How honest should I be with my therapist?

August 11, 2008 2:53 AM

As a way to comfort myself when I am worried, nervous, anxious, or sleepless, I plan my own suicide.

I've done this for as long as I can remember - from early childhood. Sometimes I try to plan it as painlessly as possible, sometimes as dramatically as possible. Sometimes I try to think of ways to make it look like an accident. There have been times (thankfully not for years and years) that I have planned ways to make it look like murder and pin it on whomever I was most upset by at the time. Nowadays, I usually think of ways to make sure my friends and family are troubled as little as possible.

In spite of all this, I am NOT actually suicidal. At all. I am a happy person, and I am way too eager to see what's going to happen next to ever end my own life (unless I was terminally ill and in lots of pain, or on my way to being completely incapacitated, but that's a whole 'nother thing entirely, I think). My suicide game has always seemed to me to be a kind of escape hatch - a way of convincing myself that I can put up with anything, and make it through intact, as long as I know I can escape anytime I want to.

Now, for the actual question. I am soon to see a therapist to help me deal with my food issues (binge eating with a little body dysmorphia thrown in for fun). I want to be completely honest and open, which was difficult for me when I saw a therapist as a teenager for other issues. I think this strange little coping mechanism is probably something that my psychologist needs to know. What I DON'T want is to be labelled a suicide risk, be declared a danger to myself, have my belt and my shoelaces taken away, and have the word 'suicidal' written in big red letters on the medical records that will follow me around for the rest of my life. So how should I approach this?

posted by Wroksie to health & fitness (23 comments total)

This is called "suicide ideation". It is a very common aspect of depression. As a depresssion sufferer on and off I have always been able to talk about it without anyone panicking as it's a known phenomenon. I have always been adamant that I have no desire to act on those thoughts and my doctors have always seemed to respect that.
posted by loiseau at 3:22 AM on August 11, 2008

I've not had any problems explaining my different levels of suicide-ness to therapists and have been able to get the care I needed. That is, when I was worried that I might act on my suicidal thoughts, I said so, and they helped with that. When I wasn't, we talked about ways to deal with it.

I think they will probably ask you questions like, how likely are you to carry this out, have you made any concrete plans and so on. To think about suicide without necessarily being a risk is not uncommon, I think. Be honest, but not dramatic. That's all. If they're any good, they'll get it.
posted by b33j at 3:24 AM on August 11, 2008

Nobody is going to steal your shoelaces. What you're going through is part and parcel of depression. I relate very closely to a T, and I am sorry to hear you're not feeling well. You can be honest with your therapist and s/he will not flip out or label you as anything or do anything other than listen and help you out. You're gonna be OK.
posted by Sticherbeast at 3:41 AM on August 11, 2008

My understanding (I'm not a therapist) is that this is somewhat common; I know at least a couple of friends who say they do it too on occasion, and have never resolved to actually do it. Although it may be a sign of depressive thought in general, it isn't necessarily an indicator of being a suicide risk, and anyone with training will recognise that. So, I think you can (and should) tell your therapist about this so they can help you talk through any associated issues, and it won't result in your being tackled by orderlies and sent to an asylum.
posted by Drexen at 3:56 AM on August 11, 2008

Just to clarify - I really don't think i am clinically depressed. I sleep fine as long as I don't have anything specific on my mind, I am VERY rarely anxious or irritable, I have an excellent relationship with my husband, my friends, and due to some serious work on all of our parts, even with my religious fundamentalist family. I recently went back to work after a couple of years of house-wifery and I am fulfilled and happy with my job. I get plenty of exercise (walking three miles a day plus longer hikes on the weekend), I rarely drink, and I'm not really one for drugs. In other words, there isn't much on the standard depression inventory that applies to me aside from the fact that I am about 40 pounds overweight and I feel kind of gross about it. I have a mental picture of myself that resembles Roseanne Barr when, in reality, I'm closer to America Ferrerra. The anxiety I have around this manifests itself occasionally in serious binge eating (once or twice a month) that leaves me feeling bloated and sick for a couple of days.
The suicide planning thing is something I've done for so long, and through so many ups-and-downs in my life, that it seems at this point more of a habit than anything - something distasteful but not threatening, like biting fingernails. I am just afraid that the therapist will focus on it to the exclusion of what I think are more important issues. And while I doubt that she will automatically section me if I bring it up, I am kind of afraid that it will colour her perception of me and make it more difficult for us to work together to help me stop eating entire boxes of cereal at three in the morning.
posted by Wroksie at 4:09 AM on August 11, 2008

And I should also add that this is an NHS therapist - I've waited months for this appointment, and it's not exactly easy to just try another therapist if this one doesn't work unless I am willing to pay out-of-pocket. So maybe that's why I am so worried about getting this right.
posted by Wroksie at 4:13 AM on August 11, 2008

If she's a good therapist, she will understand.
posted by bingo at 5:24 AM on August 11, 2008

"It is always consoling to think of suicide: in that way one gets through many a bad night."

- Nietzsche
posted by mpls2 at 5:25 AM on August 11, 2008 [4 favorites has favorites]

An involuntary commitment to a psychiatric facility as a danger to oneself requires more than suicidal ideation, it also requires a plan for executing the suicide and the means to carry it out. I.e., "sometimes I'm down and think about ending it all" doesn't get you committed, "I am going to kill myself with the gun in the glove compartment of my car in the parking lot after this session" gets you committed.
posted by The Straightener at 5:37 AM on August 11, 2008

i feel like everybody i know (including myself) does this. i had a long chat (um, sadly, i mean 'online') the other night with a friend and we both mentioned this same tendency. i would not say that either of us are depressed.

but after reading these comments... i don't know?
posted by punkbitch at 5:40 AM on August 11, 2008

I am amazed that people do this as a comfort. I find suicidal ideation very distressing.
posted by Estragon at 6:24 AM on August 11, 2008

As The Straightener says, health care professionals [as opposed to, say, your friends who may not know much about suicide, depression or other related topics] will really look for "means, motive, and opportunity" Indicating that you do not, in any way, have two of these three should leave you in the clear with your therapist. I find that there are a lot of people for whom suicidal thoughts are just not part of their day to day thought patterns and others for whom they are. Both groups are a little surprised at the other, as Estragon sort of illustrates above.
posted by jessamyn at 6:38 AM on August 11, 2008

It's a control issue, really. It's one of the few things that you can control when everything else might spiral out of your reach. It's a somewhat warped way to feel like you can always take control of one thing in your life by denying others control over your living, but most people are warped in one way or another.
posted by plinth at 6:40 AM on August 11, 2008

Oh, they were part of my day-to-day thought patterns. They just didn't feel like they were under my control. But that was some time ago, thank goodness.
posted by Estragon at 6:49 AM on August 11, 2008

I do this, quite often. I have nothing to add except for that. mpls2's Nietzsche quote really sums it up.
posted by xmutex at 7:00 AM on August 11, 2008

It should also be added that even if you presented a serious suicide risk with a plan and means to execute it your therapist would more likely encourage you to voluntarily enter a psychiatric facility, would maybe accompany you to the facility and walk you through the intake process as opposed to contacting the county mental health department for clearance on an involuntary commitment. If you get involuntarily committed you don't go in someone's car, you go in the back of a police wagon, in handcuffs and possibly mouth restraints. An involuntary commitment, once cleared by the county mental health office, becomes a law enforcement action and your transportation to the crisis center is in the hands of the local police. Mental health professionals use involuntaries as a last resort because it can be an incredibly traumatizing experience that generally destroys their relationship with their client.

These questions about "will I be committed if I say 'X' to my therapist" come up here somewhat regularly, generally I think because most people aren't really aware of how this sort of thing works. Most involuntary commitments happen because the person in question is psychotic and cannot be reasoned into volunteering for inpatient treatment, which is why at the point of transportation it becomes a law enforcement action.
posted by The Straightener at 7:12 AM on August 11, 2008 [2 favorites has favorites]

Perhaps you could develop a healthier habit. Suicidal ideation may not be a problem now, but if you became depressed, could become serious. Plan your dream home or find some other mental project, instead.
posted by theora55 at 7:39 AM on August 11, 2008

My psychiatrist really didn't react at all, just asked if I had any specific plans, which I didn't, and told me to call him if I felt concerned. He put me on the right medication and they're completely gone.
posted by desjardins at 10:09 AM on August 11, 2008

As a general answer: Therapists are most helpful if you are completely honest with them. If you're not totally honest, then you're not really going to get your money's worth.
posted by Citrus at 10:23 AM on August 11, 2008

I think it might be important to your therapy to mention this. I know you say you don't feel depressed, and that it doesn't seem related to you. But sometimes compulsive eating is a way to suppress or distract oneself from feeling feelings.

With almost any kind of habit like that (undereating, overeating, smoking) it can turn out that the behavior has a masking effect allowing you to avoid more unpleasant feelings by focusing on the strong sensory input and activity at hand, and then misidentying the source of your worries as body-related. As you explore the reasons why you overeat sometimes, you might find that you're doing it in response to stresses or sadnesses you have never articulated even to yourself. There may very well be an important connection between these ideas and your eating and body-image problems. So explain it to your therapist with the framing you gave here - that you have no interest in ending your life, but have often had these thoughts and wonder what's going on with them. You might find they really are related.
posted by Miko at 11:07 AM on August 11, 2008

For what it's worth, I've also had similar thoughts for as long as I remember; certainly since my mid-teens. I always imagine my parents at my funeral. (Maybe it means I yearn attention or something, though I'd disagree.)

I know exactly what you mean about suicide being an "escape hatch" should things get too bad. When my thoughts get to that point, I try to imagine: hang on! before I hit the airlock button, maybe I should just blow my bank account on an airfare to a million miles away and see what happens to my life there, 'cos who knows! Suicide need only be a day away, but there's always something else to do today, even if it means giving up all that exists of your life wherever it may currently be spent and all the folk it involves. You can always be a blank slate in a world of new experiences.

But as for your question, I dunno... Do what feels comfortable with your therapist. Suicidal thoughts aren't uncommon or unnatural and you won't be incarcerated for sharing them (NB: untested assertion). If your inital impression is that you'll be judged or doubted for having such thoughts, keep them to yourself for now and see how it goes. (And if you need to discuss those thoughts free of consequence: www.samaritans.org, phone, email or in person.)

Hope things get better.
posted by 4eyes at 5:24 PM on August 11, 2008

Plan methods that are elegant but extremely unlikely (e.g. climbing K2 and jumping off; getting a Ph.D. in particle physics, creating an experimental black hole, and jumping in). This will preserve your sense of proportion.
posted by bad grammar at 6:09 PM on August 11, 2008

Suicidal ideation functions as a pressure release valve -- a safe way to work out frustration and the desire to stop things from happening *to* you. So long as you're not taking steps towards planning / executing (sorry) plans, you're fine. It's very common.
posted by tzikeh at 7:34 PM on August 11, 2008