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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by afatchic on July 15, 2002, at 0:42:14
Dear Friends,
I just got a call from a childhood friend. We've been friends since we met in elementary school. I moved away after high school but we've kept in touch and have visited each other frequently.
My friend, Anna, suffers from depression to the point that it causes severe disability. I think this is one of the main reasons we've stayed close. She depends on me because I can empathize and I am always available to listen without judgement.
Tonight she called me to say that she had been cutting herself and that she really wanted to kill herself. I got her to promise me that she wouldn't do it. She told me she wouldn't do it for my sake, she realizes the pain she would cause.
After hanging up with her, I was still worried. She had said, "Please stop me from slitting my wrist, please don't let me kill myself, even though I want to." Those words kept going through my mind. What was she asking me to do?
I called the suicide hotline in her area and discussed the problem with the person who answered. He seemed very knowledgable and even knew the director of the mental health clinic where my friend had been seen.
I gave the man my friend's name and phone number. He asked if I wanted the police sent to her house and I said, "No." I just wanted someone from mental health to call her. I really believe having the police sent to her house would have made things worse and made her feel like I had broken her confidence. It is such a tough call between helping and hurting. What will make it better, what will make it worse.
Any feedback will be appreciated.
Posted by Dinah on July 15, 2002, at 4:38:32
In reply to Best Friend wants to commit Suicide, posted by afatchic on July 15, 2002, at 0:42:14
You asked what she was asking you to do. For what it's worth, I think she was asking you to do too much. I think it's asking too much of another person (especially a nonprofessional) to ask them to be responsible for your own life. And you are not a professional. There is a limit to what you can do.
Did she ask you to keep her call in confidence? If so, she was again asking too much. You shouldn't be left with that burden. You did the best you knew how by calling a professional. But ultimately she is responsible for her own life. No one can "stop" someone else from harming themselves or taking their life.
That's just my own opinion. Others may have different opinions. And I can't say that I have ever been on either side of that call. But my therapist has made it clear to me, especially when he first met me, before he realized that my occasional suicidal ideation was more obsession than threat, that the responsibility for my life ultimately lay with me.
Posted by afatchic on July 15, 2002, at 10:41:44
In reply to Re: Best Friend wants to commit Suicide » afatchic, posted by Dinah on July 15, 2002, at 4:38:32
Wow! You are absolutely right. Thank you for your insight. I feel I have a much healthier perspective now.
Posted by judy1 on July 15, 2002, at 11:26:02
In reply to Best Friend wants to commit Suicide, posted by afatchic on July 15, 2002, at 0:42:14
Dinah gave you wonderful advice. I just wanted to add that once the immediate crisis is over and you wish to stay involved- request that she asks her therapist for a plan- who to call first when she feels that way- (her shrink or therapist), a hotline, a friend in her area and maybe you. I had mine in a form of a contract (sometimes it works-depends on the person). Best of luck, judy
Posted by shar on August 4, 2002, at 0:53:45
In reply to Re: Best Friend wants to commit Suicide » afatchic, posted by judy1 on July 15, 2002, at 11:26:02
This is a contract for folks with Bi Polar disorder. I got it from Harvard, but I don't know the dept. or anything. It has possibilities, I think, for many dx's. The great thing is it provides info about what to do.
Treatment Contract
I recognize that I have a cyclical mood disorder. This is a plan to help me identify symptoms early and take steps that will be helpful. The people who can help me with this treatment plan are:my __psychiatrist____ (name):______________ (phone number):____________
my ______________ (name):_____ _________ (phone number):____________
my ______________ (name):_____ _________ (phone number):____________
my ______________ (name):_____ _________ (phone number):____________
my__ ____________ (name):_____ _________ (phone number):____________
WHEN I AM WELL
INSTRUCTIONS:
3. Next, check off any behaviors that describe how you behave when you are feeling your usual self, that is when you are neither depressed nor elevated.
4. Extra lines are provided so that you can add any other behaviors which reflect how you are when you are feeling well.
When I am well and my mood is stable, I can do all of the following (Check off the ones that apply. Use the blank spaces to add in symptoms which are not on the list.):
_____ Take care of my appearance and shower regularly
_____ Attend work regularly
_____ Attend school regularly
_____ Keep up with household chores
_____ Keep up with school work
_____ Keep up with paying bills
_____ Get together with friends or do social activities _____ times per week
_____ Exercise regularly
_____ Socialize with people without being unduly irritable or starting arguments
____________________________________________________________When I am well, I can do the following thing to help myself:
INSTRUCTIONS
5. Use the spaces provided to add any other coping behaviors you have found helpful when you are feeling well.
1. Take my medications as prescribed.
2. Be sure to keep regular sleeping hours (go to bed and get up the same time every day).
3. Work on solving the following problems or persuing the following life goals:
___________________________________________________________________
___________________________________________________________________DEPRESSION
Personal Triggers
Thoughts
____ Difficulty concentrating
____ Memory problems
____ Difficulty making decisions
____ Frequent thoughts about dying or suicide
____ Thoughts that others do not care when they really might
____ Concerns that I am worthless or evil
____ Paranoia: unreal concerns that people are plotting against me
____ Hallucinations: unreal voices or visions
______________________________________________________________________
______________________________________________________________________
Feelings
____ Feelings of worthlessness
____ Feeling guilty or without cause
____ Feeling sad without cause
____ Easy irritability
____ Not feeling good even when good things happen
____ No energy
____ No appetite
____ Lower sexual interest
_______________________________________________________________________
_______________________________________________________________________
Behaviors
____ Restlessness and pacing
____ Trouble sleeping or too much sleep
____ Trouble starting or finishing projects
____ Keeping away from people
____ Stopping work or usual activities
____ Easy fighting without good reason
____ Stop eating or eating too much
_______________________________________________________________________
_______________________________________________________________________Sometimes my depressions come on out of the blue. Other times they are triggered by certain events or situations. The kinds of situations that sometimes trigger depression for me are (Check off the ones that apply. Use the blank spaces to add triggering situations that are not on the list):
_____ The break-up of relationships
_____ Losing a job
_____ Bad life events: _______________________________________
_____ Good life events: __________________________________________
_____ Physical illness: ____________________________________________
_____ Drug or alcohol use
_____ Changes in smoking habits
_____ Changes in seasons
_____ Changes in medications
_____ __________________________________________________________
_____ __________________________________________________________When I get depressed, I will do the following things to help myself:
Instructions:
1. Items #2,3,and 4 guide you in trying to identify what may have triggered the depressed symptoms. Under #4, add in any typical personal triggers of depression to remember to think about (these may include triggering events that you have checked off on page 3).
1. Contact my doctor early:__________________________________________
Phone number_________________________________________________
2. Review whether I have had any recent medication changes for medical illnesses.
3. Get early medical attention for any physical illness.
4. Identify any triggering events.
Physical:__________________________________________________________
Emotional:________________________________________________________
5. Avoid alcohol and drugs (Even increasing tobacco can undo the effects of prescribed medication).
6. Maintain my regular daily activities.
7. Minimize sleep loss.
8. Contact support persons:
Instructions:
Fill in the names of one or two people that you could call for support (or just to talk) if you were going through a hard time.
(name)_____________________ (phone #)__________________________
(name)_____________________ (phone #)__________________________
(name)_____________________ (phone #)__________________________
9. Coping skills
Instructions:
Fill in any coping strategies that you have found helpful during the past times you have been depressed. For example, some people benefit from taking short daily walks. Others find it rewarding to write down their thoughts or feelings in a journal. Still others find it beneficial to distract themselves from their thoughts and feelings by listening to music or the radio. If you cannot think of any strategies that work for you, you may want to talk this item over with your theripist or psychiatrist.
(To do)_____________________________________________________________
_______________________________________________________________
10. Coping skills
Instructions:
Under item #10, fill in any coping strategies that you know ARE NOT helpful during periods of depression. For example, some people desire alcohol more when they are depressed, but this can make them feel even worse once the alcohol wears off. Other people want to stay in bed all day when they start to get depressed. This can also lead to more severe depression by making their sleep schedule even more disturbed, lowering the energy further, and making them miss out on activities that could give them more enjoyment or sense of accomplishment
(Not to do)___________________________________________________________
______________________________________________________________
_______________________________________________________________When I am depressed, other people can help me by:
Instructions:
Read the suggestions and add any of your own on the lines provided.
1. Trusting me to be the best judge of when I am getting depressed and not contradicting me when I tell them that I am depressed (e.g. not telling me to just "snap out of it.")
2. Calling my doctor and/or taking me to the hospital if my symptoms are serious enough (e.g. if I am suicidal) and I am not aware of what is happening to take care of myself.
3._____________________________________________________________Sometimes my mood gets elevted (too high). This mood state is called "mania" or "hypomania." I can tell my mood is getting elevated when I experience the following symptoms. Sometimes these symptoms are noticed by other people (like my family, friends or doctor) before I notice them myself. (Check off the ones that apply, and mark an "E" next to those which are Early Warning Signs. Use blank spaces to add in symptoms which are not on the list.)
Thoughts
_____ Difficulty concentrating
_____ Thoughts about having special powers
_____ Racing or speeded-up thoughts, like the rest of the world is in slow motion
_____ Thoughts that jump quickly from one idea to another
_____ Paranoia: unreal concerns that people are plotting against me
_____ Hallucinations: unreal voices or visions
_____ __________________________________________________
_____ ___________________________________________________
_____ ___________________________________________________
_____ ___________________________________________________Feelings
_____ Feeling "high", completely optimistic, euphoric
_____ More energy
_____ Feeling impatient, irritable
_____ Unusually cheerful and happy
_____ Feeling unusually self-confident
_____ Feeling the nothing bad can possibly happen to me
_____ More sex drive
_____ ____________________________________________________
_____ ____________________________________________________
_____ ____________________________________________________
_____ ____________________________________________________Behaviors
_____ More talkative
_____ Speech loud and rapid
_____ Less sleep
_____ Overly sociable
_____ Doing more projects, sometimes more than are practical
_____ Easily fighting without a good reason
_____ Spending more money impulsively, shopping sprees
_____ Driving resklessly or fast
_____ Involvement in dangerous activities
_____ ________________________________________________________
_____ ________________________________________________________Sometimes my elevated periods come on out of the blue. Other times they are triggered by certain events or situations. The kinds of situations that sometimes trigger elevated moods for me are (Check off the ones that apply. Use the blank spaces to add triggering situations that are not on the list):
_____ The break-up of relationships
_____ Losing a job
_____ Bad life events: ______________________________________________________
_____ Good life events: _____________________________________________________
_____ Physical illness: ______________________________________________________
_____ Drug or alcohol use
_____ Changes in smoking habits
_____ Changes in seasons
_____ Changes in medications
_____ ___________________________________________________________________
_____ ___________________________________________________________________When someone in my support system points out to me that I am getting manic, I will do the following things to help myself:
Instructions:
Items #2, 3, and 4 guide you in attempting to identify what may have triggered past manic symptoms. Under #4, add in any typical personal triggers of mania to remember to think about (these may include triggering events that you checked off on page 6).
1. Contact my doctor early:__________________________________________
Phone number_________________________________________________
2. Go over medication changes for medical illnesses.
3. Get early medical attention for any physical illness.
4. Identify any triggering events.
Physical:___________________________________________________________
Emotional:__________________________________________________________
5. Avoid alcohol and drugs (Even increasing tobacco can undo the effects of prescribed medication).
6. Maintain my regular daily activities.
7. Minimize sleep loss.
8. Contact support persons:
Instructions:
Fill in the names of one or two people that you could call for support (or just to talk) if you were going throught a hard time.
(name)_____________________ (phone #)__________________________
(name)_____________________ (phone #)__________________________
(name)_____________________ (phone #)__________________________
9. Coping skills
Instructions:
Fill in any coping strategies that you have found helpful during past times you have been manic or hypomanic. For example, some people prefer to stay in a darkened room without much stimulation when they are feeling overwhelmed or overstimulated.
(To do)_________________________________________________________________
_______________________________________________________________________
10. Coping skills
Instructions:
Fill in any coping strategies that you know ARE NOT helpful during periods of mania or hypmania. For example, some people desire alcohol more when they are manic, but this can make them even more impulsive and likely to do risky things.
(Not to do)___________________________________________________________
___________________________________________________________________
___________________________________________________________________When I am manic, other people can help me by:
Read the suggestions and add any of your own on the lines provided.
1. Letting me stay alone in a room with minimal stimulation when I am feeling agitated.
2. Prevneting my driving (as by holding my car keys) when a consensus of two or more of my doctors or support people judge that it is unsafe for me to do so.
3. Preventing my shopping (as by holding my credit cards or bank card) when a consensus of two or more of my doctors or support staff judge that I am too impulsive to do so.
4. Avoiding arguing with me, especially when I am feeling irritable.
5. Calling my doctor and/or taking me to the hospital if my symptoms are serious enough, and I am not aware enough of what is happening to take care of myself.
6__________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Posted by alii on August 4, 2002, at 2:29:49
In reply to Suicide--a possible contract, posted by shar on August 4, 2002, at 0:53:45
Shar,
My pdoc will thank you for this.
When I get out of current hole of hatred I'm sure I will thank you for this post as well.
But for now.....damn damn damn. I hate when my irrationality and impulsiveness is met with such calm logic presented so well.
Damn you and bless you (I hope you can tell which part of that is the depression talking)
-- alii in agony
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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