It’s Always There

“I have a secret to tell you. You know it’s always there — in the back of your mind.”

I oversaw a small partial care program for roughly two years. Roughly 15 to 20 clients attended the three-hour long program three days a week. Even though it was a small program, these clients took a lot out of you since they mostly presented with personality disorders, substance use, and mood disorders. Some of the clients received individual counseling as part of their treatment. One of the individuals I worked with was a forty something gentleman with an extensive history of depression and suicidality. He also had a history of heroin use but only relapsed once in the last 15 years.

Typically I checked in with him at the beginning of each session, assessing any suicidal thoughts given his history. During one of these check-ins, he stopped me and looked at me inquisitively. It was then he uttered those words above. I remember hearing him, but then listening to him. My brain took a few seconds to catch up to the gravity of what he said. My client’s eyes searched for my response. I could tell he was expecting me to be surprised or taken aback. Instead, I found comfort in what he said. It felt good to know that I was not alone.


My senior of high school was an absolute nightmare. My dad was recovering from cirrhosis of the liver thanks to three decades of heavy drinking. My mom was cheating on my dad. She would leave the house for days at a time without any contact. My family was in shambles financially. My mental health suffered as a result. I struggled to get out of bed to go to school. If I made it to school, I usually ended up in the school psychologist’s office in the midst of a major panic attack. This happened sometimes three to four times in a given day at school and at home. I lost all sense of self control.

I pulled back on my responsibilities and started treatment until I could better manage my anxiety and depression. In mid-October, I went on home bound instruction. Shortly thereafter, I started seeing a psychiatrist once a week. My week usually consisted of seeing three to four in-home tutors and going to my appointment. That was it. It sounded like a dream come true for most teenagers. It got old fast, and I saw little improvement in myself over the next few months. I felt myself disintegrating before my own eyes. I slept all day until my tutors came over. I did my homework and went on my computer all night long. AOL Instant Messenger and MySpace was the extent of my social interaction.

In mid-November, my psychiatrist called me out on my current state. She asked me if I wanted to try a low dose antidepressant. I was skeptical. I did not like drugs (even prescription ones) given my family history with substance use- both immediate and extended. She talked me into a low dose of Lexapro or Effexor. I cannot remember at this point. I just recall that fatigue as a significant side effect, so she switched me over to the other one the following week.

At this point, it is the beginning of December and right in the heart of the holiday season. You can imagine how I felt about it with my family falling apart. Also, my education was at risk. I do not want to get into specifics, but I will say this much. My high school started fighting me nail and tooth on things like my class schedule, AP credit, and providing me with certain classes. It made me curl up more into fetal position.

Right after Christmas, I decided to stop taking my antidepressant cold turkey. I was not seeing the benefit in taking it. Also being a stubborn teenager, I thought I could handle the situation on my own. That is how I felt anyway – like I was doing this on my own.

It was New Year’s Eve 2007. My dad and I had a tradition of eating a ton of appetizers and watching “The Ball Drop” every year. I was not going to make it to midnight this year. Around eight o’clock, my stomach rumbled. I asked my dad if I could go upstairs to rest and celebrate tomorrow. He wished me good night, and I hobbled up to my bed.

The new year was not going to let me go out without a bang though. As I laid there in bed, the pain steadily grew worse. I simply thought to myself, “What else can go wrong in my life?” My mind in its vulnerable state latched onto this idea and ran with it. Everything over the last few months rushed forward and hit me like a wrecking ball. I lay there in not only physical pain, but mental anguish and emotional agony. I stared blankly at the ceiling and felt my chest tightening. A major panic attack was setting in. I did not want to keep living like this. In the midst of the panic, I mustered up enough control to reach over to my night stand. I opened up a tiny drawer where I had a Swiss Army pocket knife stored away. I examined it intently. I did not do anything with it. I merely held it in my hand pondering my options. This carried on for over two hours and into the new year. I concluded that I needed to change something, but this was not the change I wanted.

The next day I wrote this poem to summarize the experience titled Angel.

Simply sinister,

Blinding the mind’s eye,

Shrouded in darkness and shadows,

Fear-stricken paralysis,

Well being in upheaval,

A mighty feast thrown to the wolves,

Saturated — doubt, disbelief, hatred.


Mind- nonexistent,

Heart- implosion, black hole,

Soul- vanished, dark abyss.


Unheard voice, unseen figure,

Yet thy guardian, thy savior,

Mutual understanding long sought for,

Pleasant shock, absolute awe.


Refreshed, restored, revitalized,

A before seldom smile now infinite,

Utmost gratitude now and forever.

I use the term “guardian” and “savior” as a metaphor for making a vow to myself to never hurt myself.

Looking back at that night, I believe part of my breakdown may have been attributed to me stopping my medications. Either way, my mind wandered into dangerous territory. I experienced a phenomenon called “cognitive narrowing.” Essentially, my brain put up blinders like those you see horses wear when they pull carriages. I could not see the big picture, but merely the path in front of me. I pushed to take down the blinders in order to see all of my options and not hone in on what felt like the “only option.”

There were many times after that incident where self-harm and suicidal ideation passed through my mind. The vast majority of these instances were merely passive thoughts and easily dismissed. However, there were other times where it took effort to push through them. For me personally, the intensity of these thoughts correlated with situational stressors like my home catching fire, medical issues, and my girlfriend cheating on me. The last one mentioned landed me on the psych unit for 72 hours due to prominent suicidal thoughts.

This is why I was able to relate to my client. I understood him better than he will ever know. Once your mind ventures down that path, it makes it much easier to navigate there again in the future. Therefore, in the back of your mind, it will always be an option. However, it is never the only option.

-The Caring Counselor


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