What to expect when your brain wants to kill you excerpt from chapter: CHRISTMAS

When you only see some people once a year, it is natural that after the initial Merry Christmas greetings, you compare resumes. "So, what have you been up to?" What should I say? I took a ten-week course on Skills for Safer Living with six other people, all of whom have attempted suicide in the past, just like me? It's not a good way to start a conversation. Nor is telling someone you're trying a new anti-anxiety pill that seems to work well. Once I ignore my depression and SI, there is nothing over the past year worth talking about; at least, that is what the Critic tells me.

It might sound counterintuitive, but once I have my drink in hand - usually a beer. (What am I saying? It's always a beer.) I try to stay with a group of people. This way, you can watch and listen without participating. Let others do the heavy lifting and carry the conversation forward. No one will notice that I am not part of the discussion. If they ask me something point blank, I just nod and agree. 

My favourite Christmas Eve - more of a construct than a memory - is sitting alone by the fireplace, with a lazy flame dancing on a log. The tiny coloured lights on the Christmas tree scatter a cozy, warm hue. In my hand, I am sipping a Baileys on ice. In the background, choral carols float quietly, blessing the space. Everything is calm. My mind is clear. Everyone else is already in bed. I'm the last one to turn out the lights.

...

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 chapter: POETRY

 

 

I enjoy writing.  I like expressing my thoughts on paper or on my blog.  I wish I could get more people to read my stories and poems, but that's not why I write.

I have written a couple of novels.  They have been revised over many years.  I have been tinkering with one since university.  I have carefully sculpted the other over the last 20 years.  Neither has been published.  I have tried the Literary Agent route, which is very frustrating.  You wait so long only to get a form letter rejection.  I understand why.  The number of "writers" worldwide has grown exponentially since the advent of word processing programs and the Internet.  Literary agents are inundated with story pitches.  I'm sure they can barely keep ahead of the avalanche.  I'm not criticizing them, but rather just sharing my observations.

The non-literary agents in my life - friends and relatives - advise me to self-publish.  I am reluctant for a few reasons.  First, Literary Agents want to avoid handling spoiled copy.  They want the princess to be intact, so to speak.  If I self-publish, my novels will be sullied.  It is an all-or-nothing strategy.

Second, to self-publish successfully, you need to be able to promote yourself.  All authors do marketing, but if you have a Literary Agent, you have some guidance and access to tools unavailable to lone wolves.

...

What to expect when your brain wants to kill you excerpt from chapter: 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 excerpt from chapter: STRATEGIES

All of the following are effective in some shape or form, but for them to be truly beneficial, you must make those that resonate with you part of your daily routine.  They must be deeply integrated so that when you need support, a pause or a break, or even just a distraction to get over a crisis, big or small, you will instinctively choose the right strategy for you at that moment.  Many of these I don’t embrace that tightly.  I hope listing as many as I can remember will give someone else an option they never considered.

Let’s start with ice.  Before I experienced modern psychotherapy, I equated Psychiatric Hospitals with 19th and 20th Century Insane Asylums and their notoriously harsh treatment of patients.  I have a vivid image in my head of a patient screaming and crying as they were forcibly put into an ice bath and restrained in place.  It was a technique used regularly as much as a punishment as a treatment.  As it turns out, though, ice baths significantly affect a patient’s physiology.  They are routinely used by athletes to reduce muscle soreness and inflammation and to enhance recovery.  For patients, if you put your face in ice water and hold your breath, it triggers the dive reflex, slows the heart rate, calms the nerves and makes your body conserve oxygen. 

I don’t like being cold.  The only ice I want is in a drink, so the idea of an ice bath is abhorrent.  Nevertheless, I’ve always been open to trying different strategies at least once, so one day, when I was agitated, I tried it.  I filled a large bowl with water and a couple handfuls of ice.  I then bobbed for apples, or in this case, ice cubes.  As expected, it was not pleasant.  Perhaps it would have been refreshing if it had been a hot day.  As it was, it immediately distracted my thoughts.  Bracing.  As a strategy, it was effective, but as a viable option, I would have to pass.  There was too much involved in setting it up.  When I told my Pdoc I tried it, he was actually surprised.  He rarely had patients act on his suggestions.  He was more inclined to trust medication, especially PRNs, in such situations.  I won’t dismiss this strategy out of hand, but if I ever use it again, it will be in desperation.  

...

What to expect when your brain wants to kill you excerpt from chapter: MEANS & METHODS

Suffocation, which includes hanging, is by far the most common method of suicide in Canada. More than half of the total 3809 suicides in 2018 employed this method.  

Canadian Vital Statistics Death Database

Poison, which includes overdoses of medication and peach dust, was the second most used method.   

It is interesting to note that in America, firearms are the top means of suicide. Stricter gun laws in Canada are saving lives. Guns are by far the most lethal means with which to attempt suicide. “Lethal” refers to ease of use, accessibility and the ability to abort mid-attempt. 

Most people start an attempt and abort it partway through. If you overdose on medications, you usually have time to call 911 or other assistance. With a gun, however, that ability is all but eliminated. The fatality rate of suicide by firearm is more than 80%, while suffocation is 62%, jumping 34.5% and poisoning/overdose is 1.5%. The vast majority of attempts by poison are aborted.   

What to expect when your brain wants to kill you excerpt from chapter: FAMILY DOCTORS

My father was a family doctor, so for most of my life, I never needed one. If I required any care, I was treated at home. I used to get allergy shots when I was a kid. Once a week - every Thursday - right after dinner, when he had finished his tea, my dad would give me my needle. If I had a fever or a bad cold, he would reach into his old black doctor’s bag and dispense antibiotics.


My dad was a minor celebrity in my small hometown. As a teenager, I was often introduced as “Old Doc White’s son.” I was not always thrilled by that moniker - especially when my high school history teacher used it - but as I’ve gotten older, I’ve learned to cherish such an honour. He was probably the last doctor in our community to do house calls and to visit his patients in the hospital. He set a very high bar for bedside manner.


I have lived a remarkably healthy life - at least physically and so after I moved away from home, there was no urgency to find a new family doctor. Then, one day, I was overcome with a visually impairing headache. I suffered a week before I finally gave in to my wife’s demands and went to a walk-in clinic. After an hour’s wait, I saw the doctor, who seemed less than interested. He poked a little, massaged my neck and then told me flat-out that I didn’t have meningitis. “How wonderful”! I thought. Too bad I still had a splitting headache.


I was then presumptuous enough to ask point blank what it could be, and the doctor proceeded to rhyme off a list of “don’t bother me” options, concluding with “God Only Knows.” He never even gave me any treatment options. I asked if I should take Tylenol, and he shrugged and said, “Sure. You could try that.” I was so frustrated. I could have made the GOK diagnosis myself. The agony lasted two more days before my head finally cleared. That’s my rule now: always wait 10 days before going to the doctor because chances are it’s simply a case of GOK and will clear itself up soon enough.


My father once told me that when he was in medical school, they said to always look for horses first, not zebras; that is, to look for common explanations for symptoms rather than exotic ones. Seems sensible enough, but in this day and age of advanced diagnostic imaging, the concern of missing a zebra is far more important than identifying a horse. Saving a life is what really matters. I’ve never been a zebra. I’ve never been diagnosed with a “real” disease.