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Who Needs a Therapist When (Pt. 22)

Passive Ideation Is Ever Present

By Haybitch AbersnatchyPublished 5 years ago 4 min read
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Image Courtesy of Louise Hill CC

So, I went in for surgery yesterday. It was a pretty routine exploratory surgery (meaning that they were looking for problems and confirming diagnosis, rather than treating anything), but it meant that I was put under. And as one of the nurses was working her way through the usual intake questions about family history, and whether or not you felt safe at home, and whether or not you have thoughts of harming yourself or taking your own life.

And I never know how to answer those questions. Like, I feel a little obligated to be honest. After all, these are healthcare professionals, and I believe in pushing past the stigma and shame to accept who I am.

But also, what they are really wanting to know is if I have intent. A plan. They want to know if my suicidal ideation is active. They want to know if they need to act now, if there is an urgency to it.

And it's not. It's just always there.

There was a really good article about this recently, talking about the difference between passive and active suicidal ideation. The author likens her suicidal tendencies to being out at sea. That if she stops treading water, it will claim her, but that as long as she can keep herself afloat, it is fine. And she uses pieces of her life and therapeutic techniques as life-preservers and flotation devices. They keep her afloat on bad days and make it easier to make it to the next.

I don't think I've ever read a better metaphor for chronic suicidal ideation. It isn't that I really want to die. It is just that I'm not sure that I want to stay alive. And it takes effort to convince myself that I do. I use duty and obligation as much as positive things. Anhedonia, or the inability to enjoy things, makes it really hard for me to use positive things to keep me afloat, because sometimes I just stop caring about those positive things. But I promised I'd go into work tomorrow and my coworkers will be counting on me. Which means I have to make it to tomorrow. For my coworkers, I can do that. I don't like my job, but having that obligation makes it easier to get out of bed, makes it easier to feel like there is a purpose to staying alive.

I think the part about chronic suicidal ideation that is hardest to really comprehend is that, for so many people, the experience of suicidal ideation comes on fast and hard. They've just lost a loved one, or been broken up with, or lost their job, or found out really bad health news. They've spent their whole lives on a boat and they've just been washed overboard. It is abrupt and sudden, and they are submerged before they know it. They don't have a collection of flotation devices, and they are sucked under, using all their energy just to make their heads surface. It is the suicide that is sudden, and abrupt, and extreme. The person who never had mental health issues before, and it is unimaginable how they got there.

But I can't remember the last time I stood on solid ground. The last time I was on anything more sturdy than a raft. And while that means that there is always a desire—at the back of the mind, at the back of the heart, to end it all—it also means that I am both well-equipped and well-practiced at staying afloat, no matter the weather. Sure, sometimes the waves might crash overhead, but duty will always buoy me up, and sometimes things are happy enough that I can just float and drift.

But how to explain that to a doctor? Even to a therapist? That I am careful. That there are no guns in my home, no medications you can overdose on, no easy ways available. How to explain that my calendar is a lifeline, and that I know how to lock myself in bed when things are really bad. How to explain that I've always been treading water, that recklessness and fearlessness have accompanied my lack of caring about living, and that it's been freeing in its own way. How to explain that I don't really care if I start liking life, wanting to live. I just want a slightly sturdier raft, so that my legs can take a break sometimes. I don't need an intervention. I just need a gentle push sometimes.

Last Week's (Pt. 21)

Week One's

therapy
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About the Creator

Haybitch Abersnatchy

I'm just a poor girl, from a poor family; spare me this life of millennial absurdity. I also sometimes write steamy romances under the pen name Michaela Kay such as "To Wake A Walker."

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