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!

Why I sometimes miss self harm…

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<trigger warning for description of self harm>

It’s a strange thing to admit, but if I’m 100% honest with you, I still miss self harm.  As a coping mechanism it has to be considered one of the worst.  Almost my entire body is covered with permanent scars.  The scars cause me to be self conscious and feel shame.  The scars also result in social stigma, and difficulty in being taken seriously by health care providers.  They itch as they heal and sometimes they hurt.  They are constant reminders of parts of my past that I’d rather forget.

Usually when I think about self harm, what stops me is remembering two things

  1. The self harm only ever helps for a brief moment
  2. I will have to hide the wound and feel intense shame about this, as well as worry about the consequences if anyone sees the injury

This usually works, but sometimes I feel bitter and angry.   Sometimes I have thoughts like “If society didn’t consider self harm to be SO AWFUL, I could just keep doing it, because I wouldn’t feel ashamed and I wouldn’t worry about the potential negative consequences on my family.”  I get angry and I feel like my coping mechanism is being taken away from me.  I get angry and think about how some people get fall down drunk on a regular basis and society thinks this is acceptable.   Why isn’t MY coping mechanism acceptable too?  I feel like having a tantrum like a 2 year old child!  I want it and I want it NOW!  But most of the time I refrain from self harming, not just for my children, but for myself too.  It’s not a lifestyle that I want to return to.

I do want to write about some of the complex reasons I miss self harm.  Some of this might sound completely ridiculous to you.  I’m worried about being honest and just writing this down.  I’m worried about being judged for liking some aspects of this self destructive habit.

Self harm gave me something physical to take care of, and be taken care of for,  when my inner pain was un-fixable and unreachable.

Even though I experienced a lot of maltreatment and abuse in the psychiatric system and hospital emergency rooms, I sometimes miss having a physical injury that could be fixed.

There were times when I was almost addicted to the process.  The care I received after self harming was almost as important, if not more important, than the ritual itself.  The trip to the emergency room WAS part of the ritual.   To be honest, without this part of the ritual, without the serious self harm, it seems almost useless to hurt myself at all.

There was a predictable ritual to the emergency room visit.  At times, I felt safe and cared for there.  At times it felt like a pause, a break from the day to day stressors in my life, which at that time felt unbearable.   I think there was a part of me that used self harm and suicide attempts as an excuse.  Not a cry for help or attention, but a cry that said: “I can’t do this.  It’s too much.  I need a break.  I need to be cared for.  I’m not capable.  I’m afraid to fail.

I remember some of the times I had multiple serious injuries from self harm.  It took the doctor or medical students a considerable amount of time to fix the cuts.  During that time, the doctor would often speak to me.  I had their full attention.  I was being cared for and I was being symbolically “fixed.”

There was a ritual to the process.  Triage.  Waiting room.  Exam room.  The questions.  The cleaning of the wounds.  The freezing.  The sutures.  The bandaging after.  The conversation.  The questions.  For those hours, if I was treated nicely, it was like being numb and being in another world.    A world where time was stopped, my responsibilities were paused, the outside world did not exist.    I actually FELT better afterwards, like I had been healed, but the improvement was so fleeting.  So very fleeting, that often I was injuring again only a day later.

It was as if the injury gave me an excuse to stop, validation to say “I’m not well.  I’m not coping.  I need help!”  Without the injury, without the physical reason, I struggled to ask for or to accept help.  I still do.

I’ve never really verbalized all this to anyone before.

I remember one time, I cut myself on my stomach.  It was deeper than usual, maybe deeper than I intended or realized, because I was new to injuring in that spot.  Over time I had learned to hurt myself in places I could hide.   (When I first started, I was almost hypomanic from SSRIs and I cut in visible places, places everyone could see and that were very difficult to hide.)

I went to the hospital, as I usually would, alone.  At the triage desk they examined me, discovered the wound was serious and triaged me as Emergent rather than Urgent or Less Urgent.   I was put into a wheelchair and taken back into a part of the ER I’d never seen before.  I think it was the place for seriously ill people. The lights were dimmed and the bed was actually comfortable.  I had my own room, not just a curtained area.  It was quiet and comfortable.  I didn’t have to wait very long and I remember feeling safe and calm and protected.  I felt like my health problem was considered important, legitimate and I was being cared for appropriately.  I had a female doctor and she was kind to me.  She was wearing ordinary clothes rather than scrubs or a gown.  I remember her as being fairly young.  She treated me as if I had a physical health problem, not as a mad, crazy, unworthy self harming psych patient.   I felt bad because she got blood on her clothing while she fixed my injury.   I can’t really describe exactly what happened that night.   But I felt protected and the ritual had worked, my mind was quiet.  The racing thoughts were gone.  It was silent and the room was dimmed, like the thoughts were dimmed as well.  For that time I was in another world.

I’m having a difficult week.  I’m feeling overwhelmed and lonely and scared.  I’d like nothing more than to be cared for.  To be honest, the thought of that quiet, dimly lit emergency room bed is very appealing. But I don’t want to achieve this through self harm.  I don’t want to be “sick” and treated in hospital to get a break or to feel validated in resting.

I want someone to take care of me because they care about me, not because it is their job.  I want comfort because someone loves me, not because they are scared that I might harm myself.

I want to be an adult and not a misbehaving, out of control 2 year old.  This is part of what recovery means to me.  I have to use my words, not my actions to let people know that I’m not okay.

Note: the art was made in 2005