Yesterday

Yesterday was a good day until I realized it.

Confidence

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

The hurdles of suicide

 

The following are the three hurdles you must overcome to complete suicide:

GUILT - When you think about the pain you'll cause, the future you'll cut short, your family and friends; the guilt you'll place on all the special people in your life who will wonder if there was something more they could have done to save you.

DARWIN - Your body's automatic survival response.  For example you can not hold your breath until you die because you body eventually forces you to inhale.  This is the response the doctor's rely on when you are in ER. The drugs and IVs give the body what it needs to stay alive. 

REGRET - This kicks in once you have circumvented the DARWIN response and taken a lethal dose.  It's what makes you step back and seek help whether that is calling 911 or a crisis help line. 

You have three chances to stumble and recognize the right decision and realize tripping is the best option.  At the very least, wait until tomorrow to start the race. 

My Cure

 

My cure does not come from pills but rather words, not from bandages but rather thoughts.

* Metacognition wordle by Nancy Smith

Aloneness of the moment

 

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

My Doomsday Clock

 Here is my Doomsday clock.

11:15 - JOY

I have only had a few days in my adult life 

when suicide did not even cross my mind.

11:30 - STATIC

This is a good day for me.  

Suicide thoughts are there but mostly in the background

11:45 - CHRONIC

This is a bad day for me.  

Suicide thoughts are strong.  Discouraged. No motivation. 

11:53 - IMPULSIVE

Suicide thoughts are very strong.  

I have been here a number of times in my life.  

On five occasions I took action. 

12:00 - IMMINENT

I am consumed by suicide. 

The decision is final. There is no going back.   

I have been here twice in my life. 

 

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.

I absorb stress

 

 

I absorb stress I step in before the fight begins. I'm the calm that prevents the storm. I'm the deep breath that gives perspective. I'm patience in the face of crisis. And all of this is killing me.

Withdrawl

I went away for the weekend and forgot to bring along my psychotropic medications. The first day and first night were fine.  I barely recognized a difference.  But on the second day I felt off.  My brain was light-headed. I had a mild headache.  I lost my appetite.  Nothing terrible, just off.

It was on the second night, the time when I normally take my strongest medication - the one for which I undergo monthly blood tests - that the terrors broke free.  Dark and shapeless shadows, long and stretched were chasing me down a long corridor that had no end. No matter how fast I ran I couldn't get away.  I tried to scream out but I couldn't make a sound.  I tried a second time. I screamed louder and broke through the dream. I found myself screaming in real life.  On a number of occasions over the night my wife woke me up because I was so loud. 

It took a day or two after restarting my meds for things to feel back to normal. The night terrors ended immediately. At least now I know what will happen if I stop my medication all at once again.  I suspect the third day and night would have be worse, the shadows would begin to pursue me under the daylight and the demons would devour me beneath the moon.  

.

The voice

 

The voice never stops. It constantly berates me. Throwing the past in my face. Shredding my future. Shattering my hopes. This can't go on. I'm tired. So very tired. I can't keep picking myself up. I can't keep hiding how I feel. I'm stupid. I'm wrong. I'm not enough. I'm stupid. I'm wrong. I'm not enough.

I have changed my diagnosis

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 lived in the hope that one day my medication and therapy would beat the disease, or at least send it 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 itself was the chaotic turmoil of the rapids below. Anxiety and fear felt like drowning. The doctor assured me that after treatment I would feel the exact opposite. Poor mental health would be the turmoil in the middle of the river while life itself was the calm on the bank. It was a promise I wanted to believe, after all hope is hard to resist.

But after four years, countless medication changes, dose adjustments, five different therapists, two different CBT workshops, three stints in hospital one of which lasted 6 weeks, it hasn't happened. I still get anxious. Suicide still seduces me with its promise of calm, its 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 anxiety or suicide ideation. No. Without depression? No.

I have resigned myself to the fact, I will always have symptoms in varying degrees. 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 up onto to escape the turmoil of living.

There is no cure. But there is a way to manage the distress 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 rather 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. Do I sometimes make mistakes and let my thoughts get out of control? Yes. And the suicide ideation can be strong. But now I 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 now from when I first sought help is that I now know I can do it. I know I can live.

Complements are complicated

Compliments are spontaneous words of praise or admiration but for me they are much more complicated than that.

I have lived my whole life with depression and anxiety. My self-esteem has never been strong. I often overthink someone's words and intentions to the point where my anxiety is spun into a tight knot. I am either scared of a new perceived expectation or I dismiss someone's words as unfounded.

When I was a child I hated going to the dentist. Not because it hurt or because I was scared but rather because I had never had a cavity and the dentist, after looking over my chart, always called me his "superstar". I was terrified I would let him down and he would find out his praise was unfounded. If I wasn't his superstar every time,  I was a failure.

Other types of compliments ring hollow. I once had a manager in a grocery store who was very upbeat and positive. He always said "Great work!" numerous times throughout a shift. I never believed I was worthy of all that praise, definitely not that much in one shift. His words were baseless. He didn't see me struggle with the apple display just moments before so I dismissed his compliments.

On the flip side though if he didn't compliment me the same number of times on another day, I interpreted it to mean I had let him down. I know it does not make sense to think his words are not sincere but then miss them when he remains quiet but that is how my mind works. I am either unworthy or a disappointment.

Therapy has helped me to identify this as distorted thinking. In the moment my self-esteem takes a hit but later, when I have the time to consciously go through the facts, I can talk myself down. CBT allows me to pick at the knot and put things into perspective so that I recognize that a compliment is often just a spontaneous comment, a nice thing to say. It is not a future expectation of performance or unfounded praise with some ulterior motive. It is just a kind word shared between two people. It's not meant to define who I am or gauge my value. It's just a smile that someone wants to share.

A safety plan for everyone else

Suicide is not scary. It is a solution. I don't want a safety plan because if I get that close it means I am ready. I keep one to appease everyone else. They back down on their concern if I can recite a safety plan for them. A plan I have no intention of every using.

The five most challenging side effects of my depression medication

 

I live with depression and chronic suicide ideation. Over the years I have tried many different medications and I have experienced many different side effects, everything from dry mouth to a brain fog. It took a while and a lot of faith in my doctor's intentions to continue following a path of trial and error. All along I insisted that the positive effects of any medication had to greatly outweigh any negative reactions. I was not going to take medication strictly for the sake of taking medication. It had to work.

The following are the 5 worst side effects I experienced on my mental health medication journey.

5. Vivid dreams and brain sparks. Any time I laid down I would instantly be caught up in an all consuming, vibrant coloured, hyper-realistic dream. And when I wasn't asleep there were random lighting flashes behind my eyes or, as I called them, brain sparks. While I found these side effects fascinating I was worried they were a symptom of some hyper brain activity that over time might cause permanent damage.

4. Deep sleep. This one was more of a nuisance than anything. I would sleep so deeply that I would frequently wet the bed. I also drooled on my pillows, experienced night sweats and snored. A real treat for my wife. I ended up sleeping in my own bedroom in the basement separate from the rest of the family. It was embarrassing and depressing. My self esteem plummeted. For a time I wore adult diapers to bed and washed my bedding every morning. My drool would soak straight through my pillows and would leave a musky odour. For me, living this way was not an option.

3. Loss of sexual desire. This was not a performance issue that could be addressed by Viagra or Cialis. Believe me, I tried. Rather it was one of desire, or worse. Intimacy never even crossed my mind. Interest in physical contact vanished. I was chemically castrated. Provocative images, words or sounds no longer inspired me. It was as if desire had never existed. What made it even worse was that I didn't even realize what I had forgotten until I purposely stepped back and thought about it. I felt cheated.

2. Over eating and rapid weight gain. For my entire life weight has never been a problem. I was very lucky. If I gained weight over Christmas from all the treats and chocolates and nuts, I could easily lose it all by mid-January by simple eating sensibly. I had never had to diet. But when I went on one particular med I gained 25 pounds seemingly over night. I suddenly had a middle age “beer belly” distending over my waistband. I hated what I saw in the mirror and felt embarrassed to go swimming. This side effect was devastating. It took me a very long time just to claw back half of what I gained. My body image still suffers.

1. Lethargy. The worst side effect I experienced was when I was left sluggish and apathetic. Everything was heavy. Lead courses through my veins. When I tried to speak oftentimes I could not find the words. My brain was filled with cotton batting. My short and long term memory struggled. This side effect was worse than the disease. Sure, it stopped my emotional swings, my anxiety and suicide ideation but all it left was a shell. It was not a side effect. It was replacing one disease with another. What was the point? I did not stay on this med for long.

Every mental health medication has the potential to produce a wide range of side effects. But they can also provide real relief. If you want to try medication understand it will take time to determine the dosage and drug combinations that work best for you. Be patient. Tell your doctor any side effects you experience and work together to improve your mental health.

I still live with some side effects in varying degrees, but none of them are severe. Am I cured? No. I am still in therapy, I still take my meds but at least now a somewhat normal life seems possible.

Insomnia

 

I don't want to be awake anymore so I keep rehearsing my death. Ask for my plan and I will give you more detail than what you think is safe. Every night I pray for mortality; for a life that ends.

What helps when I'm suicidal (and what doesn't)

 

I suffer from chronic Suicide Ideation which at times becomes acute. In these moments of crisis, I am often asked "How can I help?" I know it is frustrating but in those moments I have no idea what to tell you. My mind is spiralling and overwhelmed. Part of me doesn't even consider suicide a problem. I have had these thoughts my whole life. They are who I am. Moreover, I am fiercely independent. I don't want to be a bother. I don't want to ask for "help". My answer will usually be, "It's OK. I'm OK."

I know you mean well but there are a number of things that only make the crisis worse. Minimizing my challenge does not help. Telling me a string of positive thoughts just betrays how little you understand. Saying "It's not that bad.", "Look on the bright side.", "You can do this." makes me dismiss your intentions. Your words and thoughts become trivial in my mind because you have no idea what you are talking about. "Don't worry. Be happy." is just a 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." They are all insulting. They invalidate what I am going through. I know my thoughts are distorted but they are mine and they are stuck in crisis. At that moment, I don't care about anyone else. You suggesting that I should, tells me that you don't care about me specifically.

When you say "I know how you feel." and suggest my crisis is somehow common, you make me feel less important. I'm a failure. Clearly others have handled this. Why can't I? My thoughts will then become defensive. My SI is not like everyone else's.

The desperate appeal of "I would be devastated if you were gone." also 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.

Telling me to think of my children, my wife, my extended family only makes me angry. They are already always 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 am already feeling. I'm already ashamed of my disease. Your accusation justifies why I should die. Does it make logical sense? No. But that is the inevitable path my thoughts will take. I will shut down and not listen to your words.

Don't ask me for reasons to live. In crisis, there are none. The more you push the more I will dig in. We are not dealing with logical thoughts. Everything is jumbled and hyper-focused on distress and its relief by suicide.

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 never missed a dose of medication. The mere suggestion is enough to make me shut you out.

Also, don't tell me to call a help line. 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, what can you do?

First off, stay quiet. Listen. Be there for me. Let me know I am not alone but don't try to talk me down. The more words you use the less I'll listen. 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 just hide deeper in the crisis and put up my usual defences. I will quickly say "I'm fine." in the hope that 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? Is there a way I can cancel or phone in sick? 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. I'll do that later with my actual therapist. In the moment I just need 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 do 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. In my mind that 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 in that moment 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 breath deeply again.

An episode of agitation

The other day I had an episode of agitation.  It happened on a moment. No warning. No build up.  I suddenly began to pace while juggling a small ball between my hands.  With each step, with each toss my thoughts spun tighter. I couldn't stop myself.  I was completely absorbed in the agitation.

By happy coincidence my adult son was there.  Happy for the outcome not the moment.  I was embarrassed to be in such a state, so isolated in my thoughts.  He had never seen me like that. I had always made sure of it.  This time though, I couldn't hide.

He watched in silence for a few minutes and then reached out, "Are you alright?"  

I couldn't quip my usual "I'm fine."  I was in too deep to fool anyone about my mental health. I could not pretend like I usually did. I tried to breath.  I tried to refocus but my state remained the same.  I was forced to confess I was not doing well.

He watched me in silence as I paced.  He didn't barrage me with questions or immediately try to refocus my thoughts. He didn't tell me to stop.  He let me continue while making sure I knew I was not alone. 

After a few minutes and a few more laps, he said "You have been working a lot lately."  He went and looked at the calendar and confirmed his statement.  He then suggested I take a mental health day.  He offered me a solution to change the situation.  He gave me permission to be agitated and offered a choice.  I knew by this point I was in no position to go to work.  My eyes were filled with tears.  My body was stuck in seemingly perpetual motion.  I tried my best to control my breathing - in for four and out for eight - through my nose out my mouth - but nothing worked.  

He then walked over and explained himself,  "I'll do what mom always does when I get upset." He gave me a big hug.  I stopped moving. The spinning stopped. He had interrupted the agitation.

We then composed a text explaining I would not be in to work that afternoon. The agitation further subsided. 

With my breathing returning to normal, he went off for a moment to call his mother (my wife) to tell her what was happening.  When he came back he told me he had kept "mom in the loop."  He had to go to work so we all decided (my son, my wife and myself) that it would be best if I was not alone.  My wife called my in-laws and arranged for me to stay there for dinner.

I was a little bit hesitant.  I didn't want to explain "why" it had happened or what they could do to help.  To be completely honest I didn't want to talk about it at all.  Happily my in-laws did not raise the topic of my mental health.  We talked about everything but my agitation which helped me to stay calm.  There were no awkward moments and for that I was truly thankful.

By the end of the day it was over. I was exhausted but safe.

I'm fine

"I'm fine."  It is a phase I say a lot. 

What does it mean? 

It means that I don't want to share my true feelings. It means I am protecting you from my thoughts which I am certain you will find distressing.  It means I am giving you permission to not be concerned about me. I said I'm fine so we can move on to other topics of conversation, something neutral like the weather.  It means I'm feeling overwhelmed, my anxiety has been triggered and I need to shut down and reset. It means please don't push me any further or I might crumble. 

I'm fine. Let's just move on.

Anger

To solve this crisis don't feel shame or guilt,

rather feel anger and urgency.