Avoiding Suicide: My Mental Tools for Fighting Back Against a Brain on the Edge

Trigger warning for discussion of suicide and suicidal thoughts.

I’ve been suicidal a few times in my life. I’ve never actually made an attempt, but if I’d had more reliable resources for doing so during those dark periods, it’s entirely possible I would’ve.

I want to talk about the thought tools I use to stave suicidal impulses off. I haven’t needed to use them in a while, but I think they’re important to talk about, both because they illustrate the kind of headspace someone has to be in to consider suicide, and because I know I’m not the only person to turn to thoughts like these when nothing else will convince you to go on living, and I have, at times, found them good for that. I hope I never have to resort to these again, and I may not. But chronic pain is at times an unpredictable thing, and to end up in a dangerous mental headspace, all it really takes is a prolonged period of a certain level of pain. That’s a lot of what got me close to suicide the last time, and if I were in a similar level of pain today without any realistic ways to keep it at bay, I suspect I would be in the same place now.

I suspect so would you. A sufficient level and duration of pain can put anyone in this place. If you don’t believe that that’s true, then you haven’t ever come close to it. Be grateful for that ignorance.

For the record, I am dealing with my pain pretty well at the moment. I don’t see any reason to expect it will get worse in the near future. I’m talking about what that could do not because I expect it to happen, but because I think it’s an important reality for people to recognize. I think it puts suicide in a more appropriate, realistic perspective. I am not suicidal now because I haven’t been experiencing the level of pain, physical or emotional, that is necessary to put me in a suicidal place. If I had, I would be in that place. The same is true, I think, of everyone.

When I am in that place, these are the kinds of things I’ve tried to consider to keep myself among the living:

The number one most useful thing to contemplate, when I’m feeling suicidal, is the possibility that I could fuck it up.

I could fuck it up, and then I’d still be here, and everyone would know I’d made the attempt, and that would be a worse place to be than where I am now.

Not only that, I could fuck it up in a way that makes my life even worse. I could jump off a building and end up crippled, but alive; I could swallow pills and end up with a damaged brain, but alive; I could shoot myself and end up the same—damaged, physically or mentally in some way that made things even more difficult, but still alive to experience that pain on top of all the rest.

Suicide becomes an attractive option when it promises an end to suffering. In the throes of suicidal depression, the single best way I know to stave off the impulse is to consider the ways in which attempting suicide could end up making that suffering worse.

The second tool is, paradoxically, knowing that suicide is always an option. If I don’t do it today, I can always do it tomorrow. Sometimes I’ve known that what I needed more than anything was to convince myself to reach out, to talk to someone, to ask for help, or to see a doctor. The problem is that when I’m in a deeply depressive state, that’s just one more thing, one more responsibility, one more way to fail, to be disappointed, to fuck up. If I need to convince myself to take that one step to reach out, it helps to be able to say to myself, “Well, you can still kill yourself if it doesn’t work out, so the worst the could happen is you do what you’re already thinking about doing anyway one day later.”

The third tool is keeping in mind that I haven’t tried everything, and that every year our understanding of the things that cause me pain are getting better. Drugs are getting better, chronic pain science is getting better, understandings of depression are getting better, our cultural support systems are getting slowly but surely more understanding of how these things really work and should be dealt with. Or, in short: knowing that even if nothing I’ve tried has worked, there are still things to try, and that even if nothing at all works, there may be drastically better solutions to the things I struggle with in a year or two. There may be things that will work better than I can possibly imagine, and if I can hold out a little longer, I’ll be around for them.

[Author’s Note Added March 31, 2013: I’ve recently written about a fourth useful mental tool in this post]

It can be scary thinking things like the above. I find that even when I am in the midst of dealing with suicidal ideation, with things that are this morbid, it isn’t easy to talk about them out loud. But sometimes these conversations with myself have been necessary to get me through a day. Sometimes, talking about these things out loud with others has been what I needed to get through, even if it has felt overdramatic. It’s intensely strange that I can feel like having these conversations is being overdramatic when I’m trying to use them, literally, to stave off suicide. It’s a sad reflection of the culture we live in, and of how deeply I’ve absorbed that culture that I’m capable of being that deep into depression and still even considering the idea that it might be better to just go on with the suicide. That suicide might be better than to talk openly about these things with someone and risk being “overdramatic”.

I imagine this entry might be strange to read for someone who hasn’t dealt with depression personally. I am essentially explaining how I fight against my own brain about whether or not to kill myself. If you think of depression as a simple choice, this might seem like a strange idea. But for me at least, the experience of depression is a lot like a war between different parts of my brain. One side that will do anything to end the suffering, up to and including suicide, and another trying to stave off that impulse until the depression lifts (or at least lifts enough). I hope, if nothing else, this entry helps provide a small window into what it’s like to have a brain that dysfunctional.

CBT Thoughts

I had a really shit morning this morning. But for now, I’m going to talk about something else.

I’ve been trying cognitive behavioral therapy stuff over the past week or two. Getting myself to be nicer to myself and stuff. This is hard for a number of reasons.

First and foremost, it makes me feel crazy. I already knew I was generally the sort to be hard on myself, but holy shit, itemizing the ways in which I am makes me feel absolutely insane. There are so many. Fucking everywhere. WHO DOES THIS?! WHO IS THIS UNREASONABLE WITH THEMSELVES ALL THE TIME?! Perhaps this is a good thing, though. It’s harder to justify being a dick to yourself when really looking at how often you are a dick to yourself makes you feel insane.

Second, paradoxically, I think I’m afraid of not being anxious. Anxiety is a natural state for me. Obsessive “You must always know and do exactly the right thing at all times”-ism is a natural state for me. Peeking out from that is scary. You think there must be some *reason* you’re always anxious about everything, so if you’re not anxious, something must be *wrong*. I’ve had the conversation more than once in my life where I talk about being obsessed to the point of unhealthiness with being a good person, and someone else says “But you obviously are a good person, you don’t need to worry about it so much”, and I respond, “What if I only am because I worry about it so much? What if without that worrying keeping me in line, I’m really a total dick?”

Third, I think I am afraid of that sometimes. It’s not just the reflexive “Anxiety is home, you are leaving home, WHY WOULD YOU DO THAT?!” It’s that I genuinely get nervous about who I would be if I weren’t obsessively hard on myself all of the time. If I weren’t always asking if I’d done the right thing, how would I know if I’d done the right thing? I honestly don’t know how people do it, because this is the only way I’ve ever done it.

Also, I think this whole experience is forcing me to realize how much I define my worth as a friend by my ability to be supportive of others. Asking for help and support from people is something I find utterly terrifying. Piling on top of that my having to communicate the manner of support that is the most helpful to me (which my brain helpfully interprets as roughly equivalent to “Oh, you’re doing me a favor? WELL YOU’RE DOING IT WRONG, YOU FUCKNUT, HOW DARE YOU?!”), and I’m…having some challenges in that department. Everyone keeps insisting that they want to help and I keep being afraid that I’m just a drain on everyone and that people will get tired of helping me before I get better, and then what was the point of asking for help in the first place?

That is a hard fear to beat. AFGO.

What It’s Like

I’ve been in school a long time. I’ve been missing out on things a long time. In 2004, I stopped taking martial arts. 2006, I had to drop out of an a capella group I was in because I couldn’t handle standing for rehearsals for two hours–too much pain. More recently, I had to cancel a study abroad trip on account of a combination of issues with both the pain and the depression that would’ve made the trip painful at best, and put me at risk of suicide at worst.

There’s a thing you learn that I think can only really be understood by people who’ve suffered from depression or chronic pain. I don’t think I’ve ever seen it put better than in naamah’s journal on suicide: “There’s an amount of pain that will buy anyone.”

Whether the pain is emotional or physical, there is a point beyond which the only thing you can think about is making it end. There’s no rationality to it. When you put your hand to a stove and it burns, you pull it away. With this kind of pain, the world is the stove.

Maybe it’s more accurate to say your body is the stove. Either way, there’s only one way to pull your hand away.

The world is made up of things I can’t do. Sex, computer games, martial arts, swimming, playing music, watching a movie, driving for too long, etc, etc. When you’ve been dealing with all of the things you can’t do for as long as I have, managing your life to fit in the few things that you can, for as long as I have, and things still don’t get better, you feel like giving up a lot. You feel like you’re doing everything you can, and you’ve been doing everything you can for as long as you can remember, and you still have the pain. On the worst days, it’s like your own body is a torture chamber. On the best days, where there isn’t too much pain, you have to be very careful to remember that if you do too many Normal People Things without thinking, it’ll be worse again tomorrow.

This is what it’s like a frighteningly large amount of the time.

Shades of Stigma: Depression

I want to talk about the different kinds of stigma people with brain problems have to deal with. In dealing with depression, you often have to do a lot of work to overcome your own biases about things like meds and therapy. Even if you do manage to overcome those, you always run the risk of having to deal with other people who haven’t. It’s a challenge, and it can make it difficult to talk about your condition and what you’re doing about it for fear that others will be judgmental.

For today, depression itself. For a long time before I realized I had it (and was subsequently diagnosed with it by a professional), I tended to think of depression as something that you only ended up with if you didn’t understand the world very well. Something you got if your priorities were crooked or some such. I was wrong. I’ve known people who thought the key to getting out of depression was as simple as thinking positive. Those people are wrong. There is a place for learning to change the way you think about things in dealing with depression, but it is not even close to a miracle cure. Then there’s the “Just suck it up” mentality, for which I’ve always liked this response:

“I guess my other pet peeve is when people think that ‘suck it up’ is an acceptable response to depression or suicide. It doesn’t work that way, and it’s just plain not helpful. It’s like seeing someone broken down on the side of the road with smoke coming out of their engine and saying ‘Hey, have you tried fixing your engine?'”

Depression is hard shit. It’s hard, it’s complex, and if you know someone with it, chances are that things like “Think positive” or “Suck it up” are going to hurt, not help. Depression is a brain problem. There are a lot of ways to try and deal with it, but dealing with it is almost never simple or easy, and if you honestly think someone’s response to “Think positive” is going to be “You know, I’ve never heard that before; thanks man”, then here is a tip from me to you: you are wrong.

It helps people with depression to have people they can talk to about it. It doesn’t help when those people make flippant, oversimple assumptions about their condition. If you’re talking to someone who is depressed, always ask before assuming. “Have you tried X”, is a better thing to say than, “You should try X”, and, “What have you tried?”, is better than, “Have you tried X”. By the same token, asking, “How can I help”, is a much better idea than assuming you know what will help and doing that.