Tag: suicide attempt

Analysis of a Song–How to Save a Life

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

Analysis of a Song by: G. Collerone. Copyrighted 2012, all rights reserved

Music is an important part of the human race. Each individual has his/her own genre they prefer. Music can help heal a broken heart, discharge stress and to relax while going to sleep.
Often times music’s lyrics can hold a very powerful message. That is my goal with this essay to write about the song, “how to save a life” (The Fray, 2005). By using personal and clinical information, I hope to inform the mental health professionals about how to save a life when a client is thinking about suicide and what it means to get help from a mental health professional. This paper is written from the view point of a clinician and a patient who is engaged in therapy.
Jobes, Moore, and O’Connor (2007) have stated that assessing a patient’s suicide risk at each medical office visit as collecting vital signs. Quinnett (1987) has stated that there is only a ten minute window of when a person thinking of suicide will actually go through with it. It is extending those minutes that is an important step to prevent a suicide.
Sometimes there are signs indicating suicidal thinking such as, giving away of possessions, saying things will be better if I just “go away”. Sometimes these signs are not so subtle. In the wake of a completed suicide, one often wonders, “what they could have done differently”.
The rock band, The Fray, has written a song called, “how to save a life”(Slade, 2005). I would like to express in this essay, how important these lyrics are to help save a life, whether it is someone else’s or your own.

“Step one you say we need to talk
He walks you say sit down it’s just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came”

These opening lines talk about the initial conversation when the person who is having suicidal thoughts is being confronted. This is a crucial conversation as it allows you to assess what the person is thinking and to let them know you are concerned. The lyrics could also be viewed as the initial consultation a clinician has with his or her client, whether it was initiated by a friend, significant other, or family member. Family and/or friends are hoping that this person, who means so much to them, can open up to this person (therapist, minister, or counselor) to get the help that they (friend or family member) cannot offer or give. This is not to say that the friend or family has rejected the individual in his or her distress. The distressed individual may just need an unbiased, neutral person to talk openly about how they are feeling and what has brought them to the verge of suicide. Life for this person at this point is bleak, hopeless and unworthiness has invaded their soul. The individual feels he or she cannot confide in others. He or she feel they are a burden to friends and family members and have begun to shut himself off from those that love them. He sees only one option left to them: suicide. This is very dangerous thinking. The four letter word “only” is very significant and carries a lot of weight. Dr. Edwin Shneidman spent his career in working in the field of suicidality and forming the foundation for suicidologists in the United States. According to him, this word is the most “dangerous” word to be spoken by a suicidal person (E. Shneidman, 1985).
As long as there is human life, the threat of suicide is always going to be an issue. It is an indiscriminate symptom of mental illness, such as bipolar depression, major depression or schizophrenia. Some times suicide is not related to mental illness at all. It could be a response to a crisis that seems to have no end. Whatever the reason, “suicide will be a permanent solution to a temporary problem” (Quinnett, 1987).
Some experts will say that suicide is preventable, others believe that it is treatable. I say that it is manageable. When suicide becomes the only option, the question becomes what to do with this suicidal thinking: if the individual reaches out, they may go to a friend or family member for help or suffer along and pray his distress will end.
Most clinicians do not know much about suicide. Each clinician has their way of dealing with it or perhaps, not dealing with it at all. Some will refer their client to another clinician the moment suicidal thinking is mentioned. Most almost always use what is known as a safety contract: essentially an agreement, written, verbal, or both, saying that the client will not harm or kill himself or herself in any way until the next session with the therapist. If the client does not agree to this, the option is that the client will be hospitalized, often against involuntarily. If the clinician fails to hospitalize a client that is in danger of hurting themselves and the client dies, the clinician is subject to malpractice and potentially the loss of the licensure. In Rudd’s article (2006) 41% of clients under contract died by suicide or made a serious suicide attempt. These contracts have no legal standing but are used from a medicolegal point of view. To ensure the liability of the clinician, the client is placed in the hospital. In my opinion, this is the clinician’s get of jail free card and the jail term of the client. The lyrics: “Let him know that you know best/Cause after all you do know best” best describe this situation.
Is there a better way of dealing with this small yet extremely vulnerable population? There are structured treatment plans for patients at risk for suicide, but the knowledge of this across all mental health professionals is limited. It takes a mediocre trained clinician to have the courage to want to treat the client’s plea for help and to stick with that person through this difficult time.
There are two clinicians who have revolutionized the understanding of suicidal thinking and behaviors. Dr. Ronald Holden at the Queen’s University in Canada and Dr. David Jobes at the Catholic University of America in Washington, D.C., have two forms that are easy to use and are not time consuming. These forms, the psychache scale (Holden, Mehta, Cunningham, & McLeod, 2001) and the Suicide Status Form (SSF;David A. Jobes, 2006) can be used in the first fifteen minutes of a session to assess the client’s mental health status.
Dr. Holden’s psychache scale is a thirteen question self report of items based upon Shneidman’s book, Suicide as Psychache (1993). Psychache is defined as despair, anguish, hopelessness, psychological pain one feels. Each items are ranked on a 5 point scale ranging from either never to always or from strongly disagree to strongly agree (Holden, et al., 2001). Scores are from thirteen to sixty-five.
The chorus is what brought me to write this paper. The following is the lyrics:
Where did I go wrong, I lost a friend
Some where along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
Sometimes in my own suicidal thinking I had wished “someone would have stayed up with” me all night. Just to have the reassurance that you are not alone and that someone cares that much, helps to diffuse the feelings of hopelessness and helplessness that the depression and weight of the world is bringing. It also helps to know that this difficulty will pass and the individual will get through this. It also helps to know that difficulties will pass and the individual will be able to move on. It is crucial that the individual knows this for tomorrow does not exist and the important thing is to get through today.
In Shneidman’s classic work, ¬Definition of Suicide, he states that “suicide should not be attempted while feeling suicidal” (1985, p. 139). The reason for this is because the thinking of the mind is focused solely like a never ending black tunnel. The constriction is so great; all you can think about is death and cessation. Time for them is in a warp full of pain and despair; there is no tomorrow. Their thinking is solely focused on what they need to do to ease their pain no matter what. Constriction is defined by Shneidman as the “honing in, the tightening down of the diaphragm of the mind. There is dichotomous thinking, a fixation on a single pain-free solution or death. Choices seem limited to two or one” (Shneidman, 1999).
Sometimes during this constriction, you are so overwhelmed by all that needs to be done you don’t know what to tackle first. This might be tasks at work, school, or just in general. Lists become an important tool that can help to prevent suicidal behavior. Dr. David Jobes at Catholic University created and designed a well focused, detailed, user-friendly form, called the Suicide Status Form (SSF, 2006). This form has three essential components that are initial, tracking, and outcome forms. Each section that both the client and clinician fill out to focus on the treatment plans, mental status at each office visit, treatment plan that the patient and clinician agrees to, and other relevant clinical material such as axis diagnoses for proper documentation. It essentially creates a written plan on getting better. The SSF is a very carefully made tool that clinicians can use to know how much pain, hopelessness, and likelihood the client may act on their feelings. This form is the best tool to know where the client is in their thought process because it clearly documents the distress they are feeling. The SSF also provides the client with a voice in their treatment rather than to have it dictated as the clinician seems fit, because after all “you do know best”. The client will feel more centered and relieved that someone is taking the time to listen to what is going on and work with them on what will work and what will not.
The next bridge is the crucial piece of what therapy is about:
Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you’ve told him all along
And pray to God he hears you
And I pray to God he hears you

According to Dr. Shneidman, “there are many pointless deaths, but never a needless suicide” (1995). Over his career, he has stated that the main element of suicide and suicidal thinking are frustrated needs. These are the “list of things that are wrong, things you’ve told him all along”.
In Shneidman’s Psychological pain assessment scale (1999), he lists twenty needs he feels are essential to the frustration one brings to think about suicide as an escape (for more detailed use of the scale, please see article). These needs are an adaptation of Henry Murray’s work, Explorations in Personality (1938).
The key to helping any suicidal person is to listen to what the person is saying. That is the most essential piece that any clinician can do. Jobes (2008) found in his clinical use of SSF’s one thing that was the level of the perturbation and stress involved with suicidal thinking as major correlate for suicidal behavior. This might be that pain becomes so jaded the person just doesn’t feel it and all they are left feeling is the urge to do something in the moment to relieve the pressure that is building up.
Learning new coping strategies may not be easy and some will work; others will not. In formulating this, it is up to the clinician to either “drive until you lose the road (client) or break with the ones you follow” (stick with what you know or try something different). O’Carroll (1996) did a survey of current assessments of suicide and found that not all clinicians (social workers, psychiatrists, psychologists, counselors) have the right definition of what it means to be suicidal. Each profession had their own beliefs and thoughts about what it means to be suicidal and propose a treatment for it. For a select few, some therapists even transferred the client to another clinician because of various reasons (David A. Jobes, 1995; David A. Jobes & Berman, 1993; David A. Jobes, Wong, Conrad, Drozd, & Neal-Walden, 2005; Joiner, Rudd, & Rajab, 1999; Joiner, Walker, Rudd, & Jobes, 1999; Meichenbaum, 2005; Michel, et al., 2002; Ramsay & Newman, 2005).
There is also David Rudd, et al (2006) Commitment to Treatment Statement (CTS). This is a formal written and verbal agreement, on paper, that the client is committing to live and as such, has decided to put suicide on hold to try and see if therapy can help achieve the goal of living rather than of dying. It is a novel way of thinking and is much better than the expense of the hospital (even though it might happen anyway) and the loss of life.
No one is an expert on suicide. There are predictive models that show the likelihood of risk factors that might cause a person to attempt. But these factors do not apply to everyone in the human race. Each suicide attempt or gesture is unique to that individual. There may be warning signs that go unnoticed until after an attempt or completed suicide. Psychological autopsies are valuable but they are too late to do much good to someone who is already dead. Their pain is no longer felt by them, just to those that knew them. You cannot save someone once they are dead. Nor can you learn much about the why and how they chose death to end their pain. As Dr. Shneidman points out, the best source of understanding suicide is through the “words of the suicidal person” (1996, p. 6).
In summary, these tools can be used in clinical practice. I know that most of these are not empirically based as of yet but does it matter to the client who is thinking these thoughts, is hurting so bad to want to end their life not to give it a try? You can “drive the until you lose the road, or break with the ones you follow”.

Lyrics to How to Save a Life: By The Fray (2005)

Step one you say we need to talk
He walks you say sit down it’s just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you’ve told him all along
And pray to God he hears you
And I pray to God he hears you

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

As he begins to raise his voice
You lower yours and grant him one last choice
Drive until you lose the road
Or break with the ones you’ve followed
He will do one of two things
He will admit to everything
Or he’ll say he’s just not the same
And you’ll begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life
How to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life

References:

Holden, R. R., Mehta, K., Cunningham, E., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224-232.
Jobes, D. A. (1995). The challenge and the promise of clinical suicidology. Suicide and Life-Threatening Behavior, 25(4), 437-449.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Jobes, D. A. (2008). CAMs workshop (lecture 41st American Association of Suicidology annual conference ed.).
Jobes, D. A., & Berman, A. L. (1993). Suicide and malpractice liability: Assessing and revising policies, procedures, and practice in outpatient settings. Professional Psychology: Research and Practice, 24(1), 91-99.
Jobes, D. A., Moore, M. M., & O’Connor, S. S. (2007). Working with Suicidal Clients Using the Collaborative Assessment and Management of Suicidality (CAMS). Journal of Mental Health Counseling, 29(4/October), 283-300.
Jobes, D. A., Wong, S. A., Conrad, A. K., Drozd, J. F., & Neal-Walden, T. (2005). The collaborative assessment and management of suicidality versus treatment as usual: A retrospective study with suicidal outpatients. Suicide and Life-Threatening Behavior, 35(5), 483-497.
Joiner, T. E., Rudd, M. D., & Rajab, M. H. (1999). Agreement Between Self-and Clinician-Rated Suicidal Symptoms in a Clinical Sample of Young Adults: Explaining Discrepancies. Journal of Counseling and Clinical Psychology, 67(2), 171-176.
Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and Routinizing the Assessment of Suicidality in Outpatient Practice. Professional Psychology: Research and Practice, 30(5), 447-453.
Meichenbaum, D. (2005). 35 Years of Working with suicidal Patients: Lessons Learned. Canadian Psychology, 46(2), 64-72.
Michel, K., Maltsberger, J. T., Jobes, D. A., Orbach, I., Stadler, K., Dey, P., et al. (2002). Discovering the Truth in Attempted Suicide. American Journal of Psychotherapy, 56(3), 424-437.
Murray, H. A. (1938). Explorations in Personality. New York: Oxford University Press.
O’Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996). Beyond the Tower of Babel: A Nomenclature for Suicidology. Suicide and Life-Threatening Behavior, 26(3), 237-252.
Quinnett, P. G. (1987). Suicide: The forever decision. New York, NY: Continuum.
Ramsay, J. R., & Newman, C. F. (2005). After the Attempt: Maintaining the Therapeutic Alliance Following a Patient’s Suicide Attempt. Suicide and Life-Threatening Behavior, 35(4), 413-424.
Shneidman, E. (1985). Definition of Suicide (softcover ed.). Lanham, Maryland: Rowman & Littlefield Publishers, Inc.
Shneidman, E. (1995). Definition of Suicide: Jason Aronson.
Shneidman, E. S. (1985). Definition of Suicide: Aronson.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.
Shneidman, E. S. (1996). The Suicidal Mind: Oxford University Press.
Shneidman, E. S. (1999). The Psychological Pain Assessment Scale. Suicide and Life-Threatening Behavior, 29(4), 287-294.
Slade, I. (2005). How to save a Life Retrieved may 21, 2012

copyrighted 2012, collerone, G

Invisible disease

by Midnight Demon, posted in suicide attempt

Depression and chronic pain can be ckassified as an invisible disease because even if we tell people about it, and unless we look it, they are not going to believe we are in pain or are depression. Why? Because we look and act like everyone else, “normal”. We don’t act like a psychopath so therefore we are “ok” and should cheer up. I hate those 2 words. And it’s usually followed by “things could be worse”. I want to tell you if someone said that to me right now i’d deck them and tell them yea, I’m planning to kill myself so things are already worse ya moron!!
A friend of mine pissed me off, actually two did within the last 24 hrs. All for the same reason, they don’t think I’m a disabled person. I admit that I don’t like to be in that category but it’s taken me 9 months to come to the realization I will never be happy nor will I ever walk normally ever again.

I’m all ready so depressed I have had two hospitalizations in 3 months for psych. I’m constantly suicidal yet no one sees it or wants to hear about it. I try not to think about ending my life but it has become so automatic for me now soon as something bad happens it is the first thing I think about. I want to be dead because I simply do not find life worth living anymore. I’m so dead inside that I just wish my brain would turn off permanently. But that only happens like never. They say that is you meditate deep enough you can start to regulate your breathing and heart rate but it takes a lot of practice and patience. I don’t have time for that. My only objective would be to control it to stop it, which soon as I passed out adrenaline would kick in and I would start breathing and my heart rate would be back to normal again. Now putting a plastic bag over your head, that is something I’m toying with. A neighbor was found dead in the basement that way. It has been stuck in my mind for months now. And he was good too. He tied his hands up after placing the bag over his head. That is what I was planning to do with my hanging plan, place handcuffs on before jumping and strangling myself. I don’t know why I am writing about this but I am and I am sorry you are reading my deranged suicidal thoughts but this is who I am. My suicidal career has taught me a lot of things over the years and that is a good lethal plan is much better than a non lethal plan.
Speaking of which, my PCP is now scared that I might overdose on my pain medicine. I told him I am more worried about the tylenol content than the pain medicine ok. I don’t want to try and kill myself, fail, and then die a painful death because my liver fails on me. No thank you!! I then told him about the plastic bag. He still said that if I feel really blue and want to overdose to call him. He hears me soooo well. Here I am telling him I will die with a bag over my head and he still thinks I’m going to take pills. Wtf. And they wonder why the health care is so poor. Because doctor don’t listen to their patients. Hell least mine asks about my suicidality more than most doctors will. Some doctors are too afraid thinking the myth that if they ask they will be putting it in their patient’s head…

I guess I am done with my rant for now even though I know I went completely off topic with the title. But if my doctor was able to physically see my suicidality or my pain, I bet he would have no problems treating me and maybe he would have a little more compassion and empathy and possibly trust me when I tell him I’m not going to OD.

It’s 4am and I’m hardly breathing

by Midnight Demon, posted in suicide attempt

Just got finished with a couple of episodes of watching season 2 of criminal minds. I have fallen in love with this show though it is kind of creepy. I’m not sure which is freakier…that this fiction is whacked and someone thinks of this stuff or that it might actually be true and there are more serial killers/rapists/or more than I would like to think about.

The last few hours, my gastritis has been acting up. I wish I could say that it is keeping me awake but as tired as I feel, I am just not sleepy. 
I have been in a psychotic state the past few days, having weird thoughts, paranoia and delusions. 
I try not to give in to the voices but sometimes it is very difficult. It’s 4:30 and all I can think about is death. It is a constant struggle. With my nerve condition, CES (Cauda Equina Syndrome), I have had a bladder accident today that always sends me off the deep end. I know that sometimes sitting causes me to push on the bladder causing urine to come out. Because I have been on narcs and anti-psychotics, I have had some retention and don’t really know when I am full. I find it humiliating to find wet pants and not know it all the damn time. This week is also my 11th anniversary of getting this blasphemous condition and with every bladder or bowel accident, all I can think of is that another disc is going. 
The tension in my neck and shoulders from worry is causing my arms to feel weak at times. I can no longer hold the phone for more than 10 mins with out my arm going numb. And I feel that if I have cervical herniations, I will just kill myself. My only saving grace has been my nieces and nephew. I know they will not be okay even as much I try to think they will be, that they will be resilient enough to deal with my loss.

I have been trying to get a hold of my pdoc but no response. I guess she is too busy for me and it hurts. I have known her for 19 yrs now, since I was 17 and now I feel like I need to see another doc but then she knows me better than anyone. I know that the stressors of last week with the screw up of my benefits set the stage for this psychotic break. I just hope that I can getit controlled before I have to seriously consider going inpatient again. 
My fear there is that they will mess up my meds and then get it straight the day I get discharged. And besides, the docs there will most likely want to try a new expensive drug I have never been on to deal with my psychosis. No one understands the pressure of this and knows what kind of hell my head goes through. Yes, my physical pain sucks, but this madness is worse than that. Least I know that a vicoden or dilaudid can calm it down. 
Any type of stress and boom, I am crazy. Typical “normal” people become anxious or nervous, maybe even have anxiety attacks. Me I just become psychotic. The voices get louder, I talk to myself more to give in to their endless questions, criticisms, and observance of who is going to kill me or saying negative things about me. Weird thing is that every time I get psychotic, it’s different. This time in addition of them reading my thoughts, the conversations continue and no one knows what I am talking about. The conversation in my head gets externalized and the people around me whom I am carrying on the conversation have no clue what I am talking about. Sometimes it is of an intellectual nature, such as the Maya or some history that I have read and think that they know about but truly they have not read it but I know they have because the voices have. I know it is weird to think this but I know my thoughts are amplified and people can hear it and maybe the voices too. I don’t know maybe it is just part of the madness.

It’s now 5 am so I am going to try and get some sleep for at least 6 hours as I need to get up for good old therapy…

Dark thoughts, things no one talks about

by Midnight Demon, posted in suicide attempt

Been thinking the last few days of how this blog has changed my life but yet the demons of my mental illness still play their cards. I have not really thought of ending my life today, until now because the physical pain I am experiencing is driving the voices mad. I forgot to take my medication this morning. I was excited in seeing a close friend and just forgot. The price you pay for sanity is a little pink pill. The voices have created this delusion that if I cut my leg open, I will be free from pain. I cannot help but see their point in this line of thinking. I have done everything to try and sooth my pain but cut. Maybe the release of endorphins is what I need to get over the pain but part of me knows I will not feel the release because my leg is numb. The last time I tried cutting which was a few years ago it was a god awful sound of cardbord being cut that I never want to experience again. Who would have thought that being numb had its vantage points. But that is what nerve damage does to you. It numbs you, making you jaded of the things around you. And then when the psychosis starts you begin to wonder what is truth and what is fantasy. I’m in a difficult spot because although I want to cut, I know the consequences of doing so. The chance of infection is greater because of lack of feeling or that I will feel the pain, just not right away like when I stub my toe on my left foot. Funny I remember when I was a kid I thought my left side was the “evil” side of me and had to be removed because my right side was the “superior” one and would defeat all. Yes I was psychotic back then but I always kept it hidden.
See no one wants to know that you are crazy, like really mentally ill and depressed. They say things like cheer up or things could be worse. How can things be worse if you are already thinking of ending your life and you are hearing voices cheering you on, almost daring you to go through with it every day??? Yes, things could be worse. Life as a vegetable or state commitment to a psych hospital would be a  terrible consequence of telling someone that they are NOT telling someone they are hurting. Every time I hear people tell a depressed person to cheer up it makes me so angry because they are so ignorant. I want to shout at that for being dumbasses because it only created guilt in the depressed person that is just trying to survive the day without incident.
But throw in being psychotic and depressed, you have a different ballgame. Voices are constantly criticizing everything you do. You don’t tell anyone because I’ve learned that only the voices care. The voices are with you 24/7 and they know you better than the person that is saying cheer up. That person then becomes the enemy, the object of paranoia where the voices scream that he or she is going to kill you. To beware of what he or she is saying and doing because now they are after you and are going to kill you. This is what I deal with on a constant basis.
So the next time a friend tells you they are down, don’t tell them to cheer up. Find out what is making them sad because if it is psychosis, you might end up being the bad guy…