EMOTIONAL TURMOIL, SELF-DENIGRATION, AND SUICIDALITY: "I CAN'T EXPLAIN THE TORTURES THAT I HAVE."
When I asked Alexa what the central struggle had been in her experience with depression and all of the psychiatric obstacles she had faced, she responded that it had been
mental and spiritual torture . . . and such devastation of myself. Looking at myself as worthless, as as as forgotten by everyone. And people call me and I have nothing to say I have nothing to say as you can see I’m I’m talkative and I can express myself but then it’s just “yes” “no” and ah, and ah, and and it- and giving up on myself which I don’t give up I don’t do that I can’t give up on anybody and you shouldn’t give up on any- but I give up on myself.
Alexa experienced some of the physical symptoms that were typically associated with depression as well. She became lethargic and lost interest in previously enjoyable activities. Meanwhile, her mind was bombarded with a vicious cycle of negativity that played on a loop:
I would be physically really tired. Really really tired. And and lethargic and uhm . . . no interest and couldn’t sleep want to sleep or sleep too much. Uhm I took a bottle of pills once. With a bottle of whiskey. Did not die (laughing). Just slept for two days. Uhm but without the without taking the bottles of pills, uhm sometimes the ma- uh racing thoughts racing thoughts that are that are all negative and I just don’t want them! I don’t want the thoughts I don’t want the thoughts but they come into my head. And and that is so upsetting.
Alexa experienced physical, mental, and emotional anguish that she could not escape from, and this led her to attempt suicide on multiple occasions. Her thoughts consumed her. Most of the time, she fixated on heaven and hell, death, and suicide. Alexa characterized her mental torment by saying she had “racing thoughts, racing thoughts from negativity negativity and you have to die and I and I don’t want to live like this, this is not worth living.” Young (2012) posits that suicidal ideation in cases of Cotard delusion is a solution to this overwhelming barrage of mental and emotional torment: “Perhaps one could think of it as an attempt, on the part of the patient, to escape their existential quandary, which is unfamiliar to them, and is perhaps understood to be some form of punishment or damnation or possession” (Young, 2012, p.
138). Despite Alexa’s desire to escape the terror she perpetually felt, and her preoccupation with death, there was still a part of her that was frightened by the possibility that she would be driven to kill herself. “It was pretty bad. It was pretty bad. And the fear of trying to commit suicide and ending my life was horrible. Horrible.”
Alexa became preoccupied with death that first night when she began to think that her friends and the singer were all criticizing her. She left early in order to get away from the situation and asked a friend whether she could spend the night in her home to avoid being alone. However, her thoughts kept her awake the entire night as she pondered what was happening to her and how she might escape it:
The whole night I contemplated . . . jumping through the window, smashing through the window jumping down committing suicide. So quickly, out of the blue with no understanding. And I said this is this is this is impossible I can’t live like this I can’t liv- I can’t explain the tortures that I have- mental and physically I s- I was all wound up. And and tense and and then I said and I would get as far as the window and then get afraid that I would drop and God would punish me because I believed in a punishing god then. I said he will make me he . . . not he but something, the devil will let me jump down and then I will become paralyzed and I will be with these thoughts for the rest of my life so this will be my hell. . . . I did not commit suicide or attempt at it but I thought the whole night, somehow the night was so long.
Throughout her torment, Alexa had the recurring thought: “I have to die. I have to die.” Even when she felt unsafe because she was unable to trust those around her, death became a source of potential comfort; as Alexa said of one encounter she had with a couple she was living with, she thought, “If they’re gonna kill me it’s okay because it would be better than if I lived with these thoughts.” Alexa’s existential anguish reveals the worthlessness she felt. There were times she even felt abandoned by God. Alexa explained that a major component of her periods of recovery entailed a change in her attitude toward herself:
For a long time I didn’t like myself the way I was. And I had insecurity feelings and and low self-esteem so I’ve been liking myself for many years now. And loving my- I always loved myself because I told you because of this not knowing what was going on even God maybe forgot me. And I have to love at least love myself if I don’t like myself.
One of the ways that Alexa attempted to gain perspective throughout her bouts of wellness and distress was by writing. She would write words of encouragement as well as questions and insights that she had had along the way. “I thought to myself I was my own child almost. And I wrote to myself as my own child almost and Alexa has to be taken care of nobody’s going to abuse Alexa. In any way.” This was a statement of determination, that Alexa would love and care for herself no matter what happened, and that she would defend herself against harm. However, the remnants of her fears remained as a reminder of all that had transpired.