Three Things I’ve Learned in Suicide Prevention Therapy

*This is not meant to be advice; it is simply something I’m learning as our family navigates having a family member with suicidal ideation. If you are thinking about suicide or have a loved one who is struggling with thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 (In the United States. In other countries, please reach out to a similar service in your country).

Image by Mabel Amber from Pixabay

The hubby and I began participating in therapy with a specialist from a suicide prevention center just a few weeks ago. Our son, Blake, had been sharing a good deal of suicidal thoughts with us and, since he was not interested in any ongoing treatment, we recognized we needed support ourselves. So far, we’ve done an intake meeting and two sessions. Although I’m a psychologist who specializes in treating anxiety and OCD, it’s a completely different story being a patient. I am learning, for sure, so I thought I’d share three nuggets I’ve gotten so far:

1. It’s not necessarily a bad thing that someone is talking about suicide.

Emphasis here is on “talking.” It was terrifying to me when Blake shared the thoughts that go through his mind, how much he suffers, how much he thinks of dying. I became alarmed at the very presence of these thoughts. However, our therapist (and others) have told me that it is actually a positive thing that Blake is talking about his thoughts. Talking and sharing are attempts to reach out and connect with others. This is a better thing than keeping these thoughts all to oneself – and not connecting with others.

2. It’s important to listen, not try to problem solve.

Many times when Blake has shared his pain with us, the hubby and I have worked to problem solve with him about ways to cope. We’ve also tried to shine a light on the bright side of things that he may be overlooking. What I’ve learned is that the most important thing I can do when my son shares his thoughts and feelings – even though they contain very dark and frightening content – is to listen and accept them as his. It is not my job to problem solve. That’s not where he’s at; he’s in sharing mode and he simply wants to be heard. As far as pointing out the bright side, our therapist noted that, for someone who is not ready for that, it’s kind of like shining a light in the eyes of someone who has been sitting in the dark. It’s going to be jarring and unappreciated. So, I’ve been working on listening and simply hearing.

3. An increasing number of conversations about suicidal ideation does not necessarily mean the person is about to act.

In our last session, I noted to our therapist that the freqency of conversations seemed to be going up. Our son was having more conversations with us about his pain and his thoughts of death. He wasn’t sharing intent to act, he was just sharing more often. It was emotionally exhausting, at times, and I was concerned what it meant. The therapist reminded me that we’ve shifted our conversations from problem-solving and pointing out the bright side to actually just listening and accepting. She noted that the increased frequency may simply mean it’s become more safe to share and that, when a person feels like they will be heard, they’ll take the opportunity to talk more often about what may be going on in their head. So, although it feels scary to me to be hearing my son’s thoughts more, it may just be that he feels more accepted in voicing them now than he did in the past.

We still have a way to go on this journey, and we have to listen to our son to ensure we are not missing signs of intent to harm himself. On the way, I am learning, and I hope our experience can help others.

Suicidal Thoughts in the Family

*If you are thinking about suicide or have a loved one who is struggling with thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 (In the United States. In other countries, please reach out to a similar service in your country).

Image by Krzysztof Kamil from Pixabay

“I called the suicide hotline the other night.”

Blake casually drops this line as he and I sit lazily on the patio chairs and cushions in our yard. I do everything in my power to keep myself from reacting too strongly. I want to encourage him to keep talking, not shut him up with my own anxiety.

“You did?” I ask. “When was that?”

“Saturday night. I just couldn’t sleep. I couldn’t stop thinking about what a failure I am and I thought, ‘Maybe I’ll check this out.’ Honestly, I expected it to be a waste of time, but I’m actually glad I called.”

“I’m so glad to hear you called,” I say. “You must have been feeling pretty awful to reach out.”

“Yeah. I tried the text line first. But there were a lot of people ahead of me. I waited over half an hour. I decided I’d try the actual phone line because the service suggested it as an option. I thought I’d wait even longer, but there was someone on the phone with me in about three minutes.”

He pauses a bit, then he continues, “I thought it would feel stupid, but I have to say, it felt so good to tell a stranger how awful I feel. I told them about stuff that I’ve never told anyone else. I felt like what I’m so upset over is so petty, but the person on the other end of the line said, ‘That sounds so hard.’ It felt so good to hear that.”

We go on to talk about more of the particulars. My young adult son shares how he struggles to decide if he should live or if he should die. I tell him how courageous he is for reaching out, and for being honest with me now. But afterward I am hurting so much. I want to cry and feel the relief of deep, cleansing sobs, but the tears won’t come.

It’s well after midnight and my husband is asleep. I turn to the internet. I’m not sure what I’m looking for, but my son (my beautiful son) – the one I carried when he cried as an infant, explored the world with, delighted in each new step he took, soothed through huge spikes of anxiety and OCD triggers, and championed through his many brave steps – frequently feels that his life is not worth living and that he is not worth the effort of saving. I’m looking for something to help me help him see that it IS worth it. I feel desperation…and then I realize – it’s not my choice to make. It is his life and I cannot coax, cajole, or convince him to stay here. It is selfish of me to do so because, while I’m thinking of him, moreso I’m thinking of my own pain.

And that is when I realize that I am the one who needs help. I have to take care of me right now. It’s not about saving him. Yes, he could use help and support when he chooses it. But right now it’s about taking care of me so that I can live with a family member who I love fiercely and who is frequently contemplating suicide. That is a lot to navigate alone and, until now, I’ve pretty much done just that.

Maybe it’s because I’m a psychologist and I think I’m supposed to know how to handle suicidal thoughts, but I suspect that it is also about being a mom. As parents, we are supposed to take care of our children. We worry about them from the moment they are conceived until we draw our last breath. When they struggle, we look to get them help. We forget that we must be in good shape to be a support.

The next day, I call the suicide hotline myself. It had never occured to me that I could call the hotline as the parent of someone who was dealing with thoughts of suicide. As much as it sucked to make that call, it felt so good to be heard and held by another. That call led me to reach out to a suicide prevention center and today, in less than an hour, I will have my first consultation session with a specialist. It’s not for Blake. It’s for me – so I can learn how to take care of myself. I’m nervously optimistic. I’ve lived with my son’s suicidal thoughts for so long, never considering how I was doing. Let’s see where this journey leads.

All Good Things…

As I finished my lunch that Friday afternoon, I had no idea what turn the day would suddenly take, nor did I realize the strength and capability my son, Blake, would demonstrate…

The house phone rings at around half past one. I’m seated at the kitchen table enjoying a quiet moment before I transition into an afternoon of work. Most calls to this phone are sales calls, so I resolve not to answer and opt instead to screen the call. No one leaves a message. Seconds later, my mobile phone rings. It’s my mom. I pick up at once.

Right away I can tell something is not right. I brace myself for what is to come. Someone must be injured or having a health crisis. I’m wrong.

“Daddy died,” my mom says. She cries and she sounds confused. I, on the other hand, go into automatic.

“Tell me where you are.”

It takes her a moment to figure it out. I can hear a voice in the background telling her where she is. She repeats this back to me, not fully understanding it, just parroting what she’s heard. I tell her I’m on my way.

“They want to know what to do with his body,” she says. “I don’t know what to do.”

“I know what to do,” I say, though I don’t exactly know how to do this. “I’ll be there as soon as I can.”

When I hang up the phone, Blake looks bewildered. I tell him what happened. I tell him I need him to come with me; I need his help. I see him slip into the same mode I’m already in.

“Do You Want Me to Drive?”

My nineteen-year-old son, the one who struggles to get out of bed because depression tells him there’s no good reason to get out, offers to drive me to his grandmother. He hates to drive, but he’s ready to help.

“What I really need you to do is to make phone calls while I focus on driving,” I say. “I’m not ready to talk to anybody, but I can tell you who we need to call.”

As we drive, I issue commands. Call Dad. Call your brother. Call the religious leader. Call Dad’s parents. Blake doesn’t miss a beat. He calls them all, although he’s uncertain about what to say. No, we don’t know what happened. Umm…my grandpa died. Please call me back.

“Where are you?” implores my mom. She’s on the phone as I’m pulling into the urgent care parking lot. “You don’t need to come.”

“I’m here and I’m coming in,” I say kindly yet assertively. I assume she’s in shock. Moments later I’m in an exam room where my mother is sitting alone, door shut, looking lost and confused. Blake watches as I wrap my arms around her and she allows the tears to flow. Blake joins in the hug.

“He shouldn’t have died,” she says. “He wasn’t that sick.”

“What happened?” I ask. I hadn’t been aware that my father wasn’t feeling well. She unpacks the tale of the past three days. Severe abdominal pain. Unable to eat. Lots of time in the bathroom. Finally forcing him to come to urgent care. Dressing him. Leaving to get the identification that he forgot at home while he heads to the restroom. Coming back to discover he’s never left the restroom. Calling for assistance. Watching helplessly as he’s moved to the floor and CPR is begun. Being told by the doctor how sorry he is for her loss. Her loss? He’s not that sick. Wait. What?

There’s a knock on the exam room door. It’s a sheriff’s deputy. He wants to know what we would like to do with the body – my dad’s body. He takes me into another room to give me details. He realizes my father had no plans for his death. He’s taken it upon himself to read Yelp reviews for mortuaries. He points me to one with five stars. I almost laugh. No. It’s okay. I know what mortuary to use. I don’t need to call the five-star-Yelp-reviewed mortuary.

I talk to the religious leader. I talk to the mortuary. I talk more to the deputy. My hubby arrives. I hold my mom. I ask the deputy to see my dad. I need to know that this is real. He makes me promise I won’t scream – I guess because this is still a working urgent care office and there are people in the waiting room. Where are the staff of the urgent care? Oh there they are – looking wide-eyed and dazed, unable to make eye contact with me.

And then I’m in the room with my dad. There’s a sheet pulled over him. I only see an arm hanging down the side of the gurney he is on. The deputy stands in the room watching me, gently, but there to make sure nothing is disturbed and ready to intervene if I suddenly lose it all. I gently pull down the sheet, just below his neck. And it’s him, looking just like himself, like he’s in a daze, his eyes open, his lips slightly parted. Suddenly I feel like the adult in the room. My dad is helpless. I am strong. My dad cannot do for himself. I must do for him. It is my job to make sure that the vessel that held him these 76 years is properly cared for.

“Oh, Dad,” I say out loud, and I touch his hand, hold it. It is cold to the touch like I’ve always heard, yet I’m still surprised how quickly our warm-blooded bodies cool to room temperature and even feel chilled. I plant a kiss on his forehead and I study him for a moment. My sister and brother cannot be here and I feel the responsibility to bear witness.

The deputy follows me across the office, by the urgent care staff, still with their wide eyes. As I’m about to re-enter the room my mom is in, I catch a glimpse of Blake walking down the hallway deep in conversation with someone. He’s relating the details. I watch him do this again and again in the three hours we wait for the mortuary transport service to arrive. My heart wells with love and respect. My beautiful son is not the young man with depression and Obsessive-Compulsive Disorder. He is the capable young adult who places calls to family and friends, close and distant. He is the one who keeps watch over me throughout the drive and wait at the urgent care and, later, the one who takes command of my car when I abandon it to drive my mother home. I see all that he may grow to be and I make note of it.

Finally, the transport workers arrive. They drape an ornate cover over my father. It makes the contents of the gurney they must now roll out of the building appear less stark. They roll him out of the exam room, through the bullpen area of the office (staff still wide-eyed and unspeaking), and out through the waiting room with its patients sitting in the neatly arranged chairs. It is awkwardly silent. No one says anything to us.

“That can’t be good for business,” my hubby says in a good- natured way to the office manager, in an attempt to break up the silence. In the moment, I’m the only one who sees the humor in this. I go back to get my mom.

Late that evening, exhausted, I thank Blake for all he’s done today. Thank you for looking after me and making sure we got to the urgent care office safely. Thank you for looking after Grandma. Thank you for making and taking all those phone calls. Thank you for getting my car to Grandma’s house.

A few days later, we leave the house early to drive to my dad’s funeral and burial. Blake is up and ready to go. He notes how he struggled to get out of bed this morning, but then he remembered his grandpa. Grandpa struggled to get out of bed himself most of the time, notes Blake. In his honor, and because Grandpa could not get out of bed anymore, Blake chose to do the difficult thing – he got out of bed. In that moment, I am so filled with love for my boy.

This post is in memory of my father, who struggled with substance abuse, with depression, with body focused repetitive behaviors (BFRB’s), and with undiagnosed Obsessive-Compulsive Disorder (OCD) for as long as I knew him. He gave life to three human beings – two of whom I am blessed to call my brother and sister. Dad, I hope your legacy is that we learn, we grow, and that we help ourselves and others to have hope and to seek help when it is needed. Blake chose the title of this post, “All Good Things…,” noting the dual symbolism of all good things coming to an end, as well as the fact that it is the title of the last episode of “Star Trek: The Next Generation.” His grandpa, my dad, was a devoted longtime “Star Trek” fan. He taught me to deeply appreciate science fiction, which I do to this day – as well as the occasional B horror film.

Invictus

This morning Blake is up early, even earlier than I am. He is eating breakfast when I come downstairs.

He’s stayed up all night again,” I automatically think. To be perfectly honest, it’s a fair assumption. After all, he didn’t get out of bed until around 9 pm last night. His dad and I went to his room several times during the day encouraging him to get out of bed. It’s a familiar pattern – one that leaves me with a sense of hopelessness that sometimes spreads within me.

“I will,” was all we got – and then he plodded downstairs about an hour before the hubby and I went to sleep.

Blake heads upstairs – to go to bed, I assume – and I offer to make him a cup of coffee. To my surprise, he answers, “Yes.”

When I enter his room he is sitting in front of the space heater. I hand him the warm mug, plant a kiss on his cheek, and shut the door.


“Mom?” I hear from behind the door. I open it back up. “I didn’t stay awake all night. I actually went to bed a little after you and Dad.” He goes on to explain to me how it is possible to go back to sleep after sleeping nearly twenty-four hours.

I’m happy,” he says – words I haven’t heard from him in some time. In fact, I can’t remember when he’s said that. “I got up two days with my alarm this week,” he notes, “and while it might not have been in a row, it’s more than I’ve gotten up on my own in this entire month.”

He goes on to show me words and symbols of motivation he’s written on a white board near his bed. On that board are the letters “INV.” He wants me to see what they stand for and motions me over to his laptop. “Invictus” is a poem written in the 1800’s by William Ernest Henley. For those who do not know the poem or the poet (I didn’t, though perhaps I should have), Henley suffered periods of extreme pain in his early years due to tuberculosis of the bone. He saw one of his legs amputated below the knee due to this. And, yet, his “maimed strength and masterfulness” inspired his friend, Robert Louis Stevenson, to create the character, Long John Silver.

Blake shares the poem with me, noting that he reads it to himself nightly. He identifies with not only the words of the poem, but with Henley, himself. After I read it, I cry and we hug. I am leaving the words to the poem below:

Invictus

by William Ernest Henley

Out of the night that covers me,
Black as the pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds and shall find me unafraid.

It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate,
I am the captain of my soul.

Don’t Other People Do That?

I haven’t written much lately about Blake’s OCD. Though it’s been in a “waxing” period for some time now, there are still “rules” Blake follows all day every day. This was a moment we had last week.

Our cat presents a challenge for OCD’s contamination rules

Blake is helping me make my bed and we are chatting as we work. The only problem is, our cat isn’t cooperating. He insists on walking all over the blankets and sheets, making it nearly impossible to move or straighten anything without difficulty.

Impatient with our furry companion, Blake picks up a pillow and starts swatting at the cat. He’s not actually hitting him, just trying to encourage him to move off the bed. He swats repeatedly, but it’s a fruitless maneuver. The cat only moves a few feet so that Blake has to move to another part of the king size bed to reach him.

I watch this scene with interest. It’s a pretty ineffective technique for moving a cat who is determined to stay put, yet Blake continues to try to use it.

“How about if you actually give him a little nudge with your hand, honey? Or maybe pick him up and put him on the floor?” I finally ask.

“Then I’d have to go wash my hands and I’m trying to wash my hands less,” he answers.

I don’t say anything. My silence obviously speaks to Blake who asks me, “That’s not unusual, is it? People wash their hands when they touch their pets, right? Right?”

“Um…that’s not what most people do. I mean, most people don’t run to wash their hands immediately after they touch their pets.”

“They don’t?”

“No. They don’t.”

“Ew. I don’t think that would be very uncomfortable.”

“Okay,” I say.

“Do you think I’m wrong?”

“Blake, you asked if other people wash their hands when they touch their pets. I answered you that most people don’t.”

“But am I wrong?” he asks.

“Only you can decide that, honey.”

“I don’t like to feel uncomfortable,” he answers.

“I know,” I say kindly. “Maybe, if you wanted to, you could expand the limits of what makes you uncomfortable by just waiting a tiny bit longer to wash after you touch our pets.”

“Thank you, mom,” he says.

That’s my signal that the message is received and he’s done with the conversation. Yet, this is the first time I can ever recall that Blake is questioning his behavior. He’s always just asserted that he is the way he is and that he thinks he is right. Today he is questioning whether his rules about what’s contaminated are in keeping with what others do. I don’t know that it means anything…but maybe it does.

Back Home

Blake has been home now for just over two months. It’s been nice having him home. He’s been more self-reflective and more open to sharing. It’s also been a relief to know he’s eating and taking his medication more regularly. The hubby and I have been able to be calmer with him than before and less impatient with him in many ways. Yet, at the same time, things are still so uncertain with him and it’s tough to know what ways things will go.

He wants to be a writer and he spends his days working on a book he’d love to publish. Some days he write a lot. Other days – not so much. The topic of his book is a secret. I only know that it is a work of fiction, maybe even sci-fi. He ponders whether he should return to school at some point. And sometimes he’s very sad and lonely.

Recently, when he was feeling very sad, he shared that the only things he really looks forward to are eating and sitting in front of his space heater. I reminded him of how, a month ago, he enjoyed playing video games with his brother and a friend.

“I think that you’re actually a social guy and that it’s important for you to get out of the house and be with people on a regular basis.”

“But what would I do?” he asked.

“Maybe apply for a volunteer position where you’re required to show up at the same time every week?”

With a little more talk, he agreed to try. He reached out, with my help, to several organizations in our community and started a weekly position with our local food pantry. For the past three weekends, he’s ridden in the big truck with the driver, picking up donations from local grocery stores. It’s heavy lifting work and is probably good for his mood. He and his driver sound like an odd pair, yet Blake has taken to this young man (who is about 10 years older than him). Blake has even learned to appreciate a new music genre: Hick Hop! He actually looks forward to going each time.

In addition, Blake has started a blog. Again, it was at my urging, but he joyfully wrote his first post. It’s a humor blog and that first post was pretty hysterical to all of us. We’ll see where it goes. The hubby and I hope that, little by little, Blake will build up momentum to living in the world and taking more steps on his own.

Lost Enjoyment

“I don’t know if this is depression or not,” says Blake, “but it’s like there’s always a grayness over everything I do.”

Blake and I are preparing dinner together. The hubby and Michael are upstairs playing a video game and Blake has come down to help me with something in the kitchen. He had been upstairs with his dad and his brother and he is noticing how nice it is to have someone to play his new video game with. This causes him to recognize the stark difference between how he feels in this moment and how he feels much of the time.

“The thing is, for the longest time now, I’ve had trouble enjoying anything. Video games don’t even seem fun to me anymore.”

Video games are Blake’s long held passion. He doesn’t just play them; he dreams of them and plots and plans new ones. Many times I’ve caught him wandering around the family room, seemingly lost in a fog, a smile planted on his face. The smile broadens when he solves a problem in his video game planning process. That he’s saying now that video games don’t seem fun is significant.

“It’s why I haven’t played this game until today. My mind tells me that starting a new game will be too hard. There’s too much of a learning curve. It seems like too much to even try. The thing is, once I start and get into it, it actually starts to get fun and it doesn’t feel that way anymore.”

“Yes, that’s depression, and you’ve described it perfectly,” I tell him. “It colors everything gray. It tells us that things will be too tough, that we shouldn’t even try. And, yet, once we do the hard work of getting going, there’s momentum. You know, you’ve uncovered depression’s secret: if we can find strength to get going, it builds on itself and helps us to recover.”

Blake considers this for a moment, seeming to absorb it. I suggest to him that he may wish to tell his psychiatrist about the way he feels the next time they meet. He’s doing a nice job of communicating it to me; it would probably help his doctor to make decisions with him about his medication if he truly understood how Blake experiences his days. He nods and runs back upstairs to be with his dad and his brother.

Alone in the kitchen now, I am grateful that he is sharing with me. This is a new experience for us, his actually communicating, voluntarily, what he is going through. Perhaps it is another step in the direction of his taking care of his own mental health.

The Semester Winds Down

One of the successes: A lasagna Blake made for himself. He likes to photograph his meals.

Blake has been at college for an entire semester – or one week shy of it anyway. It began unceremoniously, with Blake declaring that this would be the shortest college experience of anyone in our family and dreading the start of classes. I flew back home fearful of the unknown and how my youngest might fare.

It’s been a semester of ups and downs. The downs include Blake not making it to class many days, him sleeping way into the evening on days when depression made bed the only option that felt viable, MANY assignments never turned in or even attempted. It included many phone calls from Blake saying he just couldn’t do this, that he needed to drop out. And there were the tears Blake cried over not feeling adequate, losing hope, and no longer knowing what his passion is.

The ups included Blake cooking for himself, grocery shopping, keeping up on haircuts – and being the only one in the apartment to actually clean the bathroom (though that may have been prompted by OCD fears – I digress). They include Blake joining clubs on campus and even attending murder mystery special events (something he rarely did while at home, and then only with much prompting). In short, my 19-year-old moved to a new city, lived in an apartment with three others, shared a room, and took care of the basic things he needed to in order to survive. I’d venture to say that joining clubs is a step beyond the basics.

Still, college itself definitely did not go well. I don’t know how well Blake performed in any class; I don’t know if he even knows. He has decided that this is just not the right time for school for him and he is coming home. He’s not happy about that. In fact, he feels like a failure and fears he’ll only continue to fail and to suffer emotionally. He hates the idea of being an adult in his parents’ home (and cannot seem to recognize that he is certainly not alone in that status).

Late next week, I will fly to meet him. We will pack up his apartment and come home. But we won’t be flying. The hubby and I felt that being back home in a matter of hours was too abrupt a shift from what we think was a growing experience for our boy. So Blake and I will take a road trip home. We have no planned route, no place we must stop – only an ending destination of home in a time span of three days. There will be a lot of open road and empty expanses on our way. My plan is to remind my boy of the successes he had and hope that he can find a way to hold onto those, even for a brief moment.

Monday Morning

It’s 8:32 in the morning and I send a text message to both of my boys about the Thanksgiving holiday, which is over a month away. I have to make airplane reservations and I want to check on their schedules. I expect I’ll hear from Michael; it’s three hours later where he is and he already had a class this morning. Blake I don’t expect to hear from until at least late afternoon or evening with his sleep issues. He has a 10 am class, but he’s missed attending nearly every week.

To my surprise, it’s Blake I hear back from first at 8:39 am. He confirms his schedule for me. 

Me: Whatcha doing?

Blake: Waking up.

Me: You heading out to class?

Blake: Yeah 

Me: Out of bed yet?

Blake: Showered.

Me: Wow. Just wow.

Blake: I appreciate your amazement at my basic levels of human functioning. 😛

Me: It’s a mom thing.

Blake: Are turnovers a breakfast pastry or dessert?

Me: They are whatever you like them to be. Love you.

Blake: Love you too!

It’s a brief moment in time, but it’s a victory nonetheless. Blake is awake. He got himself showered at a time that allows him to participate in the day. Whether he will leave his apartment and head to school or head back to bed is uncertain. It is just this – a moment.

Another Bump in the Road

Friday Evening…

8:35 pm:

Text message from Blake: Hey Mom. I slept through another disability meeting. Even with only two classes, I’m completely unable to function. As much as we’ve tried with everything and even switching programs, I feel like we might need to call it quits on college. At least for this year…

Me: Hi baby. I’m right in the middle of something. Can I call you when I’m done?

Blake: Yeah

I call Blake as I drive home for the evening. He’s down on himself for missing yet another scheduled meeting with the disability office at school. He’s unhappy with life, doesn’t know what he wants, can’t find a reason to even exist. 

I try to be a good listener, but I get caught in my old trap. I sink down into the well of despair with Blake and I try to fix the situation. I point out how much better he does with more structure. Perhaps he needs a job, I suggest. At one point I even ask if he needs to be in a hospital. He hates when I do this and I hate it even as I say it. He wants to get off the phone with me and I ask him to call me tomorrow after he wakes up to check in. He agrees.

Saturday Evening

8:25 pm:

Text from me to Blake: Hello

Blake: Hi

Me: How you doin’?

Blake: Rough

Me: Can you talk for a min?

Blake: Yeah

“I want to apologize to you,” I say. “Last night when we talked I just wanted to be a good listener – and I wasn’t. When you’re in a really bad place I sometimes get caught up in wanting to help. And that’s not what you needed last night.”

“Thanks, Mom. I kind of do need help because I don’t know what to do.”

“Maybe the first thing to do is to know that this feeling will pass and when you feel clearer that’ll be the time to decide what you’re going to do.”

Then I remind him of all the ways that he IS functioning. 

“You’ve got successes, honey. You made it to your English class both days this week. You’re grocery shopping; you’re eating; you’re going to chess club; you’re taking your medication…”

“About that, Mom,” he begins, “I’m not doing so well with the medication. I’ve been waking up too late to take it so I’ve been missing it.”

My worry starts to set in. Blake is on an SRI – a serotonin reuptake inhibitor. He’s on the highest dose a doctor might recommend and has been for quite some time. I know it’s not good to miss taking it.

“Honey, how often are you missing taking it?” I ask.

“Probably 75% of the time,” is the answer.

“Blake,” I say, “you cannot not take your medication. Even if you wake up late, it should still be taken. Maybe you should switch to taking it at night since you are awake then.When is the last time you took it?”

“Maybe…Thursday?” It’s more a question than an answer. He’s really not sure when he took it last.

Abrupt cessation of SRI’s can lead to a withdrawal or discontinuation syndrome. Two of my patients in just the past week ran out of their SRI medication and missed a day or two. The effects were swift – one had a quick return of strong intrusive thoughts of harming others; the other experienced a significant uptick in her depression symptoms and found herself unable to do even the smallest exposure practice for therapy. 

I know how Blake has reacted in the past when he’s even been a few hours late to take his medication. He starts to feel like he’s having electrical shocks in his head. He starts to feel dizzy. He claims he hasn’t felt any of that, but the problem is he hasn’t been awake. He’s been sleeping very late. He slept til almost 8 pm tonight. He’s feeling very down and depressed and not sure of his path. I give him a quick rundown of SRI withdrawal and have him take his medication right away. 

When I explain to the Hubby what I’ve learned, he is concerned. Could it be that our 19-year-old son is not able to take care of himself on his own? How could he not have realized that it was not okay to miss his medication? Why didn’t he say anything until now if it’s been going on for a while? I tell him that we need to wait and see if he makes the correction and if it sinks in.

In the meantime, Blake has now taken his medication two days in a row and I’ve been checking in with him regularly to make sure there haven’t been issues with that. Since he didn’t wake up until nearly 8 pm last night, he’s been up for over twenty-four hours. It’s a familiar cycle for him – one I’ve lectured him on many times before, but resist doing now. He’s still down today, but he’s been in better spirits, texting me funny photos and fun facts about goofy things. Another episode in this journey…