Moral of the story: You will, too.
That's it. That's the good survivor story. Hopeful. Virtuous. I have told that story, and when I do, I get all kinds of strokes, including publication of my writing on other websites.
Some of it is true. It did get better. For me. For now.
There is more to the story. When I tell the more, I do not get publication. I don't even get acknowledgement that my submitted piece was received. I guess I am submitting to the wrong websites, to places that have one story they want to tell, the good survivor story.David Conroy, there are 50 million people alive today who have struggled, are struggling, or will struggle with suicide. 45 million of them will die of... something else. That's success, right? 90% of us will find another way.
But that's not the same as the good survivor story. Because for the 45,000,000 of us who survive, we have all kinds of stories.
Some of us spend our lives going through crisis after crisis. Yes we survive, but we're not sure it is worth the cost.
Some of us get better, and don't quite struggle at that same level of lethality again for now. For now.
All of these stories need to be told.
Truth be told, I have no idea whether I will be one of the 45 million who die of something else. It is my ambition to do so. But each of those trips into the abyss was deeper than the one before. And I simply cannot imagine coming back from anything as deep as that last one...
- I will be sent to the hospital where a bed is available, if a bed is available, not where the treatment I want is offered;
- I will have NO choice about who my doctor is;
- My advance directives notwithstanding, the doctors will do whatever they think they need to do;
- Chances are pretty high that I will experience trauma; and
- I may well come out of it worse than when I went in.
Actually, working on the plan is pretty traumatic in itself. I can't find a psychiatrist. Oh, there are psychiatrists. Last year the pdoc where I get my primary care recommended a drug combo that triggered my PTSD - not the treatment (which I refused), but the suggestion of the treatment. It would take me two minutes to find the research papers demonstrating that her suggestion was crap. Crap in general, even before she consulted my history, which also would have demonstrated that it was crap.
I asked another psychiatrist who is an expert in bipolar (and who had already told me never to take the meds my local pdoc wanted to prescribe) to recommend a new psychiatrist for me. He had no answer; he suggested I simply hope for the best.
Hope for the best.
So, I hope for the best. It does get better. Sometimes it gets worse again. I hope that if it does, it will get better again.
Meanwhile, I will keep doing all those things that keep it from getting terrible, because those things do help.
But to anyone who ever read anything of mine that did get published by those people who publish good survivor stories, I apologize if I conveyed the impression that mental illness does not suck.
I will keep doing all those things, and I encourage you to do them too, because even if they help us feel only a little better, still, feeling a little better is better than feeling worse.
Psychiatrists and people with bipolar both have told me that my book captures what the manic experience is like.
Reviewers tend to say either, She must have written it when she was manic. Too bad her editor didn't fix it. One star. Or: She must have written it when she was manic. So glad her editor didn't fix it. Five stars.
Which gets me thinking: Doctors say bipolar is really hard to diagnose. But if people who have it know it when we see it, what if we wrote a screening tool? Bear with me here. I'm thinking something like this:
They say: A distinct period of abnormally and persistently elevated, expansive, or irritable mood.
What we hear is: Are you abnormal?
To which we answer: No. I mean, duh.
So what if they said: Has there ever been a time when everybody around you just didn't understand why the world was so great or why you felt so good? Or has there ever been a time when everybody around you was massively irritating?
That is the core symptom of mania. Moving on to the others:
- Increased self-esteem or grandiosity.
- Decreased need for sleep.
- More talkative than usual, or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
- Increase in goal directed activity (socially, at work or school, or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences
How about instead, the way we would put it:
- Despite how shitty you feel right now, have you ever understood just how special you really are?
- Yeah, the decreased sleep one works okay.
- Has there ever been a time when you had to keep trying to get your point across because others were too dense to get it?
- Has there ever been a time when others couldn't keep up with your ideas? Has there ever been a time when your ideas flowed like out of a spigot?
- Has there ever been a time when you recognized that nothing is unimportant, when everything needed your attention?
- Have you ever worked so efficiently that you were your boss's favorite employee or your teacher's favorite student? Have you ever had so much to do you couldn't waste time sitting?
- Has there ever been a time when you knew that life is a banquet and most poor suckers are starving to death?
Suicidal people have not been quiet this year during Suicide Prevention Month. Most years we are the topic of conversation, not the source of the content of all these campaigns. But Twitter, at least, has been filled with our own voices this year. I have always shot my mouth off, and seldom taken the party line. Which means my voice is never included in the campaigns of the typical mental health organizations.
This is Suicide Prevention Week - from September 8, 2011When I started Prozac Monologues, I didn't know there was a Suicide Prevention Week. I spent a month writing about suicide in June, 2009. I chose June because it is the month when the highest number of suicides take place. So I wonder why the officially designated week is in September. Maybe because when everybody else is so happy about the sunshine in June, they wouldn't give any thought to the darkness? Maybe because they didn't ask those who are suicidal?
If you want to know my take on suicide prevention, here is the link for those original posts. Among the Labels in the right-side column, you will find links to other posts tagged suicide, suicide prevention, and the like.
Looking back at these posts, I wish I had less to say about suicide. But having this much to say, and frankly, a lot more, I think it's best I go ahead and say it. That was my POV for The Suicide Monologue. And I'm sticking to it. I urge you to take the same approach. If you have something to say about suicide, go ahead and say it.
You know, all those years we never talked out loud about cancer, our silence never saved a single life.
Several years ago, John McManamy, author of McMan's Depression and Bipolar Web, gave the day on his blog over to an excerpt from Nancy Rappaport's book, In Her Wake: A Child Psychologist Explores the Mystery of Her Mother's Suicide. Rappaport wrote about how even psychiatrists sit around and wonder how a person comes to the conclusion that he or she wants to die. Most of us want to live. Even those of us who want to die, for the greater part of our lives, we want to live. Her mother's diaries are full of her struggles to survive. What happens in somebody's mind to make that change? Rappaport says it is a mystery.
In Her Wake is a powerful memoir of the aftermath of suicide. People who struggle with suicide need to read such accounts to fortify them in their struggle. But I think she has misidentified the mystery.
I think every person is a mystery.
We have our joys, sorrows, strengths, dreams, fears, failures. We have capacities and weakness that sometimes we tell to others, and sometimes they divine. But the core of the person remains a mystery.
I am a Christian, so I believe there is One to whom we are not a mystery, One who knows our true name and calls us by it. And we ourselves don't even know that name until we hear that One call it. And when we do, then we know ourselves for the very first time.
But I don't think suicide is a mystery.
Suicide is simple. Each of us wants to live. That is how our brains and bodies and souls are constructed, for life. And each of us dies anyway, when our brains and bodies and souls give out. Suicide is one way that we give out. We don't give up. We give out. We reach the limit of what we can survive, whether it be a tumor, lack of oxygen, or a knife that turns in our chest, whether figuratively or literally.
I learned this perspective from David L. Conroy, who learned it from his practice and from his own experience. And I confirm it in my experience. He says, and I repeat it from time to time in this blog,
Suicide is not a choice; it happens when pain exceeds resources for coping with pain.
After a suicide, the survivors are indeed immersed in mystery. It is the mystery of the heart of the person who died. It is the pain of questions we cannot answer. We never know the sum total of the pain another had to bear, or was able to bear, or not, nor who or what was available to help, or not. I don't know that psychological autopsies ever satisfy. What we really want to understand is the core of a person. That is the mystery.
But we can understand suicide. We can recognize its broad strokes. And we can prevent it, not every time, but most of the time, the way that suicide crisis lines do it, by relieving pain and by providing resources for coping with pain. If we can help shift that balance, between the pain and the resources, then the person at risk will be able to do what he or she really wants, to live a life worth living.
45,000,000 Suicides Prevented
Fifty million people who are alive today in the United States have or will at some point struggle against suicidal pain. I am one of them. I have a disease with a 15-20% mortality rate. Someday I will die of something. It is my fervent prayer to be one of the forty-five million who survive suicidal pain and die of...
It doesn't improve my odds for me or you or psychiatrists or anybody else to ponder the mystery of suicide. You can't prevent mystery. You can provide resources to prevent suicide. Here is a list to get you started.
Meanwhile, if your suicide needs preventing right now, tell somebody. Tell somebody who cares about you (and is not an idiot). Or call 1-800-273-TALK (8255) in the US. The Trevor Project at 866-488-7386 is particularly for young people, lesbian, gay, bisexual, transgender or questioning, and the people trying to help them. There is a link at the top of this blog called Suicide - Resources to find numbers outside of the United States and other help. They can't pay your rent. But they may have some ideas that get you through that dark hole where all your own ideas disappear.
I want you to die of something else, too.
photo of geode by Didier Descouens, made available through wikimedia.org
On the other hand, family members can be one of the most significant resources for a person's recovery and stability.
In my own case, my wife is the one who described the symptoms that helped my psychiatrist recognize that I have bipolar, not major depression. But once that happened, what did she, as a family member, as the member of the team with day to day, hour to hour access, receive by way of help and guidance?
Nothing. Not a word. Butkus. Like, not even a pamphlet.
Nope, nothing. She worried. She worked from home to protect me at my sickest. She shouldered every responsibility. She thought through and recommitted to and excelled at "for better for worse, for richer for poorer.
Eventually she got to Family to Family, NAMI's program for education and support of people whose family members have a mental illness. And that helped. It gave her a skill set. It let her know she was not alone. It was more than a brochure.Understanding Bipolar Disorder: The Essential Family Guide. Daramus, a clinical psychologist with over twenty years of experience in mental health, from psych units to private practice, has written the definitive guide for family members of people with bipolar. She takes you by the hand and leads you from a chaotic landscape to a steady path.
Step by step, the information is presented in the order that it is needed. It's a good book to read over the course of a year, and to reread for a refresher as time goes on.
- Bring something to occupy your time in the ER, where mental illness is gets to wait, sometimes for a very long time.
- Get release of information forms signed, so that the doctor can communicate critical information with the family.
- Let people have their own emotions and opinions; share them rather than argue over them.
- Develop emergency plans.
- Adopt specific lifestyle measures.
- Don't expect to get it all right all the time.
My wife and I worked out much of this on our own. And Daramus is right, ten years later, we do not get it right all the time. Weekly family meetings help. Daramus's book reminds us of pieces that we still don't have in place.
The language is clear, simple, calm. The formatting makes it easy to follow. The anecdotes are relatable.
I bought two more copies to give to friends who could use the help. How's that for a recommendation?
Frankly, I was gobsmacked by that question. It came in response to reading my book, Prozac Monologues: A View from the Edge. The book is a comedic memoir of misdiagnosis and a self-help book for bipolar. It is both uproariously funny and brutally frank about my suicidal episodes, usually at the same time.
There are two directions to go with that question. This particular psychiatrist cares about both.
What kind of behaviors and qualities could he display that would make the relationship more helpful? Honestly, not all psychiatrists are interested in this question. I don't do relationships; I use psychopharmacology to treat psychiatric disorders, a psychiatrist once told me. Well, that had the benefit of clarifying things.
How can I improve my diagnostic skills? Nevertheless just about any psychiatrist wants to get the answer to the puzzle right, even the ones who treat patients as no more than a puzzle.
So this week I am going with the question about diagnostic skills. Buckle up for lots of links to research articles. The links appear in a different color. Click on them and end up at reports written by the experts. Or ignore the links, if you can take my word for it.
Bipolar is hard to diagnose. And they are not getting better at it. It takes 7.5 years on average from first appearance of symptoms to the correct diagnosis. A third of us are misdiagnosed for over ten years. Over time, these numbers are not improving. It turns out, telling yourself that bipolar is hard to diagnose doesn't help you get better at it. And during all those years, we patients receive treatments (antidepressants) that make our prognosis worse and flip us into mixed episodes with their heightened risk of suicide. Our lives depend on getting the diagnosis right.
There are ways to do a better job. Research validates various techniques that improve results. Many of these are a couple decades old, but for whatever reason have not found their way into standard practice. Nevertheless, some doctors, psychiatrists and family practitioners both, still ask that question, How can I improve my diagnostic skills? So here are some techniques with links to the research studies that support them:
- MDQ, Mood Disorder Questionnaire. This is a simple screening questionnaire using real, nontechnical language that patients and their family members fill out. It's like those screens for depression and anxiety that are becoming standard practice for annual physicals. It doesn't make the diagnosis by itself; but it tells doctors whether they need to look at the question more carefully before prescribing antidepressants to treat the presenting episode.
- BSDS, Bipolar Spectrum Diagnostic Scale. This is a similar simple screening questionnaire in narrative form. It tells a story, while the patient decides how well the story describes his/her own experience.
- Whatever screens or questions used, it is good practice to ask family members or close friends for their input. The patient notices depressive symptoms, but often does not notice or remember symptoms of hypomania or mania that the family can see.
- When taking a history from a depressed patient, ask about overactive behavior, whether there was ever a time that the patient was able to do a lot more things, get a lot more done than usual, before asking about a time when s/he had elevated mood. It has been demonstrated that it is easier for patients to remember episodes of excess behavior than to remember elevated mood. (It was demonstrated fifteen years ago! Why hasn't this finding been incorporated into the Structured Clinical Interview, SCID-CV?) Asking about behavior/energy first improves the accuracy of the diagnosis.
I'll leave it there. Two simple screens, two simple changes in practice, each of them are demonstrated to improve the diagnosis of bipolar.
No, I'll add one more.
- Every episode of depression adds a new risk of "conversion" to bipolar, throwing the patient into hypomania, mania, or mixed episode. There is no length of time that confirms a diagnosis of MDD over bipolar. Screen for bipolar again with each episode and each failed antidepressant.
photo used under the Creative Commons license
Fifteen years! From the hypomanic first draft of Prozac Monologues on a yellow legal notepad to a published book, and the nail file that inspired it all.
The book was officially released into the wild this week and will be celebrated in two launches, one sponsored by Paulina Springs Books in Sisters, OR, and the other sponsored by Prairie Lights in Iowa City, IA.
It's a good time to talk about gratitude. Forgive my self-indulgence. It is a day to reflect.
First, people have asked whether it was hard to write about such dark times in my life, if it retriggered some of those emotions. Occasionally, it did. Occasionally I would have a sleepless night remembering, in particular, difficult encounters in treatment. One can forgive sincerely. One can forgive over and over. Still, the brain remembers. I don't harbor resentments, but I can't always hop off the time travel machine that is my brain, how it repeats the tracks laid down by past traumas.
For the most part I kept that time machine in idle with two techniques. One is reframing, putting the experiences in a box and pronouncing the "Riddikulos!" spell over them, transforming them into humor. It has to be outrageous humor, not a simple chuckle, performing the spell like I mean it. And I do. Prozac Monologues is, frankly, hilarious.
CW: Cynical Warning.
Anybody else cringe all through Suicide Prevention Day/Week/Month? Anybody else roll their eyes at the "Ask for Help" messages? Or search the lists of "Warning Signs" to make sure you're covering your tracks?
If you call a help line, what if the cops arrive to handcuff you in front of your neighbors to help you enjoy your free trip to the ER? That's the only thing that will be free. If you go to the ER, you may or may not be admitted. Either way, the bill will leave you homeless.
When the naive, new-to-the-world-of-suicide-prevention person actually asks for help and goes through the demeaning process of not receiving it, it's like that outstretched hand, the one on top, turns around and pushes down the head of the one who has been reaching up.
When nothing else worked, Social Rhythms Therapy got my bipolar under control. That's why Ellen Frank is my mental health hero. She invented it.Here is the link to Part Four. It includes links to the earlier posts.
Frank describes Interpersonal Social Rhythms Therapy like this: IPSRT [is] a treatment that seeks to improve outcomes that are usually obtained with pharmacotherapy alone for patients suffering from bipolar I disorder by integrating efforts to regularize their social rhythms (in the hope of protecting their circadian rhythms from disruption) with efforts to improve the quality of their interpersonal relationships and social role functioning.
Circadian rhythms are at the core of IPSRT. People with bipolar have difficulty maintaining the stability of our circadian rhythms, because our internal clocks, governing everything from sleep cycles to blood sugar levels to body temperature are, well, wonky.
People who do not have bipolar don't need to reset their clocks on a daily basis. Their brains accommodate little variations in schedule. But even they occasionally knock their clocks off the table: jet travel across time zones, changing work shifts, sleeping in on weekends. These knocks may not precipitate a mood episode. But they do have other deleterious effects.
Here is an explanation of circadian rhythms and, in particular, how they affect metabolism for all the rest of you.
OK Go - This Too Shall Pass. And in fact, it did. I survived to... today? I offer it to everybody who is trying to survive the current COVID cluster f*ck in the US.
I don't know what it will look like on the other side. We are not going back. But we will go forward.
Meanwhile, do what you can today to build community again, to take responsibility for yourselves and your neighbors, to learn about strangers so that you don't have to be so afraid of what you do not know. The Way of Love is the way forward.
That's it. That's the post. Bless you.
To Write Love on Her Arms (TWLOHA) harnesses the power of story to offer hope to people struggling with depression, addiction, self-harm, and suicide.
The organization itself began with a story, a young woman who was suicidal but could not be admitted into a treatment program because she was also addicted and they couldn't bear the liability of her detox.
Yes, if you think you're done after you tell your suicidal friend or family member to get help, read that sentence again. Trying to get treatment can be enough of a nightmare to push us over the edge.
But that was just the beginning. A group of friends took it upon themselves to create a safe place and treatment program for this young woman for the five days it took to detox. The treatment program was admittedly unorthodox. She stayed with friends. In rotating teams they supported her, kept her safe. They also took her to concerts, Starbucks, and church. They prayed. They smoked cigarettes. They were her hospital.
Mostly, they listened.
On the last night, she handed over the razor blade that had been in her possession the whole time. Anticipating a difficult night before going back to the other "real" hospital, she thought she shouldn't have it on her.
TWLOHA came alive. Today it publishes the stories of people who have survived these things, who are recovering. It "exists to encourage, inform, inspire, and invest directly into treatment and recovery."
I once was working on a novel that included the concept of "Hospice for Suicide" as a suicide prevention strategy. But I'll have to mine that concept another time. For now, story.
Today a psychiatrist on my Twitter feed tweeted about a time when he was suicidal. If you told me then that I would recover, qualify & receive a standing ovation from 1000 people at a conference in Lisbon for sharing my story, I would never have believed you. How differently I hear his words than those of another psychiatrist who tells me there is always hope.
TWLOHA's website is filled with stories. You can submit yours. Let's not walk this road alone.
The Hilarious World of Depression, hosted by John Moe, a few years ago. And I recommended it to you as part of my Giving Thanks series last November. A depressive himself, John interviews comedians, musicians, and other celebrities, asking the question, Is depression funny? Not everybody thinks so, but that's my brand. The show was recently cancelled. Sigh. But with five seasons, that's a lot of bingeable laughter to come your way. And you can often find Youtubes of the featured comics to extend your pleasure. So have at it.
I should mention that John has just published his memoir by the same name, for when you can sit still and read.
Sheila is an award winning journalist in the Portland, Oregon area whose career turned to mental health journalism after her husband's death. Her guiding principle is: We are all on a spectrum of mental health and everyone will struggle at some point in their life. Beyond Well is here to listen, affirm, and share stories to help you feel less alone in the world. And that does describe the effect of listening in on the conversations that Hamilton has with professionals and people with lived experience - to feel less alone.
Both Moe and Hamilton are included in the resource section of Prozac Monologues: A Voice from the Edge. The following are discoveries made after my project manager refused to accept any more revisions.
Being Unnormal is like having coffee with a friend, a powerful, dedicated, and smart friend, my favorite kind of friend, who does not mince words and is a mother tiger when it comes to her kids, and then talking about the stuff that matters to the both of you: being queer, being adhd, being bipolar, being black and traumatized... Oh, and she invited an expert to join the conversation. You laugh, you feel, you think. And you show up next week to find out who shows up next.
Berry is the mother of one daughter with bipolar, another with ADHD. She is the founder of Being Normal, a coaching and consulting group that assists people navigating the world of mental health and companies to create mental health focused policies.
And then there is Gabe Howard, who hosts the Not Crazy Podcast on PsychCentral.com, along with his former wife Lisa. Not Crazy advertises itself as the mental health podcast for people who hate mental health podcasts. This is a more reflective podcast than most, if I can use that word for heated conversations about controversial issues. Reflect: consider issues from a number of angles, rather than simply educate on a topic. They take a perspective, or Gabe takes one and Lisa challenges it. Then they wrestle it into the ground, often trading positions in mid argument. The anti-psychiatry movement, mental illness humor, the role of religion in treatment... Two people with mental illness (Gabe has bipolar,Lisa depression) arguing passionately about the things that interest people with mental illness. It works.
Personally, I love it. Their conversations remind me of late night debates in my college dorm. Okay, I went to Reed College. Maybe that's not what you were doing late nights in your dorm, but it's what me and my buddies were doing in ours. Gabe's bipolar makes me feel like I am with my tribe, loud, bright, passionate.
Psych Central Podcast where he reins in the intensity "to break down complex topics in simple and understandable ways.
I haven't read his book yet, but I post it here, because I think he puts out a quality product. This guy has been at the mental health advocacy gig for fifteen years and has earned his street cred.
So what about you? What are you listening to? Who should I add to my list?
Side comment/serious question: There is such variation world-wide in leadership and results. Some countries have got this pandemic under control. Who benefits, who is the one who gains by our abysmal mismanagement and consequent destruction of the United States of America?
But 1) name calling is not helpful, 2) I actually care about some of these people, and in general, 3) I commit to the Way of Love. So I am stuck with listening more deeply.
1.8 million LBGTQ youth (13-24) in the US seriously consider suicide each year. The numbers for trans people in particular are even more staggering. According to the UCLA Williams Institute report, 81.7 percent of those surveyed by the National Center for Transgender Equality had seriously thought about killing themselves in their lifetimes, and 48.3 percent had done so in the last year. 40.4 percent of transgender people attempted suicide sometime in their lifetime.
Suicide happens when pain exceeds resources for coping with pain. This report adds evidence to that assertion. The following statistics are pulled directly and paraphrased or quoted from this report.
The title of a recent PsychiatricTimes.com article caught my eye. Honeymoon? Then I realized it was dated May 19, so perhaps the authors could rewrite the title with the "Almost" removed.
The authors identify predictable stages of psychological response to our current pandemic. Unbeknownst to those whose education was really less education and more training for their future jobs (so things like history were deemed a waste of time), the human family has lived through past disasters, including multiple pandemics. There are patterns to these things.
Suicide is not a choice
This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.
You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.
Earlier this month, the American Psychiatric Association released the long awaited proposed revision of their Diagnostic and Statistical...
Suicide is not chosen; it happens when pain exceeds resources for coping with pain. David L. Conroy had me at the opening sentence. I...
Intending to review Ellen Frank's Treating Bipolar Disorder , I spent most of April describing the treatment itself, Interpersonal S...