How Do You Know When You're In Crisis?

[Hope4Now]

I wanted to ask this at my therapy appointment on Friday. I didn't. I asked today, but I blabbled on so much that I don't even remember if he answered or what he said.

What is a crisis?

How do you know when you need to do something dramatic, like being hospitalized or changing everything about your life?

I have three modes: "off" (autopilot); "on" (engaged and caretaking of various sorts to the point of exhaustion); and shutdown (in bed, uncommunicative). If I can keep going, I do, one way or another. Or I crash and cannot. Like when I have a high fever. That and when I end up in really bad flashback then dissociation are the only times I really actually cannot keep going. All the other times are choices, which is, I think, lucky for me in some ways...because I can force myself to keep going.

In the past year after my great meltdown, I have tried to find some kind of middle ground. Tried to make choices to care for myself in small ways...make space for myself in the midst of all the chaos. Sometimes it makes me feel better enough that I can soldier on with renewed energy. Now I'm just running on empty.

I am not good at asking for help. I hate asking for help, but I have been practicing. And I have trauma therapy 2x per week, psychiatrist 1x month. I'm on this wonderful forum regularly (thank you), I do mindfulness meditation and various forms of yoga practice and journaling every day. I have been doing everything people have recommended. It's just not enough. I am crashing.

When you need to scream for help? What does "crisis" mean, really? I mean all the psychotherapist's answering machines say, "If this is an emergency, dial 911." How do you know when something is an emergency? Seriously?

 

[desiderata310]

@Hope4Now

ummm.... hard to say.. I THINK I'm in crisis. or maybe I'm not.. I can't tell anymore.
I think crisis is imminent danger of death or harm... I almost fit that description. give me a 1300 fewer people in this building and it will be imminent
Give me a blade and there will be imminent danger- maybe not of death but of harm... harm's harder to say... I don't know.. I guess I'm often there and never ask for help.

 

[Glara]

I'm not a sufferer. My ex took one of his guns and his brand new truck and went into the woods to end it all. He said he heard his mother's voice tell him to go home. He listened. But that's a crisis. He did end up hospitalized but signed himself out. I think he was/is in crisis...

 

[joeylittle]

I think you know it when you see it.

I don't mean to be glib - I had the same question for myself for a long time, until the day that I didn't. For me, it was a total inability to apply any kind of coping skill - including negative coping skills. I could not bring myself together enough to even crawl into bed and hide. For me, that was when I understood what a crisis was.

I think when we think about 'crisis', and how to recognize it and get external help, we really are referring to the window before the crisis takes over completely. If you've ever fainted and experienced that extreme spinning head-rush before hand that can happen - to me, that's a good analogy of pre-crisis (spinny head rush) and crisis (unconscious). When you feel a faint coming, you instinctively try and make it less-worse (or avoidable) by sitting, or getting on the floor. In mental health terms, when I feel a crisis coming I will kick in with every skill I have - most of the time it works, and I never hit crisis. Sometimes it doesn't, and I need help.

It's really different for everyone, I think. But perhaps you can think of the worst time you've had of it, and ask yourself if that felt like a pre-crisis.

 

[illusionist]

Crisis to me is making plans to end my life.

 

[sun seeker]

It's a good question, and I would bet a lot of us here struggle with the same issue.

For me personally - and I'm just thinking about this as I write - I'd say I have three levels of crisis. The first, I can deal with on my own using those coping skills therapists so like to teach. :) Didn't used to be able to so well, but I'm getting better.

The second level of crisis is where I may ask for help. I don't know if you are including physical crises here or just emotional ones. On a physical level, it would be something like really needing groceries and not being able to get downtown because my hip is seized up (recurring problem spot). On an emotional level, it might be a flashback or an interaction I am upset about, or a lot of other things.

The third level is where it gets a bit tricky, because when it gets really, really bad my default is to shut down. It's not necessarily a choice; I've written before about my automatic freeze response. When I'm there, there isn't much I can do to reach out for help until I'm out of the worst of it; moving at all is a struggle and picking up the phone next to impossible. I am not one to call crisis lines. I've done so I think once with an emotional crisis and once with a practical crisis, but it feels like when I am really in crisis the last thing I want is to have to start at the beginning explaining the complications of my story to someone who doesn't know me. So when in the third level, mostly I just stay there and wait to get back to the second level or somewhere in between before asking for help.

The barriers are shifting though as I form connections and there are more people in my life I feel able to be vulnerable around, which lets me connect sooner on my way back out of freeze mode, and as I develop skills for working with body memories etc. I think as time goes on, I will spend less time stuck frozen.

That doesn't answer what is a crisis for you though, @Hope4Now. It sounds to me, from here, as if you are in crisis. You say what you have been doing isn't enough anymore and you are crashing. That would be an indicator to me.
:hug::hug::hug:
Thinking of you...

 

[Chava]

What is a crisis?

Good question. My meltdowns involve me feeling like I'm in a crisis when, in reality, I am not. The odd paradox is that when I am in a real crisis, I have gone the extra step and don't even recognize that I am in a crisis. The good news is that if I feel a raging urge to destroy myself, I call my doctor.

How do you know when you need to do something dramatic, like being hospitalized or changing everything about your life?

Personally, I would separate these questions. The hospital is one thing (good question) and would involve me feeling like I will hurt myself or am going nowhere but spiraling down (like when I was starved into hallucinating and dissociated through entire appointments with therapist). Changing everything about my life is not something my therapist would advocate. When stressed I usually want to sell my house and move. I want to just start over somewhere. Basically just "start over." It relates to feeling trapped by all of this, but it wouldn't go away. Truth is, even small changes unsettle me. When I'm most stressed I have been encouraged to not make big decisions. Even the damaging habits, like smoking, can not change if I'm really in crisis mode. So anyway, I'd separate those questions....or ask where they are coming from (like feeling trapped or powerless...and what one or two things you can do vs have to change everything...maybe?)

Be sure to tell your therapist you feel like you need more help and that you are crashing. Write it on your forehead before your next appointment, if needed. Can you take a couple days off from everything? I had such a horrid meltdown in the fall. Stress on top of stress and I couldn't come down from it. I couldn't enjoy non-stressful things like walks. My body just could not settle or feel any bit of good. I knew it and remained aware but couldn't change anything, in spite of doing all the basic self-care. So that was a scary feeling. Ultimately I had to get off some of the pills I was on. But I also allowed myself to hide out in the smallest, most interior room of my house to decompress.

It's really hard for me to notice what I need, articulate it, and ask for help, too. My meltdowns often involve distortions in time that are really overwhelming. But I also find it very challenging to internalize or nurture positive feelings that I assume could help neutralize the experience. So I'm continually practicing that, however inconsistently. Basic self care came first (eating, sleeping). That's better. Now trying to internalize and access any good feelings. It takes a lot of conscious effort. I don't know if you relate to any of that. But try doing things you love...and talk to your therapist.

Do you feel like hurting yourself or is it more like the feeling you or everything is crumbling apart? Does child's pose or wrapping up in a blanket help? Sorry I can ramble without answering a question. If you feel like you aren't going forward fast enough, or that you are slipping or struggling more, be sure to talk to your therapist. If you are afraid you are in danger, call a doc or hospital or go to ER. If you're unclear about what "emergency" means for your therapist and when extra support between sessions is warranted, ask your therapist.

Can you let yourself just be exhausted? This stuff is super exhausting...I want to quit everything often, and am now recognizing that as "I'm exhausted, I can let myself rest."

Sorry my writing feel disorganized tonight. But I hope you're okay.

 

[Hope4Now]

Write it on your forehead before your next appointment

Yes, this actually is a good idea. I sometimes go to therapy with a plan of what I want to say, then it all just disappears.

Sorry my writing feel disorganized tonight. But I hope you're okay.

It's not disorganized. Thank you for all the suggestions. I'm okay...sort of. I'm always okay...sort of.

we really are referring to the window before the crisis takes over completely. If you've ever fainted and experienced that extreme spinning head-rush before hand that can happen - to me, that's a good analogy of pre-crisis (spinny head rush) and crisis (unconscious). When you feel a faint coming, you instinctively try and make it less-worse (or avoidable) by sitting, or getting on the floor.

Yes, I guess this is where I am. Pre-crisis. I've thought about the fainting thing. That has happened to me. That's what this feels like on a sort of meta-level. I'd like to deal with it before it gets to the point of my inability to deal with it.

 

[Deleted member 1860]

This is how it was presented to me.

"Crisis" is when I cannot keep myself safe. It is beyond having thoughts that I want to hurt myself or having suicidal ideation. Crisis is when I am to the point of "I WILL hurt myself". That is, my coping skills, my grounding methods, and my self-care just aren't enough. Therapy isn't enough to keep my head above water, and a crisis hotline isn't enough to pull me out of the moment. I know that in a true crisis, I need to get to a safe place, ie an ER or hospital.

But, this is me. I tend to have those moments where I am at a 20 on a 1 to 10 scale. I know that not everybody has such moments like that where they know that the world is imploding around them, at least not in the same fashion.

One therapist told me that if once a week therapy isn't enough, then you move up to twice a week therapy. If twice a week therapy isn't enough, the next step is a day program (partial/whole). If a day program isn't enough, then you consider a trauma program that is residential or a trauma unit in a hospital. its all about meeting your need for support. Of course, at any point, if you are going to hurt yourself, that is indeed the trump card which indicates you need to get to the ER ASAP, no questions asked.

It sounds like 2x a week therapy isn't enough. I'd consider asking your therapist if there are other options available to you at this time. Would the addition of a group help? Are there local day programs?

 

[scout86]

That IS a good question. I'm sort of interested to find that it didn't occur to me that one might ask for HELP with a crisis, until I read other people's suggestions.

And I suppose that's a problem. When you didn't get the chance to learn, growing up, that "Help" was a real, true, good option or that YOU matter, it would be hard to know where the lines are.

I was thinking more of "there are bills that need to be paid and I have no money and they're fixin' to turn off the heat" kind of crisis at first. I usually notice that right about the time the roof caves in on my head. The mental health kind of crisis, I guess I'd suggest that the point where you're asking "Is this a crisis?" might be a good time to get an opinion from someone whose judgement you trust. Some of this stuff we might not be qualified to decide without a little more practice.

 

[illusionist]

The problem with actually hitting crisis for me was that I was so far gone in feeling happy to escape, that I didn't realise I was in crisis. Far better to get the help before crisis hits.

 

[Chava]

Yes, this actually is a good idea. I sometimes go to therapy with a plan of what I want to say, then it all just disappears

I would not function in this world without visual reminders. I don't know if you have any contact with your therapist between sessions, but I have told my therapist through e-mail that I want to talk about @#%) and that she can remind me (she'll totally fine with this approach and understands it's easier for me to talk about a bit if she brings it up because I will want to but not open my mouth). I've also written stuff down and gone in with my notes in hand.