“The pain of depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.”
– William Styron
“I am the wound and the knife!…
Victim and hangman alike.”
– Charles Baudelaire
A recent front-page article in the New York Times presented some some disturbing news–suicide rates among middle aged Americans’ have risen sharply in the past decade — up nearly 30% among Americans aged 35 to 64. According to the Centers for Disease Control and Prevention, more people now die of suicide (38,364 people took their own lives in 2010) than in car accidents.
When a person dies by suicide, it is a double disaster. Not only does it prematurely end a life, it wreaks havoc on the lives of those left behind. Devastated survivors are traumatized by feelings of grief, guilt, anger, resentment, and confusion. “There was no time to say good-bye,” and “Perhaps I could have done more” are examples of comments made by shell-shocked friends and relatives. Moreover, the stigma surrounding suicide makes it difficult for family members to talk about what has happened.
Because of the wreckage that a suicide leaves in its wake, many people describe suicide as a “selfish” act. But to anyone who has experienced suicidal pain brought on by an episode of major depression, there is a different explanation. Death is chosen because suffering is so acute, so agonizing, so intolerable, that there comes a time — depending on the individual’s tolerance for pain and the available support — that ceasing to suffer becomes the most important thing.
This torment is magnified by the loss of hope. People in life-or-death survival conditions, such as being lost in the wilderness or being held prisoner of war, will dream and plan for the future in order to make their present conditions tolerable. The critically ill heart patient expresses his faith in his upcoming surgery by making a date to play golf six weeks after the operation. But the depressed person sees no viable future. There is nothing to look forward to, no dreams to fulfill, only the never-ending hell of the eternal present.
Such pain and despair descended upon me during an episode of “treatment resistant” depression that I wrote about in my previous blog. After nine months of unremitting suffering, I lost hope that the pain would ever stop or that I could do anything to change it. At this point an old college friend of mine serendipitously reentered my life. Teresa was a registered nurse who worked at the Oregon Health Sciences University Medical School, where she taught stress reduction to patients with chronic pain. Her classes were based on the groundbreaking work of Jon Kabat-Zinn, a meditation teacher featured in Bill Moyers’ 1996 PBS documentary, “Healing and the Mind.” Kabat-Zinn teaches the Buddhist practice of “mindfulness meditation” to patients suffering from intractable physical pain. Through employing his techniques, they learn to alleviate not just their physical discomfort, but their accompanying emotional distress as well.
I met with Teresa in her office at OHSU, where I described the nature of my psychic torment. “Facing pain is a learned skill,” Teresa responded. “When you are in a lot of pain, whether it is a migraine headache or suicidal torment, the pain dominates all of your awareness and becomes all- encompassing. It’s hard to remember a time when the distress was absent, and it’s hard to believe that it will ever go away. It’s as if both past and present are blotted out, and you are left stranded in your present misery.”
“At least you understand,” I remarked.
“However,” Teresa continued, “if you can release your judgment of your pain and just observe it, you will notice a very important fact about the nature of pain; pain comes in waves!”
Upon hearing these words, I remembered the grief I felt after my divorce. There were times when I was so overwhelmed by sorrow and loss that I could barely function. After a period, however, the pain and the longing let up, perhaps for a day or two — until the heartache returned and began the cycle all over again — pain turning into relief, which turned into more pain, followed by more relief, etc.
“This is the body-mind’s built-in protective mechanism,” Teresa explained. “If the pain were truly nonstop, you wouldn’t survive. And so you are granted a few gaps in between the intense sensations to stop and catch your breath.”
But it feels like the pain is unrelenting,” I protested. “If you were clinically depressed, you would understand.”
“The key to reducing your perception of pain,” Teresa continued dispassionately, “is to uncouple the sensations in your body from the thoughts about them.”
“What does that mean?”
There are two levels of pain that you are feeling,” she explained. “The first level is physiological—the raw pain in your body. The second layer (and this is where you have some control) consists of how you interpret your experience. Perhaps you may be thinking, ‘This torment is killing me’ or ‘This will last forever’ or ‘There is nothing I can do about it’. Each of these despairing thoughts creates a neurochemical reaction in the brain that creates even more distress. If you can learn to detach yourself from these judgments, much of the pain that arises from them will diminish.”
“How do I do this?”
“Think of your anxiety or depression as a large wave that is approaching you. As the wave makes contact, see if you can ride the wave by focusing on your breath. Breathe through the sensations, breathing in and out while attending to the sound of your breathing. Don’t try to analyze what is happening, just breathe. It’s not even about getting through the day; it’s about getting through each breath.”
When I had worked as a salesperson in the corporate world, I learned the skill of breaking large goals into manageable parts. Now I discovered that one could divide pain into manageable parts. If I couldn’t handle getting through the day, I would try to make it through the next hour; if an hour seemed too long, I set my sights on the next minute or second.
Teresa showed me another powerful technique to use with my self-talk when my pain became intense. Whenever I cried, “My pain is unbearable,” Teresa would reply, “Tell yourself the pain is barely bearable.
“The pain is barely bearable,” I repeated aloud. There was a shift and I felt it.
In another session I screamed, “I can’t take it anymore!”
“You can barely take it,” Teresa responded.
“I can barely take it”, I replied.
Mental Illness as a Spiritual Practice
“Emotions are like waves;
Watch them come and go in the vast ocean of existence.”
– Neem Karoli Baba
Teresa was teaching me the practice of mindfulness, a spiritual practice of living in the present moment. In traditional meditation, when the mind wanders, one gently brings it back to a central focus (the breath, a candle, etc.). I was challenged to do the same, especially when, in response to intense emotional pain, I projected my present condition into the future using catastrophic self-talk that led to suicidal thinking — e.g., “If I have to put up with this suffering for the next 30 years, I might as well end my life now.”
“Just return to the here and now,” Teresa would say. “Over a period of time you can learn to relate differently to your pain. You can work with the pain and live around the corners of pain and develop your life around it. Eventually the turbulent emotional waters will become calm again. In the meantime, you can find inner stillness and peace right within the most difficult life situations.”
“You’ve got to be kidding,” I responded somewhat angrily. “How do you expect me to stay centered when the emotional equivalent of a migraine headache is pounding my skull?”
“Stop fighting the pain and see it as your life,” Teresa calmly replied. “It doesn’t mean you should like your discomfort. But there is something transformative that happens when we simply allow ourselves to experience our pain without trying to judge, change or resist it in any way. Let me show you.”
At that moment, Teresa reached over and pressed a tender point between my right thumb and index finger (I later learned that it was a particularly sensitive acupuncture point).
“Ouch! That hurts,” I protested.
“Breathe into the place in your body where you feel the pain,” Teresa responded compassionately. “See if you can ride the waves of sensation as you would ride the ocean’s waves. As you do this, notice how the experience of your pain begins to change.”
I breathed into the soreness and observed that the pain in my hand softened and decreased, until I could hardly feel it.
“Good work,” Teresa replied. “Now see if you can do the same with your emotional pain.”
Mindfulness meditation did not work all of the time, but it worked enough. The moments of peace it provided, when combined with intense exercise and connecting with people, interrupted the pain cycle sufficiently so as to make my suffering “barely bearable.”
More information about Douglas’s approach to alleviating suicidal pain can be found at Healing From Depression.com.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.