Suicidal thoughts can, at times, go hand in hand with chronic illness. Living in constant pain mentally and/or physically can be extremely difficult to endure long-term. Most chronic illnesses are there to stay, so unlike the grief you may feel from a short-term loss or trauma, it can be even more difficult to continue life as normal with chronic pain. There isn’t always a light at the end of the tunnel. Intrusive thoughts of ending one’s life can be even more present when other stressors (the kind that occur in everyone’s lives) are compiled on top of dealing with chronic illness. Individuals struggling with chronic illness may also avoid seeking help for their feelings, which can be a contributing factor for long-term struggling.
Let’s first discuss my opinion as to why individuals with chronic illness may avoid seeking help when they are having suicidal thoughts. I myself have several debilitating chronic health conditions. I belong to online support groups for those with the same conditions as myself. These online support groups serve as a way for individuals to get support from others in similar situations as themselves. Suicidal thoughts are discussed often. When I polled the members of one of my support groups in regards to this topic, I asked the question: Would they consider asking for help by calling a prevention hotline or admitting themselves into a hospital if they were to have suicidal feelings? 36 individuals selected that they would be unlikely to seek help from those options. 15 individuals selected unsure and nine individuals chose very likely to seek help. Individuals with chronic illness have also shared their feelings with me in regards to their hesitancy to ask for help. The most common reasons given were:
1. Feeling ashamed and guilty to admit they were having these feelings. Many individuals struggling with chronic illness have family and other commitments. Being chronically ill can already bring forward thoughts of feeling like a burden or disappointment. Individuals expressed feeling ashamed to have suicidal feelings when they had people in their lives whom they loved and did not want to hurt further.
2. Not feeling comfortable discussing their feelings with a stranger (and in many cases even discussing them with someone they are close to). Individuals with chronic illness are well aware of the feeling of being judged. Most chronic illnesses may appear invisible on the outside, which can bring forth feelings of judgment from others who do not understand the struggle they face internally. Avoiding judgment may be used as a safety net to avoid further hurt.
3. Worrying that discussing these feelings with a professional could have a negative impact on their future healthcare provisions. Examples individuals discussed with me were the potential of having insurance coverage affected, having pain management affected (medications taken away) and also having life insurance claims denied (for those few who were able to qualify. Life insurance policies are often denied for individuals with chronic illness).
4. Being on a watch in an unfamiliar place, such as a hospital. The thought of being placed on a suicidal watch in a hospital may be a scary thought for anyone. However, when you are chronically ill, being away from your place of comfort and even medications can cause great anxiety.
Now let’s discuss my thoughts on how the chronic illness community can be better supported on this topic.
1. The medical community should provide better options and advocacy for support. Doctors and other medical staff need to make mental health support a real part of the treatment plan for anyone struggling with chronic illness. Simply asking patients to fill out forms where they are asked if they are depressed (along with a dozen other questions) or even briefly saying to a patient during an appointment, “Do you ever feel depressed?” as a physician goes down a list of appointment check-offs is really not sufficient. The majority of the time, even though you may have individuals who are severely depressed, they may just answer “no.”
This is similar to the reason why when chronically ill individuals are asked how they’re feeling, they often answer with a short “fine” or “alright,” even though they may be feeling the complete opposite. When you struggle with chronic illness day after day, week after week, month after month, year after year, you learn that many times people don’t really want to hear the negative. You may also have received advice that was hurtful, such as “other people have it worse,” “you don’t look sick,” “have you tried changing your diet,” etc. When you have chronic illness you learn to just smile and nod your head and say, “I’m fine,” even when you’re not. You learn to push through the pain both physically and mentally. You continue through life many times struggling in silence and isolation.
Also, if you have experienced the letdown of bravely sharing what you’re going through with others, only to have them respond by distancing themselves from you (something that is discussed frequently among the chronic illness community), you may start using the protective mechanism of avoiding talking about your situation. Doctors and medical staff should be involved and engaging with their patients in regards to not only their physical health but their mental well-being as well. For example, instead of asking a question off a pre-written form such as, “Are you depressed?,” try saying something like, “I imagine having chronic illness must be tough on you and I’m sure it can be challenging at times. How are you coping with everything?” Open the door to conversation which will encourage your patient to feel more comfortable and vulnerable when discussing their feelings with you.
Please take the time to talk to your patients and really make sure they are OK. If they are not OK, do not just brush it off. Help your patients find the resources and support they need. Reassure them they are not alone and you are there for them. Perhaps they may need some counseling or therapy services or support groups. There are tools out there that may help them deal with their feelings but they need to be able to access them. Many times patients don’t know where to go or they’re concerned they’re not going to be able to afford the services. As their physician, it is your job to help them with getting the support they need.
2. Family and friends can make a difference. In many situations where a person with chronic illness is having suicidal thoughts, it is not necessarily because of one reason. Although being in constant pain and discomfort is likely a huge contributor, I have noticed suicidal thoughts in those struggling with chronic illness become more severe when at least one of these other factors are present:
– The individual is feeling unsupported by family and/or friends
– The individual is struggling with financial issues due to their chronic illness
– The individual has experienced some sort of life stressor such as a death, divorce, move, etc.
Below are my suggestions for family and friends to support individuals struggling with chronic illness in regards to the topic of suicidal thoughts and hopelessness.
1. Let them know you are there for them. Discuss what other stress factors they have in their life that are contributing to their current feelings. When somebody is going through an already difficult time, added stressors can make their depression/suicidal thoughts even stronger. For example, if someone has a chronic illness they are already struggling with, having an added stress, such as a death in the family or loss of a job, can make things more overwhelming for them. You cannot take a chronic illness away from them but you may be able to reduce stress in their life in other ways. Talk to them and go over the contributing stress factors in their life and figure out how you may be able to assist or how you may be able to gather others to assist. Be aware that financial concerns may be a factor as well and it may be difficult for them to discuss it with you. It is not uncommon for individuals struggling with chronic illness to become unemployed due to their health condition. Even with a valid health condition, it can be difficult to receive long-term disability benefits and many individuals end up spending years in court before they can begin to receive benefits. Before you can claim disability (an inability to work), you must generally not be working in any significant capacity. For this reason, many individuals continue to try to work even though they are disabled because they feel they have no options, which can be very difficult.
2. Offer nonjudgmental support and avoid criticism. Please remember there is a lot of guilt and shame that goes along with feelings of suicidal thoughts and for that reason, many times people do not want to talk about it. If someone close to you is exhibiting signs and you are concerned about them, make sure you offer nonjudgmental support. Be there to listen to their feelings but try to avoid making judgments on their feelings or making comments such as “others have it worse,” “you’re being selfish,” etc. Avoid comments that may make them feel guilty about having these thoughts. Check in with them regularly and offer your company to them.
3. Help them find joy. As someone wise once pointed out to me, the opposite of pain is joy. Therefore, somebody who is experiencing a lot of pain (both physically and mentally) would likely be off-balance in that regard. Ask them which things bring them joy in their life or what brought them joy in the past. Encourage them to discuss these feelings with you. Try to help them figure out what gives them joy and how you can help bring more of it back into their life. This may be a matter of getting them out of the house or coming to visit them, sharing a hobby, etc.
4. Hugs. I know this last one sounds rather simplistic. However, at the end of the day, just knowing someone’s there who cares about what you’re going through, who wants to help you, who makes you feel like you still have a place on this earth… that is the most powerful medicine of all.
Please know if you are having these feelings, you are not alone. I know it may feel that way at times, but know others feel the same way as you at this very moment. My heart goes out to anyone struggling with the pain (both physical and mental) of chronic illness.
If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741.
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Thinkstock photo via uba-foto.