[arkades]

We don't throw anyone in jail for being suicidal. We don't throw people into psych hospitals unless they're at imminent risk of successfully committing suicide - we don't do admits just for suicidal ideation. One of the first things you learn, even as a med student, is how to distinguish between "this person needs help" and "hide the sharp objects." That said, some patients are in the "hide the sharp objects" zone - and they get hospitalized to make sure they don't die.

You are creating an exaggerated worst-case scenario that, luckily, means you don't have to change or risk vulnerability or anything. Unluckily, your safe space sounds like a pit of shit. Depression will do that to you.

Please reach out to a professional & get help. You'll be shocked how much better you can feel in just a few months.

[ThrowawayP]

> "We don't throw people into psych hospitals unless they're at imminent risk of successfully committing suicide - we don't do admits just for suicidal ideation."

Right, which still means that the patient has to very carefully manage what they say. If they are prone to exaggeration, colorful metaphors, or are feeling just absolutely miserable enough to say something they don't really mean out of pain or anger, they may spook the clinician into putting them into an "psychiatric hold" (e.g for California: https://en.wikipedia.org/wiki/5150_(involuntary_psychiatric_...) which can last 72 hours or more. Remember, just like half of developers are below average, so are half of clinicians and you won't know which is which until it's too late.

All of this is not to say that people suffering from mental illness shouldn't seek treatment. Just know what you're getting in to and how to get out of it if need be.

[arkades]

Exaggeration, colorful metaphor, and feeling miserable enough to say something are all different things, and aren't what we look for.

Except that last one, because that last one actually correlates with bad outcomes.

You're warning people to "know what you're getting into," but clearly have no idea what you're talking about. You may have experience with this, but clearly not from the clinician's side.

Let me give you a real example:

We look for /actionable/ ideation. You'd be amazed how many patients, expressing suicidal ideation, say something like "Oh, I'd just walk into the ocean and drown." Or, "I'd jump off a mountain and die" (living nowhere near a mountain). Etc. They express unrealistic or unachievable means of committing suicide that exhibit a pre-occupation with "dying", but not the process of death. Ceteris paribus, this is a reasonably low-risk person.

Other folks, far less, say something like "Oh, I'd take a gun and shoot myself. My dad has one in his closet." It's realistic, it's achievable, and he could do it in an impulsive moment - that person is a real risk.

(Caveat: these are obviously artificially constructed sentences to illustrate the variable under discussion. Please don't nitpick the exact wording/presentation in bad faith. Patients never spit out in one sentence "Oh, I'd take a gun and shoot myself, that one my dad has on his top shelf at home." )

Note that from the various speculation people have thrown out on this thread, not one has mentioned concrete achievability. Because, shockingly, people coming up with catastrophes about why they shouldn't seek help are really not the best sources of information about what care actually looks like.

[watwut]

I knew a guy who threw computer out of window, was threatening to jump out and was noisily destroying the place (he was not owner). This was triggered by his girlfriend running away (literally running away, he made just leaving impossible). Their friends called cops who came along with mental health professionals and took him to psychiatric hospital.

He found the whole thing massively unfair. See, according to his words, he did not really wanted to kill himself, merely show her how much he suffers and make her go back to him. According to him, she should go back due to threat, but everyone else should instantly see through it and be ok with it. He would tell anyone who would listen like the whole city is unfair and overreacts to every little thing.

So yeah, it can end up in jail or hospital from point of view of suicide threatening person. And sometimes there is good reason for it. In this case, it had also aspect of protection of everyone else in the building including his girlfriend.

[arkades]

Thank you for giving a real example. I appreciate that - it gives an opportunity to highlight a couple of aspects that people keep obliquely referring to.

1) This didn't end with him going to jail, right? Which is to say, the guy who was engaging in violent and destructive behavior was directed to medical care, rather than wrongly being deemed as case that was simply in need of punishment. That's a good outcome. Sick person breaks the law as a result of their ailment, gets identified as sick, and treated as sick rather than a criminal is kind of the ideal outcome, short of preventing their deterioration to begin with.

2) If he had gone to jail, it wouldn't have been because he went to a therapist and admitted to thoughts of self-harm. It would've been because of publicly engaging in acts of destruction.

"2" really is the part that leads to mentally ill people ending up in jail. My psych unit sees people with a history of jail time all the time - and it's almost inevitably due to possession of illicit drugs, loitering, petty theft, or snowballing offenses that they don't go to court for and handle like "responsible citizens." There's a real relationship between mental illness and jail, but it's not "we send people to jail for being depressed."

It's more like, "got a ticket, didn't go to court, ignored the follow-up letter from the county courthouse, ended up with a bench warrant, and if they weren't so depressed, probably would've just taken care of it all up front and never let it snowball." Or, "hated my meds, started self-medicating with weed and liquor, pissed off my housemates to the point that they called the cops, who found my weed stash." Etc.

[watwut]

1.) No, he did not ended in jail and was never charged as far as I know. I think it was more because nobody bothered. The story is however much longer, unfortunately for multiple people.

His girlfriend helped him to get out of hospital, because she felt sorry for him, but was less loving to him after (his words). Violence continued as they had to live together as the dorm did not allowed changing living arrangements mid year.

He was violent to next girlfriend too and harassed her after she escaped. He was homeless for a period of time.

2.) Absolutely correct.

[mewpmewp2]

I don't feel like I have had much or enough help from therapy or drugs and I've been on both of them on and off for more than 12 years now.

Whenever in therapy it seems that I always try to argue against any advice given. Same online, so I guess any advice given to me I would try to oppose it, but I'm still telling about this and hoping for an answer or solution, because what else can I do. My mind only tries to find flaws in what the therapists say. I either say it out loud and keep saying it until I frustrate therapists or I keep it in my head and think those thoughts silently. I don't know how to just accept the advice. Same with social situations where I just keep silent, so I hate them too and try to avoid as much as possible in life. I either zone out or I try to find something wrong with what they are saying, but obviously not mentioning it. Maybe it's because I'm envious of their knowledge so I have to somehow find errors in them so I wouldn't feel bad about my lack of social performance/knowledge/wittiness. A lot of times maybe I purposely misunderstand rather than give benefit of the doubt in my mind, because possibly I really want them to be wrong. So all in all it occurs to me that not only am I less knowledgable than most people, I also have a terrible personality. Once again why I keep quiet, because showing it out would only sabotage my career, life etc.

And whenever I try to follow advice I have never had it work, I'm not sure if it's due to my own negative attitude regarding the advice, maybe I'm not following it properly or maybe it's just brain chemistry. But in a way where currently available anti-depressants won't affect it positively.

For instance, observing your thoughts from distance or trying to reframe them. Observing from distance - how long do I have to do that to make it work? It still doesn't kill the depression, frustration and anxiety. Reframing the thoughts has never worked since I don't ever believe the reframes and this always leads to existential crisis. If therapists suggests a reframe I will keep arguing it until it reaches "meaning of life" point again.

Another thing is sleep. I hate falling asleep. Even if I do it seems like I wake up too early. I feel like I have tried following all the low hanging fruit advice such as exercising every day, use melatonin, hot baths, whatever common tips I have found. I do running (6+ miles), go to gym every other day. I feel like I don't progress a lot, and I'm afraid because of my shitty sleep. If I take Ambien I will wake up in 4 hours, because that's how long it lasts, so it can't just be some shitty sleep hygiene either if I wake too early after falling asleep. I think I just feel disgusted about sleep and it seems that it affects any progress I'm trying to make as well. Probably affects my gym and running results, my cognitive performance - maybe that's a cop out since I'm not happy with my cognitive performance and blaming it on sleep allows me to believe that maybe I'm not cognitively as poor as I seem to perform currently and that I actually have potential.

[sergeykish]

I've never tried therapy but this looks familiar.

When I was trying and failing one more advise was too much. I had to step back, find peace with myself. It is hard. General idea is to get all the grief buried inside and release it. To find a path to unbury I sing. Without words. Like lullaby, moan, chant, whatever. It had to be sincere. Up to the point I would not not like accept that it is from me. Kind of meditation, clear state of mind like when running but it can sustain much longer - hours every day. In that state bad memories rise. Sometimes I groan, but generally search path to regret, to forgive myself and the cause of the problem. Walking and singing like there is a light at the end of the tunnel.

It is opposite from changing myself (reframe) - not manipulate inner world but trust it. I found it after started rollerskating, then dancing, then playing drums and harmonica. These skills and music especially build from inside.

And I believe this knowledge is ingrained in culture. I am not religious but I believe Church got it right. It teaches how to give peace of mind. Forgiveness, rituals, confession, community, singing, sacred place. Christian Gregorian Chants, Islam Quran Recitation, Afro Cuban Santeria.

Sleep. It is hard to sleep with alert state of mind. I had a luxury to take three years break from work. Getting back I had to accept needlessly stressed environment. Singing for hours after each working day. Ah, and who needs forgiveness the most is the body which is vessel for such pour soul.

Hope it helps

[arkades]

> Whenever in therapy it seems that I always try to argue against any advice given

You're not unique in that. There are a lot of patients that will fight against advice, tooth and nail. Sadly, we aren't very good at helping those people. That's part of why a lot of docs lead with meds and then therapy - the meds tend to get people into a position where they're more "oh, shit, I was thinking/feeling that?! That's not healthy!", so they're more open to what occurs in therapy.

But a decent therapist should focus on guiding your understanding, but eliciting "advice" from you to yourself, rather than providing their own. It's akin to motivational interviewing.

[rjbwork]

Have you tried a sleep study?

I don't have a miracle story, but I've read a number of others'. Many people's live are nearly immediately improved after a sleep study/breathing study is done.

[mewpmewp2]

I have, I snore a lot, so there's issues there, no apnoea, but this won't help with falling asleep - why I use Ambien. Although I'll try to get off it now.

And if I wake up I can't fall asleep again - unless I take more Ambien.

[Ditiris]

Have you tried trazodone?

[sfj]

> We don't throw anyone in jail for being suicidal. We don't throw people into psych hospitals unless they're at imminent risk of successfully committing suicide - we don't do admits just for suicidal ideation.

Who is this "we" you think you speak for? You may be right about what people are supposed to do, but people, even professional therapists aren't perfect. It all depends on the individual therapist, how they interpret what they've been taught, what you say to them, and how worried they are that if they don't do something you may commit suicide, and how that will look on them.

Some are very self centered just as everyone else, simply wanting more and more patients to earn a paycheck, so they will drudge up whatever they can to make you feel miserable, and get you hooked on psych drugs, all to try and get you to keep seeing them.

> Please reach out to a professional & get help. You'll be shocked how much better you can feel in just a few months.

I'd say don't do this. I've tried several therapists, one for over a year, and each session inevitably became a bout of very depressing intense navel staring.

I felt a lot better after getting away from all the self-help crap and developed interest in things outside of myself.

[arkades]

> Who is this "we" you think you speak for? You may be right about what people are supposed to do, but people, even professional therapists aren't perfect.

I can't argue about the variation in quality of practitioners. However, in every state I know of / have practiced / have worked in, involuntary holds get a lot of scrutiny. Docs are given the benefit of the doubt, it's true, but it's a far cry short of "better to cover my ass, let's admit." People are, in general, careful when they know they're going to be getting second-guessed. Additionally, admitting psych patients is generally a losing proposition for hospitals, monetarily. They're expensive, and tend to take up a lot of square footage. Docs are getting second-guessed by hospital admin, too.

As a sidenote: your average therapist is a social worker, not a physician, or even a psychologist. They don't admit anyone anywhere, and in most states can't do involuntary holds. Unless you're about to slit your wrists in front of them, the most they can do is make a suggestion, or call your psychiatrist and make a suggestion. If they do think you're an immediate risk to yourself, they call 911 ... who will take you to the hospital, where a psych will give his opinion.

> It all depends on the individual therapist, how they interpret what they've been taught, what you say to them, and how worried they are that if they don't do something you may commit suicide, and how that will look on them.

The proportion of depressed patients to inpatient psych beds is "a gazillion to one," in particular since funding for inpatient psych got gutted a couple decades ago. If you think the average psychiatrist, never mind the average therapist (not the same thing), can land every patient into a ward because "well, what if they mean it?"... I don't know what to tell you. Even the psychs I know that are trigger-happy are the kind that don't admit the vast majority of the time.

I admit that there's more trigger happiness in pediatrics. Kids, IME, are more likely to harm when they don't want to, to prove that they're Really In Pain. Their attempts are less likely to be "genuine", so to speak, so folks tend to be less confident of saying "Well, this doesn't really seem like someone that wants to die."

> Some are very self centered just as everyone else, simply wanting more and more patients to earn a paycheck, so they will drudge up whatever they can to make you feel miserable, and get you hooked on psych drugs, all to try and get you to keep seeing them.

Psychiatrists don't want to chat with you often. They will diagnose, prescribe, recommend a therapist, and see you once every 3 months once you stabilize. They don't want you to keep seeing them and, given that demand >> supply, couldn't care less if you stopped. Ideally you stop because you've gotten better, but either way, they'll fill that slot in their schedule pretty quickly.

Therapists - again, usually social workers - can't write prescriptions. Their livelihood does depend on you coming back every week. They will not addict you to anything and, if you were on meds, it wouldn't tie you to them.

Yes, they are likely to make you miserable. You're there to talk about shit that makes you miserable. If they're good, that goes double - many personality disorders are essentially "my developed pattern of dealing with things that make me feel bad is ultimately self-destructive." Addressing that involves changing "my developed pattern of dealing with things that make me feel bad." That's short-term highly aversive - that's your tool for avoiding feeling bad!

Bad therapists still navel gaze about things that make you feel bad, only without therapeutic benefit.

There's a shit-ton of bad therapists. That's more due to the fact that, like we're doing in other realms of medicine, we've decided the best way to address the shortage is to put it into the hands of woefully under- or un-trained people. Good therapists are, as a consequence, rare and comparatively very expensive (cost of a doctor's time for an hour, vs. the four simple drug visits he could have made instead vs. the cost of a social worker for an hour - yah, it's expensive).

Any reasonably mediocre therapist would have told you to "develop interests in things outside of (your)self". Therapy is like coaching: good therapy is figuring out what you need to focus on, and showing you how. You still have to go out and do the exercise.