Month 1 Health Update: Living on the suicidal spectrum (TW/CW)

Woman in red coat and plaid scarf looking over a foggy city view through lattice bars as the wind whips her hair.
Miles to go before I sleep. But at least I'm sleeping better. Photo by Diana Titenko

One month in, I'm doing a lot better. But we've still got a hell of a ways to go.

Hard to believe it's been a full month since my crisis post. Before I dive in, I just want to give a huge thanks to those of you (friends and strangers!) who have reached out to me since then. I so appreciate it.

I also didn't expect (though probably should have) some of my coworkers to read the post. My brain being firmly focused on the negative, I imagined getting in trouble for being in crisis. Thankfully, everyone has been supportive and I'm very grateful for that.

Now on to the main update.

Mental health update summary

When I last posted, I was several months into a major depressive episode and several weeks into a suicidal-level health emergency, un-medicated, and trying to work on a plan.

I'm happy to report that I now have a psychiatrist and am on multiple medications, which I am responding well to. We've also established that there are no major underlying chronic medical conditions that could be exacerbating my depression.

In the past few weeks, I've gone from majorly depressed and suicidal to (mostly) stabilized and back to my current baseline of mildly to moderately depressed. Thanks to medication, I am sleeping better and my mood swings are much less drastic.

I'm even starting to feel the full spectrum of human emotion again. Last week, I even got bored for the first time in months, which is a great sign.

3 new lessons I learned about mental illness and the healthcare system

I've learned some fascinating things in the past month.

First, I learned about the existence of the suicidal spectrum. Previously, I thought being suicidal meant three things: ideation, attempts, and, well, "successful" attempts. When I began self-harming while having suicidal thoughts, I was sure I wanted to and was going to die. Turns out there's a bit more to it.

I've dealing with something called non-suicidal self-injury (NSSI). This can take a lot of different forms, from cutting to alcohol or drug abuse, having unprotected sex, starving yourself, picking fights, and many other self-destructive behaviors.

Instead of being actively suicidal, it's often used to cope with overwhelming emotions like suicidal thoughts. Now the (permanent) result can still be the same, but it's categorized differently because the intention is not to die.

That didn't make my situation any less serious, but it did shed some light on some of my behaviors when I was depressed before. Before my insomnia really started kicking in, I'd often drink more than usual when depressed, not eat, and dig my nails into my hands when I felt overwhelmed. I also have PTSD which comes with self-destructive impulses.

Ironically, not being able to sleep made me cut alcohol out completely, so I'm guessing my brain needed to find other ways to cope this time around. And while I won't get into detail, I will say that physical pain helped me focus my thoughts and calm down. But I was also very careful not to leave permanent marks.

The good news: my last significant suicidal ideation/NSSI episode was the day before my first psych appointment. There have been a few close calls since then, but I've been able to calm myself down in time.

Second, I learned that I am treatment-averse. During our first appointment, my psychiatrist found it hard to believe that I had never been on psychiatric medication before due to my long history of trauma and mental illness. She confirmed several times that I'd not seen a professional before outside of therapy and had not taken any medication.

As she asked more questions, it became pretty clear that I'd thought I could "handle it" on my own. I hated the idea of being dependent on medication. More than that, I had a serious fear of being hospitalized thanks to wonderful memories of visiting my mum in psych wards throughout my childhood.

It's deflating to realize that after years of being all gung ho about mental health advocacy and wellness, I was a poor example of it myself. Not trying to tear myself down here, I just feel bad for my younger self who could have suffered way, way less. But there's no point in wallowing. I know it now and all I can do is take the lesson and move forward.

Finally, I learned how fucking anxious I truly am.

All this time, I've been focused on my depression because that seemed like the thing that would kill me in the end, you know? It's not like anyone fucking dies of anxiety, right? Well, after talking things through with my therapist and psychiatrist, I realized that anxiety may actually be the bigger problem here.

Anxiety amplifies fears and stimulates the irrational parts of your brain. One of the scariest parts of all this was how quickly my anxious brain spiraled into suicidal ideation. I'm talking "my husband hasn't done the dishes" to "I should probably die now" in about 20 seconds. Wild.

Racing thoughts can also make it hard to get to and stay asleep. As I write this, I am packing to leave for a trip to my absolute favourite place in the world (Scotland) for a short trip. But my excitement and all my last-minute to-dos have made sleep a lot harder this week, even with medication.

Finally, the tension you hold in your body from living in fight or flight mode can cause serious fatigue. This is also known as hypervigilance if you have PTSD, an anxiety-based disorder.

Basically, because I have anxiety, PTSD, and C-PTSD, it's not that surprising that I'm a ball of nerves.

Looking ahead and giving up control

Overall, I'm nowhere near well yet and may never be, but I am out of danger for now and responding to treatment. Next steps for me are to start on an increased dosage of my anti-depressant and sleep medication and continue to reduce stress.

I'm working with my therapist to manage some sources of anxiety in my life. I'm also looking into lifestyle changes like diet, exercise, and alternative therapies.

But I think the biggest change I've had to make in the past month or so is giving up trying to control everything. This experience has made it clear that I am nowhere near as in control as I'd like and that the need to be has quite literally made my health worse.

So along with reducing stress, I want to actively step away from some of the things I've made myself responsible for and invite support. From my husband, my friends and family, and my healthcare providers as well.

Some of them are small, like letting go of certain chores and buying more takeout. But I think it's also about recognizing that this whole process will take a while and it may not happen on my time, but that's okay because that's how it needs to be.

Hopefully soon I can get back to building this blog into a publication. But for now, I need to be a little patient, lower my expectations a bit, and focus on building a better mental foundation.

Thanks again for reading and I will catch up with you next month. Cheers!