August 6, 2007

The Dead of Night

There is an apprehension created by an active mind in the dead of night: a surety of one’s power to grasp the meanings and significance of things. One may experience a genuine sense of beneficent resignation to the past and acceptance of the future, in spite of any unrelenting anxieties or expectations.

It is the time my thoughts are the most active, to be sure.

At that late, silent time, I feel the doors of memory open easily, even though they may be tightly shut at other times. These are the hours I feel I understand myself in relationship to my hopes and aspirations: I see the juxtaposition between who I was once and who I have become, and I am contented by that vision.

One is free to consider all sorts of things in the dead of night and give no special weight to any one of them. It can be a time for unrestrained, intellectual play and it sometimes yields useful perspective on important questions like "why am I awake at four a.m.?"

Am I depressed about something? Is this insomnia? Am I suicidal?

While I have never seen a discussion about how long one has to be awake in the night to qualify as an insomniac (I am awake 15-45 minutes at a time, rather than for hours); I suppose it could be a possible classification for my sleepless behavior. My thoughts at that hour do seem to be directed toward problem solving: can I find a snack without waking my spouse?

Still, I can't say that I ever consider killing myself in that short, snack-seeking period. I guess I am just too preoccupied with hunting and gathering. But, I am curious about this wakefulness, so I read.

I read scientific writing on the connection between E. and depression. I find, inevitably, these papers address E. and depression in terms of comparative suicide rates between the majority population and the E. population. Conclusions are consistently drawn to show persons with E. are at least 5 times more likely to suicide than the majority.

But these conclusions seem flawed.

Folks of the E. community will chat about everything, and their most personal and private issues can become threads for conversation in cyberspace. Insomnia is certainly a well-explored topic. But I have yet to chat, email, etc., with members of our community who want to discuss suicide or thoughts of it. For a group researchers say are five times more interested in suicide than the general population, our community is strangely closed-mouth on the subject.

A reluctance to discuss suicide should come as no real surprise to anyone though. It may be because of a kind of confusion over what draws one to its consideration, as well as to the act itself.

Our community is all too practiced in the art of selective disclosure. We are experienced with the potential consequences to us as individuals if we make certain statements aloud. So dismissing suicide as a possible topic for conversation seems reasonable, even prudent.

Just what would reactions be to us if we began to fling personal admissions concerning thoughts of suicide about? How would our families react? Our caregivers? Wouldn't it change how people come to see us and our condition? What kinds of repercussions might we experience?

Surely the majority population feels a similar discomfort.

My own discomfort with the subject of suicide has less to do with any personal thoughts about it and more to do with the fact that it is more and more often attributed as a feature of epilepsy. A new symptom. It makes me question how reliable such studies really are. Are persons with epilepsy inclined to kill themselves at rates five times greater than the national average? If we are, shouldn't we address this? I'll take a stab at it.

As I see it, one may divide those who contemplate and/or act in favor of suicide into three groups: the compulsive, the depressives and the morbid thinkers.

The compulsives are mentally ill in a profound way. Depressives can be assisted with interventions of talk and drug therapies. Morbid thinkers, I believe, include many persons with E. because we are socially removed and used to keeping profound secrets from others about our health and well-being; and we take the kinds of powerful drugs that increase our vulnerability to such thoughts.

I read a clever description of the E. experience once:
seizure, side-effects, stigma. This sums up neatly the three major areas of difficulty people with E. have to work with every day. Those of us with E., recognize the meaning of that slogan immediately; those outside our community, don't.

I take drugs with my E. and the drugs reduce the severity of my seizures; they do not eliminate them. So I cope with my seizures. I also cope with drug side effects. These side effects, apparently, will also never go away. And I live with stigma that makes people afraid of me. So I am determined to push back against things that will in any way disinform others about epilepsy or those of us with it.

The artifacts of prescriptive living intersect in some strange ways. One common way acts to give many of us insomnia. Because control over E. heavily depends on finding sufficient rest to help avoid seizing, E. becomes more difficult to control and certainly less reasonable to bear, when insomnia is in play.

Pharmacy Times states:
Statistical analysis of the inpatient study data demonstrated that major depressive episode (MDE), generalized anxiety disorder, and suicide risk were significantly associated with insomnia... Epidemiologic studies have linked insomnia, nightmares, and sleep insufficiency with an elevated risk of suicide... (June, 2006).

Drug-induced insomnia may have the effect of rendering us vulnerable to an elevated suicide risk. Isn't it logical to think that if we are suicidally inclined, that it may be a drug-induced state, and not necessarily a new symptom?

Certainly, the drugs we use to help us with E. are important to us and have improved many of our lives. The scientific community needs to more openly distinguish between resident suicidal, depressive or insomnial tendencies and those that are drug-induced. If not, persons with E. will endure yet another layer of stigma, and I'd say our burden is already heavy enough.

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