Seeing as I didn’t go to bed till six this morning, I fell asleep only to wake up at 10 and then 12 then at 4. I didn’t go to Walgreens like I had planned. But I did take a shower and brush my teeth.
I watched the football game, well the Patriots one as always. I am so happy they won. It was an awesome game.
At around 5 this morning I took some more neurontin, about 1500 mg. that is my normal dose. I took it to get some sleep but it back fired and I hardly slept at all. I am just so tired even though I slept in intervals. I hope I don’t have an all nighter tonight. I am feeling still out of it like Neurontin makes me. I keep bumping into things like a drunk person. My mother mad me mad and so I punched the wall. She was blaming me for the settings on the tv. She messes them up then blames me for it. I hate her for it. And it’s so damn simple if she would just pay attention but no it’s better to yell and scream at me for doing something that I didn’t do.
I see my psychiatrist tomorrow. It is going to be interesting because my therapist left her a voicemail and I sent her one of my blogs. She didn’t send the police after me so I guess that is a good thing. But she does know about my plan to kill myself later this year is all doesn’t go well. Right now that plan seems far away. I know some people will hate me for it but if I can’t be who I am going to be then I am just going to end it. Screw everything. I won’t have a life anyways.
Tag: suicide
nerve pain is a bitch
I should be sleeping but instead my left foot is driving me up the fucking wall with it’s constant buzzing. My toes are even vibrating though if you touch them they will feel normal. I am very tired and all I want to do is sleep but this annoying foot keeps me awake. If I could chop it off I would.. now I am getting bone pain. My toes are cringing though they have nothing to cringe at except my wrath.
It hasn’t been this way for a couple of weeks. I actually had some reprieve for almost three weeks when I got a cold and was drinking cold medicine like it was going out of style. But now the pain has returned and I do not like it. There is nothing I can do about it till I pass out which might take a while. Right now it’s 02:45 in the morning. I tell time by military as I think it’s cool and more precise.
I got my book that I lost and had to reorder today. I forgot how dry the material is and down. I read up to chapter 1 because I didn’t want to overload myself with suicidal thoughts right now. I should probably take some pain medicine but I want to see if it will go away on its own first. That is part of my problem. I wait until I am in unbearable pain before I take my meds. What usually would be a 6 or 7 for someone would be a 10+ for me. I have a high pain tolerance. It really needs to be a 10+ in order for me to take medication. Otherwise I think I am wasting it. I know that is probably not right to do, to wait till the pain gets really bad, but like I said, sometimes it is just a passing phase and other times it is with me for days. I hate this type of pain. The pain meds just usually knock me out so I can get some sleep and calm down some of the pain. It can take days before I am pain free agin. I just wish My middle toe would stop doing what its doing. It’s like wiggling saying “hi I’m here” like some little kid that wants to play. Well I don’t want to play, I want to sleep damn it!! It also feels like someone with a vise is clamping down on the toe, making sure it doesn’t go anywhere. I hate this type of nerve pain. And it’s the result of Cauda Equina Syndrome. My bundle of nerve got crushed and now I am left with nerve pain that decides to come and play every night. It can’t come out during the day like normal pain, NOOOOOO, why would it do that? Then we might have simpler lives. We might be able to work and play with our kids. This damage costs us everything and there is nothing anyone can do to make it better once it happens. It’s all a joke until we kill ourselves from the pain. Everyone one of us has at one point or other thought about killing ourselves because the pain gets too much or we just can’t see ourselves living this hell anymore. Doctors are useless. They just like to spin us on merry-go-rounds having us go from this doctor to that doctor and so on. It took 9 doctors and two physical therapist to figure out that I was not walking correctly because all my scans and tests came back normal, they thought I was a head case or something. I was in pain 24/7 and nothing was helping me sleep except a little pain medication. It took months between this appt and that appt to figure it all out. Then I got out of work because I couldn’t walk around the lab anymore. My department of 14 yrs says sorry your restrictions are too strict and out the door I went on forced medical leave. I couldn’t believe it. I wanted to kill myself right then and there if I had a chance. At 36 yrs old I was declared disabled after fighting this condition for eleven years. It was fun being out of work for a while. But then it got lonesome. I missed my coworkers. I missed going out. I became a hermit. I had nothing to do 24/7. I played my games and that was about all. But the pain didn’t stop, even with me resting it. If I went out and stood too long or walked too far, I paid the price. Like I am doing now. I must have walked too long though I hardly left my house at all except to go to my sister’s house around the corner. Now my foot is on fire and there is no extinguisher to put it out. Simple things I just can’t do anymore. I don’t shower because it hurts to stand too long. I don’t brush my teeth for the same reason. People take these things for granted. I can only take a 10 minute shower and in those ten minutes I wash and then if I remember I brush my teeth. I dry off quickly and hope I don’t fall while I put on my clothes because sometimes my balance is off.
I still can’t believe the difference between my left and right foot. It’s so weird. I have full feeling on my right but diminished feeling on my left. Sometimes but not often I have burning on my right foot. It’s the left over nerve damage from my initial injury 12 years ago. My anniversary is coming up in a few weeks. Maybe that is why I am thinking about it now. These memories don’t fade away like normal ones. My therapist calls it a trauma. I guess when you have emergency surgery, it is a trauma.
coping skills not working
I have been depressed for the past few days and my coping skills are not working. Because of this I thought about cutting my wrist but instead I mixed my meds up a bit and slept. I guess you can say that I was a drunk because all I did in the morning was stumble around.
I didn’t plan on doing this I just couldn’t cope with the pain of living anymore. I needed an escape and I needed it badly. I know I could have called my psychiatrist or therapist but most likely they would have said go to the ER. The ER is useless. You wait for hours to be seen because more urgent cases take precedent and because you are not actively doing anything to harm yourself you just are forced to sit and wait. Then when you get put into a room you are searched, made to give a urine sample and might have blood drawn if they think you need to be admitted. Or you might have blood drawn anyways if you overdosed like I did last night. I couldn’t help it. I wanted to cut really bad and I knew that if I did and I needed stitched I would be screwed. Least with OD’g you don’t leave scars. I didn’t OD with the plan to kill myself. I just wanted an escape for a few hours as things have been shitty the past few days. I told my sister that I wanted to be a man. She asked if me if I was sure. I started to break down. Obviously I wasn’t that obvious to my family. I was just a tomboy that never grew out of it. Except tomboys don’t usually wear men’s clothes all the time. This has been the most difficult conversation that I have had in a long time, since I came out as being gay. I refuse to use the word lesbian because I am a male not a female.
I want to be able to tell my family this year because I will be going to a clinic soon as I get the guts to call to make an appointment. I don’t want to start the hormones and then questioning me why I have facial hair. I have a little facial hair now but it’s kind of stupid looking because there is a space in the middle of it.
I just want to be myself. I don’t want to hurt anyone. The only person getting hurt is me because I can’t be who I am. That is why I want to cut, want to OD, want to kill myself. Though I still feel like it would be better to bury me as their “daughter” than as their “son”. My parents are of the old generation. They don’t understand things of today. Much less gender identity disorder or being transgender. Right now I guess you can say that I am just a crossdresser except my damn boobs get in the way of that. How I loathe my boobs. It is one part that I hate the most. I want to look at my chest and see nothing but my pectoral muscles, not breast material.
The biggest question so far that I have had since coming out as transgender is when am I going to have surgery. Are you kidding me? Let me get used to being freely who I am first!! Let me try the hormones first and see how they work. I hate to think of surgery before hormone replacement and most surgeons won’t do it unless you truly have been living as the opposite sex for some time. It is not an easy thing to go through. And mentally it messes with you big time.
I know this road I have been on is the right now. My sister was worried that it is going to mess with my depression. What she doesn’t realize is that part of my depression is not being who I truly am.
Ten Faces
April 2008 Poster for the 41st Annual American Association of Suicidology conference
Abstract: I have written this paper to talk about my experience with suicide and how the works of Dr. Shneidman has helped me to find the words to the dark demons that are below the surface. This paper also talks about how I think more clinicians need to focus on the psychological pain their clients feel when suicide begins to look like the only answer to their problem. I hope that by sharing my experiences and introduce the works of David Jobes that there are assessments that are out there even if they do not fit the category of validity.
Presentation:
I began my research into suicide and psychache in the spring of 2006 while taking a psychological testing class. My assigned term paper topic was psychometric assessments or psychological tests which interested me. I chose the subject of suicide assessment/risk because of my past experiences; I had barely survived another severe episode of depression the previous winter. Despite my clouded thinking, I had carefully planned my own death. Researching this paper would reveal what the so-called experts knew about these destructive, echoing thoughts I’d suffered from and what kind of assessments and/or treatments my therapist could potentially offer me during these terrible bouts.
What I found astonished me. Despite finding over thirty articles about assessments and risk factors, not one focused on assessment of psychological pain, or, as Dr. Edwin Shneidman refers to it, psychache. In an article by Ramsay and Newman (2005) states that most mental health providers have little standardized training in treating suicidal patients during clinical graduate work, and, are equally lacking during continuing education. I also found, not surprisingly, that some clinicians, once they realize their client is or has been suicidal, opt to transfer care to another professional, especially after a suicide attempt (Ramsay & Newman, 2005). In another article by O’Carroll et al.(1996), I was dismayed to read that there is no standard definition of what it means to be suicidal.
But the intent of this paper is not to review the literature of the past twenty-years. This paper is to talk about what Dr. Shneidman calls the “human stuffy of emotions, the words of a suicidal person” (1996, p. 6). It is to focus on the three P’s of suicide: “perturbation, press, and psychache”.
In 2004, my illness permitted me a break in the gloom; I gained some insight into my suicidal thoughts. I imagined writing a book about my experiences, hoping it would help someone. Alas, that book was already written, and was entitled The Suicidal Mind by Dr. Edwin Shneidman (1996). Finding this book made me feel discouraged. My therapist encouraged me to write my book based on
personal experience rather than from a clinical perspective. I didn’t go back to Dr. Shneidman’s book or work until a year and a half later, when I was taking that psych testing class.
The terms psychache, constriction, perturbation, and press are vital components of suicidal thinking. The cubic model Shneidman(1995) writes about is the best indication, in my opinion, of how likely someone might commit suicide. When pain, perturbation, and press, the three P’s, are at their highest level, individuals are much more likely to feel trapped. Thus they feel there is no way out. Suicide then becomes the answer they seek to end their pain and their life.
Although I heartily agree that assessments of the lethality of suicidal ideation are important, the one element that has been frequently overlooked is the psychological pain that the individual is feeling. What I have learned is that there needs to be an assessment of psychological pain whenever a client is feeling suicidal or having suicidal thoughts. A good analogy is the following: Think of a time when you had to go to the emergency room because of a physical ache, maybe abdominal pain or a severe headache. One of the tools the clinician might use is a scale to rate your physical pain from 1-10 with 10 being severe. Some emergency rooms have drawings of ten faces with varying expressions of discomfort that children and non-English speaking patients can utilize to evaluate their pain. No such scale exists
in the psych world. Even most psychiatric emergency services at major hospitals do not ask about mental pain. That is what I find so striking about Dr. Shneidman. By asking, “Where do you hurt”, the three P’s of suicide, perturbation, press, and mental pain can be assessed and taken into account of how likely a suicide attempt might occur.
Current research studies by Holden et al. (Flamenbaum & Holden, 2007; Holden, Mehta, Cunningham, & McLeod, 2001) at Queen’s University in Ontario are validating a pain scale that I think is efficacious, especially in times of crisis, and possibly life saving. From my experience of those darkest moments, there are no words for the depth of pain that I feel. Holden and Mehta’s scale (2001)can help communicate how much pain the client is feeling. This scale is essentially a self-report of psychache, enabling the clinician to quantify psychological pain. It can also determine whether that pain is the driving force for a potential suicide attempt. This scale is, in my opinion, the best measure to pinpoint all three aspects of perturbation, pain, and press. As Dr. Shneidman points out, the best source of understanding suicide is through the “words of the suicidal person” (1996, p. 6).
Once the level of pain has been determined, assessment can be tracked through the work of David Jobes described in his latest book, Managing Suicidal Risk (2006). He uses the continuum of
initial interpretation, tracking, and outcome to manage a suicidal client. These forms are called the Suicide Status Form (SSF). These forms have gone through the process of refining to become efficient and use of ease in managing suicidality (Jobes, 1995, 2006; Jobes & Drozd, 2004; Jobes et al., 2004). He stresses that he will do all he can to prevent his client from fulfilling their plan, and he offers the client a more positive way of dealing with these thoughts. Through his work, he facilitates the client managing his or her own treatment, collaborating on what will effectively decrease suicidal thoughts and impulses.
I hope that someday these tools become more widely available to those that want to help the suicidal clients, even if they have not been empirically tested. As Dr. Shneidman once said, “relevance has precedence over precision, and that ‘validity’ does not exhaust the category of ‘usefulness’”(1999, p. 287).
References:
Flamenbaum, R., & Holden, R. R. (2007). Psychache as a Mediator in the Relationship Between Perfectionism and Suicidality. Journal of Counseling Psychology, 54(1), 51-61.
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., & Drozd, J. F. (2004). The CAMS approach to working with suicidal patients. Journal of Contemporary Psychotherapy, 34(1), 73-85.
Jobes, D. A., Nelson, K. N., Peterson, E. M., Pentiuc, D., Downing, V., Francini, K., et al. (2004). Describing suicidality: An investigation of qualitative SSF responses. Suicide and Life-Threatening Behavior, 34(2), 99-112.
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.
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. S. (1995). Suicide as Psychache: A Clinical Approach to Self-Destructive Behavior: Rowman & Littlefield Publishers, Inc.
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.
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