I am not always very attached to being alive
Chronic, passive suicidal ideation is like living in the ocean. Let’s start talking about how to tread water.
This essay was originally published on The Outline (RIP). Reposted for context and posterity.
I wish there was a nicer way to say this, but I don’t always want to be alive. Right now, I don’t actively want to kill myself — I don’t have a plan, I don’t check the majority of the boxes on lists of warning signs of suicide, I have a life I enjoy and I’m curious about the future — but the fact remains, I don’t always feel strongly about being alive and sometimes, on particularly bad days, I truly want to die.
It’s been a long time since that statement felt anything but mundane. In middle school and high school, there were the morbid poems, the self-harm, the overwhelming emotions that everyone dutifully labeled teen angst. In college, there were nights when I drank too much and the protective barriers keeping my depression at bay faded to nothing and the thought came to me unbidden, as seductive as it was scary. I want to die. Eventually, I finally stumbled my way into treatment. After that, I celebrated each birthday with surprise because each age I hit was one I assumed I wouldn’t reach.
At 27, I’ve settled into a comfortable coexistence with my suicidality. We’ve made peace, or at least a temporary accord negotiated by therapy and medication. It’s still hard sometimes, but not as hard as you might think. What makes it harder is being unable to talk about it freely: the weightiness of the confession, the impossibility of explaining that it both is and isn’t as serious as it sounds. I don’t always want to be alive. Yes, I mean it. No, you shouldn’t be afraid for me. No, I’m not in danger of killing myself right now. Yes, I really mean it.
How do you explain that?
In the United States, nearly 45,000 people die by suicide every year, making it the tenth leading cause of death in the country. On average, there are 123 suicides a day. That’s not counting those who survive attempts — estimated to be about 1.4 million in 2017.
And those are just the statistics we can track.
What we don’t know is how many people live in the nebulous gray space between fleeting thought and attempt — those dealing with passive, not active, suicidal ideation. “Research on people who endure passive suicidal ideation is limited by this innate stigma that it’s a bad, wrong thing, so people are less likely to report it,” said Eric Beeson, licensed counselor and faculty member at Northwestern University's Counseling@Northwestern whose research includes attitudes about suicide. Without self-reports, and in the absence of the hospital visits or attempts that help us track active ideation, it’s nearly impossible to measure.
There’s no single cause of suicidality. It’s a symptom of borderline personality disorder and is associated with mood disorders like depression and bipolar, though not everyone with those disorders automatically wants to die. But that doesn’t begin to cover it — suicidality is also prevalent in those with autistic spectrum disorders, chronic pain conditions, substance abuse issues, and marginalized identities like LGBT youth. And though that accounts for both passive and active ideation, it’s the latter that eclipses most conversations on the subject.
Take how we react to suicides in the news, especially of celebrities or public figures. The outpour of shock and devastation is always palpable. We had no idea they were struggling, if only someone had stepped in, you never know what someone is dealing with. There are calls to action: Reach out to someone, get help, call this number. For a few days, we flood Twitter with reminders that no one is immune to suicide, not even celebrities whose lives seem perfect to us.
This is true; no one is immune. At the same time, the sense of alarm and urgency in these sentiments gives the impression that suicidality is solely standing on the brink, inches from death, waiting desperately for someone to notice and intervene. And that’s how it is for some people.
But for me, and I suspect for countless others like me, the threat of suicide isn't like being carried over a waterfall — it is like living in the ocean. Not as sea creatures do, native and equipped with feathery gills to dissolve oxygen for my bloodstream, but alone, with an expanse of water at all sides. Some days are unremarkable, floating under clear skies and smooth waters; other days are tumultuous storms you don’t know you’ll survive, but you’re always, always in the ocean.
And when you live in the ocean, treading to stay afloat, you eventually get the feeling that one day, inevitably, there will be nowhere for you to go but down.
I’ve become adept at treading. I know — or I suspect, or I dread — that my legs will exhaust and I will slip beneath the surface, but I don’t want it to be soon. For now, I can and want to keep my head above water. But will is never enough, and so I have learned to surround myself with ways to stay afloat.
Some are like passing driftwood: Living to see the series finale of Crazy Ex-Girlfriend. Finishing that book that’s been taking up brain real estate for years. The prospect that maybe tonight will be the night I meet someone halfway decent on Tinder. They’re shallow motivators, hardly anchors to life, but sometimes you just need something that will get you through the month. Or the week. Or the night.
Others — medication, my crisis safety plan. My cats who depend on me. The awful thought of transferring my suffering to my loved ones — are more sturdy. These are the life preservers.
Chronic suicidal ideation takes so many forms. It can be fantasizing about passing during sleep, developing a terminal disease, dying in a tragic accident. Or it’s background noise, a staticky station whispering taunts you can almost, but never entirely, tune out. It hits some people only in the dead of night or when they’ve been drinking; others completely at random like a flash storm they have to wait out.
“Suicidality exists on a continuum and frankly, we’re all on that continuum somewhere,” Beeson told me. “Some of us are just closer to an actual suicide death than others. But in many ways, we’re all a few life experiences away from a major mental health crisis whether we like to admit it or not.”
Besides, that word is loaded in its own way. Say suicide and people don’t imagine your indifference towards life, your passive fantasies. There is the alarm and the awkward platitudes, given either too seriously or too lightly. And anyone who’s ever broached the topic in therapy might know the ensuing questions of risk evaluation:
“In the past few weeks, have you wished you were dead?”
“Do you wish you didn’t have to go on living?”
“Are you having thoughts of hurting yourself?”
“Are you having thoughts of killing yourself?”
Sometimes I worry that’s what people around me would do if I were honest with someone other than my therapist and a few close friends, about this lack of attachment to life and the sometimes-desire to be rid of it. After they know my default state, will I be self-conscious? Will I regret it? Will they ever forget it, or will it shadow my every move and our every conversation? Will they become too aware, watch me too closely?
But then I think: Isn’t there middle ground between hypervigilance and complete secrecy?
What if we acknowledged the possibility of suicidality all around us, normalized asking and checking in? If people talked about feeling suicidal — not joked, as we’ve all started to do online, but really talked — as much as they talked about feeling depressed or anxious, would we finally be forced to see how common it is and start creating space for these conversations? Would it be the worst thing in the world if we started talking about not wanting to be alive, and what might help keep us here?
Of course, even that doesn’t have a straight answer.
“We really don’t know [the impact of] having more casual conversation about suicide,” April Foreman, licensed psychologist and executive board member at the American Association of Suicidology, told me. “Stigma is lower than it’s ever been and suicide rates are as high as they were during the Great Depression. If reducing stigma alone saves lives, the suicide rates should be going down.”
But speaking freely need not solely carry the weight of prevention. It can simply be about the comfort of social connectedness and knowing you’re not alone. Like Beeson told me, the big picture is not as much about preventing suicide as it is about planning life and fostering social connectedness — which, in and of themselves, are major preventative factors.
As for the inherent awkward corners and sharp edges of talking about suicide, I figure if I can live with the discomfort of wanting to die sometimes, people can live with the discomfort of knowing about it.
If it sounds like I’ve accepted my fate, resigned myself to the pull of the ocean floor, I haven’t. But if I had, it wouldn’t be for lack of trying. Outside of anecdotal evidence, scientists just don’t know a ton about passive suicidal ideation — which means they also don’t know much about how to treat it.
“People think we understand more about suicide than we actually do,” said Foreman. “We have invested very, very little into research on suicide, especially on feeling chronically suicidal. But at a certain point, when you’re having that mood all the time, something is happening inside your body. Something’s wrong, and we don’t understand what yet.”
There are some more extreme treatments that can be effective — like electroconvulsive therapy and ketamine — but even with those, research is preliminary and scientists don’t quite know why they work, just that they sometimes do. There’s hope of more effective treatment… just not without money for research or laws that demand a certain standard of care for those enduring suicidal ideation.
Turns out, my method of coping is apparently pretty effective. In the absence of good science, one of the most helpful things you can do for chronic suicidality is curate your collection of flotation devices. According to Foreman, if mental health care can only do so much to reduce our feelings of suicidality and equip us with the tools we need to tread water, then it’s crucial to nourish a life full of things we want to stay afloat for.
I thought I wasn’t allowed to write about this until I made it to the mythical other side. You hear it all the time: When you write about a personal experience, especially one that is dark and unpalatable, you should be far, far removed from that time in your life to process it in writing. You should have a lesson, a realization, a moral, a triumph. An ending.
But I might want to die forever. That’s just how it is. But in the meantime, I need to talk about the treading. Do I hope that one day, I won’t feel like this? Of course. But according to Foreman, it may not be the case that we can entirely eliminate suicidal thoughts and feelings — yet or ever — and I’m done pretending that this is a fight I’m guaranteed to win if I only try hard enough instead of something I can, at least, manage.
Because I can manage it, and the ocean is nice sometimes. The sun comes out and the current calms, and I can find peace in the drifting. Maybe there isn’t hope of land in the distance; maybe sometimes there is. Maybe that’s not the point.
Perhaps what I’m looking for isn’t land at all, but other people out here with me. Trying, and treading, and learning to live in the water.
In the meantime, some life preservers, in case you need them:
If you’re thinking about suicide or just need someone to talk to right now, you can get support from any of the resources below.
National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Crisis Text Line
Text HOME to 741-741
International suicide hotlines
A comprehensive resource list for people outside the US.
IMAlive
Click Chat Now to access a live online network of volunteers through instant messaging.
TrevorLifeline, TrevorChat, and TrevorText (LGBTQ+ crisis support)
1-866-488-7386
Text “Trevor” to 1-202-304-1200
Trans Lifeline
US: (877) 565-8860
I appreciate this so much. I have finally met a kindred spirit because this is exactly how I have felt since I was a pre-teen. I'll be turning 61 Sunday and I'm still amazed I have lived this long.
Thank you so so much for this.