Ordinary

I considered adding those words, “the ordinary instant”. I saw immediately that there would be no need to add the word “ordinary”, because there would be no forgetting it: the word never left my mind. It was in fact the ordinary nature of everything preceding the event that prevented me from truly believing it had happened, absorbing it, incorporating it, getting past it. I recognize now that there was nothing unusual in this: confronted with sudden disaster we all focus on how unremarkable the circumstances were in which the unthinkable occurred, the clear blue sky from which the plane fell, the routine errand that ended on the shoulder with the car in flames, the swings where the children were playing as usual when the rattlesnake struck from the ivy. —- Joan Didion, The Year of Magical Thinking.

Still can’t bear to read continuously, but getting there slowly. A year after, I have just begun to pick up the pieces of my blissfully ordinary life. It feels extra ordinary to me. I feel extra tired, extra bored, extra pressured, extra indecisive and extra lost. You cannot imagine how extra lonely this feels, when everyone around me has assumed I’ve gone back to normal. But I will never go back to normal. It’s different now. After what happened my life needs to be EXTRAORDINARY. Aye, there’s the rub…Image

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The Cobra Ironman 70.3: A promise fulfilled

BEGINNING THE JOURNEY

To finish the Ironman 70.3 began as someone else’s dream. It was the dream of a man who had always believed that when it came to physical training, everything could be achieved with discipline and perseverance. Beau lived a life on the edge and when he set his goals on something, he focused with such precision that it left little room for error, much less failure. It was no wonder then that he looked the part. He had molded his body like clay, with every part sculpted patiently; belly flat from a thousand crunches, back and arms strong from the long hours traversing the walls and climbing up inclines.

I on the other hand was the complete opposite. I shared the passion for sports and the competitive spirit, but instead of willpower, I had the willfulness, patience and sweet tooth of a seven-year old child. I didn’t like extended periods of pain. Competitive sport climbing suited me. Although it required long hours at the gym, training required short bursts of power, not the long heart squeezing, slow burn pain of cardio training.

When Beau first suggested we do a full marathon together, I just said yes because I thought it would eventually erase my hatred of running. Oh how I hated running. It was a program that required 6 months of training, training that my mind seemed to consciously reject. There was always an excuse — my job, my health, and family responsibilities. Come race day I was nowhere near prepared for it. But it was our first year anniversary as a married couple and I imagined it wouldn’t do at all to have a husband rendered romantically incapable by running his first 42km while I waited around twiddling my thumbs. I might as well run with him. I decided to run one loop of 21km with him then wait for him when he gets to the finish after completing the full Monty. I ended up suffering through the entire 42km. But I did it. He told me then, as he hugged me, tears streaming down my face, that he always believed in me. “You could do whatever you set your mind to babe,” he said beaming. “You just have to start believing”. I lived in the afterglow of that accomplishment for weeks.

One day, months later, he told me he wanted to go into triathlon. I told him I would support him all the way, as I always have in all of his endeavors. When he told me he wanted us to do it together I smiled brokenly and told him there was no way I had the confidence to swim, bike and, God forbid, run in a flimsy piece of lycra. It was bad enough that I have lived my life being the overweight athlete, the one who surprised everyone with an above average performance not because it was truly amazing but simply because I just did not look the part. But my husband had a dream and I was not the one to stand in his way. We found ourselves at a Century Tri Hard triathlon clinic shortly after. And the rest was sharply bitter history.

THE PROMISE

On the day of valor, while the nation celebrated courage and heroism, my handsome, adventurous husband took his own life; defeated by a foe that nobody saw coming. It was like a fog that descended heavily into our lives, as if our happiness was a farce and we were mere puppets pulled by the universe with strings that we did not know existed. I wrote his eulogy in a daze, more eloquent than I have ever been. And in those final words I made a promise — I would finish the Ironman 70.3 for him. I knew that to him it would mean more than finishing a race. It meant I would have begun to have faith in myself, something he promised me he would spend a lifetime helping me gain. I never imagined a lifetime would be so short. And if a lifetime were so, then 6 months felt like nothing. Before I knew it, it was time.

A RAINY RACE DAY

When you make a promise like mine, the thought of not being able to fulfill it summons demons of extraordinary power. In the week running up to the Ironman I could barely sleep. My stomach felt permanently out of whack, my throat sticky and dehydrated and my mind kept serving images of failure. I was haunted by all the reasons why I would not be able to finish the race, all the hours of training that I had missed, my inability to change a flat on the fly. It didn’t help that I was booked in the city, 30 kilometers away from the race venue and that my bike, although also in Mactan, was on the other side of the island. Post-race my parents and my brother in law, who had raced with me, would be parroting lessons learned. First, arrive at least 2 days early to get a handle on logistics. Second, triathlon is an expensive sport. Book at or near the race venue even if economics has turned your dream into a cash cow. Third, no matter how anal one can get about preparations, things can always go bonkers on race day.

The one thing that is predictably unpredictable is the weather. While I am sure all 2,000 athletes prepared to bake in the heat of the southern sun, I doubt even half of us were prepared to handle the sudden squall. The night before, I stared out into the burgeoning swells of the sea from a hotel room balcony. Memories of a time not so long ago, when I bawled like a baby from fear of sea creatures and drowning in the open sea, came flooding towards me the way the water pounded the sand below. Whatever will be, will be.

THE SWIM

It was a riot. The water seemed calm enough when I dipped alongside the throng of athletes trying to expend nervous energy and warm up before the gun start. But when it was our turn to begin, the waves decided to up the ante and give us something of a challenge. We marched shoulder to shoulder like cattle being herded towards the starting line, which apparently was a string of small buoys 50 meters offshore. We looked like a bunch of yellow and pink apples bobbing in a bucket on a stormy Halloween day. I didn’t actually even hear anything. I lost all sense of direction. I concentrated on keeping calm while I floated up and down on what felt like titanic swells. Then just like that I was in the middle of a frenzy of flailing arms and legs going I knew not where. The buoy line had all but disappeared. I had no choice. It was follow the throng, find a space to swim or sink to the depths. I muscled my way through those first 200 meters. My heat rate was racing and I feared I was expending too much energy too early on. But I didn’t even know where the buoys were. If I chose to stop I wouldn’t even know what to hang on to. I might as well swim. I swam hard. Eventually I found my little space of calm, found my rhythm and began to slice methodically through the water. Periodically I would be alone in the deep, swimming too far from any warm bodies, then without knowing how, I would find myself in the middle of another group of arms, elbows and kicking legs and I would have to disentangle myself, propel myself through until I found my own space again. I have never wanted to get out of the swim so badly. I was out of the water a little over 40 minutes but it felt like so much longer.

THE BIKE

I have always loved a good bike ride. I loved to go fast. There was something so exhilarating about the wind on your face when you ride. In a mostly flat course I was more concerned about conserving as I had a tendency to lose myself in the moment and pedal with reckless abandon only to find myself nursing a creeping cramp before the run began. When I ride I feel free, the steady release of energy from muscle and sinew was empowering. Too soon, a pothole. And another. The smooth ride was over and I worried about the creaking and grinding of my complaining bike at each bump in the road that tried to slow me down. Thankfully there were a lot of distractions and the road conditions quickly relegated itself as a necessary evil I could do nothing about. There was also a lot of cheering from schoolchildren along the length of the road, probably promised a star on their little hands if they cheered for people they didn’t even know. There was also a lot screaming, this time from teenagers, mothers, cougars all beside themselves at the thought of catching a glimpse of “Mattio”, “Irwan”, and of course the iconic Papa P, who surprisingly, had the time and energy to smile and wave to everyone. The screaming followed him like a never-ending wave. Then silence.

I have mixed feelings about silence. It unnerves me at times because I wonder why I felt alone in a field of over a thousand athletes. I felt left behind and a part of me wondered where everyone else had gone. I busied myself trying to spot teammates and people I knew but they were few and far between. But I welcome the calm that the silence brings. It is when I truly enjoy the race, when I go back to who I am, why I am there and what I need to do to bring myself home. I make no apologies for being an emotional athlete. It is the well from which I draw from. I felt it strong, that headwind that I had been warned about for weeks. But it bothered me little. I consciously maintained my level of effort, looked to the sea, colors dead from cloud filtered light. I would sigh, stretch, hunker back down and continue spinning.

The specter of the Marcelo-Fernan Bridge was intimidating. While it was a beacon that heralded the end of a long ride, it loomed in front of me like a circus clown ready to crack a joke at my expense and blow my confidence away. I loved the tunnel but I do not like hills. Hills are highway hold ups that rob me of my joy. It was frustrating to be pushing hard and not be gaining any speed. I could see the crowd, they waited and I just knew I would do anything not to walk. But sometimes what we imagine is worse that what is actually there. Before I knew it I was over the peak and on the way home.

I finished sub 3-hours on the bike. Surprised I readied myself slowly for my arch-nemesis, the 21km run.

THE RUN

I don’t understand why people don’t believe me when I say I cannot run. And to be honest, I don’t even know exactly why I can’t in the first place. Having finished 2 full marathons already, one would think I had made peace with running. Runners talk of the second wind, that moment when you breach the crest and you feel like you can keep running forever. I have never reached it. My peak is to realize that I refuse to continue panting like an asthmatic dog and give in to the need to stop. It is rarely my legs that give me trouble. I think I give up far too early for my muscles to feel the stress of overuse. Heck I started walking after 1.2 kilometers and began to execute a whim-driven run-walk strategy. Forget Mr. Galloway. Even his evenly paced intervals had no space in my defeated mind. This is it, I told myself. Barely two kilometers in and tears were pooling under my lids. 19 kilometers to go. It seemed impossible I would survive it. And to be honest, I don’t know how I did. At least the weather was perfect. Had it been as hot as we thought it would be, I felt like I would have dropped dead at the side of the road. Not because I was really that tired but because I thought it was all I could do.

I looked at the side of the road and focused on trees, people, other athletes, using anything and anyone as mental landmarks as to how far I had to run before I would allow myself to walk again. They were intervals of hardly more than 20 feet each; it was as far as I can imagine pushing myself. When the illusion of the constantly moving finish line failed to fool me, I would look at the crowd, concentrate on little details of their faces, strain my ears to listen to Visayan conversations I could not understand. The aid stations were little pockets of heaven. At least when I walked towards one I felt it was a valid excuse to stop running, unlike the constant walk breaks that my plan did not originally include. I can imagine my coach scratching his head at my lack of willpower. There I was again, the 7-year old child, more willful and impatient than focused and enduring. As always I got angry with myself, a virtual Gollum with an internal struggle that probably showed on my sweat-drenched brow. I carried on like that for most of the race. Physically capable but mentally crippled. People who had not even seen my behind during the bike began to pass me one by one, and with each of them went pieces of my shattered confidence.

It was the belief of others that again saved the day for me. Beau would have been shaking his head if he were there. Fellow triathletes, teammates and friends who would bump into me along the course and say I was doing a great job. They saw it. They said I looked strong. That I was well on my way to the finish. I smiled at them because I thought it was ironic, but at least I smiled. Before I knew it, I had hit the halfway mark and last 10 km did not seem so daunting anymore.

I picked up the pace, ran faster than I knew I should to make up for the walking I absolutely needed in between. It wasn’t ideal and was far from any plan a coach would advise me to do but it was all I had then. I remembered my last race and focused on my breathing. The kilometers fell away and there it was, Shangrila.

Shangrila is described as a secluded and mystical hideaway, a place of great beauty and peacefulness. In a way that was how it really felt for me. I ran as fast as I possibly can, mindless of those who passed me in the last 100 meters.

It took me 2:48 to finish 21km. But it didn’t really matter. All I knew was I was there. I was done. I had finished. J

I began this journey because my love for Beau was so encompassing that I couldn’t bear the thought of not fulfilling what was then his greatest aspiration. I crossed the finish line to fulfill someone else’s dream. But to me, the line had a more pregnant meaning.

To me it is the beginning. The birth of a hundred more dreams just waiting to be fulfilled, not for Beau but for me, and for all those that I hope to inspire as I continue my journey through life. I will forever feel an emptiness that Beau had been destined to drop out of the race. Why that had happened is between him and God. But for those of us who live, there are countless finish lines yet to be crossed. I still believe in rainbows. I still believe in love. I now believe in me.

Life is what we make it. Let’s not just be survivors, let’s live victoriously everyday. I know I will. LIFE IS GOOD.Image

A widow’s valentine

We were Valentine scrooges, Beau and I. Not because we didn’t believe in love but because we were too lazy to brave the traffic to go out on a date and found it insane to pay the sudden premium on roses, chocolates and things pink and red. But we did find it the perfect excuse to stay home and just enjoy each others company while eating trash disguised as cheesy, salty snackfood and sharp, bubbly, sugary soda. Today is Valentine’s day again, but all that is left for me are the things we avoided about it. The man I loved is no longer around to share the calories, to share the silence, to share the warmth of a priceless hug. I shouldn’t be affected actually. We never celebrated Valentine’s. But even the “non-celebration” is a memory of what once was and again, a reminder of what can no longer be and why that is so. The latter is the more painful, as no matter how beautifully my life turns out, the horror of the way he left will be remembered with questions unanswered.

I’ve gone on a standstill with my efforts to proactively deal with Beau’s loss. If in the months right after he passed away I wrote incessantly and read voraciously to equip myself for survival, in past months I’ve dealt with my pain through avoidance. I’ve stopped talking about him, stopped writing about him and refrained from thinking about him at all. Ive blocked my pain somewhat, hoping that Rhonda Byrne’s Secret would work and that i would attract happiness instead. And in a way it has helped me to cope. I seem happier. I’ve seen possibilities and began wishing for things again. That I suppose means I now believe there is a future. For one does not wish for things when one is devoid of hope. It makes me guilty though to be trying to forget. I feel like I am doing him a disservice although when I feel that I argue to myself that it is HE who did a disservice to me by leaving me widowed so young.

Valentine’s brings those thoughts to mind. It isn’t surprising that I feel more than a bit sick and nauseated today. And while I sit and pray at his crypt what comes to mind is the emptiness that he has left behind. I am sick to my stomach and I suspect it has something to do with the burning in my heart.

I miss being loved. I miss being number one in the eyes of another. I wish to tell everyone who gives the standard well meaning line that to love myself would be the most important thing for now to go to hell and go back into the loving embrace of their significant others. Leave me be. You do not understand and fear loneliness the way I do. I wish to be loved. Anyone who will judge me for that is of no importance to me in any form whatsoever.

I will love Beau forever. But he is also gone forever. And I refuse to live a lifetime alone.

Can You Think Your Way Out of a Depression?

I’m sorry I’ve been out of it for a while. I tried to keep myself from thinking about Beau too much. I thought it would go away. This horrible pain and loneliness. But it’s back. I spent so much time thinking about so many things. I spent so much time trying to make sense of it. I figured i should write it down. It would help because it helped me before. But I’ve become lazy. But I came across this article posted on my FB account from a friend of mine. It spoke to me. I wanna stop thinking but I’m wired that way. But reading this made me realize I might be digging myself into a deeper hole. I hope it helps someone out there too.Image

Can You Think Your Way Out of a Depression?

Think about it
Published on April 26, 2011 by Jonathan Rottenberg, Ph.D. in Charting the Depths

Whether it’s advanced language, ability to reflect upon the past and plan for the future, or our access to a rich shared culture, our unique human traits are usually a source of pride. But, in my last post, I explored the riddle of rising depression in humans. It seems that the same capabilities that enable our species to harness fire and put a man on the moon lead to self-defeating efforts to control low mood. Do our special cognitive capabilities play into a uniquely human pathway into depression?

A main function of low mood is to draw attention to threats and obstacles in unfavorable environments. The consequences are a pause in behavior and a more careful analysis of the environment. In humans, this analysis is more explicit than in a tiger or a tree shrew. Our advanced language ability permits construction of detailed theories about where painful feelings come from.

It’s natural to expect, “If I understand why I feel bad, I will know how to fix it.” Humans have unique powers of mental simulation (we don’t need to put our hand on a hot burner to know it would be a bad idea to touch). Although it’s easy to make fun of coulda, shoulda, woulda counterfactual thinking, our skill at understanding why bad things have happened helps us to prevent their recurrence. By forewarning ourselves, we are forearmed.

As a scientist who studies mood, I’m naturally all for the examined life. Insight-oriented psychotherapy, weekly talk therapy sessions with the guidance of an expert, can be helpful for depression. It’s also possible for a novice to think their way out of low mood and depression by themselves. But humans are not nearly as good at this as they think they are. Here are several pitfalls of trying to think your way out of a depression.

(1) Repetitively thinking about the causes and consequences of low mood can become habitual. Some people do it even when there aren’t significant challenges in the environment. Research shows that excessive use of this strategy, sometimes called rumination, is associated with depression.

(2) Our advanced language and ability to hold ideas in mind forms a dangerous echo chamber for mood. We are in a sense too good at meaning-making. We can easily think about the meaning of a troubling situation well after the situation has passed (my boss seems mad at me; maybe it was that email I sent three weeks ago?). A bad mood can prompt a potentially unlimited number of stories and implications. These may or may not be relevant to the source of the mood. The meaning-making machine might be doing its thing 24/7, in full overdrive, coming up with dozens of reasons for “why I am so blue?” All the while, low mood could be due to a thyroid deficiency, or some other “meaningless” source.

(3) People tend to be overconfident in the use of thought. It’s much easier to list these pitfalls than to recognize in the moment when thinking is not working. The belief that, “I can just think my way out of depression” comes partially from the fact that we humans solve so many other problems by thinking!

(4) Our meaning-making machine can get stuck.  The worst situation is when persistent thinking does not arrive at a stable theory of the problem, does not solve the problem, and cannot come to terms with the problem; it simply perseverates on the fact of the problem.

(5) As time wears on, the focus of analysis turns away from a problematic environment to a problematic self. This escalating-self-focus is far from benign.  A chimpanzee does not lie awake at night thinking, “I am a terrible mother.” A human does. The next day startssleep deprived, with a mood hangover and little new wisdom won. What started out as an environmental analysis ends up as vicious deconstruction of the self.

(6) Repetitive thinking on the failings of the self is associated with a deepening of depression. Again, this exposes a unique human vulnerability. A dog does not ask itself, “why can’t I just get over this?” or “why am I so weak?” An elaborate conceptual self puts us at greater risk for serious depression when sustained analysis of mood holds the thinker at fault. It’s as if we humans are constantly playing an action film of our own life in our heads. When times are good, we are the hero; when they are bad, we are the villian of the piece.

(7) Once the meaning-making machine is up and running, it’s harder to change gears than you might expect. Our meaning-making machine does not respond to the easy advice, like “snap out of it” or “stop thinking about it”. One must be quite clever to avoid getting sucked into a spiral of negative thoughts. Talk is cheap. Totally squelching mood-relevant thoughts is almost impossible once a serious depression has taken hold. Rather, the trick is to critically engage your thoughts without getting embroiled in them. Some people figure out how to do this on their own. Others use several therapies such as acceptance, mindfulness, or cognitive behavioral –all of which involve techniques for turning down the volume on the verbal meaning analyzer. The goal: To become a detached spectator of your own mind. As you learn how to stand apart from your stream of nasty cognitions, you can question them as they occur, a first step in reclaiming thought for psychological health.

Mourning my Mornings

Featured

I’ve started to wonder why people fear the night and find comfort during the day. For the past weeks the dawn of a new day holds more terrors for me than the quiet solitude of twilight.  It had not always been so. I used to find dusk so forlorn and desolate, the slow goodbye of the sun sinking into the pallid blanket of the evening. Nowadays i find twilight restful and peaceful, the demise of the sun bringing with it the soothing comfort of anonymity, of escape. The darkness is welcome. Shadows hide a face swollen with tears shed in the stark blinding brightness of daylight and camouflage a heart wracked with guilt and doubt.

I used to love mornings. I loved waking up early to spend a few minutes staring at my sleeping husband’s face then getting up silently to prepare a breakfast that I would insist he share with me despite his protests that breakfast had never been a part of his morning rituals. I loved the smell of coffee brewing. It was a daily reminder that I had to wean Beau from his belief that 3-in-1 sachets can actually be considered a suitable replacement. I would take great care in setting our tiny table for two, obsessively insisting that we eat “proper”. There was love in a pretty looking meal, in beautifully made plates that brought out the sunny colors of food meant to jumpstart your day. I loved when he would wake up and just watch me while I puttered about, smiling a lazy smile as he wondered what all the fuss was for when he could just as easily enjoy a breakfast straight out of a cereal box.  There was comfort and reassurance in starting the day together, basking in the comfort of each others presence, sharing each others plans and knowing that the day ahead would end peacefully in each others arms come nightfall.

Our days had settled into a routine, but they were never simply habitual or mechanical. Beau had defined my mornings. He smelled of sunshine, of trees, of wind and song. Even in sleepy grumpiness he always managed to make me smile, for he was mine to keep, mine to care for, mine to spoil, to serve, to love. It was the rest of the day that to me was routine and uninteresting. Events animate and gain color only when I was back with him in the evening. It is at home, tired from the workday and from climbing,  armed with stories to tell, tales of the successes and failures of the day, that everything comes to life. He was genuinely interested in me, happy for me, angry for me, sad with me. And when he would share his day I would find calm in his joy and simplicity, in his ability to be happy with the most mundane of things.  Back then it was sleep that I wanted to delay, to do away with if only it were possible. Because when I slip into slumber, no matter that I do so cocooned in his arms, I lose consciousness of the blessing of Beau that I had in my life. Before I slept I would already look forward to the morning, when I would rise and watch him sleeping, his chest rising and falling with the cadence of peace. A peace that shattered. So suddenly. So abruptly. So incomprehensibly.

Now, mornings terrify me. I am so mortified by the coming of day that I weep in my sleep during the night, my tears saline witnesses of nightmares that I cannot remember no matter how hard I try. When I speak of panic, I mean panic. My heartbeat races like I’ve run a marathon instead of having come from a rest meant to prepare me for the day ahead. I cannot breathe and I am attacked with severe anxiety from the fluidity of the hours that lie in front of me. I feel pressured at any thought of things I have to do and I feel pressured at the thought of not knowing what to do. It is like waking up having to make a daily decision that is neither wrong nor right, left or right, here nor there. It is waking up afraid because there is nowhere to be, nowhere to go yet nowhere to stay. It feels like standing on a razor’s edge, afraid to fall yet desperately praying that someone, something would tip me over one side or the other, to tell me where I should be, where I belong, where I am organic. My chest fills full to bursting knowing that even those who love me would not really care as much where I end up. At least never as much as a husband who is half of me in spirit.  To ask me to make my own decisions on what to do and where I should be feels almost cruel. It is mocking torture. Because in my heart I knew I was meant to be making a breakfast for my life’s champion.

Even the memories of our nighttime conversations are now poisoned. When once they gave color to my otherwise mechanical day, they are now memories of signs I missed, of things I regret not having understood.  Instead of the joy and simplicity that I had seen in his smiles I now remember the days when he would come home frustrated and angry about things that were just as “simple”. I now remember his inability to see solutions and possibilities, how each problem sounded so insurmountable. They were moments, that were fleeting and seemingly insignificant. They were challenges that were Lilliputian to anyone not haunted by the ghosts that I now know plagued him. And he was a master at hiding. I realize now I was only privileged to have been let into his private world, the darkest parts of which he kept only to himself.  I wonder daily if it was something I should have caught, something that shouldn’t have escaped my notice, if it were somehow a lack of attention on my part that had disabled me from saving him from self destruction. But was it a crime for me to have seen the smiles instead of the frustrations? Was it a mistake to have seen what was whole in his simplicity instead of its brokenness when it was Beau himself who taught me to be grateful for all things given?

I mourn for my Beau. I mourn for my Beau-tiful mornings. I am angry that I am accused of choosing to dwell on my misery. I am frustrated at being asked to simply make a decision to get better.  What I would give to not have to wake up afraid to live another day. What I would give to wake up refreshed from a full night of undisturbed sleep. What I would give to find joy in delicate tableware, in matching placemats, in coffee brewed to aromatic perfection. My mornings are no longer those I have come to know. I wake up in a place cluttered with boxes of my married life just waiting to be put aside. I reach out desperately, repeatedly, for help in the mornings and know that sometimes there is no help to be found. Then I take it one minute at a time until I am embraced by the velvet ebony of night.

Anatomy of a breakdown about to happen

I’ve always been an emotional person but this depression is a first. It is emotional torture so powerful it takes on shape and form yet is still effervescent and fleeting. Impossible to grasp. You cannot tear it apart, throw it away or smash it against a concrete wall.

I feel stifled. My breath is insufficient to nourish me. My throat is dry and painful and my eyes feel like they are permanently swollen. My tears hide under my lids but come flowing unbidden and without warning. They flow after my chest feels a tightness, a constriction that caused my stomach to churn as if I had ingested something rotten and have to retch. The sadness feels like a second skin, with an adhesive so strong I feel like rubbing myself raw to clean myself. Sometimes I scratch my face and head so vigorously I feel like I am going to literally tear myself apart. The pain is soothing compared to the embrace of frustration. Its like an itch that you cannot scratch but this time it is a pain you cannot soothe.

There are days when I have to lie down on the cold tiles of my bathroom floor because it soothes the searing heat of my body. Sometimes I feel like tearing my hair out because it feels tangible at least, something concrete to grasp, something real to battle. My muscles complain as if I’ve been working out for hours even if all I’ve done was try unsuccessfully to get some sleep. I feel stretched out like an overtuned guitar string.

In the mornings, my heart pounds frantically with a terror I cannot explain. It is so strong I shoot straight up and jump out of bed because I fear that  if I stayed lying down it would choke me. I need to shake my extremities to get rid of the pins and needles that send warnings of their arrival. There is a pressure in my chest that grows. It is like air pushing down on my lungs instead of through them. I could almost hear screaming in my head, there is that incessant droning sound.

My eyes feel so tired and heavy lidded all the time. I look out through them with difficulty. It feels like a white veil has been put over them and sometimes things take awhile before they register before me. I have to blink and close my eyes several times before the blinding brightness goes away. And when it does, I feel the stickiness left by tears that I must have shed even while I was asleep. And when I look in the mirror, the image is distorted. I can see every single flaw in my face, the unflattering curves and bulges on my bloated body and I feel like collapsing inward. I am constantly on the verge of falling asleep but don’t really get to sleep. I know because after 5 hours of sleep I wake up feeling even  more tired than ever.

My taste buds seem dead. It is tiresome to even eat but I do anyway. I eat a lot because it breaks the monotony. Something else that enters and exits my body other than poisonous thoughts. But everything tastes the same.

Everything feels wrong. It feels like my body is not my own and I watch things hovering beside, behind or above myself. I fidget a lot and pace, as if moving would shake off the choking sadness the way I could shoo away a pestering fly. The thoughts come in and out of my head and they irritate me.  Sometimes that is exactly how it feels, like an insect fluttering about me with that grating whirring sound of little wings. If I could I would put my brain in my hands and handle it like I would a ball of clay, pounding it tightly until it was packed, solid and hard then throw it through a sheet of tempered glass.

I am a writer but my words fail me. One must experience to understand. Am I going insane I wonder? I do not know. I know nothing. I feel everything. I want it desperately to stop.

Am I in danger of suicide? — Joiner’s Theory

There are very important things this article discusses which I can absolutely relate to right now: The feeling of thwarted belongingness, perceived burdensomeness and the desire to just end it all (see Dead Man Walking posted on this blog). What a very educational and interesting read.

This article can be found originally published on: http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/03/joiners-interpersonalpsychological-theory-of-suicidal-behavior.html

Joiner’s interpersonal-psychological theory of suicidal behavior

M.Anestis Photoby Michael D. Anestis, M.S.

There are few, if any, more troubling phenomena in the world than suicide.  Recent data suggests that suicide is the 11th leading cause of death overall in the United States, 8th for males and 16th for females (American Association of Suicidology, 2005).  Each year, approximately 30,000 individuals die by suicide in the United States alone, which computes to an approximate total of 80 per day and one every 18 minutes.  For every completion, there are approximately 25 attempts, meaning there are approximately 750,000 suicide attempts annually in the United States (American Association of Suicidology, 2005).  This heart-breaking phenomenon reflects a significant amount of suffering among those who complete suicide and leaves in its wake an unfathomable number of mourners.

Given the magnitude of the situation, the need for a theory capable of providing a framework within which to understand suicide and to develop systematic interventions would be impossible to overstate. In 2005, Thomas Joiner of Florida State University put forth such a theory, the interpersonal-psychological theory of suicidal behavior.  The theory states that, in order to die by suicide, an individual must develop high levels of three specific variables: a sense of thwarted belongingness, a perception of functioning as a burden on others, and the acquired capability for suicide.  The first two variables, thwarted belongingness and perceived burdensomeness, comprise the desire for suicide.

Evidence indicates that, when individuals die by suicide, they often feel disconnected from others.  This feeling can reflect a sense on the part of the individuals that nobody truly cares about them or, alternatively, it can reflect a sense that, while others might care, nobody can relate to them and understand their situation.  Both sensations leave individuals feeling intolerably isolated.  In reality, individuals who die by suicide rarely, if ever, truly lack others who care about them, but the dysfunctional automatic thoughts that are characteristic of mental illness skew the individuals’ perceptions of the world around them.  The second description – the sense on the part of some individuals that, while others care, they can not relate to their experience – is a potential partial explanation for suicidality in returning veterans who re-enter civilian life after the experience of war.  In such cases, individuals can feel estranged from others who did not experience the same overwhelming events, regardless of how close they had been prior to its occurrence.

Perceived burdensomeness, like thwarted belongingness, is generally driven by distorted automatic thoughts.  Individuals experiencing elevations in this variable have the sense that they are not making any worthwhile contributions to the world around them.  They not only feel as though they are not assets, but in fact believe that they are liabilities and that others’ lives would be improved if they were to disappear.  Again, such beliefs are rarely, if ever, true, but they are nonetheless a common cognitive tendency on the part of individuals after experiencing particular types of events.  Losing a job, missing a promotion, transitioning into retirement, and failing a course are several examples of types of experiences that could prompt a sense of burdensomeness.

Both components of the desire for suicide are suitable targets for therapeutic interventions.  Cognitive behavioral approaches such asbehavioral activation and cognitive restructuring can help such individuals increase the amount of positive experiences they have while diminishing the tendency to view their environment through distorted lenses.  Setting specific, graded goals with clearly defined paths towards accomplishing them can serve to increase an individual’s sense of self-sufficiency.  An empathic and scientifically-minded therapist can help to make individuals feel as though somebody is listening and there are reasons to seek a better outcome.

A somewhat more difficult point for intervention and a less familiar concept to the world at large is Joiner’s (2005) concept of the acquired capability for suicide.  The interpersonal-psychological theory of suicidal behavior argues that, in order to enact lethal self-harm, an individual must habituate to physical pain and the fear of death.  Self-preservation is our natural instinct and this instinct is extremely strong.  In order to overcome this, an individual must become accustomed to pain and fear and be able to tolerate them in significantly higher than average doses.  This process of habituation occurs through repeated exposure to painful and provocative events.

Just as a loud, unexpected noise is frightening when first heard, but becomes less noticeable when it occurs repeatedly, physical pain becomes less pronounced over time when our body becomes accustomed to the experience.  A large collection of empirical studies have provided compelling evidence supporting this point.  For example, Nock and Prinstein (2005) found that individuals who frequently self-injure experience pain analgesia – the absence of pain – during self-injury episodes.  Additionally, a lack of pain during self-injury episodes has been shown to predict an individual’s number of lifetime suicide attempts (Nock, Gordon, Joiner, Lloyd-Richardson, & Prinstein, 2006).  Orbach, Mikulincer, King, Cohen, and Stein (1997) developed a particularly compelling study that expanded further upon this idea.  They found that individuals admitted to an emergency room immediately following a suicide attempt exhibited higher pain threshold (when they first feel pain) and tolerance (when pain becomes too much to bear) than did individuals admitted to that same emergency room following accidental injuries.  Here, not only did the experience of pain appear to impact the manner in which pain was perceived, but the effect was stronger when individuals had intentionally self-inflicted pain.  In another study, Orbach and colleagues (1996) found that individuals with multiple past suicide attempts could tolerate more pain than could individuals with zero or one past suicide attempt.

These findings are all consistent with Joiner’s (2005) idea that individuals must acquire the capability for suicide before a completed attempt is likely to occur.  This explains, in part, why there are so many attempts for every completion – most individuals who attempt have the desire, but not the capability for, suicide.  Repeated attempts, however, contribute to an individual’s acquired capability.  Additionally, experiences that involve witnessing pain and violence, even in the absence of physical pain, are believed to be capable of contributing to the acquired capability, which might explain why physicians in emergency room settings and soldiers who witness injuries but are not hurt themselves are vulnerable to suicidal behavior.

Recently, in addition to the findings mentioned above, a series of studies have been undertaken that have directly measured the acquired capability for suicide using a self-report measure entitled the Acquired Capability for Suicide Scale (Bender, Gordon, & Joiner, 2007).  Van Orden, Witte, Gordon, Bender, and Joiner (2008) found that the number of previously experienced painful and provocative events predicted individuals’ levels of the acquired capability.  Additionally, individuals with higher scores on the measure of the acquired capability demonstrated higher levels of physiological pain tolerance and had a greater number of prior suicide attempts.

So why are theories such as Joiner’s (2005) interpersonal-psychological theory of suicidal behavior so important?  By understanding the underlying mechanisms that leave individual’s vulnerable to suicide, researchers and clinicians can design optimally effective treatment interventions that aim to quickly diminish the symptoms that contribute to risk.  Additionally, understanding the variables that increase risk allows for systematic risk assessments that take the guess work out of determining whether an individual is in imminent danger.  Also, by clarifying the true nature of suicide risk, we can hopefully diminish the pervasive reach of misinformation on this topic.  Suicide, as it turns out, does not need to be a mysterious and poorly understood phenomenon.  It is capable of being understood through research just like any other health concern and the efforts put forth by the researchers mentioned above and countless others contributing to this cause will serve to bring clarity and hope to a behavior that has troubled mankind since its inception.