Some Days, I Surprise Myself

And today was one of those days.

Today, I made two important phone calls before I had the chance to talk myself out of doing so. That’s significant for 2 reasons:

  1. I took action to actually help myself rather than simply thinking about it and accomplishing nothing.
  2. I faced a few fears in the process.

After yesterday’s intake appointment at the new facility where I’ll be receiving mental healthcare, I felt hopeless, suicidal. This wasn’t because the appointment went badly or anything. On the contrary, both people I spoke with yesterday were kind, compassionate, and understanding. Rather, it was because I was told it could be late December before an appointment for therapy is available. That’s an excruciatingly long wait, especially for someone experiencing the level of suicidal ideation I have been for the past 2 weeks. However, in my overwhelm of being in a new place and having to start over again with a new facility and everything else going on in my life currently with mine and KR’s break up, I failed to mention that I’m experiencing suicidal ideation at a level of risk I haven’t experienced since 2005 or maybe as late as 2007/2008. I don’t know. This symptom is so difficult for me to pinpoint where it begins and ends. Too often, it “feels” so constant, despite knowing in my rational mind that it’s not.

Two weeks ago, I revisited a previous post, On Suicide and Suicidal Thoughts, in an attempt to put into perspective how I felt that night. That particular night I distracted myself from the thoughts and voices by literally “defining” my levels of suicidal risk. It helped. It got me through that evening, and that was the whole point. It helps to know your enemy. By defining my risk factors, I can also identify my triggers, measure and track these types of impulses, and seek out additional support when needed. Believe me when I say, this is very important when experiencing suicidal ideation. The levels of suicide risk are as much on a spectrum as the mental illnesses that cause these voices, thoughts, and/or feelings. I don’t know about anyone else’s range or levels of suicidality; but for me, it looks like this:

  1. Level 1 — No Risk of Suicide — Passive suicidal thoughts pop into my head out of seemingly nowhere. At this level the voices are actually helpful, encouraging me to “Wait it out,” distract myself, talk to someone, write about how I’m feeling, or use whatever creative method I can to prevent the thoughts from gaining control. Here, I can let the thoughts go usually by simply acknowledging them and reminding myself, “These are only thoughts. You don’t need to act on them.” Typically, frustration and lower levels of overwhelm or over-stimulation provoke these thoughts.
  2. Level 2 — Low Level of Suicide Risk — Suicidal thoughts increase in frequency and linger a while longer, yet no suicide plan or intent. Voices begin arguing among each other with most still encouraging and helpful while only a few are expressing discontent and fleeting despair. Still able to prevent ruminating thoughts and/or allow them only minimal expression for short periods of time, but it may take a bit longer to let them go. Higher levels of frustration, overwhelm, or over-stimulation trigger higher levels of suicide risk. At any level the trigger can be either internal or external.
  3. Level 3 — Moderate Level of Suicide Risk — Stronger and more frequent suicidal thoughts that may include a vague plan that isn’t lethal. I consider this to be the “romanticizing” level, where the voices (split right at 50/50 by this point) who are for suicide, glorify death and suicide as an act of great bravery while those against it are losing patience and compassion for those in pain, thus there’s A LOT of arguing going on inside my head. This is when I’m at greatest risk of using alcohol or marijuana in an attempt to “control” the voices, my mood, paranoia, and my level of distress.
  4. Level 4 — High Level of Suicide Risk — Obsessive, intrusive suicidal thoughts and thoughts about death, in general, are strong, frequent, and compulsive. Actively planning and researching methods of suicide with specific plans that are highly lethal. It’s rare at this level for me to focus on one single method. Indecision is a saving grace at this level of distress. Vivid imaginings of killing myself in a variety of ways. Aggressive voices bully me into submission and silence, preventing me from being honest with others about how I’m feeling due to severe paranoia. PTSD triggers can result in a jump from Level 1 to Level 4 with no warning. Non-lethal self-harm and suicidal gestures are at greater risk here, as well as a lower level increase in impulsiveness.
  5. Level 5 — Severe Level of Suicide Risk — Specific plan that is highly lethal with the means to do so, a time-frame in mind or high level of impulsivity (my greatest risk factor), and actual intention and determination to kill myself. Highly aggressive, loud voices that drown out any protesting voices. These are as constant as the ruminating thoughts of suicide and death. Let me reiterate: impulsive self-harm behavior can easily result in an impulsive attempt to take my life as the “will” to live is gone. Paranoia, distress, despair, and hopelessness are extremely high.

If you are feeling suicidal, please, call: 1-800-273-TALK (8255) or call a loved one or visit My Mental Health Toolkit for a list of tips and tricks that I use to help me de-stress and self soothe.


I’ve coped with suicidal ideation for more than half my life. Usually, I feel confident in my ability to manage this aspect of my mental health because I’ve had so much practice at managing my symptoms without any real emotional support system; but these past couple of weeks tested my will to survive as my level of suicide risk increased due to external stressors and internal triggers. These past couple of months have literally been one trigger after another, creating the perfect storm of circumstances and symptoms that make it feel like I’m reliving bits and pieces of my past in quick succession. It’s a frightening place to be. I wouldn’t wish this hell on anyone. Ever.

I keep telling myself I’ve already lived through all of this several times over — being discharged from treatment, starting over at a new facility, the storm of symptoms, the break-up, homelessness, all of it — and survived each one. I can do it again. It sucks, sure; but I survived.

Yesterday, I don’t think I managed to convey how dire my current situation is to either the intake counselor or the case manager with whom I spoke. The first phone call I made today was to the case manager who had told me to call with any questions or concerns I had. I thought of several and wrote them out before finally making myself call. First, I changed my mind about the psychiatric evaluation. I may need the support of a psychiatrist given the severity of symptoms I’m experiencing and considering how long it’s been since I’ve felt any relief from these symptoms. Words fail me in expressing the fear I’m facing in even acknowledging that this is the case, let alone the possibility of accepting that medication might be needed. I said I would talk with a psychiatrist. I can make that decision whether or not to take medication later. It may also take a while before I get an appointment for that, but I agreed to it.

I also made myself tell her how I’ve been feeling, about the severity of suicidal ideation. Maybe just admitting that to another person is enough. I don’t know; but I promised her (and myself) that I would continue reaching out whenever these voices, thoughts, and feelings become too much to handle on my own — like I’ve already been doing during these past 2 weeks.

We spoke briefly again about housing as well as my need to find employment before that can even be an option. I told her I called Vocational Rehabilitation last week, leaving a voicemail for the person I was told to speak to, but no one ever returned my call. Housing and employment, both, feel so overwhelming right now that they’re causing a lot of the flashbacks (to prior employment and homeless experiences) and suicidal despair, making it nearly impossible for me to accomplish anything with regard to either. I’m limiting any online searches for employment to brief, half-hour increments of time to try to avoid a lot of that; but it’s a HUGE challenge and an obstacle I have to overcome to reenter the workforce.

I also agreed to undergo a complete physical to rule out any physical causes for my symptoms, which brings me to my second important phone call and accomplishment of the day. I called the health department to schedule that physical. It’s this Thursday. I have two days to mentally prepare myself for that. I’ve been to the health department twice before; so it’s not a new place, which takes away some of that anxiety — not all but some. I don’t like to be touched, especially not by strangers. Doctor visits are particularly vulnerable situations, especially considering everything a “female exam” entails. No doubt I’ll leave the health department in that same dissociated state as the first two times I went, but I’ll go and get it over with nevertheless. This time, I plan on writing out a list of symptoms that have been bothering me, like the increased joint pain and chronic fatigue that have prevented me from taking my usual hikes for so many months, now. In the past when I’ve brought these things up, no one took me seriously. I really need someone to listen for a change rather than telling me, “It’s all in your head.”

These two phone calls may not sound like much of an accomplishment to most people. For me, though, they’re a big deal.

I began writing out this post at 5 pm. It’s now after 10 pm as I finish this up. My concentration and focus just aren’t there anymore. I struggle daily in every aspect of my life. The fact that I can’t even imagine a future, let alone prepare for it, makes my situation feel hopeless and out of control. There’s no doubt in my mind that A LOT of people are struggling to survive these days. The mental healthcare system wouldn’t be so overwhelmed if that wasn’t true. I don’t know what my future holds for me, and most days I don’t even care; but for the first time in 11 years, I don’t feel like I have to –prove- I’m struggling to cope. And that’s enough to get me through tonight.


If you are feeling suicidal, please, call: 1-800-273-TALK (8255). What you are experiencing, what you are feeling does not have to be fatal. Please, seek help. I know, easier said than done. If you find that you cannot call, wait it out, just wait it out.

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Vulnerability

I’m experiencing a hard shut down, triggered by vulnerability. “Vulnerability refers to the inability (of a system or a unit) to withstand the effects of a hostile environment.” [Source: Wikipedia.] I recognize my vulnerabilities as triggers for dissociation, panic attacks, flashbacks and nightmares, or any other symptom of anxiety, depression, or PTSD. My triggers for the defense mechanisms that serve to protect me are these vulnerabilities:

  • Specific Trigger Dates:
    • January 11th — date my divorce became final
    • January 15th — my dad’s birthday
    • March 1st — my oldest son’s birthday
    • April 11th/12th — date of first rape
    • April 14th — the day my dad died
    • April 27th — my youngest son’s birthday; memories associated with giving him up for adoption
    • August 11th — date of second rape
    • 9/11 — the day we, as a nation, were traumatized
    • December 3rd — marriage anniversary
  • Suicide Attempts (Possible trigger dates):
    1. August 9, 1996
    2. April 12, 1998
    3. October 14, 1998
    4. December 4, 2004
  • Holidays that I recognize as being triggering:
    • Easter
    • Mother’s Day
    • My birthday
    • Thanksgiving
    • Christmas
  • Certain strong emotions, e.g. rage, grief, terror, contempt, disappointment, despair, hopelessness, disrespect, humiliation, frustration, overwhelm, shame, confusion, and shock.
  • Confrontation, arguments, fighting.
  • Harsh or negative criticism and judgement by others, feeling persecuted.
  • Acts of aggression and violence (hostility). I’m horribly sensitive to media coverage that is gruesome or hateful or violent, etc. Coverage of stories regarding rape, sexual assault, domestic violence, stalking, or even sexual harassment can be triggering for me.
  • Exhaustion — whether it’s physical, emotional, mental, or all of the above.
  • Feeling exposed, out in the open, insecure paranoia.
  • Injustice. Feeling taken advantage of or inequality.
  • Abandonment.
  • Rejection.
  • Loss of safety or insecure environment. Threat of homelessness, starvation, or abuse make me catatonic, totally checked out.
  • Feeling misunderstood, unheard, or not believed.
  • Lack of consistency, routine, or structure in my daily life.
  • Change — big or small, I don’t do well with change.
  • Healthcare — mental health or physical health, either one. I still, to this day, have “institutional” type nightmares; and I never stayed at any psychiatric facility for more than one month. I have no faith left in the medical community, no faith in our doctors to actually listen, hear what they’re being told, and understand that I know my body better than they ever will given the brevity of time spent with patients. I have no patience left for psychiatry. I’m right there on that cliff of anti-psychiatry, ready to jump off. I don’t even have any trust left to give to another counselor or therapist. I have absolutely no cause to believe that corporations (pharmaceutical, healthcare related and insurance related) will grow a conscience and do what is “right” for the American people. And absolutely NO confidence in our government to protect us from their predatory greed.
  • Sex — everything about sex is triggering for me, everything. Some sexual acts are more triggering, like oral sex or anal sex (I would rather be tarred and feathered than do either); but even straight-up, vanilla, missionary position sex can cause hyperventilation or dissociation during sexual encounters with my boyfriend unless I focus on my breathing to control the physical and emotional pain I feel (and I mean, really focus on breathing, consciously aware, mindful breathing). The physical pain I feel during and after intercourse is almost as bad as the emotional baggage that prevents me from enjoying it, and sometimes that physical pain lasts for days afterward. It’s not just the actual sexual acts that are triggering for me, but also the pressure I feel to “perform” or fulfill KR’s needs. Any sexual touching triggers my startle reflex even on a good day. Waking up to KR snuggling or touching me in this way is a huge trigger! I can’t watch porn because it disgusts me to the point of dry heaving. I can’t even allow myself to feel “sexy” because in my mind, that would warrant sexual attention that I do not want. Sex was a huge issue for me long before the rapes, from the moment I lost my virginity. The rapes, sexual assaults, and sexual harassment I’ve endured throughout my adult life only further complicated this matter.*

*UPDATE: I plan to continue updating this list of triggers. I’m only now, after 23 years of on-and-off-again-therapy, beginning to recognize what triggers me.