What Helps When I'm Suicidal (and What Doesn't)

I live with chronic suicidal ideation, which at times becomes acute. In these moments of crisis, I am often asked, “How can I help?” I know it is frustrating, but in those moments I have no idea what to tell you. My mind is spiraling and overwhelmed. Part of me doesn’t even consider suicide a problem. I have had these thoughts my whole life. They are who I am. Moreover, I am fiercely independent. I don’t want to be a bother. I don’t want to ask for “help.” My answer will usually be, “It’s OK. I’m OK.”

I know you mean well, but there are a number of things that only make the crisis worse. Minimizing my challenge does not help. Telling me a string of positive thoughts just betrays how little you understand. Saying things that make me dismiss your intentions, like:

“It’s not that bad.”

“Look on the bright side.”

“You can do this.”

Your words and thoughts become trivial in my mind because it feels like you have no idea what you are talking about. “Don’t worry. Be happy.” is just a catchy song.

“Count your blessings” is also not helpful. It feels like you are just trying to change the subject. Or things like:

“You have so much to live for.”

“Other people have it so much worse.”

“Don’t be so dramatic.”

“You are being selfish.”

They are all insulting to me. They invalidate what I am going through. I know my thoughts are distorted, but they are mine and they are stuck in crisis. At that moment, I don’t care about anyone else. You suggesting I should, tells me you don’t care about me specifically.

When you say, “I know how you feel” and suggest my crisis is somehow common, you make me feel less important. I’m a failure. Clearly others have handled this. Why can’t I? My thoughts will then become defensive. My suicidal ideation is not like everyone else’s.

The desperate appeal of, “I would be devastated if you were gone” also invalidates my own experience. Now I don’t only have to think of my own consequences, but yours as well. It feels like you are guilting me into staying alive. My crisis turns to anger and resentment. It amplifies my distress. I can barely take care of myself and now you’re dumping your happiness on me.

Telling me to think of my children, my wife, my extended family only makes me angry. They are already always in my thoughts. I know they will be devastated if I die by suicide. I know it will change their lives forever. Accusing me of neglect is not helpful. Instead you only heighten the guilt I am already feeling. I’m already ashamed of my disease. Your accusation justifies why I should die. Does it make logical sense? No. But that is the inevitable path my thoughts will take. I will shut down and not listen to your words.

Don’t ask me for reasons to live. When I’m in crisis, there are none. The more you push, the more I will dig in. I am not dealing with logical thoughts. Everything is jumbled and hyperfocused on distress and its relief by suicide.

Asking if I have been taking my medication feels like an accusation. It undermines my own emotions. It blames me for the crisis. The dark thoughts are not real. Rather, they are just a chemical stew that has boiled over. For the record, I have never missed a dose of medication. The mere suggestion is enough to make me shut you out.

Also, don’t tell me to call a helpline. If you are there during my crisis, that is not by coincidence. I have chosen you to witness me in a very vulnerable moment. I trust you. I understand why you would want me to reach out to professionals, but by telling me to do so in that moment, you are abandoning me — at least, that is how it feels. Similarly, asking for my safety plan feels dismissive to me. If you are there, you are already part of my plan.

So, what can you do?

First off, stay quiet. Listen. Be there for me. Let me know I am not alone, but don’t try to talk me down. The more words you use, the less I’ll listen. Conversation only amplifies the agitation for me. Don’t bombard me with questions or try to engage me in some sort of verbal distraction. Changing the subject is not helpful. I will just hide deeper in the crisis and put up my usual defenses. I will quickly say, “I’m fine” in the hope you will leave me alone. Demonstrate empathy, not judgment. See if there is a way to give me more time, to free up my schedule, and relieve external pressures. Is there an upcoming event or appointment or do I have to go to work soon? Is there a way I can cancel or phone in sick? Simplify my day.

Stay with me or arrange for someone to stay with me. I’m not looking for a therapist at this point. Don’t try to explore my psyche or uncover past traumas. I’ll do that later with my actual therapist. In the moment, I just need time to deescalate on my own. Having someone there keeps me safe. I’ll initiate any conversation when I am ready. Just be patient.

If you do want to say something, the most powerful words you can use are: “You are important to me.” If you just say, “You are important,” I will dismiss you because I do not feel that way. But by adding “to me,” it changes the meaning. I can’t argue with what you believe. These words make me stop and think. They make me see you. They give me value that, in that moment, I don’t realize I have.

I know it is hard to watch a loved one in pain. The most important thing you can do when I reach out for help is be there for me. Without a word, you are more supportive than you could ever imagine. You give me value so I can breathe deeply again.