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Regular Thoughts Of Killing Myself

Question:

For the past year, I have felt regular thoughts of killing myself. Usually with a gun. In the past 2 weeks there is nothing else I can think about. I have still managed to arrive at work (I am a highly skilled professional and calling in sick is not an option.) I have barely been able to take care of my kids and home and animals. I will loose my job and my professional license if I seek help for depression. Is is normal to think of killing one’s self all the time? I have never been a believer in antidepressants as exercise, good eating, physical activity and proper nutrient balance and a low weight usually solve many of the depressive issues. what is your take on this?

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Answer:

To answer your question, it is not normal to think about killing yourself all the time. It is not even normal to think about killing yourself a couple times a week. It is approaching normal to think about killing yourself very occasionally during times of great stress, but even then, this tends to be a fleeting thought. So, something not very normal is going on right now. You are experiencing a crisis for whatever reason, and you might very well benefit from professional help.

Now, the form professional help may come in if you tell a therapist that you are acutely suicidal is involuntary hospitalization for a few days. Therapists and Doctors have a duty (ethical and legal both) to hospitalize you (or at least put the wheels in motion) if they suspect you are an “acute” danger to yourself. The hospitalization would largely be provided as a means of providing external restraint so that you aren’t able to kill yourself for a few days while the crisis passes. The hospitalization would also function to get you medicated on antidepressants or other medications that the staff psychiatrist thinks will help. Such medications do have a beneficial effect (along with side effects) if they are allowed time to work properly. They are not something to be avoided when you are suicidal all the time. Clearly your other solutions (exercize, healthy eating habits, etc.) aren’t working for you right now. They are helpful at warding off depression, but they aren’t enough in your present circumstance.

The prospect of hospitalization can’t be a happy one for you. The prospect of losing your license might be even worse. However, to my mind anyway, being hospitalized or even losing your license has got to be preferable to dying and traumatizing your kids for life. No one likes to be hospitalized. In this case, however, hospitals exist as a safety net to catch people who might otherwise do themselves in. If you need that net, it isn’t something to avoid.

Whether or not someone with your symptoms absolutely needs that safety net is not entirely clear. Having frequent suicidal thoughts is disturbing, but there is a difference between having thoughts and acting on thoughts. So questions for someone in your shoes have to do with how likely you are to actually act on your impulses. Do you own or have ready access to a gun, for instance? Have you made suicide attempts in the past? The more you have a history of impulsive self-destructive actions and ready access to the tools you would use to harm yourself, the greater your risk.

What is entirely clear is that you really should be professioanlly treated for your depression. You should be evaluated by a doctor (preferably a psychiatrist, but at least a general practitioner) and medicated if that doctor thinks that this will help. You should also be in at least weekly psychotherapy – not because it will help you immediately (psychotherapy takes several months of work to prove effective), but because you need monitoring for safety. Seek out a cognitive behavioral therapist for access to the best available therapy for managing depression.

You can minimize the threat of hospitalization by denying that you have suicidal thoughts or at least that you have a suicidal plan. It’s not a good idea to misrepresent yourself in this situation, however, because the alternative to being hospitalized is perhaps killing yourself and traumatizing your family. If you have a plan and will kill yourself, drive yourself to the emergency room instead and check yourself into the psychiatric ward as an alternative. Tell them that you are suicidal. Don’t wait for a doctor to declare you a danger to self if you know you are in fact a true and acute danger to yourself.

Know that *many* people today are treated for depression. Professionals do not typically lose their license over such an occurance. Those groups that might lose their license (perhaps such as commerical airline pilots) probably would qualify for disability insurance payments, as they could no longer perform their customary work. Even if you are actually at risk for losing your license, it is quite likely that your professional association has programs for “impaired professionals” who handle themselves appropriately (e.g., recognize that something is wrong and voluntarily attend to handling those problems). I would search out the policies in some anonymous fashion (perhaps a friend can research it for you?) so that you learn what the actual penalties are. Do some reality testing before you assume the worst. Again, being in an “impaired professional program” isn’t something that anyone wants to do, but it is preferable to losing everything if that is the alternative.

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