Emergency Departments Should Do More for Suicide Prevention

Photo by paulbr75 on Pixabay

Every day, suicidal individuals are sent home from the emergency room with little to no follow up. I believe this to be one of the greatest threats to effective suicide prevention.

Today is World Suicide Prevention Day. I feel the need to add to this important conversation, not only because of my personal relationship with suicide but also because suicide often fails to be recognized for the serious health issue it is. The World Health Organization estimates that about 800,000 people worldwide die by suicide every year. In Canada every day 10 people die by suicide and 200 attempt suicide. In Ontario alone 1327 people died by suicide in 2014. In short, we need to talk about suicide prevention.

Discussions about suicide prevention are not complete without looking at necessary improvements to our hospital mental health systems. While hospitals, doctors and other mental health professionals work tirelessly to support their at-risk patients, there remain major flaws in the availability, accessibility and adequacy of services provided. Not the least of these problems occurs when suicidal patients are denied care in hospital emergency departments.

The Problem

Imagine for a moment that you feel there is no reason to live. You feel that you can’t stand to go on any longer and have made plans of how to kill yourself. Imagine you reluctantly make it to the hospital, perhaps of your own will or perhaps at the urging of someone who cares. With one last shred of hope, you think maybe the hospital will help you, and what do you have to lose? You wait for hours, growing more jaded as time goes on. After sitting in the hospital all night in high emotional distress receiving only cursory information from busy ER nurses, you finally see a doctor. You describe to them that you plan to kill yourself, you explain your plans, describe your hopelessness and pain. Imagine that doctor, after only spending a few minutes with you, sending you home without offering help. Imagine feeling even more worthless and hopeless, because even the system that is in place to save lives turns you away. Imagine feeling as though doctors are telling you that you are not worthy of being saved. You return home, emotions heightened, even more certain than before that your life has no value.

This happens every day. Every day people who have decided to end it all are turned away from the very systems there to protect them. While my experiences with the ER have often been positive, this has happened to me. It is one of the worst feelings imaginable, to be at the end of your rope and have your attempt to access care rejected. Few things have made me feel less worthy of living than being sent home from the emergency room when I am a threat to myself. To add insult to injury there is often no follow up even when follow up is promised. While this is certainly not the intention of the hardworking emergency department medical staff, the message I internalize from these events is loud and clear, “Your life is not important and you do not deserve to be saved.” When in the depths of a suicidal episode even the act of being assessed by a doctor for my risk of suicide feels stigmatizing. Being asked questions with the obvious motive of trying to uncover whether I am “suicidal enough” is humiliating. Shouldn’t it be enough that we are asking for help?

Suicidal patients like myself and our caregivers have been placed in the position of having to advocate for our need for care during crisis. As a suicidal person, it isn’t easy when you do not believe you should live to present yourself to the hospital and advocate for care to keep you alive. In fact, it’s one of the hardest things I have ever done. Caregivers too are placed in difficult positions, often having to advocate for care they feel is desperately needed, sometimes against the wishes of their loved one. My husband has had to advocate me, and I know it hasn’t been easy for him to simultaneously convince me to accept treatment and convince doctors of my need for treatment. I am forever grateful that he has endured that stress, it has saved my life. These self-advocacy measures should not be necessary. We shouldn’t have to convince doctors of our honesty, our intent and our need for treatment, out of fear of being sent home with no answers.

I believe the result of these interactions with hospital emergency departments can foster a distrust of mental health systems. It is dangerous, I believe, to contribute to a person’s feeling that their suicidal ideation, plans and actions will not be taken seriously. I know many people, myself included, who have at one time or another refused to go to the hospital due to the belief that they will not receive care and their time there will only make things worse. Surely, contributing to that belief is not what hospitals should be doing for suicidal individuals. Emergency departments have a key role in suicide prevention and sadly they are not always up to the task.

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Photo by blickpixel on Pixabay

Why I Think This Happens

There are, of course, many reasons why doctors might choose not to admit a suicidal patient to the hospital. A hospital admission isn’t always in the best interest of the patient. For one, there is a broad range of what qualifies as “suicidal” and not everyone who has thoughts of suicide is an immediate risk to their own safety. According to The Suicide Risk Assessment Guide by the Ontario Hospital Association (pg. 25), doctors in emergency settings should assess the risk of suicide by determining the patient’s actual level of intent to die by suicide and evaluating whether the patient is telling the truth about wanting/not wanting to die by suicide. Based on the assessment of risk of suicide, doctors determine the level of care needed and should, ideally, help connect the patient to the appropriate level of care. In Ontario we have a shortage of psychiatrists, hospitals are frequently operating over capacity, wait times for mental health services are long. I imagine that those constraints add an additional level of difficulty in pairing suicidal patients with the treatments they require. However, sending suicidal patients home without follow up care or even a safety plan is irresponsible.

Finding Solutions

Solving this issue isn’t straight forward. This is not about a few stigmatizing doctors who believe their suicidal patients are just attention-seeking (though that is sometimes the case). Often, the capacity to offer timely help to every person who needs it is simply not there. In many places, hospitals don’t have enough rooms or enough beds or enough staff or enough funding to offer immediate support to every suicidal person who comes looking for it. In an ideal world, everyone who has plans to end their life would have a place in the hospital until they are truly safe to go home. Fixing this problem isn’t as simple as admitting every patient who may be at risk to the hospital. As it stands, at least here in Ontario, that just isn’t possible.

There are ways that I believe the emergency departments can contribute to suicide prevention. Information about free community services with low wait lists should be shared. Peer support groups, for example, can be helpful in suicide prevention and often do not have waitlists. Helping the patient create a safety plan can also be beneficial. Follow up from the hospital (calls or appointments) is another way to not only check that patients are okay, but also to reassure patients that they are a priority and have not been forgotten. Doctors should make sure the patient has a mental health professional or family doctor they can follow up with soon. You would think that all of these practices would already be used consistently, but that is not the truth of my experience or the experience of many of the people I have interacted with. The result of a hospital visit due to a suicide attempt or suicidal plans should never be nothing. No suicidal patient wants to feel that they are met with apathy at the hospital. We are failing to prevent suicides by letting suicidal individuals slip through the cracks. When all else fails, compassion from the emergency department medical team can save a life. I should know, it has saved mine.


My own personal experiences with visiting the emergency department when I am suicidal have varied. At times, I am treated with compassion and a level of concern appropriate to the severity of my condition. At other times, I have been sent home without any help, care or follow up. At the worst, I have felt stigmatized and humiliated by the words and actions doctors. My experience is not unique. There are many people who are turned away from the hospital when they truly need help. If you need any evidence of that, I suggest you start looking at the mental health community on Twitter. I see stories every day of people turned away from the emergency room without help, even when they have no other supports in place.

With all that said, I am deeply grateful to the doctors, nurses and administrators at hospital emergency departments who have helped me in the past. I have had some very positive outcomes from ER visits.

Suicide prevention is something I can’t help but care about deeply. Once you have been suicidal, you understand how big the discrepancy is between the need for effective emergency care to help suicidal individuals and what is actually available. We are told to report to our nearest hospital emergency room when we are in crisis, we should be able to expect to receive real help when we do.

Take care,
Fiona

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This or That Challenge

The lovely Elizabeth of The Uncustomary Housewife tagged me in the This or That Challenge. Elizabeth blogs about mental health as well as other fun things like cooking and geekiness. You can find her on her blog and on Twitter.

In turn I am tagging a few great mental health advocates who I’d like to learn some more about.

The Good The Human

Terminally Nice

Jen, Comically Chronic

John, The 3 of ME

Tony, The Mental Health Fog


Question 1: Shower in the morning or evening?

In the evening. I like evening showers best as I like feeling nice and fresh before bed. It is also nice to shower in the evening because I have panic attacks every time I shower, so it is nice knowing Tom is home in case I need his help to de-escalate the panic attack.

Question 2: City centre or close to nature?

Most definitely close to nature. I love trees and water, especially. My ideal is small cities/towns, I have always been partial to them. I used to work in downtown Toronto and I did enjoy the hustle and bustle, but I was glad to not live anywhere near it!

Question 3: Bright colours or neutrals?

Bright colours. I love colour. Neutrals are a bit dull for me.

Question 4: Spring or Autumn?

Autumn. I can’t think of anything I don’t love about autumn, it is my favourite season. I love the cool but comfortable weather, the colourful leaves, apple cider, apple pie, apple everything… you get the gist!

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I snapped this photo last Fall on my honeymoon on L’Île d’Orléans, just across from Québec City.

Question 5: Mint or cinnamon?

I love them both but I have to go with cinnamon. So many things are improved with cinnamon: apple pie, apple cider, apple everything… oops! I think we’ve been here before!

Question 6: Planned or spontaneous?

Planned. Always planned. I have found that especially when I am most anxious I can’t handle spontaneity. I can become hugely overwhelmed even when things deviate ever so slightly from the plan. I live in lists and planning documents. When I go on road trips or vacations I make binders full of information to help me cope and minimize surprises.

Question 7: A movie at home or at the cinema?

At home. This is especially true now with agoraphobia and social phobia keeping me clear out of movie theatres, but even when anxiety didn’t get in the way I have always preferred watching movies at home. Cuddling, better popcorn, comfortable seating, etc. There is something to be said about watching movies on the big screen or catching them before they are released for home viewing, but on the whole watching them at home takes the prize for me.

Question 8: Espresso or latte?

Latte for me – but not with coffee. It’s all chai tea lattes for me!

Question 9: Hugs or kisses?

Hugs. I love a good kiss, but nothing comforts like a hug.

Question 10: Spicy or mild food?

Mild. I am that annoying person who always asks for my Indian food served mild. I like a bit of heat but I am a total wimp when it comes to spicy food.

Question 11: Leather or lace?

I love lace. It is the height of prettiness where I am concerned.

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Bonus photo for Elizabeth – my wedding dress also had lots of lace!

Question 12: Overdressed or underdressed?

Underdressed. I mean, overdressed for social gatherings and work. But underdressed whenever it’s appropriate. I am happiest and most comfortable when I’m in my pyjamas.

Question 13: Adventure or comfort?

Comfort. This probably doesn’t come as a surprise given how much I have mentioned comfort already in this blog post. I have dreams of travelling around and trying new things, but even in adventures it is still important that I am comfortable.

Question 14: TV series or movie?

Oh, this question is hard. I enjoy both. The acting and overall art of movies tends to far exceed that in TV shows, but I love getting emotionally invested in the character arcs of TV shows. I’d probably give the edge to TV shows, I love binge watching shows and completely absorbing myself in the story. It something like reading a novel, as I spend more and more time in the fictitious stories I become more attached to them.

Question 15: Rock or country music?

Without question, rock. I love rock music and rock concerts. I rarely listen to country – the primary exception being The Dixie Chicks. I do love artists who are country/rock like The Eagles.

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Def Leppard and KISS Concert in Toronto, 2014

Question 16: Red or white wine?

Neither – I don’t like wine.

Question 17: Working alone or in a team?

Working alone. I enjoy working in teams but team dynamics change everything for me. I would rather work alone than with a team for which I am not a good fit.

Question 18: Swimming or sunbathing?

Swimming! My mom instilled in me a deep love of being in the water.

Question 19: Fast food or sit-down restaurant?

Sit-down restaurant. I love going out for a nice dinner, it is one of my favourite things to do. Chatting with great people while eating tasty food and not having to clean up afterwards is wonderful.

Question 20: Matched or mismatched socks?

Mismatched. I don’t often wear socks, but when I do I don’t have the patience to dig through my sock drawer for matching ones. I only use socks from the same collection, so they all feel the same, but I usually wear mismatched colours.

Question 21: Dancing or singing?

Singing. Singing is everything to me. I love dancing too, but I am not myself if I am not singing. Fun fact – I almost pursued a career in musical theatre. My singing chops are far better (though sadly out of practice these days) than my laughable dancing ability.

Question 22: Phone or the internet?

Internet. I like and use both but most of the time I spend on my phone is spent on the internet anyways. I like the larger screen and easier typing that my laptop provides.


Thanks again to Elizabeth for tagging me in this challenge, it was fun!

Take care,

Fiona

Challenging Assumptions: My Anxiety Triggers

Anxiety is complex. You may not know what it means when I tell you that I have Generalized Anxiety Disorder, Agoraphobia, Panic Disorder and Social Anxiety Disorder [click the links to learn more]. In short, my anxiety disorders lead me to react with excessive anxiety to triggers that do not always merit an anxious response. Anxiety permeates every aspect of my life, it is far more than a desire stay home and avoid social gatherings. I hope that in sharing my list of anxiety triggers I will help shed some light on how debilitating anxiety can be and hopefully challenge some false assumptions along the way.

The triggers listed below are my own – anxiety triggers differ greatly from person to person. The items on this list vary in their severity and the frequency at which they provoke my anxiety and panic. They are not all things I dislike or am afraid of, in fact many of them are things that I really like. In some cases I have a good understanding of why these triggers cause me distress, in other cases I have no idea. With all that in mind, here is a list of some of the things that trigger my anxiety and panic.


The List

Appointments

Being far from home

Being in the same space as other people

Caffeine

Cars

Changes in plans

Changes in temperature

Clicking publish or send on any form of online communication

Conflict (even if I’m not involved)

Discussing finances

Elevators

Excess stimuli

Feeling as though I can’t escape

Grocery stores

Hospitals

Intense sensations

Lack of sleep

Large groups of people

Leaving the house

Making mistakes

Malls

News (good or bad)

Not having a plan

Open spaces

Parties

Phone calls

Portrayals of suicide in media

Scary fictional stories

Seeing neighbours through the windows

Showering

Small groups of people

Talking in person

The dark

The outdoors

Unexpected noises

Walks


You may now be wondering how it is possible to be so sensitive and easily provoked to panic. I wish I could explain that to you. If you haven’t experienced an anxiety disorder you probably won’t understand what it is like to feel anxious, as though something truly awful might happen, in response to mundane things in your daily life. I have had Generalized Anxiety Disorder and Panic Disorder for many years, Agoraphobia and Social Anxiety Disorder are newer to me. I am still learning to understand my own anxiety and how to best manage it. It makes very little sense to me that I can become dizzy and hot, hyperventilate, have chest pain, feel weakness in my legs, shake, be disoriented and feel as though I am in imminent danger as a result of things as unthreatening as reading positive news articles. Being constantly anxious has had negative impacts on both my physical and mental health. Irritability, weight gain, hair thinning, moodiness, headaches, seclusion and muscle tension are just a few of the negative changes that my anxiety has contributed to. Anxiety has hugely impacted my life and my relationships.

Even if I employ as much planning and as many coping tools as possible, it is inevitable that I will come in contact with my triggers throughout my day and respond with anxiety. I have lived in near-constant anxiety for a couple of years now, because there is always a chance that one of these many triggers is just around the corner. The anticipation of something anxiety-provoking is often just as bad as the thing I am anticipating. Additionally, I still frequently experience increased anxiety or panic attacks without any identifiable trigger. I am slowly learning to tolerate my anxiety and panic, but my anxiety remains exhausting and incapacitating even as my ability to withstand the distress increases.

I write this because anxiety is misunderstood. When most people think of anxiety disorders they likely don’t imagine someone having a panic attack every time they shower without understanding why. You may not know that there are people like me who have been working for years towards goals like going outside for walks. The best way to understand how anxiety disorders affect someone’s life is to ask them about it, anxiety is a deeply personal experience. It can be easy to reduce anxiety disorders to chronic fear or nervousness: emotions that we can all understand. Anxiety is so much more than that, even I don’t fully understand it yet.

Take care,

Fiona

Invaluable Blogger Award

I have been nominated by The Good The Human for the Invaluable Blogger Award. I am so grateful to this lovely blogger for her continued support of me and my blog. The Good The Human is an invaluable blog about mental health and wellbeing. It is no surprise that she was one of the first people nominated for this accurately named award. A fantastic example of her positive approach to mental health blogging is her blog post “Break Your Negative Thought Cycle”. If you haven’t followed her already I highly encourage it.

The Invaluable Blogger Award was created by another one of my favourite bloggers, Nicole from Navigating Darkness. Creating this award is a typical example of Nicole’s thoughtfulness. I love that she chose to focus on kindness, support, creativity, advocacy and dedication for this award – they are all wonderful traits.

I am certainly in good company with these two fantastic advocates. I love what this blogger award stands for and hope to see it spread far.

Award Information

The following was taken from Nicole’s original blog post about the awards which also contains further details about them.

The Invaluable Blogger Award is an award that recognizes bloggers for their kindness, support, creativity, advocacy, and dedication. These traits and values make them truly invaluable to the blogging community and it is important that they are recognized, appreciated, and encouraged.

Awarding your peers with the Invaluable Blogger Award is a great way to your show support and appreciation for them and their work. The blogging community will thrive and be a much better place if we see each other as friends and colleagues as opposed to enemies or competition. We each have our own voices and stories, and there is enough success in the world for all of us.

“Bloggers who are nominated for the Invaluable Blogger Award should create a blog post, like my own, to acknowledge their award. The post should include the following:

  1. Award image
  2. Award acknowledgement
  3. Award information
  4. Answers to the questions given to you
  5. Your 3 nominations for the Invaluable Blogger Award

Questions from The Good Human

  1. What inspired you to start your blog?

    I answered this in depth recently in my blog post response to the Sunshine Blogger Award, you can head on over there if you’d like to see all the details of how I started this journey. In summary, I was inspired to start this blog as a result of being open on social media during my hospitalizations in early 2017. In a way, those social media posts were my early blogs. They received a great deal of support and positive feedback from my family and friends who encouraged me to continue being open about my experiences.

  2. How do you motivate yourself to keep your blog up and running?

    I am motivated to keep my blog up and running due to the positive comments and feedback I have received. Writing the blog is cathartic for me, but more importantly it helps me feel that I have value. I have been so supported by the mental health community, with many people telling me that my pieces have helped them in some way. I have always wanted to write, to communicate through writing something that others would find worthy of reading. I feel lucky to have found a medium through which I can do that.

  3. How much time do you spend blogging?

    In truth, this varies greatly. I am struggling every day with my depression and anxiety disorders right now; these struggles are impacting my ability to be consistent with the blog. I would love to be able to get blog posts out on a semi-consistent schedule, but at the moment the best I can do is write when I have the energy and motivation to do so. Most of my blog posts take several hours to write, but before writing I usually work out the idea for quite some time. I have a long list of blog post ideas that I am constantly editing and adding to, and always have several drafts on the go.

  4. What are your strengths that really helped you in your blogging journey?

    I always feel like I come across as boastful when I write about my strengths. That aside, a strength of mine that helps with blogging is good writing skills. I have always loved to write, it comes easily to me. I know some people who struggle to put things in to words, which is not the case for me. I am also honest and willing to be vulnerable which I hope gives my blog a sense of authenticity.

  5. Who has impacted you the most in blogging and how?

    My family and friends are those who have most impacted my blogging. In order to narrow that down a bit I will give you my mom as a prime example. My mom has been supportive of my blog since the beginning. She reads nearly all of my posts and often shares them with her network along with incredibly supportive messages. Perhaps the way she has most impacted me has been in a conversation I had with her a couple of months ago. At the time we were talking about the success of a recent blog post and she told me that she was proud of me because I was having a big impact on people despite my circumstances. I should probably have told her at that time how much that means to me– mom, that meant the world. For now, I am unable to leave the house due to the intensity of my agoraphobia and social anxiety. Since my conditions worsened a couple of years ago my life has shrunk considerably. I am not able to work, I rarely get to see my family and friends and I struggle with the most basic of things. It is hard to feel like I have worth and value from within the four walls of my house and when my depression and anxiety are so acute. Hearing from my mom that she thought I was helping others, having an impact even, was so important to me. Her words helped motivate me to try pushing myself even harder.

My Nominees

  1. Nicole from Navigating Darkness

    Nicole is the creator of this award and as such it is possible that she won’t get this recognition herself. That would be a great oversight since Nicole wonderfully exemplifies all the qualities she set out to acknowledge in other bloggers. I appreciate most about Nicole that she is devoted to building up the blogging community, frequently creating opportunities for building friendships amongst bloggers. Her blog Navigating Darkness is largely mental health focussed and I am appreciative of her advocacy in this area.

https://www.navigatingdarkness.com/

https://twitter.com/ItsNicoleCarman

  1. April from 5 Alive

April is the first blogger who came to mind when I read the specific criteria for this award. She is a frequent supporter and encourager of others on Twitter, showing the depths of her kindness and support. Her blog 5 Alive is filled with creative writing expressing her life with Dissociative Identity Disorder and Post-Traumatic Stress Disorder as well as Cancer. If her poems aren’t creative, I don’t know what is. One of my favourite blog entries of hers is “Blurbs of Words”. She is a fierce advocate, particularly within the Sick Not Weak network. She shows dedication not only to her blog but to others. I would be remiss if I didn’t include April on this list.

http://idisassociate.blogspot.com/

https://twitter.com/AFR365

  1. Jody from JodyB2016

Jody is perhaps the strongest person I have encountered online. Her blog is a powerful account of her life with Post-Traumatic Stress Disorder, Borderline Personality Disorder, Depression and Suicidal Ideation. She advocates suicide prevention, her blog post “I Want You To Want To Live” is one of the most touching things I have ever read. Her very personal blog posts offer a depth of detail seldom found, she uses her words in a way that helps me both understand and feel understood. She is a survivor and an advocate, through and through.

https://jodyb2016.wordpress.com/

https://twitter.com/onelastkick71

Questions for my nominees

  1. What motivates you to write about your experiences with mental illness?
  2. Which of your blog posts are you most proud of?
  3. Do you think you have grown as a writer and/or advocate since you began blogging? If so, in what ways?
  4. Which of the 5 traits associated with this blogger award (kindness, support, creativity, advocacy and dedication) is most important to you? Why?
  5. What is your favourite quote and why?

I hope you will all go check out the wonderful bloggers I have included in this post. Thanks again to The Good The Human for sharing this with me.

Take care,

Fiona

Gaining strength from my husband’s words

Last week I asked my husband Tom a tough question and was touched by his heartfelt and encouraging answer. I thought today I would share his response with you.

First, some context.

I am struggling through a bad low. The respite from my last depressive episode was far too brief. Now that depression has returned, I am trying to counter my feelings of hopelessness and worthlessness by pushing hard to establish my “base.” This basically means maintaining a basic routine and meeting my immediate needs by eating regularly, maintaining a sleeping schedule, getting out of bed, etc. I have learned a lot in my therapy the past couple of years, I am trying to apply what I have learned in order to keep my head above water. More often than not it feels like I am drowning, but I’m resisting as best I can.

All that to say that last weekend at this time I was ruminating about my life and what was to come of it. What was going to happen to me? Would I get back to how I used to be a few years ago or would I die soon? What was most likely? Not for the first time, I decided to turn my questions to Tom. Not for the first time, he answered with exactly what I needed to hear.

Here is what he said:

I definitely don’t think on either one extreme. I don’t think you’re going to be dead in the next couple of years or anything like that. And I don’t think you are going to find a magic miracle pill that all of a sudden makes everything peachy. But, I think that right now you’ve got a really great set up with Dr.___, who I think understands you a lot better than when we first started seeing her. I think she’s a really good doctor and she’s really helping.

You’ve also learned a lot of really good coping skills quite recently. I think right now you use them but they’re going to become a lot more so second-nature [with time and practice]. As more of those become more second-nature you’re going to struggle through the day to day a lot less. If you’re struggling through the day to day a lot less then all of the sudden it opens things up and you can be doing things like go out with me or go see a friend or you know, all these other things… Do a chore around the house kind of thing… That’ll really mean that all the sudden your lifestyle will improve a lot just with minor amounts of improvement to building your base. I think with the base right now we’re just locking it down and I think we’re going to get it locked down. And then the next time if you’re ever in a spot where you don’t have that locked down, you’ll know you can do it. You’ll know and it’s going to be easier, you’re going to be more confident and it’s not going to be so scary. Right now, it’s obviously really scary.

I think we’re going to continue to find more things like the click and collect groceries where for a long time we were worried, “we’ve got to find a way to get these groceries done.” It was really tough for you but we found a way to do the groceries.

[Me: Yeah, adaptations that suit our lifestyle. I think we’re getting to a point where we’re realizing that that’s okay.]

Yeah, there’s nothing wrong with it – it’s awesome. Click and collect groceries is growing like mad. I think we’ll find a couple more things like that and you get that base built so that on the days when you’re pushing, you’re pushing to do something like a little more. It’s going to bring the whole quality of life/lifestyle way up there. Just a small improvement is going to make a massive change to the lifestyle and the day-to-day. I really believe that.

There are so many things I love about his answer. I love that every bit of it shows just how much he understands what I am going through and my goals. He lives this with me every day, after all. I love that he acknowledged that I was thinking in extremes without mocking me for it; instead gently helping me recognize it for myself. I also love that the emphasis in his answer is that I have gained and continue to gain information and tools from therapy, the impacts of which are beginning to be established and will grow with time. He is right, if I am able to get to a point in which the beginning of depressive episodes don’t completely wipe out any semblance of my routine and my most basic of self-care practices, I will feel a lot better. That’s within my grasp. His answer places power on my shoulders, the belief that I have the ability to advance to a better situation by continuing my hard work.

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My rock.

Had Tom told me he thought I would fully recover, I wouldn’t have believed him. He wouldn’t have believed himself either. It might sound strange, but that is incredibly validating to me. We both awaited my return to “normal” for a long time. However, as time has gone on it has been clearer that we have to adjust what our perceptions of my normal are. This has been a challenge, but is bringing on some good changes for us. We have begun to embrace adaptations that work for us, like his example of ordering groceries online. This allows me to contribute in a manageable way – I make the list, I place the order and Tom goes to pick it up. I hope he is right that we will continue to find more adaptations that suit our needs.

I have found firmer footing and new motivation from Tom’s answer. What he explained makes sense and it helps me feel like progress is attainable. It reinforces my purpose with my short-term goal: strengthen my base, that alone should help make other improvements easier to achieve. Tom doesn’t think I am a lost cause, he sees me applying what I have learned and believes more improvements will come of it. That bit of hope is enough for now. It has helped me find the strength to keep trying.

Take care,

Fiona

P.S. Many thanks to Tom for not only being unfailingly sweet, honest and encouraging but also for patiently repeating his whole answer so that I could record him and write about it.