If you need immediate help, the number for the national suicide hotline is 1-800-273-8255 and they have a chat option on their website at https://suicidepreventionlifeline.org/

Suicidal thoughts are a major taboo subject, but we can’t even come close to helping if we avoid productive or honest conversation on the matter. If we’re too afraid to talk about it and shine a light on it, we’re too afraid to give help that’s of consequence too. This will be much like a previous post, and while I feel it’s an important thing to write, I don’t have it in me to edit as much as I normally would. I hesitated a lot on whether I should be writing it at all. But with the birthday of a friend that made that choice today, several friends talking about the topic, I think maybe it’s just time to get it out there. As it says in my bio, I’m not a medical professional. This only comes from self-study of the subject and experience.

We’ve all got some idea of what goes on in the mind of someone who’s deeply depressed and suicidal, whether from experience or from assumptions, whether accurate or inaccurate. For the average person, suicidal thoughts are often thought of as largely a passionate experience. To be hopelessly overwhelmed all the time. It’s where we get some of the confusion when a suicide does occur and then we see photos or videos of the person shortly prior to the incident and they appear to be enjoying life. There’s this misconception that if someone is suicidal, they will give off constant warning signs when they’re in danger.

But suicidal thoughts aren’t loud all the time.

I’ll repeat it for those in the back, suicidal thoughts aren’t loud all the time. Sometimes they are loud and overwhelming, invading each conversation and daily task. The mind turning the smallest negative aspect into a travesty. “The toothpaste is out, you can’t even remember to buy everyday things. You’re worthless.” Or “You need help showering? You’re such a burden on everyone, they’re just too nice to say it.” When they’re in so much control of your thoughts, you start to make a plan of exit. It seems to be this version that people expect when talk of suicidal thoughts surfaces. The iconic image of an emo kid, someone so burdened by emotional hardship that it bleeds into what they wear, how the style their hair, their music, and anything else that’s pretty stereotypical.

But sometimes these thoughts are nothing but a whisper of a notion that quickly passes. A bad pain day turns into a bad week, you’re talking with your doctor about options, and the thought flits through your awareness as a half-sarcastic…. “Or death, death is an option”.

It’s not with anger or overwhelming emotion that this thought slithers through your brain, knocking everything else down in its wake. It flutters through with the grace of a butterfly and gently lands in your awareness and just sits there. Calmly. Patiently. Unintrusive. Oddly comforting. “There’s always death”

Is One Type More of a Risk Than The Other?

Let’s call the two types of suicidal thoughts I brought up active and passive. Active being the drive to commit the act, passive being just a thought that calmly passes through. While it’s often thought that active is the only real risk, both need to be given proper attention and taken very seriously.

With active, it is a current emergency. They (or you) need immediate attention and active intervention from friend and family and mental health professionals. This is kinda common sense. Whatever their current crisis is needs addressed and as soon as possible. Because of this, this flavor of suicidal thoughts are often thought of as the most dangerous because the individual is actively making a plan. Emotions are not listening to true logic. They’re understood as teetering on the edge and in desperate need of a safe space.

Passive, however, is a lurking monster that often doesn’t get the attention it needs because it plays a really good game. In general, passive can be a really effective coping skill…until it’s not. The hidden danger of passive is that it becomes simply a choice. The high emotion is taken out of it. If you feel that your other options have been tried and failed, the brain starts to see it as just a logical progression. I have seen this a lot in the chronic illness community because when life is painful all the time, it can be hard to always look on the positive side. This is especially true with something like Ehlers-Danlos where there is currently no cure…just waiting for your body to inevitably get worse. A time period of complications or sliding backwards can easily trigger the brain to go, “Yeah, maybe that last option is all we’ve got left”.

So when it comes down to, one isn’t safer than the other. One isn’t better or more healthy, or even less dangerous. Their peak risk just comes in different forms and in different circumstances. If you experience either, I urge you with all the love in my little zebra heart, please seek professional help. You are worthy of such help, and you are worth the effort of finding a therapist that is a good match for you. It won’t stop the physical pain of what you’re going through, but it can help the psychological aspects. It is possible to bleed this topic into that of medically assisted suicide for terminal cases…but I do not have it in me to breech that aspect at this time.

The Appearance of Suicidal Thoughts

How do these look on the outside though? Are there warning signs? Is there something you, as a family member or loved one, should be looking for?

Well, in my limited experience, yes and no. There are always signs that people notice after a person exits that they feel they should have picked up on. How much of that is actual signs and how much is people wanting to feel that there is an illusion of control in such a situation? I’m honestly not sure. Sometimes people pull away and start to isolate themselves. Sometimes they will go on a minor binge to make amends, help loved ones, and gift their prized possessions. Sometimes they start making a point to check off bucket list items. Sometimes they go out of their way to do good things. Sometimes there’s loads of morbid humor. Sometimes they go on an emotional downward spiral. Sometimes…there’s nothing.

The difficult thing is that some of these “signs” are also just signs of someone going through the normal ups and downs of life. That isn’t to brush them off by any means, more to cause pause before panic. Just because your sister gifted you something important to her, doesn’t mean she’s going to jump from the roof. But, it may be something that should be inviting conversation. When your best friend is making a morbid joke about their condition, they may not be at risk to themselves. However, it probably is at minimum their way of subtly letting you know that life has been chucking lemons at their face and the morbid humor is their way of shielding themselves from the worst of it.

There’s no reason to immediately panic and call for a wellness check from the police. But there’s plenty of reason to reach out and simply see if they need to talk. Just to listen. To be there. Never underestimate the power just being there can have for someone.

What About More Obvious Signs of Self Harm?

While most immediately think of cutting one’s self, there’s other types. Taking high risks, substance abuse, picking fights, and similar actions are all able to be thought of in the spectrum of self harm. Even going off of one’s medications rather than overdosing can be in this category.

I’m generally familiar with two main reasons for doing think kind of thing. The first is for self punishment. The pain is felt to be deserved, if nobody else is going to do it they feel a drive to do it to themselves. I’ve personally seen this more with risk taking types where they feel like they’re giving fate a chance to step in. Doing something like crossing a street without looking because they’re giving the universe a chance to “correct a mistake”.

The other reason is to induce pain. While I’ve often been told by therapists trying to explain the behavior to others as trying to mimic the pain that’s on the inside on the outside, my personal understanding of it is that it is more often to do with the physical sensation of pain. Forcing the body to feel something other than focusing on the internal torment. To make the mental anguish stop by derailing it with physical sensation. Ever see a TV show where they snap a rubber band on their wrist? It’s an attempt to glitch out that thought cycle in the brain. Self-injury is a more extreme case, but often along the same lines.

I’m sure there are other reasons, but as I stated, I am not a medical professional an this is the limit of my personal experience and knowledge of the subject. Do not consider than an exhaustive explanation.

If a loved one comes to you or you accidentally discover this behavior, please, for all the love you have for them, don’t freak out. Make sure they’re safe first and foremost. Is the wound bleeding? Was the instrument and the site sterilized? What do they need from you right now? Whatever immediate questions are relevant to their safety. I know the instinct of most is to lecture, but I’m telling you, they already know all of it. Their brain is so deep down the rabbit hole that it didn’t matter to them. What they need from you is just to help get them in an immediate safe spot.

If they’re in a safe spot, or if when you notice by accident and the wounds are already healed up, lecturing them is still not as good of an idea as you might think. Most know why they do it, and are ashamed of the fact they’ve felt they had to resort to that in the moment it occurred. They need support and love. It can be tough-enough love telling a loved one “No, don’t you mark up my beautiful friend anymore and I love you” to a more gentle “I really would prefer that you not do that but can you at least promise me that you are being as safe as you can be?” It sounds counter-intuitive, but I can’t stress enough that the individual is already going through a hard enough time that it drove them to these actions. A lecture, yelling, threatening hospital stays, it can easily encourage any negative self-belief that they’re a burden and loved ones would be better off without them. This is not something you can logic out with them at this point by aggressive tactics. This is due to mental illness. Please don’t assume that if you just force your point, that it will be understood.

What Is the Next Step?

Whether active or passive, suicidal thoughts are something to take care with. There is no one-size-fits-all solution. But whatever you do, approach it with your heart full of empathy, love, and compassion. Ask them what they need and what you can do. When I’ve had personal experience from one side or the other, there’s a few things that have worked from time to time.

• Set up a check-in time
  Everyone is different, but set up where there’s a check-in for them to contact or at least pick up the phone. Talk to them about a secondary act about what to do next, not as a threat, but more of a “If you don’t pick up, I’m going to think the worst and call ______ to go over and check in on you. Not because I’m mad, but because I love you and I care”
  
• Sometimes a code word or image helps
  Among my nearest and dearest, we’ve got a code. Reptiles. If I’m seriously not doing okay, I can’t always talk and express my words they way I need to. So I can text a picture. The severity of where I’m at is reflected in the danger level of the reptile. The worst days, times where I’m legitimately concerned for myself and where my brain is at…I send a picture of Godzilla. If I’m just not okay, but worry I’m being a burden, but still know I need someone to talk to, it might be a rattlesnake. As I’m having better days and improving, it’ll head to a cute gecko.
  
  It may seem like downplaying the significance, but it’s actually more about finding a way to communicate. Often, the darkest spots of that state of mind really do make it hard to ask for what you need. Whether the individual has pushed so hard to hide it they are overwhelmed with embarrassment at having to have to ask or their brain is telling them they don’t deserve the help in the first place. It gives a slightly indirect way of asking for help when it maters the most.
  
• Help them get comfortable talking with a professional
  Going to a psychiatrist or mental hospital has a TON of stigma still. I remember horror stories of people insisting if you went in, you’d never come back out again. Yes, there are bad doctors and bad facilities. I’m not going to pretend otherwise. But there are so many that are truly out there to help. You and/or your loved one struggling are worth going through the effort to find one that is a good fit. Avoiding professional help because of fear is like avoiding going to the ER when you’re vomiting blood. There are terrible ER experiences…but isn’t your life worth that? Because you’re obviously not okay on your own right now. If you’d go for vomiting blood, you should go when considering taking your own life. They’re the same level of severity of symptoms.
  
  Look up reviews online. Ask support groups in your area for a psychologist they had a productive experience with. Talk to the individual in need and ask what their fears are and how you can best help get them the assistance they need.
  
• Listen to them
  This may seem obvious, but don’t brush off their concerns. Listen to what they have to say. Engage them in conversation at their level. If they can just cry, let them cry. If they repeat the same thing over and over, acknowledge that you’ve heard it by discussing the topic.
  
• Let them know they’re loved
  This may seem like another obvious, but so many times I’ve seen where others are so consumed with panic that they forget to approach the individual with love and compassion.
  
• Be honest
  Tell them that you’re not sure what to do if you really have no idea. It’s okay. They don’t need someone blowing smoke at them, they need someone being honest. You can be honest AND be compassionate. There’s no shame in saying “I’m sorry, I really don’t know what to say, but I know that I love you and I’m sorry your hurting.” or “I’m not really sure what to do here, so if I do something that upsets you, please just let me know and know that I don’t mean to”
  
• Finding any reason to go on, even if it’s short term is helpful
  While I often hear to learn to live for youself, not everyone can do that in the moment they need it. So find whatever you can.
  
  Because your pets need fed tomorrow
  
  Because you promised your best friend you’d make them a craft they’ve been pining over
  
  Because you need to see your favorite band in concert at least once
  
  Because you made an appointment with your doctors and you keep your appointments
  
  Because you promised a friend you’d meet them for coffee next month
  
  Because you have tasks to do at work
  
  Whatever keeps you going for just one more day, and then one more, and then one more. It doesn’t negate the need to get professional help, but it can help you get to that point.

What Not to Do

• Don’t lecture
  I know I railed on it a bit earlier, but seriously…don’t do it.
  
  They don’t need to hear how others have it worse. Or how they’d cause pain to others left behind. Or how they’re being selfish. They know. Trust me.
  
  But suicidal thoughts are so overpowering that there’s a discolored logic to all of it. If you say you’ll leave pain behind, they think it’ll only be temporary compared to the pain they’re currently causing. Doesn’t matter that it’s generally not an accurate statement. This is what I call Depression Brain. It refuses logic.
  
• Don’t think you’re fully responsible for fixing it
  You are not their savior. You are not flawed for not being able to fix them. If you cannot pull someone out of a dark place, it is not because you’re not good enough. You can only help people as much as they’re willing to be helped.
  
  There is a reason therapists and psychiatrists exist. Utilize their existance.
  
• Don’t mock them or their pain
  This should be self explanatory, but I’ve seen where people honestly thought it was helpful. I’m still murky on that line of thinking to be honest. I suppose it could fall into the “don’t lecture” catagory, but it seems different enough I wanted to mention it all on its own.
  
• Don’t say things that you don’t truly believe just because you think it’ll make them feel better in the moment.
  
  If the individual asks if you can come over tomorrow, and you know you can’t, don’t lie and say yes because you think that’s what they want to hear. Don’t make promises you don’t intend on at least making honest efforts on keeping. You can’t make things better for them by intentionally lying if you’re trying to get them to see how things aren’t as bad as what they seem right now.
  
  Don’t tell them they can call anytime and if you’re going to yell when they call you at 2am because they’re scared. It’s okay to have limits and know you’re not able to give them what they need. Just don’t lie about it.

There’s No Shame In Needing Help

I know I’ve already stated that if you’re feeling these things, to please get help. But please please PLEASE know that there’s no shame in getting help. You haven’t failed. You’re not a lesser person. You’re not worthless. I don’t have to know you personally to know this either.

I’ll share something that stuck with me. It came from someone I’ve grown to be exceptionally close to over the past few years and it made a big difference when it came to those moments I needed to ask for help. For context, I was in the middle of a really deep depression. I was scheduled for my first major surgery, the surgeon had told me I was on my way to walking myself into a wheelchair (which was pretty much true and no blame falls to him), I had been in a walking boot for 9 months, and I was terrified that it was the beginning of the end. I was upset with myself at being upset and not being able to put the emotions back into their box. He came by unexpected and at the worst (at least at that moment, it was really the best thing that I just didn’t want) time. He let me cry to him about all of it, put up with my apologizing over it……and then decided to give his input…

“I’m confused though, why do you keep apologizing? If I understand what you’re saying, it’s that your brain sometimes gets a litle sick. So…what’s the difference if you get a cold and if your brain gets a cold? You think you’re somehow broken because your brain gets a cold or something? Isn’t that what you see some of your doctors for? You have one that talks to sick brains right? If you’d go for a broken arm, why don’t you call her for brain sneezes? Besides, your brain having a cold doesn’t make you less beautiful. Or less smart. Or less skilled. So stop apologizing, and let’s just get you feeling better.”

So I’ll pass that to you. What you’re feeling is just symptoms of your brain being a bit ill and needing help. It doens’t make you any less of a person in any way. Because he didn’t know me that well when he told me all that. Just like I don’t know most of you. But he meant it, and you know what…I’ve found it to be true. Even if I’ve needed someone to remind me of it occassionally.

So one last time before I hit the publish button and get myself a hot cup of tea and call that particular friend for a bit of a needed cuddle… If you need immediate help, the number for the national suicide hotline is 1-800-273-8255 and they have a chat option on their website at https://suicidepreventionlifeline.org/