Identifying and Managing Suicidal Thoughts in Real Time Saves Lives
It started as a typical day. I packed lunches for the kids, grabbed a cup of freshly brewed coffee, and then headed out to get on the familiar roads I’ve driven on for so many years. Once I was on the main road, I started to review the usual checklist in my head.
Did the garage door close all the way?
Did I shut the coffee maker off?
Are the front house lights off?
In more recent years I added to the list.
How is my mood this morning?
Last night I did not sleep very well, and this morning I definitely have a full-on migraine. It was at that moment I thought:
I wonder if I’m having breakthrough symptoms. It is one of the indicators that my mood may slide like a bookshelf hanging by strained nails, as it has many times in the past.
Occasionally this becomes a horrifying experience where multiple suicidal pictures play in my head. These are images that terrify and torment me. It is usually then that I look for an escape but find only a one-button solution, finally ending the debilitating pain. This is the suffering that only those who experience it can fully comprehend. Over the last twelve years, I have learned to manage these intrusive images, becoming aware of the sensation like an aura for a migraine.
But this is not a true aura; this is a change in emotion, maybe a dip in mood at first feeling sad, occasional agitation and a sense of despair, sneaking in for no obvious reason. I can then isolate each symptom and discuss it in detail, with someone I have trained as part of my management team. These are people who care about me and understand I could possibly take my life in spite of their efforts. This needs to be understood up front because it validates that I suffer from a disease and there is no prevention from suicidal ideation, though they are most certainly manageable.
Those of us who suffer from suicidal ideation describe our experiences in our own unique ways. However, it is alarming how eerily similar they are in the methods and images of death. The thoughts sneak in, creating circular internal chaos and feeling frenetic energy like vehicles in a multi-layered intersection. My instinct tells me this is neurological, and regardless of how broken it makes me feel, I must tell someone who will listen and validate me.
I have found ways to identify my pattern of dark, suicidal, intrusive thoughts while they occur in real time, and I’ve been interviewing others for articles and public speaking, to demonstrate the validity of how suicidal ideation management works. Our hope is to offer insights in order to reduce the rate of completed suicides.
Back to my morning: my thoughts turn back to my current mental state, and, since I’ve gone so far as to question where this may wind up, I turn into a residential area and park so I can alert my management team. I first call my husband. He has become an anchor on my team after multiple serious conversations, finally understanding that it was not his fault and he could not fix it.
There are no marital vows that prepare a spouse to hear the words:
“There’s a picture in my head of picking up a knife from the butcher block in the kitchen, and stabbing myself in the stomach, but don’t worry”.
It’s like being on a respirator and having signed a DNR. For richer, for poorer, in sickness and in health, to love honor and cherish, and when the suicidal movie theater arrives.
I thought back to when I first explained the thoughts to him in profoundly uncomfortable detail, I sensed it would decrease my risk and help me feel less alone. He looked at me and said, “Okay.” I then said, “And you can’t gasp.” At first, he did. But then he pulled himself together and said:
“You can tell me everything. You can teach me how to support you, but you have to tell me everything. What I am saying is if the pain is ever too much, I need you to tell me that too. I don’t want to find you dead.”
I paused. He was right. I agreed to this deal, and we shook hands and hugged while wiping away our tears. Our agreement was tested soon after when I had a particularly challenging spring. While in a state of deep despair and feeling like I was jumping out of my skin, I had an overwhelming impulse to drive to a tall building and jump.
In spite of being well-medicated, I have experienced several reoccurrences like most people with chronic mental illness. In the last twelve years – with the support of my husband some good friends – I have persevered finding an effective combination of medications and therapy.
When my husband answers the phone, I ask him if he can talk. If he is in a meeting, he’ll excuse himself. I tell him of the pictures and my current concern of swerving into traffic, which is now a fully developed picture though it wasn’t there five minutes ago. He suggests several ideas from my management plan. Every episode is different and sometimes I can’t remember. My plan includes eating or drinking something with a distinct flavor to distract the senses of my brain like flavored coffee or a strong juice, change the temperature in the car, open the windows, take a different route, use an as-needed prescription, etc. He asks if I need to go home. I tell him I’ll see if I can shift it. It’s not like this hasn’t happened before.
We hang up, and I call my friend who has similar challenges. We run through the management toolbox, and I tell her I’ll call her when I get to work. There are several other people on my team, but they are more back up.
Creating a team for suicidal ideation is unlike creating a team for diabetes, asthma, or other serious health problems. What makes it considerably different is saying my chest is tight and I’m wheezing versus seeing pictures in my head of shooting myself, drinking bleach, or jumping off the bridge near my house.
My goal is to openly manage these bloody thoughts because I am incapable of living in distress one more moment. Each time I confess I am experiencing ideation, I feel broken and the need to hide. And even though I may eventually die from the diseases that aggressively plague my thoughts, I will not go leaving questions that would burden my grief-stricken loved ones with nothing but broken hearts.
The model of suicide management is different than prevention and is a sustainable solution to these lethal neurological episodes. Discussing openly and vulnerably how suicidal thoughts express themselves can shift the way we deal with them, and begin to seriously reduce the number of completed suicides.
There are approximately 45,000 suicide deaths per year. That’s the population of the city of Hackensack, NJ. Our children and young people are dying at an alarming rate, and as the rate increases, it is necessary to take a step back and ask ourselves what we are doing and whether it is working.
It is time for a long-overdue paradigm shift that includes more management, so people feel validated and not just told the pain is preventable. It’s not simple, but those of us who manage suicidal thoughts on a regular basis, teach the language of suicidal ideation in detail and teach our children.
Know that without suicide management, there will only be more suicides.