On Suicide

I have no idea how many times I’ve heard this:

“Suicide is a permanent solution to a temporary problem.”

Is it really? I think it’s more common that it’s a solution to a persistent problem. Or an overwhelming problem. There are people who kill themselves due to a single event or circumstance. But this quote can be more for the speaker to comfort them self by giving the feeling of offering help than a sign of understanding what is a complex issue. And in that context, it reflects an attitude of persons who don’t want to face the problem because that would require serious effort. It transfers all responsibility to a person who is suffering to get help by essentially saying, “Buck up. Life isn’t that bad.” It’s not a quote that engenders comfort or wisdom or insight. It’s a pithy little dismissive sound bite.

Here is a quote from an author named David Foster Wallace who struggled with major depressive disorder his whole life until he ended it in 2008:

The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.

Wallace offers actual insight and a powerful metaphor. No one wants to die but in the face of certain problems it becomes an attractive option. And those problems are often the problems associated with major mental illness. Suicide is the leading cause of deaths due to mental illnesses such as major depression, bipolar disorder and schizophrenia. Many people battle for years against these illnesses and if they lose the battle in the same sense that a cancer patient loses theirs, the result is suicide.

They can’t handle the symptoms. The treatment is expensive. If you’re a lower income individual, it’s difficult or impossible to get that treatment for that reason. The side effects of the medicines can be hard to cope with. Diabetes is a side effect of a lot of these medications, for example. Sometimes the medicines don’t work or stop working. There’s no magic bullet psych med and finding even one or a cocktail that works can be a long process. Talk therapy is more effective than medication alone and it is even harder and more expensive to get. Even if you can afford a therapist, many are not taking new patients. If you have to go through your insurance company to find a therapist in network then the problem of finding one who is accepting new clients is made worse by a smaller pool to draw from. The wait after making an appointment is often a month or more.  Acute care along the lines of a talk therapy solution is a crisis hospital where you can expect to be locked in for 72 hours and you will receive some group therapy sessions, visits to a psychiatrist for medicine adjustment. And these places vary wildly in quality of accommodation and treatment.Getting into one in the first place can involve a wait in a general hospital that can stretch out for days itself. The road to suicide is not short for many of us who have been actively seeking treatment.

And that’s speaking for people seeking treatment. Some people don’t seek treatment. There’s a stigma surrounding mental illness. Think about how many words in English can be used as insults that question a person’s state of mind. Crazy. Insane. Nuts. Those are a few mild ones that are useful in other contexts without me even going into specific attacks of one’s mental faculties. People may not seek treatment because they don’t want to labeled in this way should someone find out, whether it’s at work due to the specific demands of a field, the work environment and employees there or they have an unsympathetic partner they’d rather not give more evidence to the assertion that they are crazy and can’t be trusted or listened to. So they may feel the need to be stoic and hide their pain.

There are deep societal problems on display when someone kills them self and also in the reaction by segments of the population. They recoil at the idea saying, “I don’t understand why someone would do that.” Is it that you don’t understand or don’t want to understand? Understanding involves facing difficult problems with no easy solution such as access to mental health treatment and its current state of effectiveness. But it also means that anyone who truly wants to understand may have to face their own problems and failures such as admitting that they may not be as sensitive as they’d like to believe, that for some, yes, life really is that bad and perhaps the failure to understand by swaths of the public as well as friends and family members is part of the problem.

Mental illness is no longer a secret problem dealt with by locking people away but it’s also not a medical problem met with universal support in the way that physical diseases such as cancer are. There’s no CT scan showing the depression in an easy-to-understand picture. The closest equivalent would be empathy which requires effort to listen to people and how they feel and imagine what it would be like to want to end your own life. I don’t know that everyone is capable of that level of compassion or is willing to go to that extent in order to appreciate a problem that can be completely out of the scope of their personal experience. But we’re in the midst of a suicide epidemic and it would be better for people who currently offer surface-level support or outright dismissiveness to attempt to understand the mindset before it becomes part of the scope of their experience in a very personal way.

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On mass killings and mental illness

I wrote this in October and it’s relevant again because the same pattern of defense of firearms repeats itself after every such tragedy.

View story at Medium.com

And here’s an article from Vox on the subject that’s written as journalism instead of anecdote.

https://www.vox.com/policy-and-politics/2017/11/9/16618472/mental-illness-gun-homicide-mass-shootings

If I had a gun I’d be dead. And I’d have had one easily at several points if I wasn’t too depressed to go buy one. Some unexpected problems have saved my life in the past.

Antidepressants should not make you numb

My depression is severe. Paralyzing. There should be no doubt that it needs treatment for me to function. But it’s not uncommon for people to offer advice based on their experience with antidepressants which I hear make them feel numb so they quit taking them and feel better. First of all, it’s dangerous to discontinue antidepressant treatment suddenly and secondly if you feel better after you quit them than you did before you started them, I question whether you needed them in the first place. Doctors seem to hand them out like candy. General practitioners usually not psychiatrists. Who actually know how to prescribe them.

I’ve heard these type of drugs compared to pouring gas on a car and hoping some gets in the tank. This is not an exact science. There’s a lot of guess work involved, seeing how one reacts and adjusting dosage or replacing the drug itself for another one.

Effective treatment for me doesn’t make me feel numb. It’s also not a cure though. It feels like the natural inclination of my brain, what I should feel, is the kind of paralysis that I need to avoid but there’s a chemical wall in place halting the slide into that state. I might still feel bad, but I know I don’t feel as bad as I should or can.

Diagnosis is a tool to help the doctor predict which drug will be effective. If you have mild situational depression you may need a temporary low dose of zoloft or Prozac. If you have major depressive disorder or bipolar depression, you probably need a stronger dose and maybe an augmenting mood stabilizer such as abilify or Lamictal.

Your diagnosis is not a label that defines who you are or an identity that determines how you should act. It’s a medical condition that a professional can use to help treat you. That’s all it is and there’s no shame in being ill and needing help. Listen to the doctor. Take the medicine as prescribed. And don’t take amateur medical advice from anyone because they have no idea what it’s like to be you.

Out of pocket prescription price shopping

I’m on four prescriptions right now. It’s pretty common for patients with mental health issues to be on more than one medicine. I’ve also been without insurance for long periods and price becomes a major problem with decisions about what medicine to take being decided in part based on what I can afford and not what will help the most.

This article from the Better Business Bureau about those prescription discount cards offers advice about those and as the best ways to find the best price for your medicine.

Can free discount cards offer savings?

Shopping around different pharmacies for the best price can be a hassle when you take multiple medicines but it can be worth it if it makes the difference between taking an effect med versus taking an affordable one.

Some drug companies also offer a patient assistance program. I’m currently taking latuda which has no generic and can be up to $1500 a month for out of pocket payment.

Sunovion Patient Assistance

Eli Lilly Patient Assistance

Pfizer Prescription Pathways

Your mileage may vary. I pay nothing for latuda but the process has been long to get it. In fact, the only reason I have any now is due to help from the patient assistance coordinator at my local community mental health organization. The state I live in has a robust need based infrastructure for uninsured and low income people. It’s good to look into that as an option but not all states or even regions within those states will have care options that are of decent quality. In Alabama it took me several months and repeated phone calls to the same programs in order to find the right clinic for my address and they offered aid on a grant basis where the costs were paid by a charitable organization rather than being funded in part or whole by a state program.

As the BBB article states, prices vary from pharmacy to pharmacy. Publix seems to have an out of pocket, need based pricing system for the uninsured. So out of pocket prices are offered to the uninsured at a low rate depending on the medication. Even some generics can be pricey. Publix also offers some common medicines such as antibiotics completely free.

Many large chains like Kroger or Walmart have a list of medicines offered at low cost from $3-5 generally and some older psych meds are on those lists.

Costco seems to have competitive prices and you don’t have to be a member to use their pharmacy. They also post their prices online which can be found here.

Double sided blade 

This started on paper and it’s become a lot different as I typed it out. The attachment is just the same thing in a text file.There are odd little talents I have that I recognize, am unusually proud of. Certain manual labor skills that are easy to be unnoticed but can be appreciated if you can do yourself. I enjoy watching other people who are very comfortable using a hand tool. It’s a good example because, a screwdriver for example, requires no instruction. It’s use can be obvious in its design and anyone can use one with little difficulty. But there is a simple grace I notice when someone can effortlessly twist a tool like that. As you learn something, anything, it becomes effortless.I’m just kinda big on hand tools.

The screwdriver is the most common tool a hand turns. There’s a very quick way to turn the handle. Twist it fast enough to be efficient while being unconsciously aware of not stripping the screw head. Slight push and pull and a light touch on the handle. People can learn to do that without realizing it just because a screwdriver is so simple.

The tool I’m most proud of mastering is a knife. It was a process that involved multiple cuts for one thing. Not all knives but respect for tools is a common thing with craftsmen that maybe the meaning of is entirely lost on the wider public. I’m at least comfortable holding any knife, confident I won’t do anything stupid with it like cut myself or someone standing near me. The knife I’m talking about being comfortable with is a utility knife. A razor. Even a single edge straight razor. The little naked blade that probably costs a tenth of a penny to stamp out and some people might not even know what to do with if handed one.

Cuts taught me why knives deserve respect. Painfully. So I have a near constant understanding of where the knife edge is, relative to my hand, my fingers, my work, other people. I can’t control other people like I can a knife so that’s a big one. I can’t gift tool respect.

The ultimate goal and long winded intro here is to relate that kinda simple example of holding a tool to holding multiple thoughts at the same time. And quickly giving them shifting priority. They’re similar because they both involve conscious and unconscious thouts and awarenesses that can be hindrance or help at different times.

My thoughts can be similar to having multiple things going on upstairs like using a tool is. Except unrelenting. And unfocused. Multiple shifting and vague goals that need to be prioritized on the fly and undue weight to one can be a distraction, wasted effort and at times has been a life or death mistake. Which is not exaggeration.

This is stressful but I make it work pretty well pretty often. But it’s impossible to do forever without help and I’ve been overwhelmed doing it for one reason or another. But sometimes things just fall back to normal safely. So it’s really not that scary when taken as a whole. But during a crisis it’s scary to watch and scary to go through.

The stigma of mental illness will probably never go away. Crazy people are unpredictable. There’s evolutionary advantage to lack of sympathy towards them. But we’re honestly mostly harmless. I’ve earned a healthy empathy for these people that I value and I’m grateful to know that I’m nowhere near the worst off. But I’ve been homeless. I’m an acute alcoholic. Crazy people are my people. Families give up on us as a death sentence for reasons of self preservation or lack of resources. Alcoholism and homelessness are common over in the loony bin. They kill people.

I deal with shit as a fact of life that would keep an earth person awake at night. I don’t want sympathy. This isn’t a sob story. Even saying that bluntly might make it seem like it’s exactly that. Everyone in America is lucky just to live here and that fact has come into focus for me.

I cry sometimes for no obvious reason. It’s kinda part of the disease: bipolar disorder type 1. I try to hide it. That can hard. Sometimes it’s because of sadness. Or sudden overwhelming happiness and gratitude or opportunities I’ve had that have saved my life and the lack of have killed people in the same position. I think I feel more deeply than most. That I can love more or in a special way. And I have heard that from at least one person with manic depressive illness which makes it maybe more true. It’s a blade with two edges that can be a tool or a weapon and it’s not always easy to tell which direction the blade is pointing.

Personal experience with depression 

I think that due to the imprecision of language, the lack of a specific way to convey certain things due to the failure of words a a device of true understanding, the seriousness and experience of psychotic depression is lost on many people. Depression is a synonym for sadness. The disease of depression, for me, is not anything like sadness in the way a normal person feels sad when they don’t get a promotion or their team loses the Super Bowl, when a pet or even a parent dies. Those generally, for most people, elicit a normal level of sadness and depression that is just part of human experience, of caring about things and people. Depression for me is like experiencing every negative thought and emotion at once and being unable to function on a basic level due to a lack of ability to simultaneously hold all of this and also perform the basic things required of a human to live and function. Like eating food becomes a problem or a burden.
It is like torture in a way that makes me hesitant to use that word because it sounds like hyperbole and torture is also another uncommon human experience. But every word I am using is being carefully chosen in a way that I am hoping will not seem trite and melodramatic.
A writer once said that suicide is not the act of a coward, that no one truly wants to die, that it is an act of desperation like a person forced to jump out of a high rise building that is on fire or die burning to death. That, to me as a sufferer of suicidal depression, is a very real, true and clear statement. It was also made by a man who eventually came to take his own life.
Depression is an unbearable mixture of fear, anxiety, self loathing, and anger. And for people who have to deal with those of us who are sick in this way, it becomes contagious. Our loved ones become as affected. They get angry, they get frustrated, the get depressed themselves, and they feel helpless. And they should feel that way. It is a mental illness and because of this it is entirely irrational. You cannot understand it or talk the person out of it anymore than a schizophrenic can make you understand why he believes that God has spoken to him and then take that rational understanding and walk the person out of that irrational thought process. But unlike a schizophrenic, a depressed person knows entirely that they should not, may not, have any reason to feel this way, and the unintentional pain they spread creates a feedback loop that causes further feelings of helplessness, sadness and pain.
My goal here is to create empathy and understanding, mostly for the loved ones of those of us who go through this. I’ve not seen a terse, effective explanation of the feeling of clinical depression. The most effective example is Ally Brosh’s Adventures in Depression at Hyperbole and a Half. I recommend it.

Manic weight loss 

Hello. My name is Chris. I would like to share my experience and advice earned from that experience with this blog.
I believe I’ve been experiencing a mixed bipolar episode since about March. I really don’t know. But I was having issues with food. Specifically not wanting to eat and not being hungry because I was wrapped up in being hyper productive, impulsive and obsessive. I weigh less now than I did at the beginning of the year when I was homeles. By the way, I’ve been homeless a couple times in 2017.
I was looking through the pictures on my phone and the weight fluctuations were obvious. And uncomfortable to look at. Here they are in chronological order.


So in March I weighed about 160-170. I’m 5’8″.  I’ve been down to about 125-130 in the last month or so. At the moment I’m at 140. It’s scary to see physical evidence of a mental health problem.