suicidal ideation

Wellness Plan – Wrapping It Up

Peggy Rice2 Comments

I’ve now written several blogs about my Wellness Recovery Action Plan, or WRAP. And it’s time to finish off this series.

The next two sections of the WRAP plan are entitled “When Things are Breaking Down or Getting Much Worse,” and “Crisis Plan.” I’m lumping these together because both point to severe symptoms, and the potential imminence for a relapse of my depression.

According to Wellness Recovery Action Plan (Advocates for Human Potential, Inc., copyright 2018), “sometimes, even when you’ve been making your best efforts to stay well, things can get a lot worse. Some people call this a breakdown, a setback, or a relapse….often your behavior changes so much that other people can tell something is wrong…Taking immediate action can make a difference in the outcome.” In fact, I might be able to avoid the Crisis part of my plan if I can successfully turn this situation around.

Some of my key indicators that things are getting much worse include that I am staying in bed, isolating. I feel anxiety and a heaviness in my chest, an urge to drive fast and recklessly, a desire to smoke e-cigarettes (I’m a non-smoker). I may have increased trouble concentrating, which was also a red flag in my Early Warning Signs.  But in this case, it would be worse. I’d be feeling like a burden to everyone around me. I may have the desire to self-injure or have suicidal thoughts (called suicide ideation – thoughts, but not a plan), and I’d find myself unable to pray. I’d dread the future and ruminate on the past. I’d have flat affect – expressing very little emotion.

So what do I do if things get much worse? First thing – tell someone! My husband, sister, or close friend. Call my therapist and psych doc right away. Reduce caffeine – drink herbal tea instead of coffee – and sit in my glider, which I find very calming. I would try to Face Time my old therapist – he can often “talk me down.” I think I’d call in my second round of support – three other close friends who I know love me and would offer me encouragement and prayer. Perhaps, if these steps work, a relapse would not occur.

The Crisis Plan portion of the WRAP is designed to make it as easy as possible for people to help me, because if I am in a depression crisis, I might not be able to make my own decisions. It outlines who I want to help me – by name – and exactly what I want them to do for me. Things like get me to the hospital emergency room, sit with me, hold my hand. And what I don’t want done, like what medicines I can’t take. It even outlines my daytime and household responsibilities and who will do them, like care for the pets and pay my bills and contact and keep my prayer team updated.

After the crisis has passed, the Post-Crisis Plan is implemented. It’s a brief section of the WRAP where I identify things that worked in my WRAP Plan, and things that need to change. Perhaps there are people I need to thank for their help in my crisis; perhaps there are apologies or amends I need to make as a result of things I said or did during my crisis.  This final portion of the WRAP allows me to step back into the responsibilities of my daily life, slowly, as I begin to return to my normal level of wellness. This may take time – crisis recovery is not immediate, and I will need to be patient with myself. But this is a good time to evaluate and make changes to my WRAP, as I can see what worked and what didn’t. Because post-crisis can be very introspective, it’s a good time to modify my WRAP to include stressors or early warning signs that I may have missed before. I can add to the Crisis portion of my plan while it’s still fresh in my memory – what additions do I need to make so that, heaven forbid, things go more smoothly the next time?

Ultimately, the goal of the WRAP is to help me avoid a depression crisis – to identify those markers ahead of time to avert another hospitalization or emotional break down. Because this plan is so thorough, I may be able to stay in remission for the rest of my life.

Semicolon;

Peggy Rice11 Comments

98D74ADA-9F2F-44E3-8BFD-9EFAFECAA27E(TRIGGER WARNING – suicidal ideation)

I got this tattoo a week ago. I’ve wanted one for years, and finally decided to just do it! I incorporated the semicolon; it’s in response to Project Semicolon. “The goal of the project is to restore hope and confidence in people who are troubled by addiction, depression, self-harm, and suicide.” The idea is that instead of a period, where life would end, there’s a semicolon – life continues. Like their website says, “Your story is not over.”

Back in 2009, the medication I was taking that caused the serotonin toxicity made me think lots of suicidal thoughts (suicide ideation), to the point of having a plan of how and where (but not the detail of when). While I was never truly suicidal (my level of suicide risk was not high enough – I didn’t have all the markers), at the worst all I could think of was that I didn’t want to live in pain anymore, didn’t want to be “here” (in this life); I just wanted it over.

I had those “death thoughts” for days and nights and weeks, increasing in frequency. It reached an intensity that the idea of death ran through my mind constantly, even in the background when I was busy with other distractions like work. I was so incredibly miserable, so hopeless, and I couldn’t imagine that I was ever going to feel differently. The ache in my chest was all-consuming, and felt like it was eating me from the inside out, wearing me down, gnawing at me. My plan was to take all my pills, but when I was driving I would fantasize about plowing head first into a large on-coming truck or driving off the edge of a cliff. I had these thoughts, but the plan never went anywhere because I couldn’t imagine putting my family through the aftermath-pain. I never got completely to the point where I assumed everyone would be better off without me. I thought it a few times, but quickly pictured faces of family and friends crying, and knew I couldn’t do that to them. So technically, I wasn’t suicidal. But it sure felt like it to me.

One evening before bed, I poured a handful of my sleeping pills into my palm and looked at them all. “How easy,” I thought, “to simply take them and go to sleep and not wake up. ” I scared myself a little by having them in my hand, and so I poured them back into the bottle, all but those prescribed on the label.

Several days later, I called my therapist and told him that I was feeling very out of sorts, rather hyper, and that I wanted to hurt myself. He asked if I had a plan, and I told him yes; then he made me tell him what it was. I told him that I would take a huge handful of pills, probably all of my sleep meds, and just go to sleep and not wake up and the pain would all be over. He asked me where I was. “At work.” He told me to call my husband, at his work, and tell him to go home immediately and gather up all of my medications and hide them – he would be the only one allowed to give them to me. I promised my therapist, hung up, and sheepishly called my husband and told him what I needed him to do. I think it was the first time I had to openly admit the seriousness – the depth of pain – of my illness to him. My husband put all of my meds in our safe in the closet, and carried the key with him from then on.

The suicidal thoughts felt very real – they were in my head – but my therapist and psych doc and husband and friends kept reminding me that they weren’t my thoughts. They were caused by the wrong medication and resulting chemicals in my brain. They would eventually go away as my system got used to a different med and as I began to feel better. I didn’t believe them, but I trusted them, and so I started telling myself that when I would begin to think hopelessly. And it did work – took awhile, but eventually I could see that the thoughts were caused by the meds and the depression, and were not really my own.

But I wonder sometimes if they ever go away. Completely I mean. Once I’ve had those thoughts, they are somehow a part of me. I have to be cautious to fight to keep them away when depression comes and brings hopelessness. And even though I still have those safe-guards that will keep me from following through (concern for those “left behind,” promise of God’s Presence – my personal faith in Jesus, fear of the physical pain, and the shame that would remain – I’d be worse than just depressed, etc.), I know the thoughts could come again.

I later became friends with a person who had tried to kill herself with meds, and I learned that my plan would most likely not have worked, but would have made me incredibly painfully sick, perhaps throwing up blood as I tore apart my insides and in a coma with breathing difficulties. I would have had a whole other layer of shame to deal with – not just the shame that often comes with depression, but shame that comes from putting loved ones through such trauma as a suicide attempt.

I now look back on this time and thank God for saving me, for putting my husband and therapist and doctor and friends in my life who didn’t give up on me, even when I kept thinking about giving up on life. I thank God for different medications, for keeping me safe, for His Presence. I thank Him for the semicolon, and for the way He can use my depression now in helping others because my life goes on.

2 Corinthians 1:8b-10, personalized
“I was under great pressure, far beyond my ability to endure, so that I despaired of life itself. Indeed, I felt I had received the sentence of death. But this happened that I might not rely on myself but on God, who raises the dead. He has delivered me from such a deadly peril, and He will deliver me again. On Him I have set my hope that He will continue to deliver me, …”

Calling for Help

Peggy Rice10 Comments

TRIGGER WARNING: a statement at the start of a piece of writing, video, etc., alerting the reader or viewer to the fact that it contains potentially distressing material (often used to introduce a description of such content).

TRIGGER WARNING: suicidal ideation

I was recently having breakfast with a wonderful friend whom I’ve known a long time. She is the supervising manager (or some title like that) for a service offered in my old town. People can call with questions for anything – from needing to know which bus line picks up at the mall in the afternoon to whom to call with questions about public housing to someone to talk to when in a personal crisis – an information and referral hotline. I was telling her about the time in 2009 when I called.

I had just been diagnosed with serotonin toxicity, and my new psych doc had taken me off all of my medications to clear out the brain chemicals. He had prescribed mood stabilizers to help me function and my husband was in charge of distributing them. That had happened on Monday, this was now 12 days later – very blurry days. My doctor had told me that he would be on rotation in the psych ward starting Sunday for the next two weeks, and I shouldn’t hesitate to come to the emergency room if I needed help. He made me promise not to hurt myself. The serotonin toxicity had caused some suicidal ideation (thoughts about death and dying but not acting on them).

I remember lying on our bed, wrapped in my blanket which I was hauling around with me like a child. I dialed Great Rivers 2-1-1 and a lovely voice answered. I remember thinking that my voice sounded shaky.

She asked why I had called, and I told her that I wanted to know how to know if I should go to the hospital to admit myself to the psych ward. She asked if I was planning to hurt myself. (TRIGGER WARNING:) I said no, I couldn’t, since my husband had all my medications. I went on to explain that I was under Dr. Larson’s care, and he had said I could come in if I didn’t feel safe. I didn’t have any option but to be safe – my only suicidal thoughts (again, suicidal ideation, not action) were thwarted since my meds were in our safe and the key in Chris’ pocket. But still, I didn’t feel like myself, was very out of sorts. Of course, I was too tired and too weak to hurt myself – that takes energy and planning, and I didn’t have any of those. And like I said, these thoughts were not my own – they were caused by the over-saturation of serotonin on my brain. They sure felt like my thoughts, though – they were in my head.

I cried and told her I was scared, and tired, and didn’t want to fight anymore. She asked where Chris was, and I told her he was working outside in the yard. I recall it was a sunny day, maybe a slight breeze – very nice for late November.

I talked to her for awhile – I don’t remember about what. I probably told her that I had depression and my doctor was doing to be at the hospital on rotation tomorrow, and so maybe I would go in then. She thought that was a good idea. She asked if she could call back in a half hour and talk to my husband, just to tell him that we had talked. I told her, “Sure.” She made me promise to call her back if I needed to, and said she would call in 30 minutes. I hung up and told my husband, so he could wrap up what he was working on (raking leaves?) and come in.

She called back, and talked to him about how to take care of me. Not that he had to sit with me every moment that I was awake. He needed to know what I was doing, but not to hover, and he didn’t have to worry about leaving me unattended. She told him that we had talked, and that if I still wanted to go to the hospital the next day, he should take me in.

I don’t have lots of details of memory from those days – the hours kind of run together – I did a lot of sleeping. And I don’t remember her name. But I remember her kind voice, and her care – enough that she wanted to make sure my hubby was ok, too. I know that when we talked on the phone, I didn’t feel alone. She didn’t sound alarmed at my call, or even worried. She spoke in a soft gentle voice – very calming. I was glad I had called for help. Just hearing the voice of someone who cared got me through the rest of the day. I wish I knew her name so I could thank her.

I went into the hospital the next day.