To be, or not to be–with a good therapist

By Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I don’t think my family really believes that I’m at risk for suicide, simply because I haven’t made an attempt. They don’t understand that when I do make an attempt, I will make absolutely sure it takes. I will not end up a vegetable.

I drink quite a bit, but I’d say if I’m an alcoholic, I’m a very functional one. I never drink and drive, I almost always manage to sleep in my own room, and I’ve only vomited from booze once in 3 years. That one instance, I drank a liter of vodka over an 8 hour flight from London, and simply wanted to get rid of the rest before I went through security. I woke up in the hospital, which is what I regret most about it, because I’ve made it a point to stay out of hospitals. I feel guilty enough about wasting resources as it is, but hospital bills? I told my family I was just sick and dehydrated.

Alcohol is not my problem. I drink to pass the time, and to get out of my own head. It’s the same reason I play video games or watch television. My problem is that I do not want to live. There are no great tragedies in my life, and it is not something that will pass. I have no fear of death, and I recognize the ultimate futility of life. I haven’t decided one way or another to commit to living or dying. I’ve just been biding my time until something happens in my life to lean me into a decision.

The only reason I haven’t killed myself is because I feel guilty about what it’d do to my 5 little half-sisters, my half-brother, and my mom, step-mom, and dad. I do think my parents understand that I’m depressed and have suicidal thoughts, but my dad lives in London and is insanely busy. I live with my mom, and I think she’s already given up on me.

I have no illusions about my condition, and I know there is no solution. I have always felt like this, and I will always want to die. The frequency in which I seriously contemplate actually getting life over with increases steadily, and now stands at about 4 times a week. Every other day I wake up hating myself at about 11 AM. I’ll usually start drinking within the hour; depending on how much booze I have available.

While everyone is away at work, I often practice loading my grandfather’s revolver. When people come home from work, I’ll just stay in my room until I really need to use the bathroom or find something to eat. I try my best to avoid everyone that lives in my house. At dinnertime, they sometimes remember to call me down, but most of the time they neglect to include vegetarian dishes. We have other food available, it’s just disappointing. Once they’ve all gone to bed, that’s when I really let my self-destructive tendencies loose.

A pair of scissors or a sharp knife helps me both release tension, and ensure that I am capable of withstanding the pain for the final time I cut myself. I do hide my wounds, and I’ve only ever shown three people: my mother and brother when I first told them about my depression, and my recent ex-girlfriend. Really, though, I’ve begun wearing much more in the way of short-sleeves, which, I suppose, is for the purpose of someone caring. I think they know about them, but I’ve never heard word one. No wait, that’s not true, my grandmother once said, “What happened to your arm, are you cutting yourself?” and I just walked away. What was I supposed to say? She hasn’t brought it up. That’s what I think they’re all doing, just ignoring it.

Maybe they want me to work things out on my own, but they don’t understand that I’m not the one that wants me alive. How am I supposed to find motivation to get better if no one else cares? I’m always trying to find something to look forward to, but I rarely bring myself to change anything. The world is a terrible place, filled with terrible people, and far too may of them at that. The only solace I can find is that one-day it will be over.

I don’t honestly expect anyone to read all of this, for I’ve typed far too much about myself. All I really did was describe a day like yesterday, when I punched in a wall by 3 pm, and put a significant gash in my arm, past out (slept) on the floor, and woke up with a blood soaked shirt.

So, to my question. How can I find a good therapist? I’ve had three in the past, but I did what I always do. I miss an appointment. I stop going because I know they don’t care. I am a customer, and nothing more. All I hope for is that I’m worth even collecting due co-pay. They’ve all known I was suicidal, so when I stop showing up and they never hear from me again, you’d think they’d check up, if I mattered. I know that I do not matter, neither objectively nor subjectively, to others nor myself. Sorry for wasting time.

A: “Have the courage to live. Anyone can die.” This quote by Robert Cody gives us the starting place to unravel some of what you are telling me. You are going in two directions at once. This is like pointing the front wheels of a car away from each other and expecting it to move forward.

What I notice about your comments is that they are contradictions. You say, “Alcohol is not the problem,” then explain daily drinking, blackouts, and a hospitalization as a result. You want someone in your family to care, but then isolate yourself by going into your room. In effect you are telling them you want to be alone, then feel bad when they don’t call you to dinner. You describe the world as a horrible place, and there is nothing to look forward to, yet you are a vegetarian. I’m vegetarian as well, and what I know from being part of that community is that, at least at some level, vegetarians are about making conscious choices because they believe in something. That something is about the future.

You stop going to therapy and are surprised that it doesn’t work. If a therapist had followed up would you have simply said it was too little, too late? Perhaps. You are saying that you don’t matter to yourself, and that you don’t matter to others, but then explain how much your 5 little half-sisters, your half-brother, your mom, step-mom, and dad all mean to you.

At the core what a good therapist will help you see that you have become your own obstacle. You want others to care enough so you can improve, but then do everything to keep them away. To use your own words about therapy: I stop going because I know they don’t care. This means you won’t let anyone care. You’ve decided they can’t help, so you don’t let them, creating hurdles that become walls. Why you do this is the mystery, but if you give one a chance and some time, a good therapist might help you figure it out. Here is a list, and some suggestions in how to choose one. But you’ve already experienced three; you might want to consider returning to someone who is familiar with your story. In the interim the Suicide Prevention Hotline 1-800-273-TALK (8255), is a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress. You can also talk to someone here directly.

Your drinking is a problem. ANY therapist will tell you that, and that means dealing with it directly. Here is the link for Alcoholics Anonymous, AA, it is another way you are sabotaging yourself. There you will find caring support for you, but you are the one that must find the courage to change.

Finally, you say: I have no illusions about my condition, and I know there is no solution. If you believe there are no solutions there won’t be, and if you think you have no illusions how could anyone change your mind?

You didn’t think anyone would read the letter, but now someone has. I hope you use this as an opportunity to let a therapist, and the support from AA help.

Wishing you patience and peace,
Dr. Dan

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Last reviewed: By John M. Grohol, Psy.D. on 15 Mar 2010

APA Reference
Tomasulo, D. (2010). To be, or not to be–with a good therapist. Psych Central. Retrieved on December 21, 2014, from http://psychcentral.com/ask-the-therapist/2010/03/15/to-be-or-not-to-be-with-a-good-therapist/