Struggling With Urges

Yesterday was World Suicide Prevention Day.  I had sworn off doing anything remotely productive that day, so I didn’t post then, but now I feel I should have said something.

Things have been going quite well in my life for months.  So far in my Abnormal Psychology class I have a perfect score, and even though we haven’t reached the first exam yet I have every online quiz done for the whole semester.  All the little details of college have been falling into place.  I’ve managed to drive to campus 6 times on my own.

Then I had some personal losses.  Brent began working in inpatient and I was no longer able to see him, so instead of meeting his replacement I transferred all my prescriptions over to my family doctor.  I tried to share good news with some people who’ve been very important to me in the past and despite knowing what to expect it still hurt terribly.

I had a conflict with Sadie and e-mailed her to say I wanted to terminate therapy.  She said we’d discuss it in person the next Monday (2 weeks after my previous appointment) and then was sick that day and I couldn’t get another appointment for 2 more weeks.

I got some hopes up about possibly becoming part-time at work, so when I was asked to work every other weekend (instead of every 6th) I agreed, thinking that was the solution to making me part-time.  As soon as I said yes I was told I would only be a .3 (part time is .5).  I was so frustrated and upset, and went to talk to HR about it, where I was told my supervisor can’t make these kinds of changes without consulting them.  So they planned to get involved, but I had no idea where that would lead.

I was working the weekend immediately following that Friday, and my weekend was going well.  There was a short period of panic Sunday morning when the phones weren’t working correctly, but other than that it was a quiet weekend.  Then I was walking casually down the hall, returning to my department, and out of nowhere I felt an intense urge to slit my wrists.  Not the kind that results in a few bandages, but the kind where you bleed to death.  I got downstairs and locked myself in my department, sobbing about how this kind of thing is going to keep happening over and over and I will never be fit to be a therapist for someone else when I can’t get my own life together.

That evening I struggled with these suicidal urges.  And again on Monday, and still on Tuesday, when I followed up on DBT group by walking over to the main CMHC building and asking to speak with the on-call therapist, Jan.  I rambled a bit incoherently and she smacked me with reality a few times.  She said it’s quite possible that I won’t be able to work with people who are acutely suicidal or actively self-harming, but that leaves a wide variety of options that I can handle.  She also talked about no one ever having their life together and feeling like an adult.

I explained about the plan to stop seeing Sadie, and how I said it was a Wise Mind decision, that I would be able to focus better on school if I wasn’t dealing with therapy and the reminders that I’m ill.  I admitted that I was trying to pretend none of it was real.  “And when has that ever been helpful?”  Never.  And I can never pretend it’s not real because I have to take medication four times a day, so there’s 1,460 reminders a year.  After nearly a month of not seeing Sadie I’m no longer even sure about my decision.  I felt confident at first, but over time I became sad and scared.

Jan went to talk to Dr. Bhatia, telling me that she worries about me sometimes and could go either way on the subject of inpatient.  I begged her not to send me, as missing school would just make my life get worse.  She came back from consulting him and had me sign a contract for safety with notes that I would: a.) see Sadie on Monday, b.) see my family doctor on Tuesday, c.) call a friend from my safety plan, and d.) follow the rest of my safety plan as needed.

So I got home, not telling mom where I’d been.  It wasn’t until the next day that I mentioned it and she could not understand why I might need to talk to someone.  The next day I had class, and I did not want to go.  Mom offered to drive me, and it wasn’t that I was worried about driving, but I let her because that way it would guarantee that I’d go and not just drive off somewhere random.  On the way home I was saying that if I’d gone to see Jan after class instead of two days earlier, I would have let her admit me.  Mom told me to stop talking that way.

I have used so many distractions and so many social interactions trying to avoid these persistent thoughts.  I do not want to die, I want to stop hurting.  Before my last inpatient stay I had weeks where every little thing made my heart physically ache, and that feeling is back.  Yesterday I finally got home and didn’t have the energy to keep fighting, so I gave mom a basket full of my pills and razors and asked her to go stash them somewhere hidden.

A part of me longs to go to inpatient.  I can keep myself safe without being there, but staying 4 or 5 nights would help me feel better.  Unfortunately it’s too late to do that without messing up my life again.  First exam on Thursday, work on Friday.  My window of opportunity has closed.

Advertisements

An Embarrassment of Tears

When discussing Piles of Paperwork about a week ago, I mentioned that I was planning to end therapy after my treatment plan expires in three months.  I commented to close friends on Facebook that I was facing the challenge of lying to Sadie for three months so that she won’t stop me from leaving.  Their outrage was amazing, and multiple people insisted that I really needed help and should find a new therapist, which I am unwilling to do because I’m not going to start over telling some stranger all about me.  I did reluctantly admit that there are a couple of people who aren’t entirely strangers, but did not like the idea of seeing any of them.

Wednesday afternoon I headed into my appointment with Sadie, and told her that my friends were upset with me because I had told them I planned to stop seeing her in three months.  I said that therapy didn’t seem that helpful anymore.  She told me that I was being dishonest with her about my reasons, until I said that it seems like she wants me to go away and if she doesn’t think I need help then I can’t imagine her actually being helpful when I do.  She said, “So you got your feelings hurt?”  I was a little choked up saying all this, but managed to suppress it.

I told her I’d planned to lie to her for three months, not wanting her to know that I still have suicidal thoughts all the time.  She commented on how I’d been doing better and wanted to know how long the thoughts had been a problem again.  It had been at least a couple of weeks at that point.  She probed about why I was feeling so hopeless again, and I told her that I’m a worthless monster.  I tried to explain, but I’m pretty sure I was incoherent for the next 10 minutes, sobbing uncontrollably and babbling in disjointed, incomplete sentences.

This was the first time I’d ever shed more than a single tear in front of her, and to me the session felt like a trainwreck.  To her it seemed productive.  She asked me what was so bad about crying in front of her – she hadn’t laughed or made fun of me and the world hadn’t ended.  Although I can objectively see that those things didn’t happen, what did happen was that I felt extreme embarrassment at how weak I was for losing control.

I fear that, now that I cried once, every session is going to be full of my blubbering.  I fear that I’ll also cry in front of Brent when I see him in a few days.  I don’t know what to say to him.  I suspect he’s going to be upset with me when he hears how intense the suicidal thoughts were and that I didn’t call for help.

One friend suggested that it might be comforting to take my cat to therapy again next time.  I doubt she’d be much comfort to me, considering that last time she spent the whole session curled up in Sadie’s lap.

Piles of Paperwork

Last week Sadie and I had to update my ANSA and treatment plan yet again.  She expected that we could do all this in one session and still have a little time left over to talk.  She was mistaken.  We got the ANSA done with 5 minutes to spare and she asked if I wanted to do the treatment plan “really fast” or come in another time.  There is no way we could have gotten done in 5 minutes, so I agreed to come back the next day to complete it.

The next day I came in and it took us at least 30 minutes to get the treatment plan done.  She said that I’m more goal-oriented than most of her clients, who usually say their goal is “to be happy” and don’t care what else she writes.  That seems utterly unproductive to me.  Happy is not quantifiable.

My overall ANSA score, which tells her what level of services I need, has gone down from a 4 to a 3.  This is great news.  Less great was when we did the Suicide module and she said, “If I didn’t know you, I’d send you to inpatient based on this score, but I don’t think you need inpatient.  Do you?”  No I definitely didn’t.  Part of the score is based on history of attempts.  My Benadryl overdose counts as an attempt, so that part of the score will never decrease.  At the time we talked I had a concrete plan (but I will always have some form of plan) and had thought about it in the past 24 hours (because someone else was discussing a loved one’s suicide attempt), so that looked rather alarming.  However, I had no intent to act on it.

I am displeased with the new format for treatment plans.  The previous one was very open to filling it in however we saw fit.  This one pulls in the highest needs from the ANSA and forces you to choose from a list of options for things that need addressed in that area.  There is the option of adding in your own ideas, but I feel like what I actually want to work on is not addressed in the treatment plan.

However, this will be the last treatment plan.  Sadie has seemed to be pushing me away for the past few months and most recently responded to a request for help by indicating that I don’t need it.  Of course my instinctive impulses were self-destructive: overdose, self-injury, going off my meds, cancelling my appointments and not ever speaking to her again.  I refuse to let her be the reason I self-destruct.  However, after a couple of days of thought, I’ve decided that when this treatment plan expires in 3 months then I’m done.  It doesn’t feel that productive anymore.

Too Many Thoughts for a Title

Back in October, Sadie had suggested doing a Pros & Cons of Existence, which I opted not to do because it sounded too dangerous.  What would happen when I weighed the evidence and found that it was much more in favor of not existing?  Well, I’m about ready to do that pros & cons list now.

Recently I’ve come to understand how people develop Munchausen’s syndrome, in which they intentionally cause themselves illness or injury in order to get medical attention.  I found myself wanting to cut myself or overdose so that I could be sent someplace safe, where people would take care of me and I wouldn’t have to deal with my life.  As time passed I found myself reacting to every little twinge of pain or discomfort with the hope that it was a serious illness.  Every time mom and I were in the car, I would cross my fingers for us to have an accident.

I got a little taste of being taken care of when I got dizzy while Suffering for a Good Cause, but it wasn’t enough.  In my appointment with Sadie the next day, which I’d scheduled specifically to discuss these thoughts, she asked me if being taken care of was a need or a want.  I said that everyone needs to be taken care of sometimes, but I imagine her point was that I’m capable of taking care of myself at this point.  She said it was a Catch-22, that in order to form relationships with people who will take care of you when you need it, you first have to show confidence in who you are in order to attract those people.

I said I didn’t know who I am (lack of a sense of self is a symptom of Borderline Personality Disorder) and we worked on naming off some of my interests and personality traits.  She asked what I would say if I was writing an author’s bio for my book.  I was going to go with where I was born, where I live now, and that I have cats.  Somehow that didn’t seem like enough to give me an identity.  I said that identifying my values would probably help with this, and then remembered that in reading The Happiness Trap there were exercises about values.  From the website of worksheets to go with the book, there is a Life Values Questionnaire and Bull’s Eye Worksheet that can be used to identify one’s values and how far or close one is to living by them.

I had done the Bull’s Eye Worksheet but the other one looks even more specific by addressing more areas of life.  Sadie and I have to update my ANSA and treatment plan at the next appointment on Wednesday, but I will try to prepare these worksheets in case we have any time leftover.

And the pros & cons list?  Well, over the weekend I was on a spontaneous trip out of town.  Mom had asked me Wednesday evening if I’d like to go, and we made all the plans on Thursday and left at noon on Friday.  Throughout the weekend, I struggled with suicidal thoughts.  I no longer was thinking about the possibility of getting attention.  No, I was thinking about actually wanting to die.  I was crying every time mom was out of sight.

I don’t want to be dead.  The thought of dying makes me sad.  I remember back in December, when I was sure I’d be acting on a plan on January 1st, I would cry every time I did something for what would be the last time.  I saw Jean at a choir performance and tagged along behind her for the whole tour of the historic house it was held in, hoping to be able to hug her goodbye.  She never made a move to hug me, despite having done so the last several times I saw her, and I went home in tears.

Brent noted back in June last year, when I recently had started my job at the hospital and was desperately overwhelmed by it, that I had very specific suicide plans.  What I have in mind now is even more specific.  I don’t see Brent for another 3 weeks, and I don’t know if I’m going to make it that long.  Everything feels manageable early in the day, but as the hours pass and darkness falls I fall with it, spiraling into a swirl of negative thoughts and tears.  I don’t want to be dead, but I don’t have hope of things ever being better enough for life to be worth living.

Brent and Sadie tell me I could work full-time, that I’m not disabled, which would make it very difficult to actually get approved for disability if they don’t support me.  What I’m coming to realize is that I may not be too disabled to work, but I am too disabled to accomplish what I want out of life and I don’t know how to accept the idea that my dreams are unattainable.  I have some good days, but then I have some really bad ones that, if they continue, would make it impossible to follow long-term plans.

It just feels like it’s not possible to be well consistently.  I was patient in the first year of treatment, knowing that it can take a while to get the right combination of meds and have them take full effect.  Now I’m more than two years into this process and I never feel good for more than a month at a time.  Instead of manic highs alternated with the depths of despair, I have an occasional sense of peace alternated with a lingering malaise just bad enough to hinder progress.

So I’m going to make that pros & cons list.  There are some pretty big pros in favor of suicide, and I don’t know if the cons will seem like enough to balance it.  For example, I don’t really want to live to my next birthday, which is next week, but if I don’t I will never get to use the birthday gift I know I’m getting, which is something I’ve wanted for a really long time.  So I cry about the idea of not using the gift, but then I ask myself why it even matters.  If I’m dead I won’t know that I didn’t use it.

I’m trying to remind myself each evening that the next day, although it may not get me any closer to a life worth living, will possibly be just a little less painful, so I can wait one more day before acting.  If I ever feel that I can’t wait and am feeling compelled to go buy the last ingredient in my suicide recipe, then I know it’s time to call for help.

 

Happy Blogday to Me!

Today is my blog’s 2nd birthday.  I wish I had something insightful to say at this point, but instead I’m just going to talk a little about how I feel.  February was a little rocky, as always happens in February, and as a result Brent didn’t think I needed medication changes but instead to just wait it out and see how I feel in March.

Well, last Friday I was reading a Chicken Soup for the Soul book, and instead of being inspired I was struck by what a worthless pathetic person I am for struggling so much with problems that seem so trivial.  I started to cry about this, and over the two hours of crying it developed into recognizing that my thoughts and my actions – the bad things I’ve done and the good things I haven’t – make me a horrible monster.  I was convinced that I should have died 2 years ago when this whole drama began.

The only bright side is that I had no plans to act on it.  I’ve had plans many times and this time all I had was the feeling that I would deserve it if I went to sleep and never woke up again.

This feeling did pass after about 24 hours, but since then I’ve been completely lacking in energy and motivation.  I’ve done the bare necessities, but mostly I’ve spent my time lying down staring at walls.  I feel like there’s no point continuing medication because even though changes sometimes help short-term, I always come back to the point of feeling terrible and wishing to die.

I was supposed to see Brent today.  When I came in for that emergency appointment 2 weeks ago he said to keep the one that was scheduled for today, so I showed up there 15 minutes before my appointment time.  His nurse called  me back to her office, and asked if I had an appointment for that day.  Ummm…  I said yes, that it was supposed to be at 10:30, and when she looked up my name and saw the list of my appointments it was on there, but on her list of people who have appointments today, it was not.  I was the third person so far today that had this happen.

She was flailing helplessly.  Brent was overwhelmed.  People were chewing her head off.  I am not one of those people.  I could see that it would be a real burden on them if I insisted on being seen, and I asked if they could fit me in Friday if that would be better.  She asked how I was doing and I told her I’d been a little suicidal a few days ago but it passed.  She was hesitant to make me wait, and asked multiple times if I would promise to call her if I had a problem between now and Friday.  I swore that I would be fine, and accepted an appointment at 3:30 Friday (but if I show up any time after 1 they’ll try to squeeze me in earlier).

I know what it feels like to have your job imploding around you.  One particular person at work was on my nerves Monday, and by the end of the day I refused to go back to that floor because I was afraid I’d punch her if I went near her.  I am usually very good at being nice to someone’s face no matter how irritating they might be, but I was past my breaking point by then.

I feel good that I felt confident I’d be okay if my appointment were postponed.  It helps a little that I see Sadie later today (and have the exciting plan of taking my cat along for her to meet), but mostly I’m in a good mood even if my energy level is crap.

(No) Need to Apologize

While reading The Happiness Trap I came across the following sentence: “If I am with a client who tells me that he intends to go and kill himself, I naturally feel a surge of anxiety.”  It made me think of Sadie.  She has asked me in the past how I think she (and other providers) would feel if I were to kill myself, and in those moments all I could think was that they wouldn’t care.  What difference would it make to them if I were gone?  It would be one less hassle to deal with.

After reading this, I finally realized how horrible it must feel from her perspective when I’m talking about not wanting to live, maybe even having a plan, and she has to decide if it’s safe for me to go home or not.  The pressure of knowing that I could die if she makes the wrong decision, but also knowing that I can’t go to inpatient every time I have a suicidal thought.

I realized that she does care what happens to me, and that when I’ve said she doesn’t it’s because it’s easier to deny that people care than it is to come to terms with the idea that I’d be hurting others if I killed myself.

I e-mailed Sadie to let her know how sorry I was for all the times I’ve put her in that position, and for accusing her of not caring.  Her reply started exactly as I predicted: “No need to apologize!”  But I did need to.  Yes, dealing with me in those moments is part of her job, but I still regret it.

Inpatient Summary

Just over a month ago, in Oops, I Did It Again, I talked about an appointment with Brent in which I expressed some suicidal ideation and he did not think I needed to be in inpatient.  Fast-forward a week to A Narrow Miss and I had developed a plan (a combination of pills on January 1st) and Sadie reluctantly let me leave after signing a safety contract.

The plan was only to be enacted if life didn’t improve before the 1st, and life did improve.  I bought a car only 2 weeks after totalling the previous one.  It’s the same model and same year, just a different color (and in slightly better condition).  I also adopted another cat, a very sweet-tempered Russian Blue.  I no longer wanted to die.

Even so, I felt there was about a 10% chance of me acting on the plan anyway.  I felt like I was going to fail by not following through.  I was also feeling physical heartache over every little thing that happened.  Despite my goal to get through all of 2015 without going to inpatient, I packed a bag and told Sadie that I thought it was time to go.  I had to go to work doing yearly inventory, but on the 31st I had appointments with both Sadie and Brent scheduled and I fully expected to go to inpatient after seeing them.

Sadie was in favor of inpatient.  She seemed to think that I would be okay if I didn’t go, but was concerned about that 10% chance of suicide.  I was feeling a little better when I saw her, but the thoughts still wouldn’t leave my mind and she felt that inpatient would be willing to admit me if I told them the same things I had told her.  I decided I would go to my appointment with Brent before making my final decision, but I really expected to be admitted.

It didn’t happen.  I wasn’t feeling suicidal right that second and Brent said there was no reason for me to be in inpatient.  So I went home, crying, and the next day I went to work with a bottle of Wellbutrin in my purse.  I spent all day obsessing over taking it.  Work was slow, so there was plenty of time to obsess.  I managed to get through the day without taking the pills, but after texting with a friend I was pretty convinced I should go to the ER.  I didn’t want my mom to be mad at me though, so I went home after work.

I was staring off into space when mom asked what I was thinking.  I said, “I don’t want you to be mad at me…”  She said, “But you want to go to the hospital and be admitted.”  She said she would take me, but then she put her nightgown on.  She said I could have her get dressed again, but I couldn’t work up the courage to ask.

The next day we went out shopping, primarily to go to an antique mall she wanted to visit.  I was feeling a lot better that day, but kept worrying.  I’m due to go to Chicago on the 9th to visit my best friend, and what if things got worse again and I did have to go to inpatient?  If I didn’t go right away, I probably wouldn’t get out in time.  So when we got home from shopping, I picked up the bag I’d had packed for several days and we headed to the ER.

Bear in mind that I work at the local hospital and pass through the ER on almost a daily basis.  The nurse practitioner they sent to see me was a stranger, as was the nurse who took my vitals, but when I pressed the call button to ask for water it was a unit clerk I know who came in.  He brought me two bottles of water and didn’t act weird at all about the fact that I was there, despite knowing that I was waiting for the on-call therapist to show up.  In fact, he had to call over to CMHC after I’d been waiting over an hour, as the on-call therapist was late.

When the on-call therapist, a man I hadn’t met before, did show up, I explained why I was there and he agreed that inpatient seemed like a good idea, so he called the psychiatrist to get approval.  I signed the paperwork to be transferred into inpatient, and he walked me downstairs and through the cafeteria, and when I set foot in the cafeteria I started panicking and whispering to mom, “I can’t do this.  Don’t make me do this.”  I expected her to stop the on-call therapist and ask if there was a way for me to back out, but instead she just said, “Too late, sweetie.”

I did calm down once I actually got inside and started the admissions process.  Stories from my stay will be forthcoming, but at this point I’ll just summarize that I was there for 4 nights and got one med adjustment.  They kept all my existing meds, but at my prompting added Lamictal.  At this point I’m taking 25 mg twice a day, and the next dose increase probably won’t happen until I see Brent on the 27th.

The other important point is that, when I was released yesterday, I was expecting to go to an appointment with Sadie that afternoon.  I called over from the inpatient unit to verify I still had the appointment and found out it had been cancelled.  I was panicking all over the place, shaking and pacing around the room.  Jean passed through and asked how I was, and I said, “Not good.  Anxious.”  She asked why and when I explained she told me to go to the nurse’s desk and ask the people there to call and try to get me another appointment.

It turns out, one of those people was the one who cancelled my appointment.  I was pissed, but remained civilized.  She did try to get me an appointment but they didn’t have anything available except for a day in the middle of my trip.  I was still a bit panicked when mom arrived to pick me up, but it resolved later in the day.  I e-mailed Sadie to tell her I was sorry I wouldn’t see her until after the trip and she ended up having a time available on Friday morning.  I’ll have to cut it a little short in order to get to work on time, but I’m so relieved I’ll get to see her.