Chapter Four Suicide and Nonsuicidal Self-injury
Chapter Four Suicide and Nonsuicidal Self-injury
Case of Andrea
I was eight when I saw my psychiatrist. I was referred for therapy for my school phobia. Going to school was a fight that my parents and I would go through every day. I would cry endlessly and physically struggle with my parents until one of us gave in. My parents yielded most of the time so that I ended up not going to school for a few months. But before resorting to the intervention of a psychiatrist, my parents tried to resolve the problem in a variety of ways. Although well-meaning, some of these solutions may have done more harm than good. I was belted every day as punishment. The next thing they tried was offering me bribes. When none of these worked, I was brought to a priest for a pray over. Even after twenty years, I still remember the confusion and pain I felt going through all these. I started to go back to school on my own volition when finally an adult, in the form of my psychiatrist, started to listen and tried to understand what was going on. With that simple intervention, I was able to push through with school and attended it without incident until I graduated college.
Little did I know that my struggle with my mental health will continue to my adulthood. After twenty years, I again found myself in a psychiatrist's clinic. This time around I had to contend with clinical depression. I have been in the field of psychology since university but even with the training and exposure to these conditions, it actually took me four years to realize and admit that I needed professional intervention.
Within that four years, I went through phases of sadness and numbness in different cycles. Feeling sad was more frequent than numbness. I would even consider my "numb days" as the good days. During that time, I thought that I was going through a quarter life crisis and that these feelings of sadness were a given. I had been rejected by the schools I applied to and was employed sporadically. "Sayang" was the word I would hear often from others due to being an "achiever" in both high school and college. Coming from a Filipino-Chinese family, a girl my age, late twenty's, is already expected to have a family of her own or at the very least, have a good paying job. None of that was happening for me. In the years that followed, I had two cancer scares due to the growing lumps in my breast and being that my mom and most of my aunts were diagnosed with breast cancer.
I thought that maybe the sadness and feelings of failure came with the uncertainty of my life and once I figure it all out, the sadness will go away. I trudged on hoping that these feelings were fleeting and that one day it will eventually get better. But one day, that little ray of hope inevitably died out and I found myself swallowed into the darkness of my own making. I can't remember how and when that day came and I felt like I just woke up to it. I couldn't fathom how I got there. Being in the dark felt like all these monsters in my head could just engulf me into oblivion. The anticipation of when these monsters would come out preoccupied my mind and I felt that I always had to be on guard. What's worse is that I didn't even know what these monsters looked like. I was just afraid period. And this made me feel helpless.
When I started opening up to my friends and family about what I was going through, I either got puzzled looks or the ones that said, "Here she goes again."
"Maybe you're just having an identity crisis."
"Maybe you're just too sensitive."
"Maybe crying is just your way of coping with things."
"Maybe it will just go away."
"Maybe you're just overthinking things."
No one ever told me that "maybe it's clinical depression" or
"Maybe it's not your fault."
"Maybe you need professional help."
"Maybe it's something you cannot get out of on your own."
I did not choose to be sad and making me feel that this was my own decision spiralled me further into the depression. Because I felt that this was a "decision", I also decided to take matters into my own. hands and make myself "happy". I turned to faith so I prayed and prayed and prayed. That didn't work. I then decided to get into buddhism and meditate the sadness out of my system. That didn't work. I turned to travelling, going to even the dangerous areas. That didn't work. I started to smoke weed regularly, drink, cigarettes and tire myself partying until dawn came, That didn't work. I realized that I had to stop all these when I was driving and I then I started thinking about driving just a little closer to the trucks and buses that flew by me. I felt that if someone tried to kill me or I was in an accident, I wouldn't even bother to fight for my life anymore. I imagined that on my grave, it would say "suicide by apathy and passivity".
The last straw for me was when I started to feel tired every day. I was crying most of the day, even for no reason at all. I didn't want to wake up and I wanted to sleep through the day. I couldn't interact with others without crying. I started to withdraw from everyone else. My family couldn't understand and I also saw how much they were also in pain seeing my cry all the time. I pushed everyone away because I was tired of hearing their "maybe hypotheses" and it just made me feel bad to be around people. I couldn't live.
Finally, a friend who was diagnosed with Major Depressive Disorder was the first to tell me that maybe I needed professional intervention. It was through her encouragement and sharing of her experience that I was able to admit and consider that I needed to see a psychiatrist.
During my first session, I was not able to speak much. I just cried the whole hour I was with my doctor. She patiently tried to understand the words in between sobs and offered the comfort that no one has ever given me during my struggle. It felt good that someone could finally understand and help me. I was prescribed to take sertraline, an SSRI. I had to contend with the side effects which included nausea and headaches. I also had panic attacks during the first week of medication. But side effects meant that the drug was working on me. The crying stopped. The thoughts were still there but these did not feel as powerful. I felt calm despite the negativity. My psychiatrist ensured that I regularly saw her for psychotherapy during my treatment. We talked through my negative thoughts, such as being a failure and how that has contributed to where I was. In retrospect, all those sessions were just spent on surfacing these fears. Once I put a name to all these negative feelings, accepting and countering them became easier for me.
After four months I stopped medication and fears of relapsing started to cross my mind. It takes a little more effort to settle myself down compared to when I was taking anti-depressants but it's now manageable. I also informed my friends and family of my status and they supported me through the transition. Without the depression, I realized that my friends and family were on my side after all. They have also started to notice the change in my behavior. My sister even commented that if only I took medication way before then our relationship would have not been so strained. I started going out more with people and engage myself in different projects. I still feel sadness, fear, anxiety but this time, these things make sense to me now. I guess the depression also helped me by familiarizing me with these negative emotions. I am not afraid of them anymore. If anything, I learned how to listen to how I am feeling and actually accept what brought these on.
For the next two years, I stopped going to therapy and even discontinued my medication. However, I would take medication every now and then whenever I felt anxious or overwhelmingly sad. After a while, I started to notice that it's the same things that triggered these negative thoughts and feelings. I thought I could just brush everything aside and let the medication do its work. For some months, I started to feel more stable so I decided to stop medication. But then it started to go worse as the depression turned into irritability and anger. Soon, I started to engage in behaviors that I did not recognize anymore. I still managed to work and go through the daily grind but it was filled with pent up energy that made me feel tired all day. More so, I couldn't sleep well at night. I woke up feeling caffeinated and a bit tranced. I thought this was just a phase so that I brushed it off again. But one day, I found myself almost getting hit by a bus because I suddenly had the urge to race with it. I wanted to smoke which I don't do. When I got home, the feeling started to feel more pent up and then I found myself crying and hyperventilating. I felt the room was getting stuffy so I thought I'd open my sliding doors which led to a balcony. For a second, I looked at the balcony and thought maybe I could just jump off it and see what happens. This is when I started to realize that something else is going on. I sat through the tears and closed my sliding doors. This wasn't me. This isn't me speaking. After an hour, the impulse went away. But then I got scared. It felt like I didn't know myself anymore and more so, that I didn't have control of myself. I thought I was just experiencing withdrawal effects but I still went to my psychiatrist to consult her. It turns out, it was a manic episode rather than a side effect. This new diagnosis was difficult to accept. I cannot say that I am better now but it feels like there's a part of me that keeps unfolding as I go through life. Hopefully soon, everything will make sense.
Case of AP Maria Naval C. Rivas, MD
Case of AP Maria Naval C. Rivas, MD
AP, eighteen-year-old, was referred for professional help because of a suicide attempt in July, twenty seventeen. On the day of the attempt, AP was found lethargic in the living room. Her father persistently tried to wake her up until she regained consciousness. She then admitted taking at least forty tablets of different medications including: Decolgen, Neozep, Tramadol, and Mirtazapine. She was immediately rushed to the ER where she was managed.
AP was diagnosed with Major Depressive Disorder in October, twenty sixteen based on symptoms of depressed mood, loss of interest in school, troubled sleep, feelings of worthlessness, and repeated suicide attempts. She was reportedly bullied in school for the past ten years but never disclosed this to anyone. At fifteen years old, AP harmed herself each time she was distressed. She would flick a rubber band on her arm until it was painful and sore. She only stopped doing this when her friends took notice. At this point, her tendency to engage in non-suicidal self-injury progressed to suicidal ideations. The following year, she attempted to commit suicide twice. On both occasions, she tried to drown herself by submerging her head in a pail filled with water. Those attempts were discovered and stopped by her family members. From then on, AP continued to plan for her suicide by consulting the internet for various methods. She wanted to make sure that her next attempt will be discreet, painless, and completed.
In April twenty seventeen, AP was informed that a friend, whom she knew only from the internet, killed himself. "He was disappointed in her" and "She was not good enough as a friend," AP was told that those were the reasons why her friend took his life. She mourned her friend's death for five months and ruminated how inadequate, unreliable, and useless she was. "I cannot do anything to help;" "I freeze when someone comes to me in distress;" "I make things worse instead of better." These were the thoughts that constantly plagued her mind. One day, she received a call from this friend, apologizing that he faked his own death. Feeling immensely betrayed and worthless, AP decided to carry out her suicide plan. She then wrote a suicide note and drank forty tablets of different medications. She remembered feeling calm after a while. And for the first time in a long while, the rumination stopped.
She wrote....
"I don't know what to do and what to say. I feel so lost. I don't think there is a way out but please ... bear with me as I gather my last thoughts. And I hope you understand ....
Thank you mom and dad for the love you give.
Thank you brother and sister for loving mom and dad.
Thank you relatives for the time we shared even if I barely knew some of you.
Thank you friends for being there and makings things better when things are awry.
This is not just a spur of the moment thing. I have thought about this a lot. I actually thought about it everyday. And yes, I have considered the consequences .... What will happen to people around me, those close to me when I'm gone? I have desensitized myself to everything and this is the only way to solve the problem.
The problem is ME! Nobody else to blame but me. I am a burden ... a dead weight. I will never know enough. It hurts to see people I love being bothered by me.
Everyone will be better off without me."
AP survived the attempt and has been safe for a year now. She shared that the thought of her father crying when he found her almost motionless that day has kept her from attempting to take her life once again. Nowadays, her suicidal thoughts occur less frequently. She also feels that she is able to rationalize other people's behaviors better than before. Now, she tries to understand their actions in ways that would make her feel less offended. She is also currently taking an antidepressant for maintenance and goes to psychotherapy regularly.