Suicidal: Conversations on the Edge

This is a collection of observations based on times when I or a friend was suicidal. Do not freak out. I am not suicidal now. My thinking is, I admit, a bit disordered because of my toothache, but I’m quite safe.

Many of us, in the course of a lifetime will either talk TO a suicidal person, or talk AS a suicidal person. And I think we all wonder what to say or do…as usual with these posts, there is no one answer that is always right. And sometimes, an answer I list here as a wrong answer might be the right answer in a particular situation. You see, humans are capable of infinite diversity.

Scarred forearms of a schizophrenic.. Suicidal people might engage in self harm
Photograph by: James G. Owen

As always, I advise you to take suicidal persons seriously. If you have no idea what to do call this number. If the suicidal person is unable or unwilling to talk on the phone, they will talk to you and tell you what to do. Don’t get alarmed or frustrated if the suicidal person will not talk on the phone. It’s not just me, many suicidal people get weird about the phone.

Remember, when you are talking to a suicidal person, you are talking more to an illness than a person. Their illness has already shot down any positive thoughts they might try to cling to. It rarely helps a suicidal person if you approach them with the ‘Think of all you have to live for’ line. That illness, that depression, that bi-polar, that schizophrenia has already undermined all the good bright things in life. The ‘Think of all you have to live for’ attitude may only increase their sense of guilt, shame, and depression.

Another thing well-intentioned people do is try to play John Wayne playing a good-hearted Army sergeant. They grab you and say ‘Talk to me!’ This approach can scare or intimidate the suicidal person badly. A better tactic is saying “May I listen?” Remember that a suicidal person is living in a realm of rapidly diminishing choices. Their tunnel vision is tapering down to a single point. Inviting them to talk adds a new option, and it sometimes can change how they view the world.

Sometimes suicidal people engage in self-harm. Most cutters, burners, and scratchers only engage in these behaviors privately. But when people are very suicidal, they can become disinhibited, so you might see these behaviors. And they are not pretty things to see. Everyone who sees self-harm wants to say “Stop that!” and that is a reasonable impulse. But curb that impulse. Ask them, instead, “Are you doing that so you don’t do something worse?” Now, that might seem like I’m giving you poor advice, and it is poor advice, but it is also sound advice. Weigh the consequences. You would prefer to have your friend as a live cutter than as a dead friend who will never cut again.

Suicidal people often quit sleeping or eating. And that isn’t good. Try tempting them to eat with hyper-palatable foods…try ice cream, milkshakes, twinkies, doritos, whatever you think they might eat. Don’t worry that you are offering them unhealthy choices, just try to get some food in them (and if it’s me, offer pork rinds!) If they aren’t sleeping, try to get them to take a nap. They will be resistant. Build them a blanket fort to nap in, let them put their head in your lap to sleep, promise to stay while they sleep…again, do whatever you can to get them to sleep.

When you are dealing with a suicidal person, realize that they are still ‘in there’ they are just very small, very scared, and nearly voiceless. Their illness has grown large. It occupies all the space where the person normally lives. The person you know has been crowded into a very tiny corner. So speak slowly and clearly. Be prepared to repeat yourself. Your voice is a tiny whisper, the illness is roaring.

Remember, too, that the illness is the enemy. This sick, suffering person is not the enemy. You are not trying to outwit the person to get them to a safe place, you are trying to outwit the illness. The struggle is real, but you will make a mess of things if you do not know what you are struggling with. Also remember that getting the person to agree to go to the hospital can be very difficult. It is even more difficult if the person has been checked in before.

Suicidal People might be afraid to go to the hospital
Health does not always feel as comfortable as illness.
Image by ♥KatB Photography♥

The hospital will take the person’s complaint very seriously. The hospital will go to heroic lengths to keep the person safe. But the hospital is, first and foremost, a hospital. The scared, sick, suicidal person will be subjected to indignities, they will wait a long time in an ER bay (waits of 2 days to be admitted to psych are not uncommon) The hospital is good at what it is good at, warmth and comfort are not areas where the hospital excels.

But getting the suicidal person to get help, getting them to go to the hospital should be a major goal. BUT do not lie to them to get them to go. Find another way to get them to agree. Understand that they might very well know exactly what the hospital will be like. Understand that they are scared to go to the hospital. Understand that they do not want to put up with the indignities of the hospital. Just keep truthfully bringing it up as the best option. (and, sadly, it is the best option, in fact, it is the only option.) Try to offer to take them to a ‘better’ hospital. Because we all know that some hospitals are better than others. We all know that the better hospital might transfer them to a hospital that is not so good, but going to the better hospital greatly increases the odds that they will be admitted there.

Finally. A suicidal person is generally not seeking attention. If they reached out to you, it was the last desperate act. Reaching out to you took tremendous effort, probably it took all their energy to do it. They are being suffocated under the weight and volume of their illness. Do your level best to get them help. There is something about you that the suicidal person believed and trusted in with the last of their will. If a suicidal person asks for your help they are telling you how highly they think of you.

In very rare cases, some types of illness use suicidal threats and behaviors as a way to manipulate others. These illnesses are more rare. And being used like that makes YOU feel terrible. You can feel angry or betrayed. Try to put that confusion and those negative feelings aside. Remember that this person has gotten so sick that they are threatening themselves to be heard. Get them to a hospital, get them help. They are really sick, and they are a very real danger to themselves.

Basically, helping a suicidal person is the same as being a good friend at any other time. Have empathy. Listen intelligently. Use your head and your heart. Put yourself in their shoes. And act decisively to get them the help they need. The world is a hard and scary place sometimes. We need all of our friends healthy and alive as long as normal mortality permits.

PTSD: Something From the Psychiatrist

My new psychiatrist is an integral part of my new mental health team. He has a long Indian last name, so he is called Dr. Uma by everyone. He is so focused, attentive, and precise that I find him alarming,  but I think he is also very good at what he does.

A psychiatrist these days is not the old image. One does not lie on a couch and discuss one’s parents. No. You sit in a chair across the desk and the psychiatrist focuses on your symptoms. Dr. Uma fires questions at me that feel like they are being zapped out of a ray gun. Then he prescribes. I spend only about 20 minutes with Dr. Uma but it is much more intense than spending an hour with my therapist. After an appointment with him, I am shaky and weak, I only wish to lie down quietly and not be looked at for a time.

Two visits ago, Dr. Uma reviewed my medications and radically altered then. I was on a huge dose of seroquel, it did not help, it made me sleepy, it made me gain weight. I hated seroquel. The doctor had me quit the seroquel flat out that day, and prescribed geodon to start titrating up at once.

But before he wrote that prescription, and before I had decided to trust him enough not to kick at a medication change we both knew was going to put me through nearly a month of med Hell, Dr. Uma gave me something else: another diagnosis.

PTSD.

Voodoo doll with large clamp on her head. An image of suffering.
Voodoo Doll Tatto Flash by S. Grice, colored by me.

I guess I should have seen it coming, but, to me, it fell out of a clear blue sky.

To be perfectly honest, I am struggling with my new diagnosis. It feels like I didn’t earn it. PTSD is a warrior’s illness. I think of the soldiers with PTSD, and I feel unworthy to be diagnosed with it. It is true that I hate this (these?) war/s. But I honor and respect the warriors who are there fighting, those who risk their lives to obey orders and to defend their country. They did not make this war. I do not blame them. I would never scorn them. I will always honor our warriors.

Regardless of how I feel about it, the diagnosis is there, and I do think it is accurate. I have the recurring nightmares, I have the flashbacks. I do fall out of the here and now. I am perpetually being startled. If the slightest thing startles me, I jump, scream, and, sadly, if it is bad enough, I’ll wet my pants. And it doesn’t take much. My housemates have modified their behaviors so they don’t inadvertently sneak up on me. I wake from fevered dreams sweating and shaking. I know Dr. Uma is correct, I know I have PTSD…I just was not expecting a new diagnosis at this stage.

The good news is that the worst of the symptoms can be treated. The nightmares in particular can be treated. When Dr. Uma told me that, I nearly wept…not cried…wept. The only thing I can think of that would be better than not having the nightmares would be a letter from Hogwarts.

The bad news is that I have been having chest pain, and Dr. Uma will not prescribe the medications for PTSD until my regular doctor checks me out. I think I just have a touch of bronchitis, after all I live in Pittsburgh and it is Winter, and I smoke like a chimney, and in some bizarre turn of events, I took a little barefoot stroll outside the other night, and the housemates are both sick. So it is probably just bronchitis, but better safe than sorry, I suppose. I see the MD tomorrow.

Of course, there is a lot of anxiety about seeing a doctor for chest pain. Anyone would be nervous. And me? I’m pushing 50, smoke a lot, and my medications for the past 4 years have all had weight gain as a side effect. (And, believe me, I have gained weight!) Therefore, for the first time in my life, I’m also overweight. So I am worried. I’m having quite a few panic attacks, and my insomnia has shifted into high gear.

But if all is well with the MD, I’ll have the new medications, possibly before the end of the week. And new side effects. Since I don’t know the names of the new medications, I can’t research what side effects to expect. So I have stocked my nightstand with the OTC drugs that every psych patient uses to manage side effects. I put fresh sheets on the bed. I washed the two throws I keep at the foot of the bed because with my delightful hot flashes, often getting under the covers is too hot. In short, I am set up for a siege of new medication side effects.

I can not remember ever being so excited about a new medication. The hope of getting rid of the nightmares has filled me with giddy anticipation. The thought of getting a good night’s sleep-I simply have no words for that.

My insomnia is fueled by my fear of the nightmares. Often, I choose to stay awake, just so I don’t have the nightmares. I can stay awake for a couple of days at a time. That is bad for the schizophrenia, and when the schizophrenia is bad, my anxiety goes through the roof. Then my life feels so out of control that the depression kicks in hard from guilt and shame. It is the vicious cycle that creates the cage that is my life. Breaking one link in the chain feels like the start of freedom.

But this is a lot to take in.

The psychiatrist is the shaman of Western mental health. We expect him to divine our ills from the depths of his recorded notes. We expect him to shake his pill bottle rattles. We expect him to heal us body, mind, and spirit. He interprets our dreams. He probes the depths of our consciousness. He has no laboratory tests to guide him save testing blood levels of certain medications and vitamins. We expect him to walk through our damaged psyches and emerge with efficacious treatments. We expect him to fix our irreparable brokenness.

Our expectations of psychiatry are not fair. I try to balance psychiatry with spirituality. I pray daily, and I sit with my prayers waiting for blessings and answers from my Gods. (In my religion, they are called Orishas, but most people are not familiar with that word) My first set of dreadlocks did not take, so I am growing my hair to try again. This is based on an African idea that binding the hair can bind troublesome spirits to help stabilize a person. I am using all the tools my life has laid before me to find the road to wellness. So I try not to have unrealistic expectations of Dr. Uma.

But, right now, I do have unrealistic expectations of Dr. Uma. I daydream that this pill will stop the nightmares in their tracks. I daydream that this pill will break the chains of my illness, and that I will emerge from madness miraculously whole and sound. And I know better. I know it does not work like that. I know my expectations are ridiculous, and that I am about to be disappointed. I know I should be realistic.

But I’m not going to be realistic. These unrealistic expectations are part of my illness, I know that. But they also are my manifestation of hope. And hope is like a ray of sunshine in the darkness where I dwell. I know that, as always, the reality will not live up to my fantasy. But, for now, I choose to hope.

 

Rape and Schizophrenia Are Friends

So I’m not kidding around with therapy this time. I’m there to do the deep and hard work. I’ve been seeing this therapist since October, and we have done the easy stuff-religion, my life at Four Quarters then, my life with Pete now, and the people of those times who left a mark for good or ill. (Okay, nobody actually went into the ‘left a mark for ill’ department, but concluding that took a bit of sifting.)

So while working on this easy stuff the therapist and I got to know one another. We built a relationship that would enable me to do the hard work. I trust her a lot more than I trust most people. But I also know that I can not take therapy for granted. Medical Assistance pays my therapy bill, and they could decide to stop covering therapy at any time for any reason, so the therapist and I must go hard, because we never know how much time we have.

Last week, in my appointment I talked to the therapist in depth about the date rape that preceded my current derailment. I laid out what had happened in exacting detail. Continue reading “Rape and Schizophrenia Are Friends”