November 14, 2018
Dear Brian,
My last letter to you was a bit of a leap of faith... I wasn't really sure what to expect after I shared about my suicide attempt and my on-going struggle with suicidal ideation.
I was a little surprised and overwhelmed at the outreach I received immediately after I posted the letter. After all, depression tells you that you're worthless and that you wouldn't be missed. So to be reminded that that's not the case certainly was very emotional for me.
I had a variety of responses, most of which were assurances from friends that I could call on them at any time at all, day or night... which, of course, was much appreciated. I had a few suggest grief support groups for survivors of suicide loss... but I've already done that; I've done the meetings, I've grieved your suicide and am at a healthy place where my grief is concerned. I want other survivors to know that the grief does get better with time. My current mental state is not a result of your suicide, this pain is very separate from my grief over your death. Besides, it is frowned upon in those meetings to talk about one's own desire to die; it's just not the appropriate forum for that as it can be very triggering for survivors of suicide loss. That's what individual therapy is for.
I also received a lot of invitations from people to get together, go out to dinner, etc... and that's not what I was looking for or expecting. I realized that the offers were more about a way to make themselves feel better about having at least tried to reach out and that's OK. I declined nearly all of the offers because I'm not particularly good company these days and I'm certain the offers were just a formality of kindness, anyhow.
I had a few reach out to tell me that I need Jesus in my life and that He wants to help me and take care of me. I fully respect the unconditional love behind those offerings, so I wasn't offended by them; I know they were just trying to offer help the only way that they knew how. But I've done that, too. I was raised in the church. Even into adulthood I was very active in church and I believed in God. But as I got older, religion (the Bible, specifically) just didn't make sense to me at all. And besides.... all those years that I was a "believer" I was still suffering from major depression, suicidal ideation and regularly engaged in self-harm. Having a belief system didn't take an ounce of my pain away... so I really don't feel I'm missing out on anything there. It brought me no comfort then, and I don't believe it would now.
Over the years, people would tell me, "You should really exercise more. The activity will be good for you, it'll release endorphins to ease your depression." Again.... I've done that. At my fittest point of my life, I was barely 120 lbs, running a minimum of 60 miles a week, consumed no alcohol nor caffeine and ate a well-balanced, healthy diet. Yet... I was still chronically depressed and would self-harm up to 3-4 times a day. By no means am I saying that exercise isn't good for me because of course it would be. But would it take away my depression? Absolutely not.
The biggest frustration is when I'm told, "Just reach out, just get help." I can assure you that anyone that says that has not had to spend much time seeking help for a chronic mental disorder. I decided that I'd like to share just a handful of some of my experiences to elaborate on my belief that help just isn't there.
Back when I was about 25 years old, I hit a deeply low point and was contemplating suicide and harming myself pretty often. It took more courage than you could ever know to make that phone call to try and get myself an appointment with a mental health professional. Here's how that conversation went:
Me: Yes, I'd like to make an appointment with a psychiatrist, please.
Her: What's this for, ma'am?
Me: (stuttering) Well... I.... I... I'm very depressed. I've been self-harming a lot and I'm afraid I'm a danger to myself and I think that I need help.
Her: (sounding agitated) Well... you can try, but know that we are pretty booked up and we won't be able to see you for at least 12-14 weeks.
Me: (on the verge of tears) Is there a waiting list or anything? If something opens up, I can even come in that same day. I just really need to find somebody who can help.
Her: (after a long sigh, with a snippy tone) Well, I mean.... are you gonna kill yourself TODAY? If you are, then you just need to go to the emergency room. Otherwise you have to wait 3 months. What's it gonna be?
Me: Thank you for your time.
There are plenty of therapists out there. But finding a good one... or finding one you can really relate to is another thing. One therapist I saw for a few sessions when I first started to address my self harm said to me, "If you're going to continue to cut yourself, then I refuse to see you. If you want to continue therapy with me, that needs to stop right now." I was floored. That was WHY I was coming to them for help, because I was trying to stop and I needed help getting down to the root cause and deal with it. It wasn't until a decade later when I finally had one kind therapist that understood me and my disorder and simply told me, "I understand why it happens but I wish that it didn't. As we get into really talking about some deep issues that you've been suppressing, it might start to happen more frequently for a while and that's OK. All I ask is that you're honest with me about it, that we can talk openly about it and that you seek medical treatment if you're in danger." She was wonderful. I saw her regularly for a year until my insurance decided to stop reimbursing her for our sessions and she had to ask me to pay out of pocket; but $130 an hour was just not feasible for a young person barely making rent so I wasn't able to continue my therapy with her.
Monday, November 30, 2015 was my first day back to work after the death of our Mom; I happened to have an appointment scheduled for that day to follow up on my progress with my medication. My psychiatrist was pretty surprised to see the shape I was in; I was crying uncontrollably and I couldn’t stop. So of course the obvious question came… “Did you harm yourself?” I’ve made it a policy to always be honest with my doctors and therapists when I harm, so I told her that yes, I had cut myself. The night I returned back to Austin after 2 weeks in Minnesota for Mom’s funeral I just hit a breaking point; I was finally alone and had the opportunity to do it… so I cut. It was a pretty ugly one, but not one that I felt I didn’t have under control so I didn’t seek medical treatment. With all that I’d been experiencing during those weeks, I wasn’t surprised that I’d slipped up and self-harmed to release some of that pain and tension.
By the time I saw the psychiatrist on Monday, it had been nearly 48 hours since the injury. She asked me to show her the wound and I was absolutely mortified. There is no part of me that felt comfortable doing that. I’d never felt very emotionally supported by this doctor, but I had needed to see her every 4-6 weeks for a med check. (My primary care physician said my depression was serious enough that she did not feel comfortable managing my dosage so I was required to seek specialized care.) I never shared much emotional detail with the psychiatrist because she didn’t seem very receptive and, quite honestly, had such a full patient roster that she tended to rush through each session anyway. She pushed and she pushed until I finally lifted my bandage and showed her my wound. I’ll never forget her response. “Oh, god!!! Laura, this is bad. Like… really bad!! You need to go to the doctor for this, you could totally lose your arm, you know… like if this got infected or something… I mean, it looks infected. You have to go see a doctor TODAY so they can stitch this up and get you on an antibiotic.”
Admittedly, I’m not a doctor, but I’ve been doing this for a very, very long time. I told her that first of all, since nearly 48 hours had passed, that they could no longer stitch up the wound. I also assured her that no, the wound was not infected and that a visit to the doctor would be a waste of my time and money. In fact, of all the hundreds of wounds I’ve had over the years, many of them quite deep, I’ve never had a single infection. While the behavior itself seems like quite the reckless outlet, I’ve always been extremely careful and sanitary and have taken very good care of the wounds afterwards. But she was focused on getting me to the doctor so she made me promise her that I would take myself to urgent care to have them examine the injury… and threatened that she could have me involuntarily committed if I didn’t do as she advised. She had me quite scared about that possibility, so I did what she asked-- I took myself to urgent care.
It was a horrible experience. In the exam room, I explained to the nurse that I was there per the instructions of my psychiatrist to have a self-inflicted wound examined; she said she’d be back with the doctor in just a moment. I sat there, fidgeting and doing my best not to cry so I’d appear strong. I was feeling pretty good about it until the doctor came in, looked me up and down, rolled her eyes and sighed as she said, “Are you Laura?” I replied, “Yes, that’s me.” She abruptly walked over and while avoiding eye contact with me said, “Alright, let’s see it-- take off the bandage.” I did as she asked. The look of contempt on her face was unbearable; she looked at it, then looked at me, rolled her eyes again and then turned her back to me. After a few seconds that seemed like years, she turned to face me and said with a sneer, “Why are you even here?? There’s nothing I can do for you. If you wanted this stitched up, you should have come here right away… too much time has passed. And it’s a clean wound, there’s clearly no infection, so there’s no need for an antibiotic. I honestly don’t understand why you bothered to come here today.”
I mustered up the strength to tell her I’d only come because I was instructed to do so by my psychiatrist, whom I’d seen a few hours earlier and that I knew the visit was unnecessary… I was simply following her orders. She repeated that there was nothing she could do for me so it was a wasted trip. I checked out at the front desk, forking over another $75 that I really didn’t have to spend having just spent $130 at the psychiatrist that same afternoon. And all it got me was some shame and humiliation.
A few weeks later, the psychiatrist called me to find out why I hadn’t called her to follow up on that last visit and to update her on my visit to urgent care. At that very moment, I was at Mom's house, waiting for the movers to come take away all of her belongings and I was being pushed my emotional limit. Something in the smug tone of her voice just triggered something in me and I found myself, surprisingly, being quite uncharacteristically assertive with her.
She said to me, “Did you even go to a doctor like I told you to do that day-- to get stitches and antibiotics?” I replied, “Yes. Yes, I did go to the doctor like you urged me to do by threat of being committed. It was a complete waste of my time, money and energy and it turned out to be a humiliating experience. No, they did not stitch me up, too much time had passed. No, they did not clean the wound because it was already clean. No, they did not prescribe antibiotics because the wound was not infected. There was nothing they could do for me at all and to be honest, the doctor was quite cruel towards me. The visit was one of the most humiliating experiences of my life.”
There was no part of her that seemed remorseful or even compassionate about the experience I’d had. Her only response was, “Well, you should have called me to schedule another session with me like we talked about.” I calmly told her that I was not comfortable continuing to see her as my psychiatrist and that I’d be seeking treatment elsewhere. I know I have a problem and I know that I need help for that problem. But I’m also an intelligent, self-sufficient adult who deserves respect, too. I wish finding the right help wasn’t such a painful experience. This behavior is so misunderstood even by the medical and psychological professionals, how are we to expect the general public to understand?
An acquaintance of mine worked at a psychiatric hospital and would carelessly say such derogatory things about some of the suicidal patients. It made my heart hurt to hear that he felt that way. I also dated someone who was a social worker and was regularly on-call at a hospital; he was often contacted when someone was brought in who had either attempted to take their own life or was in danger of doing so. The things I heard him say off-the-clock about these people (i.e. calling them a "freak" or a "loser") made me very sad. I'm sure the job could be quite frustrating and exhausting at times and that he surely needed to vent; but to know, as a consumer of mental health resources, that this is how some professionals feel about having to help people like me surely doesn't give me confidence in how I'll be treated.
Last summer I had hit a particularly low point and decided I'd better share with my primary care doctor how I'd been feeling. She spoke with the consulting psychiatrist there; I was prescribed an additional medication to add to my existing two drugs and was then given a card for the next available appointment with him which was THREE MONTHS AWAY. The day finally arrived and it was so disappointing. He clearly had read nothing in my chart, was rushing through the questions and barely made any eye contact with me at all. I was doing my best to remain light-hearted and engage him a bit but to no avail. You're expected to open up to these people and share intimate details about your feelings and emotions but when the doctor barely even looks at you, you certainly do not feel comfortable baring your soul to them. It's no different than in your daily life, you know? We all have people that we only share certain parts of our life with because we don't trust them with the private details. But when it's a doctor, you don't have a choice. And it's so much more difficult sharing those details with someone who doesn't even seem to want to be there themselves.
A year ago today, on the 2 year anniversary of our Mom's death, I had made a plan to take my own life that evening. I'd already started the folder and planning materials I mentioned in my last letter. I was going to pull the car into the garage and die by carbon monoxide poisoning. But that morning when I tried to leave for work, it wouldn't start. It had a brand new battery... a new starter.... but I couldn't get it to turn over. I ended up having the car towed to the shop and $250 later, all I'd gotten was an oil change because they told me that after having it for 3 days, they couldn't find a darn thing wrong with it-- it was starting just fine for them. I was inclined to believe that was a sign from you and Moomie... that it maybe wasn't my time, I guess?
But the pain was just continuing each and every day. I want people to understand how difficult life is is when your mind is what is unwell... when your own mind is what is telling you that it will never be better, that you should be dead. Each and every day there is a painful war going on inside my head. My mind is doing it's best to try and kill me. I'm so exhausted. I don't socialize much anymore because literally ALL of my energy is going towards just getting myself to work, doing my job, paying my bills... by the end of the day, I just want to be alone, on my couch, watching some King of the Hill to take my mind off of how I'm feeling. I'm literally in survival mode all day every day.
People ask me, "How can I help?" I've started saying to them, "Honestly, just VOTE. Do your part to see that people are put into office who actually care about improving our healthcare system. Who care about expanding resources for the care of mental illnesses." Until we get rid of the stigma around seeking help and until we make sure that there are affordable, accessible resources for people who choose to use them, people are going to continue to die by suicide and drug addictions.
Brian, I miss getting the little "reminders" you used to send me. Have you stopped sending them? Or have I simply stopped noticing them? Or have you stopped sending them because I wasn't noticing them anymore? Or am I totally bat-shit crazy and there never were any "signs" to begin with? I had a dream about you a while back where I was trying desperately to talk to you but you were ignoring me... you had your back turned and while you seemed to hear me, you chose to ignore me. I guess it's no secret that I've been feeling extra lonely lately and I thought, "Man, I must really suck if you're even ignoring me in my dreams." If you get around to it, maybe give me a sign one of these days? I'm missing you and Moomie extra hard lately.
Love Always,
Laura