2008 August 19 « Contessa Confessa

I have a blogger “friend” that’s been writing a lot lately about her suicidal ideation and psych treatments. She hasn’t posted anything recently, which has me somewhat concerned– then again, her psychiatrist did have her sign a “no-harm contract” (which basically is a promise to the clinician that she will NOT physically harm herself).

Personally, I find the whole “no-harm contract” thingy kinda kooky (for lack of a better word). I mean, honestly, you’re sitting in a doctor’s office having a conversation about f*cking suicide!– how in the hell is a silly piece of paper going to protect you? It’s like believing your marriage license will protect you from infidelity (and I know that sh!t ain’t true… ).

Anyhow, blogger friend goes on to write that her doc deemed her “safe” enough (or would that be sane enough?) to simply be sent home with a prescription, a copy of the signed contract, and a month’s worth of weekly visits. Apparently, since blogger friend didn’t have a thought-out plan for the actual suicide attempt, she was “good.”

Meanwhile, on my side of the monitor, I’m having all kinds of cynical thoughts– about her, about me, about my mental health, about her mental health (about pills, razors, guns, and ropes). And, I’m thinking, “she’s FINE… but, I’m a f*cking mess!”

Which, naturally, leads me to TRUTH– and how I like to think that I’m being truthful (here on my little space in cyberland), but how I know I’m so full of sh!t. To be truthful would mean that I’d have to OWN my suicidal indeation. It would mean that I’d have to TELL a real-live person what I’m thinking, feeling. And, well, that ain’t gonna happen. And you wanna know why? Because my truth scares even me– and if I was truthful, there’d be NO WAY IN HELL I’d be getting out of that doctor’s office with a few pills, a slim piece of paper, and a calendar full of appointments.

So, how scary can it be?

TABLE 3 Questions to Ask Patients with Suicidal Ideation
Delineate extent of suicidal ideation • When did you begin to have suicidal thoughts? Nice years ago • Did any event (stressor) precipitate the suicidal thoughts? Problems in marriage • How often do you think about suicide? weekly Do you feel as if you’re a burden? Only to self Or that life isn’t worth living? Not really that it isn’t worth living, but that it’s a “waste”– like, what is it all FOR? Why struggle… where’s the payoff?… the goodness? • What makes you feel better (e.g., contact with family, use of substances)? running, but ironically I can’t seem to muster up the energy to get out and run (too tired) • What makes you feel worse (e.g., being alone)? my job, criticism • Do you have a plan to end your life? Not really a plan, but I’ve tossed around ideas– what would I use? Where would I do it? Note or no note? What would cause the least amount of blood? Could I make it look like an accident (so as not to burden my family)? • How much control of your suicidal ideas do you have? Absolute control. Can you suppress them or call someone for help? Can easily suppress them (would never consider calling someone) • What stops you from killing yourself (e.g., family, religious beliefs)? embarrassment, shame, scrutiny, criticism Ascertain plans for furtherance and lethality • Do you own a gun or have access to firearms? No • Do you have access to potentially harmful medications? Yes • Have you imagined your funeral and how people will react to your death? Yes • Have you “practiced” your suicide? (e.g., put the gun to your head or held the medications in your hand)? No • Have you changed your will or life insurance policy or given away your possessions? Yes