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Mental Health (Expert Forum)
Chronic Mental Illness and Suicide (long!)
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD) , bipolar disorder , dementia , electroconvulsive therapy (ECT) , learning disabilities, memory, obsessive compulsive disorder (OCD) , panic , personality disorders, phobias , post-traumatic stress disorder (PTSD) , schizophrenia , stress , transitions, and work problems.
Chronic Mental Illness and Suicide (long!)
by Toby, Oct 13, 1999 12:00AM
Dear Mental Health Forum,
I apologize up front for the length of this letter and hope I do more than vent but also clearly articulate a cogent question.
I am very frustrated with the catch phrase "suicide is a permanent solution to a temporary problem". For those of us with chronic mental illness, our "problem" can be permanent.
I am a 35 year old female. I have MPD (I was diagnosed long before the DSM-IV!), acute PTSD, clincial depression, and intermittent episodes of acute anxiety. I have had severe sleep interruptions (primarily nightmares) since I was 13 (or for the last 22 years). My PTSD symptoms are generally the most difficult to contain, and I will self mutilate when necessary to maintain my level of functioning.
And I guess that's it. I am extremely high functioning. I have degrees from Princeton and Harvard, have an extremely well-paying job that takes advantage of my creativity and varied interests, and own a beautiful 2-story Victorian. Despite numerous accomplishments, I have never been able to maintain stability for any length of time, and I think my ability to function is largely enhanced by my dissociative disorder. I live in a state of constant emotional turmoil.
I have an extensive history of documented physical and sexual abuse, and sought help my first day in college. I was in and out of therapy until I was about 24, and have been in constant treatment ever since. I have been on an endless array of medications - the most effective of which was zyprexa, which caused me to gain 70 lbs. in less than 5 months and my blood pressure to sky rocket. I have had one extended hospitalization, and 4 shorter ones. I have usually called in sick to my employer from the hospital so that I have some semblance of a life to return to when I am discharged.
I am extremely fortunate to have many friends - I surround myself with people who are healthier than I am, and am allowed the privilege of participating in their lives. But I have been celibate for the last 10 years and have never been on a date (though I was extremely promiscuous in college). Then, last year, I started having uncontrollable vaginal bleeding and had to have a hysterectomy.
My commitment to my mental health has been based largely on a desire to alleviate my symptoms and get better so that I could have a life for myself - a personal life. Maybe a partner (husband), and hopefully children. But this year I have been taking a cold, relentless look at my life and it has reached a point that I just don't want to be here anymore. All of my discretionary income goes to my mental health. All of my psychic energy has been spent managing my symptoms. For more than 20 years, I have had to spend a significant portion of every single day MANAGING myself. And I simply don't enjoy my own company.
I have been suicidal since I was about 9 years old, and have had the same suicide plan since I was 13. I have never changed or modified it - just made sure that I always had the means available to carry out that decision when the time came. It makes me feel in control - that I can choose to live or die. I've written my will, my living will, and assigned my medical durable power of attorney.
I have also always been very honest with my caregivers, but I have been a little more reticent in recent weeks, because I know they have no choice (if only for reasons of liability) to hospitalize me. There is no longer a center for trauma and dissociation where I live, insurance certainly will not cover out of state treatment in a private facility, and the other local hospitals I've been in know less about my illnesses and possible courses of treatment than I do. So, I usually just write down my own treatment plan, and they have been so impressed (especially since I maintain functioning), that I get discharged.
The catalyst for mental state at this time - my recent hysterectomy, severe black depression and the acuteness of my PTSD symptoms (I've been dissociative, but my MPD has been pretty manageable as of late). I promised myself I would never kill myself in a state of distressed confusion. But my thinking is very organized, my thoughts are clear and rational, and I'm almost frighteningly calm.
The reason I'm writing to you is twofold:
1) as an educational forum, please help (or continue to help) others understand that chronic mental illness is not a "temporary" problem; and
2) I know that some small part of me, this very faint voice, desperately wants to live - just not the life that I've been living the last 20 years. I wouldn't be writing you if that wasn't true. I mean, I know you'll probably advise me to continue working with my caregivers, to be honest with them, stay on my meds (new ones are being developed all the time), and just know that it is POSSIBLE that things can get better. But I've been trying (and I mean working really hard - being totally committed) to get better, and the nightmares just won't stop, the terror, the despair, the nausea, the flashbacks, the boredom at dealing with the same material for most of my life. But part of me is like a child who reads too many fairy tales and wants to keep trying, wants to dig in and say "we've fought for so long, we can't give up now".
Maybe part of me does want to live when I think that I'll magically start getting 8 hours of sleep a night, I'll be able to form an intimate bond with a healthy man who is willing to hang in, that children will miraculously appear in my life (with my mental health history I realize that adoption is pretty much out of the question), and that I'll be more than stable, but a healthy, functioning parent - that when my kids look in my eyes they'll be able to see that they are loved. But Doctor, that's not living in reality. That's not accepting the truth of your life, what it has looked like in the past and the direction in which it's headed.
I am so tired. My doctor says I need to think of my illness like diabetes - I think of it like terminal cancer or HIV - it's incurable, I will continue to slowly deteriorate, my deterioration will be marked by extreme (psychic) pain, and it will eventually kill me. Part of me is hanging on so tightly it feels as if my fingernails are going to be ripped out. And part of me says the only way that the pain will ever stop is for me to let go.
Being as honest as you can, are there times when doctors honestly acknowledge that certain mental illnesses (or a combination thereof) are simply untreatable?
Thanx,
Toby
P.S. I searched your archives and found virtually nothing addressing MPD/DID. A couple of articles on that might be helpful as well as more on PTSD.
I apologize up front for the length of this letter and hope I do more than vent but also clearly articulate a cogent question.
I am very frustrated with the catch phrase "suicide is a permanent solution to a temporary problem". For those of us with chronic mental illness, our "problem" can be permanent.
I am a 35 year old female. I have MPD (I was diagnosed long before the DSM-IV!), acute PTSD, clincial depression, and intermittent episodes of acute anxiety. I have had severe sleep interruptions (primarily nightmares) since I was 13 (or for the last 22 years). My PTSD symptoms are generally the most difficult to contain, and I will self mutilate when necessary to maintain my level of functioning.
And I guess that's it. I am extremely high functioning. I have degrees from Princeton and Harvard, have an extremely well-paying job that takes advantage of my creativity and varied interests, and own a beautiful 2-story Victorian. Despite numerous accomplishments, I have never been able to maintain stability for any length of time, and I think my ability to function is largely enhanced by my dissociative disorder. I live in a state of constant emotional turmoil.
I have an extensive history of documented physical and sexual abuse, and sought help my first day in college. I was in and out of therapy until I was about 24, and have been in constant treatment ever since. I have been on an endless array of medications - the most effective of which was zyprexa, which caused me to gain 70 lbs. in less than 5 months and my blood pressure to sky rocket. I have had one extended hospitalization, and 4 shorter ones. I have usually called in sick to my employer from the hospital so that I have some semblance of a life to return to when I am discharged.
I am extremely fortunate to have many friends - I surround myself with people who are healthier than I am, and am allowed the privilege of participating in their lives. But I have been celibate for the last 10 years and have never been on a date (though I was extremely promiscuous in college). Then, last year, I started having uncontrollable vaginal bleeding and had to have a hysterectomy.
My commitment to my mental health has been based largely on a desire to alleviate my symptoms and get better so that I could have a life for myself - a personal life. Maybe a partner (husband), and hopefully children. But this year I have been taking a cold, relentless look at my life and it has reached a point that I just don't want to be here anymore. All of my discretionary income goes to my mental health. All of my psychic energy has been spent managing my symptoms. For more than 20 years, I have had to spend a significant portion of every single day MANAGING myself. And I simply don't enjoy my own company.
I have been suicidal since I was about 9 years old, and have had the same suicide plan since I was 13. I have never changed or modified it - just made sure that I always had the means available to carry out that decision when the time came. It makes me feel in control - that I can choose to live or die. I've written my will, my living will, and assigned my medical durable power of attorney.
I have also always been very honest with my caregivers, but I have been a little more reticent in recent weeks, because I know they have no choice (if only for reasons of liability) to hospitalize me. There is no longer a center for trauma and dissociation where I live, insurance certainly will not cover out of state treatment in a private facility, and the other local hospitals I've been in know less about my illnesses and possible courses of treatment than I do. So, I usually just write down my own treatment plan, and they have been so impressed (especially since I maintain functioning), that I get discharged.
The catalyst for mental state at this time - my recent hysterectomy, severe black depression and the acuteness of my PTSD symptoms (I've been dissociative, but my MPD has been pretty manageable as of late). I promised myself I would never kill myself in a state of distressed confusion. But my thinking is very organized, my thoughts are clear and rational, and I'm almost frighteningly calm.
The reason I'm writing to you is twofold:
1) as an educational forum, please help (or continue to help) others understand that chronic mental illness is not a "temporary" problem; and
2) I know that some small part of me, this very faint voice, desperately wants to live - just not the life that I've been living the last 20 years. I wouldn't be writing you if that wasn't true. I mean, I know you'll probably advise me to continue working with my caregivers, to be honest with them, stay on my meds (new ones are being developed all the time), and just know that it is POSSIBLE that things can get better. But I've been trying (and I mean working really hard - being totally committed) to get better, and the nightmares just won't stop, the terror, the despair, the nausea, the flashbacks, the boredom at dealing with the same material for most of my life. But part of me is like a child who reads too many fairy tales and wants to keep trying, wants to dig in and say "we've fought for so long, we can't give up now".
Maybe part of me does want to live when I think that I'll magically start getting 8 hours of sleep a night, I'll be able to form an intimate bond with a healthy man who is willing to hang in, that children will miraculously appear in my life (with my mental health history I realize that adoption is pretty much out of the question), and that I'll be more than stable, but a healthy, functioning parent - that when my kids look in my eyes they'll be able to see that they are loved. But Doctor, that's not living in reality. That's not accepting the truth of your life, what it has looked like in the past and the direction in which it's headed.
I am so tired. My doctor says I need to think of my illness like diabetes - I think of it like terminal cancer or HIV - it's incurable, I will continue to slowly deteriorate, my deterioration will be marked by extreme (psychic) pain, and it will eventually kill me. Part of me is hanging on so tightly it feels as if my fingernails are going to be ripped out. And part of me says the only way that the pain will ever stop is for me to let go.
Being as honest as you can, are there times when doctors honestly acknowledge that certain mental illnesses (or a combination thereof) are simply untreatable?
Thanx,
Toby
P.S. I searched your archives and found virtually nothing addressing MPD/DID. A couple of articles on that might be helpful as well as more on PTSD.
Doctor's Answer
by HFHS M.D.-SW, Oct 18, 1999 12:00AM
Dear Toby,
It must be very difficult, having to struggle for so many years.
Despite all this you have accomplished many things, how wonderful.
In your letter you stated your doctor recommended thinking of your illness as diabetes. It's true diabetes is a chronic untreatable illness. It is managable with proper medication, diet and exercise, but not currently curable.
Many psychiatric disorders are also managable. The proper medications and therapy help reduce or alleviate symptoms.
Do not give up hope. IF YOU ARE FEELING SUICIDAL GO TO THE
NEAREST EMERGENCY ROOM.
Regarding DID/MPD, not much about the etiology is known. It is often associated with childhood physical or sexual abuse. There are a number of educational web sites for Dissociative Identity Disorder (multiple personality disorder) that may be helpful to you and others.
Discuss your concerns with your therapist or psychiatrist.
Best Wishes
Sincerely,
HFHS M.D.-SW
It must be very difficult, having to struggle for so many years.
Despite all this you have accomplished many things, how wonderful.
In your letter you stated your doctor recommended thinking of your illness as diabetes. It's true diabetes is a chronic untreatable illness. It is managable with proper medication, diet and exercise, but not currently curable.
Many psychiatric disorders are also managable. The proper medications and therapy help reduce or alleviate symptoms.
Do not give up hope. IF YOU ARE FEELING SUICIDAL GO TO THE
NEAREST EMERGENCY ROOM.
Regarding DID/MPD, not much about the etiology is known. It is often associated with childhood physical or sexual abuse. There are a number of educational web sites for Dissociative Identity Disorder (multiple personality disorder) that may be helpful to you and others.
Discuss your concerns with your therapist or psychiatrist.
Best Wishes
Sincerely,
HFHS M.D.-SW
