The Difficult Task of Choosing Life

I talked to my shrink on the phone a few days ago.  It only took about a week for the novelty and luxury of staying with safe people to start to wear off, and I feel like I'm losing control really quickly.  I restricted enough to drop a few pounds, which hasn't happened in a while, followed by binging two days in a row, so basically I am a paragon of health and stability.  The self-injury urges and suicidal ideation have been sneaking back, especially after Mama and Papa are in bed and that loneliness starts soaking in.  My shrink and I talked about some of my self-care activities, and the phrase she said that has been reverberating in my mind since then is, "Remember, you're trying to choose life."

Choose life.  That sounds like something that shouldn't be very hard.  I suppose I am lucky that I do have the choice to not die at this point.  The difficulty is that I am very, very sick.  I think suicide is a thought that has passed through the minds of many people with chronic illness.  There's only so much pain that one human can reasonably be expected to endure.  As a society, we recognize that.  We have DNRs and increasing acceptance of physician-assisted suicide.  We see that there is a difference between extending life and prolonging death.  Yet, somehow, this only extends to people with physical pain and illness.

I think there are a couple of reasons for this.  One is that psychic pain in mental illness is difficult to quantify.  Everyone feels sad and anxious sometimes, and far more people will have situational depression or a depressive episode than those who have chronic clinical depression.  I think this leads to people believing they understand chronic depression when they actually have no idea.  People who have had a depressive episode or two, but not recurring or chronic episodes, don't truly understand what it's like to be depressed for decades.  They think their experience can translate to someone who has been sick for a long time, but it can't.  It's like comparing someone who has broken their leg to someone who is paralyzed.  No one will deny that your broken leg hurt like a bitch, but it's nothing like being confined to a wheelchair for the rest of your life, and I don't think anyone would dare say it is.  But people who haven't experienced severe mental illness just don't understand the scope of what it is.  It's not something that can be fixed by changing habits or taking medication or a movie montage of an inpatient stay.  It's something that traps you, that limits you, that causes you pain every day, and that, when it comes down to it, no one really knows how to fix.  And since this is something that people don't understand, and isn't necessarily expressed in diagnosis (Major Depressive Disorder can be managed so that it doesn't have much effect on someone's everyday life, or it can be so bad that someone cannot live outside of an institution), the true suffering experienced by those with severe mental illness is dismissed.

Also, it is incredibly variable how people with depression respond to treatment.  Some people find relief with medications and therapy or any other combination of treatments and are able to live fulfilling lives.  Other people can have the best doctors, access to meds, and a life mostly free of external stressors, and still be so depressed that their lives are severely limited (*waves*).  People who respond to treatment may understand the agony of acute depression, but they cannot understand what it's like to have treatment-resistant illness for decades.  I think a lot of these people think that everyone with depression or another mental illness can get better, just like they did, but that's simply not the case.  What if you broke your leg, but no matter what you did it wouldn't heal, and despite the efforts of doctors and all the painkillers in the world, it just stayed broken and painful and useless for years and years?  That's what it's like to have treatment-resistant illness.  Everyone acknowledges that the sickness is there, but the things that would help most people get better do nothing to help you.  It's an incredibly discouraging and frustrating cycle that is hard to understand if you haven't experienced it first hand.

The final piece has to do with, in basic terms, the ability to consent.  As mental illness exists in the brain, it stands to reason that a mentally ill person may not be able to trust their brain to make objective decisions about their own well-being.  There are plenty of stories out there about people who have failed in a suicide attempt, only to realize that depression had clouded their judgment and they were grateful to have survived.  These stories are important.  However, what we don't hear are the stories of the people who don't have that moment.  There are big differences that I see in my friends who have attempted suicide impulsively and those who are the planners.  The ones who make snap decisions to harm or kill themselves tend to do so while highly emotional, use whatever means is easily accessible, realize they don't want to die, reach out for help, and regret it afterward.  The planners usually have one or two methods that they have researched for years.  They know exactly what they will do, and how to do it effectively.  When self-harming, they  have a specific goal and are able to injure at a time that is convenient in their schedule, putting it off instead of doing it in the heat of emotion.  When they decide to take their own lives, they are not going to look for comfort or reach out to a friend to be talked out of it.  They will have confidence in their plan and they will make sure they have no chance of surviving it.  We don't hear these stories, because we don't want to acknowledge that suicide could simply be a logical choice.  We want to believe that everyone can be helped, that everyone has a bright future, and that depression is temporary.  For some people, all of that is true.  For people like me, it's not.

Anyway.  That was a roundabout way of trying to explain the severity of mental illness, and why choosing life is less straightforward than it may seem.  When breathing hurts, when you feel like you're imploding, it's so much easier to eat a box of doughnuts to make that pain go away for a few minutes than it is to sit and wait for it to get easier.  Self-destruction is instant relief, because when your brain doesn't make enough happy chemicals, an endorphin rush feels addictive.  When harming yourself is the quickest way to shove some endorphins into your system, it becomes difficult to convince yourself *not* to injure, because life is so heavy that even causing yourself pain lets you breathe a little easier.