Thank you Meghan Markle.  For speaking out. For all of us who have imagined that we’d be better off dead and for all of us who have crossed that unimaginable barrier and attempted to take our life. 

You made it clear through your actions that having these thoughts is acceptable, if not courageous to express that we are experiencing suicidal thoughts and the right course of action is to ask for help. And keep asking.

            Before the pandemic of COVID-19 took hold of this country a year ago, we were firmly in the grips of another deadly epidemic. Suicide. According to the National Institute of Mental Health, from 1999 to 2018, the total suicide rate in the United States increased 35%. In 2018, suicide was the tenth leading cause of death overall in the United States, claiming the lives of over 48,000 people.

            In the late 1980’s during my late twenties, I was diagnosed in quick succession with anorexia, major depressive disorder and borderline personality disorder (BPD). It was my second suicide attempt in 1990 that led to my diagnosis of BPD. According to the National Education Alliance for Borderline Personality Disorder (NEABPD), BPD is a serious mental illness that centers on the inability to manage emotions effectively.

I kept my first attempt made three years prior, a secret from everyone, including the therapist I was seeing at the time. One of the nine diagnostic criteria for BPD as stated in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5th Edition) is “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.”

            I would go on to make two additional suicide attempts, the third several years after the second. I didn’t make the fourth attempt on my life until 2014, eleven months after my father passed away.  I wasn’t grieving or mourning in the traditional sense. Filled with a lifetime of hoarded rage and resentment, I imploded, swallowing a bottle of antidepressants before the sun rose one morning that March.

            A study titled “Risk of re-attempts and suicide death after a suicide attempt: A survival analysis,” states that a history of previous suicide attempt is the strongest predictor for future suicidal ideation and behaviour, including suicide ideation, suicide attempts, and suicide. 

            I realized now that my father was gone, I’d never hear the words you are good enough escape from his lips. My brother and I had spent the last few years caring for him as he declined physically and cognitively,  Secretly, I longed to please him, but in the same way as when I was a child, nothing I did was up to his standards. With his death, I suddenly became furious. I felt cheated and abandoned. 

            Between the third and fourth attempts, in 2005, I started with a new therapist, Dr. Lev, who specialized in a form of treatment for BPD known as transference-focused psychotherapy or TFP.  TFP is a psychodynamically-oriented treatment that focuses on the relationship that develops or the transference between the therapist and the client. The premise is this relationship holds up a mirror to all the client’s relationships and by exploring negative patterns and gaining insight into how to improve them, other critical relationships in the client’s life will change.

This modality differs from DBT or dialectical behavior therapy.  I had the opportunity to participate in DBT at an intensive, immersive level immediately following my diagnosis of BPD. DBT focuses on the here-and-now, teaching coping skills in each of the four modules; mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.

            When I entered TFP with Dr. Lev, I signed a contract.  The last item was if I ever attempted suicide, she would do everything she could to save me, then end the treatment. My fear of losing her was enough to hold any attempts at bay, until that day in 2014, when nothing seemed to matter anymore.

            I’d been having suicidal thoughts for several weeks but didn’t want to be admitted to the hospital, so I remained silent. Meanwhile, the thoughts morphed into a plan and gathered momentum.  There have been times when severely depressed, my depressive episodes take on psychotic features and this became one of those times. I heard voices telling me to kill myself, that I was worthless, I was a burden and would be better off dead. Coupled with my silence, I put myself in a precarious situation. Dr. Lev was aware of my propensity for psychosis during a severe depressive episode.  

When I didn’t die, I ended up cabbing it to the emergency room hours after taking the overdose because I felt dizzy and nauseous. (I live alone.) I stayed in the medical hospital for several days until my vital signs stabilized and was then transferred to a psychiatric facility. After speaking to the staff, Dr. Lev agreed to meet with me after I was discharged to determine if we should continue to work together.

            She agreed to take me back and we worked together for another two years, through the end of 2016, a mutually agreed on termination date. She continues to manage my medication; I’m take antidepressants daily and will for the rest of my life as depression is hardwired into my DNA from at least two generations back on my paternal side.

            I’ve experienced  suicidal thoughts since leaving treatment with Dr. Lev.  Her door remains open for me to return for a booster session when I need to. I’m proactive about my mood. If I feel myself start to slip or become overwhelmed, I reach out because I know how quickly my thoughts can turn dark and deadly.

            A lesson I’ve had to learn the hard way. Four times.

            My hope is that Meghan Markle has set an example for all of us, for all ages. Suicidal thoughts can be frightening, but sharing them dissolves their power. There is hope, there is healing, there is recovery and the promise of a life worth living ahead.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at  800-273-8255, or text TALK to 741741 to text with a trained crisis counselor for free, 24/7.