[Trigger warning: this post contains discussions of personal experiences with suicidal thoughts and misconceptions. If you’re in an emergency, please call the National Suicide Lifeline at 800-273-8255 or dial 911.]
No one needs to know, I told myself as I sat frozen, staring at my phone. I don’t need to call him, I tried to convince myself. I remembered how I promised I would if the thoughts came back, yet as soon as I pulled up my doctor’s number, I set my phone back down and started talking myself out of the call once more.
Why is it so hard to tell my psychiatrist when I’m suicidal?
After being sick for so many years, I’ve told doctors many embarrassing things about my body. They always apologize when they ask about sensitive topics, yet I can tell them everything without batting an eye. But discussing suicidal thoughts with a doctor I’ve seen for six years, whom I trust with the delicate task of taking care of my mind—someone who already knows so many things I’ve never told anyone else—somehow that’s the hardest for me to bring up unless I’m asked.
Ultimately, the reason why is internalized shame and has nothing to do with how my doctor will react—he’s always been compassionate and helpful. I’m in a stable place right now, but suicidal thoughts can be hard for me to bring up because there’s still a part of me that must think I’m a failure when I’m having them. It lies by saying I’m weak for wanting to give up and struggling to cope with life. It tells me that if I were stronger, I could just put my depression aside and keep going.
But who is stronger than those who fight against their own minds day after day after day? Suicidal thoughts aren’t a sign of weakness—they’re a sign of someone who has had to be too strong for too long. Not even the toughest warriors need to carry their burdens on their own—it is brave to reach out for help.
Another stigma related to suicide is that people couch it as a selfish decision—and if you’re considering it, that it makes you a bad person. But until you’ve been in such depths of suffering that dying seems so much better than living, you can’t completely understand why that isn’t the case.
One reason I keep going and have never made an attempt is indeed that I know there are people who want me to stay alive—people whom I love. However, when despair comes and wraps its tendrils around your mind, it convinces you that your problems are a burden to those same people. When I’ve come the closest I’ve ever come, I’d started to believe that it would be better for everyone if I weren’t around. In no way were my suicidal thoughts, however misguided and delusional, a reflection of selfishness.
Compassion is critical for those struggling.
We need to be reminded that we are deserving of love and support just like anyone facing a serious illness. We need you to show that you truly do care and want us to stick around—and that you’re not passing judgement on our pain. We need you to recognize the warning signs and reach out—and truly be willing to listen and help us find help.
Nevertheless, I won’t pretend that showering suicidal people with love would always heal them on its own. Often (but not always), suicidal thoughts are a symptom of an underlying illness that needs treatment.
I’ve dealt off and on with depression and Obsessive-Compulsive Disorder and suicidal thoughts since I was eleven. However, I was too afraid to see a psychiatrist until I was eighteen, so I never let anyone know how sick I was until I completely fell apart with extreme OCD at the end of high school. I had known I was ill, but I didn’t like the idea of mind-altering drugs. I also thought if any professional knew about the intrusive thoughts and compulsions my OCD generated, they would surely lock me up in a mental hospital.
First of all, not everyone with a mental illness ends up needing medication. Second, if you do, a good psychiatrist will make sure your meds help you feel more like yourself—not like you’ve been drugged.
And after this many years in the mental health system, I’ve realized that there’s nothing I can say that will shock the professionals. They’ve heard it all. If you think you’re crazy, there’s no such thing—you’re just living with a sick brain like many other people are. Chances are, thousands of others struggle with the same problems as you.
Finally, there’s one more thing that needs to be part of the conversation on ending suicide:
There are medical conditions that cause it.
And I’m not just talking about diseases that are so miserable you start wishing it would all end. I’m talking about the ones that cause brain inflammation that gets misdiagnosed as psychiatric illness—conditions like PANS, autoimmune encephalitis, and Lyme disease.
I have lived with these myself, and the challenge is how suddenly they can make you suicidal. I can be having the best month of my life, but then one morning I’ll wake up and want to die. I know it makes no sense, and I’m to the point I can recognize symptoms of brain inflammation for what they are, but it’s still upsetting to deal with these thoughts when they happen.
Tragically, people with PANS are dying by suicide at alarming rates. Although most cases of PANS aren’t life-threatening, the illness can be incredibly dangerous when the autoimmune attack on your brain’s dopamine receptors not only results in intense, all-consuming despair, but makes you extremely impulsive. And this has nothing to do with a character flaw—these people’s brains are literally being attacked by a mind-warping illness.
With such inflammatory medical conditions, of course it’s imperative to make sure people who have them are safe, which can mean psychiatric interventions. However, PANS can be cured or significantly alleviated (and often the psych therapies tapered off) by measures like getting rid of underlying infections and/or doing IVIG, steroids, or Rituxan. Without proper medical care, people with PANS and Lyme and AE are needlessly taking up severely limited mental health resources, sometimes for decades, which so many other people desperately need.
September is National Suicide Awareness Month.
On this last day of it, I want to say that people are dying due to the stigma surrounding suicide. How we talk about suicide and those who have attempted or died by it can affect whether someone feels like they can get help or not.
We can share all of the suicide hotlines’ and mental health organizations’ phone numbers we want, but until we show compassion and understanding to those wrestling with suicidal thoughts, and stop perpetuating myths, there will still be some people who will feel too ashamed to reach out for help in time.
If it’s this hard for me to speak up despite having a strong support system and a doctor I trust, then I can’t help but wonder if it’s even harder for those without either to reach out. And I also wonder how much harder it must be for men, who are often socialized to act tough and not show any sign of vulnerability?
If we want to end suicide, we need everyone to stop speaking of it and its victims in stigmatizing, judgmental ways. We need to stop preserving the myths that make some people feel too ashamed to speak up. We need those around us to show compassion and support—not criticism and simple platitudes. And most of all, those wrestling with suicidal thoughts all need access to treatments that will help, whether it’s psychotherapy or medications or IVIG.
If you are struggling today, know that you are not weak, and you are not a bad person. You don’t need to face this alone. No matter what your mind is telling you or what you’re going through right now, you are worth reaching out for help. There is always hope no matter how hopeless life seems. 💚
Disclaimer: I am not a mental health professional, and this post only represents my personal experiences. Please talk to your doctor or find a professional if you have any concerns about your mental health.