Reveal or Conceal; Suicidal in Therapy

First I must be clear that I am not recommending people avoid being open with their therapists, especially about being suicidal. I simply have found myself in an odd situation that I want to write about because I think I am not alone in facing this conundrum.

When visiting my new psychiatrist last week I told her that her inability to help me with drugs (something I somewhat expected due to the treatment-resistant nature of my current symptoms) was really only secondary as to why I wanted to see her. I also desperately needed someone, one person in my life I felt confident I could talk openly about my symptoms with.

“Don’t you have a therapist?” she asked.

I replied rather hesitantly that I did, but then made an effort to describe the issues that arise from being so open with my therapist (or GP or any other doctor, really).

The first problem generally arises from the conversation itself.

It is not uncommon for me to have symptoms that involve thoughts of violence or suicidality, and when expressing these symptoms to people they have generally produced a sort of… physical and emotional recoil. The result is something similar to taking a bandage off a wound and showing it to someone who can’t stand to look at it, and they say, “oh yes, no, that looks just fine…” but their body language denies these words completely.

As one might imagine, being able to express that these thoughts and feelings even exist within oneself takes an incredible amount of courage and vulnerability, and a reaction like this tends to make the pain from that exposed wound pulsate even more deeply.

It took me many years to begin to believe that I am not something horrible, a creature, or a villain, or unworthy of help or kindness because of these symptoms I experience. When I see the pain and fear in peoples faces when I even just mention them (when I have been living with them for ages on my own), sharing begins to feel less helpful and more like salt in the wound.

Keep in mind, I have never had a friend, relative, doctor, or therapist who could avoid presenting this kind of reaction. The only people who I have ever been able to talk openly about my symptoms were psychiatrists because the ones I have met have had the best totally blank poker-faces I have ever encountered.

Realistically, I am capable of blowing right past this issue if I genuinely need help managing these symptoms or if I require immediate medical attention. At that point, let people grimace all they want, I am usually in too much emotional turmoil to care.

The problem I have with discussing suicidality or other symptoms with my therapist(s) come most often from discussing symptoms that are present but within my ability to withstand. Which leads me to the second problem…

In Therapy, every second of suicidality is an emergency.

Today I told my therapist about the last two weeks, and it didn’t occur to me to edit anything out or omit certain details. Normally I like to be open and honest all the time, so what benefit could I possibly get by editing myself (in therapy, the one place I want to be the most open)?

The mention of last week’s suicidal thoughts put my therapist immediately into red alert.

I am happy that therapists have been taught to take every mention suicide seriously, however this method has also left a big black hole in the area pertaining to issues we can talk about involving my symptoms.

My therapist was so revved up all she wanted to talk about for the rest of the hour was suicide and while I tried my best to try to explain to her that suicide isn’t a “one hit wonder” for me (only popping up in times of emergency), the notion that anyone could live with suicidal thoughts for long periods of time and be able to simply sit with them, to prolong one’s existence by constant negotiation with these thoughts… or that there might be varying degrees of suicidality, well, it was all lost on her.

I’ve met so many people who, like me, live with suicidal thoughts that linger for days, weeks, months, maybe even years at a time. If I were to immediately be hospitalized for every situation involving suicidal thoughts I’ve had, I would probably be spending at least 1/4-1/3 of my time hospitalized or have an extraordinary number of individual hospitalizations.

Over the years I have become very familiar with my suicidal thoughts. If they are out of control I absolutely have cause for immediate concern, but that might occur in the span of a few hours, or it might take months of constant nagging to reach that point. I find these thoughts, these feelings and urges to be as fluid as my other symptoms, and coming up against my therapist (and many doctors or healthcare professionals I’ve worked with) who believes they are as rigid as a diagnosis must not have ever experienced them for themselves.

Overall, I wouldn’t want the whole system to change. I think it is important that when people begin talking about suicide there can be immediate action taken to help the situation. I guess I just wish there was more room for suicide (or other difficult symptoms) in conversation, more room for a more broad understanding of how these symptoms operate and how absolutely strong the people are who live with them every day without being able to tell anyone (for fear of recoil or blind panic or unnecessary hospitalization).

It is unfortunate to enter into an arrangement (like therapy) where I expect to be able to talk about the things I might not feel comfortable talking to other people about and find myself having to edit what I say or hide the very aspects of myself that have led me to being there in the first place.


11 responses to “Reveal or Conceal; Suicidal in Therapy

  1. What a great post. Last time I mentioned suicide, I thought I was going to be sent straight to the hospital. I cannot say it any better than you have done here. Thank you for bringing this issue to light.

  2. Reblogged this on dimdaze and commented:
    This is a well thought out post about a serious subject. If you can’t discuss this with your therapist, then what?

  3. I agree. I pay enough (ok a $10 copay isn’t much) that I want to be able to say whatever it is I’m struggling with without fear of commitment. Luckily my therapist is well adept at differentiating between thoughts, ideation and plans.

    I can discuss frequent thoughts and thinking of suicide as an escape and unless I have a detailed plan of action and am putting my affairs in order, she doesn’t take it lightly but we can discuss other things, she can provide perspective (e.g., it’s incredibly common in deep depression and bipolar disorder to think but never act) and I don’t have to lie. There is though always concern, and that’s appropriate. As is checking to see how far the thoughts went. But I’d be inclined to find a therapist who got to know me, knew it was common for me and knew or at least had a decent idea of when it was serious enough to warrant action.

    It’s paramount that therapy is for me. It’s not like we can casually talk about these things with coworkers or even mentally healthy family.

  4. As someone who lives, breathes and constantly thinks about suicide, I understand what you are going through. Have you thought about treatment goals for your suicidality? there is something called CAMS/ SSF by David Jobes that is helpful in bringing down suicidality and also collaborates with the therapist on treatment goals. It is based in the US but can be administered anywhere. I have the blog post on it for CAMS/SSF if you want to take a look at it. But your therapist has to be open to this or it’s not going to work.

  5. I remember a time when I didn’t feel suicidal. I was 4. But by the time I reached 7 or 8, I was already nursing a growing darkness in my heart. So the thought, for me, of living a life where I don’t have suicidal thoughts is unnatural. Rarely, even during my most manic and hyper moments, do I not have suicide as a viable option sitting in the back of my head. There’s always two things I tell to doctors when they get that worried look on their faces: (1) It’s been this way for a long time, and I haven’t offed myself yet. (2) If I’m talking to them and telling them about it, it’s not something they should worry about. When they DON’T hear me talk about, they should worry. That usually elicits a smile and then we can go on.

  6. LaVidaBipolar

    You so wonderfully capture a feeling I’ve known. Suicide is a thought/comfort/tormentor/security blanket/albatross with which one can have a months, years-long relationship with, not requiring immediate hospitalization. It is sad that our therapists are human enough to not understand and to not create the judgment-free atmospheres that we really need. Yet, that humanity also helps to establish the helping rapport that facilitates mental wellness. That said, I tend to hold things in because if my therapist has that type of reaction, how would my friends/family react? The isolation is painful yet bearable. I’ve chalked it up to a necessary (at least for now) lie of omission to spare others from discomfort and misunderstanding and to save myself from misguided interventions.

  7. When I was in DBT recently, I was finally able to explain to my therapist that the suicidal thoughts are almost always there. I worry about the loudness and frequency of the thoughts more than whether they are present. She appreciated the clarification and said it helped her to understand where I was coming from. Maybe that could help for you as well? I’m sorry you are having problems communicating this to your therapist.

  8. Omg! Omg! Omg! You mean I’m not crazy??! I’ve lived w/ this exact burden for more than a decade. I stopped telling people coz they just FREAK out. Granted, I’ve tried it twice but somehow didn’t succeed but still, I mostly struggle w/ it in my episodes & if I can talk it out, it’s manageable. But who do you talk to & how??
    I’ve been thinking I’m either crazy or abnormal, I can’t believe this happens to someone else as well. Might sound off but thank you. At least if know of one other person w/ this specific burden. I just wish I had someone to talk to to beat back my dark passenger when he strikes. Even right now I’m in the middle of wrestling w/ it.

  9. It never dawned on me that people hesitated when discussing this with their therapists. It is a subject we had to figure out how to deal with.

  10. I finally got around to reading this and I’m glad that I did. This post speaks directly to me. I’ve had suicidal thoughts for as long as I can remember. For me it’s just my everyday life. But when I tell people this, how much I think about killing myself, they just stare in horror or tend to back off and avoid the subject. Every time I see my counselor I tell her I think about killing myself so she’s used to it by now, but is constantly telling me how that’s not how life is supposed to be. I keep hoping one day all the counseling and meds will finally work and I can see life the way it’s supposed to be.

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