Tag Archives: suicidality

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.

 

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Improving Mental Healthcare Access for Veterans

Happy Memorial Day folks!

I wanted to take some time to bring a little awareness regarding an issue that I consider extremely important right now, and that is the long wait times and limited access Veterans have for receiving mental healthcare.

As someone who lives with bipolar disorder in the pacific northwest, I have seen (and experienced) huge wait periods between when myself or my peers have needed to see a specialist and when we’ve actually been able to see one. Unfortunately, this is something I’ve rather come to expect these days.

What I don’t expect is similar wait times for veterans. While I’m not here to say that veterans are somehow better than the regular population (in fact, I generally consider myself anti-war) but these are people who have already given up an extraordinary amount for the sake of the rest of us.

As someone who has been in the position where long wait periods for psychiatrists left me with no other choice than to enter a psychiatric hospitalization I understand how hopeless this situation can feel, and I hope our government can take action on getting these folks the help that (I dare say) they’ve earned.

You can find an article with a little more detail about the situation here.

Emotional vs. Unemotional Depression

This month depression moved in. Not the quick, fleeting sort of depression I generally have throughout the year, but the deep, slow-growing sort that seems to manifest itself during our bleak Seattle winters.

I’ve been trying to explain to the people around me the nature of this depression, because it isn’t the usual sort of fleeting, emotional, crying, despair sort I normally feel.

This depression is the unemotional, a bleak sense of resignation and a lack for caring about anything anymore.

In some ways, at first, I seem to prefer this. It isn’t emotionally jarring, I feel exhausted but don’t feel guilty if I lay around, and I don’t care from one moment to the next what happens to me (great when you have nothing happening to you). Something about it feels comfortable, like slipping on an old pair of sneakers. My anxiety seems to vanish, after all… how can you be worried when you don’t care about anything?

The trouble is that I know the end game when it comes to depression like this. Not caring about yourself and your life can be like a vacation for a week, but if it steadily grows (and it tends to for me) it can be very detrimental to began not caring for a month. Or two months. Longer, even. The longer I go without being able to care, the more things fall apart.

The other issue I have with unemotional depression is that by putting me at ease and alleviating my anxiety I lower my guard and turn a blind eye to the vigilance once keeping me from trusting the things depression begins whispering in my ear. My level of “comfort” with this sort of depression actually goes on to hurt me, because my guard is down.

It is almost like I’ve made a truce with it. Don’t hurt me any further, and I’ll let you (I say “let” as if I can actually get rid of this) stick around. 

Trouble is, it always cheats.

Before long it whispers to me, you know, you really are doing more harm being alive than you would if you were dead.

I sip my orange juice and think, “you have a point…”

WAIT! WHAT?!? NO!

Sneaky little snake!

But after months of those situations I’ve had a lot of trouble in the past not believing and agreeing. Then, you know. Hospitalization time again.

The fact of the matter is, I would like to avoid another hospitalization at all costs, and that is part of the reason for this post today. I need to remind myself who the enemy is, get to know it, and stay on guard.

Blood Test May Predict Suicide Risk

According to a recent study (published in Molecular Psychiatry) of bipolar patients in Indiana, molecules in the blood appear to indicate an individual’s current degree of suicidal intent.

The study was done on a small sample of the bipolar population (nine patients) so is really just a preliminary sort of study, however the findings were pretty interesting.

Researchers found that there are 41 enzymes and proteins in the blood that levels appear to fluctuate based on the patient’s level of suicidal risk.

One enzyme in particular called SAT1 was elevated in subjects who were feeling suicidal. Researchers also found that postmortem studies of the blood of subjects who had commit suicide had levels of SAT1 even greater than the living subjects researchers were studying.

Researchers also identified four biomarkers that may be used to indicate potential suicide risk in a patient even if the patient is not currently suicidal.

What an interesting find! You can find the whole article (with more detail) here.

The Intense Delayed Response

I would say that if there has been anything in my life that has protected me from the potential criticism of people (for having bipolar disorder), or from feeling shame about my wild emotional reactions, the delayed response would be the key.

In times of having an overwhelming response, this response might occur immediately. Other times (and more often for me) the whistle on my emotional kettle starts wailing, but instead of exploding right there, the kettle is moved to the back burner. It may sit, looking completely docile until company leaves, and then it resumes the process of “exploding”.

Because of this, I spent a long time hiding the fact that I had bipolar disorder, and though the people who knew me best were not surprised by such a notion, those that were my acquaintances often seriously doubted this diagnosis. After all, they had never seen any of these emotional “explosions” -so how could they exist?

Even when I was younger and undiagnosed, I hoped someone would approach me about my behavior. Unfortunately, most of the time (like at school) I could hold it together relatively well (for a while), and things wouldn’t come back and hit me until getting home. Not openly exploding in front of others felt almost like a curse, in that regard, because nobody seemed to believe that I was having any problems with my mood.

The same has been true at work, only there I’ve considered this delay a godsend. Being able to keep it together the majority of the time only to go home and have the acts of the entire day effect me all at once left me feeling like my job was less at risk, but the fact that everything hit at once meant mood-swings that would shake me to the very core.

And then there is the third situation where this has been an issue. In times of trauma or anxiety or discomfort, the kettle still gets put on the back burner. It might be a situation where I desperately need to let my reaction out immediately, after being harassed, or after a panic attack, or after a particularly harsh conversation. It almost feels like everything is fine at first, there is no need to talk about what happened to let anything out because it often doesn’t feel like there is anything there. I can’t hear the kettle, I don’t know it is boiling, so when I get home and it blows up in my face, things are ten times worse.

Is this something that other people with bipolar disorder face?

Is it a result of years of stuffing my feelings away without letting them out, now I automatically stuff them away even though I feel inclined to deal with them immediately?

Or is this an issue something else? Namely anxiety? Perhaps this is happening because of anxiety being the prevailing mood or feeling in the moment when I expect a response, and it isn’t until it dissipates (or triggers a response?) that the emotional response can occur?

I don’t know.

This came up though with the Suicide Prevention Workshop I attended the last two days.

First off, I have learned that the Geodon I am taking now is helping raise my mood in a general sense, but it is not effecting how I respond to stress and anxiety.

After the first day of the workshop (which, it hadn’t occured to me that talking about suicide for two days straight would be depressing -I was definitely wrong) I was extremely overwhelmed. I got home and it was just as I had described, there was an explosion of intense emotional reactions.

Obviously the topic of suicide can be upsetting, but I felt like anxiety (mostly around being in a classroom-type setting) was what was really prevailing.

With bipolar disorder, it often seems like my emotions sit right below the surface of my being, ready to make an appearance at any moment. Going into this workshop, I considered the notion of what it means (and what it takes) to be a healthcare professional (as I was the only one there who wasn’t). I admit there have been times in my life, in the more recent years, that I’ve considered the possibility of going back to school to be a social worker or a therapist… but I wasn’t sure about my ability to realistically interact with intense emotional content with someone (like suicidality) without being affected myself.

If the first day was any indication, I was affected. I came home and flopped on the bed, face in the sheets, and just cried. 

In the workshop, I had felt awkward, I had felt overwhelmed, and now that I was home, I felt discouraged. Most of the content felt like it was over my head (as someone who isn’t a healthcare worker) and my anxiety had been so high that the reaction once I got home knocked me off my feet.

I decided not to go to the second day of the training, and I wrote the following:

“Unless something that stabalizes my mood or relieves my axiety pops up, I would never realistically be able to break into the world of the health care professional but will more likely be set only in the role of consumer instead, as things have been for as long as I can practically remember.”

I even impulsively emailed one of the workshop trainers, saying I didn’t think I could complete the second day.

And then… I didn’t sleep.

At 2 am I checked my email and she had emailed me back. She said she “understood but really hoped I would reconsider and be there.”

By 4 am I had decided I was going to finish the workshop. I felt better, and I really did want to know how things were all going to come together.

So I went. And I went knowing that when I got home last night, I would probably feel like shit. I would probably cry, my head would feel overflowing with information and like it was a sponge that needed to be wrung out, and I was right. 

But, last night the crying lasted less time. I felt more like exhaustion than despair, and after 30 minutes of pretending I couldn’t move my arms or legs and laying with my face in a pillow, I stood up and helped cook dinner.

And it was done.

I still no longer feel compelled to be a therapist (or, at least, I am a bit more wary of the notion now); and if anything I really appreciate the role I have now. Unless a miracle drug suddenly cures bipolar disorder, I will always play the role of the “consumer”. That doesn’t mean, though, that I can’t talk to all of you about it like I have been, or support the actions of others like I have been, or that I can’t use the suicide prevention training that I have just received.

I feel good about doing what I’m doing now, and now that I am certified in suicide prevention, I feel much more prepared for those emails you send me in crisis, and even those messages you send me when you’re not.

I’m not a therapist, but I am someone who has probably felt how you’ve felt… and I know how scary, and how hopeless life can feel sometimes.

I truly believe with all of my being that there needs to be a place where these feelings can be expressed safely, and you can know that if you need to talk about it, you can always reach me at host@thebipolarcuriousblog.com

How Best to Assist?

I have several things to talk about, but they will need to be put slightly on hold today and tomorrow while I attend an ASIST – Youth Suicide Prevention Program workshop.

Many of you may not be aware, but I do receive a hefty chunk of emails from people in crisis, or from people who have a loved-on in crisis. If that is part of the territory of having this blog (or from having an association with a local peer support network), I figured having a little extra knowledge on suicide prevention is never a bad thing!