Apologies, this is a long post, but it gets into the meat of depression and treatment from the perspective of someone who suffers from depression and the cycle of treatment so many face.
Seeking help for depression is difficult, especially when you’re in the thick of it and can barely force yourself out of bed. If you have difficult health insurance, the search for a provider can be rather daunting as well. For me actually saying the words – the truth about how bad it really was was by far the hardest part. I held out as long as possible until I simply couldn’t trust myself with my own safety.
There are some misconceptions about people who are suicidal. It’s as if all people are exactly the same when it comes to the warning signs. There’s the whole withdrawing from family and friends bit. Then there’s the giving away significantly important items to family and friends. Happiness, even once someone’s committed to the act. Then there’s “the plan.”
I’ve read a number of things about depression and suicide in my relentless search for something – anything that would help. Did I withdraw from family and friends? Emotionally I did, but I was still very much present when I had reached my limit. My marriage was suffering greatly and every insecurity was tormenting every thought. You see, I have abandonment issues. Throughout my life, the most important people have left, be it emotionally or physically. As such, I was convinced of a few things..
For me, I sought validation through wanting to have sex. That’s another misconception that seems to be floating around in the literature. Not everyone loses interest in sex. For some, it’s the only damn release of tension and pressure they have, and masturbation doesn’t cut that need to connect, if only for a few minutes. The validation this is a separate issue, but when I was rejected I’d take it personally on a very deep level. Far more than I ever should have. So, assumption 1: She didn’t love me anymore. Assumption 2: She always enjoyed sex, loved it in fact. She must be having an affair. Assumption 3: She’s going to leave. That last assumption was actually true – I had taken her to the end of her rope. Just like nearly every relationship in the past, she uttered the words “I’m afraid I’m going to come home some day and find you dead.” For that.. For any assumption, I couldn’t blame her. In some ways the thought was terrifying and a relief at the same time. If she left, I was off the hook, so to speak. I could leave this world without making her a widow.
I didn’t give away possessions. Not everyone does that. I feel safe in assuming that I’m not the only one who the thought never crossed their mind, much less if it had that it’d be automatic.
Then there’s “the plan.” In the many years of treatment I never expressed that I was suicidal. I never said how on the edge I was. I’d say that it’s gotten real bad, but I didn’t have the apparent tell-tale signs of uncontrollable crying. You know when I’d cry? Touching moments in movies or songs. Always when I was alone. Not profound touching moments, but simple kindnesses. Basically, anything of fiction. As it relates to my own life, never. I truly mean never. The closest thing I had to a plan was the short letters I had written and kept in the console of my car to be found later at some point. They were difficult to put into words, but they basically tried to explain away any doubt people may be left with as to whether they could do anything or not. The follow-up question would be how detailed the plan was. When I was asked if I had a plan, I’d say “not really.” There was no detail. I didn’t need it. The human body is weak and if someone is committed enough, they will find a way.
So, desperate times call for desperate measures. Survival was always the goal. I’d trudge on knowing it was a cycle, so I’d wait it out. Sometimes waiting it out meant weeks. Sometimes months. On a couple of occasions, more than two years. The severity of the cycles were always the same, meaning that the thoughts of suicide were relentless consuming nearly every waking hour. I also suffer from PTSD which raises its ugly head every so often in the form of horrific night terrors. Toward the end of my ability to keep myself together I sought out every type of specialist. Doctors of every specialty. I had an insurance plan that allowed me access to some of the best doctors in the country – Harvard instructors among those that I saw. Why? Just in case there was some obscure medical cause for the relentless depression. I had stopped obsessing about the past years ago. I was indifferent. I sought out alternative and extreme, even dangerous treatment options. Anything and everything from ECT, TMS, Ketamine injections, etc.
I’ve found through the years having had many psychiatrists that each has their own belief system about what makes people tick. Each had their own opinions about the source of my own torment, and each had their own preferred cocktail of medications. So you start on the one that they prefer for Treatment Resistant Major Depression. After a few weeks, if there’s any response to the medication, which in my case meant one worked almost immediately, provided mild relief, then lost effectiveness. So, we max out the dose, usually over the corse of a few weeks, then add another medication. This requires a ramp-up of the secondary medication which takes anywhere from a couple of weeks to a month. Either way, you wait 4-8 weeks to see if it really makes a difference at a therapeutic dose. No? OK, let’s ramp you off from those meds and repeat the process. This isn’t to knock psychiatrists. It’s really not.. It’s to talk about what it’s like from the patient’s perspective. Having to wait for several weeks for any chance of relief, only for it to fail is so difficult. If you’re barely hanging by a thread, a day is a long time to wait. The process is brutal.
I remember thinking so often that I must be defective somehow. Clearly I must have been defective as a human being for not being able to cope with the stresses of life like everyone else, or dealing with depression. Maybe the advice that others were giving was good and I just wasn’t able to cut it somehow. At least that’s what it felt like. Yeah, you withdraw from them emotionally, but some people can’t be avoided.. Coworkers, family, friends, other people you see regularly.. So, you wear your mask. At some point you don’t know where the mask ends and you begin. “Fake it until you make it?” Living a lie only adds to that negative self-image. You become convinced that people have gotten to know the mask, but if they saw the real you they’d turn tail or talk behind your back.
The talking behind your back? You witness it. You hear terms thrown around out of sheer ignorance. You see the utter lack of compassion, even for those closest to them. It’s as if those suffering from mental illness are somehow less than human. Less than deserving of compassion.. If you did decide to talk to them, what would you say? “I really want to give up. I actually want to die. Not as a form of escape, but more as an act of mercy. You’d put a pet down if it was suffering with something that had no hope of getting better. Why is it not ok for people to be given such mercy? I’m not asking for help. I’m asking to not be alone with this in the end. I’ve been alone all this time with this, but I don’t want to leave alone. Is that too much to ask? I know it’s asking a lot. It’s asking the unthinkable, but just spend a little time with me in silence so that I can know at least one other person knows what I’ve lived with for so long. Bear witness to this unrelenting suffering.” See how that goes. It’s a gamble at best. Considering the alternative, it’s worth a try I guess. In my case, I wrote out for the first time in my life how intense the suffering had become. How close I had come. I handed what I had written to my therapist with the knowledge that she’d take the torch and get me the help I truly needed. I knew that it meant going inpatient and placing my life in the hands of others.
That’s the part people don’t understand with all of this. Control. If you tell someone, you will likely go inpatient. If you’re “free,” at least you can chose when and how. That’s if you’re lucky enough to get a bed in a decent facility that will keep you until you either get better, or your insurance runs out. If you don’t have insurance or you have crappy insurance the cost is staggering. Still, considering the alternative, the cost is inconsequential. In my case, it worked out. It relieved enough of the daily stress to give me a chance to rest. I slept a lot. I went to group therapy, but didn’t talk much. I did talk to interns with brutal honesty. It’s odd how open you can be with someone who cares that you’re certain you’ll never see again. Telling someone else for me was liberating. I had held that secret for so long all alone and it was one of those things that later in the day or night I’d feel a little lighter. There’s something to be said about someone else knowing the dark secret so many carry around in fear of shame, rejection, ridicule or indifference.
So, my “cocktail” of meds ended up being a mood stabilizer and a very small dose of an SSRI to help with premature ejaculation. Yeah – getting older sucks.