Suicidal Ideation Is a Spectrum. Why Can't We See That?

Content Warning: Suicide

The other day, I was reading about how humans remember the fact of our pain and its context but cannot recollect the sensation or severity of the pain itself. This is for good reason. Otherwise, we would never do anything.

It was clear most people were discussing this phenomenon in relation to physical pain, but the comments placed me squarely in the room in which I spent a majority of senior year of college — the smell of an apartment in desperate need of renovation, the view from my window of people traipsing to and from their classes on the sidewalk, the sound of constant upstairs chatter and footsteps, the taste of Green Mountain K-Cup Pods. I conjured a memory of every little thing except how I actually felt as I oscillated between hypomania and severe, crippling depression.

The farther removed I am from that time, the less I can recall even the manifestations of my internal deterioration. My physical scars have faded too. All that’s left is the context. It could have been anyone else in that room.

But it wasn’t. It was me. And it doesn’t take much to shake me out of the illusion of a life absent from mental illness. As months peel off the calendar, I will admit that I am increasingly embarrassed by how I talked about and dealt with my health issues in their throes, but I also know that this self-judgment is the very thing I was trying to fight against; I never want to project the internalized stigma I have retroactively used to shame my past self onto others who are suffering. What kind of hypocrite would I be?

“Well, I’m in recovery, so why can’t you be?” No. It doesn’t work like that. I’m a product of medication, therapy, and the sheer good luck of being able to remove myself from many of the things that exacerbated my mental illness. It is arrogant to think I pulled myself up by my bootstraps. I didn’t, and if I had to live through it again, I don’t know if I could.

I was most recently jolted back into this headspace of contemplation when the news of Kate Spade’s and Anthony Bourdain’s deaths broke. High-profile tragedies bring the issue of suicide to the forefront, but maybe more importantly, they force us to rethink our preconceived notions of how suicidal people look and behave. It could happen to anyone at any time.

Suicide rates are increasing, but we are as incapable as ever of talking about it. We don’t allow nuance. We can’t accept that there is a spectrum of suicidal ideation. People are either too sick or not sick enough, which is why many of us who have dealt with it are too scared to ask for help.

I heard the whispers of “attention-seeking,” apathy, playing the victim card, and exaggeration when I “wasn’t sick enough.” I also heard the frantic concern and simultaneous frustration when I was “too sick.”

There was constantly walking the line of being disbelieved or being threatened with hospitalization. All the while, I really couldn’t be bothered to give a shit about treatment or lack thereof.

If I were still in the thick of things, hearing about suicides (high-profile and otherwise) would not shock me so much as they would feel like permission — if not permission to die then at least permission to be sick, to plan, to imagine all the scenarios in which I no longer exist. Meanwhile, hearing the responses would not feel comforting so much as they would patronizing, however well-intentioned they might be.

Call a hotline. Talk it out. Think of your family. Know that you are enough. Count your blessings. Adopt a healthy lifestyle. Take a semester off. Blah, blah, blah.

That may sound stubborn now, but at the time, I was tired of people’s desires to hand me a quick fix.

I felt like people were willfully misunderstanding the scope of the problem — the existential side of it, if you will. Here I was thinking about and stifled by death, meaninglessness, hopelessness, aimlessness, loneliness, shame, and guilt; and all anyone could offer me was frustration and a therapy session.

“Have you tried feeding your dog? How about taking it to the vet?” BITCH, THE DOG IS ALREADY DEAD! THERE’S NO COMING BACK FROM THAT!

I understand now that the illness was the reason for the constant rumination — for my inability to cope. It was why I thought treatment was pointless.

On the flip side, it was also the reason why people who were not currently in the throes of a major depressive episode could not adequately respond.

I am of the mind that there is no sufficient response. Just as there are no “correct” words to cure cancer, there are none to cure depression. Or mania. Or OCD.

People often ask me, “how would you have liked someone to respond?” I’m always dumbfounded. It feels like a moot point.

The only thing I can offer is, “I just wanted someone to believe me.” Yes, it was all in my head, but I wasn’t making it up. There is a distinct difference.

Looking back, it would have been nice to not feel like people were scared of me, what my illness was capable of doing to me, or my occasional disclosure of being suicidal. It stopped me from opening up because the mere mention of suicide sent alarm bells ringing. If we can’t talk about suicide without assuming the person who is experiencing suicidal ideation is actively planning a suicide attempt, we can’t expect him or her to reach out.

I sensed the fear in other people when I uttered anything remotely suicidal, but while they feared my death, I feared life. That fundamental disconnect prevented me from seeing eye-to-eye with anyone who tried to help me. It is important to acknowledge the love-induced selfishness that makes people scramble to find a quick fix for an either actively or passively suicidal person. He or she wants out — if not out of a life, then out of a state of mind. Until we can come to terms with that, we won’t be able to effectively listen to anyone who is suicidal. It isn’t about us, and while it’s important to act when someone is actively suicidal, it is more important to create an environment in which that person feels confident that the disclosure of suicidal ideation won’t result in a dismissive sense of urgency before it reaches the point of an actual attempt.

We can’t put on rubber gloves when dealing with suicide. Mortality is a difficult thing to face, and it is even more difficult in the context of death by a person’s own hand.

But suicide is not selfish (staying alive in the face of suicidal ideation is). It isn’t cowardly. It isn’t a result of a moment of weakness.

It’s a leading cause of death, and no one is immune to the many illnesses, risk factors, and circumstances that result in it. It is not a choice.

I used to think mental illness was something I’d grow out of if I lived long enough to see that day. I’d stop being depressed. I’d stop being hypomanic. I’d stop the compulsions. I’d reach some arbitrary middle-age and magically be okay, but as we’ve seen, this just isn’t the case. It took medicine, an extremely gifted therapist, and luck for me to begin recovering, but I know the episodic nature of my mental illness means I am never completely out of the woods.

To be honest, I am afraid of another episode — whether hypomanic or depressed — but I don’t live my life in constant fear; however, I never want to be so far removed from those episodes that I stop empathizing with people who are suffering.

In my experience, the best things we can do for someone in the throes of a mental illness is to listen first, believe second, and, together, come up with a holistic treatment plan. Mental illness means being suicidal. It means having delusions. It means hallucinating. It doesn’t mean the automatic loss of one’s right to personal autonomy. It certainly doesn’t mean the loss of one’s right to dignity when that autonomy has to be momentarily revoked for his or her safety.

I occasionally find myself drifting into a suicidal state of mind. It isn’t severe, and it doesn’t concern me. It’s a security blanket — albeit, one I’ve sewn from the very fabric of the thing from which I am seeking protection.

Mental illness will always be part of my identity, but it no longer hovers over my every moment. That doesn’t make me stronger or better or more resilient than anyone else. It just makes me “not sick.”

I won’t end on anything cheesy. I will just say that suicidal ideation is a spectrum. Until we can accept that, we won’t be able to talk about it. As long as we are unable to talk about it, we will be blind to cries for help. As long as we are blind to cries for help, suicide will keep killing at an ungodly and ever-increasing rate.

The stigma of suicide is perpetuated by an antiquated understanding of what leads to it, but even more so, it is perpetuated by well-intentioned politeness to placate our delicate sensibilities surrounding death. We can have open and honest discussions without being graphic, and it is imperative we remove that taboo. Lives depend on it.