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Dear Therapist,
I am a woman who has been struggling for some time with the overwhelming feelings that things are just not right in my life. I question whether things will ever get better? I have spent time contemplating what the world would be like without me? I wake up in the morning and I don't want to face the world. I know that there are people in my life who love and care about me but I don't. At times I wish they would just let me die!
I want too but I can't, I don't want to hurt those in my life but why can't they see that I am in so much pain? I have tried cutting, burning and
starving myself but nothing takes away how worthless I feel. I have tried numerous medications and they seem to just make me feel worse. I have see
many therapists and although I have found a therapist who I feel I have connected with, I now have placed her in the category of people I don't want to
hurt. I beg her to stop caring about me but she doesn't listen!
My therapist also believes that I should reconsider taking medication. I am just so frustrated that I have tried so many that either gave me side
effects or haven't worked well. Because I am feeling so much sadder and hopeless, she still believes that I should reconsider going to another
psychiatrist and giving it a try again. I just don't want to be a zombie.
So I ask you, what do I do? Live with the pain so that I don't hurt my loved ones or find away to end my life?
Hurting to Live
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Dear Hurting to Live,
{This question was submitted by a therapist on behalf of a patient; the therapist is in contact with this patient and is assessing her safety on an ongoing basis. I will therefore answer the question to the best of my ability for educational purposes, but urge this woman and any other person who finds him/herself in this kind of predicament to make use of appropriate emergency psychiatric services as needed (if any kind of self-harming behavior seems likely), and not to use this forum as a substitute for psychotherapy or competent mental health treatment.}
I would like to start off by saying that yes, you should make the choice to stay alive even if you are doing it for other people at this point and even if it feels like an act of submission or defeat to those people who have not been able to take your pain away and perhaps have even contributed to it. Considering how much distress you are experiencing at this time, it makes sense that you would want some form of escape from the pain, and that staying alive would feel like both a challenge and something that you are doing for others rather than for yourself.
However, to put things in perspective, feelings pass- even if right now you can't imagine that these feelings will. Even if you have been feeling this way for a long time and you think you have tried everything, there are always more things that can be tried and there is always the possibility that you will feel better. Suicide is a permanent solution to a temporary problem, even if your problem feels permanent right now.
There are many questions to be answered in a case like yours in order to understand better which kinds of help may resolve the root of your pain. While this is not the forum for actively exploring these questions, I do encourage you to talk with your therapist about them as you research treatment options including but not limited to medication. While I cannot say whether medication is the right choice for you or not, I do see the option of becoming a temporary "zombie" due to medication as a favorable one if the alternative to that is to become permanently dead. Safety first.
Medication issues aside, I wonder whether you have a trauma history and some form of a dissociative disorder in which you either frequently feel numb and dead/unreal or experience flashbacks of painful experiences from the past that are no longer happening now but feel just as real as if they were. I would ask you what kind of pain is this pain that you feel, what does it remind you of and can it be connected to any memories from your past? Are you wanting to kill off some part of yourself that is felt to be toxic, poisonous, or bad?
Another possibility is that your suicidal thoughts are part of an overall personality disorder in which you use suicidal thinking as a way of trying to communicate the intensity of your distress, get others to respond in some kind of wished-for way, or simply numb yourself out from intensely painful feelings. Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy (MBT), and Transference Focused Psychotherapy (TFP) are all evidence-based treatments that have been shown to be effective in reducing suicidality in such cases. Information about all of those treatments is available on the "personality disorders" page of my website www.goldsteintherapy.com. I also refer you to the following list of reasons to live http://depts.washington.edu/brtc/files/RFL72.pdf.
If your suicidal feelings do not seem to be related to a history of trauma, to overall long-standing difficulties with managing feelings, or to relationship issues (like people who won't respond to you in the way you would like them to), then I would wonder whether this began as part of an acute episode of a Major Depressive Disorder and in that case, you might need to explore more biologically-oriented treatments if psychotherapy is not helping. I would also wonder how frequently you are seeing your current therapist and would encourage you to consider increasing the frequency of your meetings. There also may be a deep unconscious wish for someone to come along and rescue you from a painful past in which you were emotionally alone, that is getting in your way of letting go of the suicidal feelings; if this is the case, you may need to grieve for those things that you wished for in the past but cannot have now (like a different childhood) before you can get well- this might hurt for a while but is well worth the work in therapy that it would take to resolve.
I wish you the best of luck with finding the right help and a way out of your pain that involves reengaging with life rather than having to imagine death as the only solution to your pain.
Mirel Goldstein, M.S., M.A., LPC
Professional Individual and Marital Counseling
3 Harding Court
Passaic, NJ 07055
303-204-7039
NJ License 37PC00391500
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