In my previous post of May 10, I shared how I used mindfulness meditation to cope with suicidal pain. Now I would like to expand that blog and share other coping strategies I used to keep myself safe.
My journey into the dark night of the soul was launched by an adverse reaction to the antidepressant Effexor. Taking this medication triggered a maddening condition called Akathisia–a syndrome characterized by inner restlessness and agitation. (In ancient Greek the word means “the inability to sit still.”) Within hours of injesting the drug, I felt as if someone had injected me with six intravenous cups of expresso. My body was possessed by a chaotic force which led to me shaking, twitching and pacing back and forth across the room.
What made my predicament situation even worse was that my experience was discounted by the psychiatric community. One psychiatrist after another insisted that taking 37.5 mg of Effexor could not have created this level of distress. They were wrong. In July of 2009, the Journal of Psychopharmacology reported that Prozac and other SSRI medications can in fact induce Akathisia, along with feelings of suicidality.
Over the next few days and weeks, the Akathisia anxiety attacks increased in their intensity, and were followed by periods of dark, “black-tar” depression. As the Akathisia-depression cycle progressed, I remembered Nietzsche’s words: “The thought of suicide is a great consolation; by means of it one gets through many a bad night.” Realizing that I could always terminate my life when the agony became intolerable granted me a sense of peace and relief. Ending the nightmare was the better than living in the eternal hell of an agitated depression.
I knew I was serious about killing myself when I drew up a will, named my brother the executor, and sent copies to him and a good friend. I wanted to put my financial house in order before I died. Having taken care of my remaining fiscal responsibilities, I spent countless hours deliberating on the most efficient way to terminate my existence. My first choice was to use a gun, because it seemed so quick and final. Then a crisis counselor told me about a man who suffered irreparable brain damage when he shot himself in the head. “I wouldn’t try it,” the counselor warned. “You might end up a vegetable.”
My next plan was to jump off a building. But after picturing myself walking to the ledge and looking down, I remembered that I was afraid of heights. Also, a friend had asked me an unsettling question—“What if, halfway to the ground, you change your mind?”
Finally, I resolved to take an overdose of the antidepressants and tranquilizers that I had saved up over the past few months. This also frightened me, since I didn’t really want to die. (In his book, Why People Die By Suicide,” Dr. Thomas Joiner says that those who kill themselves develop a certain “fearlessness” about death. This was definitely not me.)
Moreover, I was concerned about the people I would leave behind. I knew that if I killed myself, my friends and family would not only be grief-stricken, but angry and guilty as well. “Why should I drag all of these people into my nightmare?” I thought.
My concerns about the impact of my death on others were shared by a fellow depressive.
“Don’t do it!” Dennis cried emphatically, when I told him of my plans.
“My brother offed himself twenty-five years ago and I still haven’t forgiven the bastard. Don’t make your friends and relatives go through what I did.”
Later that day, I reported this conversation to my therapist Pat.
“Do you have any moral beliefs that suicide is wrong?” she asked.
“No,” I replied. “I don’t believe it is a sin to commit suicide. I can’t see why a loving and merciful God would punish someone for wanting to end his suffering.”
“I’m sorry to hear you say that,” Pat responded solemnly.
“Studies have shown that people who lack a moral or religious belief that suicide is wrong are more likely to act on the impulse.”
Pat’s analysis was true. Without a clear moral reason not to kill myself, my resolve to avoid suicide was only as good as the kind of day I was having. When graced with five or six hours without symptoms, I would think, “Maybe I’m in remission,” and hope for the best. Too often, however, the respite would give way to a downturn in mood or a return of anxiety, which brought with it an inner voice of doom that said, “Madness or suicide, it’s yours to decide.” My choices seemed clear—either spend the rest of my life in hell (I believed I would live out my days in a state mental hospital), or put an end to the pain. Both outcomes were unacceptable, but I could not imagine a third alternative. In my anguish I cried out, “God! Show me another way—or at least give me some hope that another way is possible.”
Meeting a Guardian Angel
Aside from my therapist, there were few people with whom I could discuss my suicidal struggle. Suicide is a taboo subject in our culture. Even good friends would flee from my presence if I brought the subject up. Only those people who were specifically trained to treat major depression, or who had “been there and back,” could deal with my extreme condition.
One such person was a social worker named Judy. Having attempted suicide herself, she knew firsthand what goes on in the mind of a suicidal individual. Judy saw her clients, many of whom were in severe crisis, out of her small Victorian home, nestled in the Columbia River Gorge, twenty-five miles east of Portland. At our first meeting, she got right to the heart of the matter.
“Suicide is not chosen,” Judy said emphatically. “It comes when emotional pain exceeds the resources for coping with the pain.”
While speaking, Judy showed me a picture of scales to illustrate her point.
“You are not a bad or weak person,” she continued. “Neither do you want to die; you just want to end your suffering.”
I nodded in agreement.
“Your problem is that the scales are weighed down on the side of the pain. To get the scales back in balance, you can do one of two things: discover a way to reduce your pain, or find a way to increase your coping resources.”
I explained that reducing the pain seemed impossible.
“Then let me give you a coping resource,” Judy said, as she handed me a pamphlet titled “How to Cope with Suicidal Thoughts and Feelings.” I read it briefly and felt a mild sense of hope.
“One more thing,” Judy added. “I know you think that killing yourself will end your pain. But according to what I’ve read, consciousness continues even after death. Some people even believe that we reincarnate and return to earth in order to work out issues that we didn’t resolve in this life. If you decide to take an “incomplete” in the school of life, you may have to return and take the class all over again. Perhaps there is no easy escape.”
“What other option are you suggesting?”
“Stick around until you get better.”
“Beating Michael Jordan in a one-on-one basketball game would be more likely.”
“Crises, including suicidal ones, are time-limited,” Judy countered. “Eventually, something’s got to give. You will be around to experience the next chapter of your life, provided you don’t kill yourself,.”
“That’s easy for you to say, but you’re not in this hell. My intuition is telling me that I’m stuck here forever.”
“Cognitively, you cannot help but think ‘I am permanently frozen in horrible pain.’ This is what depression is—a failure of the imagination. The chemical imbalance in your brain is preventing you from envisioning a positive future. Nevertheless, I want you to at least make room for the possibility that some unexpected good might grace your life.”
Sensing that I was stuck in unbelief, Judy leaned back in her chair and recounted the following parable.
According to an ancient tale, a Sufi village was attacked and captured by a group of warriors. The king of the victorious tribe told the vanquished that unless they fulfilled his wish, the entire village would be put to death the following morning. The King’s wish was to know the secret of what would make him happy when he was sad, and sad when he was happy.
The village people constructed a large bonfire, and all night long their wise men and women strove to answer the riddle: what could make a person happy when he is sad, and sad when he is happy? Finally, sunrise dawned and the king entered the village. Approaching the wise ones, he asked, “Have you fulfilled my request?” “Yes!” they replied. The king was delighted. “Well, show me your gift.” One of the men reached into a pouch and presented the King with a gold ring. The king was perplexed. “I have no need of more gold,” he exclaimed. “How can this ring make me happy when I am sad, and sad when I am happy?” The king looked again, and this time he noticed that the ring bore an inscription. It read, This, Too, Shall Pass.
“It is an immutable law of the cosmos,” Judy continued, “that the only constant in the universe is change. Haven’t things happened to you that you never would have predicted?”
I nodded my head as I recalled the many experiences, both good and bad, that life had unexpectedly brought me.
“Since you cannot know your future with absolute certainty, allow for the possibility that a healing may be waiting for you around the corner. Pat tells me that you have already created a survival plan for yourself.”
“I use it to get through each day.”
“Good. Then stick with your strategy. Instead of fretting about the future, simply create the support that you need to stay alive, one day at a time. Please repeat this statement: “I am creating the support that I need to stay alive, one day at a time.”
“I am creating the support that I need to stay alive, one day at a time,” I said meekly.
“Good! Now I want you to repeat this statement every day. It doesn’t matter whether you believe it; keep saying it anyway. I know that you are going to live.”
In addition to her counsel, Judy gave me her phone number as well as the number of the National Suicide Prevention Lifeline (1-888-SUICIDE) and said that I must call anytime I was in danger of harming myself. She also gave me a number of Internet sites on suicide prevention that l now list on my website.
Judy came to me in my darkest hour and presented a vision of healing to me that I could not see for myself. She believed for me what I could not believe for myself. Although her faith in my restoration did not remove my physical and psychological pain, it did give me a reason to hang on. And hang on I did, until one day the miracle I had been hoping for occurred.
The circumstances of Douglas’s recovery from this depressive episode can be found in a previous Mad in America blog dated March 5, 2013–“My Story of Recovery: Prayer, Community and Healing.” More information about Douglas’s approach to alleviating suicidal pain can be found at http://www.healingfromdepression.com/suicidal.htm
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.