Trouble asking for help

I think my shrink is very worried about me. He wants me to tell him if I need help staying alive and that I'll go inpatient if I feel self-destructive. I've promised him that I will tell him if I need that help. When I made the promise I was confident that I could keep it. But in the middle of the night things are different. Fears are magnified and that confidence is shaken.

There have been countless nights that I have needed that help, but didn't ask. Hearing the pleas from inside to end the suffering and wanting to act on them (and acting on them at times), I would convince myself that I wasn't that bad off. That my pain wasn't important enough or urgent enough to require assistance. That I was either blowing things out of proportion or just trying to get attention.

That's what I've always done my whole life. Trivialize things. Focus on the little things while avoiding the life changing matters that count. Felt so unimportant that I wasn't worth anyone's time or effort. That I was a nuisance or a bother. I'm famous for saying "it's ok, it's not that big of a deal". I don't feel like I deserve help to stay alive. Any help, actually. I feel like I'm taking up valuable resources that other people deserve much more than me. I crave attention so much that my soul is literally screaming for it, yet when attention is actually focused on me all I want to do is shrink away into a corner and hide from it, become invisible. I'm so fucked up it's unbelievable.

Every time I've acted on those pleas was a cry for help. But I always held back, either by not taking a lethal dose of pills or by getting help in time, or both. On the times I got help, I was so embarrassed because I was calling attention to myself. The only reason I actually asked for help was that I was afraid I actually had taken a lethal dose and was going to die when I really didn't want to. The rest of the times I just rode it out, sick as a dog and not telling anyone why. You see, even though I was crying out for help, my belief of not deserving it, along with not wanting to call attention to myself, wouldn't let me voice the cry.

So how do I ask for help now if I need it? My whole life I've purposely avoided asking for the very help my shrink is now wanting me to ask for. Am I even capable of judging whether or not I need that help? Can I step far enough back from the pain and impulse to assess the risk accurately? I recognize how impulsive I am. Will that get in my way? And if I can assess the risk correctly, can I overcome my fears and make the call? So, the question is when the time comes, because I know it will - it always does - will I be able to ask for help to stay alive?

What scares me is I don't know the answer.