Tag: suicide attempt

in the pit of despair

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

In the pit of despair

I have been in severe pain since 1500, so basically the last 12 hours because it is now 0315. My foot and ankle have been playing the divide and conquer game, giving me different pain in different parts of my ankle and foot, all at once. I don’t like this game at all. I can’t keep up with the pain and I don’t know what medicine to use to alleviate it. It is very frustrating.

My jaw/face was swollen so I put ice on it. It brought down some of the swelling. It is still giving me a hard time though when I eat as it feels like food is stuck there but it’s not. It’s just inflamed gums. It is so annoying. Tomorrow I go back to using the yucky rinse that causes my tongue to tingle. Fun stuff. The dentist wanted me to use the toothpaste that he gave me but I told him that it hurts to brush just once, let alone twice. He said not to use it on the hurt area. I was like, that area is where you WANT me to use it, which is why you prescribed it to me, ya Schmuck. I am not using the special toothpaste until my mouth is healed. My mouth, my choice.

I am trying not to get depressed but that is easier said than done. I feel my heart imploding and there is nothing I can do about it. It hurts and no amount of pain meds can take it away, as if it were that easy. Matters of the heart are never solved by medication. What it is solved by remains a mystery. The internal hurt that never goes away.

I was thinking of my father today. I have been flooded with memories of how he treated me, not all good. For some reason, while trying to organize the pics on my phone, his pics from when I got them loaded on my phone, including the one of him in his casket, are first in the order rather than the most recent ones that I have taken. I never thought I would forgive my father for his wrongdoings because he would never admit that he did something wrong. We were the ones that “made him” do the things to hurt us. As time is going by, and he is no longer here, I am finding a sense of peace from him knowing he can’t hurt me anymore. No more calls, no more threats, no more vengeance to the people he hated. Most people would say that my father is in heaven but I know better. He is either in Hell or purgatory. He never apologized for his sins before he died and he never would because “he did no wrong”. Asshole. But the bastard is on my mind these past few days. I got to put the pics of him in some kind of folder so I don’t come across them so frequently or it is going to drive me mad, well, madder than I already am.

I joined a suicide attempt survivor group on Facebook and a depression support group. Both are very busy and take up a lot of my feed. I’m not sure if I am going to stay in the depression group. People there are really rock bottom depressed and it doesn’t make me feel hopeful that things will be better. The other group, I am not sure about either. There is a lot of talk about suicide and suicide attempts though the rules state you can’t be talking about it. I have posted my story and someone there thinks I have season affective disorder because for three months I am depressed and suicidal. Being suicidal is not part of the SAD criteria. I have no other symptoms of being depressed other than being in despair and wanting to end my life, and of course, psychache. Those three symptoms are no where near the SAD criteria so I do not have SAD. It is part of the bipolar cycle. Most people with bipolar disorder will have this downfall about now through the fall. Studies have confirmed it. I think it is in the book Night falls fast or maybe touched with fire both by Kay Redfield Jamison. I am always good at remembering shit like this but not the source. It is my downfall.

Even though I feel despair, I really just feel nothing. I am numb. My heart is so heavy I can’t feel anything. I just want to be done with this. Being in pain sucks every day. One of the groups thought being in physical pain would be better than psychache. I said I thought the same until I had chronic pain and now it just makes me want to end my life all the more. I wonder what keeps me here, from not acting on my feelings and thoughts of suicide. They are frequent but more tolerable. Sometimes it is a passing thought, but tonight it is on my mind a lot. I haven’t picked a date or anything. I haven’t done that in months. In some ways, I think not seeing my ex-therapist has helped me be calmer about my suicidality rather than keep it heightened.

My psychiatrist has been trying to get me into a pain support group for months now and every time we get in touch with the coordinator, we are met with red tape. I really don’t care for this group. It can go to hell. But my psych really wants me to go to it. She thinks it can help me. I rather just not exist anymore. I mean, what is the point? I stay in my room most days and only go out when I have an appointment or feel like getting an espresso. Some days when I don’t leave the house, I don’t even make coffee. It has been having the opposite effect on me lately, making me tired rather than awake. I sleep. I have no friends outside of social media to talk to or hang out with. I am alone. I kind of like it but being in severe pain lately has really spun me around. I have been thinking of the plan that I came up with while in the hospital. I am just too cowardly to do it, I think. I just want to be gone. Away, permanently. Why is that so hard to understand??

Therapist’s choice or fear?

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

Therapist’s choice or fear?

My therapist of sixteen years had decided sometime while on our three week break that she couldn’t work with me anymore for what reasons are still not quite clear. We had been arguing over various things the last several months, including my suicidality and it was becoming apparent that she refused to seek the given evidence based practices I was telling her about to deal with my suicidality. I was becoming more and more frustrated and wrote a blog about it that “opened her eyes”. Our engagement ended in February of this year. I was gutted. I had no choice but to end things with her if she had no idea how to work with me any more. So the hunt for a new therapist began, once I could manage it.

It is very difficult to find someone willing to work with a high risk suicidal patient, such as myself. When my therapist moved to her office thirty miles away and I had no means of getting there, I called ten therapists in a five mile radius of my house. I kept getting the run around. I couldn’t be seen by them because I was high risk and so they referred me to someone else. That someone else then referred me to someone else. I became distraught and just stayed with my therapist event though it meant more phone sessions and text messages.

Now I had the same problem, except I had no back up. There was no one. I had asked some therapist friends on Twitter in my area if they knew anyone seeking new clients. One responded and gave me a name. That therapist never returned my calls. After three weeks (one call a week), I gave up and moved to therapist number two. Same deal. It took me until April to find someone that a) took my insurance and b) wasn’t afraid of suicide. I’ve been seeing this guy for about three months now and it is getting obvious to me that we just aren’t clicking. You need a certain chemistry to work with someone is this guy is lacking. I thought I could work with him but he is my back up right now. I am looking for someone else.

The day that I had my first meeting with him back in April, two therapists returned my phone calls. One had taken three weeks to call me back so I was not in a rush to call her back even though her qualifications seemed like it would match what I was looking for. The other organization I didn’t know too much about but knew they offered CBT, a therapy modality known to work with some people but didn’t for me. I kindly told them I was not looking at this time but if that changed (I hadn’t met the guy yet so it could be possible not to work out), I’d be in touch.

So when I was hospitalized a few weeks ago and my current therapist told the social worker that I was there because of “family conflict” instead of a psychotic episode that happened that weekend, I got pissed off and realized I wasn’t going to waste 16 years with this guy to know it was wrong. I called the other therapist and she never called me back. Then I got in touch with the organization. I had a phone interview with them last week. He first went over my insurance as he didn’t take one of them. OK, but he took the other so I was okay with that. Then we talked about clinical stuff. He asked when was the last time I was hospitalized and I truthfully told him a few weeks ago. He ended the conversation saying his group would be unable to help me as I needed “intensive outpatient” treatment after a hospitalization. He basically said I was “too sick” to work with one of his therapists.

I was floored this happens in 2017. I have been studying suicidology since 2007, reading countless articles about how clinicians, particularly psychiatrists, are more prone to have a suicide during their career than any other profession. Psychologists are second to that. Yet despite the advancements in evidence based practices (EBP), there is still the fear of losing someone to suicide. I can’t make that go away and if I ever become a therapist, I too will have that fear. But there are measures you can take to decrease that risk in the high risk client, if there is a willingness to work with one. That opportunity is lost if you slam the door like countless therapists have done to me. Suicide is inherent in any psychotherapy, regardless of risk factors. It can “appear out of the blue” or not noticed until an attempt is made or a death occurs. The suicide rate keeps climbing. And one of these days, I will become part of that yearly statistic.

I look for help and get denied because of my risk factors, which are history of previous attempts, history of abuse, history of hospitalizations, and history of self harm. These factors I deem “high risk” can also be viewed as severe mental illness or “being too sick”. It was the director of the organization’s choice not to take me on as a client. Pissed me off but his choice regardless. But was it also his fear that I would take on a certain liability because I was chronically suicidal and mentally ill? I will never know but my gut says fear altered his choice. I understand that therapist want to have the kind of practice where things go smoothly and stuff like suicide is dusted under the rug. Suicide is a dirty word. I get that. I have lived it since I was eight, when I first thought of ending my life. No one wants to touch it with a ten foot pole. But excluding these people from these practices, what the hell did you enter the field for?? I have to wonder.

The therapist I work with now doesn’t follow a lick of EBP. I still don’t know what kind of therapist he is. Frankly, he just lets me ramble for 45 mins then it’s see you next week. He has explained what he does but he has yet to actually do it, which is why I want to see someone else, if I can find that person. I live in the hub of academia where there are thousands of therapists. The biggest problem I come across, other than their fear of suicide, is not taking new clients. OK. I get it but can you refer me to someone who IS taking them? No answer or try Susie Q who isn’t within my area of accessibility.

Anyways, these are my thoughts on the matter. Getting screwed by those that are supposed to help mental health patients but don’t want to deal with mental health patients that fit a certain criteria. I think that sums it up nicely.

CBT for Preventing Suicide Attempts: A Review

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

CBT for Preventing Suicide Attempts: A Review

I have been reading CBT for Preventing Suicide Attempts edited by Craig Bryan, PhD and these are my thoughts about the book by chapter. I also describe what each chapter is about.

Chapter 1: Deals with the problem of suicide and how it’s on the rise. It also describes the difficulty of knowing what works and what doesn’t. The authors goes on to what the book is about and how CBT has been shown to be useful in some clients with suicide ideation.

Chapter 2: Describes the dreaded nomenclature of suicide attempts, ideas, suicidality, etc. The authors describe how the term SDV (self-directed violence) is a more accurate term and also other terms to decide pathways on treatment protocols. They term the entire suicidality as SDVCS-Self-Directed Violence Classification System. It is used by three large federal organizations- the CDC (Center for Disease Control and Prevention), the VA (Veterans Administration), and the DOD (Department of Defense).

This chapter gives good examples of how different researchers, clinicians, and other professionals can use this classification system. I didn’t review the system pathways and yes/no guidelines because terms don’t mean that much to a suicide attempt survivor writing about my lived experience. I’m either suicidal or I’m not. I don’t need to classify and put myself into a category. But if you are a clinician/researcher or other academic interested in suicide prevention, the nomenclature is pretty good and better than what Silverman et. al. proposed in 2007 a and b (see this blog post on my thoughts about their terms).

Chapter 3 deals with what works and what doesn’t in suicide risk. It talks about studies pertaining to talking therapies and psychopharmalogical treatment of suicidal behaviors. I found this to be more of a review of what I know as of right now in terms of evidence based practices (EBP) and what is not. Some studies were really small and others were large. Most centered around Borderline Personality Disorder (BPD) as that is a high risk group. What I found upsetting is that those with bipolar disorder or those that were psychotic were excluded from most of the studies. As I suffer from psychosis and bipolar disorder, my participation would not be included and I find that disappointing, especially since bipolar disorder and other psychotic disorders such as schizophrenia have a higher incidence of suicide than major depression alone.

Chapter 4 was an eye opening chapter that I really liked. It talked about all of the suicidologists that I have been following for the past eleven years. It discusses different theories and models of suicide and risk assessment. It also discusses protective factors of suicide such as reasons for living/dying. I found this chapter to be really good and a lead off to how all of the things talked about lead to the next chapter, which is a case example.

Chapter 5: In this chapter, a case is described step by step of a suicidal older gentleman and the cognitive steps, consent, etc. are used by a play by play dialogue. Things like safety planning, coping cards, and hope kit are discussed in detail and how to implement them in therapy using cognitive therapy.

Chapter 6 talks about a brief cognitive behavior treatment (BCBT) for inpatient units called PACT (Post Admission Cognitive Therapy). It discusses the criteria for engaging patient, pros/cons of treatment and how not everyone may be suitable for this type of treatment, e.g., those with active psychosis/mania.
It would be good if this could be implemented but as the treatment is 5-6 days and on average most admissions are 3 days, I don’t see how this is to be helpful. Discussion of staff resistance and burnout are also discussed.

Chapter 7: This was very interesting as I’ve never really read about military psychotherapy before. The chapter gives specifics on how to approach a veteran or active military personnel in crisis or dealing with suicidal thoughts. It talks in detail about Brief Cognitive Behavioral Therapy (BCBT) and the steps per session. Not all persons will respond within the 12 sessions. It is individualized for each person. The chapter also talks about hot to discuss lethal means safety and means restriction (see chapt 9 for more information; e.g., gun safety in particular). When the sessions are down to the last two and command of previous exercises are demonstrated to be efficient, end of therapy is initiated. Booster sessions are discussed in case of future crises should happen. I found this therapy to be specific not only for military but can be used for any type of suicidal behavior. It’s a collaboration between therapist and client.

Chapter 8: Emergency departments are the top places suicidal people end up, either with an attempt, ideation, or crisis. Sadly, if the right precautions are not set (e.g., inpatient care or some type of follow up care), individuals are more than likely to die by suicide.
This chapter talks about the challenges and brief interventions that can be initiated so that death by suicide does not occur after a visit. The authors describe specific suicide safety planning that is individualized for that person to help them cope with stress that makes suicide appealing. It also gives crisis numbers, either a trusted person they can talk to in time of need and/or the National Suicide Hotline (1-800-273-8255, text 741741 (US only)). Once a little role play is done and the individual can demonstrate they will use this plan, patients are discharged to follow up outpatient care.
Only trouble I have with this approach is that not all EDs are equipped with mental health professionals and don’t have the 30-45 minutes or so it would take to implement the safety plan, even though it is crucial this should happen.

Chapter 9: As more and more evidence is building that suicidal individuals are seeing a primary care provider prior to death by suicide, it’s become imperative that PCPs have the training to ask patients for means restriction. The author suggests several ways to initiate the conversation and lists steps to do this. If patients are resistant, the use of motivational interviewing techniques are employed. The end result is a means restriction receipt where PCP and patient have agreed to restrict their lethal means. If possible, a supportive person is asked to help secure the means.

Chapter 10: This chapter talks about the use of psychotropic medication and the use of CBT or BCBT in suicidal patients. To date, there has not been studies where therapy and medication has been shown to be effective in reducing suicide risk. It is suggested that despite the thoughts and black box warnings of the FDA, suicide ideation is still likely to occur of not treated or dealt with at the beginning of pharmacological treatment. The author also discusses the risk of substance use and dependence disorders that can increase the risk of a suicide attempt. PTSD has also been discussed as hyperarousal states can increase suicide risk.

Concluding thoughts: Overall, I found this book to be extremely helpful, concise, and important in the prevention of suicide attempts. With the right intervention at the right time, Brief CBT can help decrease the suicide risk and possibly the overall suicide rate.

a gem found

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

hi guys,

I didn’t realize I gave my former therapist a paper I wrote during my sophomore year (circa 1992) in high school. I was reading it and I think I am going to type it up for a blog but edit out parts of it as it’s really detailed to where I grew up, unless you guys want me to put that stuff in there. I will have to edit names for confidentiality reasons.

I am wicked busy tomorrow so I will type it up either Friday or this weekend. It’s in my handwriting in block letters. That is how I wrote back then, different from what it is today and with blue ink! I primarily use black ink today.

It talks about my old dreams. I had to put it down because it brought back some strong memories. This was before I was diagnosed with psychosis a few months later and making my first suicide attempt 2 months after I wrote it. A lot of my childhood is written in there, where I am not comfortable sharing because it brings back such strong memories of the way things were and they were tough days. My father was a true bastard and I held him on a pedestal for a long time until I found out just how rotten he was. I lost my faith, love, and respect for the guy in certain ways. I never believed a word he said after what I found out. I doubt that the guy loved anyone but himself more than anything in the world. I don’t write about this in my paper, least I don’t think I did. I had to stop at page 7 and it’s 12 pages long. I got an A on it.