I have no idea
February 13, 2011 2:11 PM   Subscribe

I keep going through brief bouts of suicidal ideation. I won't carry these out, but obviously it is very distressing. What should I do? Frustration with mental health services also included as a bonus...

I know the answer will be 'seek therapy', hence the question.

I was referred to a psychiatrist on the NHS after being diagnosed with bipolar disorder a few years ago. I would see her once a month, and if I mentioned things which were concerning me at the time (eg. compulsive behaviour) she would reply with 'well, why do you do that? you don't need to do that! tell yourself that you don't need to do it.)

I mentioned the ideation a while ago. Sometimes I am getting the train home and I feel like I want to throw myself under it; I get recurring thoughts of taking an overdose, or self-harming in some way. These can be very intense, but not last long enough for carrying it out to be a serious option. To a lesser extent, I've had thoughts of 'superficial self-harm', from cutting to deliberately giving myself food poisoning, but (it's hard to explain) the effort involved in actually going through with it seems bigger than the feeling. Obviously this is a good thing because I'm not actually harming myself or worse, but they worry me and I worry I might do it one day. The feeling sometimes comes out of nowhere, and sometimes is because I am already worried/upset about something. I don;t feel like I'm hearing voices - they are definitely me and not someone else in my brain - but something tells me to do it and I have to work hard to ignore it. I mentioned this to the psychiatrist and she told me that by talking myself down from the feeling, I'm already 'doing your own therapy'.

I took some time off work last year and speaking to the social worker who saw me then was more helpful than the psychiatrist - in fact, when the psych wrot eto my Gp the diagnosis on the letter said 'borderline personality disorder' - nobody has ever said this to me. the mental healt cenntre called me recently to tell me that as they felt I was doing well at the moment,. I didn;t need to go in and see them. I asked about this diagnosis on the letter and they said they'd get the psychiatrist to give me a call, but this was two weeks ago and I've heard nothing. The obvious answer would be 'see another psychiatrist' but one has to be referred on the NHS and I don't get jurisdicture over whom I see.

I find it hard to discuss this with people because it's a hard thing to explain - there is on eperson I have spoken with, but a) they don't live close by so I can't go to them when this happens as often as I'd like b) they have suggested that these feelings are connected with other problems in my life (eg. overspending and related guilt) and while this might be making me generally unhappy this feels like it goes beyond this.

I'm on a waiting list to see a psychotherapist but this will take time as they have to get me into a group that will fit around my job.

What would you recommend to deal with this? I haven't been offered counselling on the NHS - is this something I should look into? (I found counselling beneficial in the past for something similar to PTSD.) Follow-up anon email: askmeanon@hotmail.co.uk will work.
posted by anonymous to Health & Fitness (11 answers total) 6 users marked this as a favorite
 
I think you should look into counselling. From my own and other people's experience, it seems that (most) psychiatrists are good at diagnosing and prescribing, but not so much at the therapy side of things. Counsellors/therapists/psychologists can be crap at diagnosis and in most countries are not allowed to prescribe medication, but they can be awesome at talking you through things and helping you see strategies for getting past your problems.

One thing I'd wonder about, though, is whether your medication is actually working well enough: I wouldn't have thought suicidal ideation should be occurring if you are on the right drugs and responding properly. THAT is the sort of question I would be expecting your psychiatrist to address, so it's kind of worrying that she doesn't seem to think it's an issue.
posted by lollusc at 2:23 PM on February 13, 2011 [1 favorite]


Is it at all financially possible for you to be a private-pay patient of a psychologist, therapist, or psychiatrist for at least a short term? That would give you more control over who you see. I understand that this may not feel affordable, but if your issues include overspending it might be an economy in the long run.
posted by Sidhedevil at 2:34 PM on February 13, 2011 [1 favorite]


It sounds to me like the providers you've had aren't taking your condition seriously. It may help to keep a log of what you've thought about and when/what triggers it. That is, don't say "I'm sad," say "on the 5th, the 8th, the 11th, the 12th, and the 14th of this month I thought about doing X, usually around 10am or so."

I also agree that you probably want a therapist more than just a psychiatrist.
posted by SMPA at 2:46 PM on February 13, 2011 [1 favorite]


Get a hobby. Depression and associated disorders are fuelled by, for want of a better way of putti g it, boredom. Find something that you're interested in and is time consuming. The best kind of thing to go for is learning. Doing this keeps the mind occupied and gives you future goals (eg, by next week I'll know about X or achieve Y) and essentially it really can be that simple. Don't think about depression/suicide/the futility of it all etc. Think about bettering yourself and becoming more awesome. Having gone through depression myself and escaped by the same route I give now, I can truly say that I am fond of myself now to the point that some people think it a detrimental aspect of my character. To that end, I rather recognised myself in the recent Sherlock Holmes movie where Watson and Mary Marston enter the room to find Holmes hanging.
posted by dougrayrankin at 2:53 PM on February 13, 2011


I am not familiar with how things work in the UK, so I can't offer any constructive advice on that aspect of your situation, but I wanted to offer you something that hopefully will be of some comfort to you in regard to your suicidal ideation (it is/was a comfort to me when I've gone through the same thing)...

Suicidal ideation is a common manifestion of chronic anxiety. In the Wikipedia entry for Soren Kierkegaard's The Concept of Anxiety, it mentions this concept:

Kierkegaard uses the example of a man standing on the edge of a tall building or cliff. When the man looks over the edge, he experiences a focused fear of falling, but at the same time, the man feels a terrifying impulse to throw himself intentionally off the edge. That experience is anxiety or dread because of our complete freedom to choose to either throw oneself off or to stay put. The mere fact that one has the possibility and freedom to do something, even the most terrifying of possibilities, triggers immense feelings of dread. Kierkegaard called this our "dizziness of freedom."

Now, I don't subscribe to all of Kierkegaard's philosophical thoughts (or even to all of the analysis in that Wiki link, e.g. the religious stuff turns me off) but thinking of suicidal ideation as a form of anxiety is comforting because it helps me to recognize that I'm still in control of myself -- especially when I know that I won't carry through on the impulses, and you said that you won't either, so that's very good -- and that the underlying anxiety is something that can be remedied with the right kind of help (i.e. therapy, medicine, or a combination of both).

You're definitely not alone in your feelings. Try to stay focused on the fact that you are healthy enough to know you won't carry through on your ideations, and that even though the impulses are distressing, they are very common and can definitely be alleviated in a healthy way. I'm sending good wishes that you'll find a helpful and healing course of action soon.
posted by amyms at 2:53 PM on February 13, 2011 [3 favorites]


It seems like the primary issue is intrusive thoughts, rather than a desire to commit suicide. Luckily, intrusive thoughts are very manageable! It's just that no one's ever given you the tools to manage them.

I would look to see if there is a dialectical behavior therapy group anywhere around you. This will provide some skills training to help you control your thoughts and manage your emotions.

As an example, one of the skills we teach in DBT is "turning the mind." I like to visualize a fork in a road, with one road leading to scary or distressing thoughts, and the other leading to calm and centered thoughts. Whenever I feel my mind going down the distressing road, I turn it towards the calm road. Even if your mind makes a lot of progress to distress, you can always turn it right back. Practicing this skill when you are NOT thinking of suicide- maybe you find yourself experiencing minor annoyance- can go miles to your ability to turn your mind effectively when you do find yourself thinking of suicide.
posted by quiet coyote at 3:47 PM on February 13, 2011 [6 favorites]


PTSD + chronic depression that turns into a BPD diagnosis might be C-PTSD. It's particular to people who suffered traumas in childhood, and it is a very serious, very tragic thing. It makes me angry at the world that such an illness exists, and that I have it. If you do, too, or think you might, please feel free to contact me. If not, please feel free to dismiss some or all of this advice.

At your next meeting with your psychiatrist, you should ask about several things:

1. Is there medication that can help me deal with these thoughts of self-harm? Ask about the use of atypical anti-psychotics in treating BPD, whether it's necessary in your case, and if not, why not. Ask about SSRIs if you're not already on them.

2. You can't "do your own therapy." If you've had something terrible happen to you, which is what mental illness is and often what BPD results from, you need and have a right to real treatment. I'm not saying you shouldn't be working on your own to quiet your urges to self-harm. But you need tools. Ask about Dialectical Behavioral Therapy, which will give you a concrete set of tools with which you can cope with a whole host of stressors. DBT is usually done in groups. You also need and deserve and should have the basic human right to see a psychotherapist one-on-one. I don't know what the NHS allows, but these are the sorts of things a therapist does -- help a person talk about the things they do, and why they do them, and what else they could do instead. So the question is, how can your psychiatrist help to get you into therapy? Whether it's referring you to resources outside the NHS, referring you within, or simply giving you information about the kinds of therapy available, your psychiatrist should be able to do more than antagonize you about how 'you're doing your own therapy, isn't that sweet!'

Pardon me if I'm way off track, but the diagnosis you've been given is very serious, and you deserve and should be insistent that you need more than scatterbrained suggestions to "not do that." Durr! Oh, look, I've been (insert harmful behavior here)! Obviously I should just not. That's not a solution, it's not an answer, it's dismissive and dehumanizing. If you absolutely can't get the NHS to listen to you, and you can't afford to pay for private therapy, you might look into a DBT workbook as a stopgap solution.

3. Which of the traits of BPD have you observed in me, and how can we address them?

Here's a summary of traits that need to be present in order to diagnose a person with BPD. You may actually be a "borderline type" or "borderline organization," without having full-blown BPD, and you need information from your doctor about what your diagnosis means.

If your assigned doctor won't take you seriously, can you request another doctor?
posted by brina at 4:49 PM on February 13, 2011


You might find this book useful: How I Stayed Alive When My Brain Was Trying to Kill Me: One Person's Guide to Suicide Prevention. Although the tag frames it as suicide prevention, some of the strategies I think also work well to deal with thoughts about suicide even if you are not planning to carry them out, and in any case you say you worry that you might.

You could investigate charitable (free or low-cost) therapy provision in your area.

Feel free to MeMail me if you'd like.
posted by paduasoy at 4:58 PM on February 13, 2011 [1 favorite]


Yes, find a doctor who is more respectful.

No matter what the diagnosis is, look up the cognitive distortions. These are thought patterns that everyone (I know of) engages in at one time or another. Learn to recognize when you are thinking this way, and try to counteract that thinking. This will help counteract some of the troubles you are having.
posted by gjc at 5:30 PM on February 13, 2011


she would reply with 'well, why do you do that? you don't need to do that! tell yourself that you don't need to do it.

Sounds like someone only took the first 30 minutes of a CBT workshop! CBT is not usually so crass.. thankfully ;-)

Anyway, I was in a similar situation to you perhaps 7-8 years ago (bipolar + OCD + ideations + in the UK) and had a similarly unrewarding experience with the physician side of things. Now, though, it's (mostly) all in the past! I sought out a therapist, privately, and attended sessions for some time that were a mix of CBT and "metacognitive therapy." Through this, we managed to work on my assumptions, thought patterns, and other metacognitive skills to a point where I've been able to tackle my problems without medication or significant distress.

So I advise seeking a sympathetic therapist of any sort and to start working through your problems with them. If it doesn't feel like you're making progress, be sure to change therapist! Not everyone will click for you.

An interesting effect of my path is that I still sense some of the problems. I still have obsessive and compulsive thoughts but I can rationalize and turn them on themselves. For example, if I see a cupboard that's slightly ajar and feel a compulsion to shut it (in case, oh, I might die in the next 5 minutes or whatever stupid idea pops up), I can use my improved metacognitive skills to spin it into a compulsion to not shut the cupboard and to move on with my day. Works a treat!
posted by wackybrit at 5:52 PM on February 13, 2011


Have you been following me in the past? It sounds like it.

What you have is not unlike what I've referred to as my Inner Dread Pirate Roberts ("You've done well today, plinth, but I'll likely kill you in the morning.")/

One thing you can do as a coping mechanism is to make a pact with yourself. If you're going to off yourself (which you won't) create a suitably elaborate circumstance that would require far more effort and planning than you could possibly carry out when you're at rock bottom. So much so that it's far easier to get help.

Keep track of things. Over time, you might discover that this is something that happens in the winter and that *surprise* you have seasonal affective disorder. Knowing really is half the battle.
posted by plinth at 6:47 PM on February 13, 2011 [2 favorites]


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