Learning to live in spite of suicidal thoughts

I’ve been slowly realizing something. The realization is that I can’t continue to use the same techniques for coping with my depression and suicidal thoughts that I always have, now that they are constant. You see, for years I experienced ups and downs. My depression came in waves. When I was at my lowest I could expect that I would pull out of it soon. When I was suicidal I knew that it never lasted more than a few months at a time.

That pattern changed three years ago. My depression worsened, my anxiety skyrocketed. My life changed dramatically. Since then, I’ve had only a few brief breaks from my depression and suicidal thoughts. Depressed and suicidal is my new normal.

I’ve had to adapt to my worsened symptoms, lower level of functioning and the ways they have limited my life. At first, I did what I have always done when I feel my worst. I ate comfort food. I wore pyjamas. I took baths multiple times a day. I watched all my favourite movies, over and over again. The problem is, while I say “at first”, I have been mostly doing this for the past three years. My coping has been in keeping myself as comfortable as possible. This was how I adapted, the only way I knew how.

The instinct to keep myself comfortable is a good one. It has saved my life on many occasions. It has kept me from further self-harm, helped me feel safer when everything around me seems dark and uncertain. However, after three years these attempts to self-soothe and provide comfort have begun to look more like my own form of hospice care. Being suicidal, I’ve not believed I will live. When I don’t believe I will live, I don’t see any reason to not just make what remains of my life as comfortable as possible.

What if being suicidal doesn’t mean I’m going to die? What if I can come to terms with my worsened illnesses and find ways to adjust my lifestyle to accommodate my new needs? What if I can bring myself to believe that I can live in spite of all of it? Seeking comfort in a decadent dessert, favourite movie and cozy pair of pyjamas can be helpful in coping with intermittent illness, but it’s no way to live every single day of my life. What if the things I’ve been doing every day are holding me back?

In short, comfort isn’t a solution. Comfort can help me cope with momentary distress, but is not suitable as the main line of defence against my long-term illnesses. It has a part to play, but I can’t allow it to take the leading role in my life on an ongoing basis. Not if I want to believe my life is worth living.

The alternative to comfort is, of course, discomfort. Pushing. Wearing clothes that I feel uneasy in after three years of pyjamas. Maintaining a routine for my exposure therapy even on days when it is hardest. Waking up at the same time every day and forcing myself out of bed even when my whole being revolts against it. Exercising at home, since my agoraphobia and social anxiety have stolen my ability to do it elsewhere. Eating healthily instead of chasing momentary solace in foods that cripple my body in the long run. None of this is comfortable. It is gruelling, unsettling. More importantly though, this has the potential to actually help.

I’ve been treating my day to day life as if my death is inevitable. I’ve given therapy my absolute best, but I haven’t done the same with the way I live. Despite being sure I’m going to die my mind and body have refused to give up. Even when I wish they would. Perhaps then, I should start believing that it is not my death, but rather my life that is inevitable.

I’d love to tell you that the changes I’m making and the manner in which I’m adapting my thinking have had a major effect on my illnesses. I wish I could but I can’t. I remain just as depressed and anxious. Most disappointingly, I’m still suicidal. In a way, that makes me all the more proud of myself. Proud that I am making changes in spite of feeling horrible. Proud that I’m not allowing myself to give in so easily. Pride in myself, as far as I can tell, is as good an argument as any to keep going.

Take care,

Fiona

Photo by Esther Tuttle on Unsplash

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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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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

Good Morning, Depression

This post may be triggering to some individuals.

9am – My eyes open when I hear my husband rummaging around our bedroom, getting ready for work. It’s harder than usual for him to find clean clothes, our laundry is piling up precariously high in the hamper. My dog jumps on the bed and comes to greet me. My husband says, “good morning sleepy head”, while I unclip my CPAP mask and turn off the machine. He kindly avoids alluding to my break down last night. I know from him getting dressed already that I have slept-in past my goal time of 7:30am. One of my first thoughts is how disappointed my psychiatrist will be when she finds out I haven’t been keeping a consistent sleep schedule. I remind myself that’s irrational, she will know how hard I am trying.

I slowly pull myself up in to a sitting position, noticing a crick in my neck, no doubt the result of mounting tension in my shoulders from high anxiety. “Great”, I think to myself, “more pain”. I was supposed to go see a massage therapist to help with the muscle tension in my upper body but I still need to figure out if that treatment would be covered by my husband’s health insurance. That’s a problem for another day.

I reach for my phone while my husband brushes his teeth. Last night a fellow comrade on Twitter was in crisis, I am hoping to see good news. I fell asleep shaken with the possibility that he wasn’t safe. There is strength in connection over social media, but the distance can sometimes make me feel so hopeless to help. I don’t see any news, I hold out hope that he will check in to Twitter soon to say he is safe.

My husband is back from the bathroom. He comes and gives me a kiss, says he is on his way out and he’ll see me later. I can’t hold back the tears. For the next ten minutes he comforts me, reminds me he will be home soon enough and that he can call me on his lunch break. Every touch from my husband gives me strength and courage. I feel horrible, the last thing I want is for him to worry about me while he is at work. I have dealt with many trials from mental illness, but perhaps none so terrible as the dread of waking up and having to survive another day. I try to hide how much I am hurting, but I fail miserably at this practice. I calm myself down as best as I can and give him a final kiss. I don’t want him to be late.

After a few minutes of seeking strength from cuddles with my dog who so intuitively is clinging a little closer to me this morning, I get up to go to the washroom. Passing the vanity mirror I notice my reflection. Its distorted features bear a resemblance to Quasimodo. I had forgotten that I plucked my eyebrows out yesterday when the urge to self-harm was overwhelming me. My eyes are puffy from crying and dehydration, I must remember to drink some water today. My CPAP has left a distinct ring around my nose and mouth. My whole affect is droopy, the feeling of being weighed down that I have been dealing with for weeks can be read all over my face. “Invisible illness”, I say to my dog, “not so invisible today”.

The washroom is brighter than the bedroom. I wince as I enter it. I reach for a pill bottle, but I don’t have one anymore having come off of my last antidepressant just a few days ago. There have been many attempts to find a daily medication that works for me, so far, no luck on that score. I skip brushing my teeth and hair, they are a mess but I am already drained from the few minutes I have spent out of bed. On the way out of the washroom I check that our medicine cabinet is locked, it is. My husband holds the only key, a security measure we put in place at the urging of my psychiatrist after one of my suicide attempts last year. It has often crossed my mind that I could break the cabinet open if I really wanted to, but the superficial barrier of the lock gives me enough pause to remember that is a bad idea.

I change in to a fresh pair of pyjamas. I have steadily accrued a large array of sleepwear; my agoraphobia has been crippling for the last two years so I seldom leave the house. Being comfortably dressed in pyjamas just makes more sense. As I slip on my stained pyjama bottoms I remind myself that putting on day clothing might help me feel more put together; working from the outside in and yada yada. But truly, that’s a struggle for another day. I remember the counsel my psychiatrist gave me last week, “Your job for the next two weeks is to wake up at the same time every morning, eat all three meals and stay out of your bedroom during the day. The rest is gravy.” This is sage advice, focussing on anything else right now might stop me from meeting those seemingly meagre goals.

Pyjamas on, I succumb to the will to crawl back in to bed. My head is pounding and my breath quickening. I figure I’ll relax for a while to ready myself to walk downstairs. On a better day the walk downstairs would be nothing to me, but today it is daunting. In bed I scroll through world news, frequently thinking how messed up our current political climate is. I consider texting my friends, but really who wants to hear from me? I spot that thought distortion, my friends routinely try to reach out to me. Nevertheless, that sentiment feels real today. My dog whines, he wants to play – I respond by snapping at him. I lower my head in shame, am I really irritable enough to take it out on my dog today? I gather him up in my arms and show him love. I fall into a slumber.

Waking back up, I resolve to make my way downstairs. I can’t bring myself to prepare breakfast. Instead, I find my usual place on the couch, allow my dog to jump up on my lap and begin watching the same TV show I have watched over ten times in the past couple of years. The familiar story helps distract me from the agony of my own thoughts. It’s now just past 11:30am, two and a half hours down, far too many more to go.


Take care,

Fiona

Photo by Alex Boyd on Unsplash

A “thank you” to the people who care

This is a thank you note to the people who care. To those whose kindness and compassion doesn’t end when their loved one’s mental health is at its worst. To the people who show their caring every day, or once in a while. To those who don’t always know how to help but do their best. To those who don’t always understand but strive to.

Thank you to the people whose love for us doesn’t waver no matter what. Who feel our pain so acutely and wish beyond all else that they could take it away. Who help build us up. Who support us. Whose constant care and affection gives us strength. Who get the brunt of our bad moods, who see the worst of it and are never deterred by it.

Thank you to the advocates and the researchers. The people who spread information, dig for answers, share their experiences and help combat stigma.

Thank you to the people who stay at our side through panic attacks, outbursts, suicidal episodes, hallucinations, etc. Thank you for helping us regain control.

Thank you to the people who send us letters, funny photos or tokens that comfort us. Thank you to the people who sit with us when we are low. Thank you to the people who help us keep up with our lives by running errands for us, joining us for outings or bringing us healthy food to eat.

Thank you to the people who bring us to the hospital when we are in crisis. Who visit us in our hospital rooms. Who feel uncomfortable in the psych ward but come anyways. Who sleep beside our hospital beds. Who bring us snacks because the hospital food tastes like garbage.

Thank you to the people online who offer words of hope and consolation even though you don’t know us personally.

Thank you to the doctors, psychiatrists, psychologists, occupational therapists, case workers, nurses, counsellors, pharmacists, social workers, personal support workers, etc. To anyone who care for us as a profession. Who face vicarious trauma, burn out, etc. in order to help people like me achieve health, happiness, stability and independence.

Thank you to the people who ask questions because they don’t understand. Thank you for allowing us the opportunity to vocalize what we are experiencing.

Thank you to the friends and family who never stop writing, calling or visiting. We feel less alone knowing you haven’t forgotten about us. Thank you for not judging us for not always being able to answer you, talk with you or see you.

Thank you to everyone who cares. I know you can feel hopeless too. I know you wish you had all the answers. I know want to know how to help. Thank you for caring, for trying, for reaching out, for helping, for your time and for your energy. Thank you for sometimes giving more than you receive when we aren’t in a place to give back to you. I know we don’t always make it easy on you. I know it can be exhausting for you. Thank you for caring. You are helping far more than you know.

Thank you. Thank YOU. Thank you.

Take care,

Fiona

Who would you like to thank?

Suicide is not selfish

This post may be triggering for some individuals. Please do not read if this may be distressing for you. If you are in crisis, you can find your local suicide hotlines here: http://www.suicide.org/international-suicide-hotlines.html. Your life matters.

Whenever a high-profile death by suicide rocks the social media news cycle, I am both deeply saddened by it and apprehensive of the comments that I know will come along with it. Comments like, “how could he do that to his kids” or “but she had a husband, didn’t she think of him at all?” or “what a selfish thing to do”. I’ve had enough of it this week, I have to say something. Repeat after me: suicide is not selfish.

Listen, I can understand how suicide can seem selfish to people who have never been suicidal. I know that the concern we all feel for the loved ones left behind by suicide can morph into anger at the person who died by suicide. If you have never been suicidal, you just can’t understand. Too often it is assumed that those who contemplate, attempt or die by suicide are not thinking of the effect their death will have on those around them. Please hear me, that is so far from the truth.

Drawing from my own experience, my suicidal ideation is usually accompanied by the feeling that I am holding my loved ones back from true happiness. In my darkest moments I cannot register how important I am to the people who love me, even if they are right in front of me telling me just how much I matter to them. In my darkest moments all I can see is how much my mental illness impacts those around me, how hard those I love struggle to take care of me, how much I am burdening them, how much better their lives would be without me.

When I am suicidal I am thinking about others almost constantly. Wouldn’t my friends be happier if they didn’t have to worry about me all the time? Wouldn’t my husband’s life be improved if I was out of the picture and he could find someone less broken to love? Wouldn’t my mom be relieved if she didn’t have to drive me to appointments anymore? Eventually the doubt is erased and the “wouldn’t they” changes to “they would”. These are highly distorted thoughts, they completely shut out that my loved ones want me to live. They are unbalanced, irrational and drastic. But these are the kinds of thoughts that claw away at me when I am suicidal. I am usually able to understand how much suicide hurts the survivors, but not when I am most suicidal. When I am most suicidal I believe that my death would be a relief and bring joy to those around me. My mental illness distorts my reality. “Yes, they would grieve”, I think to myself, “but after they got over it their lives would be better”.

One person’s experience alone can not explain suicide. It is important to note that suicidal thinking does not look the same for everyone. I provide myself as an example, but my experience does not speak for everyone. I am fortunate to have learned this through meeting tens of individuals who have been suicidal. Having listened to their stories I have gained an understanding of just how diverse the causes of suicide are and just how different each person’s thinking around suicide can be. However, one theme that is almost universal amongst the people I know who have been suicidal is concern for their families and friends.

Let’s consider for a second that someone’s suicidal thinking is not as preoccupied with others as mine tends to be. I believe that most people who die by suicide feel desperate, exhausted, at the end of their rope and that there is no hope for recovery. That still does not make suicide selfish. No one should be judged as selfish for fighting hard against a serious and sometimes fatal illness and then losing the fight. Yes, suicide is preventable. Yes, there are treatments available that work for some people. But at its core suicide as a result of mental illness is no different from any other illness that can result in death. This can be hard to grasp if your thoughts and emotions have never been overtaken by mental illness. For too long phrases like “committed suicide” or “took their own life” have programmed our collective thinking and made us believe that the person who suffered and died from suicide is somehow to blame for their death. This is why it matters that we reframe the way we talk about death by suicide. We need to use our words to convey that suicide should not be about the act itself but about the underlying distress or illness. People with mental illness do not take their own lives, suicide takes their lives from them. Suicide is more disease than act.

Saying that suicide is selfish completely ignores the experience of suicidal people. It contorts suicide into something that it is not and further confuses public understanding about suicide. I believe that the misconception that suicide is selfish stems from a real lack of understanding of what causes suicide. If you are someone who struggles to understand suicide, now is the time to do some research. You owe it to yourself and others to educate yourself about why suicide occurs. If you think suicide is selfish, you don’t understand it.

Take care,

Fiona

If you are in distress please reach out for help. If you don’t know where to turn for help, please consider contacting a distress line near you. http://www.suicide.org/international-suicide-hotlines.html

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