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

{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.}
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Dear Hurting,

My heart goes out to you in regard to the deep emotional pain you are experiencing. There are times that what we are feeling seems so deep and bottomless, so much as if it's drowning us, we are willing to do anything to make it stop. I believe the physical actions you took - cutting, burning, and starving - were attempts to create a different and greater source of pain so that your attention would go to that and away from the emotional/psychic source, but it didn't work.

Doing long distance therapy is hard because there's no way of discovering what the origins of a situation are, what your history is, what your family situation is, etc. I can only suppose that what you are experiencing is, most likely, the result of emotional trauma with some chemical imbalances thrown in. I agree with your therapist that medication would be a good idea to help you get through the crisis before you can really work on the emotional issues. I think what needs to be done in that regard is to connect with a psychopharmacologist "maven" - someone who really knows what he/she is doing with great expertise and experience to guide you to the right course of meds for you. I think that meds can be the emergency stop gap. If one goes to the emergency room because one is hemorrhaging, first the hemorrhaging has to be stopped, then the source needs to be discovered so that it can be prevented from happening again. That's what meds are in your situation. They need to be used cautiously and well until and if the pain stops or is at least manageable.

In general, when someone wishes to die, it is not really an end to life that's actually desired, but an end to the bad feelings. At the time, it just feels like one is impossible without the other. However, it is possible; it takes work and the right therapy to lead one to understand and accept that.

If there are people in your life who love and care about you it means you are lovable and worthwhile caring about. Sometimes it's challenging to understand that and feel that way about ourselves. Perhaps it would help, just tangentially of course, to ask what it is they find lovable and care worthy about you. Perhaps they are seeing aspects of yourself that would be a soothing surprise.

I would suggest that if your therapist really believes you are in danger of taking your own life, you consider intensive, in house treatment. If you and s/he believe this is not truly likely, continue therapy, perhaps add group treatment and do pursue medical supervision. You might even consider other therapies that are more direct in targeting issues, like EMDR or even shock treatments, which are gaining a new reputation for being much safer and much more carefully employed, and can "jolt" a person out of severe depression enough to make other therapies more effective and daily experience more tolerable.

I would never suggest you find a way to end your life, but find a way to live your life. And, while the motive to bear with it to keep from hurting others, is a positive one, the better goal is to go on and keep from hurting yourself - and even - find satisfaction in being alive.

Sincerely,
Nancy Silberman Zwiebach, MS, PD
Paramus, NJ
201-843-1373
Individual, Couple, Family and Group Psychotherapy
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