What I have learned from my suicidal patients
theguardian.com
theguardian.com
This was arguably true for me, but not in a good way. I'm pretty sure that I started having intrusive suicidal thoughts because my depression had motivated me to try to change. Said changes utterly failed to even make a dent in my depression, finally convincing me that nothing I did would ever make me feel good again (this was after multiple trials of antidepressants and talk therapy over the course of 10+ years; it's not like this was the first thing I tried).
All the generic "there is hope" and "antidepressants really work" and "go to therapy" talk that tends to surround mental illness discussion really bugs me because virtually nobody acknowledges the damage that's done when these things fail (and they fail frequently). It doesn't just damage trust in mental health professionals, it hurts the credibility of recovery as a concept.
Oof, I didn't have quite as hard of a time as you, but that description resonates a lot. My experience(s) with depression have taught me to never make empty promises to people — it is cruel to present psychiatry or therapy as One Weird Trick™ that'll definitely solve your problems, as opposed to an option worth trying. In reality it's a crapshoot and you might luck out, but you also might not.
Yes, I suspect this is probably a key trigger for suicidal people. You get a well meaning parent/sibling/relative that quickly gets in over their head trying to deal with a seriously depressed/mentally ill person and often they resort to this.
A useful public service message would connect people in this position to contact mental health support services themselves to better understand how to help the individual they care about.
In a better world we have services available for both the mentally ill, and for the people (spouse, parent, etc) that are supporting them.
I've been free of suicidal thoughts for about 6 or 7 years now.
I don't think there is a short cut.
Keep working at it. Look for reasons to keep fighting and you will find them eventually. If you look for reasons to be depressed and give up you will find them too.
Stick with it even if you don't feel better. What other choice do you have? It's a sucky reality while you are in it. But one thing that helped me was to focus on other people. Especially when I felt my worst. It gave me just the tinniest amount of reason to keep going. And sometimes that is all you are going to get.
I am really sorry you are stuck here. There are a lot of people who understand how truly awful it can be.
I just put an email address in my about. I don't check it often. But feel free to email me if you just want to vent.
When I was young I nearly succeeding is ending my life (early teens) and at that moment I knew I didn't truly want to die, but I so desperately needed the pain to end. So going down wasn't an answer, I had to keep going up no matter what and I tried to find any reason I could to keep going. This didn't stop my attempts, but it slowed them down some, and so I floated in a destructive despair for years while I tried to figure things out.
I have seen other people turn things around for themselves and it really turned out to be that everyone that did was looking for something important. And I don't mean figuratively here, they actually took real action, real effort to find something, anything, any reason to keep going.
And that is why I know this is so hard, because when you are in the deep end of despair, the last thing you have motivation for is to put effort into something that will make you feel better in a few years, or even tomorrow. But it's the only way out that I found.
Eventually I found a number of reasons that I really needed to stay alive. None of them on their own were enough, but I found that all of them together were enough on some days to get me out of bed or to put the knife down. That's not much motivation or hope, but it was a start. And I kept adding a little bit at a time. I reminded myself constantly, especially at my worst, that it's better to pull a splinter out than leave it in. I will feel better if I trust what I have already proven is true, even if I don't feel it right now. Especially if I don't feel it...
So, what is real hope? Something you know is true, even if you don't feel like believing it's true. There are people that would be better off for you being alive than dead. That is a grain of sand of hope for others that gives you something back. It's a start.
I made rules for myself, things I could say to myself, some multiple times a day. These things are all true, and I've proved them to myself time and time again, and I use them to overcome despair and overwhelming emotions that will wreck my day. Here's a few.
-Everything is ok right now. I am fine.
I say this when I feel like everything is going to fall apart today. But right now, in this moment, then next 30 seconds or whatever, it's ok and this is true every time I say it. I have a house, food, I have a wife and kids, I have work. Right now, in this moment everything is ok. It can get me out of the worst moments.
-I can do this one thing. (I don't have to face everything right now)
This is how I get myself out of bed and into the shower every day. (I say, "I can take a shower, I can handle this one thing") Even though I am no longer suicidal (a life altering thing) I still deal with massive waves of emotions that I must battle, but I win every battle one at a time. I remind myself that I like sitting under the warm shower and I will enjoy it when I am done. And I know it's better that my kids see a functional adult, and my co-workers don't have a smelly bum next to them. All of this are tiny things to look forward to in the future that help me do something right now.
-Don't make things worse.
I say this to convince myself not to make a destructive decision, because it will make tomorrow harder for me. Something as simple as drinking too much, or staying up too late with entertainment, anything that will make tomorrow harder is just going to allow despair to creep back in.
-I don't get to have this.
There are some things (as I have gotten older) I realize I just don't get to have, and I need to be ok with this. And often times that means, I don't get to feel happy right now. I can feel happy later. This helps me make better long term decisions.
-It's worth doing this.
I remind myself that every time I have done the right thing it has paid off. I know I will feel better at the end of the day if I get work done instead of collapsing into bed. Even if I feel horrible all day, I will be better off and grateful for making the decision later.
-I am scared of this so I have to do it.
Most of what stopped me from doing things that helped me vs things that hurt me was I was scared to do them. But the few times I was in a corner and had to do something scary, I was grateful I had made it through afterwards. So now if I can do something scary without my back in a corner, then I know I will be better off later. (something that can be scary is just talking to my wife about something personal, it doesn't have to be a big thing to be scary) I don't use this rule to make foolish decisions, I logically know I shouldn't do "everything" that I am scared of...
-There are people that need me today.
I have found that the most important element to turning things around was to do _more_ in my life not less. Less is staying in bed all day because I just can't move. And this has been a lot of days for me. I figured this was better than offing myself, and that is true. And when I put myself in a position where people needed, something that is really hard to do, it gave me motivation to keep going. It's frequently scary and unpleasant, but I have proved it works at helping me stay alive.
-I did poorly and things didn't go well. I am sorry and I will try and do better.
I found that if I openly acknowledge my failures to myself, that I can face them better. And if I admit them openly to others, I always (so far) have gotten support and understanding. This has been a life line when I have fallen apart and I simply couldn't do what I should have done. I say sorry to people and tell them what I will do to fix what I messed up. This is humbling but helps with my other rule "don't make things worse".
-Get something done, anything.
I found that if I can get myself to do _anything_ at all done, it will make nearly impossible tasks look a little more possible. This applies to work but also with my relationships. There are things I really want to turn around with my marriage, but right now I just can't. But I have made progress in the past, and I know that if I can get one thing better, it will be better for both of us. Success of any kind seems to be a lubricant for more success, and getting started is so hard and painful that sometimes all I can do is just one tiny, tiny thing. And I have to remember that that is really valuable, and that I should do it.
I imagine other people will make their own rules and find things in their life worth living for. You just can't give up and you have to actively look for something good.
This got really long, but maybe there is something here that will help someone else. Sorry if this didn't answer your question well.
This book changed my life for the better, as well as The Depression Cure by Stephen Ilardi. Both of them combined got me out of a deep multi-yearlong depression and allowed me to get married, get a better job, be more productive, more active and much much happier.
I still have relapses every 6 months or so but I go back to the books and re-read my margin notes and highlights and it always helps.
I didn't know Dr. Burns had a clinic in mountain view. Interesting!
I've heard of Feeling Good and CBT in general, and without going into the gory details, it really doesn't sound like it's the right approach for me.
Exactly.
When highly suicidal last year my reasoning was that I'd tried so many therapies (medication, talking, multiple practitioners) without success that I cannot be fixed and it's time to leave.
The typical suicide response ("call a crisis line" or "talk to your GP") is reasonable, but many suicidal people are far beyond that. For them the community sends around the Police to lock you up in a ward (ie "you're now scheduled") and many of those people - myself included - find it the most horrific experience of their law-abiding lifetime and understandably double down on getting away before they're unconscionably locked up again.
In a nutshell the mental health system often destroys the last hope someone had by imposing punitive sanctions with minimal insight or empathy. Have a read of a random selection of non-custodial suicide case studies at http://www.coroners.justice.nsw.gov.au/Pages/findings.aspx and judge for yourself.
The real issue here is how to better supervise the delivery of psychology and psychiatry programs so ineffective solutions for a specific person are gracefully transitioned into something else before all hope is lost. A severely depressed person isn't well-equipped to assess treatment and practitioners are too incentivized (or perhaps imprudent) to self-regulate their ineffectiveness.
It's so strange that we're allowed to have Do Not Resuscitate medical necklaces but they're only followed if something outside the person's power caused the trauma.
The real solution to these is to encourage facing reality in its entirety, including being honest when someone has a self destructive habit, tendency, interest, reaction, or hobby.
Of course, the debate remains of the "validity" of pure mathematics for its own sake. Many mathematicians, while not being religious in the common sense, have longed for a Platonic reality. Why do you think Hardy was so derided for his Mathematician's Apology?
Mathematics is simply another formal game of language, based on a number of axioms which can be either held to be true or not. Look at the differences between Euclidean and projective geometry. No one is asking which one is "true". Projective geometry helps for some lines of thought, Euclidean works for others.
What I mean, though, is that there's only so much information that a piece of humour or a comic strip can convey.
Also, you have to consider the crowd that xkcd caters to, and the crowd that typical American geek humour such as Big Bang Theory caters to in general.
Existentialism/Nihilism are common themes in geek humour, but negatively: these ideas are quick to be dismissed as edge-lording, and as 8-chan-incelling.
Geek culture and morality relies wholly on the self-supporting idea of science as the one and only source of truth. The geek's first reaction will of course be to dismiss any claim to the contrary, in humour and otherwise.
http://www.newadvent.com/fathers/index.html
http://www.newadvent.com/summa/
Whenever depression comes up on HN (as it does with surprising frequency), I'm both touched by people's willingness to share their own stories, and frustrated by otherwise very rational and logical people's speed to dismiss data. Initial treatment (meds or evidence-based therapies) work for about 1/3 of people; subsequent treatments work for another 1/3; and there are up to 1/3 where multiple treatment trials fail them. (This comes from STAR*D, plus Cipriani Lancet meta-analysis, plus vast CBT literature). But, there are a number of next-step treatments showing promise (rTMS, esketamine, variants of CBT, and so forth).
I've seen that quote floating around and never much liked it. For those afflicted with long-term treatment resistant depression, it's more like "a guaranteed solution to a permanent problem".
A lot of anti-suicide advice can seem like a sick joke, little more than empty virtue signaling. Want to really help? Offer a friendly ear and a sense that you really care about the person in question, and stand behind that over a period of time.
Being depressed is generally not a temporary problem. Many of us have suffered it for decades. It may wax and wane, but it's often not something that just goes away. In my opinion, it's something that many of us simply have to learn to live with, as with so many other chronic diseases.
Because everybody is different and even if you have been through it yourself, your experience may be nothing like someone else's, and just because it was true for you, doesn't mean it is true for them. Yes, some people get past it, either on their own, with therapy or with medication. Some people are just numbed by it, other people learn to cope even if it never actually gets better. Other people still struggle every day. You cannot know what is going on in someone else's head or the struggles they face.
Its true that many people get better, certainly with treatment, but a large number of people do not (someone else here said that treatment does not work for approx. 1/3 of people).
I'm not sure how to communicate those facts effectively to a wide audience. It is absolutely imperative that people with depression seek treatment and keep trying even if the first or second or fifth treatment fails, otherwise we're condemning people to unnecessary suffering; conversely, a lot of people with treatment-resistant depression are doubly stigmatised because of unreasonable expectations about the efficacy of treatment.
I do think it's useful for treatment-resistant patients to shift their focus away from recovery and towards symptomatic management - it's easy to get disheartened because you're not in remission, but a treatment that takes you from 10/10 depressed to 8/10 depressed is still useful. Eking out small reductions in symptoms and small improvements in functioning can be tedious and frustrating, but it's better than resigning yourself to interminable misery.
David Burns does a good job explaining why antidepressants and psychotherapy don't typically work in his most recent podcast: https://feelinggood.com/2019/11/18/167-feeling-great-profess...
While David makes a good case against drugs and non-CBT therapy, I actually don't find his his fantastical anecdotes of the light-switch effectiveness of TEAM CBT therapy convincing either.
https://www.ncbi.nlm.nih.gov/pubmed/29477251
for moderate to severe depression, the kind most posters are talking about, they're consistently better than placebo. It is true that placebo is often effective too. But most people I talk to would rather have that extra chance of getting better.
This is an honest question - is it fair to exclude people for whom antidepressants don't work in an analysis of if antidepressants work?
Bruce Alexander is talking about addiction here, but I think everything he is describing absolutely applies for depression: https://www.youtube.com/watch?v=7axaXQmdBVQ
Would be nice but it seems risky for a patient to suggest that to the clinician; depending on the exact symptomatic management being sought and the competence of the clinician (who are not, unfortunately, exempt from Sturgeon's Law), it might get the patient falsely labeled as "drug seeking". That would be problematic, to say the least.
The closest thing to a cure (for some people) can be cognitive-behavioral therapy, or long-term antidepressant treatment when indicated.
> I work in a clinic with about ten therapists. Some are better than others, but all of them are competent. I send my patients to them. In a few hundred patients I’ve worked with, zero have had the sudden, extraordinary, long-lasting change that the therapy books promise. Many have benefited a little. A few would say that, over the course of years, their lives have been turned around. But sudden complete transformations? Not that much.
> When I try all the exciting new therapies on them, they just sort of nod, say that this sounds like an interesting perspective, and then go off and keep having symptoms. It’s very rude!
https://slatestarcodex.com/2019/11/20/book-review-all-therap...
He goes on to talk about how CBT success rates have been falling, seemingly due to the wearing away of its novelty-induced placebo. As a chronic depressive, my "temporary" 20-year-old problem (if you had cancer for 20 years, would you like people to call it "temporary"?), this is the most relatable and reasonable article I've ever read on the subject.
The advertising for CBT as an entry point for therapy is over valued. Therapy should really advertise more effectively as a social role rather than going deep into the task oriented stuff.
It’s still odd to me that my parents were almost offended when I signed forms that indicates I did not want to be on life support if I’m brain dead or forcibly resuscitated if I arrived at a hospital “dead”.
As someone who continues to fight depression, I don’t understand why others feel their opninions should have weight when it comes to someone else’s decision to live or not continue to live.
There's actually a term for this, SLS: https://en.wikipedia.org/wiki/Shit_Life_Syndrome
Apparently it was coined as a "ha ha, only serious" joke but came into more general usage in the UK: https://authenticmedicine.com/did-i-discover-the-concept-of-...
It's 50 minutes, and I haven't seen all of it, but it's sad and moving and somehow perfectly combines humanity and logic.
(Edited to specify my own bias)
There's a specific separation in my mind of the definition of the two, whether that's reflected in the dictionary or not.
The video is fairly specifically about end-of-life kind of suffering, which is along the lines of my definition of euthanasia (rightly or wrongly). Re-reading my comment, and your questioning of it, I do present it more "black and white" than it actually is.
There are certainly a lot of things that could make society a better place, suggesting more people start killing themselves is not on the top of my list.
Stands true if you count euthanasia as threatment
And when you allow it sooner or later you will hear "Epstein/Khashoggi/that Uygur/this narco cop" were troubled souls and we were just helping them.
Is this saying that veterans can kill themselves more easily because they have more rational clarity about the situation? If so, isn't that a good thing? To be able to carry it out can certainly be framed as "strong" (I doubt I could, though I'd want to if I find myself in the position). Look at these guys: https://en.wikipedia.org/wiki/Sokushinbutsu
If you've thought about it with a level head and conclude, "I want to log off now, that's enough existence for me," is it better to suffer under moral or peer pressure because others offhandedly want you to exist for as long as possible?
It would be similar to how cats go off alone to die when they are sick.
I think it's more that they want to unburden themselves, but knowing that doing so will burden their close ones is what keeps them from doing it.
Quite nightmarish, if you think about it.
Your comment assumes a positive change is impossible.
I almost killed myself when I was in high school but decided not to because I didn't want to hurt my family. That bought me enough time to get things straightened out and now I am very thankful to be here.
Does suicide have place in a modern society? Probably not, but at the same time the fact people continue to kill themselves show that people really don't care about the issue. Actions speak louder than words.
It comes down to the fact that most people don't want to acknowledge their incredible privilege in being relatively unburdened by depression, I think.
I happen to know attempting suicide can be quite severely painful. Most people who try do not risk it lightly. And much of the time, in my experience, it's those "people around you" who are to blame for the person wanting to die in the first place. If we're being honest, most of us don't truly do everything we reasonably can to help those with aspirations towards suicide. Many people act as some of those in this comment section are, telling people they're being selfish and weak. How the fuck on Earth does that help matters? And before you assume I only care about myself or something, my best friend just killed himself a few months ago and I cried nonstop for days. I still support his right to do what he did.
It becomes blindingly obvious to me when a person has no idea what it's like living with chronic treatment resistant depression as soon as they open their mouths. It's just ignorance and priviliege and a total misunderstanding of the problem to blame someone who is suicidal for wanting to end their own suffering.
Evolution isn't directed, and there is no end state. Attributing positive effect to every mutation verges on https://en.wikipedia.org/wiki/Teleology.
You can look into this further: a lack of physical activity tends to worsen depression, and a hunter-gatherer with reduced mobility and/or other issues that make it hard to interact with the group is most certainly a resource drain. It goes on and on.
Evolution isn't directed but structures and instinct that are truly against the organisms interest are the exception, not the norm.
Bollocks. There is very close to zero evolutionary pressure against (and, of course, even less than that for) having a small percentage of individual of a species decide to off themselves. Especially when it's older males (the most likely age group to commit suicide).
If a tribe can do that, and increase calorie intake simultaneously then there's a double benefit.
Older males [who can't hunt or defend and after trained in anything else] who would end their own lives would improve the survival chances of their own offspring, it seems?
Better the sick person dies voluntarily than infecting everyone else with a deadly disease
Oh, so not THAT valuable.
Relieving themselves of (to them) unbearable misery is a goal, quite possibly the most rational of all goals.
No, it's quite well established, actually.
Q: Is there a strong correlation between being lonely and being heavier?
H: Being lonely has several relations to eating 'worse' food, and more of it. An economical standpoint (at least in the US). A social activities promote things other than eating to fill time. A 'rewards' perspective, where lacking other forms of joy fatty, sugary, salty foods fulfill a basic stimulation requirement.
It would be interesting if a mental health research institution designed and ran a fundamental research study to determine if one, some, all, or more (possible) of these causes were related.
I can't find the study now. But it was documented that Viet Cong soldiers had overall less PTSD years after the Vietnam War than Americans. And the extrapolation was that Viet Cong soldiers, defending their country and people from a foreign invader, were more easily able to justify their actions and thus didn't feel the remorse, guilt, and fear during fighting that their American counterparts did.
Perhaps that isn't the whole story, but I'd bet that part of the reason American vets struggle with PTSD so much is that not all of them can rationalize and defend the things the American army does in other countries around the world. It is almost always involved in offensive invasions, especially of lands where neither the natives nor the insurgents trust them or want them involved. And I think being so face to face with injustice and having to perpetrate it without any moral salve that you are doing the right thing is hard, especially in our digitally connected, personally disconnected world.
I don't think so. Doctors and veterinarians have an unusually high rate of suicide, partly because they have access to highly lethal means of suicide but also because they've become inured to mortality. For most people, the practical realities of death are somewhat foreign, which creates a psychological barrier between the urge to cease existing and the means of making that happen.
The vast majority of suicidal impulses are temporary; the vast majority of people who attempt suicide do not go on to die by suicide. While it is entirely believable that some people are afflicted with unbearable and intractable misery, that is certainly not true for most people who die by suicide.
At what point do we admit that the structure of our society amounts to animal abuse?
His family has since started a mental health charity in his honour [0].
To get a small taste of Scott's personality, have a listen to the banter at the beginning of this live performance[1]. He's one line into "The Modern Leper" (a song about living with depression) when he notices a small child near the front. Scott becomes suddenly aware how dark the subject matter is, and breaks from the song to give everyone a little laugh.
[0] https://tinychanges.com [1] https://youtu.be/ob3X77TwqEw
Edit - he also did a talk at Google before his last tour (not tech related) https://youtu.be/FT_UrM_L1vQ
Rest in peace Scott.
I tried one last time to talk to my family recently...very right wing, faux Christian, self-righteous, bigoted people who think those in need are weak, didn't try hard enough, are to blame. They have never been decent people and I avoided them my entire adult life but was forced to grovel when my health got worse and I was denied official assistance. It's been nothing but misery and makes everything worse. It's a gravity well I cannot escape, I am powerless to do anything but scream online between gurgling breaths as the riptide takes me away and they seem to enjoy that power and getting me back for all that time I did avoid them. Despite a career seeing the worst people did to each other, you never want to accept those who claim to love you are that bad as well. But people show their true selves when they have power over others, when they have an opportunity to exercise their wills, when there is someone smaller/weaker/needier in their path...people will show you who they are every time. Every time.
I am not depressed because of some temporary situation. I am not suicidal because of a chemical imbalance. I had my health stolen, my finances decimated, and my life punched down on hard by anyone who was supposed to be there for me...for whom I would have been there. I am clinging to Maslow's bottom rung and losing my grip and nobody who can do anything cares at all. Everyone I have ever known who is suicidal has some real, actionable reasons like this underlying it. But all people say is "get help"..."take pills"...."meditate". That's all putting a bandaid over a gunshot wound and ignoring the trauma underneath because dealing with that is harder and costs more. People just aren't worth that to others. I am going to die angry and alone and they all know it and do nothing but antagonize, threaten, and make it about themselves. They have important things to do like rage at "liberals" ruining the world and how unfair everyone is being to Trump. Their kids and neighbors and everyone else are tools and threats to them, nothing more, they are so incredibly ego driven it's astonishing. They say "not with MY money" to everything social for others, even as they collect their social security or use subsidized systems. That's what matters to them...their own gain and power. Not me...not others. They are legion in this country. By an accident of birth I was both ruined and abandoned. Both rooted in selfish profit driven mindsets. Had I been born in the fist world the profit driven surgery likely wouldn't have even happened, but had it I would get social assistance. Not here...here I get to go live in a ditch or die.I am too old, too broken, need too much to survive and I refuse to suffer MORE because of this backwards culture so option B it is. Thanks Murica.
No SSRI or deep breathing solves those situations...and most people who end their lives didn't have to if people would do the right thing. But the right thing isn't profitable. So they push pills, write articles, cherry pick survivor-biased tales that show someone who "got better" who didn't really have any problems at the core. They show this as some enlightenment or evidence and hold it up but the light is focused on that and ignores the piles and piles of bodies underneath who were ignored or bypassed because it was too hard and not good for business. Most people don't care about you...they don't care about society...they care about themselves.
I had a nightmare just last night about a victim I recall from early in my career...in such a horrible personal situation...who died in such a terrible way. She didn't have to. She was pushed to it and then allowed to because nobody she reached out to would help. I've seen dozens like that...and not a single one of them had to die. Every one of them was failed by their family, by their neighbors, by systems...it's shameful. But enough about silly bleeding heart things like people and the planet and whatever. There are important things to do like get those likes, those dopamine hits, shut down those losers in a political argument or downvote someone to signal how wrong they are, make those dolla dolla bills convincing someone to buy that useless to society "product" or cash out big to someone else who will because those luxury status symbols won't buy themselves. After all anyone who is suffering only has themselves to blame and didn't want it bad enough or step on enough other heads to get it. Losers.
What would improve things for you right now?
People always think you should be able to do more than you say but my body is the boss and will fall out from under me and that takes my mental state with it...as you can see now. Nearly two years ago someone here offered me a very bespoke job part time with the ability to immigrate, but my health problems and personal tragedies (family betrayals and death of the person I loved most...one I may have been able to prevent had I been back there instead of across the world) all came at the right time to confound even THAT chance. Now things are even worse physically, financially, and mentally and my capabilities less. In a modern country I'd be on social aid so I could have stability and time to assess and long term help if I couldn't improve...not feel I would be cast out at any moment with no survivable path. Maybe I'd be like this for the rest of my days...maybe I can improve a little and do more. I can't know until I have that security and access to trustworthy doctors and systems...and those are not here in America.
You mention Warsaw as a place where things might be better. It looks like you could fly there from NY for maybe $300 on a good day. Is this a plan you could shoot for?
"I had a nightmare just last night about a victim I recall from early in my career...in such a horrible personal situation...who died in such a terrible way. She didn't have to. She was pushed to it and then allowed to because nobody she reached out to would help. I've seen dozens like that...and not a single one of them had to die." I wonder if your earlier career gave you PTSD and if your current circumstances are triggering it?
You had a bad judge twice - that guy is probably retired now or has moved on. I wonder if another might be reasonable - what you need is some kind of stable income so you can get space and stability. Are there no advocates who could help some kind of claim for someone in your situation - free advisors? Don't set some kind of end of year deadline on yourself - an advocate might be able to do a lot for you.
"Surely there is...why don't you just....there has to be...that sounds terrible what would help?" etc NEVER F^%#$ HELP! They are vague, obvious, useless advices or ideas. Things I have usually made directly clear I have done. The direct answers to needs are never heard. You answer questions and nothing...like it was all just to satisfy someone's curiosity. People give you absurdly obvious "advice" they have never enacted, and certainly not in such circumstances, and then tut when you don't accept it or it doesn't work. The truth is there have been many systems and people who could have helped...really helped...and they said "no". THEY decided that not me. I had my agency stolen.
Yes I have PTSD amongst many issues but that like the rest has been scoffed at and said to be "playing victim" or whatever other excuse. Yes the judges, "advocates, doctors etc have mostly been shit but people won't accept that because it's easier to say it's my fault and pretend that it was just an edge case and would never happen to them. I am NOT setting a deadline....THEY are!!!! I have no idea when the threats and drama will appear again or when they will be realized. I live in constant fear of it and have been pointlessly F&^%# screaming HELP ME for years now. The ONE, MAYBE actionable plan was derailed by MORE BAD THINGS. I need support....stability....it's not coming. It never comes. It's like some trickster god is playing with me seeing how far he can push me. And when you say "I CANNOT DO THIS ANYMORE" you get "hopes and prayers". I wish I had never made this F&%^# account or ever talked to anyone about this as it just brings more pain on already unsurvivable pain. F&%%& everything.
Please don't worry about me, I've been through some things, (probably toughened my exoskeleton), (or something :). You are not unnoticed and I can only repeat I wish there were some real help that you will get. I am ok.
We are thinking of you here on HN. I can do nothing for you, but would always make time for you.
I have been in your situation, and I have had certain privileges you do not have which helped me. So, I do not want to tell you: "just do XYZ and you'll be better". In fact, I agree with you that suicidal tendencies are not due to mental health issues; rather, they are due to deep societal injustices. Since I can't fix those, I can't truly help you. There is a reason why indigenous communities are particularly hard hit by suicide...
I am also not going to try and convince you to not go through with it. That would be selfish on my part. I don't want to have to deal with the hard truth that someone chose to stop existing because of the shittiness of this world.
I am however, going to ask you to reconsider what meditation is. I don't care about any of the religious crap around it, and I am also not going to reduce it to "sitting down and breathing deeply". "Meditation" must happen in every moment. I think about meditation as a sort of self-awareness which provides acceptance, and through acceptance, resilience.
I recommend reading Jon Kabat Zinn's "Where You Go, There You Are".
I had an allergic reaction to the idea of acceptance when I first came across it: things like "opium of the masses" came to mind. This is not that sort of acceptance. This is the sort of acceptance that provides internal stability when there is no source of external stability; it is the sort of acceptance that lets go of the disappointment and frustration, and then frees mental power to consider: "what now?". It's the acceptance that provides resilience which leads to improvements in social justice (and social justice starts with small, everyday victories: moments, individuals, and then society). Or the sort of acceptance that provides the freedom to explore things you would have been too scared to explore otherwise ("a person who has nothing to lose...").
In this vein, I think mathematics is an amazing way to spend time. Not only does it not deal with people, but it also helped me see a...largeness...to the world that I find hard to describe. I suggest starting from here: http://www.cs.toronto.edu/~hehner/FMSD/
In a sense, you're free. You're free of the "chains" of life. Breathe deep, not because you're meditating, but because you should relax: the chains of life no longer bind you. Let your mind roam now, as it is meant to roam. Build palaces of systematic ideas, which lead to results that are surprising and enjoyable. Explore the world around you: forget about space, but instead consider the amazing orchestra of chaos that is biology. How the hell does a cell work? Layers upon layers of beauty that is hidden because of the shit of our human world...
Or...pick something else to study that isn't what _this_ stranger cares about. Devote yourself to it. Do not let yourself be disappointed with the boring, care only about the exciting. Let the excitement of finding the amazing fuel your devotion.
Dare I say: "don't end the freedom you have earned by going through this pain early; use it, before you end it"?
I find your comparison of me with your family to be extremely insulting, as you know nothing about my life.
The mistake I made, which in your eyes makes me as good as a bunch of right-wing misers, was to 1) suggest a key aspect of what my own therapy was based around, and 2) share with you what _I_ found was something useful in improving my "suffering".
However, you decided to take it as yet another sign of how people are judging you (Jon Kabat-Zinn has a lot to say about non-judgementalness too, and that was another key aspect of my therapy), missing the fact that you are judging others, and in particular in the course of this interaction, me.
I do not have the resilience, capacity, or training to deal with such judgements.
I think that you can read my first response in many different ways. You chose one perspective, and perhaps, in the future you may choose to read it in other ways. Apart from that response, in which I gave you what I felt were the most valuable things I had to offer to anyone, I have nothing else to give you.
I'll leave you with a quote from J. Kabat-Zinn's "Full Catastrophe Living":
> Acceptance does not mean that you have to like everything or that you have to take a passive attitude toward everything and abandon your principles and values. It does not mean that you are satisfied with things as they are or that you are resigned to tolerating things as they “have to be.” It does not mean that you should stop trying to break free of your own self-destructive habits or to give up on your desire to change and grow, or that you should tolerate injustice, for instance, or avoid getting involved in changing the world around you because it is the way it is and therefore hopeless.
> Acceptance as we are speaking of it simply means that you have come around to a willingness to see things as they are. This attitude sets the stage for acting appropriately in your life, no matter what is happening. You are much more likely to know what to do and have the inner conviction to act when you have a clear picture of what is actually happening than when your vision is clouded by your mind’s self-serving judgments and desires or its fears and prejudices.
But it doesn't have to be this way. There are other ways to live, there are other worlds we could have. We don't have to incentivize predation. We don't have to reduce human life to dollar values. We can make a world that does not find its fundamental basis in self-interest, we can have a world where everyone is not fundamentally, irrevocably alone.
I recommend that you try to see if you can find a local chapter of the Democratic Socialists of America, or any local group looking to further the establishment of a Solidarity Economy. Don't throw your life away because you know this world is wrong; make it right. We are out there, and we need you.
I understand the desire to get away. I understand the reluctance to believe that things can change. But you have the opportunity to help stop this. This world fights hard to make you believe that you are without agency, but that's because learned helplessness is what maintains the status quo. Collectively, we have a very real power to shift the course of society. There is more momentum building behind an end to this nightmare than you likely realize. Do you not at least want to find out if you could have made a difference?
And you might also be surprised with just how much more tolerable the pain in life becomes when you are near like-minded people who genuinely care about their fellow man.
>There is support out there for people who truly want things >to change.
A lifetime of experience tells me otherwise. What is out there is insufficient. I don't need promises of a brighter future. I don't need cheerleading. I don't need vague ideas of what should be or what someone believes can be. I need practical realities now.
>Do you not at least want to find out if you could have made >a difference?
This is deeply offensive and makes me want to scream. I DID make a difference in the ways I could. I spent my life helping in my work and doing what I could in my personal life. I walked the talk of social issues. I was ethical and honest. That I am now needing help, needing rescue rather than being the rescuer. You don't ask a drowning person to hold up a sign as they go under to highlight the dangers of swimming in the ocean. That I don't have the bandwidth to add MORE work and stress to an already overwhelmed life does not diminish that. I did my part.
End of line.
You have no obligation to anyone. I'm just trying to offer you an option of where to look for aid with those practical realities. Maybe you have already thoroughly exhausted your options, but this is just one more place to reach out to if you haven't already. I don't know where you live, but it's possible they may have a similar program at your local chapter: https://dsabuild.org/medicaldebt
In the past year, I’ve given away all of my money (less than a million bucks). Just gave away a few thousand to a business owner yesterday who was being cheap and petty. Told him to donate it to his favorite charity.
Homeless and alone, broken and finally close to absolute destitution, I’ve thoroughly prepared for suicide. It’s a combination of gratitude for the end being near and a nagging fear of the unknown. Sorry, but the fact is nobody knows what happens to them when they die until it happens. You’ll either experience nothing, or you’ll know there is existence for yourself after death. Those who believe either way (atheist - nothingness, religious - eternity or reincarnation, unification etc) are all potentially right, with no scientific way of proving anything to the living.
My short time on this planet has given me a clear perception of the existence of higher intelligences in our midst yet I remain committed to wanting to die as soon as possible. I find the machinations of society to be utterly disappointing. I made up my mind five years ago and I’m finally close to the end now. Hoping to be gone before years end and would like to be left alone so I can die in peace.
Silicon Valley is corrupt. I became a digital voyeur long ago to better understand the machines we have built and I’m disgusted. Every moment now is another reminder of why I’m thankful to almost be dead. The sick, cruel part is that my suicide is likely part of a evolutionary process to “weed out” those who can’t handle being a voyeur. I just tried typing “handle” on my iPhone it got autocorrected to “ya die” which has been a common theme. Can’t imagine my mind is always controlling iPhones secret CIA enabled Ouija board autocorrect troll mechanism.
If you're serious about any of this, and believe what you said is true, you're currently experiencing active psychosis. These are not the words of somebody who is rationally considering suicide.
If that's truly the case, odds are you'll be in a 100% different mindset after a few months of medical/psychological help. Seek it.
Don’t talk to me about active theories based on an unreliable internet post.
Don’t talk to me about your theories on what constitutes “serious suicide planning” in the context of obviously absurd theories about apples garbage auto correct mechanism.
It’s not a phrase that I ever use, so it’s unclear to me how that became a first choice candidate for Apple’s autocorrect mechanism.
Being in the middle of writing a suicide note, having Apple make such an autocorrection is, at the least, unwanted incompetence. “Ya die” isn’t something I want to see emanating from Apple’s autocorrect mechanism, ever - whether in the middle of a suicide note or not.
There’s also a huge disconnect here. Just because I say some absurd theory about mkultra in the 21st century, doesn’t mean I seriously believe it. I just observe and fit in theories like everyone else trying to make sense of their limited perception reality. Jumping on the mental illness attack bandwagon is most of why I’m out of here. If that’s how I’m perceived, just for stating a non-serious theory, then I’m thankful to almost be dead.
No common ground. Take notes, if you seriously want to figure out how to relate to someone who thinks like I do, someone who truly is at the end.
This isn’t a cry for help for me. It’s to help others understand my point of view to help others before they get to my age. I’m not going to change.
No advice, please.
I don’t like you talking to me that way. I’d like to be left alone. As stated. Spare your armchair diagnosis and condescending response. Please.
I really detest people like you: your mindset, your condescension, your tone. Please. Do not respond to me at all anymore. Please.
This is a request to anyone reading this to not respond to my post with any theories about mental stuff, suggestions to seek help, etc.
I think there’s a sort of stigma against talking about mental health (except in the third person), but it’s one of those things that should probably change. Taking Prozac doesn’t mean you’re somehow broken. It’s like a crutch: why go without?
Yet it’s surprisingly easy to go without, due to stubbornness. It feels like admitting failure to go get medication. But why? That’s as absurd as feeling like it’s admitting failure to go get a cast, or a tooth filling.
It’s fuether compounded by the fact that most antidepressants have severe or annoying side effects. So I just wanted to throw out my one datapoint: it’s not always like that, and your life can feel much better.
EDIT: Okay, clearly I didn’t emphasize enough that everyone is different and responds differently to different medications. But I know at least two people reading this are going to use that as an excuse not to go to the doctor and try it for yourself. That’s why I’m writing this.
Prozac has a number of potential side effects as well as needing commitment and a staged withdrawal.
This is a dangerous comment and should be burried.
edit: this isn't to say I don't think antidepressants are a fantastic tool; just that I don't think you should be going to your doctor and asking for a specific flavour of drugs because you heard about them on the internet. It's a really serious discussion - people should be going to their doctor and asking asking the possible (and best) solution to their personal circumstance.
Other than that, the side effects have included a renewed appreciation for life and and an ability not to have a sense of impending doom engulf my soul.
I was careful to say “my one datapoint.” Obviously, it’s not a miracle cure, and everyone is different. But it’s somewhat remarkable to diff my life vs what it was.
I’m a scientist at heart. I try to rule out placebo effect, and not attribute everything to one simple change. But a hearing aid is a simple change too.
The reason I’m speaking up is that it’s incredibly tempting to do nothing and to try to deal with your problems on your own. But it feels like that’s the real danger. Even if you succeed, why live life that way? It’s like succeeding in punching through a concrete wall for no reason. Much easier to use a sledgehammer.
You can always stop taking it. In fact, it wasn’t till I stopped for a month that I realized it had actually been working.
I’m bipolar and spend a significant amount of time helping out in a support group for people with mental health issues. All of them have vastly different experiences. One medication I was on had terrible side effects while someone else was saved by it.
My current mix of medications would put some of the people I’ve helped immediately in the hospital. I myself have been sent to the ER by my psychiatrist due to a medication I was on.
Many psychiatric medications can’t be stopped without serious risks yet I’ve know people who have stopped all their medications and been fine. Others have permanent damage.
The only thing consistent with medication is that everyone is different.
It’s important to remember that drugs affect everyone differently. But an antidepressant can be a good first step to getting out of a rut (even if exercise for SOME is as effective).
His comment is not dangerous, it's encouraging. Pharmaceuticals all have side effects and must be taken with care, I've known literally no one that went into antidepressants ignorant of those things.
Most medication has side effects.
> It’s fuether compounded by the fact that most antidepressants have severe or annoying side effects.
As does Prozac.
Nearly all medicine have side effects. People should be informed about them (it is included with the medicine, at least here).
When depressed or suicidal, the advice of going to your doctor is good. The advice to be open about anti depressants as well (though you didn't give it, one could deduce it from your post). The advice to go for this specific brand because "no severe or annoying side effects? Bad advice.
Honestly, I had less side effects from Zyban/Bupropion and Citalopram.
Full disclosure: I don't use Prozac/Fluoxetine for depression (though one could argue I suffer from depression); I used it so I can better cope with autism.
Most medicine has minimal side effects for most people. "Very common" side effects are ones that effect 10% of people taking the medication.
People should be aware that side effects are possible, but they are unlikely. Going in with the attitude that side effects are inevitable makes one more susceptible to the placebo effect causing them.
Right, and it could only be the placebo effect if those capsules contained sugar.
Has it actually worked? Your post outlines all of the bad things you've experienced, but has it, on the balance of things, been worth it?
To answer your question though. According to myself: Yes. According to the people around me: Yes. The people around me are more positive about it than I am, but they generally don't suffer from the side effects. Basically, I have less sharp edges. I am, basically, less sensitive. The moment I'm most sensitive is during public transport. E.g. commute. I go back from work, I sit alone, and at end of people hopping on two people sit on the other side of me and start eating Burger King. Which smells. Well, yeah, I still can't act that away (or fake it till I make it). They notice I am annoyed by it. I give them looks.
Also, keep in mind, that there are other options available, but these also have side effects. From what I gathered, the other common treatment option contained an anti-psychotic with severe side effects.
(I'm on my third prescription, and have no complaints.)
This isn't true for all anti-depressants, especially when you look at dosage.
For example, if you look at clinical trial data and studies for a certain drug, 60% of people experienced weight gain. Another drug caused nausea in nearly 70% of patients.
Paroxetine has a reported sexual dysfunction rate of nearly 75%, and patients who take 20mg of vortioxetine report a similar rate of sexual dysfunction after several weeks, but nearly none at all when taking 10mg daily.
To be honest, I find the discussion of side-effects in anti-depressants really strange. Depression is an extremely dangerous, life-threatening, life-ruining condition. The side effects, when they are present, are typically trivial. However, I have met many people who have not begun a course of medication because they were worried about them.
All three of those can be depressing in their own right. In the past, I stopped what was effective treatment with certain drugs because of those side-effects.
If you look at the clinical trial data for vortioxetine, the nausea component was so bad that many people dropped out of the study altogether.
As for nausea, it's my understanding that it typically shows up pretty quickly, so I don't see what the problem is with just changing the medication.
5-HT1A agonism relieves a lot of symptoms commonly associated with SSRIs, so does antagonism of 5-HT2A, 5-HT2C (Prozac does this), 5-HT3, 5-HT7 and certain adrenergic receptors. Some newer drugs target these receptors.
Certain psychedelics like psilocybin are 5-HT2C agonists, which is responsible for the anxiety, dysphoria and nausea that some people experience when they consume it.
> Are 5-HT2A and 5-HT2C related to 5-HT2B at all?
You'd really need to look at in vivo binding profiles when it comes to serotonergic drugs. Some drugs are selective for other receptor subtypes compared to 5-HT2B, others aren't. Almost all antidepressants are tested for 5-HT2B affinity because of the association with heart disease and birth defects, and because of the lawsuits that resulted from them.