Welcome to the current newsletter issue of
Advances in Medicine (AIM)- Take AIM against pain.
Feel free to send me an e-mail with your own thoughts
and experiences. Email: timsams@mypainreliefdoc.com.
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SUICIDE AND HOPELESSNESS
One of my patients, Angelica, lost her battle with chronic pain
this month. She died by medication overdose. We may never know
for sure if it was accidental or on purpose, but in my heart,
I'm pretty certain that she wanted to die. This is the third
person I've worked with in the past five years who lost the
battle to chronic pain. I am overwhelmed by the tragedy of this
loss, and the unerring belief that life could still have had
value for this troubled, delightful woman.
Most of the people I work with are depressed and anxious. Many
of them take medication for depression and anxiety. Most of them
have had at least passive suicidal thoughts, such as, "It
wouldn't be so bad if I just didn't wake up tomorrow."
What causes someone to go from passive to active suicidal
thought and then to make a life threatening attempt? In Chapter
27 of ABC's of Pain Relief and Treatment, I discuss suicide and
the concept of rational suicide which I support on moral
grounds. I commented that I realized that there were four
criteria I used that seemed to determine my mental and emotional
reaction to the suicide of a person in pain. 1) That suffering is
so intense in the present that the person does not want to
continue living. 2) That the person has done almost everything
possible in the past to decrease suffering. 3) That the
suffering will inevitably be as bad in the future. 4) That
suicide is consistent with the person's moral beliefs and common
decency. (A married man with no life insurance and two kids who
suicides because his mistress broke up with him, fails this
test).
These four criteria for rational suicide are similar to the
thought processes that most people in pain go through when
considering suicide. Almost inevitably, the person is
overwhelmed by numerous other intense stressors and losses in
addition to pain. The sequella of pain can be catastrophic as
well. Every year, I treat hundreds of severely depressed people
in pain who will never try to take their lives. Why not?
Because hopelessness, more than simple depression, seems to
drive suicide attempts. The belief that things will be as bad or
worse in the future and there is nothing I can do about it
propels suicide attempts. Hopelessness is the intersection
between chronic pain and depression.
Honesty compels us to admit there are situations in which
hopelessness about improving a situation may be logical and
accurate. An eighty-five-year-old man with severe chronic pain
and limitations, and no family or friends, whose loving wife of
sixty-two years dies, may decide down the road, "It's just not
worth it." It's hard to fault that logic or emotional pain. But
such situations are the overwhelming exception, not the rule.
I am not okay with Angelica's death. I am deeply and profoundly
saddened by her loss. I do not believe her situation was
hopeless or that she was doing everything possible to suffer
less. I do know that she was exhausted by the fighting, the
pain, and the loneliness. She was a deeply spiritual woman and I
can only hope that she is with her God now. Still, here on earth,
her death is a tragedy - for her family, her friends, and
everyone graced to have known her-a light snuffed out by the
breath of a bitter wind. The light of the world is forever
dimmed.
If you are feeling suicidal, talk to someone. On the home page
of My Pain Relief Doc (www.mypainreliefdoc.com) you can download
an article about hope or contact one of the pain psychologists
listed by area code. Talk to a family member, friend, or pastor.
There are people who do understand much of what you are going
through. We're all in this together. Feel free to reach out and
receive help right now. You can return the favour later.
Good light,
Dr. Tim
My Pain Relief Doc
http://www.mypainreliefdoc.com
Copyright 2006. Dr. Tim Sams and My Pain Relief Doc.
All rights reserved. http://www.mypainreliefdoc.com
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include the entire article, along with the web links
and copyright information. Thanks, Dr. Tim
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