The Catch-22 of Suicidal Ideation

When I was in the depths of my worst mental health a little over a year ago, I was often faced with a dilemma. And it’s one I’ve never seen discussed before.

I dealt with chronic suicidal ideation, as is unfortunately common with severe depression and/or borderline personality disorder (BPD). I was also taught I should tell someone I trusted and my therapist, and if it was really bad, I should go to the hospital emergency room for an evaluation.

What I found though was that it wasn’t so simple. I would instead get stuck in thought spirals about whether or not to go to the ER. I was frozen with indecision because I was in a catch-22. There was seldom a winning option.

The catch-22 was this: When I was suicidal, I was supposed to go the hospital. However, if I went to the hospital voluntarily, I demonstrated a certain level of “mental stability.” It was often interpreted as a lack of intent to go through with hurting myself, and I was usually just sent home. In order to keep myself safe though, I needed to be in the hospital, but how do you get admitted to the hospital without asking for help? And by asking for help, you demonstrate a level of stability where it could be interpreted that you aren’t “as sick” or really suicidal. And around and around we go…

The solution my unhealthy, desperate brain came up with was to find ways to be sent to the hospital involuntarily. There was a correlation between how seriously I was taken at the ER and whether I walked there myself or was driven over in a police car. So, often I opted for the police car. When the hospital was deemed necessarily, my therapist would ask if I could get there on my own. I often panicked because I knew this decision would have a huge impact on how the ER interpreted my mental status; I would avoid answering until my therapist took my lack of answer as a “no.”

Similarly, if I was with a non-professional when severely suicidal and they didn’t want to call 911, my hypersensitive brain felt invalidated and once again panicked. In response, my emotions escalated rapidly until I was threatening verbally to kill myself, and they were forced to call 911 to take me to the ER.

I don’t want people to read this and interpret it as me being dramatic or attention-seeking or causing crises per se “on purpose.” It was more a matter of intense pain and desperation for help. I didn’t have the skills to react in any other way. Moreover, when I got myself into a crisis and was taken to the ER via a 911 call or police escort, my pain was taken more seriously and I received more help. This cycle was heavily reinforced.

Yet, while I acknowledge this and try not to blame myself, I do feel a sense of shame when talking about my past. Perhaps one too many professionals acted as if I was wasting their time when I showed up at the ER for the umpteenth time saying I was suicidal. I have surely internalized some judgment and stigma. I am publishing this though because I think it gives a good glimpse into what it is like to live with BPD or similar emotional instability.

I’m not sure how to solve this catch-22. Obviously, there is a shortage of emergency resources, and the professionals were just doing their best to triage. But somehow, we need to find a way to also acknowledge those patients who take action to get themselves help. I was told to go back to the ER if I was suicidal; shouldn’t I be taken seriously for doing so? Only then can we reinforce this initiative to get help rather than only reinforcing acting more helpless and passive.

I can’t tell you how many hours I spent thinking about this paradox when I was in my darkest, deepest pain; it was time that could’ve been spent thinking through coping skills or other productive matters. To go to the hospital or not? To call 911 or have someone else call? To tell my therapist I’m suicidal directly or subtly? How will I actually get help? Through DBT, I did learn skills to ask for help more effectively than escalating and threatening, and to be more active in my own recovery. Yet, I would still love to have a discussion on how we can solve this seeming catch-22.