September 24, 2013

Darkness Visible, Depression, and Suicidal Ideation

By Anonymous
Him the Almighty Power
Hurld headlong flaming from th' Ethereal Skie
With hideous ruine and combustion down
To bottomless perdition, there to dwell
In Adamantine Chains and penal Fire…
As one great Furnace flam'd, yet from those flames
No light, but rather darkness visible
Serv'd onely to discover sights of woe,
Regions of sorrow, doleful shades, where peace
And rest can never dwell, hope never comes… 
~ from Milton’s Paradise Lost, Book One (1674)
Wikimedia Commons
In the passage from Paradise Lost above, Satan has launched his unsuccessful war against God and heaven and rightfully been cast down into the pits of Hell. He finds himself chained in unbreakable chains to the floor of a fiery pit without even the comfort of light from the flames. In “darkness visible” he sees only “sights of woe, / Regions of sorrow, doleful shades.” In the absence of God’s presence he flails about in pain, doomed to never know peace, rest, or hope again.

It was on a beautiful spring day—birds chirping, sun shining in through the window, adoring, four-legged friends at my feet—that I used the passage above to describe to my girlfriend how empty and defeated depression made me feel.

We have different names for these things now, but “sights of woe” sound an awful lot like intrusive thoughts; “doleful shades,” to me anyway, accurately described the synesthesia of strength-draining darkness that had creeped over me. With all promise of “rest” and “peace” dashed by medical science and the constant voices of doubt in my head, I had certainly lost hope.

Worst of all? The closest comparison I could come up with to describe myself was that of Satan. A lot of doctors would call that “a poor self-image.”

Fast forward a few months.

Not many people talk about suicidal ideation. It seems they’re either embarrassed, worried about alarming their loved ones, or afraid of being locked up. These reasons are all valid, of course. But I made a promise a long time ago to be open and honest about what I’m going through because I think it makes me stronger while helping those around me. So, again, here it goes.

The other night I was lying in my bed, completely in the dark, waiting to fall asleep. The self-effacing negativity and spitting of curses at myself ran rampant as it had for a while. It was something I’d grown accustomed to since quitting my medications in the spring. For me, not having medications is a tradeoff where I can better control my impulses at the expense of increased depression. When I’m alert, the dark thoughts are easier to push away. But when I’m tired, about to fall asleep, it is often a different story.

For me, as a man who experienced a suicide in his immediate family, it will never be an option. I realize on both an emotional and intellectual level that it only hurts the ones you love. But that doesn’t stop the theatre of the macabre from acting itself out my head. Thoughts and images of hurting myself flash before my eyes faster than I can stop them. I know I will never act on them. I know I am physically in control. Still—and I doubt I am alone on this—simply having the thoughts can be discouraging.

I find that flashes of self-harm occur vividly and alongside waves of self-deprecation and doubt. The slightest slip-up or failure can trigger them. Those who know me well have learned that I vent this negativity through jokes and creativity. I used to be able to pop a VA-prescribed pill when I felt down or anxious. I used to be able to PRN-my-way through about any situation. But since going cold turkey I’ve been forced to find more and more behavior-based methods to deal with PTSD and its aftermath.

I’ve been grappling with this issue both intellectually and spiritually over the last couple of months. My goal has been to symbolically represent the causes of the condition through language and understand—beyond the limits of medical science—the role of my soul. But learning causes didn’t result in the ability to produce effects. So, each day I’d learn something new. Each night, I’d lie in the dark, struggling, waiting for that ability to come to me.

Suicidal ideation is like being strapped to a chair and forced to watch a really graphic movie of your own death. Here’s the catch: You’re both the protagonist and the antagonist—literally your own worst enemy. The voice you hear, the one screaming that you’re “pathetic” or “weak” or “disgusting,” it’s your own voice. And, after a while, you become convinced that you are the one doing the talking. Why wouldn’t you? It’s your voice. Your brain. You are the one conjuring up these thoughts because you are “sick,” right?

I’m no longer convinced.

On the night in question, I looked up. There hung my trusty shotgun—the one that PTSD tells me to keep ready for intruders at all times. Then came a flash of me shooting myself and collapsing on the bed. It lasted less than a second. But it was so disturbing and graphic that it wounded me. It was like being punched in the gut.

In its shocking repetition, suicidal ideation makes you feel very much like a victim of abuse. But you’re the abuser. What gives?  I was in control, but the thoughts weren’t going away. I felt like I was losing the battle—that it would just get worse and worse until I wasn’t in control. That was what knocked the wind out of me.

I said to myself, “You know...if you’re thinking about blowing your head off, the responsible thing to do would be to lock the gun up in your safe.”

“Yeah, I don’t want to do that. What if someone breaks in?”

I tried to be rational. It dawned on me that the safest alternative to locking up the weapon would be to crawl over to the corner of the bed and sleep there. That was the furthest spot away from the gun. I wouldn’t have to risk getting near it but could if someone broke into my house. Then it hit me that I’d just told myself to curl up in the fetal position on the corner of the bed.

“How did it get to this point? Listen to yourself!”

In the background during all of this, that vile, contemptuous voice kept talking. It had been telling me to “do it” and reinforcing its previous points about my being weak, pathetic, and disgusting. In my mind’s eye I stepped back for a minute and asked myself something I hadn’t before:

“If I’m listening, who’s doing the talking?”

I created a representation of the scene the best I could in my brain. I saw myself stepping away, outside of a circle of white light. Inside the circle, crouching and holding a severed head like a puppet, was the thing that had been talking. It was black like venom with skin the texture of a smoky-ink. The head it was holding, and by extension the voice, was my own. But I was clearly on the outside of the circle. I was listening.

“There you have it.” It wasn’t me talking at all.

I’d describe what happened next as an epiphany, but it wasn’t really that. It was more like something remembered—something I used to know but had forgotten. I paid particular attention to the voice: it tapered off; its tone described someone who’d just been caught. And it muttered something to the effect of “this doesn’t change anything.”

But I knew better. I made one conscious decision to listen and, for the first time in months, the voice shut its mouth.

What ensued was astounding: my head and face tingled. I felt a distinct crunching feeling in the tip-top of my brain—as if the folds of my cerebral cortex where tightening and strengthening themselves. I’m used to getting headaches, but a new, different one presented itself at my forehead. I welcomed it. I knew something big was happening. That some new—or old and forgotten—pathway was being opened up and I was (re)learning how to use it.

In “darkness visible” I opened my eyes.

Since then, I’ve come to call that voice the “Puppet-Master.” It was like he had his hand in the back of my neck, making me spout off terrible obscenities and lies about myself. The sound of my own voice did a lot to convince me. But so did the constant message that there was something wrong with me.

There might be something wrong with my brain. There might be something wrong with the way I live my life or the decisions I’ve made. There’s definitely something wrong with the things that have happened to me. But those things are not and have never been me. I held somewhere deep down inside the view that there was something defective with my soul—that I deserved the constant torment. It was a lie, and now that I’ve learned to put a muzzle on the liar, it’s one that makes me burn with a healthy anger rooted in self-respect.

I’m sure that the Puppet-Master reinforced that lie. He still likes to catch me unawares and slip in self-hate and violence when he gets the chance. But I’m onto his game now. When I catch him, I get angry. I step out of the circle, locate him, and drag his wretched ass to a nice box I constructed in the corner of my mind. I borrowed the box metaphor from my fellow veterans. Now I know what to put in there.

What should you make of all of this? I don’t know. You might think I’ve lost my mind or that I’ve used too many psychedelic drugs. To me, it seems like a lot of veterans and people struggling with mental illness believe lies about themselves. What I’ve done, in my best estimation, is find a way to represent the source of the lies—a Puppet Master—and a way to control it. Some people achieve this through medication and therapy, others through exercise, and still others through religion and service. My journey has been a combination of all of these things and it isn’t over. But I just won a major battle.

For now, I’ll just keep listening. I’d encourage you to take the time to listen to yourself, too. You might be surprised at what you learn.

September 18, 2013

Ty Carter's Advocacy in Context

The most recent Medal of Honor recipient has perhaps one of the most impressive citations in the War on Terror. As a participant in a battle that nearly overwhelmed a small Combat Outpost (COP) named Keating, Army Staff Sergeant Ty Carter repeatedly braved danger, injury and certain death to aid fellow wounded soldiers. When running to the assistance of wounded comrades his fellow soldiers attempting to aid others were killed. Carter provided first aid and ammunition so the wounded could maintain a desperate stand, Carter stated that the outpost lacked water, necessary medical supplies and ammunition. Despite hunger, thirst, and injuries and, in some cases mortal wounds, they continued to fight. In a battle that carried multiple valor citations, Carter’s performance carried the most accolades....

See full post on Khronikos here.