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.

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Things I Like About Me

Sadie frequently encourages me to do thought diaries, which I am very resistant to doing.  We can’t figure out why, since I always go above and beyond on other tasks she assigns.  Ironically, a Bing search for “thought diary” has the first image result as one from my blog.

This week Sadie and I were discussing my overall lack of self-liking.  She wanted me to identify positive traits that I have, and since the daily gratitude journal has been helpful I suggested that I also write down one thing I like about myself.  She tweaked this a bit so that I’m supposed to identify a situation in my day and what positive trait I showed in that situation.

On the first day, I said that crying in front of Sadie (yes, again) showed that I’m able to show vulnerability.  On the second day, I showed cleverness by tying someone’s derailment in DBT group back to the topic at hand.  On the third day, I was insightful in knowing that I couldn’t deal with productivity at that moment and needed to veg out by binge watching TV on Netflix.  On the fourth day, I showed that I care about my health by scheduling a follow-up for a leg injury.  On the fifth day, I showed that I can keep things in perspective by realizing that losing my Fitbit was not a huge tragedy.

I’ve been writing these in my regular journal instead of a separate book, but may have to get another book and copy them over since it seems to be really helping.  I was actually lying in bed last night feeling at peace with my life for the first time in forever.

Wandering Restlessly

Last time I saw Sadie I suffered from An Embarrassment of Tears.  I managed to not cry when I saw Brent last week, but am really apprehensive about seeing Sadie again this afternoon.  I spent last night sobbing and suicidal, so either I’m going to cry again and feel embarrassed, or I’m going to not cry and feel ashamed that I’m not fully participating.

When I saw Brent he initially told me that he was making no changes and to return in a month.  Then he hesitated and said he could increase the Lamictal since my dose is so low, and maybe that would help the depression that still pops up frequently.  So I’m now taking 50 mg twice a day.  Dose increases in the past have led to a few days of feeling agitated, anxious, and irritable, so I was unsurprised when that happened, but then when I’d been on the new dose a week and it hadn’t improved I realized that this feeling had actually started a few days before the dose increase.

I called Brent’s office and his nurse called me back so I could repeat the same things I’d said in my voicemail.  She asked if I was having thoughts of hurting myself and I said no, because I wasn’t in that moment, but after she hung up to go talk to Brent I realized I probably should have said yes.  The nurse called back a few minutes later and said that Brent wanted me to wait for my next appointment (in 3 weeks) but call back if things got worse.  I hung up and burst into tears.

Brent had just commented to me on the fact that I tend to bottle things up and not ask for help, which leads to him and other practitioners being surprised when I am “suddenly” not doing well.  Except when I asked for help, I got told it wasn’t bad enough yet.  How am I supposed to know what bad enough is?

So I continued with my restless wandering and my snapping at mom over trivial annoyances.  I continued feeling tense and nauseated and having my heart race over absolutely nothing.  And I started taking more and more of my BuSpar.  I’m prescribed 45 mg a day, but a couple of times in the past I had taken a little extra and Brent was not concerned by that so long as it didn’t happen regularly.  Not sure what he’ll say about it being a lot extra for several days, but I’m sure it won’t be good.

The maximum daily dose is 60 mg.  I took 115 mg yesterday.  I laid in bed unable to sleep and fighting the urge to go swallow the whole bottle…and all the other bottles of pills in my possession.  I fought the urge to make a long, deep cut in my flesh.  I also fought the urge to call Deputy Wayne and sob to him about how horrible I am and how I should die, because it would just end up with me walking through the inpatient doors as a client again.

I’ve wanted to work there for two years and finally have some feeling that it might be possible.  I’ve talked with a number of CMHC staff members about the idea of working in that field, even in their organization, and they all indicated that it would be okay.  Brent said he currently has a client who works there.  Sierra said she’s known other staff members who still need to be hospitalized a couple of times a year, and the rule is just that they need to go to a different facility to do it.  I’ve submitted applications several times and recently wrote to the HR staff and explained why I think I’d be great for the job.

So going in as a client is not going to happen.  Except it might, because I don’t see how it can be possible to work in that field.  My dream was to work as a program assistant in inpatient while I finish up a BA in psychology, then work as a case manager while I get a master’s in counseling.  Then I realize that I can’t actually do any of these jobs because I’m a shitty person who is unfit to help others.  What’s the point of any of the plans I’ve been making, when I know they aren’t going to lead anywhere but to more misery?

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.

 

Messy Interpersonal Situations

I didn’t have therapy last week because Sadie was off work.  It was sort of a test run for the every other week method, which we’ve tried unsuccessfully in the past.  This time around, I was finally feeling ready to try it, whereas in the past I was reluctant.  However, it was a really rough week and I don’t know anymore how it’s going to go to see her less.

I had one evening in which all the hope I had for job hunting and college and general life improvement came crashing down.  I’d done a lot of “life management” that day, and the prospect of having to deal with that sort of thing on a daily basis was overwhelming.  I was crying and thinking about how wrong Sadie and Brent are to say that I could work full-time.  I was thinking about taking too much of my medication, which was actually possible to do since I’d been feeling so much better that Sadie called mom and told her to let me have my medication back.

Then I was crying even more because I have this list of people I can supposedly contact in a crisis but I felt like there wasn’t anyone I could actually contact because they’d all just be fed up with me for intruding on their lives.  After many hours I was over the crying, but still needed to talk to someone.  Deputy Wayne had told me I could call either him or his wife if I needed anything, and I wasn’t about to call and he doesn’t reply to texts, but I did text his wife.  I was worried that she’d be irritated he volunteered her for that, but we ended up texting for a while and even made plans to get together a few days later.

Our conversation went well, but she is very religious and I am not, and although she said she wouldn’t push it on me I felt a little uncomfortable.  I wondered if I was talking with her for the right reasons.  I like her and want to get to know her, but was I really doing it because of her, or because of her husband?  If the latter, I feel like that makes me a horrible person.

In the meantime, I may have accidentally gone on a date.  I’m not sure, because I’d never been on a date before and the situation was kind of weird.  A guy I know asked me if I wanted to hang out, and although I never say yes to spontaneous plans I had a built-in end time due to a meeting for work, so I agreed to meet him at Dunkin’ Donuts.  I was thinking on the way there that it was obviously just friends hanging out, because he has a girlfriend.  Then he told me that he broke up with her.

He talked a lot, and I didn’t get to say much in return, and then some friends of his happened by and they were very dominating.  I ended up driving him home because he had walked there, and he mentioned possibly going to a movie sometime.  My panic system went off.  He’s a very nice guy, but has a lot of baggage.  We are completely opposite.  Yet I believe that people deserve to get a chance to straighten out their lives.

I spoke with my best friend about it, and although she told me what I’d already been thinking, I hated what she had to say.  She told me not to get involved until he had his life straightened out, and what that said to me was that people don’t deserve love until they have everything together.  Given that I don’t have everything together and don’t foresee when I will, I started crying over the fact that I don’t deserve love either.  The idea of overdosing was back at the front of my mind.

Someone commented in her blog recently that she gets more anxious in the evenings.  I notice that my emotions tend to go haywire in the evening as well.  All the little things that I could handle earlier in the day start piling up and bringing me down.  I have fortunately learned to use the Moment to Pause skill to stop and identify what is triggering the feelings, which lets me recognize that it will seem less overwhelming after I get some sleep.  If it’s too early for sleep, then I find a distracting activity, such as coloring or scrapbooking, to fill the time.

I had asked Sadie if we could go over the Interpersonal Effectiveness skills again because I rarely mark them down on my diary card.  I may be using them, but not consciously and I can’t name what I’ve used because they are all a big jumble in my mind.  Funny that before we even got to do this I wound up in two messy interpersonal situations.