Talking Suicide

September 10th 2018 was World Suicide Prevention Day. To mark the day from a personal point of view, I put up a post on my Facebook page and Tweeted too. A few weeks ago I was filmed by the RNLI Film and Image Unit for a short film they are making about my voluntary role with Tobermory RNLI Lifeboat and my accompanying mental health struggles. I recently had a long and helpful appointment with ‘my’ Community Psychiatric Nurse after a long period of not seeing her. This blog entry is a description of how I live with my suicidal thoughts. I hope by sharing this incredibly intimate aspect of my self, I will help increase awareness and understanding about deep depression and suicide. This is an account of my personal experience and cannot be read as a generalisation of suicide per se. I am confident though, that there are contextual similarities with others who struggle like me which will be helpful.

Recently, despite the many good aspects of my life and my uniquely privileged lifestyle, I have been fighting familiar intrusive thoughts that my life is worthless, that I am worthless and it follows that the most natural conclusion is to take my life. These are not constant thoughts which continue to eat away at me through the day and night. They intrude at the most inopportune moments, sometimes fleetingly but generally with enough force to stick for a good while. They are private thoughts, triggered by any number of interpersonal interactions, thoughts, memories and moments. An incredibly astute observer might see for a split second, a grimace of pain cross my face when these thoughts of death reach into me. They would also hear me emit a muted cry of pain or a deep, lingering sigh.

Since I’m so used to this happening, I find myself burying these thoughts and feelings, fighting them inwards and hiding them deep within me. I used to be a psychotherapist so ‘internal dialogue’ fits comfortably as a term which describes what’s occurring. The thing is, there is no voice attached to these thoughts. I do not hear myself or anyone else, actual or imagined. They are thoughts accompanied by powerful emotional and physical feelings. Essentially they are beliefs - basically an overarching belief that my life should come to an end because of my ineptitude as a person.

Whether these thoughts are serious enough for me to become worried about my intentions and I consequently reach out for help, depend on how I grade them. Because I recognise them so clearly now, I give them levels of seriousness depending on how they arrive in my psyche, into my being and how durably they ‘stick’. First off I have the fanciful thoughts. The ones which are romantic notions of taking my life. This could be anything from the day being a lovely and sunny one, when I might think, “this would be a nice day to die”. Or, “I could head out in my kayak, capsize and drift off towards the far horizon”. The latter might be a response to recalling a moment of embarrassment when I believe I behaved badly to someone in my past. This kind of fanciful thinking serves to assuage my painful thinking in the moment by being a distraction, where I fantasize about a semi-honourable death, drifting off towards slow oblivion in a suitably restless sea.

A level up from the fanciful ideations are the ‘thought punches’ into my head and the ‘body blows’ into my being. These are powerful enough to stick and set in train semi-serious thoughts of suicide. Unchecked they might build into more enduring beliefs that the most obvious solution is to take myself off to my chosen tree and hang myself. If they occur in the dark hours of the deep night when I ping wide awake, as I often do, I might consider slipping out onto the deck of our yacht and lowering myself into the night-time sea to eventually die of hypothermia. I would be clad only in my underpants because I never want to be found naked. These thoughts and feelings of powerful desperation are promulgated by the more entrenched self-beliefs I hold about myself. Examples of these being; believing I’m a feckless father, a life failure in employment and business, a wasteful daydreamer, an untrustworthy person, a poor friend, I have nothing of worth to offer, I am a burden, and so the seemingly inexhaustive list continues. These thoughts and feelings may present themselves at any time, whether life is going well or I’m struggling with a dose of depression. Generally of course, they are stronger and more present when my mood is low. I have learned to rationalise these thoughts, to attempt to see them for what they are and realise that it’s certainly not logical to act on them. If I think I’m struggling with this process I might express to Karen (my wife), that I’m having a tough time and “I’m feeling suicidal”. This one simple sentence, spoken out loud and knowing I have been heard, is usually enough to dissipate the strength of the feelings and/or the thoughts I’m experiencing.

However, there are times when these body blow suicidal thoughts stick like a ball of mud thrown against a brick wall. With sun, the mud might set rock hard and become insoluble. (It reminds me of when I was a boy in Africa, my friends and I used to have battles with clay lakkies - hand squeezed balls of mud on the tips of whippy sticks, which when flicked like a tennis serve, sent the mud screaming through the air. Brutally powerful and accurate. Great fun as well to plaster house walls with nasty splats of mud!) What happens is, I find myself unable to now rationalise my thinking with any certainty. The thoughts metamorphose into beliefs and these then set deep within me. The primary belief being that the time has come to end my life and there is no point in lingering any longer. It could be that I might be berating myself for being a horribly curmudgeonly husband or as with 2017, a useless sea kayak guide. The belief that I am eternally useless, worthless and a burden to others, takes root and instead of distracting myself from this belief, I find myself arguing, “why not kill myself?”

This is a dangerous time for me. This is when the thought of death has become realistically pragmatic. It has shifted from being an attractive desire, to one where it is now the most reasonable solution. When I am at this depth, I begin to make my plans. I have already chosen my tree. It is local, within ten minutes walk and hidden from public view. I know the type of rope I will use and its length. Being an outdoor instructor, I know the specific knots I will tie. The only unknown is whether to leap off the branch in the hope I break my neck, or lower myself off and hang until strangulation has done its work. More recently I have been considering immersion in the sea and dying of hypothermia but here, I find myself pulling up short, because I don’t want my Tobermory RNLI colleagues to be the ones who find me. In terms of being found, I have in the past prepared letters for the local police and coastguard with GPS coordinates of my suicide location. I have also written letters to individual family members.

When this is occurring for me, I am now in the grip of deep depression with a very strong desire for suicide.

Even in this state, with every fibre of my being now craving my obliteration, I find within myself a desire to hang on to life and I make my thoughts and intentions known, not only to my wife but my community mental health support network too. This may be the psychiatrist, the community psychiatric nurse or the local GP. I will do so knowing that I may be admitted to hospital and in some respects, this is what I desire for hospital is a safe haven for me. What I fear most, is that the final decision to take my life will be made beyond my conscious awareness. I know within myself from my adventure activities, that before a risky undertaking I have a propensity to weigh up all the factors, and once done, if they are in my favour, to suddenly act without a conscious decision to do so. It’s almost as if my body moves into action before a cognitive process has taken place. I believe that if (when) I take my life, this is how it will be. I will be in the firm grip of a belief that death is the only course of action to take, I will have negated the consequences and I will act on this - suddenly. I use the word courage to describe the motivating emotion which will literally see me release myself from the tree branch I will hang from..

Equally, it is courage which drives me to struggle against the forces raging within me. The belief that I must die is real - in that it appears very real. Any amount of dissuasion by concerned others does not seem to work. I hear their words but do not take them in. In a vain act of self-aggrandisement, I argue the reasons why I believe I have the right to choose my own path and it’s far better for me to end the pain I am struggling with - for pain it is! It’s a palpable emotional, cognitive and physical pain, gripping my thinking and emotions along with a agonised chest. My mind is a continuous maelstrom of self-destructive thinking and the dreadful reasons why this should be the case.

In these moments despite my firm belief that I must die, I do find myself making agreements to keep safe and to make contact with the health professionals if I’m feeling close to acting. In this regard, I’m thankful that I’m a person of some honour because I feel duty bound to keep my word. When I’m considering taking myself off to my death, I find myself agonising with the fact that I would be breaking my word if I went through with the act. However, even then, I have moments when the desire for death is more powerful than my reasoning and this is when I will choose to be admitted to a psychiatric ward. Here, cocooned in the warmth of the ward, I believe myself to be safe.

Recovery happens. Inevitably it takes root within the process of my struggles and inexorably I begin my long climb back to normal reality. Slowly and surely the light and colour returns to my world and to my thinking. Through dialogue and peaceful ‘time out’, I readily grasp onto nuggets of hope and my beliefs of the inevitability of my death are replaced with aspirations and plans for the future. Needless to say this process of recovery is not linear and there will be times when it seems as if I slip backwards. These moments or relegation become sparser as time goes by until at long last, I’m feeling like my happier adventurous self again.

Recovery does not mean an absence of my depression. This will always be there in my life and very recently, I have come to accept that it is an illness I will have to live with, rather than constantly seek a cure. Not having acted on my suicidal desires and thoughts does not mean that I do not have them or that they are not serious. These are not prosaic cries of help which I have often heard suicide referred to in the past. They are real for me and it is only through fighting hard for myself, that I manage to keep myself from acting on my desires.

Being open about my mental health struggles is becoming increasingly helpful for me. Each time I share my struggle (as I am doing here), I gain confidence in sharing more often because of the warmth and the love I receive when I do. My online community of friends and acquaintances are instrumental in this process. Twitter for me is a power for good! I hope that by being open I may normalising the dialogue around the subject of suicide. This is my hope, that increasingly, our society will become less offended or frightened by the subject and becomes willing to really listen to those who need to talk about their suicidal thinking. It is my experience that it is not helpful when I express my suicidal desires some people either change the subject away from the issue, or attempt to make it better by telling me of all the reasons I have to live. I term the latter a sticking plaster approach. Both responses are undoubtedly well meaning and I am grateful for any time I am given by those who have a desire to see my internal pain healthily diminished.

To bring this blog entry to conclusion, I want to say, at the moment of writing this I am safe. I am currently experiencing suicidal thoughts and feelings but I have these in check. There is enough firm reality in my life for me to focus on and I have exciting plans to fulfil. Additionally, there are the powerful metaphoric insights I gained from my 3 Peaks by Kayak journey earlier this year to remind me that suicide is a permanent solution to an impermanent situation. The simplest and most enduring of the metaphoric insights being “live life” when I saw a tragically injured Gannet on the island of Ailsa Craig and “this discomfort will pass” when I was struggling across the eighteen long miles of Luce Bay against a strong ebb tide.

Finally, thank you for reading what I have shared and I welcome any responses you may have. If you have been touched by what I have written and my words resonate and have a personal impact on you, please don’t dwell and find someone you are able to chat to about what you are experiencing. Please take good care of yourself.

Thank you.

This Thing Called Depression

Yesterday I had my monthly appointment with the Psychiatrist who is responsible for my care. I like him and more importantly, I trust him. He is personable with an easy yet professional manner. He is a yacht owner too so we share yachting stories and he likes to tell me of his recent trips.  Amongst these short conversations we also speak of my clinical depression, how I'm doing with this, and checking how safe I am with myself. He is thorough in his assessment of my current situation and willingly offers suggestions for new approaches. This certainly was the case yesterday.

At the moment I'm locked in to a severe bout of depression which is not shifting in anyway shape or form. The medication I have been taking is simply not making a dent on my low mood or even imprinting any form of colour into my life. The upshot is a diagnosis that I'm struggling with 'treatment resistant' depression and if this cannot be overcome with medication alone, then other treatment courses will have to be attempted. 

My Psychiatrist has prescribed one last medication which he hopes will provide me with increased energy and thus motivation to turn my current lethargy around. However, there are risks attached to this medication (see my previous blog post) and it may not suit me. Hopefully this will not be the case and it will work the magic he thinks is possible. It's not a medication for depression per se but there is evidence that it works for people like me, who have been fighting a deeply stuck low mood. 

If this new medication does not work then I will be admitted to hospital for further assessment and possibly a referral to a specialist NHS unit for people with severe and enduring clinical depression. Apparently there are non-medication approaches which can be explored, some of these almost experimental. Thankfully it seems that I'll not be put through ECT again because this clearly did not work for me.

Bringing my session with him to a close yesterday, my Psychiatrist implored me not to give up hope, assuring me that we were nowhere near the end of the road and I was not going to be given up on. One of the struggles I'm dealing with at the moment is a strong sense of hopelessness, sometimes to the point where I believe there is no reason to continue fighting for my recovery. Associated with this, is the gnawing belief that I'm nothing but a burden to my family. I'm not sure if I was entirely mollified by his assurances that I will recover but I did leave the Health Centre with a little more hope than I had before.

I have started to take the new medication which is an adjunct to my current pill regimen. Time will tell if this will work or not. Sadly I will not be able to celebrate their success or deal with their failure with my Psychiatrist because he is moving on to new pastures. I will miss him for his professional and affable care, and the ease with which I'm able to communicate with him. 

Here's to HOPE.

"One Flew Over..." Life On a Psychiatric Ward

My Space                               Photo: Nick Ray

I clearly remember the first time I was admitted to a psychiatric ward. It was 1998 and I was in crisis with deep clinical depression, very thin and underweight. Then, as I walked onto the ward with the Community Psychiatric Nurse who had brought me in, I remember two emotions flooding my limbic system. The first was fear - a fear of the unknown, the fear of becoming mad, the fear of "One Flew Over The Cuckoo's Nest". As the loudly alarmed door to the ward closed behind me, the second emotion then enveloped me and this was by far the most useful one. The sensation of safety and the relief of no longer being totally at the mercy of my depression.

Eighteen years later and this is my fifth psychiatric admission. I wouldn't say that I'm now an old hand but I do know what to expect and the fear of the unknown - the fear of entering a world of madness from which I may never escape, has long since disappeared. It's an odd experience for me to feel a sense of normality in an environment where 'normal' is a concept which many folks here are struggling to determine. However being here does seem familiar and comforting. This comfort is largely due to the healthily warm therapeutic atmosphere created and embodied by the staff team. The ward is a safe environment where apart from physical and verbal violence, anything goes. Expressions of human emotion in all its guises are OK here which is a psychological release for many - like myself. In our society we filter how we express our core emotions of Joy, Fear, Anger and Sadness because we may harbour shame and reticence in doing so. Here on the ward, my tears of sadness are unapologetic. My anger is not extinguished but allowed to burn out naturally. My fear is not quashed but encouraged to be faced and somewhere amidst all these, there are increasing moments of pure joy which burst through the vacated chinks in the emotional armour I have created.

We are a transient, sometimes ragged band here on the ward. Each of us carries our own wounds and we require healing in individual ways. There are unwritten and unsaid laws of existence here. We do not delve into each others lives apart from asking where we live and what family we may have. Any other information which is offered up by a person is warmly received but even then we do not unpick at any loose threads of information for fear of unravelling more than either party has bargained for. We accept each other for who we are no matter what behavioural traits we exhibit. In a way, we are a model social community where each person is met with openness and trust and where no unfair judgement is meted out. Nevertheless tensions do arise and we can choose to interact less with folks we have little in common with.

There's an awareness too of the intimacy in how we live and share our lives on the ward. Sleeping space is shared four to a room, meal times are shared, there are two television rooms and a quiet room and the seating in the entrance hall is a favourite place for folks to hang out. Many on the ward are not allowed off the premises either at all, or unaccompanied. This means that for many of us we are living together 24/7. We learn the valuable lesson of tolerance very quickly and in doing so we accept we each have our personal foibles.

Routine is key to our happy existence here. Very quickly I slipped into being governed by the times for breakfast, lunch and dinner. In between these are set times for tea and coffee breaks. I soon identified what is important for me and I established a routine to meet my needs. I rise at six for my first coffee of the day and to watch the morning news. Often I will be the only person up (apart from the night staff) and I enjoy the calm and solitude. I enjoy the time between getting up and breakfast at eight because of the relative serenity around me. Our time on the ward is very much our own - we are not compelled into any activity though we are encouraged to participate in what is on offer. I enjoy the pottery sessions on a Thursday and the art and craft sessions on a Tuesday. Other than these two I entertain myself with reading (avidly) and teaching myself watercolour painting through the university of YouTube. Very rarely I will allow myself to sleep during the day and when I do it is a delicious luxury. Even more rarely I will sit and watch daytime television knowing how alluring "Homes Under the Hammer" can become after a while. You'll pleased to hear, I hope, that I avoid watching "Jeremy Kyle" at all costs! Dinner is at five in the evening. I find the time after this drags a little where I drift in and out of the television room or sit and read. I sometimes watch a film or programme on BBC iPlayer. After the tea break at eight I then begin to count the minutes to 10pm when I get my medication and a sleeping pill. I need this fast acting sleeper (as we call them) to knock me out before the snoring commences in the room I'm in. My three erstwhile companions are pretty loud and it's impossible for me to fall asleep if they tune up before I have dropped off.

So the routine of life here marches on. Days blend into each other and the weeks slide by just as effortlessly. It's certainly not an uncomfortable existence but neither is it one that I hope to continue indefinitely. It is serving its purpose. I feel safe, I feel cared for and importantly, I feel acknowledged. There is power to be gained from living in the moment - the power of now. I am healing - there is no doubt about this.

I think that in general society is far more aware and more accepting of mental health distress than it was when I first encountered the service nineteen years ago. The view of mental health hospital provision has moved way beyond the one portrayed by Jack Nicholson and his cohorts in the renowned 1975 film. I am confident of openly sharing my mental health experiences and not hiding them away for fear of judgement or shame. However I am less confident about making an admission of my mental health history when it comes to seeking employment and I find this very sad.

I am ready to leave hospital now. The routine has begun to grind and I am missing home terribly but I have to accept that I'm going to be here for a good few weeks more. My ECT treatment is due this Friday and so begins a new phase of treatment for my depression. I can put up with my life on the ward in the knowledge that I am tackling this weight I have carried with me. However I look out of the windows at the budding plants and trees longing for the freedom of the open seas and the cry of the Gulls above. It won't be long now.