51
" Suicide is a form of murder— premeditated murder. It isn’t something you do the first time you think of doing it. It takes some getting used to. And you need the means, the opportunity, the motive. A successful suicide demands good organization and a cool head, both of which are usually incompatible with the suicidal state of mind.
It’s important to cultivate detachment. One way to do this is to practice imagining yourself dead, or in the process of dying. If there’s a window, you must imagine your body falling out the window. If there’s a knife, you must imagine the knife piercing your skin. If there’s a train coming, you must imagine your torso flattened under its wheels. These exercises are necessary to achieving the proper distance.
The debate was wearing me out. Once you've posed that question, it won't go away. I think many people kill themselves simply to stop the debate about whether they will or they won't. Anything I thought or did was immediately drawn into the debate. Made a stupid remark—why not kill myself? Missed the bus—better put an end to it all. Even the good got in there. I liked that movie—maybe I shouldn’t kill myself.
In reality, it was only part of myself I wanted to kill: the part that wanted to kill herself, that dragged me into the suicide debate and made every window, kitchen implement, and subway station a rehearsal for tragedy. "
― Susanna Kaysen
55
" The case of a patient with dissociative identity disorder follows:Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis.Cindy had been well until 3 years before admission, when she developed depression, " voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen.Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life.Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged.At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters. "
60
" Rape and war, she explained are among the most common causes of post-traumatic stress disorder, and survivors of sexual assault frequently exhibit many of the same symptoms and behaviors as survivors of combat: flashbacks, insomnia, nightmares, hypervigilance, depression, isolation, suicidal thoughts, outbursts of anger, unrelenting anxiety, and an inability to shake the feeling that the world is spinning out of control. "
― Jon Krakauer , Missoula: Rape and the Justice System in a College Town