|
|
Why is it so hard for us to recover from being suicidal?
by David L. Conroy, Ph.D. Original location
Combat veterans, sexual assault survivors, and other victims
of trauma are vulnerable to a condition called Post-Traumatic
Stress Disorder (PTSD). People with PTSD suffer from a range
of symptoms that interfere with their capacities to enjoy
normal life.
People who suffered suicidal conditions, particularly
conditions that were chronic, recurrent, or included one or
more attempts, may also be victims of PTSD. According to its
definition, PTSD may result when a person suffers an event or
situation that is outside the range of normal experience,
exceeds the individual’s perceived ability to meet its
demands, and poses a serious threat to the loss of life.
Suicidal people meet the formal criteria for PTSD. Severe and
prolonged suicidal pain is not something that most people
suffer. People in suicidal crises feel that they are at the
breaking point of what they can cope with. Since 30,000 people
die by suicide each year in the United States, it is a
condition that poses a serious threat to the loss of life.
Many of us are haunted by memories of acute crises, acts of
self-injury, or extended periods of severe depression. Like
citizens of a besieged city, we lived through periods of time
in which we had a realistic and unrelenting fear that we would
soon be dead. We suffer PTSD simply from having been suicidal,
independently of whatever particular traumas may have
contributed to our becoming suicidal, such as abuse during
childhood or exposure to the violent death of someone else.
Our 'suicide PTSD' is also distinct from whatever traumatic
events may happen as a result of being suicidal, such as
involuntary hospitalization or job discrimination.
Undoubtedly, most of us suffered many types of traumatic
events in our lives, and these events and their consequences
need to be addressed in recovery. But the suicidal crises
themselves may be events that induce PTSD.
The PTSD literature for veterans and sex assault survivors
lists conditions that are commonly found among survivors of
those types of trauma. Survivors typically have only some of
these symptoms, and the severity of a particular symptom may
vary from individual to individual. Survivors of different
types of traumatic events often have a different range of
symptoms. A remarkably large number of these conditions are
common among people with long-term histories of suicidal pain:
- Problems with memory. Persistent, intrusive, and vivid
memories concerning the traumatic situation. Events of
daily life may trigger distressing memories related to
the trauma. Memory lapses for parts of the traumatic
situation. Many suicidal people are troubled by strong
images, such as the feeling that they have bombs inside
their bodies or a knife over their heads, and in recovery
continue to be bothered by the memory of having had these
images.
- Avoidance of things associated with the traumatic
experience.
- Denial on the seriousness of the experience.
- Persistent anxiety.
- Fear that the traumatic situation will recur. The trauma
is often an event that shatters the survivors’ sense of
invulnerability to harm.
- Disturbed by the intrusiveness of violent impulses and
thoughts.
- Engagement in risk-taking behavior to produce adrenaline.
- A feeling of being powerless over the traumatic event.
Anger and frustration over being powerless.
- A feeling of being helpless about one’s current
condition.
- Being dramatically and permanently changed by the
experience.
- A sense of unfairness. Why did this happen to me?
- Holding oneself responsible for what happened. Feeling
guilty.
- The use of self-blame to provide an illusion of control.
Sexual assault survivors often blame themselves: 'If I
hadn’t been at that location, worn those clothes, behaved
in that way, then it wouldn’t have happened.' This
pattern is also found in the survivors of a completed
suicide. 'If I had only done x, the suicide would not
have happened,' can be used to try to cope with the fear
that suicide will happen again in the family--i.e., it is
preventable if I just manage things differently. The
suicidal are often full of self-blame. As in the other
cases it is partly due to an internalization of social
attitudes that blame the victim or family, and also due
to the effort to gain mastery over the situation. To
imagine we could have done more is more tolerable than
total helplessness.
- An inability to experience the joys of life.
- Feelings of being alienated from the other people and
society in general. 'I am different. I am shameful. If
they knew what I was like, they would reject me. I don’t
belong in this world. I’m a freak, an outcast.'
- When people with PTSD try to return to normal life, they
are plagued by readjustment problems in the basic
elements of life. They have difficulties in
relationships, in employment, and in having families.
- A lack of caring attachments. A sense of a lack of
purpose and meaning.
- Some chronically traumatized people lose the sense that
they have a self at all.
- Veterans report the feeling that they never really made
it back from the war. Formerly suicidal people feel they
never really made it back to normal life.
- One Viet Nam veteran with PTSD said, 'I don’t have any
friends and I am pretty particular about who I want as a
friend.'
- PTSD was aggravated for Viet Nam veterans because they
returned to a country that had negative attitudes toward
them. For sexual assault survivors, stigmatization is the
'second injury'.
- When Viet Nam veterans returned home people were angry at
them. They had shamed the country, they had done
something wrong, they were potentially harmful to others,
it was dangerous to be with them. Sexual assault
survivors may receive angry responses--on the grounds
that they have done something that shames the family.
Suicide attempters often experience great anger from
family and care providers.
- A deep distrust of co-workers, employers, authorities.
- Left with unexpressed rage against those who were
indifferent to their situation and who failed to help
them.
- In personal relationships there are problems of
dependency and trust. A fear of being abandoned,
betrayed, let down. A belief that people will be hurtful
if given a chance. Feelings of self-hatred and
humiliation for being needy, weak, and vulnerable.
Alternating between isolation and anxious clinging.
- Trauma often causes the victim to view the world as
malevolent, rather than benign.
- No sense of having a future, or, the belief that one’s
future will be very limited.
- Feel that they belong more to the dead than to the
living.
- The feeling of having a negative 'Midas
touch'--everything I get involved with goes bad.
- Loss of self-confidence, and loss of feelings of mastery
and competence.
- A resistance to efforts to change a maladaptive world
view that results from the trauma.
- A mistrust of counselors’ ability to listen.
- People who suffered traumatic experiences as children,
teenagers, or young adults may simultaneously become
prematurely aged and developmentally arrested. A part of
them 'feels old'. Another part feels stuck at the age
they had when the trauma occurred.
- PTSD can be worse if the sufferer experiences the trauma
as an individual rather than as a member of a group of
people who are suffering the same situation. Unlike
earlier wars in which units went overseas together and
returned together, in Viet Nam each soldier had an
individual DEROS (Date of Expected Return from Overseas).
This reduced unit cohesiveness; each soldier experienced
the war from an individual point of view. Suicidal people
experience their near-death situation with extreme
isolation. They see their conditions as being completely
unique - 'terminal uniqueness'. They have no sense of
identification with others.
- The severity of PTSD symptoms tends to increase with the
severity and duration of the trauma.
- The use of alcohol or drugs to cope with the PTSD
symptoms.
- Attempts to do things to gain a feeling of mastery over
the traumatic situation, e.g., become a volunteer on a
hotline.
These kinds of conditions may be found again and again in the
chronically suicidal. Upon reflection, it should not be
surprising that we should suffer PTSD. Many of us suffered
from suicidal pain for years - and years - and years. The idea
of dying is terrifying. We recoil at thoughts of dying by
automobile accident, plane crash, murder, cancer, AIDS,
drowning, suffocation. The idea of dying violently simply by
forces generated from within ourselves is in some ways almost
too horrible to apprehend. How could anyone survive such a
prolonged siege of pain and terror - and remain unaffected?
Survivors of traumatic experiences are often told, 'It’s in
the past. Forget about it and get on with your life,' 'Why
can’t you just forget about all that, and enjoy life like a
normal person?' If we could simply 'get on with life', they
would have done it. PTSD helps explain why it is so hard for
the chronically suicidal to recover. Because we were suicidal,
we subsequently suffered many of the conditions associated
with post-traumatic stress disorder. These conditions are
serious problems in their own right; they are formidable
barriers in the recovery process.
We can heal from the original trauma, and we can heal from the
PTSD conditions that have plagued us since the trauma. The
basic steps of PTSD recovery programs provide helpful
guidelines:
- an environment that is physically and emotionally safe
- treatment for addictive behaviors
- patience: PTSD recovery takes time
- caring attachments
- restore sense of mastery
- rest and relaxation
- recall the traumatic event(s) in small steps
- gradually assimilate painful feelings and memories
- fully experience fear, anger, shame, guilt, depression
- grieve one’s losses
In a support group we have a chance to talk about our suicidal
histories without the fear that we will be taken to a hospital
for doing so. We can talk about the isolation, the fears, the
pain, the confusion, the acts of self-injury, the behavior of
others that was stigmatizing, denying, abusive, the horrible
sense of estrangement that exists when you are in a terrible
situation and there is no one who understands what you are
going through, the hatred and contempt for oneself and the
world, the debilitating sense of personal weakness. We see
that we are not alone. We do not have the seriousness of our
condition minimized, denied, or belittled. With time, the pain
abates and the troublesome PTSD symptoms diminish.
Top of page
Webmaster: wulff@ratatosk.net
|
|
