I still remember the moment I had suicidal ideations for the first time. I was deeply depressed, but knew that I wanted to live and that I had my life reasonably together. Despite that, as I cut up some chicken to cook for dinner, something in my brain suggested that I should use that sharp knife on my arm instead of the chicken.
The urge to cut my arm open, and follow the vein up, was disturbingly strong. I was able to resist it, but the fact that that was where my brain went disturbed me deeply.
A week or so later, I had a similar voice in my head about the sleeping pills I took every night. Why didn’t I just take all of them and not wake up again? Wouldn’t that be easy?
I withstood the urge and took action to protect myself from falling prey to that thought, but the fact that it occurred terrified me.
Defining suicidality
Suicidality or suicidal ideations occur when a person repeatedly considered ending their life or has regular thoughts about how much easier it would be if they weren’t around anymore.
Many people connect committing suicide with either mental health issues or some form of weakness or escapism. I’ve repeatedly heard the idea that suicide is a selfish act, but am aware that usually from the perspective of the person carrying through with the idea they feel that it is the only option.
The challenge is that there is a large percentage of people who do not have ongoing mental health issues but may have a period of high stress where they have suicidal urges, and there is also a large percentage of people with mental health conditions who don’t become suicidal.
Another thing that mental health professionals have found is that about half of the suicide cases who are under a doctor’s care don’t identify as being suicidal or having suicidal thoughts.
Historically, suicidal thoughts or ideas have been viewed as a dangerous symptom of people with mental health issues.
If a person is depressed or anxious, it makes a degree of sense that they may reach a point of thinking that the world is better off without them, or that death will end their pain.
However, there is now an argument being made that suicidality may be its own completely separate diagnosis. One of the suggested terms for this separate condition is ‘suicide crisis syndrome’.
Differentiating ‘suicide crisis syndrome’ from the standard understanding of suicidal ideation.
I agree that this is an important differentiation to be made. The occasional thought of suicide or fading out of life is a very different thing from the intensive urges I have dealt with a few times.
I agree that thoughts of no longer existing or an idea that dying or fading away might be easier does fit as a symptom of depression or anxiety.
Maybe once or twice, I’ve wondered if the world would have been a better place if I’d never been born(hasn’t everyone had a moment or two like that?), but to me, suicidal urges are a very different thing.
The standard understanding of suicidal thoughts is intellectual to me while ‘suicidal crisis syndrome’ is much more of an emotional response.
While I agree that the intellectual ‘what if’ type contemplation of ending one’s life fits as a symptom of depression, that urge towards specific action feels like a much rawer and more emotional symptom.
When I had a voice in my head suggesting that I could use the knife or overdose on my meds, it was an urge, something akin to an addiction or compulsion.
Even though I intellectually knew I didn’t want to die, my emotions were screaming something different.
Even though I knew that I wanted to keep living, the urge was there, pulling at me in a similar way to how I’ve heard addictions described.
The urge to cut myself or overdose on my pills was a sirens song, harder to resist(and much deadlier) than the urge to have “just one more” of my favorite food.
Self-injury and suicidality – not necessarily synonymous
Another important distinction to make is the difference between self-injurious behavior and suicidal actions.
I’ve dealt with a desire to hurt myself so that I feel something other than depression’s numbness.
For many people, causing physical pain or marks on themselves may be a form of stress relief, physical expression of emotional pain, or serve some other purpose.
I’m not saying that this is the healthiest way of coping, but I do want to differentiate between mild self-injury, where the point is to do damage or feel pain, and suicidality, where the point is to end one’s life or become unaware, possibly forever.
I know that much of the time I practiced self-injury or had self-injurious desires, it was more intentional and controlled than the suicidal urges I’ve dealt with – it was a way to feel something in the midst of depression, or to express my rage without breaking things.
It wasn’t something that was necessarily going to escalate into suicidality, though I freely admit that I had both psychological and psychiatric support during that time and was getting the help I needed.
Suppose you or someone you love is experiencing self-injury or self-injurious urges.
In that case, mental health support will be very useful, but please don’t assume that these urges or behaviors mean that suicidality is the next step.
Dig in and learn why these urges happen and what the desired outcome is(or what release may come from it), but please don’t conflate self-injury and suicidality.
Suicidality as a side effect
This is another one of those weird statistics. People with severe depression are more likely to attempt suicide right after starting their antidepressants than before they take antidepressants.
Why?
Because often antidepressants increase energy before the patient’s mood recovers.
Does that mean not to take antidepressants?
Of course not!
In the long term, they can be very helpful if needed.
However, it is important to know that statistic, as well as that one of the possible side effects of taking antidepressants or other psychiatric meds, may be those suicidal urges I mentioned.
Again, this doesn’t mean don’t take them, but it does mean to be aware of this possibility and to possibly have somebody to check in with for the first couple weeks on a new psychiatric medication to help make sure you are thinking clearly.
The risk for this is especially high with children and young adults who take psychiatric medication. Basically, anybody under 28 is at a higher-than-average risk of this particular side effect.
Why does it matter?
Currently, there are a few researchers working on this – the goal is to not only define the condition but also to create a treatment plan and method to guide hospitals and doctors towards better protecting patients from their urges.
If you personally find this differentiation useful for yourself or others, feel free to share it.
There are two differentiations that I think are most important.
One is recognizing that in some cases, suicidal ideas are an urge that you cannot prevent rather than an idea you can choose not to think about.
The second is that suicidal thoughts like these also may be a stress response, rather than a symptom of a specific mental illness.
Both of these can help you to better manage ideations you might have or help you be more supportive to a friend struggling with their own ideations.
I know that when I could think of it this way, I was able to focus on how to not give in to the urge rather than beating up on myself for having it in the first place.
I also have found it helps me be supportive of friends going through this type of crisis since I don’t take their ideations as some form of slight to our friendship or as a cry for attention or as something that can be solved immediately.
What can I do if somebody I know goes through suicidal ideations or crises?
Often one vital piece is reassurance: remind them that you are their friend and that you care for them and want to support them.
People managing depression and other health issues often fear being seen as a burden and may shy away from communicating deeply about their concerns out of a fear of rejection.
Help them find support!
Depending on their situation, they may need to be hospitalized or participate in a peer support program or see a psychologist or counselor(or get in touch with theirs if they have one). An immediate step may also be calling a crisis line.
As a friend, you can talk to them about what they need and you can discuss what you personally can do, and what additional supports there may be out there.
Sometimes, the most helpful thing is simply to be with them.
I know that I was most comforted by friends taking time out to just sit with me, hold me, or watch a movie with me(depending on the friend and circumstances) which helped me reassure myself and gave me time to regain control and not listen to those urges.
When the urges hit me, part of my personal management solution was to call a friend or family member on the phone, explain what happened and have them help me make a plan to move forward.
I very clearly remember calling my mother after the chicken incident, and her comforting me and suggesting that I order a pizza after we got off the phone, so I wouldn’t need to touch the knife again.
If you get a similar call from a friend, work from your strengths, but be aware that a person dealing with any form of suicidal ideations also feels overwhelmed and may be having a hard time thinking things through or finding their best options.
Help them make plans to get from one step to the next. For example, if they go to the hospital, encourage them to have a plan(such as a treatment program or therapy appointments) before they leave.
You may also suggest that they check in with you between steps, or that you accompany them for certain steps they find challenging(such as offering to pick them up at the hospital, asking that they call you when they get home, or offering to accompany them to their appointment).
You also may ask to be their health advocate and emergency contact. Often hospitals are disturbingly bad at helping patients with transitions – especially those managing mental health issues.
Don’t forget to take care of yourself! If you don’t, you’re going to need more help and won’t be able to keep helping them either.
Connect with other friends or family of theirs if possible.
You can’t do or be everything for your friend, nobody can.
So, reach out to mutual friends or ask them to help you contact other friends of theirs(or supportive family members), so you can potentially coordinate support and work together to help them.
This can be as simple as knowing others are also checking in, or taking turns keeping them company so all of you know that somebody’s there all the time.
Conclusion: separating suicidal crisis syndrome from general suicidality can be very useful
While currently suicidality and suicidal ideations are seen more as a symptom of many mental illnesses rather than a condition in its own right, it can be very useful to make that distinction at certain times.
While people with depression and other mental illnesses can have thoughts of suicide or of how other’s lives(or their own) may be easier if they aren’t around, other people do not report such thoughts before suddenly hitting a crisis point where ideas and plans for their own death suddenly crop up and can become overwhelming urges.
Both categories of people need help and support, but the current definitions leave out many people in this second category. You do not have to have a mental illness to develop suicidal crisis syndrome, nor do you necessarily have a desire to die. It can be a stress response of some sort, where these urges occur despite everything else.
These suicidal urges and ideations can also be a medication side-effect, and often there is a brief period after starting an antidepressant where suicide may be more likely due to an increase in energy prior to mood improvement.
If you or somebody you know is going through an intense period of suicidal thoughts or urges, company is often helpful. Hospitalization may be needed in a severe case, and support programs are available to help manage these intrusive thoughts. If the person doesn’t have a therapist, one may be helpful in the long term.
Have you experienced any sort of suicidal thoughts or urges? If so, do you any additional thoughts to share?
