How Suicidal Ideation Is Like a Sprained Ankle

People are scared to talk about suicide because it’s a scary thing to think about, and because the only time we talk about suicide is after we’ve lost someone by it. Anthony Bourdain. Kate Spade. Chester Bennington. Our suicide awareness and discussions come at the expense of being shocked enough to open our eyes.

We see suicide as a point-in-time event, like a strike of lightning, as opposed to considering it a lengthy storm. We often hear people say the attempt “came out of nowhere” and was completely unexpected, but that doesn’t make it true. Whether we could see the signs or not, suicide is often not an impulsive decision. People can be careful to not show signs of what they’re thinking, but it doesn’t happen overnight. Therefore, if someone survives an attempt, we cannot treat it as a one-off.

When we talk about suicide when the person survives — if we talk about it — we talk about how they made it through. We talk about how they survived and things will be better now. Surviving an attempt means life continues, but the hard work is after the attempt. Surviving an attempt doesn’t mean the pain that caused the attempt disappears. The hard work is rebuilding, or building from scratch, a life we can live. When we see people survive a suicide attempt in movies or TV, that’s a happy ending. It’s not. It’s just the beginning. It’s what comes after the attempt that we need to lean in closer to; it’s how we all have to band around that person and make their experience a little better.

Now, I can’t speak for everyone, but this is how suicidal ideation is for me. Suicidal ideation is like a sprained or broken ankle, or any big injury, really. Have you ever broken a bone or had a bad fracture or sprain? And no matter how much physiotherapy you go to or how much you take care of it, it can still hurt sometimes? Maybe the weather changes and you feel that part ache a little more, or you work out too hard and the impact forces you to take a couple extra days of rest before working out again. Sometimes you have flare-ups from sleeping funny or not resting enough; sometimes, you get flare-ups for no reason at all. For me, suicidal ideation is just that. It’s the sprained ankle that will never be the same. And you can still do all the things you did before, like run or play sports or do the things you love, but maybe you’re a little bit more careful. Maybe it’s the first thing to get triggered to indicate that you need a break. I have to be mindful of my “triggers” and take a bit of extra care to avoid flare-ups and avoid unnecessary pain.

What if we treated people who survive suicide attempts the way we treat people after an accident? What if instead of never talking about that “one dark time” that’s finally over, we talk to them about how rehab/therapy is going? What if we reassured them that it’s a process, and it takes time, and there are ups and downs to physiotherapy (or psychotherapy)? If we normalized that and didn’t pressure them to be OK overnight? What if we accepted that they will need a brace or supports every now and again, maybe forever? And five or 10 years down the road, when our friend complains of shoulder pain from that car accident they had, after which they were never quite the same, we offer to hold their bag and slow down. Similarly, if our friend who survived a suicide attempt five or 10 years ago mentions they’ve been having some passive thoughts of suicide, what if — after confirming they have no intent to act on it — you just offered to help take some of the weight off by listening?

People are so happy when they hear I haven’t attempted in almost five years. It’s a great accomplishment, and I’m very grateful for my first, second and third chances because life has been so worth it. But I can’t remember a time I didn’t have passive suicidal ideation — “passive” meaning I have no intent or plan to act on my thoughts, but they’re just floating around. Not strong thoughts of wanting to die, but fleeting thoughts of being OK with not being here. In my world, I can think about suicide and not be suicidal. In Frank King’s TED Talks, he says “Let’s say my car breaks down. I have three choices: Get it fixed, get a new one, or I could just kill myself.” It’s so common for me that I hardly notice it anymore, and of course in King’s example, it’s not the option he is going to go for (personally, I’m rooting for option two — new car), but as he says “[suicide is] always on the menu.”

This is usually the part where people get scared and think this is very, very serious, and they’re not wrong because suicide is scary. It is scary. But the reason I’m telling you this is not to be scared; I’m telling you because we need to reframe the way we think of suicide as a single occurrence and adjust to seeing it as a process. We need to make these conversations OK because talking about it really, really helps. And if we respond to these conversations with rushing to a hospital or freaking out, we make it unsafe to talk about something big and scary.

Offer love. Offer compassion. Throw judgment out the window. Isn’t that what we should be doing when anyone talks to us about their mental health anyway?

As a caveat, I must add that if you or someone you love is experiencing active suicidal thoughts, it’s important to help them get the help they need immediately. Remind them they are not alone.

Follow this journey at the author’s blog.