One Of These Things Is Not Like The Others

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 This post contains discussion of chronic suicidal thinking. There are no actual suicides described or images.  Please read at your discretion.

 

Cate

Click to read Cate’s bio

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?

 After thought

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.

© Cate Reddell and A Canvas Of The Minds 2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Cate Reddell and A Canvas Of The Minds with appropriate and specific direction to the original content.

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25 thoughts on “One Of These Things Is Not Like The Others

  1. This post brought to mind several things. One, that it really is true that no one other than the patient is a true expert at what might work, or what might be detrimental to any proposed plan, especially as it applies to their own experience with other medications or therapies. Also, that somewhere early in my treatment, it was brought to my attention that not all people experience “sustained suicidal thinking and behaviour”. I remember it took me a while to believe this was true, and then it ended up making me feel even more isolated and alone. Before, I had believed that ALL people struggled against the irrepressible desire to end their own life, (in order to end their own suffering and pain), and had always just assumed I was failing at managing this compulsion. After finally realizing that there were people out there that never felt this way, and had no point of reference, it ended up making me feel even more like a freak of nature; somehow damaged beyond repair.

    Thankfully, eventually I realized my “sustained suicidal thinking and behaviour” was a direct result of having lived through many years of chronic abuse (physical, sexual, emotional, and psychological), and with help, I slowly and methodically began learning life skills that helped me overcome the effects of bipolar disorder, chronic depression, post-traumatic stress disorder, and dissociative disorder. Over the years all sorts of diagnoses were applied, and many different medications were tried, and various forms of therapies were used, up to and including electroconvulsive therapy (ECT) with Lithium, as well as hospitalization and rehabilitation.

    For me, medication was not a viable alternative (for various reasons), although initially some medications were helpful in keeping me somewhat stabilized while other therapies were initiated. In my case, life management skills and psychotherapy were probably the most valuable tools that helped me through the roughest of those “sustained suicidal thinking and behaviour” years. I’m now 56 years old, and it’s only been in about the last four or five years that the suicidal thoughts and behaviors have significantly decreased, but just like addicts can never make the mistake of believing they are cured of their addiction, a person who has lived with chronic suicidal thinking would be well-advised to remain cautious and aware of the possibility of such thoughts and behaviors resurfacing. With that being said, I’m relieved to be in a place in my life where I’m able to truly have a tangible glimpse of what the other side of life looks like, when you aren’t constantly plagued by the intense compulsion to end your own life, but rather, you are able to relax and enjoy the little pleasures of life that exist in every direction. Cautious and alert, but also grateful for a different point of view.

    • What you say makes a lot of sense to me. I think I’ve been on a similar (but still different) journey. It is difficult to understand that not all people go through this same journey of “sustained suicidal thinking and behaviour”. For a long time I just assumed that if people weren’t on this road, then they would be some time. Realising that this wasn’t true was difficult for me too.

      I remember a doctor saying to me at one point that I couldn’t expect anyone (including my therapist) to be willing to talk about my suicidal thinking. He said it simply wasn’t fair to put that on anyone. The problem was that his thinking isolated me further. Not only did not everyone think this way, now I wasn’t ‘allowed’ to talk about my own thinking. Thankfully in time, I found a good therapist who ‘allowed’ me to talk about anything and everything, including my “sustained suicidal thinking and behaviour”.

      I think for me too, that therapeutic journey (which lasted many years but is finished for now) allowed me to move beyond that place. But like you I don’t for one minute think it is the end. I suspect that there could be many times in my life ahead where I am plunged back into suicidal thinking. While I have skills I previously didn’t, I believe it will perhaps always be an issue in my life given the right (or wrong) conditions.

      Thanks so much for your comments. They gave me some good thinking.

    • You ended up in the Spam folder six times over, Cat! I have no idea why, and there isn’t much point in publishing those comments, as you did eventually get your message through. I did, however, make sure and mark you as “Not Spam”, so hopefully this won’t be an issue ever again. I do always look through the Spam folder anyway, because of weird hiccups like this, I never assume spam is always spam. As the site admin I’m actually the only one who can access the spam folder, so Cate would have had no way to find your comment. Sorry that this happened, but you get massive determination points! 🙂

      • Hi Ruby…this happens to me so often, whenever I do a long comment, I always copy before sending. Thanks for letting me know 🙂

        • Very strange indeed! My role in blogging has quietly changed over the past year or so, and part of that is that I don’t do very much commenting. When I do, my comments tend to run very long, and having had a few instances where WP has “eaten” my comments, I know the value of copying and saving any comment that runs to more than one or two sentences, so I’m glad you didn’t have to rewrite all of that!

          I wish there was some identifiable method as to why WP marks legitimate comments as spam every now and them. I actually dissected yours for any words or phrases I’ve flagged, and did a few other things to try to figure out what the problem might be and (of course) came up empty. I’ve had it happen with other regular readers every now and again, which is why, as I said, I do always check the spam folder manually.

          Thanks for keeping at it until you got through. Your thoughts are always especially valuable. 🙂

  2. I also prefer to do my own research on meds and have often refused, much to the dismay of health professionals.

    I am in two minds about the doctor. On one hand he sounds insensitive and maybe even a little unprofessional, but on the other, he certainly promoted self-care and freedom of choice.

    If health professionals could learn anything from this it is not to tarnish us with the same brush forever. We do change and so does our risk. Now lets see if my fourth attempt goes through 🙂

    • Cat, it worked. yeah, my experience is that most doctors don’t like it when we use out own brains and research meds. Actually this particularly doctor (i didn’t say this bit) went as far as to say that he wished the internet hadn’t been invented. It seems he couldn’t trust his patients to use good, reliable sites. I didn’t even get into that one. I personally think some doctors want to believe that they are the only intelligent beings on the planet. Was that too harsh?

      I can’t decide about the doctor. I think he was walking a fine line, but I did appreciate that he wasn’t going to tell me what to do.

      As for tarnishing us with the same brush for ever is another bug bear of mine. Thankfully I have shifted often enough that I have had a regular change in doctors so that as long as they don’t read too far back in my notes, I have largely been safe from this. That said, the changes in doctors have other problems.

      • Some Doc’s do think they are above the rest of us. I am lucky in that my GP does change with me and trusts me with a lot more than he probably should have, but I’ve never let that down and it is all part of the patient/Doc relationship

  3. I like your doctor! He is smart to realize that only you know exactly what you’ve been through, and that his job is to help you make an educated decision, not to pressure you to choose a treatment you’re not comfortable with. I would also be nervous about taking that medication, because I have had suicidal thoughts many times, and I don’t want to take anything that might increase the odds of my feeling that way again!

    • I agree. I accept that it might not be the best way of treating some people but for me it was right. I also agree with you about not wanting to take anything that would send me suicidal again. I never want to feel that way ever again and would rather live in pain.

  4. I’m glad you go the appropriate support for that situation, Cate. Hopefully the student doctor will go away having learnt a lot from that interaction, and will be able to put into practice the same level of compassion. And even though the medication didn’t work, you got the confirmation that really, we all need – we should be our own medical advocates and we shouldn’t assume the doctors will automatically know the best options for our situation – regardless of what it is.

    • You’re so right Faith, and it’s something I hadn’t stopped to really think about. We should all be our own medical advocates and we should never assume the doctor knows best. Thank you. 🙂

  5. Blimey. What an awful, despicable creation money is. Other than weapons, our worst, methinks.

    On the upside, now I have a happy earworm. One of the very few happy childhood memories I have. Thank you. Hope that at least that gives you a bit of a smile today

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