Why This Photo Shows the Need to Normalize Talking About Suicide

The picture above was taken the day before I tried to kill myself. I was 16 years old, and it was my best friend’s birthday party. You can tell how long ago it was from how thin my eyebrows were! It was the first time I wore liquid eyeliner – she’d had to apply it for me, in her bedroom where we’d got ready for the night, both of us holding our breath to get a perfect line.

I’d been living with low mood and self-loathing for around four years at that point, and had been engaging in self-harm for two years. I had never told anybody about the suicidal thoughts I had. Who would I even have told? I had visions of being dragged away from home, kicking and screaming while people in white coats threw me into a padded cell.

After my suicide attempt, I spent some time in hospital, none of which was spent in a padded cell, and was allocated a care coordinator to help me in the community. Even then, I was scared to talk about the suicidal thoughts I experienced. White coats still danced in my mind whenever she asked me about suicide. This meant that I continued to secretly think about suicide for many years, even though I never had any real intention to act on them.

The problem with suicide is that once it has become an option, it’s then always on the table. Whatever life threw at me, it was always in the deck of cards I could pull from, regardless of how rarely I seriously considered going through with it. I think of this quote from Susanna Kaysen’s “Girl, Interrupted” often:

“Made a stupid remark — why not kill myself? Missed the bus — better put an end to it all.”

Years later, as a graduate living in a different city, I went to a state-funded psychologist for an assessment. In the UK, these services are called Improving Access to Psychological Therapies (IAPT), and anyone can self-refer for a low-intensity brief intervention — usually cognitive behavioral therapy (CBT). They are designed to ease the burden of depression but have been criticized for having narrow acceptance criteria, minimal therapeutic interventions and long waiting lists.

It was a pretty textbook case of depression: low mood, poor concentration, not enjoying things, suicidal thoughts. The therapist told me that the service was not designed to treat people with serious symptoms like that. But I thought suicidal thoughts were a “normal” feature of depression?

The problem with state-funded primary mental health services rejecting you, is that you’re then left in the muddy puddle of people who are simultaneously too unwell and not unwell enough. I was never going to be picked up by secondary mental health services for moderate depression, but IAPT wouldn’t touch me. This is where charities and peer support groups pick up the pieces, and many people would not be alive without them.

Years later, I went back to university, and started experiencing very invasive suicidal thoughts. I remember losing track of what my seminar leader was saying one day because I was distracted identifying all the suicide methods in the room. I didn’t intend to act on these thoughts, but they were affecting my academic performance, so I scheduled an appointment with the university mental health services and told them about my intrusive thoughts. The therapist had me on the phone to the emergency services immediately. The call handler seemed completely baffled, as did I, but the therapist quickly made me an emergency plan to keep me safe at all hours. I shuffled out, embarrassed.

I outline these two incidents — one with the psychologist in state services, the other with the therapist at the university — to highlight something I have repeatedly encountered in my life: a fundamental misunderstanding of the nature of suicidal thoughts. Intrusive thoughts of this nature are very common in many conditions, such as anxiety and obsessive-compulsive disorder (OCD). Many people without mental health issues have experienced the intrusive thought of suicide. The biggest problem is that unhelpful reactions like those above reinforce prejudices about padded cells and seclusion rooms, and means they don’t talk about it.

Left to fester, these thoughts may well escalate to the point where the emergency services are required, as when I was young. How often do you hear, after a person ended their life, “I never would have guessed they felt that way. They never talked about it.” Silence is killing people.

When I was in hospital at 16, I was encouraged not to talk about what had happened to anyone other than my care team because of the stigma I would face. It was then that I decided to talk about it to anyone who would listen because if I had known then that experiencing suicidal thoughts doesn’t mean you’ll be kidnapped from home and locked away forever, I might have told someone. I want everyone to know that they can.

I have heard friends say that they are having difficult thoughts sometimes, but they don’t want to talk to their doctor for fear of being “locked in a hospital.” Now I am a mental health professional, I almost laugh: do you think we want to lock everyone away for having difficult thoughts? Do you think the National Health Service (NHS) can even afford that? In secondary mental health services, our thresholds are much lower: if someone experiences suicidal thoughts in a mental health unit, we aim to talk them through it, keep them safe, come up with strategies to help and enable them to help themselves.

Even then, though, the words can catch in my throat. Assessing a person who wanted to go on leave, I had to ask about suicide. “Have you been having thoughts of … harming yourself?” I apologized and asked again. “Have you been having thoughts of killing yourself?” She smiled and told me no and thanked me for asking. I was shaking.

Suicide. It’s a terrible thing, but a word we must say.

Suicide. Thinking about it doesn’t make it happen, but it can be a sign that things aren’t going right.

Suicide. Talk about it, ask about it, be open about it.