Sunday, January 31, 2010

Depression and suicide

7. Depression as an indicator of suicidal thoughts and actions. One sees a great deal written about suicide and depression in the literature and unfortunately it is quite a misunderstood area. All sorts of statistics quoted. For instance George (2008) states, "A retrospective study of 132 young people who completed suicide in Western Australia found that nearly three quarters had shown definite signs of depression in the weeks prior to their death"(p.25) Or, "Depression increases the risk of suicide by 15 to 20 times, and about 4% of people with depression die by suicide."(p1373), Hawton, and van Heeringen, (2009). This of course means that based on this research ninety six percent of people with depression do not die by suicide. Other research has varying figures. Clark and Fawcett (1992) estimate that fifteen percent of those with a diagnosis of major depression will complete a suicide. The statistics tend to waver around the ten percent mark which means that the vast majority of those with depression will not complete a suicide attempt. There are many depressed people who are not suicidal at all. Of course this does not mean that one forgets about making an assessment of suicide with the person reporting depression but one needs to be realistic about its occurrence which is not often found stated in the literature.

Key symptoms of depression related to a risk assessment

In real terms depression is merely a collection of symptoms, it is not so much that depression is linked to suicide it just happens that people who are suicidal have symptoms which are not uncommon in depressed people as well. In using this measure in a suicide risk assessment one does not enquire about depression per se but one enquires about some of the symptoms found in the depression that the person is displaying.

The DSM-IV provides a list of symptoms which define depression, these being:

1. Depressed mood most of the day which can include a sense of hopelessness.

2. Loss of interest or pleasure (in all or most activities, most of the day).

3. Large increases or decreases in appetite (significant weight loss or gain).

4. Insomnia or excessive sleeping (hypersomnia).

5. Restlessness as evident by hand wringing and similar other activities (psychomotor

agitation) or slowness of movement (psychomotor retardation).

6. Fatigue or loss of energy.

7. Feelings of worthlessness, or excessive or inappropriate guilt.

8. Diminished ability to concentrate or indecisiveness.

9. Recurrent thoughts of death or suicide.

Taken from, American Psychiatric Association (1994).

In this diagnostic system one needs to have five or more of these symptoms to be diagnosed as depressed. Thus every suicidal person automatically has one symptom of depression already as shown in symptom number nine. The best clinical predictors of suicide in depressed people include previous self-harm, hopelessness and suicidal tendencies. (Beck, Steer, Kovacs and Garrison (1985) and Beck, Brown and Steer (1989) both found hopelessness to be one of the best indicators of suicide risk). If the depressed person reports a loss of appetite, psychomotor agitation, excessive guilt, hypersomnia and increased indecisiveness then they meet the criteria of depression but show none of the best clinical indicators just described. Indeed unless the depressed individual reports the last symptom, recurrent thoughts of death and suicide, it seems safe to say that the person is not a suicide risk at this time. They are not even thinking about suicide at this point even if they have all eight other symptoms of depression. If a person presents as depressed one firstly asks if they have the symptom of thoughts of suicide and if they do then one also enquires about a sense of hopelessness and any previous self harm. If they present with all three one is getting a much more accurate assessment of the current level of risk.

In the literature one finds very little research on the number of people who report depression and who report no recurrent suicidal thoughts. One has to search long and hard and three such research studies were found. The first from many years ago by the 'father' of depression, Arraon Beck (1967). He presented research results which examined the presence of suicidal wishes in the depressed person. He makes the distinction between neurotic depression or the milder forms of depression and psychotic depression or the more severe forms of depression. (This distinction will be discussed more later in this chapter). The results were:

Mild or moderate level of suicidal wishes present:

Neurotic depression - 58%

Psychotic depression - 76%

Severe level of suicidal wishes present:

Neurotic depression - 14%

Psychotic depression - 40%

More contemporary research by Akechi, Okamura, Kugaya, Nakano, et al (2000) reports that in patients with major depression fifty three percent had suicidal ideation. Wada, Murao, Hikasa, Ota, et al. (1998) also report a similar finding of around fifty percent of those with major depression having suicidal urges as well. This allows the conclusion that about fifty percent of those with some form of depression do not report any recurrent suicidal thoughts. Thus it seems safe to say that fifty percent of depressed people are not at risk of suicide as they are not even thinking about suicide let alone planning anything.

Timing of the depressive episodes

If the individual does present as depressed and does show the principle signs of recurrent suicidal thoughts, a sense of hopelessness and previous self harm then of course this is an important factor in the risk assessment and definitely requires more investigation. One of the more important aspects to investigate is the course and stage of the depression. As stated by the Bayley (2004) depressive episodes can be single, recurrent or chronic and this has significant implications for the assessment and management of the suicidal individual.

For about five to ten percent of depression sufferers the depression is chronic. If an individual with chronic depression also has recurrent thoughts of suicide then the level of risk increases and over time it could be seen as continuing to increase. In the longer term this person could be seen as quite a significant suicide risk. One would to be questioning the individual as to their feelings about tiring of life and particularly a sense of hopelessness. These individuals have a poor quality of life with the spirit crushing depression and often quite unpleasant side effects from the medication like obesity, lack of energy and so forth. If they have tried just about every type of medical and psychological treatment with little improvement one would be assessing a definite increase in the risk of suicide.

To make matters worse there is not much one can do in their management. A no suicide contract is of less use as there is no end in sight for the depression. As the suicide risk increases over time one can place them in hospital or on some kind of suicide watch but what does that achieve? It simply relocates them geographically and how long does one keep such a person in hospital as they will be depressed upon release.

However for most depression is cyclical as is shown in diagram 4 with the mood changing over time from a normal level to a depressed level and back.

Diagram 4

The cycles of depression

As stated in the Bayley (2004) the rate of recurrence of depressive episodes is quite high, "50% of people who have had one episode of depression will relapse, 70% of people who have had 2 episodes will relapse, and 90% of people who have had 3 episodes will relapse"(p159). The average duration of an untreated episode is about twenty to twenty six weeks but many can have much briefer episodes of around four to six weeks. If treatment is obtained early then the duration and severity of the episode may be significantly reduced.

Types of depression

In using depression as a measure to assess suicide risk one needs to distinguish a number of different types of depression. As is shown in diagram 4 one can move from a normal mood range into the range of dsythymia. In this phase the depressive symptoms are at a moderate degree. Historically this has also been known as neurotic depression and I use the terms interchangeably. This is seen as less severe than the next level which is called a major depression. In this phase the depression symptoms are at a severe degree. Sometimes this is called 'clinical depression' and the individual is significantly incapacitated and is very depressed. Also at this level one can have a condition known as psychotic depression. This is where the individual has the symptoms of major depression plus some psychotic symptoms. This terminology has been around for many years and psychotic depression is well summarized by Beck (1967) who says it is "...characterized as including patients who are severely depressed and who give evidence of gross misinterpretation of reality, including at times delusions and hallucinations"(p82).

In summary in this model we have:

Normal mood

Dysthymia or neurotic depression

Major depression and psychotic depression

In diagram 4 we have an individual who begins with a period of normal mood who then moves into a phase of depression that is consistent with the diagnosis of dysthymia. Eventually that depressive episode ends and he recovers again for a period of normal mood. Unfortunately at a later time he again moves into a more severe episode of a major depression which he eventually recovers from and moves back to a state of normal mood. To assist with making a suicide risk assessment one can create a graph like this for the person who complains of depressive episodes.

In assessing the depressed person one need to look at four aspects of the depressive cycle W, X, Y and Z. Firstly one is wanting to assess the length of the non depressed periods (W) and the lengths of the depressive episodes (X). Of course this relies on the person having had previous episodes and one simply takes a history of the person in this way. How many have there been and how long were they? Also were there any precipitating factors such as marital problems or financial difficulties that lead to the depressive episode. These can then be charted on a graph as is shown in diagram 4. People tend to behave in patterns and one is obtaining this information to assist in predicting future episodes and thus future times when suicidal urges may increase in conjunction with the depression. Of course future episodes may be different to past ones but this does give some guidance to assist the suicide risk assessor.

For example if there is a pattern in the timing of the episodes one then knows when approach the person for a risk assessment in the future. A good example of this is with what has become know as Seasonal Affective Disorder or SAD. Typically the depressive episode begins in autumn or winter and remits in spring. Alternatively previous depressive episodes may be related to particular events such as examination time at college or when a loved one has to travel away for work. Plotting the 'W' and 'X' of the depressive episodes will allow the risk assessor to improve the timing of their assessments.

Degree of depression and suicidality

One also needs to assess the quality of the depressive episodes by making an assessment of the 'Y' component. Here one assesses how depressed the person becomes, how the person has felt in past episodes particularly in relation to suicidal thoughts. As mentioned before the system being presented here distinguishes between normal mood, dysthymia or neurotic depression, major depression and psychotic depression.

This is an important component to distinguish in a suicide risk assessment as there is some research which concludes that those who are more depressed are more prone to suicidal thoughts. In their research on depression and suicidal thoughts Garlow, Rosenberg, Moore, Haas, et al (2007) report “These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students...”(paragrpah 1). In addition Perroud, Uher, Marusic, Rietschel, et al (2009) state “Increases in suicidal ideation were associated with depression severity...”(p2). Finally Beck (1967) cites research which shows that a severe level of suicidal thoughts were present in fourteen percent of those with neurotic depression and in forty percent of those with psychotic depression. In conclusion, the more depressed one is the higher the risk level of suicidal thoughts. Thus one can see the importance of making the 'Y' component assessment of the reported depressive episodes.

As just noted the person with major depression or psychotic depression is at more risk of suicidal thoughts than the person with dsythymia. However it seems reasonable to conclude that the person with psychotic depression is still at even more risk than the person with major depression as a psychotic depression involves a major depression plus the presence of psychotic symptoms. That is the person experiences severe depression as well as psychotic delusions and hallucinations and thus the features discussed above in point 4, "History of mental illness" become apparent as well. There is sort of doubling effect of suicide risk factors in this instance. For example the person with psychotic depression is likely to be more regressed than someone with major depression because the psychotic features result from very poor Adult ego state functioning and thus there is increased regression. In addition the psychotic is more prone to command hallucinations as well. As a result, of all the types of depression the psychotic depression is probably the one of highest risk value when making a suicide risk assessment.

Finally in diagram 4 one needs to make an assessment of 'Z' in the depressive cycle. Suicide risk may increase as the person improves particularly in a major depression or a psychotic depression. In these depressive states the person is so depressed that they become incapacitated. They are so depressed that they literally do not have the energy to think seriously of suicide or certainly making any definite planning moves. As the depressed state lifts, along with that comes an increase in energy which may bring about an increased ability to act on any self destructive wishes, as they improve one may need to be more vigilant as they reach that part of the depressive cycle.

In addition for the individual with psychotic depression as the depression lifts the psychotic symptoms may begin to subside as well. Their Adult ego state becomes more functional and thus planing a suicide attempt becomes more of a possibility. Most suicides occur in the non-florrid stages of a psychotic episode when the person is relatively free from acute symptoms. Of particular note in suicide risk assessment if the person is at one of the lower points in the depressive cycle such as at stage 'Z' and all of a sudden shows significant improvement, that may be ominous sign. They may have made the decision to kill self and are just getting organized and waiting for the right time.



  1. Some people are very good at this. They just pop into visit and they walk up to you carefully, straight faced and say how sorry they are and stuff. Then – well, I've already had my cry first thing in the morning so I'm feeling ok – they relax; you know like when you notice when you're stressed only when your bum muscles relax after the coast is clear type thing – you kind of see or feel that happen to them. NO! I don't stand there watching people’s bums but you do know what I mean don’t you?

    Opps – more visitors – I’ll be back...

    We’ve just come back from the club after dinner with friends. I was sitting in the lounge type thing and cried. Like totally out of the blue. It was so weird and out of control. I hope I didn’t scare anyone but that’s just what’s going to happen for a bit now so... I guess that’s that. People just hug you and they are all sorry and sad looking – it’s a bit intense isn’t it? Holy smokes!

    But they need to grieve too. It’s difficult to remember that one sometimes.

    AND... what do you think of this one...

    There are no rules. I can do nothing wrong. I can’t make mistakes in this one – it’s all out of my control. It’s one of those times when there are no rules, and that’s why everyone behaves differently toward me. There are no rules so some just stop in their tracks, others just keep going with caution, some become angry at the inconvenience of not being told what to do and they should be shown or told, and stuff like that. As if we’re in Sydney at peak hour and all the street lights have gone out and what usually happens changes. Is that more like it? Is that how it really is? I really can’t seem to understand. I don’t know what its like.

    I’m frightened about new stuff now. I’m frightened of when the numbness is gone. What do I do then? People make it sound as though it will be terrible Tony. Will it be as nasty and mean as they make me think?

    I’m so tired and sore again. A friend called by and bought me lots of mangos. Yes... she knows me doesn’t she? She looks at me through worried eyes so I mustn’t be behaving properly – I mustn’t be doing very well. I don’t know how else to be Tony. So I’ll just have to keep going this way and work it out as we go. Yes? Perhaps? No? Maybe?

    Ohh, hang it – that’s just about the only thing I can be so... that’s that I guess.

    I don’t like pain. Its going to hurt isn’t it? I mean... its going to hurt bad isn’t it. Well, I’m here now and this is it for now so whatever comes will come regardless.

    Tomorrow morning I’ll be alone in bed during my cry time. I’m a bit frightened about that. I wonder what will happen. Its a bit exciting. I’ve never had my cry time alone before. Hubby was with me yesterday and today but he’s going to work tomorrow so... ooo, it’s a bit scary; I’m a tad excited.

    Well, g’night – off to bed now with the weary clueless girl – whatever may be on its way, let it come and see what it brings. I’m so glad you like my adventure and thank you for being here. You have become so very important to me – I’m so glad you’re alive. I have imagined you asking yourself once or twice over the years (I don’t know why I think this about you), I’ve almost heard you asking ‘why am I here?’; still living and breathing on this planet. Well, I don’t know why Tony – but I do know that I sure am glad you are. You’re special that’s for sure.

    Thank you for that.

  2. Well Roses you are welcome and I am glad that you are glad.

    When I read your thoughts about how this loss and grief thing with your sister is happening I think you are articulating how I have responded to the loss of a loved one but never really put into words for myself like you are here.

    yes pain, yes grief but there is another quality as well and when you said it is a bit exciting I realized I get that also.

    When my son died and when my mum died it was very sad indeed but it was also a bit exciting. I think that I should not think that but I do now that you have said that is one of your responses. In this sense there is an atractive quality - tsk, tsk.


  3. Oh, so it's ok to find the excitment in the adventure as well as all the other stuff. I am very relieved to hear that. Everything i've done today is something i've never done before. And that includes everything I've done since Wednesday morning. Its a bit intense living on the 'edge' isn't it?

    I really have to sleep now. My skin hurts and my bones are irritable and annoyed. Good night, sleep tight, and... ohh! Let the bloomin bugs bite (stupid bugs!).

  4. Well I don't know if it is OK or not Roses and then who decides if it is OK or not? Maybe we should decide for the world Roses.

    Yes it is living on the edge I agree and I think that in part is what I found exciting about it in the first place.

    I recall when I worked at the prison one thing I really liked about it was the excitment. It was living on the edge working in there as there was always the constant threat of physical violence in the air which happened quite often. Most often prisoner on prisoner but certainly prisoner on staff member happpened also relatively frequently

    All this new stuff Roses? this is an appropriate place to talk about this topic. Grief is a kind of depressive reaction in that alot of the things one experiences when a close loved one dies is similar to what the person who is depressed thinks and feels. So if you have never had depression Roses you now know what it is like.


  5. Ooo you thrill seeker you!

    I have had the internal physical terrible feeling inside my body - the sinking dropping feeling that kind of scrapes down the lining of your skin. Like a dread or something. I remember living that not too many years ago - and no one had died then. But I can think this time. I can talk to people this time. Going outside is not the most horrific thing in the whole wide world this time. In fact, I can know that there is an outside this time. The sky is still blue and I have...

    There's no big black hole that intimidates like last time so its quite easy for me to pop my head out of the sadness and function with other humans. There’s no murky blackness that grabs and sucks life away till you’re so tired and just give up.

    This time there's no helplessness that binds you up and sappes - well, there was no hope left to take away. My eyes couldn't see, I could hear no one – actually, i kind of recall the first time i heard a bird chirp and noticed that there were trees and a sky. I remember telling someone when that happened. Gosh - i've not thought of that for the longest time. It is too frightening a thing to recall (deliberately).

    This is much better than that time – well, so far. That time hurt to breathe, it hurt to be or was it that I’d ceased to be, or wondered could I please cease to be so it wouldn’t hurt anymore. I couldn’t consider others – there is no such thing as ‘others’ in that dark cold place.

    No – this one is different. Oh Tony! I’m so thankful for that!

  6. Yes I am glad it is different too Roses,

    Well the process is pretty simple really. Keep expressing those feelings, keep going out into the world when you feel it, keep talking to others and in the not too distant future she will become a good memory for you with out the intense anguish at times.

    Go Grrrlll!

  7. Yes I will. Because I can. I'm putting off going to bed because I'm frightened of my 'alone cry time' in the morning but... nothing can stop what will come so...

    I am going this time. Sleep well. Nity night.

  8. Yes Roses,
    Embrace your alone cry time. It is your friend and not your enemy. Go with it and don't fight it.


  9. I didn't have my cry time yet today. Its 9.06am. I understand what might happen if I don't cry in the morning. I'm angry right now. Its not a normal kind of angry either. Its unpredictable and I can't trust it. I'm going to go now and have a cry time in my bed.

    This anger is seething and dangerous I think. I'm not going to risk it - thanks for your advice. You seem to know. It constantly amazes me. Thank you

  10. Yes. That's much better. I ignored someone this morning when they called around to offer me their grief. I hid. I didn't answer. But now after a cry - i took a few grief offerings (just then at the door) and can smile and giggle and talk again. I can now face the day and what ever it may bring.

    I don't want that darkness to swallow me up again and it frightenes me to think about it. I was afraid of the deep sobbing because I thought that was the badness but it isn't is it? You're right Tony, the crying, sobbing and heaving sadness is what saves me from the other terrible thing... it saves me from that murderous depression.

    You are such a clever bloke aren't you? But you're an even better friend.

    I'm so proud of you!


  11. Hello Roses,
    I am not sure what to say. Should I simply say, I understand Roses and I am thinking of you at this hard time.

    Whilst people who say that sort of stuff usually are well meaning it can sound a bit condescending as well sometimes, I think.

    Or I could come from a counsellor point of view and say what my thinking would be if a person presented at a session with what you said, which is more suited for this blog. So I will do that and if you don’t want this done then say so and I will say no more and delete this comment Roses.

    Oh! I see you have just made another comment. What I am saying here is in relation to your comment two up made at 6.10am.

    So some of my thinking.
    The importance of the person to you? Being your sister she was probably emotionally very important especially if you had relatively regular contact with her. Check out how regular the contact is and assess the degree of attachment to her. The death was very recent so it is appropriate for the emotions to be strong in terms of a timing point of view

    R: “This anger is seething”

    That is a statement about a high level of emotion but it is probably appropriate considering what I just said above. Thus it is probably not a hysteriod type of reaction or an overly dramatic emotional reaction thus it is probably Free Child which is what we are wanting.

    As I wrote to you before Roses about my writing of the book I am flying by the seat of my pants at this point and letting my unconscious Free Child take charge in terms of when and how much I write. In grief the best scenario is for the same to happen.

    It is possible your FC woke up this morning and said “I don’t feel sad this morning I feel angry about her death instead”. So it is best to go with the flow and run with that and talk about and express the anger rather than trying to turn it into crying just because you were expecting to cry in your crying time.

    However, and this is a big however, as I have mentioned to you before anger has been a good friend to you for many years. It has played a important protector role of your vulnerable Free Child so this is where a therapist has to make a difficult and fancy judgement call. The anger may not be FC at all instead it may be from the Adapted Child ego state and is simply there protecting the crying child in you.

    If this is the case then the anger is confusing the grief process as it will not allow the appropriate crying times. So what I would do is go with the anger and encourage you to express it as anger is also appropriate in the grief process and your FC has a lot to be angry about at the moment.

    I would also be wanting the crying and sad to be happening. I would not want the anger to dominate your grieving too much so I would adopt a monitoring role at this stage and see if the FC crying is occurring. If it is then the FC anger is not a problem and the grief is progressing normally. If it is not then I would have to make some therapeutic moves to deal with that.


  12. Hello Roses,
    This is about the last comment you made. So you did have a cry which is relevant to my other comment above. Sounds like you FC is doing OK in the grief process at the moment. If this continues to happen then the depression you talk about wont happen.

    "murderous depression" - interesting term Roses.

    As long as the AC anger does not dominate the grief process which it isnt at this point then you will be fine. So at this time plenty of FC sad and anger.


  13. Aww thanks Tony. You don't have to 'do' anything but that you feel it good to is a lovely thing. Thank you for that.

    At first i couldn't cry. I was still so frightened of it. But then my tense-ness let go and gradually the natural free release began to flow.

    I think i'm living on the edge with the valley of depression on one side and grief on the other. Its like cooking - "season to taste". I need to find out which thing leads to health and which leads to hell (depression). So I taste and see - then add, change, move, feel or allow according to the 'Not hell' direction; anywhere but there. I listen to everything you say and just simply sift out what I can understand and go with that. I trust your judgement. Just as you, I too am 'flying by the seat of my pants'. That's the exciting bit.

    We live across the road from the cemetery and so my brother-in-law just came to see how I would be if she were buried there. What a sweetie! I'm fine with death in that respects. It was never her body that was precious to me. I loved her – not her body.

    If its even possible; I knew her... you know what I mean? For a time there when we’d first moved up here we kind of needed each other. That’s why my kids are so affected by the loss of her – besides me, she was their ‘other’ mother. Every day she would arrive on my doorstep and have a list of ‘things to do today’. My first and her second son were just born at that time (9 days apart). Then when we had our next (around 20 months later, she had a daughter and I another son) they were 6 weeks apart, we seemed to see each other more – as if every day wasn’t enough. I needed her and she needed me it seemed.

    Then when my eldest was around 9 years old, I began to go to church and create a whole different daily routine. I just wasn’t available every moment for her and we began to build for ourselves different networks and lives. I’m a changeable person – its a nice challenge every now and again so I found it not too alarming to move on. Over that 15 year period we saw each other frequently – she’s so good at the keeping in touch thing. As you know, now I’ve moved on from church life to journeying in the psych world. Wow! I’m having a ball.

    She’s a ‘doer’ and I’m more of a ‘be-er’. In other words she will ‘do’ for you but I on the other hand will ‘be’ for you. It worked well I think.

    Gosh! I’m raving. Sorry about that. I’ll go now and ‘be’ for today. Cheers mate...

  14. Tony? NO!
    I've changed my mind. I want her back. NOW!!!

    Its wrong and she can’t just do that! She has to come back. That’s just wrong. You just can’t do that. NO. We have to change this somehow. It can’t happen like this. There has to be a better way than for her to just go away and I just can’t find her anywhere. Its wrong. Its so wrong like this. Can we fix it somehow? There has to be a way – its broken – i’m broken!!! Stop! Stop! STOP FOR CRYING OUT LOUD! WHERE IS SHE!

    Tony... I feel really really bad today. I’ve been howling like a wild thing and writhing like a dying fish. Please Please can we change this? Please? Can’t we rub something out so she can come back? Please. Do you know if there’s a way? Do you?

    I think I’m frightening my hubby but if this stuff doesn’t come out I know i’ll die. I just know it. Depression will murder me and I want to live. I don’t know anyother way to get it out of my system.

    Its ok. I just had to see this in words. I’m feeling much better now. Thank you for being alive.

    Ohh this is such hard work... talk to you in the morning... roses

  15. I guess life sucks sometimes Roses.


  16. Yep. I guess you're right Tony.

    A lovely friend came over last night and just held me in her arms. People are amazing aren't they? I think we might be going to dad and mums place today. I don't know how they're getting along - I don't know if they've ever mourned either. They've both been through a war and stuff so... probably have.

    I know why I cry and writhe. There is pain now. I can feel it now. Gosh! Its a bit yucky isn't it? When i hurts the worst, there seems to be no place on my body, in my body and beyond my body that is not touched by its icy cruel hands. I'd never even dreamed it could be like this.

    We have never lost a family member - none of us have ever died. The closest is pets and friends family - people we don't know well or have never met. We are the only family we have ever known - dad, mum and 4 kids. I'm now beginning to understand, a little, how important it is to have and know more family members than that. To have grandparents that get old and die; aunties and uncles that have accidents and stuff like that. Its pretty important.

    Its no ones fault and there's no getting her back now - i understand that - but there was a time yesterday that i would have called her or something and... well, she's dead now isn't she?

    It wasn't me, just because it wasn't. That's why it wasn't me who died - just because.

    There are no need for answers it seems - but for some reason, the questions have to be asked. Is it just me or does that seem silly and weird? Cause it does - its just silly and weird and 'is'.

    Its 7.36am and i've just put the washing on. I'm going back to be for a bit... just because.

    I hope your Tuesday is sweet to you. I hope it is because I want it to be. Nothing more. Nothing less. Just because.


  17. On the inside, I can’t help it laugh at the irony of this whole thing – you know, the concept of death and mourning.

    Its all about me.
    So weird how that is but, its so totally all about me.

    All i can think about is how I was feeling when she was around or how this or that affected me when I was with her. It, for some silly reason, is all about me. Its a difficult reality to get ones head around isn’t it? Little things like... I’m so tired; I’m in pain; I’m sad or I’m angry. So I’m not in the least bit sad for her or about her because its all about... me.

    What is the statement, “I’m so sorry for your loss”, I can’t seem to find the meaning for it? Though I understand the kind thought for someone to even say it, when I think about it, I haven’t lost anything have I? I mean, she’s lost her ability to live because she’s dead now but that’s her loss not mine. She chose to give all her organs away so she no longer has them but I’ve still got all of mine. Her husband and her kids have lost their wife and mother, but I haven’t lost anything at all. My sister is dead. That’s really all that’s happened? She’s the one who’s lost stuff. She’s lost time with her kids or being able to make more memories (good or bad) with her husband, she can no longer come visit me or anyone else – but that’s not my loss.

    I just don’t seem to ‘get’ it. This stuff doesn’t seem to make any sense to me. Is it just that people feel awkward so they learn to say things that are acceptable protocol when someone dies? I guess that’s actually a nice thing for society but it would be nicer if someone told us what it all means so we (clueless people like me) know what it means and can then respond genuinely to their grief offering. Its quite the awkward thing to not know how to respond but I do the best I can and what happens from there is up to them. Maybe?

    So I guess my question is... why am I throwing such a tantrum about all this? Why do I want to feel so sad and so much so that my body will hurt in this physically alarming way through such indignation? Why am I angry and what am I angry about? I mean, all she did was die – everyone does that. Not a lot of this stuff makes sense - its a bit bizarre.

    The funeral is on Tuesday at 11am. I’m so glad about that sometimes *giggles* - that sounds so crazy – sometimes I’m happy that its then because I’m hoping I’ll be feeling better by then but then sometimes I’m feeling not so happy about that because I don’t want to go to a funeral right now. Geez, why do i have to go to a funeral now? What a stupid time to have to go to such a yucky thing. Its ok to giggle and grin at that – I’m laughing inside remember? We can chuckle together... so... don’t be afraid... its ok.

    We have flowers, food, cards, people calling ... I don’t understand what’s happening. A lovely lady brought us some soup and yummy food but said she didn’t want to stay because she, herself, would like to be alone if it were her. I really hugged her and giggled after she said that. It was so nice!

    But people have to grieve and its only for a short time – and in essence – I just know that my sister would have so totally loved all this attention. So... its not really my job to work all this stuff out right now – probably just go with it for now and find out what it was she liked from all this attention stuff.

    I don’t miss her yet. I don’t know why.

    Oh yeah... its me again... roses

  18. "let me hear more about your adventure as it happens my good friend"

    Are you regretting saying that to me yet? *Giggles*

    ... roses

  19. Yes Roses, Keep saying the stuff that you are saying here if you like. I am fine with you doing that. Sometimes I will respond and sometimes I wont but that is because I feel I have something to say and I am not so busy at work at that point.

    You are making some really good cooments though that i could write another post about really.

    Like your comment about death and mourning being all about me. I agree with you and it is an insightful comment. Grief is a very self centered and narcissistic act. Why do people go to a funeral, well it certainly isn't for the dead person as they are dead!

    they are going for thmeselves in some way, usually so they can feel better about themselves in some way, a self centered act.

    As to the why of your strong tantrums and sads?
    I could answer that from a psychologists poistion but I am not sure if you are wanting that now.


  20. Well, i've already read so much stuff that i'm going through in the things that you've written already. That's what i mean when i said that i sift through the things that you say and appreciate the ones that i can understand a bit. Not so much the things you say here and now but the things i've read you say over the time we've known each other. You're pretty spot on i'd say - good stuff.

    I understand that you're busy and really don't expect an answer. I'm a christian remember - i'm used to spasmodic answering if any answers come at all. But what I appreciate more than anything in this 'plastic' world or society is lovely honesty and a willingness to see things as they are. A lovely ability to speak about these things frankly and in doing so... risk.

    You go do what you must do and i'll keep getting this stuff off my mind and onto the screen. If you're here that's great but if you're not, its nice to know you're busy - its good for you.

    Thanks for the hugs... roses

  21. I'm finished now. I don't want to grieve anymore. It's not only so yucky but its getting really boring too. Its finished now I hope.

    Good night to you. Talk to you on the morrow sometime. I'm meeting a friend (or is she picking me up) at something like 7.30am or so to go and have brekky somewhere. Then another friend is coming over tomorrow night - we're watching a movie if nothing else comes up.

    I think i'll be sleeping like a log tomorrow night!


  22. Have a good sleep Roses, and when tomorrow arrives let you FC greive or not depending on how it feels,

    You seem to be doing FC mourning so far


  23. Hello Graf and Roses,

    Before I write a comment on the post I just want to say - don't know why - that I started reading the thread of comments above then stopped as I felt I was intruding. I got a gist of what is happening in your life right now Roses but don't know the detail as I stopped reading.


  24. Hello again Graffiti,

    Just passign through - I guess I have become a bit of an irregular blogger these days.

    As you may remember, I have had an episode of depression for a few years now and been on medication. I have to go back to the doctor regularly to get repeat medication and I always laugh inside at their naiveity (which I cant spell!)

    They look at their computer screen and ask me a series of questions to assess the level of my depression. They always slip in at the end, either because they are embarassed to ask or they are trying to catch their patient unawares - "do you self harm or think about self harm"

    What I think they mean is "are you suicidal"

    I smile because they are two different questions in my mind.

    Incidentally, over the last month I really feel that my depression is gone and I think in a few weeks when I have to go back to the doctors, I may ask to come off my medication. I feel that a cloud is gone and I feel hopeful. Life seems to be going pretty good. I am full of hope, though careful not to hope too much in case everything comes crashing down around me! I just feel so different like I havent for a good number of years. Yes there is shit, but there is also a lot of good things too. I feel that I have a bit of magic and sparkle around me. There are a couple of things that seem like they might happen which will be fantastic. I cant blog about them in case I tempt fate!

    hope things are good for you. I must pop back to FB soon and pick up with everyone.

  25. Oh Kahless,
    Thanks mate. It doesn't matter if you read the comments or not. Its not really me writing them - so weird how that works some how. I'm not really thinking but instead just writing - letting my fingers do the talking. That's why its so helpful for me to re read everything I write - though, i'm not at all certain how i'm feeling at any given time. It makes me laugh cause nothing seems to make sense.

    I'm using Tony's blog to help me hear some of the things that might be going through my head with out me knowing - thoughts and feelings can be so tricky and sneeky... you know what I mean?

    Yep - i'm hooked on Tony. I'm a Tony user from way back *giggles*.

    All the best with you and yours...

  26. Oh Tony!
    I realise now. Grief isn't about feeling sad or happy or anything like that. Its not like that at all. It, some how, is a physical thing. I can't just shake it off like everything else. It's not like a cloak i have to wear for a time so when i need a break from it, i can just take it off for a little bit and then put it back on when i need to. No. It's inside and it's all the time. Its something we carry on the inside that can't be let go of or put down for a bit. It just is.

    I can't change it. Though it is my first day of not mourning anymore so... i guess we'll see how we go as the days go by. Honestly - i am so sick of grieving - its just so yucky.

    Well, this is only how it seems to be for me. Everyone is so very different so some would be better at this process than me. I tell you... thats such a relief to know!

    By the way... I'm not expecting you to answer ok? Just keep on keeping on. Breky was lovely too. Cheers...

  27. Hello Kahless,

    Well it is good to hear from old pommy friend and especially when you report that things seem to be going a bit better with your depression. I might use you as a case study in my book!

    Yes you maybe right about their self harm question, some are a bit silly about all that.

    As you know this is a public forum blog so no you are not intruding by reading what Roses and I have said.



  28. Again Roses you seem to be doing some more good Free Child grieving. I see you
    1. report what is going on inside you with your feelings and thoughts,
    2. acknowledge what is happening in the here and now
    3. state how you want it to be, but accept what the FC dishes up each day
    (Now ignore what I just said)

    good stuff and I might use this in a grief workshop at some time.

    As for the timing of grief in relation to your last comment, yes because her death was so recent it is an everyday event but that will change especially if you keep doing what you are doing. I have written some stuff on the timing of grief but I cant find it, but I might post the grief graph on it later today

    Take care


  29. Hello again Tony and Roses,

    I know what you mean Roses about the writing. I suspect the reason I am not blogging so much is because I am not feeling depressed and therefore feel I have other outlets for my inner self. Not sure, I'll ask myself the same question in a few months and probably be able to answer more definately then.

    I am sure enjoying popping back here again though.

    Tony - a case study? I am guessing you jest. I am not sure there is much to say about me. And I am not sure why the depression has lifted.


  30. Well that is good news that the depression has lifted.
    How many depressive episodes have you had. ie has this happened before and is your depression dysthymia or a major depression. I really know the answer to that already as we have blogged in the last year or so but any past episodes

  31. I think I may have had mild depression in my teens looking back - not sure and not diagnosed

    Age 21 - following friend dying I was definately depressed - lasted c. 18m - I never went to the doctor because of the taboo

    Age 26/27, following aunt and grandfather dying - depression - on medication for about 18m

    This depressive episode age 39-41

  32. Hello Kahless,

    So it seems your depression has been primarily reactive and at the level of dysthymia.

    For significant preiods of my childhood and adolesecence I think I had chronic moderate levels of dysthymia. This persisited into adulthood and when significant adverse circumstances arose I would even get more depressed to the level of high dysthymia but I have never had anything like a major dperessive episode.

    When I separated about 15 years ago I went on anti dperessantsa for 6 months then stopped them. Since then I have had no depression at all and I mean none. Not even a little bit. Whcih is great but a bit perplexing as to why as I did not do anything different.

    Maybe getting a divorce was a life script release for me.


  33. I guess with only 6 months on the antidepressants (the min recommended time?) maybe the non return of your depression is because something major has shifted for you, such as a script change. I am really pleased for you. How does the depressive mood of any of your clients not rub off on you?

    Yes I think my depression has been reactive. Bereavement is a major trigger and one I guess I am fearful of in the future. I guess that is why I have made plans for when Mrs K dies - though I hope that is many many years into the future.

    You have just reminded me I havent taken my tablets tonight....

  34. Yes Kahless,

    as the cessation of my depression was so abrupt and so complete it would tend to indicate some pre-programmed lift script release is at work. I never really realised until about 2 years down the track when I looked back at my mood in that time and realised there had been no sense of depression at all and it has continued on until this day.

    If bereavement is a major trigger for your depressive episodes then they may not be depressive episodes at all. They may be more correctly described as recurrent delayed episodes of archaic bereavement. Because the symptoms of depression and bereavement are so similar one can misdiagnose them.

    When you have a current day loss and suffer the symptoms of bereavement your Free Child may think,

    “Hang on a moment, I recall this feeling when I was 4 years old when I suffered the loss of ‘X’ and I never resolved that bereavement. So maybe the opportunity has arisen again and I will have a another go at resolving it now”.

    Hence you end up with a depressive like episode for months which is really the Free Child precipitating another attempt at resolving the original bereavement. Remember we are talking about a small child here so the thinking can be a bit wonky at times.

    The loss does not have to be of a person or a pet or the likes but could be a whole wide range of things including the perceived abrupt loss of parental love such as when mummy got sick or for some reason her attention was taken off the child for as substantial period. Or if the child was in the heights of the oral stage and the parents suddenly removed its dummy and did not allow any thumb sucking could also be such a loss. Such things may seem inconsequential to an adult but for a child in the middle of the oral stage it can be a big event indeed.