Depression Understood Forums

I'm a man in my fifties in suburban California. I've suffered all my life from major depression, and autism spectrum disorder. (Some folk might argue I have Asperger's, but my medical professionals say the psychiatric sector is trying to move away from the term.) I've been in treatment since I was a child, and am versed in contemporary depression management methods such as DBT and CBT. My story is complex. For now I will distill it to the most essential elements.

~ As a white man between 45 and 55 years, my demographic (age/sex/race) is statistically the highest at risk for suicide. I am not suicidal today, but my circumstances could turn quickly to change that. When it happens (If, hypothetically it were to happen -- see below) I would have no-one I can talk to. I would have no psychiatric regimen in place. I would have no safe space free from persecution. This would put me at considerable risk. Add to this that since the new century, the suicide rate in the United States has only increased year after year. More and more Americans seem to work out this is not a good time to live in.

~ As of June 2019, I am out of routine therapy. My psychotherapist of over a decade has taken maternity leave and may not be back for more than a year or two. I'd like to get treatment locally (psychotherapist, psychiatrist, social worker) but location and insurance have been factors in my failure to do so.

~ A couple of years ago I moved from San Francisco to the my current residence in a rural-esque suburb. In the process of moving I lost my Medi-Cal, though not for want of trying to preserve it (and later trying to recover it). My Medi-cal state-appointed case worker does not communicate with me or answer phone calls. Dealing with bureaucratic institutions -- especially non-responsive ones -- present for me an extreme trigger risk. I need a social worker or benefits-advocate to get my insurance in order, but to do that, I need first to have insurance that a social worker or benefits-advocate would take. I have Medicare. That's it right now.

DISTRUST OF HOSPITALIZATION

~ I've been the victim of abuse as a patent in a hospital program. I've also heard stories from peers who have experienced abuse in hospital programs. Some of these stories are pretty extreme. I've consequently been motivated to research the phenomenon of institutional abuse of patients. There is very little oversight of mental health institutions with public transparency. Still, there is evidence that inpatient abuse within our hospital and prison systems is likely epidemic and systemic, and worker attitudes in interviews with hospital staff are consistent with an environment of systemic abuse. Were I to surrender to detention in a hospital, I would be at risk of abuse again.

~ And yet, this is the common solution the US psychiatric sector relies on when confronted with persons who present as a danger to themselves and others. When professionals are alerted to someone in suicide risk, they are obligated to report, which can lead to involuntary commitment, which incarcerates victims in a prison that can be worse than death. As our law enforcement has militarized, as our penal state has involved more and more private prisons, this situation has only become worse.

~ Consequentially, I will never report as a suicide risk or as a danger to myself or others. I will never report anyone else, even in the role of a peer-support person, as a suicide risk or in danger of self-harm or harm to others. The US mental health system has betrayed me, and I will not expedite its betrayal of other human beings.

~ Over fifty percent of police-involved slayings in the United States are victims of mental illness (or were before they were killed). Sending the police to manage a suicide serves in the twenty-first century as a means to facilitate the self-termination.

PLAN OF ACTION

~ In this moment, as I write this, I'm not suicidal. I am rational and I am not a danger to myself or others. However all this could hypothetically change at any moment, say if I were exposed to an unlucky run of triggering events, or my life were to suddenly become destabilized by state action or natural disasters. Under the supposition that I ever did become at risk of suicide, I would have no social resources that I could trust not to ultimately call on authorities to intervene, which would increase the risk my situation would escalate. My problems would resolve, but I would become someone else's mess to clean up.

~ I need a plan of action. Something that I can do when there's nothing I effective I can do. I need someplace to go when there is no place safe I can go to. I need people I can talk to while I have no one I can trust. I have no idea when next I am going to have professional help. And I have no idea how next my life is going to come apart, and how I'm going to manage it.

As you have acknowledged, it is important to have a plan of action in place in the event your situation changes.

It is a shame you’ve had bad experiences and the resulting distrust with hospitals and the mental health system.

Ideally, it would be great to have a plan of action in place. In my experience, however, I found that, besides hospitalization, I didn’t have one. Depression can be such a lonely and isolating existence.

I hope you can establish some plan of action. I am not sure how one goes about it, especially if you distrust the system in which nobody can blame you after what you’ve experienced.

A lot of the strength and plan of action will probably need to come from you. That is often the reality of the situation—at least it was in my case.

Perhaps build up a support network. Friends? Family? It is hard when you don’t have trust. Maybe trust is something you can work on building again lest you become more isolated than you already are.

I was fortunate to know a psychologist and therapist when I moved out of home at fifteen and into a youth accommodation service. So I got consultations whenever I needed them.

I should actually track them down to give my gratitude for donating so much of their time in attempt to help me. At the time, I just assumed free consultations were the norm :facepalm: I will forever grateful to them, and I need them to know that. I only just realized this fully after reading and responding to your post.

However, I spent more years depressed without therapy than I did with it. During these non-therapy periods, I ended up giving myself therapy, typically via self-help books. You may find self-help books useful in shaping your mindset and possibly lowering your suicidal risk.

In my case it did help, albeit to a limited extent. Although the Bible is now the only self-help book I need, at the time, those man written self-help books were valuable and saved my life in many ways. The books made me feel less alone. They gave me motivation, and hope of a better future. They gave me the strength to live one more day... and another... and another.

It helps to be resourceful, self-reliant, and open-minded so that you can find what works best for you to overcome depression or even just life problems in general.

You mentioned you have been in therapy since you were a child. That is a long time in therapy and just seems odd to me. But you did say your story is complex, and I'm aware there are people who receive lifelong treatment, including synthetic antidepressants. Or, perhaps, it is time to venture out and try other alternatives to get real, lasting results... just a thought.

This forum might be a good starting point for you. Hopefully more members will respond and you find people on here you can talk to.

I should clarify I didn't spend all my years in therapy. My treatment was intermittent for years at a time but pervasive through my life. I do better when I am in routine therapy. It's one of the factors I miss from San Francisco. The city welcomes non-profits that provide services or connect patients to those who do. But yes, as a kid I was already pegged as someone who was odd / sensitive / highly intellectual and our understanding of autism wasn't as robust as it is now. I took sessions with school psychologists and later specialists. It was the 80s (before the psychiatric renaissance of the 90s) and so the methods were blunt and harsh.

The alternative I relied on when not in weekly sessions -- again, much easier when I lived in San Francisco -- was to attend support groups of which twelve-step is a subset. Even when my own issues didn't match the topical affliction, it was a place to process and maybe find other groups. To be fair, I haven't looked up the recovery sector here. This town is far less populated and its public transit is scant, but I might get lucky if a support group is commutable without hardship.

Self-help books are a toss up. There's a lot of them in print and scant few of them are useful. High on my did actually help list was The Depression Book (Amazon) which is not about recovery but utilizing the struggles of mental illness as a path to spiritual awakening. It has a lot of the same self-awareness exercises that are used in DBT, and my practices from it served later when I went into DBT training and support groups. I'm happy to see that more recent books focus on practical day-to-day coping rather than trying to push suffering-through-the-hidden-trauma rhetoric.

Sacred books are problematic as they require a lot of interpretation especially to apply them to modern (post-feudal) societies that recognize modern ethics and human rights, and there's a lot of disagreement. Just as I cannot trust psychiatric institutions (which are supposed to have oversight but don't), I can't trust religious institutions either, as they never have had oversight in the United States, and to the last, all the large churches have become self-serving, having long taken for granted the draw of the laity. (Exception: US Federal law enforcement is actually quick to investigate and persecute NRMs for fear they will become dangerous cults. But I'm not looking to join an NRM, culty or otherwise.) But, the rise of prosperity gospel, the prioritization of persecuting women and LGBT+ and women over the traditional wars on hunger and poverty are demonstrative of how Pournelle's Iron Law of Bureucracy applies even to churches. Even Jesus had a bit to say about that, at least while he was still alive.

One of the drawbacks of being a naturalist and a devotion to facing uncomfortable truths is the realization there is no safety net. Not by divine grace but sheer luck (and a state that, in fact, believes in at least a modicum of socialism) I have stayed afloat this long. I have no security that God's hand will catch me if I fall through the cracks, which is why my current partially-insured state is a stressor difficult to manage. It doesn't help at all that our current administration in the US and social trends here and worldwide are responding to fears of scarcity. We're looking to purge our undesirables starting with most recent immigrant. When we start packing the cattle trains in earnest, nut-jobs like myself are not far down on the list of persons to be purged.

But still, yeah, in writing this, I recovered a vector I can still look for support. I appreciate you writing me back, Spleefy. I was worried what I wrote might be too dry to slog through, or that I had already ruled out all the available troubleshooting options. It turns out I had not. And yes, hopefully I can find a welcoming and useful community here.

i'm not yet in a place where i feel i can give advice or guidance, but fwiw i'm rooting for you.

Well, this effort was short lived. Got notice today from the HHS that my medication insurance is discontinuing January 1, 2020, which means I won't be able to afford medication. And that means it's questionable whether I'm going to survive to February 2020.

I suspect by then I'll be ready to self immolate in front of a government building. These days they don't really get messages, but I won't really care after the fact.

I'm getting really tired of living in a nation day in and day out that gives zero fucks and wishes guys like me would just disappear. Well, soon they're going to get their wish.

TotallyNotABot wrote:Well, this effort was short lived. Got notice today from the HHS that my medication insurance is discontinuing January 1, 2020, which means I won't be able to afford medication. And that means it's questionable whether I'm going to survive to February 2020.

I suspect by then I'll be ready to self immolate in front of a government building. These days they don't really get messages, but I won't really care after the fact.

I'm getting really tired of living in a nation day in and day out that gives zero fucks and wishes guys like me would just disappear. Well, soon they're going to get their wish.

Man, please don't kill yourself. I know how tempting it may seem but it's not worth it. Maybe move out of California to start? That state is a shithole and only getting worse by day.