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Working in: Exercising the true you. Keeping strong inside is a necessary balance


This is my story about suicide.

Go back to the very beginning of this blog. You’ll find that I used to write about many more of the modalities of wellness. For the past year I’ve focused on exercise, diet and other physical components of health. In other words, it’s been fitness and “working out.” There isn’t anything wrong with that; however, I’d like to bring some balance to this column. I want to speak more often about “working in.”

Several years ago I did a better job of addressing the wider concept of wellness. Physical health is comprised of its own modalities, but it is still only a portion of your general wellbeing. Wellness is a complex balance of your physical, intellectual, psychological, emotional, social, financial, sexual and spiritual selves. I want to share my thoughts about the modality I have never yet discussed in all these years: Psychological.

The ongoing specter of suicide

In 2016, when a devastating relationship put me into the hospital after a botched suicide attempt, I was finally able to receive the treatment I’ve needed practically my entire life. In 1999, while I was 22 years old and experiencing the rigors of graduate school in Los Angeles, CA while living with an alcoholic boyfriend, I had a breakdown and was diagnosed with Bipolar Disorder II. Looking back, I know I began developing the symptoms from the age of perhaps 10 years old and definitely by 12. That was when I began contemplating suicide as my first response to any source of intense stress.

The problem is that our health system is already bad enough to navigate when you have acceptably sympathetic illnesses like cancer, Parkinson’s or Cystic Fibrosis; however, society demonizes and shames two categories of disease. Specifically, I’m talking about sexually transmitted infections and mental health disorders. It was literally impossible for me to get effective, long-term treatment until I was 40 years old.

What you may not know is that you generally need a referral by your main practitioner for practically everything. The one glaring exception is mental health. For that you must self-refer. Because you’re not likely a licensed expert, you aren’t qualified to diagnose and refer yourself. As I was descending deeper and deeper into depression from mid-2014 until mid-2016, I told my primary doctor multiple times what was happening. A week before my latest suicide attempt, I pleaded with him to give me a referral. His reply stopped me cold: “Call 911, if you think you’re going to off yourself.”

Then he walked out the door. My five minutes were evidently up.

That was sobering

Over the course of the next week, the situation with my boyfriend and my apartment lease deteriorated worse and worse. A series of terrible coincidences aligned simultaneously, and I attempted “to off myself.” But some small, quiet part of me had enough rational thought left to call a friend with a background in psychology, and to explain calmly to him what I was in the process of doing. In turn, he calmly told me what to do to prepare myself for the arrival of the ambulance and police.

I faced an impossible situation. I had to do the work of contacting over 200 psychiatrists and therapists (all of whom were listed as in-network by my insurance). Not a single one of them would see me. All those with independent practices focused on teens, battered women, the homeless or whatever other specialty. All those attached to hospitals couldn’t see me until I was in the system for their particular hospital or group of hospitals. I couldn’t get into their hospital systems until I showed up in the emergency room, but I couldn’t show up in the emergency room unless I tried and survived a suicide attempt.

In retrospect, I think the small, rational part of me who called my friend was also the part of me who decided to take a gamble on getting into the system via the emergency room. His bet paid off. My luck held out for that spin of the roulette wheel.


Getting help

I’m sharing this to make a point (or three). If you know you need help, do not put off doing the work of seeing a doctor. US health “care” is a purposefully confusing labyrinth, but you have to start navigating it while you feel well. You will not be able to get through it while you’re in crisis, unless you get lucky like I did. Also: Our medical system is a failure, pure and simple. I don’t care if it offends you for me to say it. We’re sacrificing our people to this behemoth, and it must be fundamentally changed. And lastly, mental health is not something to blame people for developing.

If I could “just snap out of it,” don’t you think I would? Don’t be mean. We’re all imperfectly wired machines, and we each break down in different ways. For some that means brittle bones, for others it means brittle emotions.

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I want to finish this off by saying that since I left the hospital in May 2016 I’ve been properly medicated, I have access to a behavioral health clinic and I’ve established a relationship with a therapist. I have been socializing with others more, and trying to be an active agent of good in their lives. I’m doing the hard exercise of “working in” as much as I do the “working out.” I’m much better for now. I have bad days, but they’re manageable. There is one problem that remains: My insurance still doesn’t cover the doctor or the therapist. I have to pay for those out of pocket, but both providers have generously agreed to see me for a wildly reduced cash copay. BlueCross/BlueShield covers my meds, but I have an ongoing reminder each month that I am still at precarious risk. As with building muscle for the long haul, I’m also building a stronger sense of self — one exercise at a time.

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Jack Kirven is a mobile personal trainer in Charlotte, NC. He is the owner of INTEGRE8T Wellness.

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