When I talk about suicide and suicidal ideation I often talk about chronic pain as well. Because for me depression was saturated with pain. Pain was twisted right through the depression. And suicidal ideation was all about wishing for that pain to just end. Often I would fall into deep depressive stated in high pain at night when I had nothing to distract me from the intensity of the pain and I would think about having to try and function with that level of intensity the next day. Because these high-intensity bouts back then could last days or weeks. You would get in this sort of raw, desperate state with nothing to even dull the edges of that pain. And yeah, suicidal ideation was sometimes that happened. And happens to many people with pain.
But I was also depressed. I had major depressive disorder. Likely in the beginning of years of unmanaged pain, I had depression associated with chronic pain like my psychologist originally thought I had. But over a decade in with unmanaged pain, well, must have been fifteen years in? That depression became its own, very serious beast. And it complicated the pain quite a bit. As its own beast suicidal ideation was more frequent. Still wrapped in pain. Still with the ‘reason’ of wanting the pain to end. Still with thoughts about how mad it was to exist in this pain, suffering endlessly. But the depth of the depression itself was deeper and more profound a beast. The plummets of depression more severe. And dangerous. When in those deep episodes of pain and depression I would think about ending my life. Plan it. Fantasize about it. By I wouldn’t. For my family. And I didn’t 1001 times. But then 1002 came along and it was too much for me to handle. The pain. The endless pain. The intensity of it that week. The thought of having to work like that. I couldn’t handle it one more day. And I couldn’t call in sick, not with the ultimatum work had hanging over my head. So I attempted suicide. Crossed the line between thought and action.
So I know about suicide. In thought and action. I know what it feels like afterward. The trauma almost. And the guilt of it. And the wishing you had succeeded. And the ambivalence you are alive. For a while, things are not normal. But they get there slowly. Back to depression again. And fighting that. Until I went on Abilify anyway. And then that helped me with my deep plummets and got rid of my suicidal thoughts and actions. Sometimes we need medications for depression.
So I wanted to say to people with chronic pain: It isn’t always just the pain that makes you have suicidal ideation. Sometimes it is, pain alone does cause them. And there is a difference between ideation and INTENT. If you have intent you need immediate assistance. But it isn’t always the pain we blame depressive moods on. Sometimes it is depression. And we should be careful to make that distinction because depression should be treated to help you manage your pain better, but also to help you feel better. I denied my depression because I thought ‘everyone would feel this way with this pain. It is normal’. But it isn’t. I can say that now, it isn’t. And you don’t have to feel that way.
I would say to people with depression: You already know the beast for what it is. You likely are already treating it. But don’t be ashamed you need to take medication. This is an insidious disease we have. Medications can make a massive difference and sometimes we need them to function. There is no shame in that. Some of us need therapy, which is also very beneficial. It is a long process but eventually, we can begin to feel a bit better or well managed anyway. Feel like we have some control over how we respond to the depression. It isn’t easy to treat for everyone. And for some people can be a lifelong battle. But it is a battle worth fighting.
If I ever become suicidal again I know I have to wake my spouse up and talk to him. Or talk to someone online at that moment. Call my mom and talk to her. Call 911 if I have to. Make myself safe. Or one of the Help Lines. I was told by my psychologist to make myself safe first and foremost.
I look at this and I, personally, had red flags. The negative view of self. Self-isolating. And feeling hopeless. No one could see that. And maybe I showed it in the gallows humor I had, but that was about it. You can’t always see it. There isn’t always obvious signs of it. Not to others. To yourself, you have signs. You might even recognize your own signs. Missing work. Showering less. Becoming reclusive. Preparing a will or tidying up loose ends, just in case. You know when you are in the danger zone and need help. It is time then to reach out to your loved ones or doctor.
I had a hard, long, battle with depression. I wouldn’t want anyone to endure that. I don’t want one more person lost to depression or pain, or both diseases. All I know is mental illness cannot be ignored. It is part of our overall well-being and just as important as physical health. We should do something every day that supports and improves out mental and emotional wellbeing. We should obliterate the stigma surrounding mental illness and be able to talk about it freely so people are not afraid to get the treatment they deserve and not face stigma for it.
Two things I know. Pain kills. Depression kills. If both were effectively treated then the deaths due to suicide would be less. We need the skills, we need the therapy and we need the treatment. Otherwise, pain and suffering exceed our coping skills…. and our risk factor for suicide increases.