How to cope with chronic suicidal thoughts…

People who don’t struggle with chronic suicidal thoughts sometimes imagine suicide as the type of crisis that happens in the movies.  And it can happen this way, but not for everyone.  You know the cliched scene (we’ve all seen it) someone loses their job, breaks up with their partner, makes a terrible mistake, suffers the loss of a loved one etc. and they spend a dark night contemplating ending it all.   Maybe they reach out, a friend comes over, makes them tea, stays up all night and talks them through it.  Or maybe they are taken to a hospital emergency room, where staff admits, them and they are released a few days later, on medication and thankful that they are still alive.

Yes, single episode suicidal crises happen.  They are terrifying and frightening and can be medical emergencies.  If you are struggling with this type of crisis, you are not alone.  Suicide is a permanent solution to a temporary problem.   There is help available, even though reaching out can be scary.

But what if this isn’t your experience.  What if, like me, you struggle with chronic suicidal thoughts, on and off, for decades?   What if suicidal thoughts and suicidal impulses became, during times of trauma, part of your coping mechanisms?  What if suicidal thoughts, ironically and paradoxically both threaten your life and help keep you alive?  What if it isn’t just “one long dark night”?  What if it isn’t something that a trip to the local emergency room and a short psychiatric admission can even touch?  What do people like me do when they hit a rough patch?

It’s complicated.  It’s complicated for a number of reasons.

  1. It’s very hard to even talk about suicide.  It’s not an easy subject to bring up.  I’m always afraid that people will either overreact (ie. treat it like the suicidal crisis described above and call emergency services) or under react (and ignore my disclosure or not offer support).  Let’s face it, most people aren’t comfortable talking about suicide.  If someone asks me: “How are you doing today?”  they don’t want to hear “Actually I’m dealing with suicidal thoughts at the moment, thanks for asking.”  It’s just not something I can say.
  2. If I do disclose that I’m having suicidal thoughts, most times people just sit there awkwardly.  Try to figure out if I’m joking or serious.  And then change the subject.  Meanwhile, I’m sitting there, just as awkwardly, feeling guilty for making the situation awkward and not just saying “I’m fine.”
  3. See point #1.  Talking about suicide is a societal taboo.  I’ve had these thoughts for 20+ years.  I’m still alive and I’m still finding it difficult to talk about them.  There is something about this that doesn’t quite make sense.
  4. There is an incredible amount of shame related to this societal taboo.  This means that not only do I feel suicidal, I also feel ashamed about it.  I also feel afraid about the consequences that could occur if people find out and misunderstand what chronic suicidal thinking means (aka…911 calls, police, hospitals).
  5.  Suicidal thoughts are not a “cry for help” or a “way to get attention.”  Most of the time I deal with suicidal thoughts alone and people aren’t even aware that I’m having them.  Even when I do disclose, I generally minimize how bad they are.  I try to cope by myself as much as possible.  Self harm has also been a very private thing in my life.  For something to be a “cry for help” generally other people need to actually know about it!  It would be more accurate for me to describe the suicidal thoughts as a way to gain control, the ultimate control, over an overwhelming or out of control situation in my life.  It’s also related to obsessive compulsive thinking, and in that way can be circular and very difficult to control.  Sometimes I have intrusive thoughts about suicide that are obsessive and not related to anything in particular in my life.  They are disturbing to me and they are  unwanted, arriving in my brain suddenly and then leaving.

So how do I cope with these chronic, obsessive suicidal thoughts?  I use some combination of the methods below, depending on what type of thoughts I’m having, how long they last and how severe they are.  It can be helpful to make your own “safety list” with various ideas that you can use when your suicidal thoughts make an appearance.  I suggest that you create a variety of coping ideas, because chronic thoughts of self harm are very persistent and won’t likely go away with the use of just one distraction or grounding technique.  If you are lucky enough to have a supportive partner/friend you can give them a copy of your safety list and they could help you use some of the skills in a crisis situation.  For some folks, taking medication or calling a support line can be items on their lists.

  1. Delay. Delay. Delay.
  2. Distract. Distract. Distract.
  3. Remind myself of reasons why I need to stay alive (aka my kids)
  4. Listen to nature sounds on Spotify.
  5. Get in a safe space (aka my bed, under lots of warm blankets, away from anything potentially dangerous.  This works best for the most severe thoughts when other techniques may not be safe)
  6. Take a walk outside, ideally in nature.  Breathe, move my body.
  7. Drink a hot beverage (tea, hot chocolate, coffee)
  8. Reach out to a trusted friend (I may or may not tell the person I’m struggling)
  9. Blogging (others may use journaling, art or other creative outlet)
  10. Helping others, volunteer work, helping a friend in need (this works very well for me, but caution as it can lead to burn out if this is your only coping tool)
  11. Disassociate or zone out (ensure that it is safe to do so)
  12. Pay attention to your environment.  Count things you can see, feel, touch, hear.  Ground yourself in the present moment.

If you are coping with chronic suicidal thoughts, I hope that reading this post helps you to feel a little bit less alone.  If you don’t struggle with them, I hope it helps you to understand them a little bit and maybe allows you to help others around you who might be living with them.  Many people live with suicidal thoughts for years, it’s exhausting.  So very exhausting and nothing at all like what is presented in the movies.  But it has to be better than the alternative.  So I keep trying and keep breathing!  Keep hoping that it will get easier for all of us!

I feel like an imposter.

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Some days I don’t feel like I belong.  I feel like an imposter in my own life, or like my life doesn’t belong to me.  It’s a disorienting feeling and very difficult to describe to others. When I’m depressed or coping with PTSD symptoms I often feel like I’m faking it.  Like I’m pretending to be something I am not, or I am not what I am supposed to be.  I don’t fit in anywhere, even within my own life,which I struggle to believe is actually MINE.

During the workday, I help abused women.  I’m a counselor, a support worker, a health care professional, a peer supporter, and I help others.  I believe that I am good at most aspects of my job, especially those related to support work.  I have slowly developed some confidence that I can help other women.  That my experiences may have some meaning because they have given me the skills to deeply connect with others who are living with abuse, trauma and the impacts of violence.

But it’s incredibly disorienting when I leave work and am forced to deal with abuse, trauma and the impacts of violence in my own life.  Sometimes I feel confused, sometimes I feel like my life can’t really be this bad, this difficult, this out of my control.

Sometimes I feel like I’m living inside a public service announcement for domestic violence awareness.  How can I truly help others, when my own life is still being impacted by an abusive ex-partner?  How can I truly help myself?  How can I separate the past from the present, the triggers from the actual risks?   How do I stop this terrible helpless, disoriented, exhausted feeling?  Can I be a good support worker if I can’t solve the problems in my own life?  If I don’t follow my own excellent advice?

Last week I was at a doctor’s appointment with my children and my ex-partner.  It was very difficult and very triggering.  The doctor was asking the kids questions that they obviously couldn’t honestly answer with their father sitting in the room.  I felt a deep sense of pain and discomfort.  I wanted to tell the truth to the doctor about what my kids are struggling with, but I knew that if I said too much it could have impacts on my kids’ safety with their father.

The doctor asked questions about “do you feel safe?” and “do you have thoughts about harming yourself?”  On one hand, I was glad to see that this doctor was asking mental health and abuse screening questions.  On the other hand, I felt panicky and unsafe because the situation was so impossible.

I remember a time years ago, when I went with my then husband to the emergency room for a migraine.  The triage nurse asked me “do you feel safe in your home?”   The question made me pause, stop and think.  I knew that I didn’t feel safe in my home, but I also knew that answering honestly would cause something to happen.  My husband was sitting only a few feet away.  I didn’t know exactly what the “something” would be.  I hesitated for a second and answered “yes,” the only real possibility in that moment.

But I was thankful that the question was asked, because on a different day, or for a different woman that question could have been the permission and the space needed to disclose domestic violence or sexual abuse.

Health care professionals MUST ask these difficult questions.  They must ask their patients about thoughts of self harm, thoughts of suicide and experiences of violence.  They must ask if their patients feel safe at home.  These questions are vital and open a potentially life saving door.

But if the professional doesn’t have a clear plan as to how to handle a disclosure, they can do more harm than good.

Don’t ask a question you don’t want to know, or aren’t prepared to know, the answer to.

Don’t ask if someone feels safe, unless you are prepared to help them find safety if the answer is no.

Don’t ask someone if they feel suicidal unless you are prepared to support them, connect and hold space for them.

Don’t ask about abuse unless you are willing and able to support, believe and validate that potential disclosure.

Please, don’t ask questions unless you are willing to help or do what is needed to find help.

Sometimes it’s not enough just to believe someone.  Sometimes that person might need concrete help and support.  Health care professionals need enough time and enough resources to provide this help.  They shouldn’t be rushed in their jobs, they should be given adequate time and privacy to complete interviews.  They should have training in trauma informed care.  They should have resource lists, with shelter numbers, sexual assault centres and other options available.  And they should receive specific training around handling disclosures related to violence.

It was so triggering for me to be in a situation where these questions were asked in front of my abuser.  Where I knew my children didn’t have the ability to speak freely.  This situation was not conducive to health.  When in doubt, children could be interviewed alone.  Or if the doctor sense there is something complex going on, they should follow up. In a timely manner!

I know this doctor could sense the tension.  I did get the impression that she believed and could tell that I was afraid.  I didn’t feel like she did harm or had ill intent.  But I’m still constantly frustrated how many adults, doctors and counselors “believe” my children, and “believe” me, but have either no power, or no will to actually intervene to influence change.  The systems that have the power to intervene don’t believe (or are too slow) and the systems that do believe, ultimately have little power to impact the situation.

It means something to be believed.  But if the dangerous situation is allowed to continue indefinitely, it makes it difficult for survivors to trust.  It makes it difficult to feel safe and supported, anywhere.  It makes it more and more difficult to continue to disclose and continue to ask for help.  It makes me feel crazy.  It makes me feel like an imposter in my own life.  Where nothing makes sense and what I know to be right and fair and good is not able to transpire.  Where I can’t effectively protect myself or my children.  Where I help others by day, and feel panic, helplessness and fear each night.