Magazine article Family Therapy Networker

Bearing the Unbearable: Learn to Adjust Your Perception of Pain

Magazine article Family Therapy Networker

Bearing the Unbearable: Learn to Adjust Your Perception of Pain

Article excerpt

The mind is its own place, and in itself Can make a heav'n of hell,

a hell of heav'n.

                               --John Milton

"Why did he have to do it?"

I had just learned that John, a friend and colleague, had taken his own life, leaving a wife and 4-year-old son behind.

As I listened to our mutual acquaintances express their grief and anger over John's "selfish act," I realized that I was in no position to judge my friend. Just two days earlier, I had come within a hairsbreadth of taking an overdose of antidepressants and tranquilizers and washing them down with a pint of vodka.

Last year, John and I were just two of the 15 million people in the United States suffering from clinical depression--the most diagnosed mental health disorder in the country, and the most lethal. According to the National Institute of Mental Health, 15 percent of those afflicted with a major depressive disorder who are not treated (or who fail to respond to treatment) will end their lives by suicide. This is 35 times the normal suicide rate. People with serious illnesses, such as cancer and heart disease, do not kill themselves in large numbers; depressed people do.

Many theories exist about the motivation for suicide. Freud postulated a death instinct. Others have suggested that humans are endowed with "a drive to destruction." But to anyone who has experienced suicidal pain, the explanation is so simple, so self-evident, that it requires neither psychiatric nor psychological jargon. Death is chosen because suffering is so acute, so agonizing, so intolerable that there comes a time--depending on the individual's tolerance for pain and support available--that ceasing to suffer becomes the most important thing. This "aggregate pain model" of suicide is supported by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV ). In its section on major depression, the manual says: "It is not possible to predict accurately whether or when a particular individual with depression will attempt suicide. Motivations for suicide may include a desire to give up in the face of perceived insurmountable obstacles or an intense wish to end an excruciatingly painful emotional state that is perceived by the person to be without end."

To one who has not experienced the torment of a clinical depression, it is hard to put this pain into words. It cannot be described as stabbing, shooting or burning; neither can its sensations be localized to any one part of the body. It is an all-encompassing malignancy--a crucifying pain that slowly permeates every fiber of one's being. Falling prey to a depressive illness is not like being gored by a bull; it is more akin to being eaten alive by an army of starving termites.

In the midst of my depressive episode, coping with such unbearable pain became my central task. Each day felt like an eternity as I struggled to stay alive in the face of overwhelming feelings of hopelessness and despair. In this context, I saw suicide not as an act of self-destruction, but as an act of self-love.

It was then that I had the good fortune to meet a social worker who helped me see my predicament in a new light.

"Suicide is not chosen," Judy said emphatically at our first meeting. "It comes when the emotional pain exceeds the resources for coping with pain."

While speaking, Judy sketched a picture of a scales, with pain on one side and coping skills on the other, to illustrate her point.

"You are not a bad or weak person," she continued. "Neither do you want to die; you just want to end your suffering."

I nodded in agreement.

"Your problem is that the scale is weighted down on the side of the pain. To get that scale back in balance, you can do one of two things: find a way to reduce your pain, or find a way to increase your coping resources."

In the weeks following my conversation with Judy, her image of the scales haunted and obsessed me. …

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