Live Through This

Flickering Light by Christy Curro

I woke up one Saturday morning and couldn't stop thinking of killing myself. It was intense, sudden, and jarring. It was December of 1996, and I was fifteen years old.

My life was essentially good — I loved my school, I got good grades, I had great friends — yet some part of my brain ran on autopilot.

I imagined a gun in my hands, the feeling of cold metal against my skin, and what my gravestone might look like. The images were vivid, terrifying, and painful. It was like a video projector playing the worst horror movies on a loop. The movies played often, almost constantly, alongside my everyday thoughts and activities. I couldn't concentrate on my schoolwork, and even socializing felt empty and sad. Sometimes the thoughts and images were so loud and overpowering that I couldn't think of anything else. Sometimes it felt like tunnel vision — despite all of the good in my life, I couldn't see anything but these dark, horrible thoughts. I would wake up too early in the morning, hearing those thoughts like voices shouting in my head. It was a scary, isolating experience to be afraid of my own mind.

I remember sobbing on the floor, in front of my parents, literally crying for help. I was scared of the images in my brain, scared that I would never feel better, scared that I would lose control and hurt myself. No one in my working-class family had ever gone to therapy, yet they desperately wanted to help me. Looking back, as an adult myself, I imagine that they felt helpless, scared, and/or confused. I imagine that they would have done almost anything to get their daughter back.

My mom also worried about the cost of therapy. My school counselor gave me a referral to an agency that offered therapy on a sliding scale, for $27 per session. It still wasn't easy for my family, especially when I attended twice a week, but they somehow made it work. I started paying the bills myself when I turned sixteen and got my first job.

Therapy helped. A lot of the work I did with my first therapist involved learning to name my feelings. Even as a teenager, I had a tendency to give long, rationalized explanations of what was going on in my head. Therapy taught me that feelings are expressed in single words, not sentences. It was strange, empowering, and cleansing to learn to say “I feel angry” or “I’m so sad.”

I also did a lot of work on learning how to be honest with myself. My journals from late 1996 into 1997 show a huge change in subject matter, as I stopped talking so much about the drama of high-school social life, music and clothes. I started talking more about the inner workings of my relationships, my thoughts and fears and the darkness inside of me, using all of those newfound vocabulary words about my feelings.

Learning those skills helped me, but the suicidal thoughts continued.

I was hospitalized for eighteen days in February of 1997. I feared so much that I would lose control of the thoughts and impulses that tormented me. I was terrified that I would die of a self-inflicted gunshot wound, when I desperately wanted to live. I couldn’t promise my therapist that I wouldn’t go to my friend’s house and use her stepfather’s gun to kill myself. My therapist and I decided together that it was better to check me in, in order to keep me safe. The hospitalization was difficult at times, but I’m glad I did it. I believe that it saved my life.

The hospitalization was nothing like I had feared. I’d envisioned restraints, patients screaming in the hallways, forcibly receiving sedative injections, the stuff of dramatic movies. My hospitalization experience was mostly sedate. It was on a normal hospital floor, albeit one locked for security and with reinforced windows! I was on a ward with about a dozen other teenagers, and shared a room with one other girl. We watched a lot of TV, did daily group therapy (including art therapy and exercise), and did our schoolwork, which was faxed over from our schools.​ ​There were also lots of one-on-one interactions with the staff, which gave us opportunities to talk about feelings and challenge our negative thoughts. In ways, it was nice to be able to focus on feelings and communication and getting better, unhampered by the distractions of the real world. At the same time, it was difficult to be isolated from my friends and family, except for fifteen-minute phone calls on a shared phone, and visiting hours in the evenings.

The inpatient stay itself wasn't so bad, but getting insurance coverage for it was a nightmare. Nurses told me every couple of days that my insurance company wanted to send me home. I was both angered and saddened. Couldn't they see that I was afraid of hurting myself, and doing the best work I could? Insurance ended up covering much of my stay, but my parents still received a bill for several thousand dollars. They paid it off in $50 increments.

***

The day I was discharged, one staff member advised me never to be alone if I'm feeling suicidal. "Even if you just go to 7-Eleven," she advised. I’ve kept that in mind over the years, as another tool for keeping myself safe.

When I was released from the hospital, I felt like I'd made a lot of progress. Having spent so much time with other young people with similar issues helped me feel less alone. One of my fellow patients had an extra teddy bear, which she loaned to me. I found it helpful, so my mom and I stopped at Target on the way home, to acquire a teddy bear. (I still have it.)

Going back to school was strange and difficult. I’d only told a handful of friends where I’d been. Telling everyone else felt too vulnerable, so I mumbled something about the flu. My teachers were supportive, but I felt like people were treating me like I was fragile​. I ​didn't feel fragile; I felt like I’d survived a hurricane.

***

I liked some therapists more than others over the years, but especially as a teenager. While some were human and accessible, others were judgmental and uncreative. During a family therapy session, one therapist told my parents about my adolescent experimentation with alcohol, which wrecked my ability to trust her. Another told me that my beat-up Converse sneakers made me look like "trash," and suggested that I wouldn't be depressed if I joined her religion. I'll never forget the psychiatrist who told seventeen-year-old me that "if [I] don't stop being depressed, [I'll] be diagnosed with borderline personality disorder, and then no one will take [me] seriously." After hearing that, I stayed away from therapy for many years during my young adulthood, during a time when I really could have used the support that therapy provides. I was so afraid of being labeled, judged, and disregarded by people who were supposed to be helping me! Yet, I returned to therapy several times over the years, when my anxiety and suicidal thoughts became too much to handle on my own. My fear of being labeled paled in comparison to my fear of my own thoughts.

I also took medication. I had one psychiatrist, at age sixteen, who kept increasing my dosage of the same medication, over several months, even though it was clear that the drug wasn’t helping me. I wondered, later, whether he had been receiving kickbacks from the drug’s manufacturer. I later tried several different medications, and combinations of medications, before I found one that was helpful.

Medication has never made me numb or docile — it simply quiets down the noise and visuals from the movie projector in my brain. It takes the volume down from about an eleven to a four. I'm still feisty, and still get angry and sad, but I'm no longer spending days in bed crying because I can't stop thinking about hurting myself.

***

At age twenty-six, ten years after my first round of therapy, I gained a fuller understanding. I was living in another state, visiting another sliding-scale therapy clinic, lamenting that I still can't stop thinking about hurting myself, even though I'm basically happy with my life. The therapist paused for a moment, then suggested that perhaps I don't actually have depression, as everyone had assumed, but obsessive-compulsive disorder.

I was bewildered and shocked, and we wrestled with the idea for a while: ​how could I have OCD? My room isn't particularly clean, and I don't wash my hands excessively!​ She gently explained that there are several different manifestations of OCD. Some people struggle with obsessive or intrusive thoughts, but don't have outward compulsions.

After that therapy session, I did a lot of thinking, and a lot of reading. For a while, I felt a sense of shame, as if there had been something fundamentally flawed about me for having this diagnosis. At the same time, it helped me make sense of a lot of things, starting from my childhood. The OCD diagnosis explained not only my intrusive suicidal thoughts, but also my health anxiety, fears of accidental poisoning, and religious scrupulosity, all of which first surfaced at around age seven or eight. I'd always lived uneasily with those thoughts, as if they

were a strange personality quirk, but the diagnosis felt like pieces of a jigsaw puzzle clicking together.

After that diagnosis, and in the years since, the focus of my therapy changed. We no longer try to talk my brain out of having dark thoughts. Instead, we acknowledge that those thoughts happen, but I don't need to give them any credence. Indeed, treatment for the intrusive suicidal thoughts based in my OCD has included learning how to give them as little attention and energy as possible, which takes the power out of them. Another facet of treatment involves learning that these thoughts don’t ​say something about me o​ r express some secret desire; they’re just garbage that my brain produces. One therapist likened it to a tiny yapping chihuahua — it’s annoying background noise that I can disregard.

In the years since, I've had periods of anger that my OCD wasn't diagnosed sooner. For so long, I'd felt like there had to be Something Wrong With Me for not being able to just magically stop being depressed — when it turns out that I wasn't actually depressed in the first place! I still have those moments of anger, but they are tempered with a gratitude that I have been able to access treatment, and that I did finally receive a diagnosis that helped me understand myself.

***

I have also had periods of ​actual​ depression since my initial stint in therapy. My depression can also manifest as exhaustion, irritability, or apathy. My experience is that suicidal thoughts based in depression feel completely different from those rooted in OCD. My suicidal crises based in depression are more time-limited; the intensity of the despair subsides within a few days. (Perhaps​ ​this is the type of suicidal crisis my insurance company expected when they refused to pay for more than a few days of inpatient care!) Depressive suicidal thoughts feel like a logical extension of desperate sadness, whereas OCD-based thoughts startle and scare me. Suicidal thoughts based in my OCD often stick around a lot longer, permeating my everyday life but eventually fading away, only to return again in the future.

***

I'll be forty on my next birthday. My hospitalization was more than half a lifetime ago.

I still have bad days and bad weeks. I struggle with my mood every winter, which leads to increased intrusive and suicidal thoughts. I strive to get enough sleep, eat well, get exercise, and plan both socializing and solitude, because all of these things keep me balanced. Most of the time, I’m in a mental place where it feels natural to ignore those nagging, intrusive suicidal thoughts. The thoughts are often worse when I am under stress and during periods of change in my life. I still go to therapy, generally every 2-4 weeks, and I expect to take medication for the rest of my life.

As I've gotten older, I've met more people who have been suicidal, and more people who have OCD. Suicidal thoughts and attempts are relatively common, even if they’re not always openly

discussed. I also believe that, in the two decades since my initial crisis, our society has become more comfortable with talking about mental health.

I've also learned that my OCD, the thing powering the radio station that plays garbage inside of my head, is also the thing that makes me detail-oriented, hard-working, and conscientious. I suppose that's a bit of a silver lining.

I have been lucky to have had a lot of support, but, in the end, it has always been up to me to save my own life.

Because of my struggles with my mental health, especially my obsessive suicidal thoughts, I have learned to find peace within myself. I've gained a huge toolbox of coping skills, and am more able to sit with my feelings. I have gained sensitivity and perspective. I have the ability to unflinchingly sit with others who are struggling, without worrying about saying the wrong thing. Friends know that they can talk about their mental health with me, that I'll never be shocked or judge them.

I love that the work I've devoted to my mental health might help someone else who is struggling. I'm glad to tell my story about how recovery isn't linear and suicidal thoughts aren't always based in depression, in hopes that it can help someone else out there.

I’m 14 years old. I’m sitting in the office of a therapist I have accessed through the government-funded Family Services department. I started seeing this therapist when my parents found out I was cutting myself. I have two best friends. The first also cuts, and the other shares my penchant for thinking about killing myself. Our conversations go something like this:

“If you died, I would kill myself.”

“Me too. I love you so much I would definitely kill myself if you died.”

We don’t talk about why either one of us would die, or why we so often talk about killing ourselves. We do talk about how we would do it, daydreaming together. Our top two choices are the train tracks and the bridge. Sometimes we sit on the train tracks together until the train comes.

So, let’s talk about this weird hierarchy around “serious” or “medically serious” suicide attempts versus “non-serious” ones. In short, it’s harmful to all of us with lived experience of suicidal intensity of any kind.

Based on what we know about suicide attempts, there are over 1.2 million each year—and those are the ones we’re able to count. Many folks attempt suicide and don’t seek care—because they’re afraid to tell anyone, because they’re afraid they will be hospitalized against their will (and such disruptions could end up with results like job and income loss, which could put a person already in distress in further distress), because they don’t think it was serious enough. I’d wager that “serious” or “medically serious” attempts are in the minority. This isn’t a judgment or a statement with any kind of unstated-but-implied meaning; I just assume that most folks who use “serious” methods don’t live, and get counted in a different statistic: over 48,000 Americans died by suicide in 2018 (the last year for which we have data).

I think minimizing any suicide attempt is harmful; all are valid and indicate that a person is in distress, and thus, needs help of some kind (which is not always therapy and/or meds). We often hear people say that an attempt was a cry for help, that the person was looking for attention. If someone is in so much distress that attempting suicide is the only way to get attention then, to me, that means they need attention. Further, more violent means do not equate to more serious intent. Separating people out into groups in this way runs counter to our goals for the folks we serve. 

Folks with “less serious” suicide attempts are hospitalized all the time, and sent through the same processes that can help or harm folks who used methods that were potentially more lethal. It’s possible they are held for 72+ hours (and maybe more), have traumatic experiences with police (QTBIPOC folks are at high risk for this), have traumatic experiences in the emergency department and potentially traumatic experiences in behavioral health units, where physical and chemical restraints may be used on them involuntarily. The seriousness of an attempt is irrelevant throughout that process. 

There is a lot of harm done by this hierarchy, wherein people who have made “less serious” attempts don’t feel their pain is validated by folks they encounter, from their support systems, to law enforcement, to medical professionals. I cannot tell you the number of people who have said to me, “I don’t know if you want to hear my story. My attempt wasn’t particularly violent/serious.” The fact that anyone feels or thinks that breaks my heart.

The pain or hopelessness or whatever-it-is that makes someone want to die isn’t any less because a person reached for whatever was around them when they wanted to die and it wasn’t a gun or a ligature. I’m not sure that folks who make more “serious“ attempts are any more likely to die by suicide than others. 90% of attempt survivors go on to die of other causes. If there is literature on this, I’m not familiar with it (but open to reading), and I’m positive folks with lived experience weren’t involved in asking those research questions—because they miss the point. 

I always feel so pressured to participate in Suicide Prevention Month when I don't particularly want to and don't, at this point, see much value in it. 

The reality is that all the same messaging goes out over and over and over, from every possible suicide or mental health adjacent org. A lot of our messaging is regurgitated; puts the onus of finding support on people in crisis (as if the crisis itself doesn't already take up 100% of a person's bandwidth); and it's often in direct conflict with itself. 

As an example: we tell people over 48k Americans die by suicide annually. It's the 10th leading cause of death overall, and 2nd for youth aged 15-24. These stats imply that it's deeply important and that it happens often. In the very next breath, we will tell you that it's a "rare event" and not to normalize it. We might follow that up by telling you that every other person in the room you're in has been affected in some way. It's incredibly frustrating. If we follow the public health trajectory of cancer, we know that normalizing it as A Thing That Happens to People & A Word That Is Okay to Say was helpful: for coping, support, policy, funding. 

But here we are. Regurgitating and contradicting ourselves over and over, and wondering why it's difficult to get people onboard. 

And everyone who does this work? We're all so burnt out by the end of September that we need a month off (which we obviously can't have). And we're all sad and frustrated, because after 9/30, it's business as usual for the rest of the year. And we're sad and frustrated anyway! Because the funding isn't there; because the resources aren't there; because people are forced into treatment that traumatizes them when they need safety; because true, life-saving support is fucking hard to come by. 

There are so many faults with this work and this field and the politics around it, but I'd bet lots of goldfish crackers that most of us come to it with great love and passion. I know I do, which makes it hard for me to watch this cycle over and over and not say anything. I try to change messaging and perspectives about suicide every day of my life, so I don't feel compelled to run on this particular hamster wheel. But I sure do feel pressured, given that some folks view me as a leader in the field. 

So: talk about suicide this month (and all months), but find some new way to add your voice to the same ol' mess. 

Tell your story if you can (esp if you're a mental health professional/academic/researcher—let's clear out all the gross prejudice in the field). Tell it to a stranger, to your boss, to your journal, to your friends, to Twitter, to Facebook, to your pillow. Get it out of you however best suits you. There's power in the telling.

Donate to people with lived experience: do they do work you love (hi, a plug: livethroughthis.org)? Are they struggling with bills? Maybe thank them for being in your life with dinner or a nice gift. Mentor them. Do their dishes. 

LISTEN to people with lived experience when we talk. Put yourselves in our shoes. What would it take to make you want to end your life? Work on your empathy. Make yourself safe to come to in crisis. Learn about what happens when someone pushes the panic button and the cops get called or someone goes to the ER. 

Learn about mental health and involuntary commitment laws. Learn about how all of the above affect civil liberties. Learn about how you can advocate for someone who has been involuntarily committed and who has few supports. Understand that all of this affects Black, Brown, Indigenous, people of color, and LGBTQ+ folks differently than it would a person who presents as straight and white. 

Consider how YOU might support Black, Brown, Indigenous, people of color, LGBTQ+ folks, and disabled folks, and how that might look different from how you might support someone who presents as straight and white. 

Do you know any trans* folks? Use their preferred names and pronouns. Donate to their legal name change/gender marker change funds. Donate to surgery funds. Throw them parties for these big life events. Celebrate them. Love them. 

I'm just spitballing here, which is what I'm hoping to inspire y'all to do. Like I said, Suicide Prevention Month leaves me like 🤬🤬🤬. 

Do you know someone looking for a therapist? Trying to navigate an insurance system, TANF/SNAP, or trying to establish disability? Are you good at navigating these systems? Offer your time and expertise. 

Do you know someone in the middle of a breakup? Support them. Listen, even if you're over it. Grab them dinner and drop it off. Validate that pain, no matter how old they are (yes, I'm talking about how we invalidate these teenage experience). And oh god! Be a safe adult for these kids. I had so few safe adults in my life when I was a teenager. Kids deserve our love and care and guidance, even if they're not our own. 

Look, suicide prevention is ALL of these things. It's both subtle and explicit. Suicide and mental health diagnoses often intersect, but they are not one and the same. 

Suicide prevention is so much more. It's supporting people who need help—with food, money, therapy, legal fees, bail. It's validating their feelings, letting it be about them, using their pronouns, ACCEPTING THEM. Suicide prevention is having food, housing, a living wage (and hey, maybe even some extra cash for fun things), healthcare. Suicide prevention is acknowledging structural oppression and white supremacy, and it's DOING SOMETHING ABOUT CHANGING THAT. Suicide prevention is fighting for disability rights, for civil rights, for reproductive rights, for voting rights. 

“I made the resource that I wish I'd had, and others in my life had, when I've been in the thick of it or knew someone who was.” —Sam Dylan Finch

FOR THOSE OF YOU ATTENDING #AAS20 VIRTUALLY THIS WEEK:

Friday at 2pm pt: Live Through This: A Decade Making Art for Social Change & Fighting to Legitimize Lived Expertise in Suicidology

A decade ago, if you'd just survived an attempt to take your own life and you Googled "suicide survivor" because you didn't know how else to name your experience, you'd have been met with pages of information about suicide loss survivors, which likely didn't reflect what you'd been through.

Dese'Rae L. Stage, a self-trained photographer, lived that moment, and it inspired her to create Live Through This (LTT), a documentary-style multimedia storytelling series that aims to reduce prejudice and discrimination against suicide attempt survivors. LTT reminds us that suicide is a human issue by elevating and amplifying survivors’ voices through raw, honest stories of survival, and pairing them with portraits—putting faces and names to the statistics that have been the only representation of attempt survivors in the past.

Though it began as arts advocacy, LTT has grown organically into something much larger, due in no small part to Stage's time as a member of AAS. LTT is used as a resource by clinicians, in trainings at crisis centers, as a teaching tool at the undergraduate and graduate levels. Stage has also partnered with researchers in an effort to bring attempt survivor experiences to the forefront of suicide research using narratives from LTT.

In this hour, Stage will talk about what she's learned from interviewing nearly 200 suicide attempt survivors in 38 U.S. cities, what the field of suicidology has gotten right and wrong about people with lived experience, and where we need to go.

"You're gonna have things that are gonna make you depressed, and maybe you'll have suicidal thoughts, but just because you have them, it's not the worst thing in the world." —Jonathan Bierut

He makes a good point. For some of us, this is just a part of life, and we learn how to make it through. Not every suicidal thought is a crisis; it's a spectrum—there's nuance here.

“Stories matter. Many stories matter. Stories have been used to dispossess and to malign, but stories can also be used to empower and to humanize. Stories can break the dignity of a people, but stories can also repair that broken dignity.”

Last week, the New York Times posted an appalling op-ed. I wrote a letter to the editor, but even when I cut it down, it was twice their suggested length. They didn’t publish it, so I will. It certainly doesn’t take all my issues into account. If you’d like to read them all, here is my uncensored Twitter rant. Letter to the editor as follows:

In the Op-Ed, “Why Are Young Americans Killing Themselves,” Richard Friedman presents teen suicide as both novel and sensational, reduces it to a simple problem with a simple solution, and pushes damaging myths about psychiatric medication. Friedman, a psychiatrist, seems suddenly aware of suicide, and keen on solving it. He claims it is an ignored “epidemic,” as if there aren’t thousands of people and whole fields dedicated to preventing (suicide prevention) and studying it (suicidology). Despite his training, Friedman does little legwork toward a nuanced understanding of suicide, and cherry-picks data to use on the reader as a shock and awe tactic.

Friedman asserts that depression is claiming the lives of America’s young people. Meanwhile, in 2018, the CDC released a report indicating that 54% of Americans who died by suicide between 1999-2016 did not have a mental health history; further, that many factors contribute to suicide deaths, like relationship problems, recent crises (NOS), substance use, health/financial/legal problems, and loss of housing. Suicide is a complex phenomenon. Marrying it to mental health diagnoses significantly diminishes the scope of the issue.

Friedman emphasizes his belief that assessment, therapy, and medication are the answer—despite concerns that assessment when done incorrectly can result in forced treatment, despite difficulties accessing therapy, despite inconsistency and harmful side effects associated with medication usage. He blames the 2004 FDA black-box warnings on antidepressants for a decrease in prescriptions that resulted in a rise in teen depression. But between 2004 and 2007, prescription rates dipped—so, too, did suicide rates. By 2008, prescriptions began to rise again, the efficacy of the warnings waned, and suicide rates rose. By 2011, suicide became the second leading cause of death for teens in the US.