TRIGGER WARNING SENSITIVE MATERIAL
One of the comorbid conditions so often present with Complex PTSD and Dissociative Identity Disorder is chronic suicidality. It is hell and a scourge to live with. It is all consuming. You can actually be having a conversation with someone, engaged in that conversation and at the same time planning your own suicide in minute detail. It is terrifying that you can live in two worlds at the same time.
The presence of chronic suicidal thoughts is one of the more difficult issues to deal with in psychiatry. It is one of the issues that separates psychiatry from all other branches of medicine. When patients visit a GP, they want to get better. Sometimes, when patients see a Psychiatrist . . . they just want to die. This freaks people out. You can be sure it freaks the Psychiatrist out, sometimes. But it is part of the business so, I guess, they must have learned to deal with it. Part of the difficulty with it is the sense of being out of control of it. Surgeons like to cut and sew. If something is broken, the way to fix it surgically is pretty clear (tho’ obviously requires great skill). Maybe it will work, maybe it won’t . . . but what to do is usually clear. And the doctor runs under the assumption that the patient will do everything in their power to cooperate with the healing process. Patients who present with chronic suicidal thoughts are not so simple. This is especially true if the patient does not have clear stressors that are producing this sense of despair. Someone who has experienced significant loss, be it job or a relative, often has difficulty re-defining himself. That sense of loss-of-self that comes with that situation gives a clear direction to proceed. Most of us have had such a loss, and most of us have entertained killing ourselves. Thoughts like that are really quite normal . . . as long as you don’t follow through on them . . . And addressing the issues is relatively straight forward. Redefine yourself while grieving the loss. (I didn’t say it was easy . . . just straight forward).
But what about the person who has relatively little life stress? Or the stressors are not the sort that would seem to be at the root of such a strong desire to eliminate one’s self. This intangible state is what is most difficult for the patient, for their family, and for the health care providers that are involved. For some patients, the presence of chronic suicidal thoughts can be the manifestation of past abuse. It can be the result of appalling childhood sexual abuse or narcissistic parental abuse beyond that person’s control. It can be as a result of Dissociative Identity Disorder or Border Personality Disorder. It can be an indication of significant personality disorder. But for many, it seems to be an independent entity that occurs with limited cause. In my case it is the diagnosis of Complex PTSD, Dissociative Identity Disorder (DID), Bipolar !! and associated anxiety and depression. Quite a mouthful really. My alters drive the suicidality making it all the more difficult to treat. Example for the last seven nights straight I have presented to the Emergency Deparment with severe deep lacerations driven by one of my alters.
Very, very scary.
But, not without a possible solution.
More than with any other patient group, we as patients with suicidal thoughts must be connected with a therapist who we trust and respect. We must be actively working with that therapist on life skills management that includes social networking without fostering dependence, developing a pattern of activity for ourselves that supports physical and emotional health, and strengthening spiritual connectedness with other people. And, most importantly, an emotional distance between who we are and what we think. After all, we don’t have to follow through on EVERYTHING we think about doing. Imagine the chaos if we did!! Even though the thought to kill one’s self can seem as irresistible as the urge to take the next breath, it is necessary to purposefully distance yourself from that thought. Acknowledge the thought . . . but distance yourself from it. “OK, I have the thought to hurt myself . . . I think I’ll go for a walk instead . . . ” My therapist encourages me with these thoughts to develop a very clear list of things that I will do before hurting myself. She doesn’t tell me I cannot hurt myself. She decided a long time ago that it was foolish for her to think that her admonishment to not hurt myself would carry more weight than someone who is close to the person. But she does expect that they will follow through on our plan (key here is OUR plan) to keep them safe. And one of the items on that list of to-do’s is that they MUST talk to her or my psychiatrist. . The idea here is to create a system of diversions that waste time. The more time that goes by, the more likely it is that the I will move from the “have to hurt myself” stage to the chronic nagging stage of self-injurious thoughts that are much easier to ignore.
While this sounds a bit simplistic . . . it can work. If the I “works it”. As with all of medicine, the active participation of the me in the healing process makes a profound difference.
From a pharmacologic standpoint, what is done with chronic suicidal thoughts? Obviously, the underlying depression or anxiety is treated. But, in addition to that, other medications can be used. Of all the medicines that we have, Lithium is the only one that has been shown to decrease frequency and severity of suicidal thoughts. Sometimes, the effect is very dramatic.
I have lived with chronic suicidality for five years now since I was diagnosed with Complex PTSD as a result of childhood sexual abuse at the hands of a paedophile ring organised by my parents in Ireland thirty-five years ago. It had remained suppressed since the age of twenty when I emigrated to Australia and only surfaced when the Royal Commission in Institutional Abuse was announced in 2012 in Australia. Hearing the stories of the witnesses triggered me and I had a breakdown and started suffering flashbacks and ended up being hospitalised following a suicide attempt. I have had many attempts since. Each day I fight to stay alive. I have a wonderful Psychiatrist and Psychotherapist that work with me and my family are amazing and have never left my side supporting me completely. I am very lucky as many marriages collapse under the strain of Complex PTSD and Bipolar. We take it one day at a time and follow the strategies outlined above and it’s working. I am still here albeit precariously. I require constant supervision which my husband is happy to provide. It dominates our lives; that and the care of our children. For any of you reading this who are coping with chronic suicidality we can beat it. WE MUST.