The following interchange exemplifies what I mean by expressing yourself to individuals in your life who know intimately what you know or how, at times, you may feel because they may have felt likewise. They can gently remind you of principles you actually know to be true but have perhaps lost somewhere in your efforts to effect change in the world. This woman and I are both crusaders for suicide prevention. Both of us work with the military. Both of us are therapists and educators. Both of us are God-directed. Both of us have been tested by limitations placed on us by an often resistant, unenlightened and intractable institutional atmosphere of varying degrees. We have commiserated about it and the taxing effect it has had on our resolve, which has been sorely tested but never wavered. We have never met in person. I often address military battalions and squadrons on the subject of suicidality and talk about exactly what to do on a daily basis in order to actively help a battle buddy who might be struggling. I refer to my booklet “Suicide Prevention for Battle Buddies and their Families” available soon for free download at my website (https://www.jsp3.org). I speak honestly about my own 24 years of suicidality and how I came to successfully understand its origins and to manage it with the help of my dedicated and goal-directed friends. The intention of this cadre of friends for years was to carefully and insightfully keep me alive until I learned how to keep myself alive. This was a message that I sent my east coast buddy on the eve before 2014 convened. L, you are truly one of God’s gifts. Keeping going is one of the hardest things to do especially when it is difficult to see any changes happening and people suffering in the meantime. I addressed a very young Stryker battalion this November where the mean age was 24 and two was the average number of deployments. I spoke earnestly and from the heart using as many examples that I thought they would find meaningful. Later on I overheard my husband telling one of the sergeants that he was miffed at the guys in the top rows laughing and giggling, although quietly, during my talk. I tried to suck it up. Originally I thought I did a good job until we were at dinner that night and I realized how many “kids” in that battalion were goofing off, maybe making fun of me, but maybe (hopefully) deflecting the austerity and reality of the message. However, while I was paying attention as I always do during my suicidality talks, I was astonished at the number of heads that were bowed and NOT making fun, but unable to look up and engage my eyes. Later on I looked at husband John across the dinner table, and said, “I didn’t reach them. As much as I prayed I would and as hard as I worked on my talk, I did not reach them.” And then the tears began to flow. I couldn’t stem them and I knew the only thing to do was cry it out. I decided to go out to the car and wait for John to pay the bill. As I left the restaurant, three kind young men opened the door for me. I had my head down but raised it just long enough to hide my tears while thanking them. One of the guys said, “Hey, you’re the lady that spoke to our battalion today. You were great. You were the best speaker we’ve ever had and we really heard what you had to say.” Huge tears rolled down my cheeks. I looked up and said, “Thank you, but I was convinced of just the opposite.” They asked if they could help me out to the car and I agreed realizing I needed some guidance. They put my walker in the backseat and asked what else they could do for me. With tears still pooling, I replied, “Take care of yourself, but most of all, listen and take care of each other.” Then I gave them each a hug and we went on our way. I cried all the way home. I still don’t know what to think about that day. I don’t know if I am too old to talk to and be heard by the majority of young people today or am I asking too much of them? I know I must do what I can and if it helps one person I need to be able to endure the derision of a hundred in order to make that one miracle happen. And ego be damned, eh? So you keep going. We’ll all keep going. You are blessed. And you’re a precious child of God. Everything we do to reach out to help someone anywhere, anytime is important. Love, Randi J. This was her enlightened response. Dear wonderful Randi, You touch people so much more than you know, and though your awareness of your effect on others didn’t seem helpful – it absolutely was. The military culture as you know better than me is one of stolid fortitude and resistance to vulnerability. Many learned as children that being vulnerable meant they gave others a “weapon” to hurt them. The walls they build up, you pulled down. Those chuckling in the top rows were listening, even as they felt they were conveying their machismo and barriers. Do not doubt this; He is well pleased with you. There isn’t a service member or vet alive that hasn’t been affected by someone (or themselves) who wants to end their own life. I can say with assurance that you reached many more than those three young men at the door. We’ve never met in person, but we already know more about each other than we imagine. Your talk was a gift to them, and my belief is that your words come back to many of them at the oddest times; your words don’t just dissipate into the ether; they stick with people. God brings people together for a reason, and He doesn’t make mistakes. You’re right, keeping going when we don’t want to do so is what makes us different. But I don’t think I know how to not help people, and neither do you; it’s why we live every day. I have never been in the emotional space you have, but I’ve been mightily challenged. We wounded healers are the sustainers of His will, and we bow to that will, knowing He will give us what we need, even when we sigh and weep and wonder. It’s what we DO. With great care and His love, peace, my friend, in 2014, L. That’s what I mean by knowing who to talk to and who to keep close to you in days of questioning and times of challenge. We cannot be afraid to have tender underbellies. There is no one who does not have one. If we are wise in whom we confide, we could know that vulnerability can be expressed without fear of exploitation. The question to ask yourself is, are you someone who can be confided in? Or more expressly, are you someone who can be fearless enough to be the one confiding?
What have you done in 2013 to help prevent suicide?
The American Association of Suicidology asked about new things that have been done to prevent suicide in 2013. This was some of my response. You ask, “What have you done in 2013 to help prevent suicide?” I just saw a client who had recently been discharged from a well-known local private psychiatric hospital. She is the second suicidal patient who told me the same story. They both experienced condescension and judgment from the staff. Essentially they were told to “get over it” and “quit belaboring their problems”. They were told they both needed an antidepressant and to try to stop dwelling on the past. There is nothing wrong with taking an antidepressant if it can help the brain’s information processing and provide some uplift and/or clarity by increasing the necessary neurochemicals that the brain in question is lacking. But to rely on medication as the most significant solution is not going to make the patient feel they have any more control over their condition than they had before their hospitalization. They both felt like they were warehoused until willing to say they were no longer suicidal…whether they were or not. A hospital truly devoted to preventing suicide could do it by creating a discharge plan that included educating and forming a support team of the friends and/or family members identified by the suicidal person. To release a suicidal patient without obtaining releases to talk to and educate the concerned others in how to support the patient is unconscionable. There are no confidentiality or HIPAA (Health Insurance Portability and Accountability Act) violations involved with forming a JSP3© support team. The patient is the one who actively plans, approves and leads their own support team. Forming an educated support team for a suicidal patient should be routine. I provide free 3 hour sessions to form JSP3© (Jensen Suicide Prevention Peer Protocol) support teams for suicidal people who want to retrain their brain and learn a new way of being. I help suicidal people get into and stay in the driver’s seat of their lives. They realize they can’t do it alone because most have tried unsuccessfully for years. When introduced to the JSP3© support team method of retraining their brain, the suicidal person begins to feel agency and self-efficacy sometimes for the first time in their lives. It is important to note that epidemiological research shows that the greatest risk for suicide is in the first few weeks following discharge from the hospital.1 In fact, in Britain, researchers discovered that 41% of the suicides after discharge occur before the first follow up mental health appointment.2 In addition, it is estimated that nearly 1% of inpatient discharges result in suicide within the first year following discharge.3 I am doing everything I can as a suicidologist (who specializes in and teaches treatment of suicidality) to convince hospitals they need to form JSP3© (Jensen Suicide Prevention Peer Protocol) teams for those who are dealing with suicidality. I have provided free counseling and free formation of JSP3© teams for clients and their families and concerned others and it works. By explaining the psychobiology of suicide, the entire team including the suicidal person realizes that the patient’s suicidality is not their own fault. They understand that it is an enduring coping mechanism that formed a neural pathway and requires retraining the brain to atrophy that long-term neural pathway. The JSP3© team provides the support in this process while a licensed therapist helps resolve the underlying trauma that produced the helplessness and the hopelessness where the need “not to be here” began. More information is available in my book,” Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide”, where I reveal how I retrained by brain with the help of a dedicated team of friends. After 24 years of suicidality and my daily struggle to stay alive, with the support of my peers, I came to know a new life. I now do this for my clients and it is the most empowering thing they have experienced in their lives. When I teach “Recognition, Assessment and Treatment of Suicidality”, a course now required for all mental health therapists by Washington state Department of Health, I currently include the importance of peer support. More information is available at www.jsp3.org. During my 24 years struggling with suicidality, I spent three long hospitalizations in psych wards, each after suicide attempts of ever increasing lethality. Never did any of those ward clinicians suggest that a support team of my concerned others could make life easier for me battling suicidality on the outside. Instead my friends stepped up on their own and remained determined that they were going to work together in an organized way to keep me alive until I could keep myself alive. It was through this process developed through intuition and dedication that underpinned my recovery. Now I form those teams for others who want to climb into the driver’s seat of their lives and begin retraining their brains. I will never give up forming JSP3© support teams. Although I sometimes gave my team plenty of opportunity, not one member ever gave up on me. If not for them, I doubt I’d be here. 1 Crawford, M. (2004) Suicide following discharge from in-patient psychiatric care. Advances in Psychiatric Treatment 10. 434-438. 2 Appleby, L., Dennehy, J., Thomas, C., et al (1999a) Aftercare and clinical characteristics of people with mental illness who commit suicide: a case–control study. Lancet, 353, 1397–1400. 3 Goldacre, M., Seagroatt, V. & Hawton, K. (1993) Suicide after discharge from psychiatric in-patient care. Lancet, 342, 283–286.
Knowing who to call
Knowing Who to Call – Commiseration with the Right People Four weeks ago I met with a patient who told me that the night before she met with me she was an “11” on a scale of 1 to 10, with ten being the highest degree of suicidality. She was trying to do it all alone. And she has severe chronic pain. We talked about the psychobiology of suicide1 and how she can start being in the driver’s seat of her life. In order to do that she needs to ask for support from the right people, hopefully from peers who can relate to what she is going through. The following is a definition of peer support paraphrased from the article, “Peer support: A theoretical perspective” by Meade, Hilton and Curtis2. Peer support is reciprocal empowerment achieved through giving and receiving help from those sharing respect, responsibility, and mutual agreement of what is helpful. There is no basis in psychiatric taxonomy, labels or diagnostic treatment. It is the shared empathic experience of emotional and psychological pain that creates the therapeutic connection. The mutual affiliation affords an equality in status without the constraints of traditional (expert/patient) relationships. As trust develops over time peers are able to challenge each other’s old behaviors and encourage new ones. There is more information about peer support at www.jsp3.org. Understanding that this patient needs to develop peer support is vital to retraining her brain and creating new behaviors based on those new concepts. We discussed how she needs to realize who in her life actually supports her and who does not. But, more importantly, at pivotal times in our lives we all need to figure out who in our lives might want to support us but simply can’t because they don’t know how nor do they have the capacity to learn how. And the hardest lesson of all is realizing the people we think should be able to help us (like our blood kin or long-term friends) are either overwhelmed in their own worlds, living in fear of anything shaking their beliefs or holding on to their own preconceived notions that prevent them from opening their minds and hearts to new information. Hard to know what really stops people from having compassion for us when we need them. But it sure hurts when you need it and don’t get it or worse get derision, shame or blame instead. So we talked about how you actually figure out who might be supportive. The best indicator is past behavior. If a person has been supportive of you in the past or if you know someone who might be supportive of you if you build a relationship based on mutual honesty, you have a good prospect. But probably the most important aspect of finding supportive people is finding people who have been through what you have or have some intimate knowledge of a similar situation. Research indicates that peer support from troops who have had similar combat stress or other trauma can provide for each other mutual compassionate support that can actually prevent post-traumatic stress disorder3. So it seems if you can find someone who personally knows something of what you have experienced, you have a better chance of receiving “emotional support, informational advice, practical assistance, and help in understanding or interpreting events” (p.14)3. I know this for a fact. I have certain friends I call for certain kinds of support. I emailed a colleague last week after I worked diligently on a conference proposal for 5 days. I thought I had 2 hours leeway in submitting it. But after I entered it into the proposal portal, the date/time stamp on it revealed it was 2 hours too late. I had not noticed that the proposal deadline was midnight EST, not PST. All that work seemingly for nothing. I could only tell that to someone who had been there and knew what that kind of research and prep really meant. Few others would have fully understood how disappointed I was in my own stupidity. One thing that makes my chronic pain patients (and me, too, because I have chronic pain) frustrated is doctors that eschew the psychological effects of unrelenting pain. They treat the physical pain the best they can but usually spend no time dealing with the devastating mental effects of intractable pain. This is sometimes obvious when the patients gets the blame from the doctors who are relegated to just treating the symptomatic pain because they cannot successfully solve the causative health problem. I’ve learned when fibromyalgia lays me out for days, unable to walk but haltingly on my walker, there is nothing I can do. Day follows day and upon awakening each morning perhaps after a disturbed, pain and fit-filled night, comes the realization this day is no less debilitating than the day before. I do everything I can to mitigate the effects of unmitigated pain. I switch around my obligations as best I can, reschedule patients, ask for favors from husband and friends, reassess priorities, and accept this is how it is. I handle it the best I can by myself but sometimes I need help from others who know what this is like. I call my friend in Florida who has Chronic Fatigue and Fibromyalgia. She is one of the funniest people I have ever known and can make me laugh even when we are both in serious pain. We’ve known each other for 45 years. We’ve had our ups and downs and we’ve both gotten over disappointments in each other over the years. In contrast and in testament to our enduring friendship, we still celebrate moments of hysterical insanity from years of sharing work hours and the goofing off hours in between. But moreover, we can rely on each other for compassion in dealing with our chronic pain. I’ve been struggling all week with “through the roof pain” and broke down today, angry because I had to cancel another day of activity. I called her and make no mistake about it – this was not then nor is it at any time wallowing in distress. This was not misery loves company. This was and is vital mutual support for mutual suffering. When I call, she reminds me I’m not alone and that I do have much to be thankful for – but it’s the way she does it that makes it perfectly healing. I told her, “I’m exhausted from not being able to do anything.” This is what E told me. “I haven’t been in this much pain in years either. I think it could be the weather, but either way, this sucks. My house is a mess. There is so much crap on the coffee table I can no longer see the other side of the room nor the body from which my husband’s voice is emanating. I want to clean it up but I really only have the energy to think about it. When I’m watching our gigantic TV and I can no longer read the news crawl on the bottom of the screen, I know I have to start lowering the stack of crap in front of it.” We went on to talk about how we distract ourselves using different TV shows. I use stupid 60’s sitcoms. E uses true crime shows. She says, “whenever I start feeling really bad I watch a murder on ‘I’d kill for you‘ and then feel glad that’s not me.” She reminds me how grateful she is that she’s retired and does not have to work. She and I agreed that even in all of our pain, we need to be thankful that we do not have to spend our precious remaining days standing all day saying, ‘Hello, Welcome to Walmart’ or asking, “You want fries with that?”. See what I mean? P.S.: E called me the next day and asked me, “You didn’t think I was trying to “out pain” you, did you? Because I hate people when you tell them how much pain you’re in hoping to get some understanding, and they ‘one up you’.” She wanted me to know she heard me and that she wasn’t dismissing my pain with hers. She made me laugh again and really guffaw. I was grateful. The pain disappeared out of my consciousness for a few seconds more. There’s something special about knowing who to call. References: 1 Jensen, R. (2012). Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide. Smashwords. 2 Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal, 25(2): 134-41. 3 Defense Centers of Excellence. (2011). Identifications of Best Practices for Peer Support Programs: White Paper. Retrieved from www.http://dcoe.health.mil
Suicide and Don Quixote
I just this week watched on TV the film, “Don Quixote”. I remembered in strange reverie that this was one story I could relate to in my struggle to stay alive in the early 70’s – the height of my suicidality. I would sing along with the movie’s song lyrics desperately in search of my own destiny, something faithful and worthy to follow. “I am I, Don Quixote, the Lord of La Mancha, my destiny calls and I go”. I longed for the knowledge that something besides death would call to me. I felt like Quixote did, alone on a quest that had no real discernible future. That music gave me something to focus on though, some knowledge that out there was a story punctuated by compelling melody written by someone who knew a deeper truth, a deeper yearning in the human soul. I was drawn because somehow I knew I could find solace there. I have found many of my patients find certain songs express the pain inside better than they could ever verbalize it. They listen to a particular song repeatedly, memorizing every word and inflection. I did exactly the same thing. And I felt a tremendous comfort in knowing someone had found a way to express my torment – that there might be someone else out there who felt my same way. Suicidality is so isolating. It seemed maudlin to any unsuspecting eavesdroppers but music and story always played a part in my slow path towards my healing and my destiny to heal others. I realized that the reason I spent 24 years in agonizing suicidality was to be able to discover the means to help others through my research and my own personal experience. Why it has taken so many decades for me to get here pains me because I feel the urgency of Quixote. I feel the loss of every spent moment and am compelled to jealously garner every second in retribution for that lost time. I’m going on vacation next week and I know how badly I need it. I’m going to a local quarry for 5 days to learn how to sculpt. I want to go and I need to go. I’ve always wanted to work with stone. It is a powerful healing metaphor. I’m looking forward to it. Yet, I feel precious moments ticking away. There are more things I could be doing to save lives perhaps in a more demonstrative immediate way. I wrote the book (Just Because You’re Suicidal Doesn’t Mean You’re Crazy, 2012) and I add to and am revamping my website (https://www.jsp3.org), but I am perpetually thinking, “What more, what more…”. In my meditation this morning the Lord spoke to me and told me my continued mission of preventing suicide in the world is at the quarry. “GO and wait on me”, was the clear and poignant message. So, you see, in watching Don Quixote this last time through new and enlightened eyes, I realized fully that my ministry is not necessarily in what I do, the deeds I accomplish. It is in who I am as a person – the essence of benevolent intent. The blessed entity that is who any of us are in the world surpasses all we could ever do. Today I am renewed. UPDATE: An unfortunate misunderstanding prevented me from continuing my sculpting plans. I spent only one day at the quarry, felt totally extraneous, unwanted and in the way… and left. I was overwhelmed with loss of expectation for most of the remaining week. I found myself in deep reverie and meditation, wondering what that experience was all about. I can only think of rare occasions when I have felt so disrespected and disparaged. Expecting the opposite, the reality hit me twice as hard. But life is filled with little disappointments and griefs like this. The best thing to do is put your big person pants on and move on. It took a while and I’ve moved on. I’m not worrying about deeper meaning or lessons learned – just movin’ on. Only thing that drives me crazy is that one of my most unfavorite sayings fits perfectly here: “It is what it is.”
Fundamental Understandings about suicide
There are some fundamental aspects of suicidality that I have learned through my research and decades of counseling suicidal people. Find out more in my book, “Just Because You’re Suicidal Doesn’t Mean You’re Crazy“. Suicidality is amazingly common1 The action is usually impulsive and acute however the thought pattern that sets it in motion is chronic2 It has its basis in adverse childhood experiences3 The process is completely unconscious4 Thinking about suicide becomes an excellent and successful coping mechanism5 When faced with overwhelming situations which can’t be resolved by the individual (one feels helpless) This causes stress – elevated cortisol which creates the need for relief Thoughts of “not being here” repeatedly bring on the relief of “feel good” endorphins Repeated “feel good” endorphins build a thought neural pathway which gets more entrenched over time “Not being here” progresses to “Not being anywhere” (suicide) in order to bring relief (the need for increased endorphins to achieve the same relief)5 Suicidal thought operates as a coping mechanism for dealing with overwhelming difficulty, however, sooner or later it becomes a negative and destructive pattern that prevents problem solving6 The progression is totally unconscious Suicidal people do not know where their suicidality came from or why it continues2,4,5 Suicidal people are convinced by society that there is something inexplicably wrong with them2,4,5 Suicidal people have no natural insight into how to defeat their suicidality2,4,5 Suicidal people do not know that their “not wanting to be here” neural pathway is permanent5 Suicidal people do not know that their negative emotions are warning signs that they have a problem needing immediate attention towards solution7 Suicidal people do not know that they can solve any problem with the help of an educated support system5 The Conspiracy of Denial is the one thing that promotes suicidality. What is The Conspiracy of Denial5? – Common attitudes, beliefs, and actions that innocently deny a person’s suicidality. People usually deny the reality of a person’s suicidality because they do not want to believe that this person would consider such a drastic thing. After all, why would people who do not think about suicide think anyone else would? To them, it is truly “unthinkable”. “A non-suicidal person can only see why a person would want to live. A suicidal person has difficulty giving those reasons more value than the promise of escaping the pain of existence.” (Just Because You’re Suicidal Doesn’t Mean You’re Crazy (2012), p. 111) Refuse to partake in the Conspiracy of Denial and tell people the truth when they make comments that perpetuate the Conspiracy of Denial. Listen to more about the Conspiracy of Denial at www.americanheroesnetwork.com (Sept. 3, 2013 broadcast). References
1 National Center for Injury Prevention and Control. (WISQARS): www.cdc.gov/ncipc/wisqars
2 http://forums.psychcentral.com/depression/10363-coping-suicideideation.html
3 Center for Disease Control and Prevention, http://www.cdc.gov/ace/findings.htm
4 http://forums.psychcentral.com/depression/65258-suicidal-ideation.html
5 Jensen, R. 2012. Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide.
6 http://www.helpguide.org/mental/suicide_help.html
7http://my.clevelandclinic.org/healthy_living/stress_management/hic_warning_signs_of_emotional_stress_when_to_see_your_doctor.aspx “Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide” – Download to your E-reader or as PDF to your computer at http://www.smashwords.com/books/view/209400 more info at www.jsp3.org