This post contains discussion of chronic suicidal thinking. There are no actual suicides described or images. Please read at your discretion.
I was sitting in the office of my Pain Management Specialist. Also in the office was a medical student. I know most people don’t like medical students sitting in on appointments, but I don’t mind. They have to learn about the patient’s perspective somehow, and because in New Zealand their exposure to mental health, as part of their training, is so small, I think it’s vital that they get all the exposure they can get.
I wasn’t there strictly to discuss my mental health but today I knew we would be talking about suicidal thinking. Actually we were discussing a medication the Pain Specialist wanted me to try to treat chronic nerve pain. I was pretty keen to try anything that might work, except I am someone who reads up on any medication that has been proposed.
Why don’t I just trust the doctor in their recommendation? Because I have ‘been there, done that’ and I came off worst. I have been taking lithium for about 10 years. There are many medications you can’t combine with lithium and they can have bad consequences. In my experience doctors aren’t always as careful about this as they should be, so now I do my own research. There is this thing called ‘lithium toxicity’ and I can tell you first-hand that it isn’t nice.
I had done my research and found that the medication being proposed by my specialist had a side effect of suicidal thinking. I know, of course, that drugs are different for different people and that side effects can be very rare, but I needed to be sure simply because I knew myself. I know I had chronic suicidal thought and behaviour for a very long time some years back, which included a few major attempts on my life. There is no way that I was going back there, if I could possibly help it. If I did go back there, I knew myself well enough to know I would be risking my life.
Did you guess which thing was not like the others?
Did you guess which thing just doesn’t belong?
If you guessed this one is not like the others,
Then you’re absolutely…right!
I very quickly found, that day, that ‘one of these things is not like the others’. And that one was me. I started by saying this was a big deal to me, without disclosing too much of what I call the ‘gory detail’. I just said I’d spent a long time dealing with what was eventually called ‘chronic suicidal ideation’.
In what I thought was a rare moment of doctor self-disclosure, the specialist said that he had never had a suicidal thought in his life. The student was nodding, as the doctor admitted that this made it impossible for him to comprehend what I was saying and how I might feel about taking a medication that might put me back there.
I don’t think I have ever had a doctor make such a statement about anything I was dealing with. Mostly my experience was that they would assume to know how I was feeling.
Part of me was thinking ‘one of these things is not like the others’. Wondering what percentage of the world population has never had these thoughts? I don’t even think I can guess, but for the ‘right here, right now’ I knew I was the ‘odd one out’.
These health professionals had never been where I had been. They had never felt what I had felt. From my own pool of thoughts and feelings, they had never experienced no hope, never been so alone that there was simply no future beyond today, never felt that nothing mattered anymore.
I was pretty amazed that day that a doctor would admit he didn’t know what suicidal thoughts were like, and he went on to say that because of that, I would have to make my own decision about whether to take the medication, but that he would stand by whatever I decided. Wow!
My experience is that when I have mentioned suicide before the seemingly instinctive reaction of health professionals is to take over, and leave you completely out of control. Obviously I wasn’t actually suicidal in this conversation, but I had assumed that if I refused this medication, I probably wouldn’t get any other pain management assistance. Except he said he would stand by me, and I knew that meant I would still get their help.
I think that what happened here was that little bit of honesty respected my experience. He was perhaps saying that this time I was the expert about me, the patient. I knew more than he did because I had lived chronic suicidal thought. And from that, my fear went away.
Eventually after we built a framework of support (in case I began to feel suicidal), I decided to give the proposed medication a go. If it worked then it was going to make a substantial difference. Yes, I was scared. I didn’t want to go back to what had been a nightmare for me with sustained suicidal thinking and behaviour. If I did, I could very well end up dead.
I don’t for one moment expect doctors make such disclosures about their own health history. I know that would be completely inappropriate. While what my doctor did reminded me that most people never experience (thankfully) chronic suicidal thinking/behaviour, perhaps the more important lesson for me was that I am the expert of my own health.
This whole interaction made me think, what lesson is there in this for mental health professionals and suicide prevention organisations? Is there any? Maybe the case of a suicidal patient is too risky to have anyone stop and think about patient empathy. What do you think?
In case you’re wondering, I tried the medication (fearfully). No suicidal thinking emerged (thankfully). It took nearly three months to wean up to the recommended dose, at which point the doctor and I agreed that it wasn’t working. It just hadn’t made the anticipated improvement in my pain levels. I’m now in the slow process of weaning off. It seems that there is no medication (available in New Zealand AND that I can afford) that I can use. That is a whole other post.
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