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I am doing an all-morning outpatient program Monday through Friday. Group therapy, skills, expressive therapy – all working to put me back together again. Following the program, I’ll be going to Texas for a couple months to be with family for reestablishing healthy ADLs (Activities of Daily Living – hygiene, cooking, exercise, cleaning, etc.) that I can then use and not neglect when I return to my little apartment. One of my friends will board my cat for me while I’m gone – very generous!
An important revelation occurred to me in the last couple days. I’ve felt shame, ashamed of myself, since I was a very young child. Guilt is something you feel when you make a mistake. You can make restitution, ask for forgiveness, and change. Shame says “I am a mistake,” leaving very little room for fixing anything. I think this shame I’ve felt for so long may be fueling my suicidal ideation. If I’m not worth anything, then might as well take me out. It’s a wonder I only came across suicidal ideation after the fall of a high mania when I landed in the hospital with suicidal depression. The visions of me killing myself have plagued me since – almost 7 years now. And yes, I still feel shame. Not sure that will ever go away.
asMid January through early February I spent in the hospital. Yes. Again. My psychiatrist was adamant we need to find another way than bouncing in and out of the hospital. I agree! The changes we agreed upon were staying with friends if I didn’t feel safe. That would allow me to ride the wave of emotions longer without using the hospital before I need it. And it would provide a chance for me to trust myself to keep myself safe. These things seem basic and “Why didn’t you try them before?” We have, but not with the same rigorous energy to keep me out of the hospital. The bouncing this time was ridiculous.
In other news, I’m still in physical therapy after shoulder surgery in early December. It still hurts, and the exercises seem to make it hurt even more. This pain has kept me from getting back into the pool for water aerobics. I’m too concerned about damaging the progress we’ve made. I could go to the gym and focus on the lower body. I’d be moving and re-establishing the habit of going to the gym. The water aerobics classes that are best for me are in the evening. But going to the gym in the afternoon and evening uses up any available energy. I’m a better morning exerciser.
A real factor in the exercise department is that I’m depressed and low energy from the depression. Any extra energy anywhere is like pulling teeth. So even though there is concern about hurting my shoulder in the pool exercises, the going-to-the-gym option seems less of an option because I am depressed. I already feel bad about myself. Now I can have guilt for not exercising added to that. Another real factor is that my drugs keep me hungover for most of the day too. And yet another real factor is that I made the decision I’d rather be healthy than skinny. That doesn’t help motivation to get back to the gym. I do still want to work out, but I’m less concerned with weight loss. Might be a mistake, but my mood affects the decisions too. I’m still trying to manage the mood. How am I supposed to manage pain and weight loss too, when my energy is zapped and I feel horrible about myself anyway?
One foot in front of the other in a boring life right now.
I’ve been out of the hospital for a month now. That is a milestone for this past year. Last time I was out for a significant period of time was last spring and summer for 6 months. I wasn’t happy, but I was out of the hospital. Not suicidal at all.
It was a mostly good time. I was doing important volunteer work, but it wasn’t feeding me. What was missing was something that seemed meaningful to me and used my skills that I still had from being a pastor. I wanted to speak and teach, two of my greatest strengths and what I imagined I would do in the future. Instead I was volunteering where I was mostly alone.
This time around I am putting together a presentation that I will share with churches. “Hear the story of the Rev. Deborah xxxx and her life with mental illness and how congregations can be involved in mental illness help in and outside their doors.” I’m offering it for free – there is no barrier for small churches with little or no budgets for adult education. I think this will help with reducing my own stigma about myself, as well as stigma in society. Congregations can be powerful actions for change. I can start somewhere.
I feel like I’m doing meaningful work and using the skills I love the best. I hope this keeps me out of the hospital for a very long time.
My longest stay occurred from early March to late May. I was mostly confident I could discharge since I was going to a friends’ house to stay and daily spend some hours at home for a couple weeks.
I was overwhelmed with my first time back at home, even with friends there. And then again today when there alone. It’s filthy, with even just one cat living there alone. I guess she really does need staff to look after her. I called a cleaning service but they are booked out till the following week, which is probably the case for most places. So, I’m looking for teens who need spending money. 🙂 I can’t do this alone. I’ve got to keep asking for help. I spent 80 days institutionalized. Living on the outside takes some time.
Some details about my time inside. My doctor increased my mood stabilizer and lowered my anti-depressant. That led to a depression that led to a suicide attempt. So we spent 6-8 weeks coming back up from depression. Then we tried a different mood stabilizer cocktail. That didn’t seem to help. Then we added an additional anti-depressant to help the one I was already on. That would take 4-6 weeks to kick in, and we figured I’d be out before it kicked in but ECT would speed up the process. So I tried one ECT again and called it quits. It’s just not for me. Never got results from it anyway. And as it turned out, I was in the hospital the 4-6 weeks needed for the second anti-depressant. Meanwhile I’m taking heavy duty prns to handle anxiety and agitation. Finally got a day of stabilization without having to take haldol or thorazine on a huge increase of mood stabilizer. I got sent home with haldol and accompanying drugs just in case.
All the while I’m in daily group therapy with a very good therapist. And we uncovered the shame and anger and embarrassment of being in the hospital again, of having and living with bipolar and having to ask for help. Lots to talk with my regular therapist about.
For about 9 weeks I felt like this:
Death is not. It is nothing
I am not. I am nothing.
I don’t want to die. I want to die.
Make it end. Make the thoughts of hurting myself end.
Make the emotional pain end – anger sadness.
I am less than human because of them – thoughts, feelings.
I am pain, a hemorrhage of negativity.
No one understands unless they know this darkness.
Black hole, sucked into nothingness from images of gruesome death.
Am I romanticizing it, or speaking truthfully from a hurting being?
I am not thinking of others.
Their pan will be deep and unending.
I will not be in pain anymore.
Whose pain is worse?
Do I deserve to be less human because others will have pain?
It’s been well over two months since hospitalization, but I had such a difficult time around Christmas that I feel like stability started with the first of the year. I feel mostly stable – mood pretty solid and thoughts of suicide everyday (my baseline) with varying intensity. I’ve had a cold which kept me down a few weeks, still recovering from that. At its height I had fewer suicidal thoughts, which my doctor expected. “Your brain isn’t thinking well and shuts down.” Hallelujah for sick brain! Got a few days off from thinking I need to die.
I haven’t been volunteering (or exercising – sick), so my schedule revolves around television and being social. I’m starting to get an itch again to volunteer – the first I’ve felt in several months. I want it to be in mental health though, which has been my dream for a few years. Sharing my story or teaching a class. Office work. I have to be out of the hospital for at least 6 months for one main place that is the obvious place to volunteer as a speaker. I’ve found a few places in the local area worth a phone call. Maybe there is something I haven’t thought of in the depths of google.
I’ve made it a considerable amount of time into the program. I have adapted to the schedule, but I’m starting to notice days when I’m doing too much according to the Spoon Theory, and then having to make up for it with a mostly day of rest. Therefore, I’m still trying to find the balance. I’m staying away from the gym as much as I usually go (5 days a week, down to 3, maybe 4). That reduction might be reasonable with what I have planned. I go to a NAMI support group twice a week and a MeetUp group once a week. I’m having meals or coffee with friends in person or online once or twice a day in order to keep social and not just be focusing on myself in my little corner. I see my psychiatrist and therapist once a week each, and my therapist calls me another day. I’m part of group therapy/class called AIM for an hour twice a week.
It’s a very busy and focused schedule, very much like how regimented a residential program is – which is the point of what I’m doing. The other thing that is going on that makes this likes a residential program – again, the point of what I’m doing – is that it is bringing up painful or uncomfortable issues that I need to address and resist addressing. Having places and people to process with, and expressive therapy such as art therapy every day, helps me try to change a little bit at a time.
I need to stay away from the hospital, or what it represents – safety from myself for feeling suicidal. I have many times come to the conclusion that I will always have suicidal thoughts, and many times I’m able to use Thought Defusion and Expansion/Acceptance to just let them be and go on with my life. I was especially able to do this after the residential experience in February, and stayed out the hospital for 6.5 months. Since early September, I’ve lost this ability and been in and out of the hospital. I had such a hard weekend that I thought I was going to end up in the hospital again. In my trunk I was carrying a bag of clothes and toiletries to go the hospital. It’s still there.
Addressing committed action according to my values – core idea of ACT – seems to trigger me toward believing that I’m not sure I want a life at all and suicide is a good idea. I’m ashamed that I believe in suicide, but the mental pain becomes so strong and I can’t find a way out or through. And the pain takes me by surprise and I try to use skills, to no avail most of the time.
Yesterday was the first day in a long time that the thoughts were less and I felt like I could manage the thoughts. Today, not so much again. I think I need to fully pack for the hospital when I go out to see my psychiatrist since she is near the hospital. I’m ashamed of how many times I end up in the hospital for not being able to handle my suicidal visions and thoughts and the desire to die. I know that’s what they are there for, but I am embarrassed each time I go. I have the belief that using the hospital is a one- or two-time experience to stabilize you and then you use outside resources to keep going in your treatment. I shouldn’t need to be stabilized so freaking often! 30 times in 5 years. Sigh.
I hope I can continue in the DIY residential program, and I hope it keeps me out of the hospital.
It’s been about a week of the DIY Residential Program. Following the strict schedule has been moderately easy. Dealing with suicidal thoughts has been HARD. As happened at my residential therapy experience in February, and is happening again – a rather normal reaction – I felt challenged by the material and resisted what my therapist and group therapy and classes presented. I’m resisting the ACT requirement of Committed Action toward your values, because I’m not at all sure I want to live or have a meaningful life. I think I’m just resisting and I’ll eventually break through, provided I don’t end up in the hospital first.
I looked up on the internet overdosing on my many medications, I called a suicide prevention hotline (1-800-273-TALK – they are amazing!). I keep a bag packed in the car in case I need to drive to the hospital. My support system has been life-saving, and I’m so sorry for dragging them through this horrible journey. Partly it’s because I don’t have residential staff to talk to about the terrible things I think about or see in my head, so I’m sharing them with my support system, local and national. Y’all have been great at encouraging me to keep moving forward and not follow through with the thoughts and visions. But as one of the images below says, I feel like I’m on a never-ending treadmill of suicidal voices and visions that I use defusion on every time they come up. Which is A LOT. In the middle of conversations, in the middle of reading, when I’m laughing at something someone said or at a funny show. Any time I’m alone, or with people. There they are, waiting for me to give in this time.
I started a new workbook that is specifically for using ACT with depression. I have high hopes for it. Until in one early chapter it makes the claim that depression is only a little bit biological and almost all about how we respond to situations – emotional avoidance or fusion with unhelpful thoughts. I’m still open to what it says, as clearly I need new ways of coping. But even though I’m depressed, I feel like I’m depressed more from the suicidal thoughts than I am in the traditional sense. I still get up and do everything I’m supposed to do as though I am following my values. But I still feel numb and separated from life, which is a feeling associated with depression. I’m avoiding feeling the emotional pain of suicidal thoughts? or what the suicidal thoughts are trying to tell me? (that I want things to be different? that I want to be strong again? that something needs to change?)
I also think I’m lying to myself in a couple different ways.
- I keep saying I want to die and need this life to be over. But I keep asking for help and I keep doing the positive things such as taking care of myself, exercising, socializing, going to the hospital to be safe, etc. Those are things that seem to say that I want to live and I want things to be different, not that I want to be dead. I really like the thought of being dead though. I’m very fused to that idea and I use a lot of defusion techniques with that one. So the lie is that I want to die, when my actions say I want to live. Which is what my therapist says too.
- I’ve started saying that I no longer have viable options for killing myself since the information I got about overdosing looks like I’d just end up waking up in the ER or ICU with heart and liver and other damage, or if I took enough I’d have seizures and a heart attack. Not the go to sleep forever image I have in my head. And I’ve mostly given up on slicing my arms or throat open after talking with people who have and still ended up waking up in the ER. So, the only plan that would really work involves a gun and I don’t have access to one, which everyone says is a great thing. It seems that I don’t have viable options. But I think I’m lying to myself, because maybe a heart attack from too many meds wouldn’t be so bad. I’m totally irrational on this lie. I really don’t think I’d do anything, I’d rather die from something that took my life and I didn’t have to do it. I just really want to be dead, which is the subject of Lie number 1 above.
With all of these lies and thoughts I’m continuously using skills to defuse from, to make room for them to just be, and just be words and just be pictures and not be imperatives I have to follow. I’m doing the right thing according to everyone in my care team (about 6 people, plus a bunch of auxiliary people when I’m in the hospital). I just still really want to be dead. And out of pain. It hurts a whole heck of a lot to feel like there is a black hole in the center that is slowly, tortuously sucking you dead into its center.