I’m going to talk about suicide and other hard and ugly things. If this isn’t for you, please, move along. Comments will be monitored.
I have spent a great deal of time recently in doctor’s offices. Nothing particularly new or alarming, just more fallout from my round with breast cancer. That is a story for another day. The important bit, the part that has inspired this foray, is the PHQ-9.
What is PHQ-9? You likely know it as the Patient Health Questionnaire. It’s that short list of questions the doctor, or more likely PA, asks you whenever you step into a non-descript exam room.
Questions like –
Do you have little interest in doing things?
Feeling down, depressed, hopeless?
Feeling tired or having little energy?
Poor appetite or overeating?
And the kicker: Thoughts that you would be better off dead, or of hurting yourself.
And there’s a little matrix of boxes to tick. (Literally, boxes to tick.) The available answers are: Not at all, Several days, More than half the days, or Nearly every day.
I have heard this list of questions so many times recently I have started to see the gross irony of the PHQ-9.
You see, if that form meant anything, I would have professional help. Because my answer is Yes, Nearly every day, for every one of those items. And the result of being asked those questions a lot in the last two months has been — *crickets.
Not one damn thing. Nada. Niente. Zip. Zero. Bupcuss.
Well, except for the exceedingly uncomfortable looks on a few faces. Oh, dear. The woman is ‘in crisis.’
Then why does the form exist? And while I would love to diverge into a rant about mental health care and medical practices in the U.S., that’s not what this is about.
What I want to address is that by the PHQ-9 I am ‘deeply in crisis’. I should get immediate help to preserve my life because I am obviously a danger to myself.
Well, yeah. So what? It’s Tuesday.
Or any day of the week you like to check in with me, rest assured, I’m probably thinking about ‘checking out.’
GASP* Shocking, I know.
But, for a great many of us, who have lived with severe depression, the idea of suicide is rather background scenery. It’s the comforting red light at the back of the movie theater that reads ‘exit’. You might never use it, but it’s nice to know it’s there if you need it.
And that is something it seems the world at large just doesn’t understand. It’s knowing that option is there that keeps many of us putting one foot in front of the other. Knowing that the option is there helps us to choose to go on.
For most people, yes. But for those of us who live in a burning room, being able to see that sign is a comfort. It is a lodestone that helps us find our way.
And, yes, that is a very sad state of affairs, and I wouldn’t expect anyone who hasn’t lived with Complex-PTSD to understand.
But there’s another twist to this scenario, which you might not see if you aren’t aware of Complex PTSD.
Yes, we are ‘in crisis.’ That is the nature of CPTSD. We have likely been ‘in crisis’ for a majority of our days on this planet. We live with the depression, we live with the anxiety, we live with the crushing belief of our own inadequacy and our flawed, imperfect, unloveable, undeserving selves.
And you know what? We cope. In a world that doesn’t ‘get it,’ we cope. In a world we are conditioned to think of as inherently dangerous, we cope.
And that’s why we lie when someone whips out the old PHQ-9 form. Because we fear losing our independence, our ability to adapt, our exit sign, if we are locked up in ‘the system.’
The irony is ‘the system’ is so broken, so ineffectual, that even though I have been admitting I am ‘in crisis’ for over two months, I’m still running around on my own. And yeah, I think, like many folks with CPTSD, I would like help, but on my terms.
You do not get to take away my exit sign. You do not get to trap me. You trust me to cope, because that is exactly what I have been doing for years.
I’ll admit the coping isn’t pretty at times. I won’t deny that nearly every day is a struggle. I won’t go into the 40 years I have lost to this monster – that is a different essay.
But somewhere, deep within, there is a spark undimmed by what we have lived through. That undaunted potential, dare I even say ‘hope’ that we can live one day instead of just coping exists. That spark keeps us moving forward, but knowing where the exit is really helps.