Suicide is a heavy topic for a Soulcare Sundays piece. I get that. However, in the last few weeks a few people in my inbox have reported suicidal thoughts, and I've had a bout of them myself as a symptom of my illness. About 25% of the population will experience this as a symptom at some point in their lives. It's also the home grand prix of Daniel Ricciardo - a mental health ambassador - this weekend. Thus, it's clearly a topic that should be here and googlable as a reference for y'all if you need it.
The following is how I experience the suicidal spectrum. It's one perspective, and that of someone with bipolar mood disorder. Your experiences, or the experiences of the friend/loved one for whom you are googling, may vary, and so the strategies listed below may or may not work for you. Let this be a starting point, a set of guidelines within which you (or your friend/loved one) can build a set of strategies for dealing with these thoughts when they arise.
Suicide usually arises as a result of long-term untreated (or perhaps drug-resistant) depression. Some depression is the result of a medical illness – that is, it's caused by low levels of neurotransmitters like serotonin in the brain. However, depression can be triggered by an event like realising your dream is dead (see the 90-something percent of millennials who dreamed of a productive job and have found themselves working unfulfilling dead-end jobs and being told to feel grateful). It can also be experienced as part of the natural cycle of grief.
According to the DSM IV (the Fourth Edition of the Diagnostic and Statistics Manual – the American Psychiatric Association's Bible of all the ways in which one can be crazy), the following are symptoms of depression:
1. Depressed mood most of the day.
2. Diminished interest or pleasure in all or most activities.
3. Significant unintentional weight loss or gain.
4. Insomnia or sleeping too much.
5. Agitation or psychomotor retardation noticed by others.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive guilt.
8. Diminished ability to think or concentrate, or indecisiveness.
9. Recurrent thoughts of death
Two symptoms from the list is considered a case of minor depression; five symptoms or more is considered major depression.
I experience depression as a spectrum from a mild 'meh' feeling (mostly 1, 2, 6, 7, and 8, but mildly) to constant intrusive thoughts (thoughts that come from nowhere, often the result of a neurochemical imbalance) of suicide and/or homicide (9, and the only reason I don't act on the homicidal urges is the excessive guilt from 7). I'll go through the general categories from mild to intense.
The Grey, 'Meh' Feeling
Commonly referred to as depression. This is fairly common, and the incidence is rising among young people. It's the feeling that the world is too overwhelming to deal with right now, the feeling that there's no colour left in the world, just pointless shades of grey. If this is left unchecked, it can lead to more serious symptoms.
It's not really possible to 'just snap out of it' and 'just think positive' and get better. Sometimes, a talk therapist (or coach, if the thought of a talk therapist with a doctorate intimidates you) is what's needed. Sometimes, a few months on antidepressants works. Research has shown that a combination of drugs and therapy is the most effective, and the vast majority of cases respond to treatment.
There are people who have drug-resistant depression, but this is a very small percentage of cases. There are experimental treatments, involving either an electromagnet applied to the affected brain regions, or for more serious cases electrodes implanted in the brain kinda like a brain area pacemaker. For others, like me, depression is a symptom of chronic illness, which comes and goes based on stress levels and other factors.
Bottom line: if you have two or more of the symptoms listed above, see a doctor about some treatment. Just because this illness is 'all in your head' doesn't mean it's not an illness. Illnesses like this get worse when they're left to run their course. As tempting as it may seem, DO NOT TOUGH IT OUT ALONE! Asking for help is courage, not weakness.
I would like to say a word here about friendship, random acts of kindness, exercise, and keeping a bullet journal, which I have found helpful in alleviating the symptoms of this phase of the spectrum. Always, always see a doctor for appropriate treatment, but friendship and exercise are like turbochargers for drugs and therapy.
Having deep conversations with a loved one produces oxytocin, which is one of the four neurotransmitters dubbed 'the happy hormones'. Cuddling, orgasms with/from others, and holding a baby (those last two preferably not at the same time), among other similar activities, all produce this hormone. Make time to do these things, even if you don't feel like it.
Being kind to others, having kindness shown to us, and seeing other people be kind to each other all produce serotonin in the brain. I find paying for a stranger's coffee is usually enough to make my serotonin spike into the 'warm and fuzzy' zone. Other options include: tipping a busker, giving a sandwich and a box of sanitary towels (click here to find out why) to a homeless person, writing an appreciative note, keeping a log of things for which I'm grateful in my journal, etc.
Exercise stimulates the production of endorphins. Endorphins exist to relieve the pain caused by the small tears in muscle tissue caused by exercise. They last for about a day after exercise (and then we notice something called Delayed Onset Muscle Soreness). Good news for people with depression, what psychologists call 'psychic pain' (aka 'feels') looks like physical pain on a brain scan. Thus, nature's physical pain killers work for painful feelings of the 'all in the head' variety too. You may not feel like going for a bike ride, but strap your helmet on and get out there for your happiness.
We get dopamine from achieving goals. Dopamine feels good. Dopamine is the chemical that gets people hooked on drugs (including everyday drugs like sugar and caffeine). We also get dopamine from ticking things off to-do lists. A way to hack dopamine when you're feeling grey is to keep a 'done' list – a page in the diary for the day, on which you write things as you accomplish them. Sure, we're supposed to schedule ahead of time, but that's not always possible with depression. I got that tip from Buzzfeed; their article on bullet journalling for mental health has been helpful for me.
The 'Why Do I Bother Living' Feeling
This is a more intense version of depression. This is when the happy hormones (serotonin, oxytocin, dopamine, and endorphins) drop low enough that living and dying seem like equal options. I usually feel this in response to a specific incident that highlights how far I am from achieving something. When this feeling hits, if you're not already on anti-depressants and in therapy for your depression, this is the meatball flag that sends you back into the pits for a tune-up, or at least find a friend to talk you into doing so.
I find a good, long hike works to get me back on the happiness wagon if I get this feeling despite being 'observant of the drug regimen' (the psychiatrist's words, not mine). This is supported by the data for three reasons:
1. By spending six hours exercising, my brain has a good dose of pain-killing hormones to relieve it of its psychic pain.
2. I usually go hiking with friends (woodland safety practice – hike in groups of three), and in six hours together, we'll have time to get through what ails all of us, giving us a nice dose of oxytocin and serotonin, alongside the endorphins.
3. It has been shown by scientists that fifteen minutes of walking improves performance on creativity tests. The IQ of a group is always higher than the IQ of any individual member. Thus, if I take a walk with a geek for six hours effectively bathing my brain in happy hormones, I'll eventually come up with a creative way to solve the problem that is causing my 'why do I bother living' feelings.
APA's (American Psychiatry Association) name for it, not mine. I call it 'having the suicides'. This is when I spend a lot of time thinking about dying – how I'd do it, what I'd need to do before I did it to not be thought of as selfish, etc. Mostly how I'd do it. I'm not a cutter, so I usually have to find a way to kill myself that doesn't hurt too badly or run the risk of failure (most methods involving pills induce puking, which is counter-productive to dying).
Ways to deal with this: call a suicide hotline, a trained mental health care-giver, or a friend who's good at talking people off the ledge. I have a collection of friends (a soldier, an engineer, a pastor and psychologist, and someone who describes her job as 'a house elf') who understand how the whole 'suicidal thoughts' thing works and how to lead me through the valley. I do have a therapist whom I could call, but I get irrationally worried that she'd hospitalise me if she knew I was thinking about it so I wait for our next session to discuss it. Waiting for our next session also helps if I don't get the chance to talk to someone in the meantime.
If, for whatever reason, you can't call someone, there are ways I have found to talk myself off the ledge. Don't worry, I'm not going to tell you to 'think positive' and 'be grateful for all the good stuff in your life'. That doesn't work at this point. The only way is to go deeper into the canyon and follow the river at the bottom out into the sunshine.
Ways to push myself deeper into the canyon include: thinking of how sad my dog would be if I went out one day and never came home; how awful my corpse would look and how scarred the person who found me would be (this is more effective if I think of one of my parents or a close friend finding me, rather than a stranger); all the things I'm going to have to do to commit suicide responsibly (make sure my browser history is parent-friendly, make sure there's someone to run my non-personal social media accounts, lodge my will with a lawyer, etc.); thinking of what a waste it would be that nobody would be able to receive my donated organs because I'd been dead for too long when someone finds my body; medical students practising vaginal exams on my corpse while I'm in the morgue; thinking of how few people would come to my funeral because they'd feel too awkward about mine being a suicide funeral to show up.
That last one generally leads me to, 'Well, that'd be a waste of a perfectly good croque en bouche, and I'm not dying without everyone getting a sugar/dopamine high from a croque en bouche at my funeral.' The list above are morbid thoughts, for sure. But if you're reading that list instead of killing yourself, you're already one step closer to recovery. There's a contact form below. If you haven't got a local suicide hotline, or a friend you trust enough to ask for help, explain your situation to us, and we'll do our best to find you appropriate help.
Intrusive Thoughts of Suicide
This is when literally everything that can be used to kill myself is a temptation. I see a kitchen knife? I have a mental image of slitting my wrists. I see a lamp post while driving fast? I have a mental image of crashing into it. Literally everything reminds me of a way to kill myself. I've only ever had this symptom when I've been off my meds for a few months, and/or when I quit smoking. It's not part of my normal experience.
I'm a coach (rather than a psychiatrist), but I'd bet that if you have this symptom you have a similar illness to me. The only treatment for this is medication and intensive talk therapy. There's no 'happy hack' to get out of this one. This is only fixable by psychiatry professionals with practising licenses. If you have this symptom, get medical help as soon as humanly possible.
You will find a contact form below. If this piece has resonated with you, feel free to use the form. If you found this piece because you googled 'suicide' to find out more about your symptoms (or, God forbid, find out how to kill yourself), feel free to use it. If you are a coach/therapist who'd like to be on call for people in your area with this issue, feel free to use it. The inbox is open for you to chat about this issue.