When You Can’t Trust your Mind, Listen to your Body: Lessons from the Lines


photo for lessons from lines_sisAdapted from a previously published article titled “The Four Noble Truths of Suicide Prevention” in Turning Wheel: A Journal of Socially Engaged Buddhism.

Three weeks ago, Joseph set himself on fire, figuring that if he didn’t die, at least the hospital would supply him with enough pain killers to try another way. This was his second suicide attempt and his first time calling the Suicide Prevention Center. He kept apologizing for wasting my time. “I don’t know why I called,” he admitted, “the truth is—I don’t feel much like talking.”

I was a volunteer Crisis Counselor and had been trained to respond to the needs of each caller, but I didn’t know what to say to Joseph. None of my techniques helped him, and he already had access to medical and psychiatric support, so I didn’t need to look through my books for resources. His sister kept a watchful eye over him and had given him our phone number because she, too, didn’t know what else to say. She had caught him in the backyard holding the edge of a blazing matchbook and lighting the perimeter of his t-shirt. She threw a blanket over him and put out the flames immediately, but not before some skin loss on his arms and abdomen.

“I was in a trance when I did it,” he said. “What’s wrong with me? Who does that? What’s wrong with me?”

When we started the volunteer training sessions, I wondered if I’d make it through to the end. My sensitive nature makes me empathetic, but also easily overwhelmed. I was relieved—and initially surprised—to find out that I could serve as a witness and a resource without absorbing other people’s pain. When I left the Center at the end of each four-hour shift, I was usually able to leave the callers’ circumstances as well.

But not Joseph. I couldn’t stop thinking about him. I kept imagining him in his backyard, cringing at the thought of his burnt flesh. I felt his sister’s alarm when she saw her brother with that matchbook. It made me sick inside.

two_candles_250I was admittedly fascinated by Joseph, perhaps because he attempted the one method I had always rejected. When I was suicidal, I considered just about everything except setting myself on fire. The goal was to bring an end to my pain, not create more—and besides, fire just scared and mystified me. I’d burn candles in my room and stare at them. Where did the wax go? It just vanished into the air. I didn’t want to vanish; I wanted transformation and liberation—a confrontation with life itself. I considered taking poison or pills, cutting my neck or wrists, hanging myself, jumping off a building, driving off a cliff, driving head-on into another vehicle at top speed, provoking a police officer until he had no choice but to kill me, and shooting myself. All this made me a lower risk than someone who had settled on one method and had a plan to enact it. But I didn’t feel like a low risk. I thought about suicide almost every day during my teens and early twenties.

I understood callers and never judged them because I was one of them. Well…almost. I didn’t dial any numbers. My sister was the one who picked up the yellow pages and called the Suicide Prevention Center.  She knew I was suffering and didn’t know what to do about it. She shoved the phone into my hands as I tried to push it away.

“No!” I shook my head and refused to look at her.

Talk to them!” she demanded, and pushed the phone past my hands and into my lap. She left it there and went to sit on the bed. Her big, hazel eyes were open wide.

heart_cord300“Hello? Is anyone there?” I could hear the counselor calling out to me.

“Mm–hmm.” I wouldn’t open my mouth.

“Are you thinking about killing yourself?”

NO,” I said, to the woman on the phone as I glared at my sister from across the room. I think they both knew I was lying. But I wasn’t ready to confess.

I wanted to unclench my jaw and unleash my pain. I wanted to say YES, I am thinking about killing myself—all the time. YES, help me. YES, I am lost and confused. I closed my eyes and could feel my thoughts extend like radii from the center of a circle with no circumference. A vision of worldwide prayers intersecting in infinite patterns flashed through my mind: Who am I? Will I always feel so alone? Why was I born? Do I belong here? What should I do?

I knew I wasn’t the only one asking those questions. Or the only one who doubted the value of her own existence. Here was evidence: a hotline just for us. But I was still judging myself. How can I complain about my meaningless life when there are people starving in the world? When there are little girls sold as sex slaves? When there are boys with guns and soldiers at war? Torture and abuse and terror?

Now I know it’s not a contest. My private pain helps me understand human pain. I understood Joseph’s question, because I used to ask myself the same thing: what’s wrong with me?

Like Joseph, I couldn’t trust my own mind. It was sending me the wrong messages: I’m worthless. I’ll never be good enough, and I’ll never contribute anything important to this world. I don’t deserve to live.

On some level, I knew none of these things were true, but when your own mind tells you ugly things again and again, they become more convincing than evidence from other sources. I had to retrain my own mind, and while doing so, I decided to trust my sister—not myself. Or I should say: not my mind. Because my body told me something else.

It was a family dinner. Not my favorite—boiled hot dogs. I was playing around with my sister and for some reason, ate a bite of food and ran down the hall into the bathroom, laughing. The hot dog got stuck in my throat and I started to choke. I couldn’t swallow it or spit it out, and I couldn’t breathe. My sister called for my parents when she saw my face turn bluish purple, and then she passed out. My dad turned white.

I saw myself in the mirror and thought Oh my God, this hot dog could kill me! My lungs tried so hard to find air. My stomach heaved and tried to expel the obstruction. My eyes watered and my arms went numb, as if to donate any available energy or blood. I panicked and froze, but my body clung to life and fought for it.

My mom grabbed me from behind and did the Heimlich maneuver, and that piece of hot dog came flying out across the room. I coughed and cried and was so relieved. Not being able to breathe made me respect life so much more. I was young when it happened, but the memory stayed with me.

When I was on the phone with Joseph, words kept getting stuck in my throat and I knew I wasn’t helping him. He kept mumbling: what’s wrong with me?

As much for myself as for him, I asked if he was open to a suggestion. I was out of other ideas.

“Sure, what the hell.”

“Will you take a moment and just breathe with me?”

I asked him to inhale slowly through his nose and allow the breath to touch the place in his body that hurt the most. “Let’s do it together,” I said.

On the first exhale, he burst into tears. He cried for at least four minutes without pause, and my heart rate increased as I started to worry—was my request inappropriate? Did I overstep my role as a volunteer? What would I say to him now? Am I making this worse for him?

Suddenly he stopped and said, “Goddamn. I haven’t cried since I was a kid. Thanks.” Then he hung up.

This was not a typical call, in part because I had never asked someone to breathe with me before, and in part because there’s no such thing as a typical call. Each combination of caller and volunteer was unique. We were free of the limits and future needs and fixed expectations of most relationships. Because we were not parent and child, student and teacher, husband and wife, doctor and patient, we could remain simply: two people on the phone. That allowed for a great deal of freedom and a different kind of listening.

I tried to pay attention to subtle cues for how to best address each caller’s different needs, but started every call with the same question as all the volunteers: what’s going on? Nobody started a call by asking: How are you? Probably not so good if you just called a suicide hotline. Besides, everybody answers that question the same way. I’m fine; how are you? Even when we are not at all fine. Even when we could care less how the other person is doing. I’m fine; how are you? It’s like an out-of-office auto-reply we shoot back unconsciously. As a counselor, I wanted callers to know that this will not be a conversation like all other conversations. You don’t have to be fine and you don’t have to pretend. So tell me: what’s really going on?

It’s the question I always wished my parents had asked me. They did try once. My high school counselor contacted them after he read my suicide note. I had given it to a friend who promptly took it to the office. I was a straight-A student who rarely missed class, so when Mr. Alpert found me sitting in my car in the school parking lot in the middle of the day, he knew this was no joke. I was in the driver’s seat of that big, blue ’83 Buick Regal—my mom’s old car—wishing it wasn’t such a sturdy vehicle because it might protect me if I drove it off a cliff. I found two mountain roads that lacked streetlights and guardrails. Perfect. But what if I just ended up mangled—and alive—in the Regal? I started to think about how I could get my hands on a gun. I studied myself in the mirror, tilting my head this way and that until I found the best entry site for a bullet. I knew a lot of other kids in Los Angeles had access to firearms, and I had access to some of those kids.

That day in the parking lot, the Buick was my only option. I was gripping the wheel and crying, thinking, now you have to go through with it because everybody knows. You are so stupid. You deserve to die.  Mr. Alpert opened the car door, knelt down next to me and looked into my eyes. I looked away, but I knew he could still see me.

My father, too, looked into my eyes and wanted to know if I was ok. I folded my arms across my chest as usual. “I’m fine,” I said. We both wanted to believe it, so that was the end of the conversation. I was not fine.

I split myself in half when I lied to my father. I continued to drag my body to school, but my mind was somewhere else. Perhaps to signal this divide, I altered my appearance by bleaching half my brown hair orange, and using thick, black eyeliner and dark purple eyeshadow when my parents weren’t around to see it. I put safety pins through my earring holes. I wanted to be perceived as wild, and punk was in style. But inside, I longed for order.

Chaos in my own life felt intolerable, but at the hotline, chaotic calls were my favorite. It’s not that I took delight in the struggles of other people; rather, I was fascinated by the manifold expressions of the human mind on those lines, and I was utterly impressed by anyone who could pick up the phone and ask for help, something that took me years to learn. I also found that callers who were severely mentally ill often made the most astute, even creative psychological observations. It was like a treasure hunt to find clarity through their chaos. One of my most memorable such calls was one of my first. Dave was 46 years old, and distressed because his father died. But then he said his father was sitting next to him on the couch and wanted to speak with me.

At first, I just tried to get his story straight. He said he was upset with his son, but when I asked why, he became irate and yelled, “I have no son! You are just like everybody else and you don’t understand!”

I gave up on the family dynamic and instead asked him, “If you could change one thing about your life, what would it be?”

He became gentle and whispered, “I wish I was born taller. Then maybe people would have treated me with more respect.”

Dave’s story was incoherent, but his desire was clear—and as misguided as my own initial answers to that question. Dave and I both obsessed about things we couldn’t change. I wanted to bring my dead boyfriend back to life. I wanted to snap my fingers and be a different person. Not so vulnerable.

I am stronger now, but I still have a highly sensitive constitution, and probably always will. This is something I have learned to accommodate, not change. It’s a lesson I learned from all the callers who wanted to change something unchangeable. I heard a lot of it: “I wish I didn’t have that back surgery—the pain is worse now…I shouldn’t have cheated on my wife—it wasn’t worth it…I wish I was never born.”

planting_hands300For those of us who already suffer from repetitive, obsessive thoughts, this approach just fuels the spin cycle. To find a way out of it, I started asking people to name one thing that has brought them relief in the past. Just about everybody named something simple: playing guitar, walking in the park, taking a bath, petting the dog, exercising, calling a friend, getting a massage, cleaning the house, watching the sunset, planting flowers, getting a manicure, shopping at the farmers market, cooking a new recipe. Embodied activities gave us all something to do, which is an enormous relief for people whose habitual approach is to think instead of act.

Sometimes, I got stuck just like the callers. There were a lot of conversations that started like this one:

Me:                  What’s going on?

Stephanie:        Nothing.

Me:                  Why did you call today?

Stephanie:        I don’t know.

Me:                  Is there anything you feel like talking about?

Stephanie:        I don’t know.

Me:                  Stephanie, are you thinking about suicide?

Stephanie:        (long silence and a sigh) I don’t know.

That call was frustrating. Stephanie was shut down, and I was scared that any push in the wrong direction—or too much silence—would make her hang up the phone. I wanted to snap her out of it and ask, “well, what DO you know?” But I knew that sometimes, a blank, emotionless caller was often more at risk for a serious attempt than someone distressed or argumentative. The ones wrestling with their pain are usually still in the fight. The ones who are too calm may have crossed over into resolution.

Because Stephanie’s words offered no cues or signals, I started to think about her body. Maybe there was something more alive, more accessible, in the form of sensation, even if it was pain. I asked, “Stephanie, where are you calling from?”

“I’m at home.”

“And where are you now? Which room?”

“I’m laying on the couch,” she said, “in the living room.”

“Will you do me a favor?”

“What kind?”

“Change your position. Sit up in a chair with your feet on the ground. Just for our phonecall, ok?” I did the same. I had been sitting cross-legged with my shoulders hunched over. I sat up, straightened my spine, and put my feet on the floor. Stephanie said she would do it, but had to get a towel first, because she had been making small cuts on the back of her thighs with a pocketknife, and didn’t want to get any blood on the chair.

I doubt that phonecall had a significant effect on Stephanie’s mental health, but it did help her get through the night. I understood my limitations. We weren’t therapists and weren’t there to diagnose or promote a particular viewpoint. I didn’t even try to reassure people or remind them that suicide is a permanent solution to a temporary problem. For people whose pain far exceeds every other feeling, a permanent solution can sound like a good idea.

The Suicide Prevention Center was a special place—a place for complete honesty. Since most callers were accustomed to hearing things like “don’t be so upset” or “don’t worry, everything will be ok,” I offered the opposite. Tell me the worst of it. What makes you the most angry? Most afraid or depressed?

Most families, even when they notice potentially suicidal behaviors like stockpiling pills or giving away treasured possessions, will still avoid a direct confrontation about suicide. I spoke with several dozen parents who called the line seeking advice, and even those conscientious people had trouble uttering the word. They’d ask their kids, “You’re not thinking about it, right?”

It’s understandable. Nobody wants to hear a loved one say “Yes, I am thinking about killing myself.” Then what? I tried to help them with some follow-up questions. Do you have a plan? How would you do it? How often do you think about it? Has anything happened recently to intensify your feelings? Have you told anyone else? Have you ever tried before? Are you willing to speak with a doctor?

Many callers admitted that they were dishonest with their own therapists and families because they didn’t want to worry or disappoint anyone. Many also knew their suicidal thoughts would be judged as criminal or sinful or abnormal. There was no such stigma at the Center. We wanted to help people release the burden of secrecy, so we’d ask, directly, over and over again, “Are you thinking about killing yourself?”

I remember Brandon’s call because he didn’t even wait for me to ask the question. When I said hello, he blurted out, “Yes, I want to die. My grandmother is here and she says it’s time.”

I found out from our shift leader that Brandon had called many times. He was a paranoid schizophrenic who often refused medication. He heard many voices, this time from his grandmother Mildred. He said she died last year, was lonely for company, and was telling him to hang himself in the kitchen. Brandon was so agitated that it was tough to follow his thought process. He hung up in the middle of one of his own comments, and I sat there feeling confused. He called back several minutes later, and I thought about trying to ground him by asking him to put his feet on the floor like Stephanie, but he was out of breath and wouldn’t sit down. He had been running around the house looking for rope.

When I realized he was back in the kitchen, I said, “Brandon, what have you eaten today?”

“Nothing!” he shouted, and then told me he found some twine but that it probably wasn’t strong enough. I asked him about his eating habits and found out that his favorite food was peanut butter on toast. I asked if he was hungry and wanted to know why he hadn’t eaten anything yet that day (it was almost two o’clock in the afternoon). He hung up again.

When he called back a third time, he was eating his peanut butter snack, and said his grandmother was taking a nap. The rate of his speech had slowed and I could follow him a bit more. Obviously food wasn’t going to alter Brandon’s diagnosis, but it did help stabilize his body chemistry, which had an immediate impact on his mind. He made me realize that I was sipping at my fourth cup of coffee that day and had eaten hardly any protein. I started to look even more toward the body for information, and found that people’s eating, exercise, and sleeping patterns offered immediate indicators for how to help them address some of their immediate emotional concerns.

Bringing folks back into the present moment was particularly helpful for the callers who would catastrophize or spin off into the future (What if I get fired? What if he leaves me? What if I never get better?). I would ask them to finish one of these statements: Right now I feel…Right now I need…Right now I am…. It worked for Roberto, who was 15 years old and holding a gun in his hands when he called. His father had punched him after seeing him kiss another boy. Roberto said, “what if he kicks me out of the house? What if I can’t finish high school?”

Roberto’s answer to my question was, “Right now, I need to tell my father I know where he keeps his gun.” He agreed to place the gun back in its case and into the closet during our phonecall, but I didn’t want to leave him empty-handed, so I asked him to find something else to hold, something that represented hope or possibility. He chose an old deck of his dad’s playing cards.

I don’t know if my request had any impact on Roberto, but it helped me to help him. I couldn’t concentrate knowing he was holding a weapon, and at least the cards gave me a way to talk about hope and choice.

I used one other technique with Roberto that I learned in training. I asked him to rate his anxiety at the beginning and end of our phonecall. I’ve seen reality-show therapists do this; in the middle of a challenging situation, they ask a patient to rate their stress on a scale of one to ten. A hoarder, for example, who clings to her mother’s moth-eaten sweater might rate her anxiety at a ten when she decides to throw the item into the trash. This is the moment many hoarders want to give up. But if they stay with the therapist, take a deep breath, check in with themselves and talk about their feelings, the anxiety starts to decrease, and several minutes later, they rate themselves an eight. And then a six. As they endure the process and receive support, they learn that a ten will not always remain a ten and it becomes a little less terrifying.

Numbers feel real, just like the body. Since many callers are accustomed to being evaluated by others, many also find it empowering to assess themselves instead. Am I at a ten? No, it’s not my worst moment. An eight? Assigning numbers to feelings makes them feel finite, and therefore manageable. I still do this for myself in highly stressful moments. Los Angeles traffic makes me tense, because people tailgate and speed and cut across lanes without looking, all while texting and talking on the phone. It makes me angry and fearful, even more so since a recent car accident with a teenager who was on his phone when he hit my car. But now, instead of crying or screaming out the window, I check in with myself when a vehicle gets too close. Is this a ten? No, I can handle this. A seven? Yes, I am really upset! But it never stays that high. Fixing the encounter at a seven prevents it from escalating to eight, and helps me focus instead on six, then five, and so on, which I always do by counting the length of each breath in and out to match my own measurement.

According to the World Health Organization, at least a million people worldwide commit suicide annually, and ten to twenty million make an attempt. I can’t help but think that if some of those people could see all the volunteers in our little office, waiting for the phone to ring even in the middle of the night, they’d feel less alone, maybe more likely to reach out. The suicide hotline is now called a lifeline, which feels right. Being of service on that line has also strengthened my own link to life, and to others who seek support.

two phones 77120611

National Suicide Prevention Lifeline

Free call 24/7

1-800-273-TALK (8255)

www.suicidepreventionlifeline.org

and for Hearing and Speech Impaired:

1-800-799-4TTY (4889)

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