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.