Risk Matrix

[Jaquta]

I was wondering ...

when does the benefit outweigh the risk (or vice versa)?

Last year a psychiatrist briefly explained risk matrix's and said that due to my traumatic experiences within the local mental health services that hospital would never be an option.

I am a bit confused as to where to go for support.

I have been feeling increasingly suicidal and ... I'm at a loss as to how to work this.  I often feel so overwhelmed that I feel death is the only viable option.

I was previously diagnosed with severe depression and more recently bpd.
I have been in therapy three times a week until two months ago when my T relocated.  I am currently seeing the head of the psychology department for 50 minutes of ?constructive psychotherapy once a week until a new T is appointed at the end of the month.
My GP has been concerned about the decrease in intensity and has seen me twice a week for the past two weeks.

I feel things are deteriorating and are at a loss as to how to contain them.
I am terrified of relationships and any new involvement.  (Perhaps this is a case of abandonment/ engulfment??)

OK, I am feeling seriously fragmented.

I don't understand the function of the safety stuff and so feel powerless to intervene.
Safety never feels like a very safe subject to talk to anyone about either.
Maybe this is just regression due to lack of containment??  And will pass??

Any thoughts/ suggestions would be greatly appreciated.

J

[Jaquta]

I think there are probably a number of things that are key.  I think good communication is essential.  I think it helps when both parties are receptive.  I think it helps when there is trust.

In an ideal world these may exist, but when a patient is unwell and a doctor is under undue pressure, they don't necessarily happen.

I get fed up with the mhs when they claim to be able to offer assistance in various areas and then when their services are called upon, they either don't understand what is being asked of them or they are inept.

It sounds like you have a good treatment team.

My GP gave me a script for six sleeping pills and 10 lorazepam to help with anxiety.  He was firm when telling me not to abuse them.
When I take medication (or if I take it) it is usually controlled, but sometimes it is not.
I find the responsibility of having medication in the house difficult at times.  (But then our electrician left loops of wires that look like nooses and mum and dad leave needles and syringes in the kitchen and elsewhere).  Everything can be a responsibility.

I agree with you about being open and honest, but ... these people have violated my trust.  When I go to the mhs it feels like talking about abuse with the abuser.
Also, I think clinicians need to be a little bit flexible too sometimes.

The situation is extremely complicated.

I'm glad your therapy is going well.  I hope the next five years are even better.

J

[Brian884]

iF YOU REALLY CARE WE HAVE TO ACKNOLEDGE SOMETHING. I FOUND COMMUNICATION FROM BOTH DOCTOR AND PATIENT IS KEY. MANY OF US HAVE DIFFICULT SITUATIONS. ALL I KNOW IS THAT AFTER SEEING 8 PSYCHIATRIST AND A THERAPISTS. I FOUND ONE I LIKED WHO SEES ME WEEKLY AS WELL AS CHANGING DIET AND ADDING EXCERCISE THAT I TAKE MY MEDS SOME OF WHICH MY DR. TOOK A BIG RISK IN PRESCRIBING  {MEANING ARE CONTROLLED} AND SIMPLY BEING HONEST OPEN AND WILLING THINGS HAVE GOTTEN SO MUCH BETTER IN THE LAST 5 YEARS I CAN'T BELIEVE IT ,
GOD SPEED GOOGD LUCK

[Jaquta]

I am still feeling extremely confused by my situation.

When I reach out for help I feel like a real idiot and feel that there is nothing wrong.
When I am alone I can feel the tension mounting and feel that I do need support.

The psychologist whom I am seeing for constructive psychotherapy seems unconcerned by my increasing stress levels and safety issues.
He did say that morbid thoughts are one way to regulate mood.  He also said something along the lines of the limbic system firing simultaneously with the orbito-frontal cortex.
Does that mean that if I am experiencing strong impulses or urges that I should be able manage them?  Why does that not feel easy?

I also spoke to my GP.  He was going to speak to the psychologist who is overseeing my care at present as he has concerns and is on leave next week.

This feels so difficult.  The struggle between sessions is feeling much harder.
I feel trapped and are starting to feel increasingly desperate.

I don't even know if I need help anymore.
Is the regression an attempt to absolve myself of responsibility when I don't feel I can cope?  I wish this made more sense.

I am so stressed.  There are workmen at home, my mum has severe head injuries, my father is either depressed or has Alzheimer's, I have just had breast surgery and are awaiting pathology results.  I hate people touching me.  Surgery triggered off nightmares about ect and memories of being intubated in icu after a drug overdose.
I try to distract and are confronted with images of me nearly drowning plus our family being involved in a head on car crash.  I enjoy watching medical programs but then desperately want to hurt myself.
I am either binge eating or not eating.  Sleeping too much or too little.  I can't organize myself or structure my day.  I have repetitive behavior which severely impacts on my life and drives me nuts.  I can't initiate exercise.  Climbing Mt Everest seems easier than putting my shoes on and going for a walk.  I was running -I ran a half marathon earlier this year- but I feel defeated by my achievements and they tip me into a suicidal crisis.  I had to have my wisdom teeth out.  I am very sensitive about my teeth and my physical appearance in general.
I just think I'm getting over one crisis when another comes along.
I had four family members die all within one month.  I have problems managing my finances due to my binge eating and impulsive behavior.  I am unemployed, uneducated and basically just a waste of space.

If I need help, is it even worth it?  
It seems debatable, not to mention a waste of resources.

I asked the first psychiatrist I saw what one life was.  He answered with a rhetoric, what is three million?
In the media there are stories of people having killed others (sometimes hundreds, sometimes thousands) who are sentenced to death.
It makes me feel that all lives are not equal and that some are seen as superficial, meaningless, insignificant and worthless.  Is mine any different?  I'm not functioning.

Is there any point treading water, wasting time, trying to change when nothing seems too.  Maybe I am more insightful but my quality of life is still extremely poor.

If bpd is about having a fragmented internal world, why doesn't someone develop an adhesive that will integrate the splits??

I think taking excess medication, etc is a viable option.
I hate that my GP says stuff like: he thinks I have potential, he doesn't think I'm stupid, that harming or killing myself would be a mistake.  I hate that he puts this little beacon of light (and possibly hope) out there in this dark stormy sea that seems to be my life.

I am so confused and I hate myself so much!!!!!!!!!!!!!

J  (I hate signing this and owning my life too!!!!)

And how selfish am I when others are facing wild fires and other real life crises??

[Jaquta]

I'm not sure why that question came up at this point in time.  
At the time, when I did need support, I felt very alienated.

I am currently having issues with pursuing support (or the appropriate support?).
This is confusing.  Not only does my mood fluctuate (causing me to feel I either need support or I don't), but the mental health services have given mixed messages as to what constitutes an emergency and what support can be given.

If on a scale of 1-10 (where 10 is acting) I feel at a 9.8.  That .2 can represent a very fine line, or conversely, what feels to be a world away.

At times I can't get LD 50's, poisoning monographs, hanging, etc out of my head.  (A significant person previously in my life gave me a rope and told me to hang myself plus stuff I have read on the net about cutting off blood supply to the carotid artery which is suppose to render one unconscious pretty quickly).  Along with these I've had urges to abuse alcohol and medications.
I thought discussing this stuff with somebody would dissipate the thoughts, or at the least, the intensity of them.  It is an extremely difficult subject to talk about.
I guess once I gained some insight into my behavior I believed that safety issues communicated to others my distress.  I have since learned that T's are more interested in the emotions that precipitate the crisis (which seems logical when one is able to describe emotions and doesn't split them off).

So I go from thinking terrible thoughts to thinking I need to access support.
Then I feel trapped because of my history, my fear and my degree of wellness.  It seems ludicrous to ask for support when that support entails things you don't like and don't want.  For me in the past that meant hospital, being restrained and forced to take medication, being threatened with, but not given, ect.
Is this what I'm asking for when I'm asking for help?

This is dumb!  This is my dilemma and that is why running away and harming/ killing myself seems the best solution.

Why don't I?  Do I have protective factors, am I too fragmented or too tired to act??
My anger use to drive my suicidal and homicidal thoughts and urges, now I just feel tired and numb.  And when I do feel something I just feel desperate and overwhelmed.

I wish I could see an end to bpd and see myself living a productive/ functional life.
This just doesn't seem worth the effort.

Thank you for listening.  I just need to make it through two more days.

J

[Roger Gould, M.D.]

I don't not understand why you should not be in a hospital if that is required for your  care.  Having a bad experience at one time in history at one place is not a permanent injunction against hospitalization. Only you and your therapist can determine whether you need hospitlizaiton at this time so I encourage you to talk to your therapist about this as a possibility.