Print Story Absence
By toxicfur (Sun Jun 20, 2010 at 06:41:30 PM EST) (all tags)
I went to the doctor recently to get my Ativan refilled. It had been nearly three years since the last time I needed medical help with my anxiety. I discovered just how much I was self-medicating when I quit smoking and my health care provider at the time offered a very low dose Ativan as a way for me to handle the panic attacks and not return to smoking. It worked, and after my mom died, I carried the not even half-used bottle of them in my backpack as a security blanket, but I didn't take them. Recently, when I started waking up, bathed in sweat, heart pounding, in the midst of horrible nightmares, I talked to Grace, my therapist. Ativan was a great idea, she told me.

So I went to my doctor and I explained to her the anxiety and what I wanted. She went through her own series of questions about what I was feeling, my mental health history, and what current stressors were in my life. She gave me the Ativan and a prescription for Prozac.

"Are you suicidal?" she asked.

"No," I said, with only a slight hesitation.

"Are you homicidal?" she asked.

I began to laugh. She did not.

"No," I said, finally, still smiling at the absurdity of it. "I'm not homicidal."

I told Grace about the rather frustrating trip to see my doctor and she questioned my need for anti-depressants. I've been her client for two years, and she's seen my ups and downs through my grief over my mother's death, learning to deal with my job stress, and figuring out how to cope with my family, among the day-to-day problems I face. She's seen me happy and sad and anxious and any number of places in between. My doctor sees me only a few times a year. I trust Grace's assessment, and I asked her if I should be taking the Prozac.

"You don't seem depressed to me," she said, and she went through a series of questions to assess my overall mental state, ending with, "Are you suicidal?" she asked.

"No," I told her. "Not now."

"Promise me that you tell me if that changes?" she asked.

"Yes, I promise," I said, and I meant it.

Part 1: High School
I've never really talked about my flirtations with death very much, though the impulse to erase myself has been a part of me for almost as long as I can remember. Even before I knew what it meant to die, I felt the urge to be absent, to take a break from my life. I began to call it 'suicidal' when I was a senior in high school. My father, who had been a horrible, abusive presence in my life, was gone. I recognized my mother's pain and my brothers' grief, and I felt intensely guilty and responsible. I didn't think it was my fault, really, that he left, but I was the only one who felt the insane sense of relief that I didn't have to avoid him, to protect myself from him. I was the one who had wished and prayed for his death or his absence my entire adolescence.

When he was gone, I should have felt relief. I felt responsible. My mom confided in me the various pains her marriage had caused her -- the suspected affairs, the alcoholism, the impotence, and his constant undermining of her desires to improve our station in life. These weighed on me, with the secret knowledge of the abuse I'd been victim to. Then she began to date other men, and she told me about those relationships, and about her flirtations at work, and the married man she fell in love with. I felt each confidence. I stumbled through my last year living at home, and I knew that I was different. I knew I was queer, even if I didn't understand precisely what that meant for me. In a town of 3,500 people, in a family that prized secrecy over nearly everything else, I was intensely, painfully alone.

I began to plan my death. I wanted it to appear to be an accident, so I began scoping out likely trees to run my car into. I began to drive fast, recklessly, hoping I wouldn't have to actually make the decision. I got a Swiss army knife for Christmas, and I held the blade against my wrist, imagining what the first cut would feel like. Imagining the release of the warm blood. Imagining the floaty elation that would come before unconsciousness.

I told a friend in an off-hand way that I'd had these fantasies. I should've known she'd tell a teacher. After all, isn't that what the after-school specials say to do? My teacher took me to the county mental health department, where I had a few therapy sessions with an ernest man who asked questions about my mental state, and I lied. I didn't want my mom to know that I wasn't handling life particularly well -- I was responsible for her, of course. And I really didn't want to be locked away. "Danger to self or others," I repeated to myself as I smiled at the therapist and glibly glossed over the worst  of my pain.

Part 2: Graduate School
In graduate school, the woman I believed would be my partner for the rest of my life left me. Kicked me out. Fell in love with another woman. It was a terrible relationship, all things considered. She was abusive and controlling, and she undermined my confidence as often as she could. I don't think she was necessarily malicious, but she and I were not well suited. By the time we broke up, I had no idea who I was. The pain was immense, and I just wanted it to end. I remember looking at an aisle of shower curtains and not knowing which one was the right one to pick. I began to sob in WalMart, and I left without buying anything. I sat in the tub and washed myself again and again.

It was after the initial pain, though, that I began to seriously think about the absence of myself. I  looked at freight trains longingly. I drank heavily. I began to smoke. I began to see a therapist who I didn't completely trust, but I went. She suggested antidepressants, and I tried them. Celexa made me manic. Zoloft did nothing. Prozac had some effect until I lost my insurance and could no longer afford either the prescription or the regular visits to a medical doctor to get the prescription. In the meantime, I fantasized more and more about being dead. I wanted no afterlife. I just wanted everything to cease. Dead. Absent. Completely finished.

By this point, my therapist had me in the cheaper group therapy, and someone asked me if I was suicidal. I laughed as I talked about how I wanted to be absent. It's a weird paradox. I didn't want people to take me too seriously ("Danger to self or others"=locked up), but at the same time, I wanted people to understand that this wasn't some sort of melodramatic cry for attention. It was real, but I had no idea how to communicate that. The people in the group -- including my therapist -- scoffed at me. I did not return to the topic.

I dropped out of school, and I talked to my mom about caring for my pets if something were to happen to me. "Like if I get hit by a car crossing Hillsborough," I told her, thinking of the initial jolt of pain, followed by unconsciousness, and I shivered with something almost like pleasure. I moved to Asheville. I got wasted daily. I drove as fast as I could. I dropped off large sums of money in the middle of the night in a deserted area of downtown. I wanted to die.

Part 3: Now
The thing is that I didn't die. I remember lying on the couch in my shitty singlewide and thinking to myself that I knew that if things got really bad, I'd be able to end it. I had no doubt that I'd be able to take the pills or make the cuts or whatever I needed to do to make sure. None of this walking into traffic or driving into a tree. Done. Finished. Absent. I could. And, somehow, the knowledge that I could end things kept me from taking that final step.

Now, I answered Grace honestly. I answered my doctor honestly, too, though, unlike Grace, she didn't have the entire story. I'm not suicidal, though the fantasies of absence, of quiet, of escape float comfortably through my thoughts. I am in a different place now, and I know that I can never act on those thoughts. It's a loss, really. No matter how bad things get now, no matter what I go through, or what losses I suffer, or what pain I face, I cannot end my life. Too many people depend on me. I would be leaving my brother alone to raise his children, without family who he can lean on. I would be abandoning ana. I would be screwing over the people I work with and for. I would leave my nieces and nephews to grow up without the queer aunt who might be able to ease some of their pain as they grow.

I don't regret the responsibility. I want to see how it all turns out in my life. I do miss knowing how to find the exit, though.

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Absence | 16 comments (16 topical, 0 hidden) | Trackback
"Are you homicidal?" by jimgon (4.00 / 2) #1 Sun Jun 20, 2010 at 08:49:05 PM EST
What kind of quesiton is that.  Anyone who actually is homicidal is going to answer no.  Psychopaths aren't going to discuss this stuff, and sociopaths are going to conceal it out of self preservation.  For homicidal individuals who does that leave?  Stressed out Irish-Americans who were bullied by their older brothers? 

Technician - "We can't even get decent physical health care. Mental health is like witchcraft here."
Yes. by toxicfur (4.00 / 1) #2 Sun Jun 20, 2010 at 08:57:14 PM EST
That was pretty much my feeling -- in terms of determining whether someone is a danger to self or others, that seems like a pretty blunt and ineffective tactic. But, I guess, she gets to check off on her list that she asked and I said no, so she's covered if I get stabby on the subway or something.
The amount of suck that you can put up with can be mind-boggling, but it only really hits you when it then ceases to suck. -- Kellnerin
[ Parent ]
Due Dilligence by jimgon (2.00 / 0) #16 Tue Jun 22, 2010 at 05:32:13 PM EST
Asked dumb CYA question in event my patient blows up a school bus, so that my ass doesn't get sued.

Technician - "We can't even get decent physical health care. Mental health is like witchcraft here."
[ Parent ]
you'd be surpirsed. by clock (4.00 / 1) #3 Sun Jun 20, 2010 at 10:00:01 PM EST
remember, psychopaths aren't the ones a counselor worries about because most psychopaths aren't in therapy.  the ones who are on the edge sometimes are.  i've heard many stories from many counselors about the ones who said they were and were talked off the ledge and the ones who said they were and still acted on it.  can't stop them all.

I agree with clock entirely --Kellnerin

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i spent by LilFlightTest (4.00 / 2) #4 Sun Jun 20, 2010 at 11:29:50 PM EST
a lot of time in college feeling terrible in general. i felt useless, out of place, tired, lost, and eventually it combined into a long physical illness. then terrible faded to numb. and then, all i wanted was for the world to stop. at one point i saw a therapist who (i realized later) didn't really listen, didn't help.

one morning i woke up and looked in the mirror, and realized- this has to stop. i did the one thing i hadn't been able to do before; i called my mom. that one thing led to leaving school, and rebuilding my life...but giving up was probably the hardest thing i've ever done.

i was never self destructive, never reckless, but i know that sense of wanting nothing more than to be absent.
if de-virgination results in me being able to birth hammerhead sharks, SIGN ME UP!!! --misslake

the effort by iGrrrl (4.00 / 1) #5 Sun Jun 20, 2010 at 11:40:37 PM EST
On another site someone on my reading list posted a discussion of her serious issues with bipolar that doesn't have the good manic, but the self-destructive kind. One of the things she commented on was just how tiring it can be to deal, on a daily basis, with the question of whether or not to keep living. She has a severe case. I read her stuff last week, and this tonight, and, yeah. I get it/remember it/feel it--that broad zone from actively planning to simply increasing the odds of a fatal accident.

Nothing to add. Just...yeah.

"Beautiful wine, talking of scattered everythings"
(and thanks to Scrymarch)

IME with myself, friends, and loved ones. by toxicfur (4.00 / 1) #8 Mon Jun 21, 2010 at 08:51:51 AM EST
I'm not sure there is a "good manic." It's destructive, even when it feels kind of good, and if it doesn't feel good, then it's... yeah. I get the making the conscious decision thing.
The amount of suck that you can put up with can be mind-boggling, but it only really hits you when it then ceases to suck. -- Kellnerin
[ Parent ]
Sorry. That was her phrase by iGrrrl (4.00 / 1) #14 Mon Jun 21, 2010 at 12:19:44 PM EST
There's the perception sometimes in people not close to anyone with the illness that the manic phase allows you to Leap Tall Mountains and Be Productive. In her post she used it to counter that possible assumption, but I didn't need to parrot it here.

"Beautiful wine, talking of scattered everythings"
(and thanks to Scrymarch)

[ Parent ]
Draining by me0w (4.00 / 2) #11 Mon Jun 21, 2010 at 11:18:04 AM EST
I have Bipolar II (more depressive than manic episodes), and some days/weeks are a constant struggle - despite being on medications that are supposed to stabilize mood. I can vouch for how tiring it can be - sometimes there is control... being able to question whether or not to keep living, but sometimes that control is very thin and there is very little in the way of questioning.

[ Parent ]
We like our toxicfur by Breaker (4.00 / 4) #6 Mon Jun 21, 2010 at 05:39:49 AM EST
Very much present, thanks.  Please to be keeping it that way, kthxbai.

Thank you, by toxicfur (4.00 / 1) #7 Mon Jun 21, 2010 at 08:49:59 AM EST
and I'm not going anywhere.
The amount of suck that you can put up with can be mind-boggling, but it only really hits you when it then ceases to suck. -- Kellnerin
[ Parent ]
Excellent. by Breaker (4.00 / 1) #9 Mon Jun 21, 2010 at 09:25:59 AM EST

[ Parent ]
You know, those questions by ObviousTroll (4.00 / 1) #10 Mon Jun 21, 2010 at 10:22:39 AM EST
When my GP put me on Zoloft she thought she was doing it because I seemed so maudlin when I talked to her - but it had a surprisingly positive effect on my desire to strangle people. I didn't even realize how tightly wound I had been until I'd been on it for a little while.

I've begun having nightmares about assorted face-eating nightmares attacking my family again. (I suspect the nightmares are secretly named "unemployment", "incompetence" and "middle age" - they seem to work best as a team.)

Maybe I need to get a refill. 

An Angry and Flatulent Pig, Trying to Tie Balloon Animals
hang on by Merekat (4.00 / 1) #12 Mon Jun 21, 2010 at 11:25:43 AM EST
You mean there are people who go through life who *don't* want to strangle people at least once a week?

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i think that's just a phase/symptom by infinitera (2.00 / 0) #15 Mon Jun 21, 2010 at 06:47:17 PM EST

[…] a professional layabout. Which I aspire to be, but am not yet. — CheeseburgerBrown

[ Parent ]
In my (somewhat limited) experience, by toxicfur (2.00 / 0) #13 Mon Jun 21, 2010 at 11:44:02 AM EST
and based on my (much more extensive) research, antidepressants in the absence of other kinds of things (exercise, which you're doing; cognitive-behavioral therapy; etc.) are not particularly effective in actually fixing anything longterm. I think they can have some limited benefit, but after I talked to my therapist, we both decided that while the antidepressants might help some, the other things I'm working on will probably work better.

Still, though, to get rid of the nightmares, I'd do just about anything... Good luck with it all.
The amount of suck that you can put up with can be mind-boggling, but it only really hits you when it then ceases to suck. -- Kellnerin

[ Parent ]
Absence | 16 comments (16 topical, 0 hidden) | Trackback