Monday, September 3, 2018

I’ve Been There

            “I just can’t go on,” the female voice on the other end of the line said. 
            “Okay.  I got it.  You feel like crap.  Are you willing to talk?”
            I then began the coaching call I have done for other clients to help them get through this darkest time.  She could only see and feel the endless pain of her depression and felt hopeless to get through another night feeling there was a no possibility of things ever changing.
            Because many of my clients live with severe depression, we have shared a look at that place that feels so interminable.  In going through this experience, they have gained some willingness to take steps to keep themselves alive long enough to call and have that conversation in which we make choices about staying alive through this night. 
            Among the issues we discuss are the chemistry of the brain that makes this pain so excruciating while seeming to be endless.  I explain that the blinding intensity of the urge to kill herself lasts approximately 20 minutes.  During that time the impulse is strong, and it is important that together we find something she (he) can do to prevent acting on the impulse for self-harm.  I suggest an abrupt change of temperature, intense exercise, or even paced breathing.  Those simple acts can take about 20 minutes, long enough to allow clients a deep breath and think about not hurting themselves.
            Why do my clients think of suicide when they feel living is an impossible burden?  What makes any individual feel that staying alive is more painful than killing him or herself?  Often the urge to take her or his life has been a recurrent thought.  When sadness or hopelessness get very strong the depressed individual often finds the thought of suicide reassuring because it is an option which takes her out of that pain.
            My work is to both recognize and accept that my client is suffering and to offer short- and long-term solutions.  Together we explore the steps needed at the moment of the call and with her or his ideas and editing, we find action she (he) can take in order to stay alive through the intensity after we end our call.  Our work is to keep her (him) alive by finding action they can take that is tolerable and works in that moment.  We also prepare for the next day in which the emotions that were driving her (him) to consider these steps may now include feelings of shame for having considered such intense self-harm.
            When I look at my clients who are or have experienced thoughts of killing themselves I recognize the enormity of their pain.  The question I consider as I aim to support them is:  what can I do to give them the skills needed to tolerate this pain?  Why do individuals who seem to “have it all” think about or even attempt to kill themselves?  Today, on the one hand, we have better tools to support individuals in pain.  We  have medication and therapy both individual and group treatment and we have support groups in many different settings.  There are spiritual counselors from various religious denominations and we are applying mindfulness tools in almost every area of a daily lives. 
            And we are still experiencing increasing numbers of people whose feelings of hopelessness and helplessness lead them to attempt suicide.  One of the answers to why is existential.  We are living in a world of constant change which, for many people is also a world of uncertainty and fear.  These new ideas and new policies as well as the seeming limited ability for each of us to find safety are the starting point for many individual’s pain.  How do we reach out for those personal connections that were so easy to make before our communication was impersonal electronic media?
            Why are the highest number of people who complete a suicidal action in the age group of individuals who are supposedly at the peak of their professional growth and family satisfaction?  Do we, as a culture, put more pressure on women and men when they reach a certain age or a specific level of professional growth, or do we expect people to never feel vulnerable? 
            What is missing in our culture that we are unable to connect to our friends, our neighbors, and even those people we see every day walking our dogs?  What made the fear that prevents us from making these contacts grow?  More importantly, what do we need to know in order to diminish this fear and take the risk of expressing empathy (a very important and healthy quality)?   
            Understanding that we are living in a universe of change that impacts all aspects of our daily living is an essential and fundamental tool if we are to become a healthier culture.  Empathy is both a rich and a key skill for surviving in these stressful times and it is an action we are afraid to demonstrate.  Demonstrating this quality requires both courage and a willingness to remove the mask behind which most of us hide. 
            Offering the homeless person in front of the drugstore a smile or a greeting is the first step in recognizing that we are all - all of us - experiencing some level of fear and loneliness.  This willingness to take a chance and offer contact to another person is the beginning.  How do we attack this epidemic of depression and of suicidal feelings?  By recognizing that we are all human, and we can all start our healing, with the willingness to take responsibility for our own good health.  This healing also includes recognizing that we are part of a bigger world. 
            Those phrases we hear so often, “we are all one,” “we are all connected,” are true and much too easy to forget.  As we work to lower our own pain, we can also remain aware that we do have an impact on the people around us.  It is so important to keep in mind that everyone has issues with which he or she is struggling.  Why is the number of suicides among individuals ages forty-five to sixty so high?  What happens to us as we reach those years?  Mid-life is supposed to be the most fulfilling and is the age of the largest numbers of suicides.
            Some of the answer is seen in the question:  these are the years that are identified as “the richest,” or “the most satisfying.”  We are now living the rich relationship that we have created through the years of being together, without the stress of children.   The pressure to demonstrate the achievements of our 40 or so years often feels empty.  These are the years just prior to retirement when, so the media tells us, we have reached our goals and are celebrating our lives.  And, yet, this idea is another urban myth. 
            The economic and social changes over the past fifty years have left many individuals struggling to maintain an image of success.  Many individuals have ended relationships and cut ties with family and are thus isolated in a world that does not provide the social connections enjoyed at an earlier age.  Women go through hormonal changes at this time that may exacerbate a pain of isolation created by changes in relationship status.  Men are experiencing changes that impact their professional identity.  These physiological changes can produce a vulnerability to emotional pain for which he or she is not prepared.
            Culturally, we have not prepared individuals to grow into a rich and satisfying older age.  As we stand on the brink of becoming an elder statesperson, a status that many cultures celebrate, we find that we no longer have the purpose of parenting, of career growth, and have not created another area in which to find joy or satisfaction. 
            We are finally talking about the impact of this isolation that becomes more profound in these shifting times.  We are facing changes in the community and the economy that impact our capacity to process those predictable daily slings and arrows.  Additionally, there is the demand for tolerance of the unknown for which we are not prepared.  Willingness to accept our limited capacity to understand living with these changes is an important step in caring for ourselves. 
            We cannot know how to live with every new concept occurring in our environment and we certainly don’t know how to resolve the challenges presented.  What we can do is let go of the need to control those changes. For many, dread of the unfamiliar leads to thoughts of suicide.  The intensity of the emotions rising out of our loss of skillfulness leads to the urge to take some stand.  We must act in a way helps us regain the authority we feel we have lost. 
            Understanding the limitations of our power to adapt to change in our lives is fundamental to accepting.  With acceptance comes the capacity to tolerate, and even adapt, to the constant change within our world.  Change is inevitable.  Growth is optional.
            Bethany decided to take a walk.  The sun was beginning to set and, if she went down to the Palisades, just above the beach at Santa Monica, she could watch the gold and red and magenta colors slipping into the ocean.  “Will you be okay walking on that path?” I asked.
              Bethany was quiet for a  moment.  “Yes.  I’m going to be okay.” 
            “You must call me in the morning to tell me how you’re doing,” I instructed her.  “Okay.” 
            “And if you don’t call by 10, I’ll call you.” 
            Bethany was silent for a moment and then replied, “I didn’t want to go to the hospital.”
            “You are very brave to ask for help.  Call me in the morning.”
            “Thanks.  I will.”
            “I’m here.  I want you alive.” 

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