Tag: suicide ideation

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.

Recovery…what does it mean?

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

Recovery…what does it mean?

I keep hearing people talk about recovery and I am at a loss. Can someone enlighten me on what the hell it is? And what exactly are you recovering from?

I hear from suicide attempt survivors all the time this word. Do people who think about suicide really recover after they attempt? Because I keep wanting to try again and again. I haven’t made an attempt in years but I think about suicide constantly. Or is recovery just something that happens after you learn different coping mechanisms?

The reason I do a lot of suicide research is because I want to find something to help me. If I never looked for it, I wouldn’t have found CAMS and the SSF so useful. I have also found other assessment tools but nothing else worked. Traditional therapy didn’t work for me. I had to find a therapist that treated me as an equal and collaborate with me on what works and what doesn’t. It’s still an ongoing process as my suicidality gets worse during certain times of the year than others.

I don’t think I will ever recover from my mental illness. I think it will wax and wane, just like my suicidality, but it will never get better. I might find symptom relief through medication but even with medication, my depressions get the better of me. They are too severe and too frequent to really get relief from them. Medication has been proven useless with treating them. I am just left to suffer through them until they pass.

Then I have the physical pain that I deal with. I don’t think I will ever recover from that. It just seems to get worse during the temps of New England. My former PCP thought that I can just do something to make me feel better and things would be better. Wishful thinking. As much as I don’t want to be on meds, I know it’s my new way of life. It’s the only way I can survive. Otherwise, I think I would entertain the thoughts of killing myself, and by entertain, I mean attempt.

Dealing with Pain, or lack there of

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

Dealing with Pain, or lack there of

I woke up this morning with my leg bothering me. I thought the pain would subside if I got out of bed. I was able to shower today and help my sister prepare Christmas dinner. It proved to be too much for me. I am now in excruciating pain and almost in tears. I went up to my room to take a pain pill and then went back down. I thought by the time I reached the last step my leg was going to give the final fuck you and let me fall. I was just in a lot of pain. I couldn’t stand and I couldn’t sit. As I am typing this, it’s the only thing that position that I am really comfortable. I am going to go to sleep soon as the pain meds kick in.

I wanted to watch a TV show tonight but it doesn’t look like that is going to happen. I usually watch “It’s a Wonderful Life” but I don’t know where the DVD is. I have to order a new one. I also need to order another Titanic DVD because I am missing disc 2. Granted I like the part 1 better than the sinking of the ship but it would be nice to see the whole movie rather than just the first half. I think I will just watch Home Alone. I could use a comedy.

Waking up in pain is no fun. It sort of ruins your whole day. If I wasn’t feeling so restless, I would probably be sleeping. I did have a big meal. I really tried to make Christmas this year but it always seems I am in pain or am sick. Last year I had a nasty cold. It would be preferable to this pain that I am having. At least I know the cold will go away. I am not so sure about this pain. This pain I have been having since before Thanksgiving. I thought it was nothing but it turned out to be something. I am currently waiting for an MRI to find out what it is. I might be facing surgery again. It’s something that I am dreading.

There is no guarantee that surgery will fix this. But I know there is something wrong with me. This pain shouldn’t be happening unless there is something wrong. And with it brings my anxiety up a few notches, making my PTSD symptoms worse. I am in constant vigilant mode, always on edge. It’s awful to be in this state. And waiting for this MRI is not helping matters. The secretary was supposed to call me Wednesday and I haven’t heard anything. I kind of want to call the office and see what the hold up is. I hope it’s not my insurance. My father gets his CT scans all the time and doesn’t have any problems. We both have the same insurance. This waiting is just killing me because the longer I wait the longer I suffer, both mentally and physically.

I am so tired of dealing with pain every day and now to have this leg pain that makes walking and going up and down stairs difficult is just torture. I can usually tolerate a lot of pain but I am almost burnt out at this point because there has been no relief. I am usually in pain with my ankle/foot. But my leg pain is worse than my ankle. I just have low tolerance these days because I get no relief. I can take pain meds for my ankle/foot and it works but the new pain doesn’t want to settle down with it. I am again thinking of ending my life because I can’t deal. And that isn’t a good place to be.

Hot Chocolate and other Thoughts

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

Hot Chocolate and Other Thoughts

A blogger friend made a comment on my Dark Hot Chocolate post and I thought I would have a cup. I have been up since 0445. I plan on taking some nerve pain meds to get back to sleep. I want to finish my cup of cocoa first.

My mood is still down and I cannot seem to fix my TiVo. I am very, very sad about this. There are shows on there that I haven’t seen, like Rizzoli and Isles and definitely, Bones. Part of me doesn’t care and part of me is extremely pissed off that I didn’t watch the shows when I could have. I am going to play around with it sometime today to see if it will boot up.

I’m still having suicidal thoughts. My therapist called me after I sent her a distressing text. We talk for a bit and she made me promise that I wouldn’t do anything this weekend. She really wants to see me on my birthday. Now I have to get a Zipcar. My only worry is that I won’t be able to get one at a place that I know. I really want to get the same car I got last time. It drove really well. I think next time I am going to take the highway home rather than go through the back roads. It seemed to take forever to get home through the back roads and I was getting really aggravated because I wanted to go home. It depends on how I feel. I was going to take the other highway home but there was traffic due to construction and I didn’t want to sit in traffic. There was no traffic on the back roads but I was just impatient to get home.

My suicidal plans are put off, again. I am not sure how I feel about this. I feel discouraged and angry. I shouldn’t have told my therapist about this. I don’t know why I seem to do things like this. I just feel so hopeless about every thing that is going on in my life. I can’t seem to do a damn thing. The only thing I can do is watch my niece when my sister needs me to, though I can no longer pick her up from school. The distance is just too much for me. There are too many hills for me to climb. It saddens me because I was once able to do those hills without a problem. And it kills me that I am disabled. I fucking hate being disabled where I can no longer do the things I was did. I can’t walk, which was my major stress reliever. I had my game, which was also my stress reliever but it shut down and I haven’t been able to find something similar. I could play Farmville but there is no challenge to that. You just plant your crops and collect “money” when you harvest then plant your crops again. It’s lost its appeal. I just have no other activities to keep me occupied so I think about suicide most of the time.

The reason I think about suicide is not only because I am disgruntled that I am disabled, but also because I don’t have anything else to occupy my time. Sure I go out to Starbucks and have my drink and write in my journal. But then I get anxious and need to come home. I only stay for about an hour, sometimes less. And then my mother calls me to see what I am doing. She also calls to let me know what we are having for supper. I try to have enough funds to last me through the month but sometimes it doesn’t work out that way. This month I bought coffee so my funds were lower than they should be. I meant to add more funds to the Starbucks card but I never did. So now I have the entire weekend to ponder about my upcoming appointment with my neurosurgeon.

Saturday, I am going out with my sisters for Chinese food. It’s my birthday celebration with them. I wanted to go to another place but I have been deprived of Lo Mein for a while and I want it dammit! I also want General Gao. So I already know what I want. That will be a distraction for a little while. I am sure I will continue to write my Saturday Blogs. I know I have been writing more blogs. It helps to write my thoughts down.