Why are suicidal thoughts returning?

By Dr. Marie Hartwell-Walker

Q from New Zealand: Two years ago I became very anxious and suicidally depressed. I attempted suicide 3 times, the last time while hospitalised. I am ‘lucky’ to be alive after a fairly lethal attempt. Prior to that I had no psychiatric history.

I now realise that I was in an emotionally abusive relationship. My husband was very depressed, emotionally disturbed (I believe from some childhood experiences), and also suffered from a mild traumatic brain injury that occurred just after we were married 13 years ago.

A year ago I separated from my husband. It relieved the tension on the children (5yrs, 8yrs, 10yrs)and myself. We had all felt like we were walking on egg shells around him and his anger was getting out of control. He had stopped working because he could no longer cope and he became quite fixated on me and more controlling and overtly verbally abusive as well as shoving me a few times.

It was an extremely difficult decision to give up a cherished ideal. I see my husband’s pain and loneliness and I feel terribly guilty and sad for him. I had thought I would go back after a period of separation but just thinking about it fills me with anxiety. He is the most charming man and the most hurtful man I have ever known. He professes profound love for me and I feel he puts me on a pedal stool but then quite swiftly changes to calling me the most nasty things and ignored me for much of our marriage. When I see the good side of him I think maybe we can work things out but when I seriously contemplate it I feel a sense of doom. Mostly I cope by not seeing him at all. I have gone back to work as a registered nurse part time and my life is getting back on track.

Mostly things are going well – on the outside at least. I never thought I could face work again in a hospital after becoming a psychiatric patient but have got over the stigma. However for some reason every now and then I feel like I’m falling off the edge again and it frightens me intensely.

I am feeling very fragile right now – tearful and sad. Good things happen and I feel ok but it just doesn’t last. As soon as work is over my brain tunes out again. I drive in the car and feel like crying for no reason. I have that butterfly feeling in my stomach back. I have not been able to sleep properly since the original episode of anxiety and depression. I feel tired all the time, I can’t sleep, and if I didn’t have children I simply would not get out of bed. Another strange thing is that I haven’t been able to read for pleasure for the last two years. I can not settle to read a book but I can read something I have to for work. Previously I loved reading and would always have a book(or a few)on the go.

Can you help me to work out why this is happening now? I have a craft knife of surgical sharpness which I have left at the top of my wardrobe for the last year because I fear myself with it. I honestly bought it for cutting tiles (I have made tile mosaics in the past and thought I would get back into it). I have lived with bouts of suicidal thoughts occurring every couple of months or so for the last couple of years but thought it was over now. They have been less and less intense. I worry that I won’t be able to work and support my children and if I go crazy when I am employed I’ll never have a career again.

Just to clarify: I do not fear for my patients, I fear not being able to work because I get so immobilised by depression, and all my colleagues would know and I would not be able to return. When I went quite crazy I didn’t realise what was happening to me – I’d always coped well with many various difficulties. It was a shock to realise that I had been very much in denial of my feelings of sadness for a long time. I am 44 and used to think I knew some stuff about life. Everything I believed has been shaken as I thought I was doing the very best thing for my family when I went mad.

If you have any insights I’d be grateful to read them. Thank you.

A: Once someone has been seriously suicidal (or been close to someone who has suicided), ending life becomes more of a real option. You’ve already faced the prospect of death and decided several times that your misery in life outweighed whatever fear you had of death. The fear of the unknown of death is an inhibitor to suicide for most people. It’s not there in the same way for you. (The same thing happens for some people when they survive a life-threatening illness or accident. Death just isn’t so scary any more.) There is a kind of peace that comes with that but it also puts you at more risk.

With all you’ve been through, it’s not too surprising that you’ve developed a sleep disorder but it certainly isn’t helping things. Sleep deprivation makes people feel fragile and vulnerable. My guess is that it takes all the strength and concentration you’ve got to hold it together all day at work. Of course you fall apart on your way home. It also makes sense to me that you can’t read for pleasure. By the time you’ve taken care of your patients and your kids, you’ve about used up your ability to focus for the day.

That you even entertain going back to a husband who demonstrates signs of being a habitual abuser worries me greatly. Although this is common among wives who’ve been on the emotional roller coaster of an abusive marriage, it does suggests that you still have some important work to do in therapy.

You said you have been hospitalized. You didn’t mention whether you have had follow-up care. Continuing in therapy can help you work through your feelings of anxiety, guilt, and pain and will help you regain your self-esteem and confidence. You would probably also benefit from attending a support group for abused women or using one of the chatroom support communities.

Please give yourself lots of credit. You’ve managed a job, kids, and your own inner turmoil for a long time. You’ve done it in spite of little sleep and lots of worries. You have a core of strength that maybe you didn’t know you have but you’re getting worn out. Regular, professional help will give you the added support you need until you replenish yourself. Write me in a month or two and let me know how it’s going.

I wish you well.
Dr. Marie

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Last reviewed: By John M. Grohol, Psy.D. on 2 Jul 2008

APA Reference
Hartwell-Walker, D. (2008). Why are suicidal thoughts returning?. Psych Central. Retrieved on November 26, 2014, from http://psychcentral.com/ask-the-therapist/2008/07/02/why-are-suicidal-thoughts-returning/