A Letter From Your Mentally Ill Suicidal Friend

*TW suicide, self harm

When I wrote this in a notebook last night, I of course had no idea I would be posting this on the death day of Anthony Bourdain. I have elaborated on some things that I would have normally kept vague because of this and made sure to add a "trigger warning" in case anyone is struggling while reading. My only goal is to help. I hope this does. I debated whether posting was a selfish act, as I included a hefty amount of my personal story, but after having to take several breaks to weep for all of us who suffer this way, I feel it was something that just should, maybe must, be written. Indeed, it flew out of the pen last night and onto paper faster than anything I have written in a long time. There are far more articulate people who have probably said it better, but here you are.

In my first post, I told you that two years ago I lost my mind. In course of fact, I have experienced mental illness, including suicidal ideations, since I was a very young person. I was between the ages of 10 and 15 when I started to regularly think the thought, "Buy a gun and shoot yourself." Nothing would prompt this thought. It didn't pop up during any certain mood. Just randomly, unexpectedly, my brain would tell me that I should kill myself, for no apparent reason. So, it was perhaps a culmination of nearly twenty years of relatively untreated and for the most part undiagnosed illnesses, their symptoms, and several drastic life changes in rapid succession that prompted my Britney-esque hypomanic, then severely depressive, meltdown worse than I had ever experienced a breakdown before. Luckily, my little nuclear unit ended up in a safe place supported and cared for directly by people who loved us and encouraged me to seek medical help.

After a few months of confusion, dellusion, diffulty making choices, choosing various forms of physical and emotional self-harm, and finally having to be hospitalized, I started intensive therapy and a variety of medication. Because of where we lived and the support we recieved, my children were shielded greatly from the majority of my mood swings, impulsive behaviors, and a few attempts to kill myself and consequent hospitalizations during the first few months of auditioning psych drugs. Of course, my friends and family needed and explanation to give the children while I was away, and so, "Mommy is sick," was born. Kids are more perceptive than we give them credit for though. My kids are used to hearing detailed explanation and truth. They can tell when there is more to the story than we let on, but, I, as a parent, had to very slowly become able to articulate what "sick" really means in a way they would understand.

That is sort of the purpose of this post. Not to presume I know how to tell you to talk to kids about mental illness, but to maybe explain what having mental illness, and suicidal ideation like mine can be like in a way that may help people to better understand and help someone they love who may experience similar things. The following is the story of my most recent breakdown. After, is a list of sorts that talks about ways to help, and things we do with great intentions that are not only not helpful, but possibly harmful.

A few months ago I was feeling much better. My moods had improved, though I was still very depressed, but I was thinking more clearly. I still had not much further explained my illness as there seemed to be no need. Mommy was sick but she was getting better. Because I remained depressed, I thought a change in one of medications might help, a mood stabilizer that I asked my psych doctor to lower. She agreed it could help. Then, halfway through our visit, she informed me she would be switching practices to a hospital out of town and this would be our last visit. I imagine someone who does not have illness like mine may not have, but I felt shocked and abandoned. It was a sudden change I was completely unprepared for. I had struggled greatly to navigate the medical system when we started treatment. BPD and other comorbid disorders means that change and abandonment are very serious and sometimes intense triggers, but, initially, I handled it well.

I set out to find a new doctor. In my city, there are only three practices that accept state insurance: the one that was now unable to take any more patients as my doctor was leaving, one hospital that had an immense caseload and was heavily regulated by the state, and a small practice with only one doctor who was miraculously taking new patients. I chose to wait more than a month for an appointment with the third option and was told to make sure I had no refills of my meds left when I started. By now, I could tell there was a negative change from having lowered my medication. I was wary of this idea, but I went forward as I was more wary of being a number at the other hospital. So, I waited, and things progessively got worse.

Finally, the day of my appointment, I rallied myself to walk the eight blocks to hopefully get started getting back on track. It was difficult to even leave the house. I was hardly able to do things with the children or around the house, but I was still able to force myself to be present for short periods of time to do those things, if only a little. Worry about this appointment had pushed me to panic several times, fearing judgement, mistreatment, med changes, or worst of all, denial of services. I knew I needed to be under the care of a psych doctor soon before things got out of control. I could see the signs and I wasn't headed a good direction.

In the waiting room, in front of other patients the secretary or nurse for the doctor informed me very loudly that I wouldn't be seen because I had been being prescribed a low dose, narcotic anti anxiety drug. I began to feel the panic coming in quickly and tried to slow my breathing and hide the attack, but I was showing classic visible signs. If you have ever tried to do this, you know it often has the opposite effect.

"I am okay with going off that medication," I struggled to say through uneven breaths.

She turned on her heel and said as she left that she would talk to the doctor. When she returned, my breathing had gotten worse despite my best efforts to calm myself. I was afraid I was no longer in control.

"I'm sorry. We would have to keep prescribing it, and we dont do those here."

"I don't understand." I was huffing and crying without my consent, knowing I was overreacting, accutely aware other people could see me, inwardly chastising myself. But I knew this was wrong. She shouldn't be talking about this in front of people. She should be helping me through this attack. I just wanted to advocate for myself.

I pleaded, "I dont have to take that medication, but I really need a psych doctor. Things are getting bad."

"I'm sorry," came the middle aged woman, almost ching me off, "Maybe you should try to go to (other town,) to your old doctor."

At this, I became insensed. My situation did not allow for the 37 mile one way trip. I was very close to being out of a very important medication that I had already not been taking enough of and any option to get a refill prescription would be a wait that could mean I would miss possibly several days. That would invariably mean a very steep decent or incredible rise in my mood which could mean making sudden, drastic or destructive decisions. I began to sob.

I want to pause our little doctor's office tragedy to explain. Once in a manic or depressive state, depending on how severe, I can sometimes no longer see the difference between what is real and what is false. I have very believable and logical dellusions that people are interested in hurting me or leaving me. I begin to make impulsive choices with very little or no thought about the consequences and create dramatic and sometimes tragic dillemas that can be further exacerbated by more impulsive decisions, dellusional thinking, et cetera. To simplify, going off my meds suddenly could mean me being stuck in the house, choosing self harm or other coping mechanisms to deal with depression, or I could be moving across the country with zero plan and a handful of dollars. Or, you know, I guess there's a chance my brain would right itself and for the first time in my life I would think like normal people without having to work at it. One could hope, you know, for a miracle, where never again in my life would I be eating my daughter's birthday cake with her and think while we laugh, "None of this is real. Kill yourself."

"Are - you se- rious?!" I said, incredulous, between uncontrollable breaths just as the doctor came into the waiting room. He shook his head, scowling disapprovingly and held up a hand as if to say, "Stop acting this way." I was appalled.

"Come with me," he ordered. There was no comfort in the voice of a man who should be able to see how panicked and highly emotional I was.

"I- just... wow... no..." I said gathering my things and desperately trying to gather myself.

As I made it to the door, without any consolation, the woman said in a loud voice, "There's always (other town.)"

It was warm outside. A bright sun forced me to remove the button down overshirt I wore as I struggled every step to control my breathing. I walked more quickly than usual, not wanting to be seen breaking down behind a building. I walked down alleys and through the neighborhood in hopes no one would stop and ask, "Are you okay?" Or stare unabashedly at my wet, red face and heaving chest.

Over the next couple of months, I used my PCP for med refills and luckily did not miss doses, but through some oversight, the medication was lowered again. Because of an insurance issue, raising the medication would mean a wait and I was so terrified of a breakdown, I just decided to wait, but things continued to get worse and now I was again experiencing racing thoughts and more frequent suicidal ideation. I want to be clear that I have never not thought about killing myself for very long and that it doesn't always mean I am at incredible risk. But I could tell the risk was getting high because the tools I had learned to use through therapy were not working as well. I was unable to focus. I was on the verge of neglecting my kids and was losing my temper with them constantly. I knew I needed help. My husband worked hard to pick up my slack, but he was coming to the end of his abilities and I was becoming very suicidal. I cried out for help from people around me until I was finally able to get a break and try to focus on therapeutic things to bring me away from the edge. So many people have reached out to help in so many ways, it is incredible, but that has not always been the case. This is the best support sytem I have ever had, and, because of therapy, I finally know what to ask for and what I might need.

When I saw that I was headed for another hospital visit or worse, I knew it was imperitive to get the kids somewhere safe. Even if nothing happened while they were gone, they would get a vacation and I would get a break. My emotions were volatile and some friends came to the rescue and offered to keep them for a while, but my daughter needed to better understand. And so it was time for a real explanation.

"Why are you sick though?" She said with tear filled eyes. "What makes you sick?"

"I don't know for sure why, but I'm not sick where my body hurts a lot, though it does sometimes, or with a fever or runny nose. I'm sick inside my brain. And it does hurt, but not like a headache. It hurts because it makes me feel sad and angry for no reason at all. And sometimes it makes me do and say things I would not normally do if I am not careful and don't take care of myself and stay responsible."

"Can't I help you?" She said, seeming to be mulling over what I had said.

I thought for a moment about that. Certainly this should not be her responsibility, but I would be lying if I told her there was nothing she could do. We can all always do something.

"Sure baby. When I need quiet time and ask you, you can try to keep the noise level down. You can offer me lots of hugs and kisses whenever you want to and you can remind yourself when I am sad that it doesn't have anything to do with you."

I feel confident in that response and I think it's a good starting place for people who are close to people with mental illness. I think the first step to helping us is believing us and trying to trust the help we ask for (given it is not harmful, or manipulative) is what we need.

I've compiled a list of do's and don't's for supporting your depressed or suicidal friend.

• Believe them when they tell you it's bad. Do not down play or minimize. Good questions are, "Do you feel safe where you are/ with yourself?" "Do you know what you need?"

• Offer your presence if possible or to talk with them in some other way, but make sure to stay present in your conversation and, if they have expressed that they are thinking about or planning suicide, it is sometimes a major help if you can keep them talking.

• Learn some of their warning signs for a very low or suicidal place. They may even be willing to talk to you about that stuff because that is a great way to keep ourselves safe. Generally, a big red flag for just about everyone is making or having a plan for killing themselves. At this point the person has made a commitment to end their life.

• Ask your friends how they are. If they give pat answers, like, "ok," or, "fine," ask again and let them know you are asking because you truly want to know. Don't force them to talk. Just making sure they know you are genuinely interested and available is enough.

• If they are in a bad place, ask what you can do to help, not if. They can totally still turn you down, but you have made it easier for them to accept your help by keeping them from having to ask. You've changed the thought from if they want your help, to what they need. This is good even if they opt out because they are focusing on solutions.

• Randomly let them know the good things you have seen them doing, especially if whatever it is may be hard for them. Tell them the things you like about them or admire in them. No need for a long winded letter of love. Just a couple sentences worth of compliment can go a long way for anyone, mentally ill or not.

• Remind them they are loved, why, and by whom. Details are important sometimes because we can collect evidence pretty quickly in our heads to negate your claim.

• Be honest about those compliments and stuff but also about your feelings. Telling us how you feel can help us stay accountable for our behavior.

• "You are not a burden." "I really enjoy hanging out with you." "Thank you for being here with me." "That sounds rough. Want to talk about it?" "I believe you can make it through this. Can you think of anything that helped before?"

• Offering physical comfort is great, but always ask first and respect consent. I really enjoy being touched. It is very important to me, but before, during, and after a panic attack any kind of touch could send me into hysterics.

• A little on consent: The only "yes" that exists is "yes." "Maybe," "I don't know," and, "I'm not sure," are all a no. An answer like, "If you would like a hug later, I'm down," is great, or, "If you would like, I can hold your hand/ stroke your hair/ hug you/ let you lean on me when you are ready."

• Remind them of something they have to look forward to, or plan something that is acheivable and follow through.

• Make them dinner or bring them food or a snack. Offer to stay while they eat or eat with them, but don't be offended if they say no.

• Offer help with everyday chores or duties. Offer your company for errands or appointments. These things can be rife with anxiety and loneliness, and can be less overwhelming when you are not alone.

• Try not to take insults or calloused or cynical dialogue personally. This could very likely be a tactic to push you away before you have a chance to abandon us.

• If the person is actively suicidal, talking about a plan to kill themselves, or threatening to take their own life DO NOT CALL THE POLICE unless you have done all of the things I have listed that are practical in the situation, and a few more which I will list shortly. Calling the police on a suicidal person can mean financial ruin from an ambulance and hospital bills, and could be deadly, especially for a person of color. Here are some more things you can do, specifically when someone is suicidal, before involving the authorities.

• Offer your presence. I know I said that already, but it is so important that someone be with this person. Offer to give them a ride, or to bring a friend over for them. Offer to bring them something comforting, or something they like.

• Remind them that there is no hurry. Affirm that it is their life, but what's the hurry? You could always see how you feel in a few hours, or tomorrow. "And, remember that thing we have planned... maybe that will help you feel better."

• Offer to take them to the hospital of their choice, and to wait with them to be seen.

• Ask them if they are willing to make a "contract" with you, an agreement that they will try their best to refrain from harming themselves for x amount of time until you can see or talk to them again.

• After you have exhausted all of these options, if the person is actively tryng to kill themselves, combative to themseves or other people, or has become unresponsive/ incoherent, it may be time to call for an ambulance. Before asking to involve anyone in law enforcement, be sure there is no other option to keep the person from harmimg themselves or others. Remember that involving the police is dangerous at best and deadly at worst.

Remember, if someone has decided to come to you with this, they are choosing to trust you with their vulnerability. Some things you should avoid, and maybe never do with someone who is experiencing thoughts of self-harm or suicidal ideation and has confided in you:

-Relate by talking about that one time you felt suicidal. "I've been there," is not only not helpful, it is most likely untrue. There is a difference between having suicial thoughts as the result of a trauma, or "hard times," and struggling with chronic suicidal ideation. They are only similar in that if they are not taken seriously and treated accordingly, they have the same end.

-Offer prayer/ spiritual guidance without request. Phrases like, "Have you prayed about it?" and, "Sending lots of love and light," are dismissive, though their intent may be pure.

-Say things like, "It will get better." You simply do not know that. A better direction to go may be, "I know things may not get better, but they will probably change."

-Do not offer advice unless it's asked for. Just don't. Anything that starts with, "Have you tried," or, "You should," is probably one to mark off the list.

-Do not suggest or encourage big changes that have not been thought about and planned for thoroughly. If the suicidal person is complaining about their relationship, suggesting they leave while they are in a vulnerable mental state could set them up for failure. Unless the person is in danger, do not suggest big changes to their lives.

-Tell them the damage their death will cause. I can just about guarantee they are already thinking about that and are already carrying the guilt as if the deed were done. A better way to make your point is, "I will miss you if you go."

-Tell them they are a coward, or are "taking the easy way out." In the movie Cloud Atlas
::SPOILER::
Robert Frobisher writes in his last letter, "A true suicide is a paced, disciplined certainty. People pontificate "suicide is a coward's act". Couldn't be further from the truth. Suicide takes tremendous courage." If you have ever sat with the object of your demise and prepared for the end, then you know there is nothing cowardly about it. I fear the day that I am brave enough.

-NEVER ever say, "get over it," or, "You won't really do that." Believe us. We know when it is bad.

-Avoid phrases like, "I'm sorry," or, "You're so strong." These are dismissive.

-Never ever compare them to others or yourself in a way that would suggest, "some people have had it worse." Never.

EDIT:
I left out something incredibly important. You are not responsible for your friend's life. This was meant as a list of ways to support not necessarily prevent. You cannot fix or cure them. You are not responsible for their happiness or their depression.

This blog took a lot out of me to write, and I hope it will not be used against me, but I feel it is important for mental illness to be visible. It is important for marginalized groups and poverty, and all the things we like to hide and pretend aren't there to be visible to all but especially privileged people. That is how we create real and lasting community: by honestly viewing our society, and it's flaws, and making a concentrated effort to rectify them. Thank you if you got this far. You reading my writing is an accomplished goal for me. If you liked it or you think it could be helpful or meaningful to someone, please feel free to share wherever you do your thing.

Until next time.
ReformedPirate out.