Taking care of me.

February 12, 2009 8:37 AM

To call or not to call? (depression-filter)

During really stressful periods, sometimes I just need to shut down. This usually means: hiding in bed, usually with some combination of drinking extensively, cutting as a stress-reliever, sleeping a lot, taking painkillers, and listening to music (usually for a couple of hours) until I can reenter the world. I'm home alone a lot, so sometimes these can be kind of scary episodes.

I know what you're "supposed" to do, during times like this, is make sure you're around people so as to be safe. Last year I had two or three close friends who would call to check in periodically, to make sure I was still alive and OK during a particularly bad time. (This group isn't really available right now, which has made things kind of hard). Right now I have a wonderful partner (also a close friend), who is aware that I do this, and sympathetic -- i.e. aware of the issue, not freaked out by the cutting part of it, and has been through similar things -- and who would be really great to talk to during these moments. (we're long-distance, so this would mainly be a phone thing)

The problem being: I have no idea how to ask for this kind of support, and I feel like he won't extend it (rightly so) unless I ask for it. What I want more than anything during these moments, is hear a friendly voice, to be distracted and be reminded that things are going to be OK. If support is freely extended, it's wonderful, but I feel like I can't ask for it. What I definitely can't do, when I'm feeling really fucked up, is initiate a phone call.

How do I broach this conversation? I don't want this to be something that takes over my life -- I just want to be able to get in touch with someone, and feel like it's OK to do this, when things get really bad.

I've been in and out of therapy for this. These are my thoughts:

1) It's a rare therapist who won't immediately pathologize self-harm and assume you're suicidal. I've spent hours trying to explain the difference (and there *is* a very clear difference, at least for me), and am really tired of having this conversation. The best they do is prescribe medication -- and I think the last thing I need, during these moments, is access to a bottle of pills.

2) My school doesn't have ongoing resources for this sort of thing, so even if it were helpful, therapy in my area would be pretty much unaffordable)

So it's just me, for now. Which is OK. But I'd really like some feedback on how to create a better support system.

Thanks in advance for your advice, Metafilter. I really appreciate it. throwaway account at "[e-mail]"

posted by anonymous to health & fitness (17 comments total)

I don't know where you are from, so I can't recommend anything local. But what I can recommend is that you call a hotline. I volunteered for one after 9/11, and all sorts of people called ranging from "sad" to "suicidal". I have no idea where you fall in, but maybe you should call a line and just talk for a bit. They'll be more than happy to talk with you.

Talking anonymously (where they don't know you) might give you what you need to broach this subject with those around you.

Good luck.
posted by hal_c_on at 8:43 AM on February 12

An awesome, supportive, understanding partner is such a fantastic resource - and I'm really glad you have that, in addition to some great friends.

Though it might be awkward to have the conversation, what if you asked your partner to send you a few love letters/letters of encouragement in the mail? Then, keep them in a safe place, and don't open them until they're really needed.

Voila - instant access to reassurance and care for someone who truly loves you. And you can read them over and over, as many times as you need.
posted by harperpitt at 8:50 AM on February 12

You describe this as if it's a brief aberrant period of time in an otherwise okay existence. Quite frankly, if you can describe a period of heavy drinking and self-mutilation mixed with painkillers as not that big a deal then your judgment is compromised. You're glibly dismissing therapists as largely being unable to tell the difference between self-harm and suicide as a way of justifying not getting professional help.

You are wrong.

It could well be that you're right, this is a somewhat stable condition and you could continue this way indefinitely. However you're really not competent to make that call from within your condition. You're already engaging in some cognitive dissonance here when you claim therapists are going to falsely call you suicidal and then within 30 words say the last thing you need during these episodes is access to pills.

You need something more than a sympathetic ear, and you've described a situation that isn't going to work anyway. You want this person to be able to be a crutch for you in the bad times but you're incapable of initiating a phone call during those times? How is that going to work? This person's going to call you every hour on the hour? You're going to call every hour and s/he'll call you if the call doesn't come through?

Seriously, you need more structured help here. You don't give any indication that you've actually tried to make use of your school's resources, merely declared that they don't have ongoing help. Recognize that as someone suffering from depression that you are not competent to make an objective judgment about how well a long-term plan is going to work out and go try to get some help.
posted by phearlez at 9:01 AM on February 12 [13 favorites]

Last year I had two or three close friends who would call to check in periodically, to make sure I was still alive and OK during a particularly bad time.

and

I have no idea how to ask for this kind of support, and I feel like he won't extend it (rightly so) unless I ask for it.

You had 2-3 friends who were willing to call you on a regular basis. There's no reason to think that your partner won't do the same. I think you are afraid of being rejected, and you're afraid that will push you further into your depression. I am TOTALLY sympathetic to this; I also have neurotic thoughts that I am not really that important to anyone, including my husband. I also think that nothing will change with your partner until you ask. He's not psychic. If you can't do it by phone, send a letter or an email. If you're reluctant to talk to him on the phone, do it over IM. All you need to say is "I'm in a bad spot, and it would help me if you called me every day/week to check in." Do not feel guilty about this: this is what friends are FOR.

On preview: what phearlez said. You need more help than your partner can give.
posted by desjardins at 9:03 AM on February 12 [1 favorite]

In all seriousness, can you copy and paste the part where you tell us what you need from your partner, and how much, and write an email that thanks them for being so supportive, telling them it's hard to ask for, and can they [paste].

Sometime it's easier to write something than to say it.
posted by KAS at 9:39 AM on February 12

You've developed some pretty bad coping mechanisms for whatever is going on in your head. I've been exactly where you're at, except for cutting, although really there are such a variety of self-harm techniques.....
I completely understand why most therapists pathologize this and why you don't feel they can help. But I would urge you to keep looking. I would strongly recommend Stone, Hal & Sidra "Embracing the inner critic" as a staring point.
In the short term having your partner check in on you at random times will help, but you really need to lay down some tiny foundations for the medium to longer term. I say random because you will start to prepare for his/her call and just displace your self-harm around it.

Tiny small steps are a way to go. This will pass. You will get better. People who make you feel anxious or guilty about your coping mechanisms are just trying to help although you will feel more pressured by their obvious disapproval. Try to see beyond that to the more positive ;- they care.
Huge hugs to you, you clearly see the problem, it's just a few more small steps to getting more help than you currently have. Keep up the search and don't dismiss medication out of hand unless you realll feel it is a threat. It can be doled out in small amounts by agreement with your therapist & pharmacist so don't let that worry stop you. Meds can and are life-saving in many cases.
posted by Wilder at 9:42 AM on February 12 [3 favorites]

Everybody needs support, and I think you should ask.

But honestly, it appears you are looking for the perfect external situation that will enable to preserve your addictions and self abuse cycle. You have found this balance in the past with your friends, and you might find it with your partner, but the sorts of behaviors you describe tend to be progressive. Binge drinking and abuse of painkillers tends to get worse over time. I won't even get into the cutting. Finding the balance gets harder and harder.

The reason you want to preserve these behaviors, and reject assistance that might actually help you, is probably because your life would feel unmanageable without it. However, it is unmanageable with these behaviors. Things will inevitably slide to worse and the difficulty of finding this balance will get harder and harder as your behaviors get worse and worse.

You need to find the help you need to overcome the problem, not find the exact amount of support that will allow you to keep up the behaviors but prevent you from doing permanent harm to yourself. This balance is impossible to maintain in the long run. Please seek the help available at your school.
posted by milarepa at 9:52 AM on February 12

It's a rare therapist who won't immediately pathologize self-harm and assume you're suicidal.

Are you sure? I don't think this is true.
posted by salvia at 9:57 AM on February 12

Seconding above people who say that simply asking straight-out is probably OK. Your partner sounds really supportive. Writing an e-mail is a great way to say exactly what you want to say without fumbling, and gives the other person time to reflect and work through feelings before responding.

I wonder if your campus has a support group that would suit you, as well. That would help you create a network for mutual support, people who would understand how important contact is and be willing to help keep in touch with you, since your circle of friends isn't available right now.

Listen to Wilder, too. Some good advice there.

There are better ways to take care of yourself when things get bad. Making sure you have human support is a good start for learning those better ways, and it is a good insight you have that people can't give you what you need unless you tell them, plainly, what that is.
posted by not that girl at 10:18 AM on February 12

If you're not suicidal, why would the last thing you need be 'access to a bottle of pills'? Please call a suicide hotline.

Take good care of yourself.
posted by Space Kitty at 10:25 AM on February 12

I agree that the poster has some pretty bad stuff going on, and that professional help is probably in order. That said -- the OP says that they have tried therapy (more than once?) and has at least looked into the school resources available. Setting up a decent therapeutic relationship takes time, even under the best of circumstances -- and ultimately, it doesn't work for everyone.

The OP has said that these options, at the very least, have been tried.

What s/he is asking about are stop-gap procedures -- letting people know when it might be good to call, even as a distraction. Which seems like a reasonable short-term goal -- especially if the idea is to keep the "normal" coping measures (withdrawing, listening to music) from tripping over into the scarier stuff (cutting, drinking, suicidal ideation). As someone who's wrestled with this same kind of stuff, I don't have a good suggestion in this regard, other than to repeat the above -- that s/he seems to have a good group of friends, and should not be afraid to be honest with them.

All the same - "get thee to a doctor" is one of many options -- but doesn't seem to be the one the poster is asking about.
posted by puckish at 10:29 AM on February 12

If you need support during those times. a crisis hotline such as RAINN might be your best bet.
posted by watercarrier at 10:56 AM on February 12

anonymous: The problem being: I have no idea how to ask for this kind of support, and I feel like he won't extend it (rightly so) unless I ask for it... How do I broach this conversation?

Oh, honey - you're thinking about this all wrong. It's not a conversation to be broached, unless your relationship is much colder and more business-like than it sounds like. You tell him, "I'm feeling sad right now." Then you and him can talk about it, if you like. And if you want him to call periodically to check up on you and see how you're feeling, you say, "this may sound weird, but can you call me every once it a while - like, say, once every two or three days, if you don't hear from me - just to see how I'm doing? Sometimes I like to have somebody to talk to."

If he's your partner and friend, the situation isn't that you owe him some kind of explanation for demanding that he call to check up on you. Just ask him to - and he will. If he really wants to go over your whole history and have a rigorous cross-examination, then just say "I get sad sometimes. I don't really know why; it just happens." But I don't think he'll want a long, drawn-out explanation - I have a feeling he'll be more interested in talking and being there for you.

anonymous: It's a rare therapist who won't immediately pathologize self-harm and assume you're suicidal. I've spent hours trying to explain the difference (and there *is* a very clear difference, at least for me), and am really tired of having this conversation.

When you indicate that you've seen multiple therapists who've assumed that you're suicidal, everybody's always going to worry about you and tell you that you should get help somehow. (But you already knew that, right? I mean, you've read all the comments so far, so you see how people are when they're concerned.)

Look, my perspective is this: I know what you mean. Sometimes it can seem like there aren't really any good therapists out there, and it can seem like they all have a hair trigger. Someone who can rattle off a phrase like "immediately pathologize self-harm" has been around the therapy block enough times to know the way the game works, I'll bet. Here's what I think you should do on that point - it's really up to you what you choose, but I think this would work:

(1) If you're in your 'coma' right now, wait it out, and maybe call your boyfriend and talk with him if you can handle that. When you're doing better, you can start to work a few things out.

(2) Forgive the bad therapists - I mean, they were only trying to help. On their end, they were worried about you, and they heard 'self-destructive' and got more worried. Psychotherapists aren't supposed to get worried, but it's human nature. There are good psychotherapists out there. I know; I've seen at least half a dozen in the last ten years, but good ones exist.

(3) Look into health insurance. There are lots of different health plans out there, and it seems like a huge hassle, but it's easier that it seems like it's going to be, and it's worth it. Lots of health insurance plans actually have a component that helps pay for psychotherapy - you may have to look around, but often there are good programs aimed toward students. Also, I don't know a whole lot about your situation, so I don't know if parents are an option, but I know that "mom and dad, I need money for therapy" is a tough question, whereas "mom and dad, I need money for this health insurance plan that I found that I think will be good for me" is a lot easier to ask.

(4) Call around to therapists and ask questions. Be choosy. Grill them a bit over the phone - if you want, be honest, and tell them that you can sometimes be self-destructive, but you want someone who's willing to talk about your issues with you rather than talk about emergency treatment options. Seeing what they say to that might be revealing.

(5) Get ready. You are going to have to face your demons - you know you don't want to go on forever like this, don't you? It's not normal, and it's not happy. Like you said, it's good to have a network of friends to support you when you try to get past something like this, so hold on to them.
posted by koeselitz at 11:06 AM on February 12 [2 favorites]

I'm going to go, first, right to the root of your question: how to get your partner to check in on you without having to start a whole conversation about how you feel first.

Here's what I would suggest to deal with that: you already have a throwaway gmail account. If you don't have a real gmail account set up now for mail and chat that you check every day, do that right this second. Put your partner on there as a chat contact.

Leave the gmail window open all the time, whenever your computer is on, and ask that he do that if it's at all possible. Then just pick a word--you've heard of a safe word in sex, right? This is your "I need help" safe word, it can be anything--and when you need help, any kind of help, you send that word to your partner through gmail's chat.

If you prefer AIM or YM or whatever, that's fine--all you need is an open chat window and ONE WORD. It's hard, when you're severely depressed, to do much at all, but one word, I think, is doable.

Set that up now with him, while you are doing okay, so that when you aren't able to cope, it's already in place.

Now, about the long run. First off, and you already know this, you've got to get off the painkillers and the alcohol you use to cope. What you have is depression that is triggered by stress, and you are smart enough to know that there are triggers that set it off. Good. Sleep and quiet are not necessarily a bad coping mechanism when you're stressed. Alcohol and painkillers are depressants. They may feel like they're numbing you, but they're really just making what you are going through worse.

Who am I to give you advice, anyway? See, I was suicidal. And now I look back and think, WTF was I thinking? But then, I couldn't see it.

I get that you don't see your cutting in the same way, and that you think there's a clear difference. But it's just possible, isn't it, that the reason you've talked to therapists for hours on end and they still don't get it is--maybe you're the one not getting it?

Maybe you're just really scared that they will 'put you away' if you admit that sometimes you really do want to hurt yourself. Who wouldn't be scared of that? It IS a really scary idea.

Now, I'm still here, nobody put me away, and I don't get depressed like that any more, even when I'm stressed. In my case, the things that helped? The supportive people (Good for you that you know how important that is!) and that bottle of pills you don't want to take, the ones the therapists want to give you. I have a great therapist now, too.

So please don't give up on therapy, either, and continue trying to find a therapist who really does get you. And if you are worried about having access to a bottle of pills, you know, not all pills are alike! There's a ton of different kinds of anti-depressants, for example, some that work on dopamine and some on serotonin levels and one of them might just help you from going through this crap ever again--that's worth trying to find, right?

I'm so glad you are thinking about all this and trying to set up the help you need to cope, that's a really positive thing to do. If you want some more support people, I'd be glad to gmail you too, sometimes, just to make sure you're okay. I'm not the judgmental kind, believe me.
posted by misha at 1:43 PM on February 12 [2 favorites]

My best freind and I do this yearly. We both have Seasonal Affective Disorder - I have it in the winter, she has it in the summer. We didn't really figure this out until 2007.

We inadvertently had been keeping each other sane for about 10 years just by being ourselves. I'd be chirpy and happy in the summer, checking in, and generally being a pest. She'd be the same way towards me in the winter.

There was one winter that was particularly bad, and while she and I were chatting via IM one day, I just let her know that I was scared for myself, that I'd get locked in myself and not be able to come out. She promised to check on me every day until I came out of it.

Since then we've asked each other to do that periodically. I'd be frank and say, "you're someone I can trust with this - will you help me help myself? I'm not trying to cling to you or make you think you're keeping me alive. I just need to be able to vent to you and be at my most depressed, and just have you listen and understand."

After a little bit your freind will get a sense for when you need to vent and when you really need to get up and about and generally walk it out, if not snap out of it.

Distance is not an issue. We live six hours apart.
posted by lysdexic at 2:56 PM on February 12

I've found that people you are close to won't necessarily need you to specifically lay out all your thoughts when you call. When you are feeling well, go for coffee with one of your trusted contacts (or talk to your partner on the phone) and describe the episodes you go through. Do your episodes tend to happen in the AM or PM? Mention this too. Then talk about the possibility of calling when you feel like this. Discuss how he/she can help you, by talking you out of bed, and getting out of the house (to work, to the gym, to the library, wherever), and break the cycle of staying in bed, drinking, etc.

With this info on hand, you really should be able to just call the contact during the day/night (or get on IM) and say "I'm not feeling so good." (or perhaps a "safe word" as misha suggested above) When I do this, my friend knows EXACTLY what I mean, and can say "OK, lets make a list: 1) stand up. 2) shower, 3) brush teeth..."etc. It gets me out of bed, and it gets me safe/in a better place, without having the awkwardness and effort of calling her while she's at work and having to say "Hi, So-and-so, sorry to interrupt you at work, but I've been crying for 3 hours, and I want to die."

Seconding about not giving up on therapy/trained therapists. My severe episodes are far enough apart that I can space out calls amongst friends, and it isn't disruptive to their lives. But firends can only be leaned on for so long, especially if they themselves have depression/mental health issues. Try a help line (talking to someone and xpressing your feelings does wonders), or talk to a therapist if your episodes are frequent enough that you feel like you're leaning too much on your friends/partner.

Good luck... I really wish you the best in breaking out of this, because alcohol + meds is really playing with fire.
posted by NikitaNikita at 8:43 PM on February 12 [1 favorite]

Man, seriously, seriously, seriously. It doesn't sound like you're looking for actual advice on how to get better, but that's what you need, so please listen.

I cut for the first time when I was 15. Growing up, I was sexually molested by my father, abandoned by family, friendless, overweight, and lived in abject poverty. Filthy mattress on a littered floor poverty. My father was an alcoholic and did just about every drug in the book. The very first time I cut, I think my intention was just to get out the pure and utter rage I felt inside, but it ended up costing me a trip to the hospital - 27 cuts, many, many stitches.
Time goes by. Cutting becomes a secret coping mechanism that I never, ever tell anyone about. I stay away from alcohol for the most part because I hate my father and never, ever want to end up anything like him. Eventually though, I do break a little and start smoking pot habitually and gradually start doing other drugs. I don't think I was ever addicted to anything, besides the cutting and the depression of course. I loooved being sad. Crying. Feeling so goddamn rightfully sorry for the shite life that I'd been given, and man... I spent what felt like every moment of every day planning my grand exit from this mortal coil.
That started at 15. Zoom forward 11 YEARS. I'm a grown adult. Guess what? I'm still cutting. I'm still crying. I'm still addicted to bad relationships and pain. I still use every opportunity to make myself feel like shit. I meet the girl of my absolute dreams and I start with my insecurities, my jealousy, all of the luggage I've been carrying for years. Then I cut. She saw the cuts. It escalated to the point where I lost control over the situation, a phrase that seems so comical because I honestly never had control over anything, including myself, ever. She leaves me. I go to see her, to plead my case, to beg her. She refuses me. I go to the next room where I hide my razer. I cut deeper than I've ever cut before and this time, it's down the tracks, not across.
When I awoke in the hospital, I didn't bother lying. I know the right answers to make sure I don't end up spending a night or two in the mental hospital. This was, after all, my third suicide attempt. This time, I told the truth. I didn't feel safe, I didn't want to be out. I didn't care anymore about anything. I had been engaged to the most beautiful, perfect girl for me and because I couldn't GROW THE FUCK UP and be an adult, because I lived a life of reacting to situations instead of acting before situations arose, I had lost everything. I didn't think I'd have a job when I got out. I didn't care.
For the first time in my life, I went to therapy. I started seeing a psych and he prescribed prozac and lamictal. I took them faithfully, and dude, I felt better within days. It was hard to let go of my wanting to be sad, it was hard to let go of how angry I was that I never had a childhood, a prom, a normal sexual interaction with another human being, that I'm overweight and balding and that I'd done literally nothing with my life. All the things that picked at my mind like the worst, constant, unending pickaxe at my happiness.. I made a choice to start looking forward instead of back.
That was 3 years ago. I haven't cut. I haven't had a manic episode. Nothing. I eventually won the girl back, got married. We have a nice house. The things I felt I'd never accomplish ever I either have or am starting to.
You have to make a decision, and it shouldn't take a second thought. Life, cliche as it sounds, really is what you make it, and why waste the only opportunity you have to do exciting things, meet new people, create exciting experiences - why waste it or worse, possibly throw it away. Nothing, NOTHING is that bad. I don't care where your depression stems from - I'll take you toe-to-toe. Look up my dad man - go over to the maricopa county court website where you can check out people's criminal histories. Paul allen press, Phoenix, arizona. You'll find he's in florence right now for child molestation. You'll find it's not his first trip. I'm not bragging. This is very hard for me to even talk about. If you want help, pick up the phone and call a therapist, a psych, and make the decision to change your life.

Please.
posted by Bageena at 2:46 AM on February 13 [1 favorite]