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[ersatz_forumite]

Sock of a regular forumite here, which is probably obvious from the stupid moniker. I didn't want to post this under my regular moniker as I would prefer to remain more anonymous -- many of you know me, so I figured it would be better to post even more anonymously than usual, partly so as not to have this permanently connected to my posts under my regular moniker and also because I don't particularly want to freak anyone out (i.e. cause forumites to worry about me specifically). I apologise in advance to those of you who don't like socks, and also thank you in advance for reading what is likely to be a rambling, incoherent mess.

I find myself in a similar situation as Threadbare Sock was in hu's post earlier this year, though obviously my own reasons for being here and my history is different, the problem itself is almost identical. I'm having real trouble with suicidal 'ideation' at the moment, and I just cannot shake the feeling of how easy it would be to use that 'escape route'. I think about it all the time, how I would go about it, what I would need to do to get to the point where everything was in order beforehand etc. I have a diagnosed mental illness for which I am being treated already, with (though not so frequent recently) regular appointments with a psychiatrist and medication. The treatment helps when I follow the treatment plan properly, and though I'm not exactly as disciplined with this as I really should be, I don't think my problem stems from inadequate treatment/failure to adapt to treatment. I'm not even sure that it is necessarily related.

Over past few months, I have effectively distanced myself from just about all of the people I would had a lot of close contact with in the past. Most of them have done nothing at all to trigger this reaction in me, and I have not had any notable disagreements with any of them, it is just that I have an increasingly low tolerance for socialising in my current social circle. I am intensely lonely, yet when I meet up with them, the only thing I can think about is how to get away, and I'll go on to drink alone to the point of alcohol-induced sleep and memory loss. I hate that I have the capacity to do this as I have been on the recieving end of behavior that results from alcoholism, and I am conscious of the fact that I could end up becoming an alcoholic myself, yet I do not know how to stop it. It's not that I make the decision to do it, it just sort of happens. I completely hate myself. I feel utterly dysfunctional and useless, like I have so many things I would love to be able to achieve but I don't believe I truly have the ability to do it. I get to the point of near-completion, then I burn out. I am incapable of making the right decision about anything, and I feel like a total fraud. I'm just acting, in everything I do--I'm totally incompetent yet I act the opposite, and nobody would know it on the surface, but get to know me and it becomes evident that I'm exceptionally adept at screwing up. I can't help but think that the people I haven't pushed away already would be better off without having me around. I am a total PITA and I feel like I contribute nothing but negativity to friendships, that I must really p*ss people off but they're nice enough not to tell me. I would not be friends with myself; if I met me I would run away, fast. Generally I feel like I am just an inconvenience on every level. I'm that annoyingly negative friend with unresolved past issues, a tendency towards dangerous self-destructive behaviour and a twisted view of the world that interferes with interaction on a basic level, and really, nobody wants to interact with someone like that do they?

I have felt like this before, but not so intensely. Suicide has often been something I have thought about in the past but not necessarily believed that I could ever act on those thoughts, and when I have made 'plans' before, that in itself has been the turning point away from actually going through with anything and I have moved towards a healthier position on whatever situation had provoked the initial response. Things are different this time, though; I have a plan and making that plan has not made me rethink anything. I honestly just feel like giving up. Right at this point in time it is logistically impossible -- the plan takes time to execute, so it is not something I could do spontaneously -- but it is there, and I cannot stop thinking about it.

Now, obviously because I am making this post instead of making a start on that plan, I actually don't want to go through with it. I want to find a way to get it out of my mind and work on identifying what it is, exactly, that is pushing me towards wanting to do it in the first place. It's becoming an obsession, almost, consuming so much of my time. I really do not want to feel this way but I don't know how to change it. I really don't think that I'm depressed, either.

I recognise that this is absolutely something I should be discussing with my psychiatrist and not on here, however I find it incredibly difficult to talk about this openly in real life. I cannot just tell someone about it, and I feel apprehensive about bringing it up in therapy in case it leads to some sort of intervention that forces me into intensive treatment that I do not want to participate in; I cannot afford to end up getting institutionalised, for example. It has already been expressed to me that that is a very real possibility if I end up in a situation like the one I am in now. Call me stupid, but I would rather manage this myself. If I can 'fix' myself, I won't screw myself over in the process. Getting stuck in a mental institution might sort me out, but it would create so many problems (i.e. problems with work) that I want to avoid.

I had a clear idea of why I was writing this post when I started, but now I'm finding it hard to express what exactly I want to achieve by posting it. I'm not going to do anything irrational right now, so nobody need worry about that. So many of you have been extremely supportive to me in other situations that I feel I can talk about this here without the fear of being judged, and I guess I'm just looking for a bit of support , a "sounding board", as I work out what I'm going to do about this, and because I find it so hard to actually talk about it to anyone yet not so hard to type I felt that this was a good idea. I am completely open to suggestions on things I can maybe do to help get out of this frame of mind that I seem to be stuck in.

Thanks for reading all that. I really do appreciate it--and hope that this thread might end up being helpful to other forumites who may be in my situation as well.

[frogfactory]

Could you perhaps print this post out and post, or email it to your psychiatrist?

Reading your post made me think "whoah, I didn't know my past (or quite possibly future) self had a sock". 

You're still wanting to 'fix' your problems yourself - it's a positive thing, I think, that you still want to (I can assure you, there are lower depths to sink to), but I wonder if you're really in a place to assess whether you're capable ofdoing so or whether it's time for more extreme measures like hospitalisation.  Apart from anything, there's an inherent contradiction in this:

The treatment helps when I follow the treatment plan properly, and though I'm not exactly as disciplined with this as I really should be, I don't think my problem stems from inadequate treatment/failure to adapt to treatment. I'm not even sure that it is necessarily related.

that makes me think that maybe the rigidity of an institution might actually be more helpful for you than you might currently believe.

I'm sure you'll receive loads of sterling advice here.  I wish you all the best.

[zuzu_]

I have nothing wise to say.

I just wanted to say I care, and that you actually sound like you'd be a pretty good friend, despite your perceived and/or real flaws.

[lizzy]

No real wisdom here, either. But some suggestions:

You've asked us not to worry, but your post is in fact very worrisome. Please please please talk to your RL therapist now about your feelings. Please.

It's hard to suggest ways for you to get out of your current state of mind without help from someone who knows what to do--i.e., your therapist, or perhaps a new therapist if you're not comfortable talking to the current one about this. But you probably are well aware of some basic strategies--exercise, a new hobby, art, music--identifying your passion and immersing yourself in it.  Making a real effort to reconnect with friends and family in new ways--feeling your relationships with the people who love and value you.

Your post suggests that you know that something significant needs to change. Perhaps you need some help to identify what that something is. Please talk to your therapist or find a new therapist to work this through with.

And please keep us posted.

[t_r_b]

I don't have time to reply at length right now, but I did want to comment on this:

I recognise that this is absolutely something I should be discussing with my psychiatrist and not on here, however I find it incredibly difficult to talk about this openly in real life. I cannot just tell someone about it, and I feel apprehensive about bringing it up in therapy in case it leads to some sort of intervention that forces me into intensive treatment that I do not want to participate in; I cannot afford to end up getting institutionalised, for example. It has already been expressed to me that that is a very real possibility if I end up in a situation like the one I am in now.

I disagree. Any mental health professional can tell you that suicidal ideation happens all the time, and only a minute fraction of those who ideate actually try to harm themselves. They will not lock you up over this. If you walk into a shrink's office and say, "I have a gun in my glove compartment and I'm going to use it," then they may put you in an inpatient psych ward, and even then only until you're no longer a threat to yourself and others. Unless you pose an IMMINENT threat, or explicitly ask to be hospitalized, they will not lock you up. Really.

Tell the docs exactly what you told us: overwhelming ideation, you've got a plan, but you don't want to act on it, and you want help on an outpatient basis. They will know how to handle it. Many, many of us have gone down this road at one time or another, almost all WITHOUT even voluntary institutionalization. This will pass. I promise.

As for coping: start with taking a walk. Just a short, slow, easy walk around the block. Do it at a quiet time of day if you don't want to run into anyone. Do it again tomorrow. And the next day. Any day in which you take a short walk is a success. You'll build from there.

Also, about the ideation: the trouble with obsessive thought is that the harder you try NOT to think about something, the more it eats away at you. It's like an awful song you get in the head. The only way out is to give your mind something else to focus on - like taking a walk, or watching a silly movie, or sitting on a bench feeding the pigeons. Again, start small. One step at a time. You'll get through this.

[t_r_b]

Could you perhaps print this post out and post, or email it to your psychiatrist?

f***ing brilliant. Do this.

Reading your post made me think "whoah, I didn't know my past (or quite possibly future) self had a sock". 

Big old chime to that.

[caesura]

You can be hospitalized against your will only in pretty extreme circumstances (and if those circumstances are present, you need hospitalization to stay alive).  So even if hospitalization is offerred, you can refuse it if you want.  So that's not a very strong reason for deciding not to get treatment.

Are you able to see that the litany of thoughts you described are symptoms of illness, not truths about you?  They may contain a germ of truth about some of your problems, but that kind of catastrophic, pervasive negative thinking about yourself is a hallmark of depression.

I'd second the suggestion to print out your post and give it to your psychiatrist, if you feel unable to talk about how you feel.  I did that once, and it worked out very well.

[frogfactory]

You can be hospitalized against your will only in pretty extreme circumstances (and if those circumstances are present, you need hospitalization to stay alive).  So even if hospitalization is offerred, you can refuse it if you want.  So that's not a very strong reason for deciding not to get treatment.

This is true, but I'm not convinced a voluntary inpatient stay might not be helpful.

[prytania3]

Damn. Is there something in the water?

Ersatz, seriously, why are you so negative? And why do you think you are incompetent? And everyone screws up. The fact is if you take life too seriously, then yeah, suicide is the only answer. I mean, who could take it? People too often want to be important in this life and do worthwhile and meaningful things. That's mistake #1. Anyway, I used to when I was younger, and then one day, I thought, why? Who gives a flying rat's ass? And not for nothing, but we're all going to end up in the grave soon enough, so why rush it?

And so what if you *are* a fraud? Being a fraud is cool, but you are probably no more fraudulent than the next guy.

I will give you the same advice I gave to Threadbare. Find something fun you like to do.

Also, if you are worried about becoming an alcoholic, chances are you've already become an alcoholic. Go to an AA meeting. You don't have to say, "Hi I'm Ersatz. I'm an alcoholic." You don't have to say anything. Just listen. You will find a lot of people who understand exactly how you feel. Alcoholism is a disease of negativity.

Good luck to you, and please don't do anything stupid.

[systeme_d_]

No wise solutions from me, either, just support.

I love the email idea, because you have GOT to talk to your psychiatrist about this.

The drinking (self-medication) worries me too.  You could be preventing your prescribed meds from working correctly.

[oldfullprof]

I disagree with some of the above.  The key elements in suicide are thoughts, a plan, and means to carry through.  If you are having constant suicidal ideation, you need to see (or even change out) a psychiatrist.  Yes, ideation without the other two components is less of a problem, but you need to get rid of most of it.  You may need to go on some (or better) meds.  MAO inhibitors can be used in entrenched cases (but have bigtime dietary restrictions.)  ECT can also be used ethically and sparingly in a few cases.  It's likely as others have said that there's an obsessive-compulsive component here too, and that can be helped medically as well.  I'd make sure to add talk therapy as well, because research shows that combining that with meds is best.  I worked psychiatric crisis intervention in LA county for about three years, and acute psych wards for ten years prior.

[prytania3]

I disagree with some of the above.  The key elements in suicide are thoughts, a plan, and means to carry through.  If you are having constant suicidal ideation, you need to see (or even change out) a psychiatrist.  Yes, ideation without the other two components is less of a problem, but you need to get rid of most of it.  You may need to go on some (or better) meds.  MAO inhibitors can be used in entrenched cases (but have bigtime dietary restrictions.)  ECT can also be used ethically and sparingly in a few cases.  It's likely as others have said that there's an obsessive-compulsive component here too, and that can be helped medically as well.  I'd make sure to add talk therapy as well, because research shows that combining that with meds is best.  I worked psychiatric crisis intervention in LA county for about three years, and acute psych wards for ten years prior.

Meds don't do a damn bit of good if you're hitting the hooch.

OP sounds like she has very typical alcoholic thinking. Nothing works and nothing gets any better because she's drinking too much. It never does in those situations.

I'm sorry, Ersatz. Don't drink and go to meetings.

[oldfullprof]

TRB has a good idea.  You can "paradox" the ideation by putting yourself on a "think about suicide" schedule.  Every half hour, say, you schedule yourself to think about it for a minute, timed on the clock.  The starting to walk as exercise is also a great idea.

I'd try to lose the alcohol.  I think you can legitimately ask for a benzodiazepine, like Xanax, if you are disciplined about taking it.  I'm getting the intuition that you're using public mental health.  If that's so, make sure you have a good case manager, who can advocate for you-- probably a social worker or nurse.

[oldfullprof]

Meds don't do a damn bit of good if you're hitting the hooch.

Agree, actually.  But I tend not to be a fan of the CD-only approach.

~Friend of Bill

[frogfactory]

Meds don't do a damn bit of good if you're hitting the hooch.

Agree, actually.  But I tend not to be a fan of the CD-only approach.

~Friend of Bill

Disagree.  The drinking isn't helpful, but don't ditch the meds if you can't/won't stop drinking.