Keeping Up Appearances

Someone asked me why I chose such a depressing blog layout.  To be a good friend, I picked a brighter, more cheerful layout.  Are you happy now?  So am I.  Everybody is happy.  Happy, happy, happy … and above average.

The Crutch: two perspectives

TDHP view:

He should be getting back to work today; that’s good news.  Oh, here he goes again: “I’m sick; I’m depressed; I’m suicidal; I can’t go back to work now; I need to go to the hospital.”  He does this every time he wants to avoid doing something.  It’s time to grow up, you coward.  Why can’t he just get his meds right and start following his doctor’s advice?!

Patient’s view:

Man, I have to go to work tomorrow.  I’m so scared.  What must my co-workers think of me?  They will all be staring.  And, why shouldn’t they?  I’ve been playing hooky for seven weeks, hiding in my room feeling sorry for myself, getting smashed at the pitty party every night.  What makes me so special?  They have to deal with the same stuff I get and they don’t just skip out and leave their work for their co-workers to complete.  I’m just pathetic.  I suck.  I really never should have been born.  [hours later] F&F: Call 9-1-1! I think he’s really hurt himself this time….

Another patient’s view:

Man, I have to go to work tomorrow.  I’m so scared.  What must my co-workers think of me?  They will all be staring.  And, I know what they’ll be thinking.  “He’s been playing hooky for seven weeks, not coming to work because he feels sorry for himself, just throwing himself a pitty party every night.  What makes him so special?  We have to deal with the same stuff he does and we don’t just skip out and leave our work for our co-workers to complete.”  Yeah, well I’ll show them I haven’t been faking it.  I’ll show them I have been dealing with some really heavy shit.  They’ll see.   [hours later] F&F: Call 9-1-1! I think he’s really hurt himself this time….

What can I do to help?!

This is probably one of the most frustrating questions family and friends (F&F) have when dealing with suicidal patients.  Unfortunately, the answer is not at all clear and probably different for each of us.  That’s not of much help; but, hey, no one ever said this was an easy disease.  I will try to list some of the thoughts I’ve had over the years.  If I end up contradicting earlier posts, just keep in mind that I am in a fairly good mood now, which may not have been true when I wrote the previous comments.  And, in any mood, I am full of contradictions.  (I am losing weight, but I am still large enough to contain multiples, if not multitudes.  Perhaps when I get down to 190 lbs. I’ll be of a single mind!)

There is one thing I must say emphatically before giving any useful advice (such as I might give): do not try to convince your loved one that they shouldn’t be depressed!  Spewing a list of reasons someone shouldn’t be depressed or suicidal to someone who is depressed or suicidal, will only cause anger and resentment.  Why?  For you warm and fuzzy types, acknowledging our current state of mind validates our humanity and reality (subjective though it may be) giving us the feeling that someone understands us — in particular, that our thoughts are crazy, but we are not.  For you logical folks, I’m affraid a somewhat longer-winded explanation is necessary — a very quick lesson in brain structure. 

For our purposes, the human brain can be roughly divided into the ancient/animal brain and the new/rational brain.  As you might guess, the animal brain controls our most basic functions, emotions, and responses — “Ug must eat, Ug envy Og for food, Ug must club Og to get food.”  (Grammar apparently wasn’t very sophisticated in Ug’s and Og’s day.)  As you might further surmise, this part of the brain is not too concerned with mitigating circumstances.  The new part of the brain, is much more nuanced — “I certainly am hungry and Mr. Og Jones has quite the bounty.  I am much stronger than Og, so I could just take his food.  But, Og trapped and prepared that food making it rightfully his.  If I simply took his food, then there would be no trust amongst neighbors and therefore no basis for a civic life, no basis for ethical behavior…”  So Og is safe because we have logic to save us from fight or flight, right?  Well, not quite. 

Here are the other facts you may not know: the animal brain is incredibly fast and tends to deal with the most urgent needs like eating; the new brain is much, much slower and tends to deal with more esoteric needs such as the meaning of life or the condition of man.  As it turns out, the newer brain is incredibly powerless against the old brain when strong emotions and the impulsive actions they drive are in question.  This is as it should be because “Tiger! Run!” really ought to win over “Why must the tiger eat meat?  What is its motivation?”

So, when you tell us, “you have nothing to be depressed about; you have food, a lovely family, a good job, a nice car, …” when we are contending with “everyone hates me and I have no reason to live, so I should club myself, …” your words just don’t have a chance.  Our subjective reality has hijacked our psyche and no amount of evidence from your absolute reality will change that.  Much better is to accept the fact of our crisis, help us through it, and only afterwards bring us back to your world of facts and statistics.  And with that, I shall begin my list:

Suggestion 0: Acknowledge how the patient feels right now and save the debate for Hanity and Colmes.

Suggestion 1: Stick to the script on the safety plan.  (Remember suggestion 0, don’t argue!  Just stick to the script.)  Don’t have the safety plan?  Then, you aren’t on the patient’s list of go to people; get over it.  If they don’t have a safety plan, then suggest they formulate one with their therapist before the next crisis comes. 

Suggestion 2: Ask the patient what you can do to help them, but don’t expect a good answer.  Then, make suggestions of things you think might help.  This will hopefully spawn a constructive conversation that, in and of itself, will be helpful and may even yield useful actions for you or the patient or both.

Suggestion 3: Don’t belittle us, don’t guilt trip us (yeah, well, it’s a verb now!), and don’t compare us to Middle-eastern Jihadists.  Suicide may be immoral and stupid in your mind, but obviously it isn’t in ours.  Appealing to our sense of guilt and shame is almost always the exact opposite of what we need to hear.  I have never thought to myself, “Gee, you’re right.  Suicide is an unforgivable sin.  What kind of a man takes the coward’s way out?  What kind of father would even consider abandoning his kids like this?  I hate myself for who I have become.  Won’t you please take this gun out of my hand?”

Suggestion 4: Be yourself, and no one else.  Be a friend that cares for us; be a family member that cares for us (rare, but it happens); just don’t try to be a savior.  You aren’t likely to save us — something only we can do — so your efforts will at best fall on deaf ears and at worst make us feel pathetic.  Save your cable t.v. psychobable for the singles bar because it will probably do more harm than good in a real situation.  (Sorry to be so blunt, but we are paying someone else $150/hr. for their years of training and education in this area; your arm chair psychology is worth … well … what we paid for it.)

Suggestion 5: Actually listen to what we have to say.  Don’t call us with your generous offer of support, then get engrossed in a football game while we are opening up to you (rare, but it happens).  Do you know the old song, “Mister Cellophane“?  Most suicidal people feel like that.  Don’t add to the problem.

I’m all out of suggestions for now.  I could think of more I suppose, but it’s 1:30 am and I am thinking about getting back to work after seven weeks off, so I’d better choose sleep over profundity.  Hopefully, we will get a lot of comments so the F&F can get a sense of what they might do to help.  We know you care, so read up and show us how much you care.

Good night everyone (that wasn’t a euphimism, so don’t get depressed).  I am looking forward to reading the comments of other silk folk and the thoughts of their F&F.  I know this is not easy for F&F — it may even be the hardest thing you ever have to do in a relationship (sexual acts not withstanding) — but you can do it.

-Ashley

The “S” word (Suicide)

Suicide.  There, I’ve said it.  You can try it to.  Trust me, it won’t kill you.  Nor will it kill the person with whom you associate it.  It’s just a word.  It has no special powers beyond the specific definition it encapsulates.  We hender acceptance of the disease when we use euphemisms such as “ended it all,” “gave up,” and (my personnal favorite) “took the cowards way out.”
The same goes for “depression,” “bi-polar,” “manic depression,” “suicidal,” “attempted suicide,” “mental health hospital,” etc.  These do not need to be exchanged for “feeling down,” “moody,” “mercurial” (although, that word is kind of cool), etc.

When we give the word special power to turn down eyes and stifle conversation, we give up on communication in the most direct and honest way.  No one ever says “heart disease” with a whisper and an anxious look around the room.  Consequently, we can talk openly about heart disease without fear of killing the party or being crossed off next year’s Christmas list.  Heart disease has been normalized as has tuberculosis, broken bones, and cancer.  Indeed, even spinal meningitis doesn’t carry the social stigma associated with “depression” and “suicide.”  Let’s say the words, let’s talk about the problem, let’s discuss the social and emotional implications, let’s get it out of the closet.

Altogether now:

“Suicide” it’s not such an evil word.
“Suicide” not the worst thing I’ve ever heard.
“Suicide” can kill you like a heart attack.
“Suicide” ignore it, but it’s coming back.

“Depression” it’s just another bad disease.
“Depression” say it over till you say it with ease.
“Depression” will get you if you don’t take care.
“Depression” it’s treatable, so don’t dispair.

Keep singing this until the words roll off your tongue.  The next person who calls to check on me had better say, “Hey, I heard you were suicidal.  How’s that going?  Have you found a good doctor yet?”  Well, for now I’ll settle for “Wow, suicide.  Man, that’s tough.  So … how about them Bears?!”

The Will to Recover

This is probably one of those topics that patients have considered quite deeply and one that victims may have thought about but never voiced.  I want to talk about the curious phenomenon of not really wanting to get better.  Yes, you heard (or read) me correctly: sometimes, even after a failed suicide attempt, patients find it very difficult to begin the process of recovery.

We want to be better of course, but the third phase of life is quite a bit different than the life we have been living for so long.  I know this won’t be true of everyone, but I think it is for quite a lot of us: life before now has been one of constant emotional turbulence with thoughts of suicide always near at hand, life now is consumed by thoughts of suicide–the ultimate “Get out of jail free card,” life in the future will be completely unrecognizable … maybe.

I cannot even imagine what a life free of depression, insecurity, anxiety, and suicidality would be like.  I have been sick for so long, it feels like a part of who I am–an integral piece of my personna.  In college, I had that dark, contemplative thing going.  Not exactly popular with the sorority crowd, buy something of “charm” in the tree-hugger liberal crowds with whom I ran.  It was cool in that respect.  It’s not so cool now that I have children, a mortgage and retirement looming ahead.  Shaking it though is not as easy as recognizing the need for a change.

I am also guilty of using my illness as a crutch.  How can I not, given that the crutch has become part of my body?  If I lay around in bed all Sunday, is it because I am depressed or because I didn’t want to work on those cabinets in the basement?  Difficult to say.  Probably a little bit of depression and a little bit of habit.  Perhaps laziness in the morning leading to depression in the afternoon due to being such a loser for staying in bed all morning.  (The chicken and egg conundrum is appropriate here.)

Lisa had a very good paragraph or two expounding this issue.  I couldn’t find the e-mail in which she related this idea to me, so I hope she will post them as a comment to this blog entry.

I know I haven’t done such a good job of this blog entry.  I hope to do better next time, but right now, I just can’t seem to get out of bed long enough to write for more than ten minutes at a time.