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When You Live With Constant Suicidal Thoughts

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I’ve been thinking a lot about suicide lately. Now, before you get concerned, hear me out. Suicidal thoughts have been a constant in my life since I was 12 years old. While suicidal ideation may not be a “normal” reaction to life stressors (or so I’m told), I don’t know what it’s like to not consider suicide. I realize that to those who have never wished to die, this probably sounds absurd. I have treatment-resistant major depressive disorder and suicidal thoughts ebb and flow regularly for me. Sometimes suicide is all I can think about and sometimes I go weeks or months with just the acknowledgment that those thoughts are lurking in the recesses of my brain, likely to return in the near future.

Not everyone who dies by suicide has depression. There is a high correlation between mental illness and completed suicide in that 90 percent of those who die by suicide meet the diagnostic criteria for a mental illness; however, depression is by no means a death sentence. There are so many other factors that come into play with suicide risk such as co-occurring mental and physical illnesses, substance use, stress, environment, access to resources/treatment, the presence or absence of support systems, oppression and discrimination, history of trauma, feelings of hopelessness, etc.

Personally, depression has been a significant factor in my suicidal ideation and I prefer to use the diagnostic term for my condition because it helps me to conceptualize it and engage in self-compassion. Conversely, mental health diagnoses can be pathologizing and suggest that individuals are irrational when they are actually responding appropriately to a past or current circumstance of trauma, discrimination or oppression. Not everyone who identifies with the symptoms of a mental illness will subscribe to a diagnosis, and that is understandable given the stigma associated with mental illness in our society.

I haven’t spoken openly about my depression or suicidality because I don’t want to risk losing my job, my kids, my reputation or my autonomy in decision-making about how I live my life. I fear I will not be allowed to continue my life as I know if I’m honest about my thoughts of self-harm and suicidal ideation. There is a great deal of misinformation and stigma associated with suicidal thoughts. The prospect of a person taking their own life is frightening and so we try to pacify that fear by categorizing suicidal people into a neat little category separate from ourselves. We say suicidal people are “crazy,” “selfish,” “weak” and “attention-seeking.” In other words, we profess that we would never do such a thing and thereby put ourselves firmly in the “sane,” “rational” and “normal” category of society.

Our understanding of suicidality secondary to depression is thick with the shame of a society that treats depression as a choice rather than a potentially deadly illness. In our Western medical model, illnesses that cannot be easily identified by changes in physiological markers (such as those obtained through observation of vital signs, lab tests, imaging, or even exploratory surgery) are generally not taken as seriously as illnesses that can be quantified by their effect on the body. Individuals with “invisible” illnesses (such as mental illness, chronic fatigue syndrome, fibromyalgiachronic pain, etc.) are much more prone to questions about the validity of their illness and face more barriers to obtaining effective treatment.

Depression can affect mood, thoughts, behavior, motivation and cognitive processing. As if that weren’t enough, depression can also manifest in physical ailments such as psychomotor activity changes, joint pain, gastrointestinal problems, headaches, sleep disturbances and appetite changes. All of this with no definitive physiological cause (although there are many theories) and no guarantee of recovery. The symptoms of depression can be treated with medication (usually at the cost of significant side effects), therapy, and lifestyle modifications; however, figuring out which combination of treatments will “work” for one person can take years of trial and error with the possibility that treatment may simply make the condition tolerable – not cured. There seems to be a misunderstanding that major depressive disorder will pass after a “reasonable” amount of time — as if it were a fleeting emotion. It is estimated that 10 to 30 percent of those diagnosed with major depressive disorder will meet the criteria for treatment-resistant depression, meaning that their symptoms do not improve (or only improve marginally) in response to typical treatment methods. For these individuals, there is only so much patience and tolerance that our society extends before it is suggested that they should “snap out of it,” “think positive thoughts” or some variation of the sentiment “it’s all in your head.” While the nexus of depression lies, quite literally, in one’s head, it cannot be remedied by thinking one’s way out of it.

When depression descends with no reprieve, the rational human response is to find a way to stop the misery. It is a biological human instinct to distance ourselves from pain and struggles. When we aren’t capable of sitting in the discomfort of our feelings, we protect ourselves from emotional pain by implementing coping mechanisms. Coping mechanisms fall on a spectrum from benign to harmful depending on one’s perspective and interpretation of the situation. Of course, any coping mechanism can be problematic in excess, regardless of how “healthy” it may be in moderation.

When we’re in pain, it is likely that the long-term outcome of a particular coping mechanism won’t matter to us. Whatever coping mechanism is most accessible or provides the most immediate relief is going to be what we rely on in the moment. We may choose to cope in a way that is harmful to us because the risk of harm is outweighed by the reprieve from our current emotional pain. We all act in risky ways based on what we perceive will result in less pain in the moment. That doesn’t mean we’re bad or wrong or more or less deserving of worthiness — it just means we’re doing the best we can in any given situation.

Coping mechanisms can allow us to numb out temporarily, but no state of disassociation from reality can last indefinitely — except for death. This is important to understand because it makes the distinction between suicide being an irrational choice and suicide being a logical action by a person who’s current coping mechanisms are overwhelmed by emotional distress. Suicide legitimately appears to be their only option to end the struggle permanently. Consider for a moment how much pain and misery someone must be in to override their body’s instinctive reflexes to stay alive. Do we really have the right to judge someone in that amount of pain?

People who have suicidal thoughts should not be shamed for wanting the pain to stop. That is a natural human reaction to discomfort and a logical solution when one believes that all other avenues are hopeless. It’s not “crazy” to want to die – quite the opposite: suicide makes a lot of sense when you understand the way depression affects a person’s quality of life. Depression can make someone’s life a living hell while simultaneously convincing them that there is no hope of recovery. Is it any wonder that those who struggle with depression also exhibit a vast hopelessness about the future?

I purpose another way to view those who battle suicidal thoughts: They are brave and perseverant every moment that they continue living. They are strong for dealing with their vast internal turmoil day after day and year after year. They are selfless for sticking around because people rely on them and they know their death would be a burden to others. They exude hope in each moment that they continue fighting. Sometimes the burden is too much and people don’t have the resources, circumstances, support, or will to continue on, but this isn’t their fault. No one gets to choose whether or not they have depression or how depression will affect their mind and body.

With this in mind, we need to make room in society for people to be mentally ill the way they are physically ill. This means removing the stigma, blame and shame from mental illness and putting an end to the illusion that a person can or should control it. It also means allowing for adequate healing time — even if that’s years or a lifetime. It’s often not reasonable to expect someone with depression to keep up with their previous pace of life and we need to honor that the same way we would for someone with a chronic physical illness. Likely, the recovery from depression will not be quick or linear or without relapse; but instead of blaming the person — we should be blaming the illness and providing critical support and accommodations.

Most of the time, I don’t know if I’m in recovery from depression or in the thick of it. My depression is omnipresent. For people like me who live with treatment resistant depression and contemplate suicide on a fairly regular basis, a 72 hour hold probably won’t resolve suicidal ideation. This is not to say that formal psychiatric care doesn’t have its place – it can be life-saving under the appropriate circumstances; however, for someone who has lived with these thoughts for 15 years – removing me from my family, friends, and routine would probably cause more harm than good at this point.

What would benefit me, and everyone with mental illness, is to live in a society that gives us the time, space and resources to care for ourselves in the midst of our illness, while refraining from stigmatizing us for having a mental illness in the first place. I don’t want to have to prove that I’m “sick enough” to get help and at the same time, I don’t want receiving help to mean I no longer get to participate in the life I’ve built. I want to know I can ask for help without fearing I will be discriminated against in the future because of it.

So can we put down the judgment? Can we try to imagine the agony that a person struggling with mental illness must be in to feel their only viable option is to override their biological drive for survival? We need to realize that we’re all walking a thin line between “normalcy” and circumstances (including mental and physical illnesses) that make us question our will to live. When we’re the ones teetering on the edge, that’s when we’ll realize how important radical acceptance of others is to their well-being.

My depression will probably be a life-long condition and thoughts of suicide are likely to go along with that. I can manage the symptoms to the best of my ability, but I really don’t have a choice in the matter. Where choice does come into play is how we as a society choose to respond to those in the depths of mental illness. We can continue to respond with discrimination, shame and blame or we can choose to respond with compassion, empathy and a willingness to learn. I can’t choose to rid myself of depression and suicidal thoughts, but you can choose not to judge me for it.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

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Unsplash photo via Anton Darius

Originally published: October 26, 2017
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