in any clinical scenario. It is basic and to the point. Clients should be active in the care but sometimes that is just not possible. I mean if you have a throat infection, you are not going to argue with your doctor about treatment. You will want the antibiotics so that the infection doesn’t spread and you get sicker (if it is a bacterial infection to begin with). But it gets trickier with something complex as say diabetes. This blog doesn’t deal with that so I won’t say anything further about it. Just know that you should always advocate for your say in treatment and ask questions about why you are being placed on medication or physical therapy or whatever your doctor prescribes.

Basically, I have to agree that this commitment to treatment statement (CTS) is better than a “no suicide” contract because it (CTS) allows open discussion and collaboration of treatment whereas the no suicide contract will just state that the client will not kill him/herself.

The second part of the CTS agreement is the Crisis response plan (CRP). It states:

When thinking about suicide, I agree to do the following:

Step 1: Try to identify my thoughts and specifically what’s upsetting me
Step 2: Write out and review more reasonable responses to my suicidal thoughts
Step 3: Do things that help you feel better for at least 30 mins (examples can include, trying to sleep, play internet games, brush hair 100 times, write in a journal, listen to music, etc)
Step 4: Repeat all of the above
Step 5: if thoughts continue, get specific and I find myself preparing to do something, I will call XXX @ 555-555-5555 or suicide hotline
Step 6: if I cannot reach above I will call my therapist or psychiatrist
Step 7: if I am still feeling suicidal and I don’t feel like I can control my behavior, I go to the ER or call 911 (or whatever the local emergency line is for your country).

Either plan is effective even though neither have been empirically tested. The CRP I have used in my treatment and I have found it useful. During one of my recent hospital stays, I actually gave out the CRP to other patients hoping they would benefit from its usefulness.

nothing man

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

“she loves him// she doesn’t want to leave this way// she needs him that’s why she’ll be back again”. Better Man, Pearl Jam

This is how therapy goes with me. I need it, she needs me.

****Warning might be triggering****

I was thinking about writing a story about my suicidal thoughts and I think I have it all set. Here goes:

He cuts the length of rope that needs, enough to cover the bed and his neck. He doesn’t know why they don’t sell a smaller rope size. 250 feet is really too long to do the deed for such a small space. All he needed was about 50 or so feet. If they sold it in bulk, he would have asked for that but the Home Depot didn’t. Somerville Lumber did. How he misses working in that store. He misses the people more than he did the regular customers that really kept the business alive.

He figures out the length and then carefully double knots everything so it stays in place. All attention to detail must be made. The biggest fear he has is that the bed will come with him as he hangs out the window. It is a cold day today. Maybe he should put on some heavier clothing, he wonders then laughs at the idea. He hopes God will forgive him as he take the final step out the window. Good-bye world he says, to himself. No one else can hear him. He struggles with the rope around his neck. He wants it off, it is strangling him. He feels like he is going to lose consciousness and finally he does. He just hangs there, lifeless. His task completed. His horror over.

difference is hormones

by Midnight Demon, posted in mood disorders, suicide attempt, transgender

*****WARNING MIGHT BE TRIGGERING*******

I was listening to some old songs tonight and it got me into a depressive funk. I then started to think of why I am depressed as I had no real reason to be. I started mindlessly picking at my chin. Then I realized I shaved off my goatee yesterday. I think a bit of my “manhood” went with it because my mother yelled at me to shave it off. She is never going to be accepting of the transgender identity I have. I guess that is why I feel so depressed and suicidal. I feel no one understands me. My sisters didn’t say anything about the goatee I was wearing in support of my baseball team. My father had nothing to say. Not even my soon to be 90 year old Aunt/Godmother said anything when I saw her in the hospital a few weeks ago.

The reality is that I am a female, not a male like my brain and my feelings think I am. It makes me sick. Really it does. I should be in the grave by now. They always say that transgendered are the most likely to kill themselves. I don’t know why I just don’t go downstairs and get the rope. End it sometime after this week. I can play with the knots and length of rope I will need. I never intended to kill myself at my own house but hotels are too expensive and I don’t have a credit card anymore. I couldn’t get one unless I was paying THEM to get it.

I don’t know why I keep struggling to hold on. Even now I am just saying one more day to get through, just one more day. I don’t want one more day. I want to be dead NOW. Sure there are people I can talk to about this stuff, not. No one understands what I am going through. I don’t even understand what I am going through so how is anyone else? Yet tomorrow I am supposed to put on a happy face and see my family for my Aunt’s 90th birthday celebration and pretend that nothing is wrong with my life. I feel like my whole life is just a poser, an imposter of some sort. I have the façade of someone else all the time. But who that is, I don’t know. But don’t we all at one point have different sides of self? But this isn’t a side of me. This is the whole me that wants to die because I can’t be a male. I was looking at a photo of my Mexican friend with his little Mexican mustache and I was so jealous. Jealous because he can grow facial hair better than I ever could. And the difference is hormones. I have been contemplating getting supplements that boost testosterone. Only problem is that I am afraid it might also kill my liver or some other important organ. I know someone that gets hormones through a gym but I am not the type to do anything illegal. I don’t even know if I could “shoot” up the stuff in the first place. But I am getting far a field with these ideas.

The way I see it I have two choices: die or become a male. And frankly, dying seem a hell of a lot easier.