Saturday, September 3, 2011

Our Guest Blogger Writes About Suicide

Kerry is our regular guest blogger, her posts appear here at least twice a month and this is her third post with us, she has more waiting in the wings (in our gmail inbox). Here are links to her last two posts.
(Please note, if you are interested in guest blogging for us we are always open to new guests, it's nice to help promote other people. We prefer posts to be about mental illness, but will also accept other topics.)

As always we have a little intro before we get to Kerrys entry, but we'll let her have the last words:)

Right up front we want to say we agree with Kerrys stance on suicide. As someone(s) who have experienced many many suicidal thoughts (and one major attempt), we found her entry to be amazing...and genuine. Having said that, please...always think of the never know, there might be something amazing right over the top of that jagged mountain peak you feel you are desperately trying to climb.

We've written before about overdosing in our early 20's, when we were married, and thus being labeled with a couple of mental disorders that, while a couple of us experience largely we do not feel, as a whole, that these are things that we experience. Catherine experiences social anxiety/paranoia and Cassandra can get pretty depressed, of course there was one other diagnoses that was just plain wrong...largely over the years they (The Other Girl, Cassandra and Catherine) have managed it with medication when needed for over seven years. Having been off of our medication (we were only one in the end, Welbutin) for a year we do experience some major thoughts of suicide (being on the medication did not stop that, however) far less frequently than ever before.

We will admit that at the beginning of this year we thought of them very heavily. There were nights we'd go to bed and one of us would beg that we don't wake up...and to please make it stop, and we would entertain thoughts of suicide. It still happens on occasion, but if you've read about our life, you know we don't fucking give up, we have someone for that. Someone to keep us strong (that someone is me). And Emmie helps too...without a body how could she do those disgusting things she likes to do?

As a side note, attempting suicide will make you ineligible for life insurance (in the United States), if you are young, and later in life marry, expect to have to explain to your new bride/groom why they can't get life insurance for you, if you attempt it and don't succeed. (yikes, that sounded harsh...but it's something you probably haven't thought of...hey, failure is a possibility even when trying to end you life...)

I have kept impulses at bay this year, desires to jump off of the bridge walking home, desires to walk in front of the city bus...desires to hang ourselves from the shower rod...but let's be honest, that thing would never hold our weight.

More than once in July I made calls to Fabulous People, our support person (who we miss, btw...just sayin'...*sigh*) asking her to put us on suicide watch. She watches our she used to know to pay attention to any lull in activity (in case people wonder about the <in the kitchen> or other Tweets regarding out activity). It's for us to see how long we are doing things (losing time sucks) and also to let our "handler" (hahahahahaha) know that it's a normal offline and not something to be alarmed about.

Bottom line, suicide sucks for people who love and care about you. The fate of the first boy we liked, who actually liked us back, in grade eight, had a huge impact on one of us all these years later. The rest of us choose to not think about it.

Anyway, if you have children, friends, family members who deal with suicidal thoughts, or you suspect Kerrys advice. You might save a life.

Is Suicide An Option – Discuss

Suicideand attempted suicide is SUCH an emotive issue. This blog entry is an attempt to discuss this issue in an open and frankmanner.  It is not my intention to hurtor offend anyone and the opinions expressed are my own and are not connectedwith Just Call Me Frank or any companies that I work for. Fhew now that’s overlet’s talk.

Inmy line of work I frequently, often daily, come into contact with people whoexpress a desire to die by their own hand. This can be difficult to hear and difficult not to act and not to tryand rescue that person.  So let me tryand break down my training and thought process for you.

People:that is you, me and everyone, try and move away from pain.  If you are in physical pain you try and shiftyour body into a more comfortable position or take some pain killers.  If you are in psychological pain, such as abroken heart, you will do things to ease that pain such as drink alcohol ormainline chocolate.  This is a basicprinciple, and you will need to understand it for the rest of this piece ofwriting to make sense. 

Somepeople have so much pain in their lives, physical or psychological, that it mayappear that there is no way they can carry on living such a painfulexistence.  Everyone bar none has hadsuicidal thoughts of some kind or another, at some time or another.   It maybe standing at the top of a tall building and wondering what if; to having afull blown plan to kill yourself; and all points in between. 

Thereare, to my mind, several stages of feeling suicidal. 
  1. Initially there are suicidal thoughts, these are transient, they flit in andthen out of your head.  Everyone, at onetime or another, has experienced these. 
  2. The next level up is thoughts that flit into your head but stay a while.  These would include when you split up fromsomeone and you think well I’ll just end it as a complete ‘fuck you’ to theperson who hurt you.  Again these arenormal and everyone has them. 
  3. The next level would be where these suicidal thoughts arrive in your head anddon’t go away.  Often people will thinkabout what preferred method they would choose if they did commit suicide e.g.overdose, hanging and so on.  LOTS ofpeople think and feel like this, however, it is very distressing.  Having these thoughts does not mean thatpeople will act upon them.  Thesethoughts are on the same level as fancying a colleague [affair]; you may think aboutthem a lot but ultimately you will not be cheating on your spouse.  If people are experiencing this level ofsuicidal thoughts I would suggest telling a health care professional such as aGP or a nurse as they are possible experiencing some form of depression or lowmood and these thoughts should be taken seriously.
  4. Having a plan. ‘I want to die by hanging, I will go and get the rope from theshop and I will tie it to………’  The moredetailed the plan the more at risk that person is of being successful in theirattempt to kill themselves.  Means (stuffyou can kill yourself with), motive, and a time frame and the alarm bells ringin my head.  The situation is serious andrequires action.
  5. Having a plan and telling someone but then deliberately doing somethingelse.  I’ll give you an example. OnThursday at 2pm I am going to jump of the bridge at (specific location), butwhilst help by way of police or health care professionals are at that bridge onThursday at 2pm I am at the other side of town overdosing so I will not befound in time.

Sowhat do I do when someone comes and tells me that they want to die?  For clarification I spent 3 years atuniversity learning about this stuff before being let loose on the public. THENI received a LOT of supervision and further educational courses to help me workwith and help people who feel like this. I am NOT a lay person; I am a professional who knows what I amdoing.  That does not mean to say that myheart isn’t in my mouth when someone tells me that they want to commitsuicide.  If someone comes to you sayingthat they want to die, take them seriously, support them but don’t try and be atherapist or a have-a-go-hero, direct them to some professional help. This maytake the form of going to the doctors, phoning the Samaritans, going to agroup, going to a therapist or counsellor. There are lots of people available to help.

Thisis what I do.  I take themseriously.  I do not dismiss theirfeelings of pain/fear/rejection/hurt. I acknowledge that they want to diewithout encouraging it or saying that they should not do it; a very finebalancing act – don’t try it at home!  Avery normal reaction is that people try and say ‘no, no, don’t do it’ but thisis dismissive of that person’s feelings and invalidates their emotions.  No one should have their emotionsinvalidated.  Some people say that peoplewho talk about suicide don’t do it; this is so very not true.  A lot of people I talk to want to talk abouttheir feelings and their fears without being judged.  I find people want to be taken seriously; thisis the ultimate serious emotional state and they should be given the respectthat they are due.

However,the difficulty arises when the person being told about the suicidal news cannotbear the emotional strain.  This is whenthe patient (this is the term I use for the people I help; service user, orclient can also be used) tend to get short shrift because their emotional stateis normally dismissed by the nurse because the nurse finds it toouncomfortable.  Ways in which it isdismissed by the nurse include them  saying ‘oh, you don’t want to do that’ or ‘butyou have so much to live for’ or they may make a joke and giggle about it (thisis called lightening the moment).  Let mebe clear that this does not always make them bad people, just human.  Hearing that someone wants to die may strikea little close to home, they may feel panicked and ill prepared to deal withsuch information, they may not have a clear idea of what to do now that theyhave the information. It takes practice, skill and nerve to be able to ‘staywith’ someone in that emotional state. To be able to accept that the psychological place that they are in nowis unbearable.  It is not too dissimilarto seeing someone having chest wracking sobs: most people will try and comfortthem; it takes a different outlook to just let them cry but to stay with them.

Naturally,once someone tells me that they want to die I don’t just leave it there.  If they are new to me I will try and find outwhere about on my rating scale of suicidal thoughts they are and if they have aplan I try and discretely find out what it is. Risk management is paramount in situations such as this.  Since they have disclosed this to me I have alegal duty of care to help them to the best of my ability, manage the risk andtry to save their life.  Mental healthnursing may not be the most glamorous or sexy but we do save lives!  If they are really set on dying there areseveral things I can and will do. I call the Crisis Team to see if intensivehome support/treatment may help or if they need admitting to hospital.  If I deem it to be more serious I can requesta mental health act assessment where the patient will be assessed to see ifthey need to be detained in hospital against their will.  Personally I do not like taking this optionbut I have used it in the past to save people’s lives, who have then gone on toget better and live life how they would wish to.  I can also call the police – desperate timesdo call for desperate measures.

IfI have known the patient for a while, I may not jump up and down.  They may just want me to hear how desperatethey feel, which can make them feel better. This may be all I have to do.  Historyis one of the best indicators of risk; if someone takes an overdose but makessure that they will be found in time, whilst their distress is very real, itmay not require as direct a response as someone who has taken a lifethreatening overdose in the past and were only found by accident.  So you see how different historical contextwill require different responses, it is not always appropriate to ‘rescue’people.

Whatabout people who are ‘attention seeking’? In my opinion if a child is seeking attention, they want it for areason.  If an adult is seeking attention,they are also requiring it for a reason. For some people attempting suicide is a way of expressing their distressbecause their emotions are just too much to keep inside.  They cannot hold it or keep it to themselves.  To my mind, people who do this require myhelp just as much as people who are wanting to die and are not seeking for meto intervene in the nick of time.

Commonmyths.  In no particular order:
  1. People who try to kill themselves want to die and cannot be helped.WRONG!People who try and kill themselves can be helped and often just do not want tocarry on living the life that they have.
  2. People who suicidal thoughts must be mentally ill.No,everyone has suicidal thoughts at some time or another.
  3. People who talk about suicide will not actually kill themselves.Themajority of people who are successful in committing suicide, have alreadyspoken to at least one person about feeling suicidal prior to killingthemselves.
  4. Once someone has made a serious suicide attempt they do not try again, it isout of their system.Previoushistory is a good indicator of future behaviour.  If someone has taken a serious overdose, theyhave little regard for their life and are more likely to do it again ratherthan less likely.
  5. If you talk to someone about feeling suicidal, you put thoughts in their mindand make it more likely that they will try and kill themselves.Thethought is already in their head, talking to them about it lets them sharetheir distress and does not normally add to it (unless you are veryinsensitive).
  6. People who say they want to kill themselves are just attention seeking.Peoplewho are feeling suicidal feel distressed and may need to share their feelingsof distress.  In seeking the attentionthat attention you give them may save their life.

Thepeople that I meet in my professional career want help with their mentalillnesses.  I am acutely aware that theyfeel terrible and are usually in a place where I would not like personally togo but professionally I extend my hand to them, down in their deep pit ofsorrow and despair.  I know that for someof them, they believe that there is no other solution but to killthemselves.  This makes me feelhumble.  Who am I to say no to someonewho is living a nightmare?  I will notjudge someone who’s darkest moments are so much more dark than my own.  For them, yes I believe that suicide is avalid option; just as life is an option and medication and therapy.

Itwould lack a certain finesse if I said that I was pro suicide or anti suicide;life is never that simple nor is mental illness.  I like to keep an open mind.  The benefit of taking this stance is that Ican talk to my patients openly about wanting to die because if I don’t know howthey feel, how can I change things to make things better.  I try everything in my arsenal to helpsomeone.  People who know me, understandthat I go the extra mile.  However,ultimately, the decision and the choice lies with the individual – and theymust also take their share of the responsibility too.  I read many articles about the failings ofmental health services to prevent deaths (suicide is classed as a preventabledeath) but if someone is hell bent of dying there is really not a lot I can doabout it – only delay it in the hope that they will change their mind.

Itis occasionally said that us nurses can be heartless and that we ‘move on’ tothe next patient after one dies.  I havenever found this to be true in my experience, there is always a period ofmourning.  I have been fortunate and onlybeen involved in one suicide in my whole nursing career.   I was a first year student nurse, 7 yearsago.  I still remember what they looklike, their hair, their eyes, the way they walked, their favourite food.  Being so new and inexperienced and quite farremoved from the care of that person, no blame was attached to me, but Isearched my soul to see if there was anything different I could have done.  Even now I could not have saved theirlife.  I still regret and I still mourn.

Ihope that this post has given you some insight into why I think that being veryanti suicide is not helpful whilst not being pro suicide either.  Discourse and action are the way forward.  Keeping the person at the centre of theircare and as much in control as they can be is, in my mind, the best course ofaction.  Sometimes, it is only a smileand a look that can save someone’s life.


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