Flashbacks and intrusive thoughts

Content warning: self-harm and suicide mentions

I started the day with anxiety feeling like a hole in my chest, and disgusted by this body of mine and the person I am. But I had things to do and a train to catch, so I got out of bed to get on with the day.

I felt the anxiety, the self loathing and self hate, the frustration and anger of rationally knowing those feelings don’t necessarily represent reality while still feeling them, and then the fear that maybe this is all there is.

I spent an hour or so first thing in the morning afraid of myself and sobbing uncontrollably. Irrelevant detail, but this caught me while sitting on the toilet doing my business. Mental illness is anything but pretty and cinematic and I want to acknowledge that, embarrassing as it may be.

I first had flashbacks of the day I tried to kill myself. The desperation, the guilt, the anxiety, the pain… All the feelings as fresh as if I was right back there sitting on my bed on that day swallowing handful after handful of tablets. Then the other intrusive thoughts. Graphic images that I don’t want to see and urges I don’t want to act on, but they show up and even with my eyes open I just see those realistic images playing in my head. Some are things that haven’t even happened at all, or have happened but to a much lesser extent. Most involve self-harming in various ways where the result would range from needing some medical attention to straight up lethal, but no need to go into specific graphic details here.

All of this accompanied by the feeling that I’m just so unworthy of everything, that I’m a burden, that I’m not good enough or just no good at all. My brain forever dysfunctional and my body forever incomplete. Feeling ashamed of these things I have gone through and still go through, while also getting frustrated because rationally I know there’s no shame in having a mental illness and having specific difficulties or needs because of it.

It’s difficult to sit with the feelings by kindly welcoming them, reminding myself it makes sense that they would surface sometimes and that it’s ok and it doesn’t mean I’m going right back to square one. It’s difficult not to judge myself or beat myself up for having them. The dissonance between what I’m feeling and what I think I know to be real only creates more distress. I get angry at myself for still having such feelings and thoughts because I know they’re not true, and then I doubt myself and think what if I should actually listen to them? I get even angrier at myself for daring to question whether those negative thoughts are representative of reality.

And then I thought what I needed was to have a drink, or perhaps take a couple more painkillers than I need, just enough to take the edge off and numb things down. But I didn’t because I know better.

I just stayed where I was and I kept crying, hoping my mind would eventually calm down and stop the intrusive thoughts trying to get me to hurt myself and to convince me that all I am and all there is to my life is being ill. I find that with this as well as with panic attacks, it helps to just let it run its course gently guiding myself out of it rather than forcing myself. I wouldn’t say “just stop” to someone going through the same thing, so I try to be kind, understanding and patient with myself as I would with someone else.

I try to regulate my breathing slowly instead of trying to jump into a 7-11 rythm immediately (that’s 7 seconds breathing in, 11 seconds breathing out). Physical ways of grounding myself are also helpful, and the unhealthy methods I used in the past were self-harming and punching walls until my hand was all swollen. The healthy ways I then found are mainly using a weighted blanket by folding it as many times as possible to concentrate all the weight on my chest as I lie on the floor or in bed (don’t do this for too long!), or by sitting against a wall and pushing against it as hard as I can (if I have something I can push against with my legs that’s even better). I have tried other things suggested to me such as shocking myself by splashing cold water on my face or biting into a lemon, and those don’t really work for me.

What most professionals I’ve seen in my life failed to address was the importance of aftercare. You don’t just pull yourself out of it and get on with the day as if nothing happened. Sometimes I do have to carry on as soon as I can, for example if I’m at work, but it’s still important for me to make some time later in the day to at least check in with myself. Again, if this was someone else I would still keep supporting them after the worst of it is over. I’m getting used to always asking myself how would I treat someone if it was them and not me going through whatever I’m going through.

Today this meant that instead of rushing to get showered, pack my back and run to catch a train, I rescheduled for a later one. I got ready without rushing, left early enough to not have to walk really fast, and found myself a quiet spot on the train. I allowed myself to acknowledge the sadness and frustration instead of immediately trying to distract myself with something else. Over time I’ve learned to recognise when it’s safe for me to engage with some of the thoughts and feelings that arise, and when I actually need to find a distraction before acknowleding them so as to avoid triggering myself back into the same state. Then I got to my destination where I had planned to do certain things, but instead I rested at the hotel for a bit and then went on a quiet walk.

I can’t always drop everything to do some self-care and self-soothing, and more often than not I have to carry on with what I was doing without much of a break. But it’s always possible for me to re-think what is and isn’t essential in that moment, and to re-adjust things things to the extent that I can in order to make life a bit easier for myself. I still feel selfish doing this, even when those adjustments don’t really affect anyone else.

If I really don’t have the time for anything right away, I still find a few moments at some point to just see how I’m doing, think about what’s happened and whether anything triggered it, see how I feel about it now and leave space for those feelings, see what worked and didn’t work in the moment, and see whether there’s anything I can do for myself that would help now.

It’s a learning curve and I always remind myself that no matter how helpless I feel in the moment, it will always pass and I just have to ride it out as best as I can. But this isn’t always easy and I don’t always believe it.

And going back to the fear I mentioned at the beginning of the post that maybe this is all there is… Where does my unaltered self end and my mental illness begin? I don’t think they’re separate. My self is mentally ill. There’s no “before” where I wasn’t affected by mental illness or a weirdly wired brain in one way or another. There’s no future where I will be free of it. It makes me have a lot of gratitude for every day I get through where I’m stable and content, but deep down it also just terrifies me feeling like there’s this ticking bomb inside me and one day I won’t be able to extend the timer any longer. I’m confident in my coping skills at present and my medication is working really well, but there’s no guarantee that will never change. What if the stability of these last two years has been just a fluke? I know episodes will still happen at some point to some extent, and with medication and the right support network I will be able to get through them… But what if I can’t? That terrifies me.

What we don’t talk about after suicide attempts

There are some things people don’t often talk about after a suicide attempt.

After my first attempt, the main question no one could give me an answer for was ‘how do I live with myself as depressed as I am, knowing that I tried to kill myself and had no regrets, when I still feel suicidal?’

The second attempt was different. After the first attempt, not only did I not get answers to those questions, but I also didn’t get any help. The help I was given was addressing problems I didn’t have, so it didn’t work. I had appropriate help and support after my second attempt, so this changed things. I was hopeless at first, but as I started to recover I found the genuine willingness and desire to live that I hadn’t felt in many years. Having had no regrets didn’t imply the inevitability of another attempt, but it did bring the fear of knowing if I were to hit rock bottom again, it was very much possible I would attempt again and succeed.

I wrote more about the experiences and thought processes behind these two attempts here: https://not-just-bipolar.com/2021/03/03/i-am-happy/

What’s left after two attempts is the knowledge that I had no regrets, the knowledge of what rock bottom is, the memories of what it was like to fall there, the memories of the attempts, and the weight of all the pain I caused to those who care about me.

Whereas after my first attempt there was just acceptance that it was only a matter of time before I attempted and completed suicide, what I had after the second attempt was fear that it would happen again and that I would die this time.

This was a very intense fear at first and it caused several panic attacks during the first couple of months out of the hospital after my second attempt. It was not just the fear that if I hit rock bottom again it would be inevitable, but also the fear that I would spiral down again and I wouldn’t be able to stop it. I got so worried and scared any time my mood changed in the slightest. As time went by, I kept proving to myself that I am strong and resilient, I have developed good and effective coping skills, and I know myself and my healthy range of moods and emotions a lot better. So I’m a lot more confident in my ability to stop things way before I reach a point of no return. I can’t say I know for sure what I would do if I hit rock bottom again, but I do know what to do as soon as the first warning sign of an episode appears.

Now it has been nearly two years since my second attempt and I don’t live in fear anymore, but it is still in the back of my mind. It’s not a constant fear, but any dips in my mood even within my normal/healthy range make me afraid that I’m about to spiral down again. I track my mood daily and put it on a spreadsheet every couple of weeks, so I can look at a graph and know that it’s not the case. As I said, this keeps getting easier with time, but some amount of sometimes irrational fear remains. The knowledge that I felt relief as I was dying is not something I can forget. I didn’t die, but at the time I was sure there was no way I would survive, so I was dying. It’s a very strange thing to be alive, to want to live, while knowing I was at peace dying.

I think a small amount of fear is helpful, it keeps me away from danger. It’s when it goes beyond that healthy level that it affects me. Not so much consciously, but I’ll go to bed at night second guessing whether my being tired today was normal tiredness or the beginning of an episode. I will then have bad dreams and nightmares where I suddenly wake up agitated and anxious. It’s often screaming in despair within the nightmare that wakes me.

In these dreams I feel as I did leading up to my last suicide attempt. I won’t go into detail as I’ve written about this in other posts, but needless to say it is upsetting and unsettling.

The theme of these dreams, aside from feeling like I’m in a whirlwind of mental instability, tends to be that of being unable to escape a situation or do anything about it, often trying to scream with no sound coming out. This mirrors the experience of waking up delirious after my first attempt, with the perceived danger and the inability to escape it or get help, as well as waking up after my second attempt trying to scream but not being able to because I was intubated. As I awake, the feelings transition from being immersed in that state to knowing I’m not there, but deeply fearing I will.

Something else I haven’t seen being discussed that much is flashbacks. When you look it up, most of the content is related to PTSD in people who have witnessed a suicide. I found two personal accounts of experiences from people who attempted suicide (A Flashback About My Suicide Attempt Is Not a Setback and Facing The Aftermath Of A Suicide Attempt).

These were more frequent and stronger the first few weeks back home from the hospital, when a reminder would trigger a flashback. Luckily I don’t really experience this anymore. Medication lingering long enough in my mouth to feel the bitter taste, taking meds with an empty stomach, sitting on my bedside or lying in bed in the same position I did that day, getting in bed when there’s still daylight, taking a pain killer and looking at the clock to know what time it will kick in… these things would take me right back to that moment. They don’t trigger suicidal thoughts, but they bring these vivid memories right back and for a second or two it’s like I’m right there on that day.

It’s good I hardly ever experience that now, but the memory of having tried to die, of knowing I actively wanted to die, is something very difficult to shake off. For about a decade, there was rarely a day I didn’t think about dying to some extent. This ranged from passively thinking “I wish I’d never been born” to actively planning an end. In contrast, for the past nearly two years there hasn’t been a day I don’t remember I tried to end my life. This always comes with the reassurance that I’m happy to be alive. Every day I get out of bed grateful I woke up to live another day. It doesn’t matter if I’m in terrible physical pain and want to go right back to sleep, if I have a stressful work day ahead, if there are unpleasant things to deal with in the day… I still wake up grateful to be alive. Sometimes there will be an actual reminder like someone mentioning suicide, mental illness, or something that relates to what I went through such as certain hospital experiences that will remind me I tried to die. But most days there’s no explicit reminder and I don’t consciously think about it, it just pops up in my mind even if just for a split second.

I don’t know if I will ever not remember it so often. As I said in the beginning, no one really tells you what it will be like to be alive after trying not to be. Whether it’s “I attempted suicide once and now I have to carry on living feeling just as suicidal” or “I’m no longer suicidal, but I was relieved when I thought I was dying and now I live with that knowledge”, they’re not experiences someone can easily guide you through. I will start counselling soon to explore other unrelated issues, but I’m hoping I can explore some of this too at some point.

Maybe it’s a good thing that I can live with these memories somewhat comfortably, accepting rather than trying to bury them, and letting them fuel that healthy amount of fear and self-awareness that keeps me in check. And they aren’t constant upsetting or distressing memories unless I dwell on them, they just come and go sometimes nearly unnoticed like briefly catching someone’s perfume as they walk past you. In any case, it’s a very strange feeling having these memories and these experiences that hardly anyone in my life can fully understand.

I understand why these things aren’t openly talked about and shared, but at the same time, it can be a very isolating experience never hearing about them.