Before I start this, I’d like to get a few disclaimers out of the way.
First, I’m not a danger to myself or others. Second, I’m definitely not doing this to gather attention, I’m rather braving myself to share this to raise awareness about mental health. Third, there IS a difference between feeling passive and active about this topic I will be mentioning. So I hope this doesn’t come across to you as a huge shock or scare or concern. And fourth, I am at a relatively (slightly) better place at this point in time (Jan 2021) so no huge worries are necessary as you read this post below.
I was supposed to discharge from my public mental health clinic at the end of 2020.
From when I returned from Korea till middle of 2020, I didn’t have very many emotional or mood concerns through the viewpoints of my psychiatrist and mental health nurse.
Therefore, we all concluded that I may be ready to be discharged at the end of 2020. As much as I loved receiving care from this clinic, it wasn’t sustainable for me to be a patient at this clinic for a lengthy time. It is considered that the clinic’s aim is to prepare its individual patients with enough coping mechanisms and mental wellbeing independence, rather than consult them for an indefinite period of time, so that the individual patients have the skills and knowledge to be able to mentally take care of themselves.
This discharge nonetheless doesn’t necessarily mean that I am fully healed / recovered from my mental illnesses; rather, it is just an indication that I am skilled enough to gain the independence from my mental health clinic.
With the current types and dosages of medication that I am taking, it was to become my GP’s responsibility instead of my psychiatrist to prescribe me them after I was to be discharged.
But first, my psychiatrist wanted to wean me off my mood-stabiliser med I was taking (aripiprazole) so that I am not taking unnecessary dosages of meds that I am not needing at that point in time. And so I slowly and successfully weaned myself off that.
The other two meds I was taking – anti-depressants (venlafaxine) and nerve pain killers (gabapentin) were more of necessities to me than the mood-stabiliser, therefore we decided to keep me on those.
And so I WAS supposed to discharge by the end of 2020.
But yet, it’s 2021; and I am still a patient there.
Why?
Here’s my story of the past three months.
[Warning: potentially distressing or controversial contents below.]
During my two to four weeks after coming off my mood-stabiliser, I started developing particular thoughts about a topic of interest.
First of all a disclaimer (again); there IS a difference between passive and active feelings about this topic I am about to mention.
And so, I write the next line as I hold my breath in apprehension.
I started to become passively suicidal.
Passive and active suicidal thinking are what I want to talk about in detail.
Suicide is obviously a highly stigmatised topic.
People’s reactions when they hear such a word is to either:
- ignore it; or
- treat it like a priceless china artefact; delicate and frail.
But here’s a breakdown of this contentious topic.
Passive suicidal thinking is the wish to die; having the thoughts of suicide or self harm, without any plans to actually carry them out. It is only an ideation; the person will not act upon these thoughts and put themselves in danger.
Active suicidal thinking is where the person has developed a plan, and they plan to carry it out. They will take action on what they planned on.
There is a difference between passive and active suicidal thinking / ideation. But the line between them is very blurry. Just because someone is just passively ideating about suicide, it doesn’t necessarily mean that it is any less serious than if actively ideating because it can quickly turn into active ideation.
Sometimes, there are no signs for others (friends, family, workmates, etc) to recognise when someone has formulated a plan to carry out suicide. Most times these are just thoughts that the individual will keep to themselves.
However, according to Better Help, there are a few signs and symptoms to look out for; these are split up into three categories – behavioural, physical, and psychosocial.
Behavioural:
- Giving away possessions;
- Talking about death, dying, not being around in the future;
- Using phrases that make death sound like an option, such as “when I am gone….”;
- Saying goodbye to loved ones;
- Social withdrawal;
- Increased drug / alcohol usage;
- Not participating in activities that were once enjoyable; and
- Engaging in risky or potentially harmful behaviours.
Physical:
- Scars from past attempts of suicide or self harm;
- Sudden or drastic changes in eating or sleeping patterns;
- Chronic illnesses, or cognitive symptoms; and
- Obsessing over the belief that suicide is the only end to their emotional pains.
Psychosocial:
- Feeling helpless and hopeless;
- Feeling that their emotional pains are never-ending;
- Self-hatred feelings;
- Paranoia;
- Emotional pain;
- Frequent / drastic mood swings;
- Sudden changes in personality or behaviour; and
- Increase in intensity in anxiety and irritability.
If you notice anyone around you showing these symptoms mentioned above, these are some of the things you can do for them:
- Ask them genuinely about how they are doing. This is a meaningful way of showing that you care;
- Be there for them when / if they need you. Don’t give ‘advices’ to them about their circumstances, just actively and genuinely listen;
- If situation is serious, involve a GP or mental health professional, or call the hotline (0800 543 354) for help and advice; and
- Keep checking on them until you feel certain that they are in a safe state of mind again. But be careful – they might just be putting a facade on, so check on them even though they do seem fine – they may just be hiding it for now.
If you, yourself, are feeling suicidal (passively OR actively), here are ways you can cope through these thoughts and ideations:
- Identify the trigger(s) to these suicidal feelings – e.g. loss / death of someone you love, substance use, stress from work or relationships, etc. Eliminate or improve what you can, or talk to someone who can help you eliminate or improve these triggers;
- Remember that feelings are temporary. Sometimes, even just taking a nap or going to bed early when you’re feeling especially low can reset your mood; at least, enough to stop your suicidal thoughts;
- Take care of yourself:
- Eat healthily, don’t skip meals;
- Rest plentifully;
- Exercise regularly; and
- Maintain good habits, such as putting aside time for hobbies or meeting with people you love and who loves you.
- Build a community of support with people who positively influence your life and make you feel good about yourself;
- Help others and give back to the community – these are great ways to find meaning and purpose in your life;
- Keep a journal to help you understand and manage your feelings;
- Get active – develop personal and professional interests that give you a sense of purpose; and
- Relax – find personal ways to relieve stress levels. E.g. meditate, practise mindfulness, challenge self-defeating thoughts.
Anyway. So. I was up to the point where I mentioned that I recently came off my mood stabiliser, aripiprazole.
About four weeks after I came off my mood stabiliser, on Monday 2nd of November, I experienced the worst depressive slump I have ever experienced during my history of depression.
If my Mood was plotted against Time on a graph, a section of Mood along the Time axis may be able to be extracted as roughly one cycle of a sin-curve. Starting from 0, then maximising at Peak mood, then back to 0, then declining to the lowest mood point at Trough, then perhaps increasing again back towards 0. This one full cycle of Mood may vary with different values of time – I could do a full cycle in one hour, one day, one week, one month or a few years. Of course, each unit of time would just show the approximate trend of the curve overall, without regarding the trends of smaller units of time. Is all this nonsensical?
Anyway, what I am trying to say in conclusion is that, on Monday 2nd Nov, I was at the relatively lowest ‘trough’ ever recorded in my life.
My workmate, who I studied with at uni, recognised something was wrong with me when she came up to my desk at work to talk to me about a project that day.
She was my first saviour of that day.
She asked me if I was okay and looked deep into my eyes. By that day mid-morning, I was already struggling to concentrate on my work as depressive emotions and suicidal thoughts swarmed around at the front of my mind continuously, blinding me from being able to function normally. And so I looked back at her with lost, blinded eyes, and she immediately knew something was wrong and sprung into action.
“Do you want to talk about it?” She asked, and she ushered me into a small meeting room.
I have never been afraid to tell people about all the emotions I experience, so I did not hide or hesitate to tell her truthfully that I wasn’t feeling emotionally well. However, it did take a few extra pauses for me to finally get the courage to spit out that I was feeling passively suicidal. This was the first time I felt fearful at what my listener would think when he/she heard this – for obvious reasons. But she took this news totally respectfully, and asked the right, non-provoking questions.
Main questions I remember her asking were: “since when did you start to feel like this?”, “what do you think the trigger to these thoughts are?”, and “have you told anyone else this?”
She also reassured me by saying she didn’t want me to take any regretful actions, especially because she, personally, was one of the many people around me who surely wanted me to stay. I am so thankful for her words.
She then asked if I told my transportation leader (whom I’ve been continuously in touch with since my TDG internship days) about how I was feeling. I responded warily; “no……. I know he’s really busy. I don’t know if he would have the convenience to make time for me.”
She reassured me that he would definitely want to hear this, and that he would make time for me especially if it regarded my wellbeing.
And he was willing to make time for me. In a meeting room, I carefully told him my mental state, and he sprung into action. He wanted me to book an appointment with my GP for that day, because he wanted my GP to assess whether my medication levels were appropriate for my circumstances, and to provide other advice for me. He even offered to drive me to there personally (we both live in East Auckland) to ensure my safety.
He was my second saviour of the day.
I called my GP clinic, but they didn’t have any available bookings for that day. Bummer.
Then I called my mental health clinic to talk to my nurse. She was on duty, but she was willing to make time to see me because this situation was considered as a Crisis.
And so my transportation leader drove me over to Highland Park, where he sat for the duration of my one-hour appointment and drove me home; again, to ensure my safety. I was incredibly grateful for this, because it was warming to know that someone was willing to go that far into helping me out.
The appointment was interesting, it wasn’t like any other appointment I have had during my time at the mental health clinic.
My mental health nurse went into Crisis mode, and ran the session by preparing a Safety Plan with me.
- “What methods of suicide have you thought about?”
- “Do you have access to a rope?”
- “Do you have any intentions of driving today?”
- “How much supply of medication do you have in your possession at home?”
- “What are ways you can occupy and distract yourself from such suicidal thoughts?”
- “Do you have names and contacts details of people you can contact when you’re feeling unsafe?”
These were some of the questions she asked me. As I gave responses one by one, she typed them onto her Safety Plan template. Then she printed it out and passed it to me, to ensure that I can follow it when / if I need to.
And then we talked about why I was feeling passively suicidal. So that felt like a normal counselling session. It was nice to vocalise my struggles, and to see that she was genuinely sympathising with me.
But I still felt empty inside. Numb.
The session ended, and my transportation leader drove me home. He asked me what I would be doing for the rest of the day. I said I am planning to meet two very close friends for dinner that night, and so it will be a relief being amongst their company. He seemed convinced that I would be alright, so he let me go.
I had dinner with two of my closest friends, both of whom are doctors now. At the beginning of dinner they asked me how I was going, where I responded without being able to lie, so I said I had an ‘eventful’ day. They reacted positively, thinking that I meant that comment in a good way. But then I started getting into the details.
They attentively listened and were really respectful throughout my talking.
The main thing I say out of this moment is that – I was really grateful that they didn’t react in any questionable way. They didn’t jump, flinch, exclaim, seem surprised or shocked, pull faces, etc. They are used to receiving news that may sound shocking to the average person – it’s in their jobs to hear these kind of news often at work.
I know, this confession may sound strange, but it’s actually crucial for a person going through mental health struggles to receive such respectable reactions from people.
Why?
Well, if you think about it, suicide is a very controversial, sensitive topic to vocalise, but I am pulling all the strength together to tell these people about it. I am overcoming the huge wall of Vulnerability to do this, and so it is natural that Fear also comes into play; fear of how people will react when they hear my news. I NEED these people to not react in disrespectful ways. I NEED them to show that I can trust them with what I have to say. I NEED to know that I am not alienated with what I am going through. I NEED to feel safe amongst people I trust.
And so they mentally saved me that night, and they put me at ease.
The handful of people who I have told about this recent happening of mine have all questioned me what the trigger was, for my passive suicidal thoughts.
The first few times I was asked this, I couldn’t really pinpoint exactly why I did have such thoughts. So I said I didn’t know.
I had to think a bit on the spot. But now it’s a bit easier to say, after much gathering and thinking.
It’s a mixture of things. A build up of many things over the years of experiencing my Fibromyalgia, depression, and anxiety.
To me, they are subjectively rational. But they are not objectively logical.
This post is already a thesis-length so I will skip explaining about the built-up triggers. But perhaps another episode may come when I am dying to vocalise (haha) what these triggers are.
My most trough day was that Monday 2 November, on the week that I was to fly down to Christchurch for seven days from the Wednesday. Out of the seven days I would be in Christchurch, four of the days I would be alone, but three of the days I would spend at the Stantec Christchurch office for a development weekend with fellow Stantec employees.
I was actually genuinely concerned about going on this trip, when I was so emotionally and mentally unstable. Some reasons are outlined below.
- I was afraid of being alone. Concerned for my own safety. Worried about being in an unfamiliar environment, not knowing what could trigger me.
- The work weekend event was an opportunity for technical self-development and networking. I was to be one of 25-30 people with less than 10 years of Stantec work experience to get together in teams and go through a weekend of challenges and networking. I had to switch on my attentiveness, enthusiasm, determination, team-working, social, and networking modes. But was I in a capable position mentally to switch ANY of these modes on?
The Wednesday 4th November came. I went to the airport, bracing myself for the next week ahead. I did a 15-minute call there with my mental health nurse, for her to check up on my wellbeing. I was the most minutest bit better than Monday, which was more than enough for my mental health nurse (and my best friend, when I told him that I was feeling just the slightest bit better than Monday) to be reassured that my safety was not an immediate concern anymore. She wished me a safe flight and hoped that I would have a good time down in Christchurch. I was to get in touch with her anytime if I wasn’t feeling well. I said okay.
And I so flew down.
And just to sum up that next week; it was utterly energising and I was at my most comfortable self for the first time in a while.
That weekend changed me. I was refreshed, it was an opportunity to reset myself, and I thrived from being around people; networking, learning, developing. This was what I was most comfortable at doing, and I enjoyed every moment of it.
Before this trip, I found myself at a point where life had no meaning or purpose, where I lost my motivation and forgot about my life’s drives and passion. I couldn’t visualise myself in the future, or find anything that stimulated or excited me. My smiles and laughs felt deceptive and fake, and I felt empty on the inside.
But the Christchurch trip allowed me to find something that sparked my genuine interest, related to transportation engineering. Which is amazing, and just what I needed to get myself back on track in looking forward to life. I came back feeling refreshed and changed. Christchurch was a time I spent to recharge and reset myself, and it was just what I needed for the time being.
Returning to work the following week, I was determined to take active actions to take care of myself. I decided to reduce my hours even moooore from the current 32-hours I was doing – I decided to aim to do a minimum of 24 hours a week over four days. I wanted to take it easy, and to give myself a bit more time to not pressure myself with commitments and to enjoy other things in life, such as meeting up with people I love and doing my hobbies. I needed to get my ducks in a row and to get my shit together.
I have hope, for the time being.
Reference:
The Difference Between Passive and Active Suicide Ideation
https://www.biltmorecounseling.com/anxiety/the-difference-b-n-passive-and-active-suicide-ideation/
Let’s Talk About the Difference Between Passive and Active Suicidal Thoughts
https://themighty.com/2016/10/the-difference-between-active-and-passive-suicidal-thoughts/
What Is Suicidal Ideation? A Look at Dangerous Thought Patterns
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