At the Mouth of a Personal Hell
On February 8, 2016, I said the words aloud, “well, down the rabbit hole,” just before I swallowed my first dose of antidepressants.
On February 21, I met with my psychiatrist to report a number of side effects of the medicine. He had a good feeling about my progress despite me listing numerous complaints, and proclaimed I would be fit to work again very soon. I had severe headaches, stomachaches and increasingly more vivid and disturbing dreams.
On March 1, I awoke to a dear friend calling me to convince me that it was best I be admitted to the psychiatric ward for watching and for further help. I had been having more and more disturbing thoughts, the most powerful of which was an almost magnetic draw while standing at the platform and waiting for a train, thinking through the pain in my head, “why not now?” They were not comfortable with me going around with such thoughts and did not want me to be alone.
I was institutionalized at Psykiatri Nordväst in Stockholm, Sweden for the next half week.
What happened there?
Considering the spectrum of suicidal thinking and behavior was not something that came naturally. I think it most natural that I responded to my own thoughts the way I did: with fear and panic. The first thing that happens when such a contemplation about ending it all comes into my head is: “oh gods, where is this coming from?”, followed by, “is this really me?”, and subsequently, “I’m afraid of myself. I’m horrible.”
When under watch at the psychiatric ward, one meets with a doctor for a conversation and judgment every day or every other day. They go into the acute symptoms of what you’re experiencing, talk about possible band-aids to them, and look into your propensity to rationalize — and predilection to continue self-harming or attempt suicide. I gained quite a lot of insight into my own thought and behavioral patterns, and despite being terrified of revealing them at first, I quickly became calm about talking about them. I felt myself stepping above the thoughts for the first time, because I could see the doctor’s position outside of and above them and mentalize his perspective. While I’ve been quite aware for awhile that my behavioral patterns that have to do with self-harm and self-hatred are almost entirely learned coping mechanisms passed down by watching during the most impressionable periods of my upbringing and this has been a source of comfort to me, it’s unsettling nonetheless to witness your thoughts go towards not wanting to live. But what I learned to do together with the doctor was separate the types of thoughts.
When he ended up classifying most of my thoughts as compulsions as a side effect from SSRIs, it was not to belittle my experience and entrapment with these compulsions. To view my thoughts as compulsions, or more like “what-if’s” and hypothetical fantasies followed by immediate fear, was actually a relief. It’s very common to have experienced this; many psychiatrists believe that, with the lag time between a resurgence of energy and the stabilization of seratonin (and whatever else SSRIs do, they have about a million effects and no one truly understands why they work), the risk of being depressed enough to not see much else but darkness whilst also having the energy to do something drastic about it becomes pretty large. There are a number of different types of suicidal thinking, and it’s important to separate and identify them in order to prevent — or make it less likely to fall into — judging yourself for them. I’ll return to these types of thoughts later, true to the order in which I began to understand them truly.
Getting patients to have a proper night’s sleep seems to be the first line of defense for the psychiatric ward, and it has since also become my first line of defense against being set up for a panic attack throughout the day. What do I do every night? I wake up several times and consider the paralyzing amount of life choices ahead of and behind me. Things I haven’t even done, things I will soon do or have to do, things I could have done — life choices that aren’t even applicable to me because I made them in a nightmare that I just awoke from, which is the everyday norm for me (today I woke up thinking I had picked a fight at a Korean BBQ joint in L.A. with some Swedish men, one of whom reminded me of a sexual abuser who had used me when I was a boy, leading to my friends ditching me, and then was referred by an Über driver who noticed my panic from the abandonment to a job as a mechanic at a junkyard specializing in WW2 vehicles, with a very friendly boss with a massive, fluffy, colorful dog who he plopped onto me and had me hug — and my first job was to go to war with neo-Nazis). To combat this, both at the psychiatric ward and now at home, I had to, yet again, overcome one of my most massive fears and strongest associations.
Great, more medication.
It may seem at first that you are just being peppered with medicine, hoping for some of the flecks to land properly and bring the dish to life — everything from anti-anxiety sedatives to sleeping pills to your usual prescription SSRIs — but one thing I have come to realize is that I have to trust the doctor. A brilliant dear friend tells me in the midst of my panic attacks and depressions, “I know you can’t see much good or hope right now, but you have to trust the process.” And this is what I have begun to do: when all internal voices fail to give me hope, when I can’t see much brightness, I can just lend a bit of energy to trust the practical process itself. I had been so averse to medication all of my life and throughout the rampant, exponential growth of my symptoms to crippling levels of depression and panic (from experience with a suicidal mother who had taken pills and alcohol to numb herself on several bouts of unconsciousness per month) that I was blind to an entire field of possibilities for getting through the next moment, the most critical moment, so that I can begin the real healing process.
But there is a point to it. You have to trust them — and it would also mean so much to me if you trust my word as well. If you’re not able to stop thinking about hurting yourself, and you’re as averse to medicating as I was, you’re not going to get through the next few moments without getting hurt in order to have a future in which to heal.
At first, I was extremely sad about the fact that I’m just drugged and affected all the time; the classic “feeling like I’m something other than myself” that so many experience while on antidepressants. It’s kind of a point of fixation within literature and media to portray the sadness of a drugged existence, of a constant altered state, to the point of ideological commentary on the concepts of ‘purity’ and ‘genuineness’. But soon, I had a revelation and an understanding that my illness is one that is not only behavioral and cognitive, it is also chemical. Drugs will not cure everything and true treatment must include all of the human experience, but to start with a proper, functioning chemical baseline will be a godsend to the mind who hasn’t really spent a significant portion of its lifetime without the constant buzzing of floods of cortisol. The brain won’t be prepared to tactical strongly engrained and undesirable pathways until it knows what a proper night’s sleep is like, without torment from subconscious fears bobbing to the surface without control within dreams, proper replenishment of neurotransmitters, and resting of synapses from firing. And a godsend the medicine truly is for those things.
Aside from all of these steps in the treatment, now on the more rational side of the experience, I have seen a few tactics really work and I now practice them on a day-to-day basis. I’ve turned off my Facebook feed, barely if ever scroll down the stream of posts, and the ‘do not disturb’ setting on my phone has become a best friend. These have all been incredibly powerful in reducing my stressors, and while I do recognize that everybody is I believe what I need to do most now is disconnect, minimize input, reduce stressors. Things stack up whether we recognize stresses building or not; spiraling, after these triggers are reached and added onto each other, is a real, powerful, and serious thing. And I must learn to become independent when realizing that my stresses are stacking up.
Let’s talk about it.
There comes a point where talking about it no longer helps me, and I’ve reached it. Venting has become a source of panic. Turning to talking about it with those close to me, one-on-one, has become less and less of an option. The shame of feeling the way I do and the fear of somehow imprinting or passing on that weight turns the point of letting the weight off of my heart through speaking against me, into a downward spiral of self-hatred. To expedite the growth of self-hatred inside of a panic attack, when speaking with people I love and who may not be going through similar things, I judge myself excruciatingly harshly for not ‘getting by’ like everyone else (seemingly) is — when I’m barely scraping by at the full-time job of working not to hate and hurt myself. People whom I love become triggers into full-on panic attacks and this makes me feel terrifyingly alone and despicable.
I’m in a valley, a pit. A trough of existence. I can’t rationalize living or dying right now, and I can’t source a reason within myself for anything truly remarkable or beautiful that I do or will do (and I know, this is due to a chemical blindfold — being depressed is like have blinders and tunnel vision into the core reactions of judging the self harshly — and this is temporary, but it is my reality right now).
So where, then, does one turn? A girl in the psychiatric ward told me:
“We are all here because we have reached rock bottom, but that only means that we have nowhere to go but up; nothing to do but heal.”
In this trough and in the cold and dark shadows of the surrounding peaks, on which a depressed and anxious mind perceives nearly everyone else to seem to be standing on, things that are normally uplifting are only numbing and overwhelming at times, and things that are normally downers actually become uplifting. (While taking a walk at night with a few friends, wearing only a smoking jacket, a friend asked, “it’s not exactly spring yet, aren’t you cold?”, to which I replied after a brief silence, “I like to be reminded of my own mortality.” Another friend laughed and said that I’ve been listening to too much Welcome To Night Vale. Nah. Satirical existential horror is exactly what I need to become comfortable in the incredulity of asking ‘the existential question’ and to start laughing at it.)
Where did I turn? I’ve since turned to books, articles, journalism, literature, and science again, devouring whatever information and stories touch my heart — aside from the full-time job of postponing and overcoming anxiety to just be okay, this has filled my days and given me some inkling of purpose in the meantime while I still can’t see a point to myself and what I do/will do. A lot of this binge-reading has been in psychology, which has nothing to do with all of my prior fields of study and background, but everything to do with each and every one of us in a very intimate way. I feel a bit false reading and attempting to comprehend the field, but it’s possible for a layperson to explore their interests and understand pertinent things, and I do believe in the power of picking up puzzle pieces where one can. Things like reading up on the psychology of depression and on suicidology seem to be the opposite of what one should do when deep in an existential crisis, but it’s actually very comforting to me to understand where the things I’m struggling with come from.
“The paradigm of suicide is not the simplistic one of wanting to or not wanting to. The prototypical psychological picture of a person on the brink of suicide is one who wants to and does not want to. He makes plans for self-destruction and at the same time entertains fantasies of rescue and intervention. It is possible — indeed probably prototypical — for a suicidal individual to cut his throat and to cry for help at the same time.” E.S. Schneidman.
Maybe it’s the scientist in me, but reading the statistics about suicide actually brings quite a lot of hope, and here is where categorizing the types of suicidal thoughts that exist becomes important and helpful. It’s a powerful thought to know that both empirical and remarkably widespread anecdotal evidence enforces that suicide attempters regret the decision afterwards. Many survivors remember changing their minds mid-jump, mid-pill swallow (calling emergency services just after attempting to overdose is overwhelmingly common). A poignant fact is that a remarkably small number of people who attempt suicide go on to successfully take their lives later (conflicting studies exist; one says 4%, another 10%, but all of them are incredibly low numbers). The fact that 90% of people who commit suicide have mental illness diagnoses shows that most of them aren’t fully able to make an unfogged decision through the clouding of thoughts by disorder and sickness; very, very few can fully rationalize and philosophize their way to being convinced that they truly don’t want to live (the proverbial pulling of the plug on life support when one is diagnosed with a chronic, crippling illness, for instance). And indeed, suicides are mostly rash decisions, and given time, a suicidal patient at a psychiatric ward will have rather large chances of having changed their minds. There is an at-risk period in which suicides are more likely when linked to a depression as well as beginning medicinal treatment, and statistically I’m still not outside of that period, which is helpful to me in recognizing my thought patterns and understanding that it will be different someday in the future and to take it easy on myself, to not judge myself for them.
It’s impossible to prove, but the numbers tell me that most suicidal thoughts do not actually mean that one wants to die but rather are just telling the self that one truly needs help — indeed, I’ve encountered in myself only ~10% of my self-harmful thoughts being centered around the contemplation of whether I really want to live a life with recurrent, pointless episodes of panic and depression, the rest of them are just automatic thoughts stemming from learned hating of the self — and in this, I find solace.
“Can I ask you a question? Say you’re at a pub and you meet somebody who you ask what their profession is, and they respond with, ‘oh, I’m a suicidologist.’ What would you say to that person?”, I asked a friend at the natural science student union’s pub one night, when we had already been talking about heavy things and so the risk of sounding ridiculous was at a low — though still making me anxious — but I wanted to open up the conversation. And I mean the conversation. The one that society needs to have.
“Well, that’s a very good question. It’s not exactly something where you would be like, ‘Oh, that’s awesome!’ about. Most people would probably say, ‘Holy shit. That’s dark. Anyways…’”, he answered. He was right, and I’ve heard numerous of like responses to other serious topics and reminders during discourse. We had one of the most wonderful, compassionate conversations about openness to all of life’s and humans’ problems following that.
So I return to the idea of “talking about it”. You may think it odd that I’m writing this at all when talking about my thoughts and emotions has become a trigger, but it truly is not. This medium, an outreach to the rest of the world and to you, my friends and family, in a public, open, and traceable forum, is exactly the kind that makes me feel best right now. (And in massive fear for any future employer reading this and determining my own instability for me, which is exactly the kind of stigma that I’m hoping to break — I certainly have had a lifelong battle with these thoughts, but I’m aware of them, their roots and their almost synthetic behavioral pattern nature, and I will make them known henceforth to the people who need to know in order to help me get through them.) This medium is where I can formulate my thoughts into logical patterns which I can observe from an easily survivable distance; it is almost the only way I can go meta on what I am feeling during a period of panic and depression now. I am beginning to understand and know that my friends are there for me despite not feeling like I should be loved at all, but perhaps I am reaching the next stage of my growth and healing: an my ability to step above my own patterns of anxiety, depression and panic and witness them as if I were observing a computation take its course, which is an independence stemming directly from my firm understanding and knowledge of the love of those around me.
And this is the most massive step in overcoming a fear of abandonment and exploitation from a troublesome upbringing to date.
An urgent reminder for those feeling imprisoned with their own thoughts and contemplating the end: you need to get second opinions to your own thoughts. Sure, no one can understand what you’re going through and know what kind of pain and hopelessness is happening inside, ever, but there are people who will help you have the time and rest as well as the insight that you need to make a more informed decision about the future of your life. Remember again that nearly all survivors of attempted suicide regret their decision, and that a remarkably small percentage of suicidal people truly wish to die but rather are in need of calling out in a big way.
Getting in touch with psychiatry, police, a suicide hotline, or a friend certainly feels like calling out in a big way — and it is — but it is the way to get the help that you really need in your dire situation. Do not fear what consequences might come from it; I was terrified of being admitted and of being watched, and most of it came from self-judgment. But you must get past judging yourself. There is nothing shameful about going to a resting place to get better. As one of my closest friends said as he waited with me before getting settled in, “people go to the hospital to get better, and this is no different.” You are no less of a beautiful soul for being watched and taken care of.
So, on to the resources, of which I’ll list a few that were indispensable to me and that can help most of my friends (in the U.S. and in Sweden), please, please reach out if necessary to:
- Mind’s suicide hotline in Sweden, reachable by calling 90101, or going to an online chat if preferred.
- Counties have mobile urgent care, like Stockholm county’s Mobila Akutenheten Karolinska, reachable through 08–517 750 40 and in operation between 08–22. They will help by determining the best course of action, including coming to you if necessary.
- In the U.S., you can reach the Suicide Prevention Lifeline at 1–800–273-TALK (8255), and states and counties have their own hotlines which can give local infrastructural guidance.
- If it’s almost too late or you’re truly afraid for somebody in an urgent moment, do not, do not be afraid to call the emergency services like 911 in the U.S. and 112 in Sweden/the E.U., or the local police.
I began writing this while in the psychiatric ward, and am finishing it here, at home, able to think rationally and having some energy to live, really live. If you couldn’t tell, I’m incredibly open about these experiences — for a reason, and that is because I want others to be able to get through their own struggles. If it reaches anyone and touches them, then I’m happy. And if you want to talk about the process or any experiences, I’m here to do so.