On Being Suicidal

By Will Falk / San Diego Free Press

Woman With Bangs By Pablo Picasso / Public Domain

“I am suicidal.”

Three words only — but, the three most difficult words I’ve ever had to say. I did not want to say them. I fought so hard to leave them in the chill darkness of my depressed mind and now their expression feels like a declaration of defeat.

I fear that giving voice to my suicidal thoughts will make them more dangerous. And, when I admit being suicidal, the demonic voices whispering on the edges of my consciousness will escape through my words to materialize as physical shadows hounding me wherever I go.

Because of these fears, I tried desperately to ignore what the words meant. Having already attempted suicide twice in my life, I know what can happen if I deny the words for too long. I know where that seductive path leads.

And so, after several weeks in one of the worst depressive episodes I’ve experienced in years, I sit in the white light of my psychiatrist’s office, head in hands, spitting the words — and their awful taste — out.

I expect my psychiatrist to scribble something on her notebook and to reach under her desk to a panic button. I expect a squad of grey-clad men to burst into the room to seize me and take me to a distant hospital’s psyche ward where some of my friends and family will come to sit across from me in a sterile cafeteria that smells like stale french fries and cheap coffee. They will look at me with that peculiar expression of pity and fear that asks, “When is he going to crack again?”

But that doesn’t happen. My doctor does not move at all. Her eyes are compassionate and she says, “Thank you for telling me, Will. I am very sorry you’ve been feeling this way.”

***

September is National Suicide Prevention Month and my September passed as I fought to prevent my own suicide. August brought one of the worst depressive episodes I’ve experienced since being diagnosed with major depressive disorder four years ago. With my history of suicide attempts, suicidal thoughts take on an extra measure of seriousness. Each successive episode brings new insights into my illness and, as a writer who struggles with depression, one way I cope with the disease is to find some wisdom in the experience to share with others who struggle like me.

What troubles me the most about my recent episode, is how long I struggled silently with suicidality before I finally told my psychiatrist. Despite having extremely supportive friends and family, I told no one else, except for vaguely hinting at it to my partner. Writing is a place where I find it much easier to be honest than almost anywhere else. But even in writing, I failed to mention the suicidal thoughts affecting me when I wrote an essay for the San Diego Free Press called This Is What Depression Feels Like.

Why, when I know – intimately – the danger suicidal thoughts pose, do I find it so difficult to tell someone?

One reason is I know the stigma that attaches to mental illness, generally, attaches to suicidal ideation in an even stronger manner. For example, I just read that some therapists are reluctant to take suicidal patients.

I was raised Catholic and I know that the Church teaches suicide is a mortal sin – one that can send someone straight to hell. I know many of the other Christian denominations share similar teachings.These teachings, even though many now challenge them, seep deeply into the cultural psyche. We say “he committed a crime” and we also say “she committed suicide.”

Some of the reasons can be attributed to my lack of courage, perhaps. I fear that people who hear me declare the presence of suicidal thoughts will leave me, will ridicule me, will criticize me. I imagine situations where friends distance themselves from me as an act of self-protection. If they perceive both the potential that I might kill myself and the emotional trauma that would cause, maybe my friends will cut me out of their lives?

Having seen the looks on the faces of my friends and family in the mental hospitals I’ve stayed in after attempting suicide, I know the emotional investments my loved ones have made in me. When I recognize the presence of suicidal thoughts, I feel I am my loved ones. “I thought you said, ‘Never Again,’” I can hear them saying.

People may overreact. When I tell someone I am suicidal, I do not trust them to distinguish that statement from “I am going to kill myself.” As a lawyer, my mind jumps to the arguments the State can make to demonstrate that I am “a threat of harm to myself or others” in order to gain a court order to put and keep me in a mental hospital. I do not want my words to be used against me.

***

According to the Center for Disease Control, more than 41,000 Americans kill themselves a year.

Less people would die by suicide if they felt more comfortable discussing their own suicidality. So, the question becomes, How do we create an atmosphere where the suicidal openly discuss their suicidal thoughts?

I think it starts with demystifying the experience of suicidal ideation through honest, accurate accounts of what being suicidal is like. Most people never report suicidal ideation in their lives. It follows that they do not understand suicidality.

Are there similarities in the general experiences of those who kill themselves? According to the National Alliance on Mental Illness (NAMI), 90% of people who die by suicide experience mental illness. The Federal Government’s Substance Abuse and Mental Health Services Administration (SAMHSA) adds that people who die by suicide are frequently experiencing undiagnosed, undertreated, or untreated depression.

My experience with being suicidal, it would seem, is similar to the way many people experience being suicidal. Maybe my experiences can offer a glimpse into the suicidal mind. Suicidality originates, for me, after struggling against the symptoms of depression for a long time.

I often hear people wonder aloud about someone’s suicide asking “Why would he do that?” Or, confusion in the lack of situational or externally observable clues, “I never knew anything was wrong.” Chances are the person who committed suicide had been experiencing depression – and the pain, insomnia, mood swings, guilt, inability to concentrate, inability to take pleasure in daily life, etc. – for a long time before seeking the ultimate relief. When I hear of someone’s suicide, I wonder whether suicidality came to them as an unconscious reaction to immense pain, or whether they made a calm, cool, collected decision to die.

I do not think many people who experience suicidal thoughts actively will those thoughts into existence. I know I don’t. They are hallucinations, mirages in the desert, siren songs that I must not listen to.

I do not form suicidal thoughts with my own active logic. I do not experience depression, take a calculated look at my life, and decide that killing myself is a viable option. No. Suicidality, for me, is an instinct. How do you know water will quench your thirst? How do you know food will quell your pangs of hunger? Feel thirst for long enough and you will seek water. Feel hunger for long enough and you will seek food. In each case, you feel discomfort and then seek the action that will alleviate the discomfort. So it is for extended bouts of depression and suicidality.

***

What follows is how suicidal thoughts forced their way into my mind during my last depressive episode with medical explanations for what I was feeling. I include the medical explanations in an effort to combat the notion that depression and suicidal ideation are simply emotional issues.

This is how I became suicidal, last time:

My concentration disappears. My focus deserts me. My mind simply isn’t sharp.

I am applying for admission to the Utah State Bar so I can practice law in the state. After spending three years on the front lines of environmental movements, I’ve seen how the legal career I walked away from after my first suicide attempt could be revived to protect the communities I love.

I have a huge checklist of tasks I need to complete and a long list of documents I need to obtain to send to the Board of Bar Admissions. It was my time as a public defender in Kenosha, WI that led me to try to kill myself the first time. I find the residues of horror on the steps I take towards becoming a lawyer again. Lead starts solidifying in my veins. My mind slips out from under me. I find it very difficult to concentrate on this checklist.

It takes me an hour just to come up with a plan that involves stopping by the police station to be fingerprinted and then walking next door to the post-office to mail a records request to the University of Wisconsin-Madison Law School. It takes forever to force myself to get in the car to drive to the police station. With the inability to concentrate comes guilt. I feel I am letting down those communities I want to protect. The whole trip, itself, takes less an hour. But, when I get home I feel distracted and exhausted. I spend the rest of the day on the couch.

This lack of motivation and inability to concentrate are hallmarks of depression. Dr. Stephen S. Illardi, associate professor of clinical psychology at the University of Kansas and an active clinical practitioner, explains in his book The Depression Cure that a key trigger for depression is the brain’s runaway stress response and this runaway stress response causes a dramatic decrease in left frontal cortex activity – the side of the brain responsible for positive moods and the impulse to pursue goals.

Ilardi then describes what happens to memory when the stress response goes on for weeks at a time like the stress response experienced during an episode of depression. Ilardi writes, “Cortisol begins to exact a toxic toll on the memory circuits of the frontal cortex. These areas of the brain actually start shrinking, and mental function grows less efficient: concentration, memory, attention, and abstract reasoning are all affected.”

I go six nights without sleep. On the seventh, I fall asleep, but my mind only slips from waking anxieties to the surreal anxieties of the dream world. I have dreams that I am shot, stabbed, maimed. They pull me screaming from my pillow.

I can handle those dreams. I’ve never been shot, stabbed, or maimed. I cannot handle the dreams that stay just close enough to reality that they mimic my waking anxieties. In one dream, my partner leaves me saying she’s just too tired of living with my depression. In another, my parents check me into a hospital because they don’t know how to help me.

Doctors know where the insomnia that so-often accompanies depression comes from. Illardi explains, again, that the brain’s runaway stress response causes the brain’s stress circuits to engage and “when the brain’s stress circuits are fully engaged, they can profoundly alter the structure of sleep. Specifically, there is a steady disappearance of the deep, restful form of slumber known as slow-wave sleep – the phase of sleep the brain needs to keep chemicals and hormones in balance, and to coordinate things such as tissue repair.”

As my sleep fails, the energy I have for combating the illness fails, too. My mind feels constantly inflamed. I spend hours cycling through rumination and each cycle comes closer to completely convincing me I am worthless and that I have failed my loved ones.

This inflammation is an indescribable pain that has no identifiable source but hurts everywhere.

Current research explains, physically, the source of this excruciating pain. Illardi describes how this happens: “…some of the brain pathways that register physical pain serve double-duty by signaling emotional pain as well…As far as the brain is concerned, the experience of depression is very much like an excruciating physical sensation that never goes away.”

Several weeks with this pain, and, then, still awake at 4 am, knowing I have to be up for work in a couple hours, I walk into the kitchen where all my pill bottles are lined up on the counter against the wall. It’s not intentional. It’s not a thought that I want to think. But the sight of all the pills pulls something deep in my consciousness. I know that there is a way to end the pain.

When I feel the pain of major depressive disorder for long enough, something deep within me seeks death. There is no single moment that marks my first suicidal thoughts and another moment that signals their end. I feel the pain of depression for weeks before I sense the instinct for death. Most people cannot understand how long and how hard I’ve been fighting when those first suicidal thoughts cross my mind.

The first suicidal thoughts are bad enough, but when they’re placed on the kitchen counter next to all my medicine, when they poison my dreams with anxieties more terrifying than I could imagine possible while awake, when they make that turn from insane impulse to reasonable suggestion, my mind becomes a shop of horrors. Consciousness, itself, becomes a struggle.

***

Being suicidal is terrifying. Telling someone you are suicidal, even your psychiatrist, is also terrifying. No matter how difficult it is to communicate that you are suicidal, the failure to do so can prove lethal. I know. Twice I chose to remain silent about my suicidal thoughts, preferring to struggle in the hidden quiet of my own mind.

And, twice I’ve tried to take my own life.

I want a world where suicidal people openly discuss their feelings. I want a world where expressions of the pain of major depressive disorder are viewed with the same compassion as the expressions of pain accompanying other illnesses. I want a world where nausea, broken arms, and suicidal ideation can be be discussed in the same breath. Most importantly, I want a world where less people are killing themselves.

The first step to achieving this world is open, honest discussions about suicidality. These discussions will happen on a more consistent basis when those who have struggled with suicidal thoughts honestly describe the horror and those who have not struggled with suicidal thoughts are sincerely open to the notion that the pain is almost, almost, intolerable. Once these discussions are happening, we will be on our way to developing the requisite empathy that will be invaluable in the effort to eradicate the suicide epidemic.

For those who love someone who is suicidal, consider that your loved one’s experience of depression and suicidal thoughts might be similar to, or even worse than, my experience I have shared here. There are some in this culture who view suicidal thoughts as a weakness. This needs to stop. A person who is strong enough to withstand the pain of depression, to resist the instinct to reach for death as the ultimate painkiller, and to confide her suicidal thoughts in another is very strong, indeed.

And, if you are suicidal right now, I am very sorry and I understand how hard it is. You can describe your pain. You can ask for help. Your life might depend on it. Keep fighting.