What to expect when your brain wants to kill you - excerpt from: SLEEP

Sleep is the fastest way to escape depression. When I feel overwhelmed, I go to bed, where I can drop the Mask and silence The Critic. The worse the depression, the more worn down I feel, the more tired I get, the more I want to sleep. Denial naps during the day, early bedtimes, and late sleep-ins help fill the time without confronting the worst of it. 

The better I am managing, the less I sleep.

I don't want to try

I don't want to try

because I'm afraid I will lose the chance.

 

Joy

 

I have the capacity for joy

but not the confidence to embrace it.

 

What to expect when your brain wants to kill you excerpt from: Major Depressive Disorder - A PRIMER

 

Major Depressive Disorder is a severe mental illness which affects 7.6% of the population or nearly 2.5 million Canadians (Statistics Canada).  It is a deadly disease which kills, by way of suicide, between 2% to 7% of those suffering from the illness.

The percentage of Canadians 15 years and over who have had a major depressive episode in the past year has increased substantially over the last decade.  In 2012, 4.7% met the diagnostic criteria, compared to 7.6% in 2022.  Young women between the ages of 18-24 were most likely to report suffering from MDD (18.4%).  Among males in my age group (45 to 64), the prevalence is 5.4%.

The most common symptoms of MDD are :

• Depressed mood

• Feelings of guilt, worthlessness, helplessness or hopelessness

• Loss of interest or pleasure in usually-enjoyed activities

• Change in weight or appetite

• Sleep disturbances

• Decreased energy or fatigue (without significant physical exertion)

• Thoughts of death

• Poor concentration or difficulty making decisions

My primary symptoms are a constant and overwhelming urge to plan and complete suicide, a feeling of being useless and worthless, being overburdened with stress and anxiety, being paranoid of the future, feeling hopeless in the present, and regretting my past. My mind is constantly fatigued by a barrage of destructive thoughts. I'm often exhausted by the noise in my head.

The diagnosis of a mental health disease is unique from other medical conditions. Since there are no objective tests that can be given, it relies on the skill of the psychiatrist or family doctor and the honesty of the patient. Don’t embellish your symptoms or dismiss them as inconsequential (as I did). The only way you will get better is by building trust and sharing how you really feel. By listening to your words and observing your behaviour, a doctor can provide an effective course of treatment.

 

I was first diagnosed with the PHQ-9. Pfizer released this screening and monitoring questionnaire in 2010. It consists of 9 questions, which are designed to gain insight into a patient's thoughts and feelings. It asks, "How often have you been bothered by the following over the past 2 weeks?" It covers 9 different symptoms of depression ranging from appetite to sleep patterns, from self-esteem to suicide ideation. Each answer is assigned a score. The total of all nine questions identifies the level of depression the patient is experiencing.

The first time I filled out this questionnaire, I was identified as severely depressed. Even today, with my depression somewhat managed, I score between moderate and moderately severe. 

 PHQ-9

...

What to expect when your brain wants to kill you: THE CRITIC

You've been coiled around my brain for so long
I thought you were me;
your whispers so common,
I thought they were mine. 

This is the most challenging chapter to write. This is the topic I fear the most. 

The Critic has been part of my life since I can remember. A voice that amplifies everything I do wrong, that offers suicide as a relief. I don't actually hear a voice; instead, it is an internal dialogue that drowns out every other thought. The Critic tells me I am destined to die by suicide and that my greatest action of free will is choosing when it will happen.  

The Critic is not always blunt. In fact, in most cases, he acts as my greatest ally. Rather than dictating what I must do, he often sympathizes with my concerns and offers relief. 

Come sit with me

for a while

and I'll tell you

your story.

It won't take long.

I've watched from afar

and have stood by your side.

I know all the details: 

the hollow dreams

the heartfelt wishes

the prayers

the loneliness

I'm the only one

who understands;

the only one

who has shared your burden.

Come sit with me now.

Share my blanket,

throw it over your shoulders

and melt into it's warm embrace.

Soon, it'll all be over.

Your ears will rush,

then fall silent.

Your thoughts will scatter

then disappear.

Your mind will clench

and then relax

and in that moment

that very last moment,

your story will end.

He recognizes my weaknesses and offers me peace. His ideas are so seductive that, in the moment, they make complete sense. It's only after the fact that I recognize how dangerous and permanent they are.  

I have had many therapists (See Chapter on Therapists), but only one identified and separated out The Critic completely. She set up an empty chair so I could address and directly challenge his assumptions and arguments.  

At times, I even sat in The Critic's chair. The dark thoughts I spewed were vicious; the self-hatred was exhausting. He identified every mistake in my life, real and imagined. He told me that I've accomplished nothing and never will, that I am a failed introvert without confidence and friends. My dreams have no hope of fruition. It is a lie that if you just persevere, you will win, so why bother? I have let down myself so many times. Why try? Writing these words is a waste of time. The Critic's thoughts are relentless and know precisely when to strike. All other words escape me, and I'm left to listen over and over, again and again. I am all I'll ever be. You'll cause pain whenever you choose to go, so why delay any longer?  

The Critic views suicide as my greatest accomplishment. Even better if it is unexpected. I was proud of my last attempt when I caught my pdoc entirely off guard. The Critic told me it was something to be proud of, to wipe away the doctor's smugness. (see Chapter on Pdocs). They locked me up in the hospital for eight weeks. (see Chapter on Hospital) Something else to add to my resume.

The Critic steps in when others try to help me. When someone asks, "Can I help?" The Critic tells me I have had these thoughts my whole life. How can anyone help? He adds that they are just trying to be polite and don't really want to share your burden. And so I reply, "It's OK. I'm OK."

If someone continues to engage, The Critic twists their words. They don't understand the relief suicide holds. When someone tries to minimize my challenge by telling me a string of positive thoughts like, "It's not that bad.", "Look on the bright side.", "You can do this." He will dismiss your words out of hand, arguing that they betray your naivety, that they are trivial and trite. You have no idea what you are talking about. "Don't worry. Be happy." is just an annoyingly catchy song.

"Count your blessings" is also not helpful. You are just trying to change the subject. "You have so much to live for." "Other people have it so much worse.", "Don't be so dramatic.", "You are being selfish." The Critic declares all of this insulting. They invalidate what I am going through. In the moment where The Critic holds sway, I know my thoughts are distorted, but they are mine. At that moment, I don't care about anyone else. You suggesting that I should tells me that you don't care about me. 

When you say, "I know how you feel." and suggest my crisis is somehow common, you make me feel less important. You are proving The Critic right. I'm a failure. Clearly, others have handled this. Why can't I? My thoughts become defensive, and He declares my SI is not like everyone else's and proudly describes me as incurably unique. 

The Critic despises the desperate appeal of "I would be devastated if you were gone." He declares it invalidates my own experience. Now, I don't only have to think of my own consequences but yours as well. You are guilting me into staying alive. My crisis turns to anger and resentment. It amplifies my distress. I can barely take care of myself, and now you're dumping your happiness on me.

Likewise, telling me to think of my children, wife, and extended family only angers Him. They are already constantly in my thoughts. I know they will be devastated if I die by suicide. I know it will change their lives forever. Accusing me of neglect is not helpful. Instead, you only heighten the guilt I'm already feeling. I'm already ashamed of my disease. Your accusation justifies why I should die. Does it make logical sense? No. The Critic never does. But that is the inevitable path my thoughts will take. I will shut down and not listen to your words. My every thought is jumbled and hyper-focused on distress and its relief by suicide.

Attempts at intervention are often rebuffed by The Critic. Asking if I have been taking my medication feels like an accusation. It undermines my own emotions. It blames me for the crisis. The dark thoughts are not real. Rather, they are just a chemical stew that has boiled over. For the record, I have only ever missed one dose of medication, and it was by accident. (see Chapter on Medication and Chapter on The Rules of Suicide). The mere suggestion that I did it on purpose is enough to make me shut you out.

Also, don't tell me to call a helpline. If you are there during my crisis, that is not by coincidence. I have chosen you to witness me in a very vulnerable moment. I trust you. I understand why you would want me to reach out to professionals, but by telling me to do so in that moment, you are abandoning me; at least, that is how it feels. Similarly, asking for my safety plan is dismissive. If you are there, you are already part of my plan.

So, how can you help me in crisis and calm the Critic?

First off, stay quiet. Listen. Be there for me. Let me know I'm not alone, but don't try to talk me down. The more words you use, the less I'll listen, the more The Critic will argue. Conversation only amplifies the agitation. Don't bombard me with questions or try to engage me in some sort of verbal distraction. Changing the subject is not helpful. I will hide deeper in the crisis, in the Critic's thought, and I'll put up his usual defences. I will quickly say, "I'm fine." hoping you will leave me alone.

Demonstrate empathy, not judgment. See if there is a way to give me more time to free up my schedule and relieve external pressures. Is there an upcoming event or appointment, or do I have to go to work soon? Can I cancel or phone in sick to simplify my day?

Stay with me or arrange for someone to stay with me. I'm not looking for a therapist at this point. Don't try to explore my psyche or uncover past traumas. Right now, all I need is time to de-escalate on my own. Having someone there keeps me safe. I'll initiate any conversation when I am ready. Just be patient.

If you want to say something, the most powerful words you can use are: "You are important to me." If you just say, "You are important." I will dismiss you because I do not feel that way. The Critic won't allow it. It is hyperbole. But by adding "to me," it changes the meaning. I can't argue with what you believe. These words make me stop and think. They make me see you. They give me value that I don't realize I have.

I know it is hard to watch a loved one suffer. The most important thing you can do when I reach out for help is to be there for me. Without a word, you are more supportive than you could ever imagine. You give me value so I can breathe deeply again.

One of my pdocs identified The Critic as Obsessive Compulsive behaviour because my thoughts always go there. There is no why, just a sudden compulsion. (see Chapter on Suicide Note) The Critic is addictive:

I have an addiction.

Not with a bottle

or a needle

or with lusts and desires.

It's where I go,

chased

by my darkest thoughts,

where I find relief

or at least solace,

where I stop

and stand my ground,

no longer helpless,

my life in hand,

where that feeling,

that power

washes over me,

euphoria,

to stand at the edge

to not turn away,

where eternity

for a moment

is mine. 

The Critic offers the solution to my depression and makes me question everything my Pdocs, Therapists, family, and friends are saying.

  

My ending is already set.

It stands right before me.

My GPS tells me I'm here;

just one step away.

But no,

I have to keep

reminding myself

that when my thoughts

are at their darkest,

I must turn away

and ignore

the constant recalibrations

that lead me back

to this same spot,

this one destination.

I have to keep

reminding myself

to turn away

and forge a new path

that will take me

further and deeper,

the long way 'round.

Over time, I have changed my diagnosis. I used to always say I suffered from depression, anxiety and suicide ideation. It was a disease I was fighting like cancer. It was win or lose. I hoped that one day, my medication and therapy would beat the disease or at least send The Critic into indefinite remission.

At our first appointment, I remember telling my psychiatrist that suicide felt like the calm of a shady river bank while life was the chaotic turmoil of the rapids below. Anxiety and fear felt like drowning. The doctor assured me that I would feel the exact opposite after treatment. (see Chapter on Pdocs) Poor mental health would be the turmoil in the middle of the river while life was the calm on the bank. It was a promise I wanted to believe. After all, hope is hard to resist.

But after seven years, countless medication changes, dose adjustments, five different therapists, two different CBT workshops, an SFSL workshop, and three stints in the hospital, one of which lasted 6 weeks (see Chapter on Hospitals) it hasn't happened. I still get anxious. The Critic still seduces me with his promise of calm, a shady river bank safe from the turbulent river. I admit the rapids are not as chaotic as they once were; the overwhelming sense of drowning has settled, but am I cured? No. Will I ever live without The Critic? No. Without suicide ideation? No.

I have resigned myself to the fact that I will always have varying symptoms. Life still lives in the rapids and whirlpools. My thinking has not flipped. My psychiatrist lied. But at least now, with therapy and medication, I have a life jacket and, at times, even a raft, which I can pull myself onto to escape the turmoil of living.

There is no cure. But there is a way to manage The Critic, and each day, I get better at it. I have let go of the idea of being "all better." I no longer assess my progress based on how far I am away from a "normal" life. I no longer see myself as suffering from depression but instead living with it. I have decided my condition is more like diabetes than cancer. I have tools and strategies to manage the "glucose levels" in my brain. (see Chapter on Strategies). Do I sometimes make mistakes and let The Critic take control of my thoughts? Yes. The suicide ideation can still be intense. But I now recognize the calm of the river bank is permanent. It's where life ends. And so I do my best to swim, to hold onto my safeties, my therapy, my meds and my resilience. The difference from when I first sought help is that I now know I can do it. Despite what the Critic says, I know I can live.

Being depressed and listening to The Critic is accepting the way things are. Accepting that I am powerless and that suicide is my only strength. Confidence is about recognizing the power of change and the ability to keep changing. This alone is the act of empowerment.

I set a goal for myself,

to write one word today,

nothing ambitious

or profound,

just one word

to start again,

just one word

to show the way.

Believe.

Happiness

You can't rekindle happiness. You can only remember it.

My mind is always creating

My mind is always creating whether in a dark space with destructive thoughts swirling round infinitely inevitably, leaving my brain stuck in itself or in a spring day with my imagination engaged molding meaning excited exuberant expanding without limit or cause If only I could force one into the other but I can't stop the dark thoughts with metaphors and meaning; and the happy creations are immune to destruction.

Yesterday

Yesterday was a good day until I realized it.

Suicide

Suicide will be my greatest accomplishment. The only feat I'll be remembered for. My courage, my planning will be a surprise. No one will suspect. l'll win. Those are the thoughts, tantalizing, seductive, relentless, that give me purpose, an attainable goal. It's all I have to hold onto while I delay, living out the days and numbers that count plus one, slowly plodding again and again. Each day ending with the same prayer: that I sleep the endless sleep that my last breath leaves me mid dream and I die beneath the covers.

Smile

Give them the best of you. Let them see you smile. while inside your orbit continues to decay.

Kind or cruel?

I like to think of myself as kind and empathetic but deep down I know  I'm the exact opposite: cruel and selfish. That is what the thoughts do. It's a constant fight over the very core of my being, over who I really am.

I am divided

I am divided whether I want to get better or not. There is a sense of satisfaction in surprising my pdoc with a successful suicide. It's a sense of power, of freedom, free will, defiance. It would be my most intimate creation, my ultimate accomplishment. But then I remember how far I have come all the tears I have shed. Sure, they gave me the drugs but it was me who stood on my own who reached out for help. They can be smug if they want but I know the truth. I've done all the heavy lifting I deserve all the credit I can be so much more if only I had confidence. I just don't know where I stand Do I continue to climb with a blind faith it will all get better or do I create and succeed entirely on my own terms?

Confidence

The worst part of depression is that it steals all your confidence and leaves you full of  doubt and despair.

Aloneness of the moment

 

The wind rushing past my ears reminds me of the space all around, the aloneness of the moment.

Content

 

We live in an era of disposable content, of binge watching and the constant demand for more. I don't want to write the next episode. I want to be reread. How arrogant is that when all I've ever written remains unworthy and unread?

Easier

 

Life is a whole lot easier when you give up on your dream.

Happiest days

 

I already know the happiest days of my life.