Alternatives to Suicide: Strategies for Staying Alive


At last count, I’ve wanted to die on more than 7,300 days of my life. I’ve spent only six of those days in a psychiatric hospital, setting that hospital’s record for shortest involuntary commitment.

How can a person who deals with such frequent thoughts of suicide complete college, hold a job, have a career? How can she be as successful as I am?

September is Suicide Prevention Awareness Month, which makes it a great time to learn from people like me who have been preventing our own suicides for years.

Wanting to die is, it turns out, not terribly unusual. People want to die because they’ve committed what they consider to be an unpardonable social sin, because they’ve failed in some way at work, because their spouse has ended the marriage, or they’ve experienced too many bereavements.

Wanting to die is a pretty reasonable reaction to lots of terrible life circumstances. Been there, done it all, still alive.

So the real question is why and how do some of us keep going when we frequently want to die. The answer lies in a mix of motivations and solutions that we practice. Here are a few of the “alternatives to suicide” that I have used over the 40-plus years since I first wanted to die:

Escape strategies: Binge watching television, binge reading fiction, writing revenge-themed novels, staring at the ocean, staring out the window.

Exhaustion strategies: Logging long hours at the gym, on a trail, up a mountain, on the bike, in a kayak.

Engagement strategies: Using some creative skill; petting the cat or dog; arranging wildflowers into a bouquet, spending an hour shopping for $5 worth of giftwrap and ribbon.

Encouragement strategies: Marking every little step forward. Creating a to-do list so detailed that you count it progress when you finish your shower… your breakfast… your commute. Reminding yourself during times when you are without hope that the God in whom you believe has promised “a hope and a future” to you (Jer. 29:11). Even if that comes far in the future, when you finally arrive in the country where God wipes away every tear (Rev. 21:4).

Extension strategies: Extending yourself for others, even when you feel like nothing. Sheryl Sandberg, in Option B, her book about surviving the grief she suffered after her husband’s death, says one tool she learned was to log daily three ways she had influenced others for the good. Offer kindness. Volunteer. Show a colleague a new skill.

Remembrance strategies: At one point, my best suicide preventive was recalling that I would have killed myself if I’d tried the particular overdose I’d considered at age 19. Some years later, I held to the memory of a voice (that I know as God) telling me “If you don’t have a reason to live ’til spring, plant bulbs.” I still plant bulbs, lots of them, every year.

Ritual strategies: Daily routines that never change can keep you going. For me, these include alarm at 6. Coffee. Oat cereal with milk and berries. The print newspaper. The chair where the Bible and journal and planner wait. The routines resume in the late evening, when 9 p.m. brings on hot tea, the buzzing electric toothbrush, jammies and a book by the bed.

Safety strategies: At the worst, we keep ourselves safe. We call the friend who is willing to come over, so we’re not alone. We text the person who will remind us that we don’t always feel this terrible. We check in with a suicide hotline or the crisis text service when we need to say things that even the best friend shouldn’t hear. (And by the way, the hotline care strategy is to listen first, then help the caller identify any circle of belonging and even one thing the caller will do in the next 24 hours other than kill herself. That is to say: name notwithstanding, “suicide prevention” hotlines are designed not to prevent suicide, but to help us find alternatives to suicide. And the evidence is that they work.)

None of these is a suicide “prevention” strategy. Suicide “prevention,” as we practice it today in the US, trains thousands of “gatekeepers” to peer into the lives around them for “signs” of suicidality. It pushes them to push people like me toward professionals who hold the keys to locked wards, where we can be almost perfectly protected against self-harm.

Ironically, we have trained so many people to be on guard against “symptoms” that ordinary human supports have become much less available to people experiencing challenges. Today, I have to consider carefully any potential confidant. Is this a person who will (with or without professional qualifications) assess me to be a danger to myself, call police for a midnight “welfare check,” insist that I need to take a medication that time has proven doesn’t work for me? Will they shuttle me toward another locked ward?

Me, I’d rather hold my tongue than risk the professional suicide that an inpatient event provides. I’ve only just rebuilt a new career after my one-and-only psych hospital stay more than a decade ago.

People who have lost loved ones to suicide, professionals who have lost patients to suicide — even those who have temporarily protected family, friends, and patients from one episode of suicidality — don’t know even a percent as much about eluding suicide as those of us who have stood this battle for years. My friends and I don’t “prevent” suicide. But we each maintain our personal lists of “alternatives to suicide” that we put into practice when the urge hits. Even when it hits really often.

This Suicide Prevention Month has taken place at a time in our nation’s history when the suicide rate remains staggeringly high. We now have a number of multi-nation studies suggesting that as a nation improves access to psych meds and hospitalizations, its suicide rate will increase. Which is exactly what we’ve seen in the US over the last 30 years.

For more than 7,300 days of my life, waking up the next morning required me to make a conscious choice to diligently pursue something — anything — other than my impulse to die. Perhaps it’s time to reconsider our “suicide prevention” approach. Maybe the best teachers of how to avoid suicide will not be the people who are afraid someone else will die, but those of us who can explain how and why we regularly choose to live.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Thank you for this Carlene.

    I’m similar. It seems to be like a default switch that I always fall back to when anything (and I mean anything) goes wrong. The yogurt is spoiled, I’m done. My nails and hair are getting worse (and the doctors can’t help) – I quit. Nobody came to my event, nobody will miss me (my thoughts are more graphic than this, but you get the idea).

    I’ll add one more strategy that kept me going when nothing else would. Get a pet. Not a warm fuzzy cuddly pet – but a cantankerous rascal of a pet that “only a mother could love.” One that lives awhile.

    Mine was a cat. Nobody loved that cat but me. That cat loved nobody but me. I couldn’t quit, couldn’t succumb – because – nobody would be able to take her. She would have to be put to sleep. And that’s unfair. If it’s unfair to her – it was unfair to me, too (but I only learned that in retrospect). She kept me alive for 20 years, and by then I had learned how to do it.

    Thanks for normalising thoughts that – I believe all of us have – but that expressing aloud causes “freak outs” in other people. It’s like a giant Shadow that we all have that if anybody mentions it, it gets bigger and scarier and must be squelched.

    Whereas really, it’s usually a frightened, insecure person, even a child inside, that just needs connection and comfort – not “treatment.” And definitely not a big fuss.

    One of the questions I dread the most is, “Are you alright?”

    Short answer is always yes – because I’ve walked with this suicidal companion for 33 years now, and I will continue to walk without heeding these – urges? voices? default settings? – but I always cringe, because – often something is not right, but I can’t say it, can’t ease it out into safety, and so must process it alone.

    It would be much better if we could speak, normalise, and let these things go.

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    • So true! We understand that isolation is a torture technique that can cause people to lose their sense of human identity … then we use it as a standard social behavior to separate “those crazies” from “everyone else.” And then are surprised that “those” people get worse. Thanks for writing. And my cats are huge in my success!

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    • Suicide was also my default setting for quite a while. And, like you, a cat taught me how to create new and different default settings. And like your cat, my cat is one cantankerous individual. His name is Sweeney Todd so that should tell you something.

      I also agree with you in that I feel that most of us deal with these feelings by ourselves. Thank you for your post.

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  2. Thank you Carlene, this is a very inspiring and very helpful article. When someone feels they can no longer go on it is often because of ongoing traumatization, challenges, losses and set-backs. As you state “Wanting to die is, it turns out, not terribly unusual” and “Wanting to die is a pretty reasonable reaction to lots of terrible life circumstances”. This is so true yet some mental health professionals remain very closed-minded and tone-deaf. They are unable to, or refuse to, appreciate or understand the challenges and difficulties some people unfortunately must deal with in life. The professionals that are so quick to judge, criticize and pathologize others likely never had to experience the same or similar losses, challenges and suffering.

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    • And since the late 20th century, they’ve often been quick to judge (based on a current spiritual belief system) that people “choose” and “invite” into our lives the difficulties we experience … Which makes Auschwitz the fault of its victims, I guess. Walk in the strengths you have! Know you can do what matters. To have survived this far speaks of a powerful person. Best to you!

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      • Too true! A lot of psychiatry and therapy ends up being about “stopping” those uncomfortable feelings that the “helpers” have projected/externalized onto their “clients.” This is one of the most destructive things about the DSM – it allows and even encourages the ostensible “helpers” to externalize their own demons to be symbolically wiped out in the “clients” who are making them so uncomfortable. If I can drug away everyone else’s “depression,” maybe I don’t have to become aware of or deal with my own.

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  3. Hi Carlene,
    thanks for sharing. 30 years and counting for me. I guess I’ve been lucky(?) that my wife never takes me seriously when I tell her how I’m feeling nor my family the few times I’ve mentioned it publicly, so I’ve never been institutionalized and suffered that indignity on top of the daily struggle just to keep going. For me it’s all about hope…or the lack of it. And when my hope wanes that things will ever get better, the struggle to keep going increases, and vice versa. Today’s an especially hard day to find some hope to hold onto.

    I really don’t understand why suicide is such a difficult concept to grasp and why the ‘experts’ seem so ignorant of the mechanics of it, sigh. Maybe I’ve been journaling about my life for so long that the subject is just obvious to me at this point when I’m struggling with it and when I’m not and exactly why and the various strategies I have to keep it at bay.
    Take care,

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    • Sam, keep on keeping on. I don’t know the meaning for our challenges; at the same time, I do know that we are extraordinarily strong to continue persisting. Let others keep you from falling over right now. I’m proud of you for continuing to work this through over so many years.

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  4. “Maybe the best teachers of how to avoid suicide will not be the people who are afraid someone else will die, but those of us who can explain how and why we regularly choose to live.”

    That’s so obvious but brilliant at the same time.

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  5. Thank-you, Carlene, for sharing your truth here. I’d go further and state that experiencing some “suicidal thoughts” is a completely normal and natural part of being human. I think ALL people go through one or more times of some level or degree of “suicidal thinking”. ALL adults have “considered suicide”. I know I have “thought about” suicide, when I was on psych drugs. But whatever being “suicidal” is, I got over it years ago.
    (Sorry about all the “quotation marks”, – that’s the best way I know to write the words which best express my thoughts. This is one subject that calls for more nuance than our language commonly allows.)
    Once, 20 years ago, 2 employees of the local “Community Mental Health Center” called the police, and LIED, and claimed I was “suicidal” when I wasn’t. The police surrounded my apartment, broke in, and dragged me out naked in handcuffs. Literally. They took me to the local hospital emergency room, where a different CMHC employee attempted to coerce me into “admitting” my “suicidality”. But I wasn’t at all suicidal, so the police arrested me on bogus charges, and $500. cash bail. A few weeks ago in August, based on a lie of being “suicidal”, my friend was put against her will in the isolation cells in the local hospital for 5 days, then driven to the State Mental Hospital in handcuffs and shackles by the Sheriff’s. She was NOT at all “suicidal”.
    Being (supposedly) “suicidal” is actually used as a WEAPON against people. This just confirms what Carlene is saying, – that teams of people will spring into action, to “prevent” a “suicide”, but they aren’t willing to just sit with, and listen to, a “suicidal” person. The whole “Community Mental Health center” paradigm, and the pseudoscience lies of the drugs racket and means of social control known as “psychiatry” has done, and continues to do, far more harm than good. And “suicides” CAUSED by psych drugs? NOBODY wants to look at THAT!….

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  6. I think about suicide daily. I tell myself it’s just a bad thought and it will pass. It does. Currently I plan to kill myself in about a week but I’ll most likely blow it off. I have learned to lie, that’s all. Being honest will get you locked up and drugged with neurotoxins.
    Thanks for this article!

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  7. Thanks you so much Carlene,
    I too have struggled with feeling suicidal but my love for my family has always been what has stopped me. 18 months ago my then 16 year old son after suffering after losing 8 people through death in less than a year (including 3 teenagers and his step mum) was picked up by the Maori Wardens, as he was standing on a motorway over-bridge, who took him to the police station where he was seen by the adolescent crisis service who did not pathologise what was happening for him but gave him hope. This year they abolished this specialist crisis team for no other reason than financial and that it was the only service like this in all of New Zealand. The man that saw my son put his career on the line and spoke up at a public meeting to try and stop that happening. My son spoke out and thanked that man publicly for saving his life. The last I heard he got suspended from his job. Now our teenagers have to deal with the already over stretched adult crisis team who do pathologise such thoughts. It makes me so sad and angry to see such a backward step. We have the highest teenage suicide rate in the world and my region had the lowest out of all the regions……so much for suicide prevetion

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    • Pauline and Kabbal, interesting points. From what I saw of the crisis team it was a box ticking exercise that was slow to react and aimed at protecting themselves, it wasn’t really equipped to deal with a crisis anyway.

      I have come to wonder if MH services are really on your side at all. They protect themselves at all costs and aim to eliminate risk by hospitalisation and attempt without much success to eliminate symptoms with “medication”, even if that stops you getting back on your feet.

      They would say that dead patients don’t recover, but you could also say drug-wrecked patients, life chances shot, debilitated by a diagnosis of some made-up chronic condition, will become more suicidal. And it is quite possible to commit suicide in hospital anyway. There must be another way.

      Looking at strategies is a worthwhile thing to do, certainly we need a bit more than deep breathing and elastic bands. I sometimes think we need a 24 hour psychology service, a kind of “para-psychologist”, who is confidential, non-judgemental and separated from psychiatry, but then I think, thats what a supportive family might sometimes be able to do.

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  8. what a remarkable person you are Carlene. I must have attempted my life 20 times at least i have lost count. now i know i have to live for my son. this last time i was going to stop eating and drinking and did that for two days with one day left to go. i called for help because yet again i thought of my son. so my plan is to just not have any pills in my house available for me to overdose on. i overdosed on vitamin pills and herbal sleepers. nothing happened of course. i googled the dangers later and found out they are just chalk.

    suicide prevention and i did make myself quite ill last time is something you seem to have learnt to do as a fine art. well done. quite remarkable.

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  9. Bippyone – Herbal sleepers usually contain valerian which blocks the metabolising enzymes which metabolise most drugs including psychiatric. This can cause akathisia which is not just a movement disorder as doctors would have us believe, it is THE condition which causes strong suicide ideation and toxic psychosis). Anyone can get this. The enzymes are called Cytochrome P450 and they have names… important ones being CYP 2D6 and CYP 3A4.

    I very much hope that this information may help you.

    It is explained here.. a bit technical, but well worth watching and concentrating on to understand the significance and importance:

    Auntie Psychiatry may also have information that will be of help to you and can be contacted here:

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  10. Carlene. I think that anyone who writes about suicide must read James Hillman –Suicide and the soul to get rid of the theological thinking about the psyche. It is no about the prevention, it is about the resurrection of the phenomenology of the death in the psyche, we must to know it and must to believe in the reality of death, the reality of psychological hades. We are blaming the circumstances, the material world, it is not enough, this is a fallacy, and wrong attitude. There are many styles of perception. The hardest form of living is when you are psychologically in that reality. PSYCHOLOGICALLY. I believe in psychological socialism, the death in the center of the state. Not the money, the death/psyche, and only then, everything else will be in the right place. We do not need to prevent the death, we first need to have courage and wisdom to face it. We must know the phenomenological meaning of the death in the psyche.

    James Hillman Re -visioning psychology.

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    • Hi danzig666 – ‘PSYCHOLOGICALLY, I believe in psychological socialism’

      yes me too. and the fact death is so much part of life. it surrounds us. but nobody talks directly to us about our own death. we will all encounter our own death. there is no escape. to control how and when we leave this planet should not be seen maybe as a failure in life as such but the fact we took our lives in our own hands. we had the ultimate autonomy. it wasn’t left to doctors or caregivers to say exactly when we should leave this world. we decided. we took it upon ourselves. death was no longer prolonged by medication or we weren’t drugged into oblivion. we decide when we commit suicide. why should it be considered such a tragedy. why should death be considered such a tragedy. if life continues and nobody really knows afterwards or if we are in endless sleep then we either enter a new realm of adventure or we know nothing about it. it is only a tragedy for the lives left behind and each has their own personal way of dealing with grief.

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      • Death is not a tragedy, I agree. It should be a value. But thanks to medicine and thanks to theology, death is seen only as EVIL. This is also an underestatement of human value, as well. Medicine does not own the death, they want to control it. Theology does not own the death also. Death is a psychological reality with biological symptoms in the body.

        Death is not for our bodies, it is for us. Death is a main part of the psychological reality that owns our bodies.

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  11. yeah denzig666 i agree totally. I also believe we are consumed by electric impulses in our bodies. I believe they came from out of space and we just host our earthly bodies and when they die our electric impulses some may call the soul go back into space. we are only here for the ride so speak to find out about earth and what it’s like to live here at any given time. I think this has always happened. I believe there is a God Almighty Ruler of the Universe and that nobody on earth has ever seen it or is likely to. I believe jesus christ was an alien hybrid. that his mother had a visit from an alien and was artificially inseminated. that joseph her husband to be also had a visit from an alien and jesus was half human half alien. hence he could perform miracles. of course he died. then went back into space. to me i am immortal and it is kind of like star wars. i don’t fear death on earth and i believe my husband is travelling the universe as i write this. may sound quite bazaar but has its rationality about it don’t you think?

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  12. Thank you for this, it’s been three days of pretty much hell, making out the will, making arrangements for my body to be retrieved so it doesn’t decompose (too much) and stinks up the joint, and writing a variety of notes to different people.

    Your post taught me I should just take a bath, drink a cup of coffee, play with dogs and basically tough out this desire to finish up this life and ease my torture.

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