This is the final post (3/3) concerning what to do about the question of suicide after brain injury. The prior postings introduce the reason for this article (1/3) and share my suggestions to caregivers (2/3). This final post is a message to survivors with my thoughts about suicide and why it is NOT the best option. If you have not read the previous posts, I suggest you do so now. Thank you for reading and please leave your thoughts below.
To Survivors
The choice is yours.
Let’s be very clear on that.
YOU must make the choice of whether YOU want to live. You cannot rely on any other person to convince or inspire you to “continue living” — seeking such codependent support will strip away your personal autonomy and leave you always looking for that someone. To live is a choice YOU must make.
But it makes sense to choose to live.
Making the choice to live is leaving yourself open to the infinite realm of possibility. Life changes — that is inevitable — sometimes it’s in an instant and sometimes it’s over years — but life will change. The only thing constant is change. Sometimes change is a result of good or bad luck, and sometimes a result of choices made — I believe that most often it comes from some combination of these, but regardless change will come.
There are times when life may seem to be plush with luxury — and then that will change. This same life may become filled with challenges that bore into the soul — but that too will change. To employ an oft used metaphor — life is a rollercoaster with hills, valleys, steep climbs, fast falls, an unexpected and terrifying plunge, a stretch of calm that presents glorious views and leaves you breathless at the splendiferous beauty of the world, before tossing you into another stomach twisting tirade of turns — every life has all of that, and each event is the result of change.
To end your life is to end change. Don’t kid yourself — committing suicide is not fixing anything, but it is stopping change. Once you die, your life will remain how it ends. Mind, the life of those who care for you will be a marred by your passing — and once you’re dead, you can’t do anything to help. You cannot win an argument with suicide — suicide will never “prove a point”, but it will end the debate. Suicide will not bring revenge upon anyone — it will cause pain and sadness for those who love you, and this pain will necessarily be dealt with through reasoning, and then filed away into the shelving units of memory so that the pained person can continue to live. Suicide does not combine with other events to cause anything — suicide does not Do anything — suicide is an end.
But a sad survivor may say, “I’ve given up any hope of change — any change that might occur will surely be negative.”
I ask, “How can this be known? How can there be any assurance of a negative change?”
I continue by suggesting, “You have a choice in how a change is viewed. Rarely — if ever — is an event all good or all bad — we make choices regarding the shades of emotion that are used to color events. By making the choice to stay alive, you leave yourself open to change — and you can make the choice to recognize the positive elements of a change.“You are a survivor of brain injury. The life you had before your injury has been inalterably affected — change has occurred.
Now choose how to accept that.”
Stripping away the “quotation marks,” I’ll tell you — the reader — that my life is not at all what I had intended when my brain injury occurred — how much of that is from brain injury and how much is from the infinite-other-changes-of-life is something that cannot be known. Brain injury certainly caused some changes, and the events that came from these changes inspired still more changes.
And Life occurred. And now, here I am.
To this day, there are countless moments when I regret never having felt secure enough to pursue my previously planned path, but there are more times when I recognize how blessed I am to have witnessed the journey of life I find myself on. It is my choice — I have made the choice — to focus on the treasured moments that my life has led me to instead of the dreams I had once hoped to pursue.
But the sad survivor may spit a spiteful reply — “Well isn’t that good for your life. My life is shit — I have no treasures — I don’t expect any. There is nothing to celebrate.”
And it is a choice to take that view — at times a tempting choice. It is easy to see only pain and, in some sick way, it is a temporarily pleasurable to bask in the bile of self-pity — but the pleasure does not last. There have been times when I have made this choice to wallow in misery — but in my experience, I found that the anger and hatred and agony quickly overcame any comfort that I found in masochistic self-pity — but this is a choice one can make.
Or you can change what you see. You can choose to recognize pleasures that reside in the decision to live. It takes practice — it takes patience — it takes dogged determination — but I say with confidence that there are times — things — events you can appreciate.
One way to practice this — begin small. Find a thing that makes you smile — an instant, a smell, a taste, an image — find anything that give you the slight nip of joy. Push yourself to find this nip — go for a walk, look out the window, listen to music, watch a movie, do something — just get outside yourself to discover what can give joy. Then write it down — document it — store it in your heart — and then look for the next joyful nip.
Choose to find five things a day — and once you find those five things, find ten more — and then find more — and it can become a habit to document joy.
Try it — let me know how it goes.
Or try a different way — the choice is yours.
It is always your choice — as long as you are alive, you have a choice.
Thank you for choosing to read this. I would love your comments on this blog or facebook — messages to hear how these words reach you. And please share with anyone you think might be helped. This was a difficult entry to write, and I would appreciate knowing your thoughts.
Please note, the scenes appear in reverse order and may cause confusion. To get a clearer understanding of the story, please start with the early entries in the blog. Thanks - enjoy.
Wednesday, April 24, 2019
Wednesday, April 10, 2019
Responding to Suicidal Ideation (2/3)
This is the second (2/3) posting concerning what to do about the question of suicide after brain injury. The previous post presented an introduction to these thoughts. If you have not read it, please do so now. This posting has my suggestions to caregivers and the reasoning behind them. Thank you for reading, and please leave your thoughts.
To Caregivers
To begin bluntly, know that a caregiver — especially a nonprofessional caregiver — cannot be the “hero” that “saves” a person from the thought or the act of suicide. Get rid of any idea like this — it puts an unfair burden on both the caregiver and the survivor. Suicide is a choice made by the person who commits the act. A caregiver can, and should, seek to positively influence the survivor, but should not take on responsibility for a suicidal decision. Taking on such responsibility can not only cause extended emotional trauma for a caregiver, but can also lay further stress upon the survivor — the survivor is no longer responsible for only personal wellbeing, but also the wellbeing of the caregiver. In my experience, feeling “pressure to live” and not kill myself for the sake of other people became another stress — I was not encouraged to live but felt further defeated. My thought process was, “Well, I’m getting pretty good at screwing everything else up, why not die and just add one more thing to an already long list. At least that way the list of my screwups won’t get any longer.”
Similarly, the caregiver should not seek credit for helping the survivor — the survivor is the only person who makes the choice to live or not live. Furthermore, this decision to live should not be a glorified. It is an important choice, but also — very simply — necessary. Any person who wants to continue in this life constantly makes the decision to live, though often it is done unconsciously — death is always possible, but most times we ignore this choice. For a caregiver to take credit for encouraging a survivor to decide to live takes away the power of that decision from the survivor.
With all those caveats, This puts the caregiver in the unenviable position of being a person who works a thankless task and never receives credit for the work done — what’s more, a caregiver can never know if any work done has affected a survivor in anyway. It is always a survivors decision.
But what is this work? What can a caregiver do to encourage a survivor to make the choice to continue living?
This work is — to Be there.
In the purest sense, simply be there — let the survivor know you are available and would like to listen, if there is anything to hear.
This is not asking ‘Are you okay’. This is not suggesting behaviors. This is not offering guidance.
Just listen — without judgement.
“But how?” A caregiver may ask, “How do I Do this?”
It’s not a thing to do, it’s a way to be.
At this point, I run the risk of falling into the realm of spiritual mysticism — “Just Be, man” — and that might shake some people, so let me cut that thought off — this is NOT about being mystic or meditating or the spiritual. It’s also not about “fixing” a thing. This is about trusting in the person for which you care to come to you when they are ready to express a need.
Now, that said, I do suggest a caregiver try to keep a light line of communication open — don’t go out of your way to ignore the survivor, but when you talk, keep things emotionally light — “Hey, how you doing?” “You wanna get some coffee this afternoon? No? Okay, let me know if you change your mind.” “Anytime you want to do something, just let me know and I’ll see what’s up.” Don’t try to force your way in — that will only push the survivor away — but just be there as someone who cares.
As a survivor, I remember needing to cry, to complain, to scream without the fear of having some other rehabilitation or therapy or life-affirming habit thrust into my life. Recovery sucks — things may be slowly getting better, but let a survivor recognize the pain and confusion and hate and all the negative feelings and emotions by talking about them — being able to express the negative is the beginning of moving onto positive thinking. As a caregiver, it is not your job to fix everything that is wrong — it is your job to CARE for the survivor, and sometimes that care is best shown by simply being there and letting the survivor dump all the shit out of his or her mind — and as a caregiver, its gotta be okay to wipe off this shit, smile at the survivor, give a hug, and brace yourself for the next load.
That is the first, and I believe the most important step — care — with no expectation or desire for recognition — care. Be there.
I recognize this cannot be easy. Giving care is often thought of as an active event, and the act of simply being may seem aggravatingly passive. Don’t worry, as a caregiver there is still a lot you will need to do — transportation to doctors’ appointments, preparing meals, helping the loved one navigate a new set of physical limitations — we could continue as the list of necessary things to do for a caregiver is rather extensive, but I do not want to become distracted. This is about the question of suicide — and this is one thing a caregiver cannot actively do. From my experience, a caregiver can best help by actively being there — available, ready, but not insistent.
In tandem with this, a caregiver can — and should — have information about suicide prevention services, encourage participation in social activities, demonstrate positive thinking, and be knowledgable of suicide dissuasion methods — these sort of actions are important for a survivor to have in his or her life, but first there must be trust. A survivor will have difficulty hearing a caregiver offer positive information if this information feels forced upon the survivor. I remember knowing that there was self-help information when I was in the intense part of my early recovery, but often felt I was being pushed toward it — and it made me uncomfortable to make the decision to access such help and extra curricular services when I did not feel autonomy over the decision to do so.
This raises the question — Would I have had less suicidal ideation if I felt more autonomy in the decision to reach out for rehabilitative resources?
I don’t know.
Maybe I did have a person or persons who provided a sort of unobtrusive care, but it was done in a way that I wasn’t even aware of the care, and this care helped to keep me from making the wrong decision — in which case these caregivers did a damn fine job and I am eternally grateful. Or maybe I didn’t have these people and I was fortunate to navigate the precipice of suicidal ideation on my own.
I cannot know.
A frustrating answer, but the only one I can honestly give.
What I can say is that living with my new and continuously changing set of skills provided a series of pressures, and at times these pressures squeezed out thoughts of suicide. How much it was my caregivers — those recognized and those I was never aware of — that inspired me to temper these thoughts, and how much it was my personal tenacity that kept me alive is unknown. It’s a damnable unknown, but one I’m thankful for and one I can Live with.
Returning to the role of a caregiver in curbing suicidal ideation, the primary job is both the simplest and the most difficult. Be there. Allow a survivor to cry to you, to complain, to consider all choices — all paths — all results. Have information at the ready and answer any questions asked of you, but do not insist that you know the “correct” thing to do. By being there with unobtrusive consistency, a survivor can find comfort in knowing there is support as he or she continues into a new stage of life.
I hope this makes sense. Please share with friends if you think they might find this entry interesting or helpful.
To Caregivers
To begin bluntly, know that a caregiver — especially a nonprofessional caregiver — cannot be the “hero” that “saves” a person from the thought or the act of suicide. Get rid of any idea like this — it puts an unfair burden on both the caregiver and the survivor. Suicide is a choice made by the person who commits the act. A caregiver can, and should, seek to positively influence the survivor, but should not take on responsibility for a suicidal decision. Taking on such responsibility can not only cause extended emotional trauma for a caregiver, but can also lay further stress upon the survivor — the survivor is no longer responsible for only personal wellbeing, but also the wellbeing of the caregiver. In my experience, feeling “pressure to live” and not kill myself for the sake of other people became another stress — I was not encouraged to live but felt further defeated. My thought process was, “Well, I’m getting pretty good at screwing everything else up, why not die and just add one more thing to an already long list. At least that way the list of my screwups won’t get any longer.”
Similarly, the caregiver should not seek credit for helping the survivor — the survivor is the only person who makes the choice to live or not live. Furthermore, this decision to live should not be a glorified. It is an important choice, but also — very simply — necessary. Any person who wants to continue in this life constantly makes the decision to live, though often it is done unconsciously — death is always possible, but most times we ignore this choice. For a caregiver to take credit for encouraging a survivor to decide to live takes away the power of that decision from the survivor.
With all those caveats, This puts the caregiver in the unenviable position of being a person who works a thankless task and never receives credit for the work done — what’s more, a caregiver can never know if any work done has affected a survivor in anyway. It is always a survivors decision.
But what is this work? What can a caregiver do to encourage a survivor to make the choice to continue living?
This work is — to Be there.
In the purest sense, simply be there — let the survivor know you are available and would like to listen, if there is anything to hear.
This is not asking ‘Are you okay’. This is not suggesting behaviors. This is not offering guidance.
Just listen — without judgement.
“But how?” A caregiver may ask, “How do I Do this?”
It’s not a thing to do, it’s a way to be.
At this point, I run the risk of falling into the realm of spiritual mysticism — “Just Be, man” — and that might shake some people, so let me cut that thought off — this is NOT about being mystic or meditating or the spiritual. It’s also not about “fixing” a thing. This is about trusting in the person for which you care to come to you when they are ready to express a need.
Now, that said, I do suggest a caregiver try to keep a light line of communication open — don’t go out of your way to ignore the survivor, but when you talk, keep things emotionally light — “Hey, how you doing?” “You wanna get some coffee this afternoon? No? Okay, let me know if you change your mind.” “Anytime you want to do something, just let me know and I’ll see what’s up.” Don’t try to force your way in — that will only push the survivor away — but just be there as someone who cares.
As a survivor, I remember needing to cry, to complain, to scream without the fear of having some other rehabilitation or therapy or life-affirming habit thrust into my life. Recovery sucks — things may be slowly getting better, but let a survivor recognize the pain and confusion and hate and all the negative feelings and emotions by talking about them — being able to express the negative is the beginning of moving onto positive thinking. As a caregiver, it is not your job to fix everything that is wrong — it is your job to CARE for the survivor, and sometimes that care is best shown by simply being there and letting the survivor dump all the shit out of his or her mind — and as a caregiver, its gotta be okay to wipe off this shit, smile at the survivor, give a hug, and brace yourself for the next load.
That is the first, and I believe the most important step — care — with no expectation or desire for recognition — care. Be there.
I recognize this cannot be easy. Giving care is often thought of as an active event, and the act of simply being may seem aggravatingly passive. Don’t worry, as a caregiver there is still a lot you will need to do — transportation to doctors’ appointments, preparing meals, helping the loved one navigate a new set of physical limitations — we could continue as the list of necessary things to do for a caregiver is rather extensive, but I do not want to become distracted. This is about the question of suicide — and this is one thing a caregiver cannot actively do. From my experience, a caregiver can best help by actively being there — available, ready, but not insistent.
In tandem with this, a caregiver can — and should — have information about suicide prevention services, encourage participation in social activities, demonstrate positive thinking, and be knowledgable of suicide dissuasion methods — these sort of actions are important for a survivor to have in his or her life, but first there must be trust. A survivor will have difficulty hearing a caregiver offer positive information if this information feels forced upon the survivor. I remember knowing that there was self-help information when I was in the intense part of my early recovery, but often felt I was being pushed toward it — and it made me uncomfortable to make the decision to access such help and extra curricular services when I did not feel autonomy over the decision to do so.
This raises the question — Would I have had less suicidal ideation if I felt more autonomy in the decision to reach out for rehabilitative resources?
I don’t know.
Maybe I did have a person or persons who provided a sort of unobtrusive care, but it was done in a way that I wasn’t even aware of the care, and this care helped to keep me from making the wrong decision — in which case these caregivers did a damn fine job and I am eternally grateful. Or maybe I didn’t have these people and I was fortunate to navigate the precipice of suicidal ideation on my own.
I cannot know.
A frustrating answer, but the only one I can honestly give.
What I can say is that living with my new and continuously changing set of skills provided a series of pressures, and at times these pressures squeezed out thoughts of suicide. How much it was my caregivers — those recognized and those I was never aware of — that inspired me to temper these thoughts, and how much it was my personal tenacity that kept me alive is unknown. It’s a damnable unknown, but one I’m thankful for and one I can Live with.
Returning to the role of a caregiver in curbing suicidal ideation, the primary job is both the simplest and the most difficult. Be there. Allow a survivor to cry to you, to complain, to consider all choices — all paths — all results. Have information at the ready and answer any questions asked of you, but do not insist that you know the “correct” thing to do. By being there with unobtrusive consistency, a survivor can find comfort in knowing there is support as he or she continues into a new stage of life.
I hope this makes sense. Please share with friends if you think they might find this entry interesting or helpful.
Tuesday, April 2, 2019
Scene 28 -- Responding to Suicidal Ideation (1/3)
****************Scene 28*****************
Larry,
did try to commit suicide
one time.
But It wasn’t all my fault,
see,
I was on these new anti depressants, so my head was in a weird place,
and I also had these pills…
When I took them, they made me feel real good,
kinda high,
and I knew if I took too many of these pills -
more than one -
I could OD and, like, maybe die,
But,
I don’t know,
like,
everything just…
SUCKED,
A lot.
And it wasn’t getting better,
So I thought - the pills -
Maybe I could, I don’t know,
feel good as I go out.
So I tried to OD on my medication. they found me,
got me to the hospital,
Turns out, couldn’t even do That right.
*******************Commentary***********************************
Suicide rates increase after brain injury.
Depending on the source cited, studies indicate that suicide rates increase 2 - 4 times after TBI (Suicidality in people surviving a traumatic brain injury...clinical management - Rates and Predictors of Suicidal Ideation During the First Year After Traumatic Brain Injury - 17% of people with traumatic brain injury attempted suicide)
The previous entry shared my experience with suicidal ideation, and I suspect that there are further thoughts of suicide that go unreported, as mine did — particularly in light of the responses I received concerning the previous article. When I was in the midst of often having thoughts of suicide, I remember learning the “correct responses” to questions so that my ideation would not be recognized and I would not raise any further concerns for those around me. If this is true for survivors other than myself, it suggests that instances of suicidal ideation may be greater than the amount reported in these studies.
Or I may be mistaken. It may that caregivers and professionals are able to pull back the veil placed over ideation and are able to see such “unreported” impulses with more clarity than I give them credit — these are professional research studies, and the possibility of deceptive responses may have been factored into the study. Whatever the case, I don’t want to dwell on this point — this is not criticism toward those studies — we can agree that there is a significant increase in both suicide attempts and ideation after brain injury. This article — posted in three parts — is my attempt to address this truth.
It comes from my personal experience. I cannot claim that I am an expert in the area of suicide, and should there be a conflict between my thoughts and those of a trained mental health professional, I encourage listening to professional recommendations over my ideas every time. That said, I want this article to present something new — to provide something more than a series of quotations — therefore I have written what I learned from my journey through recovery and suicidal ideation. My research into the subject seems to support the ideas that I share, but I ask for any responses that support or call into question my claims. The goal is to provide the best information.
This article will be posted in three sections — First is the short introduction that you just finished — thank you for that, but please keep reading. The next post (posted within the week) will be my suggestion to caregivers of how to respond to warning signs or fears of suicidal intention. And the final posting is a message directed to survivors that shares my philosophy about suicide and why it is not the best option.
Thank you for diving into this topic with me. It is a sad and scary reality that needs to be addressed — please keep up with these posts and share your thoughts.
Larry,
did try to commit suicide
one time.
But It wasn’t all my fault,
see,
I was on these new anti depressants, so my head was in a weird place,
and I also had these pills…
When I took them, they made me feel real good,
kinda high,
and I knew if I took too many of these pills -
more than one -
I could OD and, like, maybe die,
But,
I don’t know,
like,
everything just…
SUCKED,
A lot.
And it wasn’t getting better,
So I thought - the pills -
Maybe I could, I don’t know,
feel good as I go out.
So I tried to OD on my medication. they found me,
got me to the hospital,
Turns out, couldn’t even do That right.
*******************Commentary***********************************
Suicide rates increase after brain injury.
Depending on the source cited, studies indicate that suicide rates increase 2 - 4 times after TBI (Suicidality in people surviving a traumatic brain injury...clinical management - Rates and Predictors of Suicidal Ideation During the First Year After Traumatic Brain Injury - 17% of people with traumatic brain injury attempted suicide)
The previous entry shared my experience with suicidal ideation, and I suspect that there are further thoughts of suicide that go unreported, as mine did — particularly in light of the responses I received concerning the previous article. When I was in the midst of often having thoughts of suicide, I remember learning the “correct responses” to questions so that my ideation would not be recognized and I would not raise any further concerns for those around me. If this is true for survivors other than myself, it suggests that instances of suicidal ideation may be greater than the amount reported in these studies.
Or I may be mistaken. It may that caregivers and professionals are able to pull back the veil placed over ideation and are able to see such “unreported” impulses with more clarity than I give them credit — these are professional research studies, and the possibility of deceptive responses may have been factored into the study. Whatever the case, I don’t want to dwell on this point — this is not criticism toward those studies — we can agree that there is a significant increase in both suicide attempts and ideation after brain injury. This article — posted in three parts — is my attempt to address this truth.
It comes from my personal experience. I cannot claim that I am an expert in the area of suicide, and should there be a conflict between my thoughts and those of a trained mental health professional, I encourage listening to professional recommendations over my ideas every time. That said, I want this article to present something new — to provide something more than a series of quotations — therefore I have written what I learned from my journey through recovery and suicidal ideation. My research into the subject seems to support the ideas that I share, but I ask for any responses that support or call into question my claims. The goal is to provide the best information.
This article will be posted in three sections — First is the short introduction that you just finished — thank you for that, but please keep reading. The next post (posted within the week) will be my suggestion to caregivers of how to respond to warning signs or fears of suicidal intention. And the final posting is a message directed to survivors that shares my philosophy about suicide and why it is not the best option.
Thank you for diving into this topic with me. It is a sad and scary reality that needs to be addressed — please keep up with these posts and share your thoughts.
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