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.

What stability looks like so far (1 year on meds)

I started my medication in mid 2020 after my diagnosis, and I reached the full dose I’m currently on in August 2020. Thought I’d show what my mood has been like since then, and reflect a bit on the past year.

I have been tracking my mood using the Bipolar UK mood scale and my own spreadsheet (template here).

Some reflections in no particular order

Ups and downs still happen. I have relatively long periods of a consistent neutral mood, but I still have low days (and some high ones) here and there. But they became less frequent, less severe, less long-lasting (a couple days of feeling low as opposed to a couple months), and way more manageable.

Meds take time to kick in. Although I was in a much better place when I left the hospital after a few weeks titrating meds, it took me another six months or so to reach a point where my mood was stable and where I felt in control and confident in my ability to manage it.

The first few months are scary. Coming out of a mixed episode while inpatient after a suicide attempt was scary. Wanting to be alive for the first time is scary. Every slight mood change had me worried I was about to spiral out of control again.

Intrusive suicidal thoughts took a while to go away. I still have them sometimes, but rarely. They were more common at the beginning. I didn’t want to die, but after being suicidal for over a decade, it was just my brain’s go-to thought.

It took time to know myself. I didn’t instinctively know what my healthy range of emotion is. I had to re-learn what normal sadness and normal joy looks like for me, what’s a normal reaction and what’s a warning sign of oncoming depression or hypomania.

It’s not always the bipolar disorder. I have frequent migraines (not chronic, but close) and part of the prodrome for me is a depressed mood with increased anxiety. Many of the lows in my chart are migraine-related, which is something that took me a few months to identify.

It’s not just medication. I wouldn’t be alive without medication, let alone function without it. But meds alone don’t do all the work. When my mood goes up or down, it’s a lot less severe and more manageable than it would be without meds, but it’s up to me to use coping skills to get it under control and get back up (or back down) to something neutral.

My baseline leans more towards the low side. I’m more likely to have low than high moods when I deviate from neutral. This might be the nature of my bipolar, or it might just be the nature of my life circumstances (a crappy job atmosphere, migraines, some dysphoria as I sit on a long waiting list for surgery). But it’s completely manageable.

I haven’t fully come to terms with it yet. I fact-check and research most information I come across. I’ve read about migraines, about gender dysphoria, about why bright sunlight makes me sneeze, about so many things in my life big and small. I still haven’t read much about bipolar disorder besides self-management strategies because I’m not ready to fact-check how much of a progressive illness it might be, or how likely it may or may not be that my meds will stop being effective or that I will have another episode. But I don’t like living in ignorance, so I’m working on it.

I don’t take stability for granted. I know I’m not cured or fixed. I know I’ll live with this for the rest of my life, and I have a few decades of life ahead of me if nothing gets in the way. I track my mood, I’m self-aware of my thoughts and emotions, I take my meds, and I avoid any known triggers to the best of my ability. I know stability is not forever guaranteed, so I’m grateful for it and I try my best to maintain it.

It will be interesting to see how things go as the years go by. They might get worse at some point, but I’m confident in my ability to handle them better than I was able to in the past.