Tag: therapy

stigma and suicide

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

Stigma and suicidality
“Among the 10 leading causes of death in the U.S. most are claiming fewer lives each year but sadly suicide is on of the few that continues to rise. Depression and other diseases of the mind that contribute to suicide are real illnesses, not weaknesses. Not character flaws. People battling these illnesses deserve understanding and treatment afforded people with any other llness.” Robert Gabbia AFSP Executive Director.

There is a stigma out there that mental illnesses are not real. That if you just pull your boot straps up you will be ok and not suffer from depression. I have a friend in Canada, a place where the suicide rate is higher than the US because they are still in the dark about treating depression and other mental illnesses. Like Mr. Gabbhia states this is not a character flaw or a weakness. This is real. It takes character and strength to admit there is something wrong and to see help for it. And if you don’t succeed the first time try again until you do.

If I didn’t try and try again, I probably wouldn’t be here today. I probably would have taken my life. I have seen over 10 therapists over the course of my treatment for my mental illness. My current therapist I have been with for the past twelve years and it has been the a huge difference. With the stability of treatment providers I don’t go to the hospital as much and with the value of trust between us, I can state my suicidal feelings without being held against my will in some treatment facility. I am open about how I feel with my therapist but it took a long time to get to where I was. It took about 3-4 years to really trust her and for her to trust me.

I say that it takes trust between us because most therapist are under the believe that all people that have suicidal thoughts should be hospitalized immediately if they cannot be held to safety contracts, which are worthless. Therapist think this is the way to go but it is not. It just takes the legality of it all away from the therapist and really does not put trust in the relationship. Nor does it build an alliance with the therapist because the client is always in fear of being put into the hospital for fear of stating their true feelings. Is that how therapy is supposed to go? Again you have the stigma that if you talk about suicide, you will cause suicide. That is a common myth that everyone still believes is true except for those that actually deal with it. Like me and other suicidologists around the country. Those that deal with suicide are afraid of being sued but there are measures that can be taken so that it is not as frightening as it is. I am not saying that the person with a loaded gun or is in eminent danger and threatening suicide should not be hospitalized and that that gun or other means NOT be taken away. I am saying for those that are chronically suicidal be given a chance that doesn’t include the hospital all the time. In the course of my therapy over the past twelve years I have been hospitalized 4-6 times, compared to twice a year for the previous ten years.

For resources on dealing with suicide:
http://www.suicidology.org the American Association of Suicidology.

Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.

comparisons of psychological pain scales

by Midnight Demon, posted in Chronic pain, mental disorders, mental illness, mood disorders, psychache, suicide, suicide attempt

Suicide attempts are the leading reason why people go to see a mental health professional. What does it mean after an attempt and will the person get the help they need. There are many assessments on risks but few deal with the psychological pain that is attached to the attempt. In my research I have found three clinicians that have developed assessments to help deal with this issue. They are Dr. David Jobes from Catholic University of America, Dr. Israel Orbach in Israel, and Dr. Ronald Holden from Queen’s university in Canada.

Dr. David Jobes wrote and developed what is known as a suicide status form and believes that by collaborating with the client, you can decrease the suicidality (Jobes, 2006; Jobes & Drozd, 2004; Michel & Jobes, 2011). The form consists of three parts: initial, tracking, and outcome. The initial form has the initial evaluation of suicidality, followed by a treatment plan agreed upon by both client and clinician, and then clinical notes such as axis I diagnosis, mood status and session outcome (follow up appt, discharge, or hospitalization). The tracking and outcome are similar in nature. Tracking follows the suicidality. This is used until suicidality is resolved. I base his study on research articles and the two books he has written on the subject.

Dr. Ronald Holden was able to validate his scale of psychache that has helped to focus treatment on psychological pain. This is a 13 item scale rated on a Likert rating of 1-5. The total number of points is 65. The higher the psychache, the higher risk of suicide. The first 9 items deal with the psychological underpinning of what is causing suicidal thinking. The last 4 items deal with the likelihood that this person will act on it. His work I base on his research article.

Israel Orbach (Orbach, Mandrusiak, Gilboa-Schectman, & Sirota, 2003; Orbach, Mikulincer, Sirota, & Gilboa-Schectman, 2003) also has a mental pain scale but has 44 items and cannot be used, in this author’s opinion, in the clinical setting but does have some merit in the initial evaluation of psychological pain. The overall score is intricate and complex as it breaks down the 44 items into quartiles. The study was very small, less than 50 participants and was broken down into two parts. I base his study on his research article.

These combined formed my contention that psychological pain is a causal factor in suicidal thinking.

Suicide status form:
This is a collaborative effort between client and therapist in understanding the reason why a person is suicidal. These forms, initial, tracking, and outcome, provide a base for which to form a treatment plan for working on decreasing suicidality. It was built on the theories of multiple clinicians in the field of suicidality. These clinicians are Shneidman (Shneidman, 1993), who focused on psychological pain, Beck, who focused on cognitive treatment of depression, Baumeister (Baumeister, 1990), escape theory in suicide as escape from self, Linehan (Linehan, Goodstein, Lars Nielson, & Chiles, 1983), reasons for living when you want to die, and Jobes (Jobes, 1995), tracking suicidality.

Dr. Jobes has developed an assessment tool and mangement for suicidality. This management includes the suicide status form (SSF) and uniquely tailors the treatment around individual needs. This is based on the client’s direct input into their treatment. This collaboration takes away the therapist as expert and puts the client in charge of treatment. This also makes things more comfortable and meaningful. Dr. Jobes believes that by tracking the course of treatment, there may be better outcomes and those that are suicidal do not go by the way side, meaning get lost in the system or are ignored after their treatment ends. In his seminal work (Jobes, 1995), he found that nearly half of those that reported to be stressed and suicidal responded to treatment. The other half either dropped out of treatment, got hospitalized, or remained chronically suicidal. This propelled him to develop the SSF to keep track of the suicidal clients and their outcome.

OMMP: Orbach and Mikulinger Mental Pain Scale.
This scale is a 44 item assessment that measures mental pain on nine factors ranging from irreversibility, loss of control, narcissist wounds, emotional flooding, freezing, self-estrangement, confusion, social distancing, and emptiness. These factors are what contributes to mental pain as explained by the authors (see Orbach et al, 2003). Items are scored on a Likert scale of 1-5. In my opinion, given the complexity of this assessment, it cannot be used for clinical use but does hold a valuable research tool.

Holden scale.
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, and psychological pain one feels. Each items are ranked on a 1-5 point scale ranging from never to always agree, neither, or from strongly disagree to strongly agree (Holden, Mehta, Cunningham, & McLeod, 2001). Scores are from thirteen to sixty-five. This scale is easy to use and can be used clinically, with the permission of the author to reproduce it. What I like about this scale is that it is user friendly, scores can be added quickly, and the tracking of suicide can be seen. With higher results, suicide is more likely to occur. The lower the score, the lower the risk of suicide.

These three assessments are comparatively the same but are just called different things. The main point of suicide ideation is to find out what is driving the person to think about suicide and to try and prevent it from happening. Ideally these scales should be used in the first session and the Holden and/or SSF used thereafter.

Baumeister, R. (1990). Suicide as Escape From Self. Psychological Review, 97(1), 90-113.
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.
Linehan, M., Goodstein, J., Lars Nielson, S., & Chiles, J. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51(2), 276-286.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.
Orbach, I., Mandrusiak, M., Gilboa-Schectman, E., & Sirota, P. (2003). Mental Pain and Its Relationship to Suicidality and Life Meaning. Suicide and Life-Threatening Behavior, 33(3), 231-241.
Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schectman, E. (2003). Mental Pain: A Multidimensional Operationalization and Definition. Suicide and Life-Threatening Behavior, 33(3), 219-230.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.

Copyright 2013 Collerone, G

suffering with a price

by Midnight Demon, posted in Chronic pain, depression, mood disorders, suicide, suicide attempt, writing

Today was a little better day without my nerve condition bothering me so much. I still feel pretty down.

I’ve been trying to work on my blog for the new thing that I am involved in and it’s tough editing my own work. I am to add in some questions but don’t know really where to begin. I feel like just drafting a whole other paper but I don’t want to start from scratch. Drafting this paper was a piece a cake the first go round. Editing it is a little more difficult.

I finally saw my therapist after not seeing her for a few months. I think I might be able to see her every Tuesday but I am not sure I can commit to that. I have a hard time waking up and getting the car from my sister’s work is a hassle. I then have to pick her up from work and sometimes I am too tired to drive back, even though it is a MUCH shorter distance than my therapist’s office. I had to give her my forms for my long term disability so I might see her next week so she doesn’t have to mail them out and I can send it in with the other stuff that they need. I’m seeing my psychiatrist next week so I will drop off the paperwork to her and my primary care as he is in the same facility. I don’t get to see him till the end of the month and I want them sent in ASAP.

I just looked over the paperwork and they have a section for vocational stuff. My psychiatrist isn’t involved in that kind of bullshit and neither is my therapist. Oh the hoops these idiots make you go through for a buck.

Been starting to feel suicidal again. I just keep thinking that I just have to die. I can’t go on living. Then today a video comes in that my niece wanted and she is overjoyed and tells me that she loves me so much. How am I to die knowing that she will be messed up if I die? It hurts too much to think about but yet it kills me to suffer the way I do all the time. I get no reprieve. No alleviation at any time. Sure I was able to drive 30 miles today to see my therapist but it cost me my back to be hurting and mentally I am still depressed and suicidal. We talked about this new group that I am hoping to get into. I don’t know, maybe it will help things. I know it will give me something to get out of the house but the group meets at the time of my therapy appt on Wednesdays. I know it’s not a big deal to reschedule my appt but it is to me. I hate it when the schedule gets messed around. Trying to find another time is not always that easy. But I still think that suicide is a way out of my misery. I don’t have to go to group or therapy. Just crush a teenager’s heart or two. I try not to think about stuff like that because it really brings into the picture of what suicide does to the family when you are gone. I keep thinking they will be alright but I know they won’t. People always keep reminding me of that and it kills me because it means I have to suffer longer. I just want my pain to stop. If I had cancer I know they wouldn’t want me suffering so why can’t they just understand it that way. That I had to be out of my misery because I hurt so much. But no one sees it my way.

Ramblings 25

by Midnight Demon, posted in cauda equina syndrome, CES, Chronic pain, chronic physical pain, depression, medical, mental disorders, mental illness, mood disorders, physical pain, psychache, psychosis, suicide, suicide attempt, transgender, writing

Not been feeling good today. Back has been bothering me and so has my stomach. Seems like no matter what I eat lately, I get indigestion. I just took some Mylanta, the Walgreens equivalent as the real Mylanta hasn’t been on the market for quite sometime.

I got my haircut at my cousin’s house tonight. I had to get my haircut because it was getting too long. It’s been at least two months since my last cut. I like to keep my hair short and buzzed close at the sides and back. I wanted to take a shower afterwards but I just couldn’t bring myself to. I just washed my hair and that was it.

I was supposed to go out tonight but the Bruins are playing and I didn’t feel like going to a bar. I just don’t like loud places anyways.

Person from my long term disability company called me yesterday to check in. I don’t know what to say to her. I still have pain but it has been minimal because I no longer leave the house anymore. I might go out three days tops, and that is only if I really feel like going out for a coffee. Today I went out and now my ankle is thanking me with pain. I just can’t win. And what if she asks me about my mental health. I will just say yea I think about killing myself nearly everyday and wish every night before going to sleep that I don’t wake up. I just can’t face another day of nothingness. I haven’t been taking care of myself, more now so than before I got the disability. I shower maybe twice a week if that. I don’t do housework, though my mother now needs help with it. I’m not sure how I can help her as I can’t really be on my feet for too long.
It sucks having Complex Regional Pain Syndrome (CRPS). I’m lucky it likes the cold as the temperature has dropped to the twenties. I cannot tolerate the heat anymore. I like to be warm but not too warm. Sometimes I can’t even have the sheet on my feet/leg it bothers me so bad. But at least the swelling has gone down some though I still have a lump in my leg where it shouldn’t be. I so want to excise it. But I have been told that I might cause more damage if I excise than leaving it alone. I’m just glad that the voices haven’t been around telling me to excise it. I would have to go back to the hospital. I am taking my antipsychotic med. I have to take it every other day or else I become delusional and psychotic. It has been helping with the paranoia that I had when I was on a crowded bus or train. Now I can be around people without freaking out that they are going to kill me. How fun it is having Schizoaffective disorder or as my therapist calls it just bipolar disorder with psychosis. Apparently I don’t have the “positive” features of the Schizoaffective part.

I haven’t been hospitalized for almost six months. That’s good but I have been feeling like I should be in. I just can’t take living my life anymore but then I know I won’t really get the help I need. Most hospitals don’t have time for individual work and so lump you in with a group of treaters to talk for 15 minutes of the day. Then it’s back to the ward doing nothing but arts and crafts all fucking day, least until dinner time. The groups they have are useless. On a good day you might get psychotherapy group. I like that group, I can get something out of it. I should make an effort to go to an outpatient group therapy but of course I have no motivation or inclination to do so. I think it might break up the monotony of the day but that would mean leaving the house at least once a week. I was thinking of going to a LGBT group to be more comfortable. And maybe help with the transitioning of things but I don’t think you can do that in a group. I don’t know, maybe next week I will call. Or have my therapist call to find out more information about it. It will be local so I wouldn’t have to travel too far. I just am afraid I might not be able to walk to the center because it is too far from the T stop. There isn’t a bus that goes by and the closest train stop is more than a few blocks away. Difficult for someone with mobility issues. Course I could take a cab but that is just wasting money to me but maybe it is something to think about. But that is if I get “accepted” into the group to begin with.