Suicidal Feelings – Still a Taboo Subject?

If you’re feeling suicidal right now, this is a good guide for avoiding acting on  those feelings. Above all please talk to a friend or family member, or call a crisis line in your area – here’s a list.

In an attempt to reduce the shocking suicide statistics, we’re encouraged to talk about suicide, especially during Mental Health Week. There are 24-hour suicide lines and guidelines for reporting of suicide, especially the sudden deaths of the uber famous like Robin Williams. There are support groups for survivors – those who lose loved ones to suicide.

But suicidal feelings? Not so much. They are buried in the mush of the word ‘depression’, which is so vague it refers to any kind of low mood. Suicide is caused by depression, apparently, and therefore depression is Bad, and so is mental illness. At least these assumptions signal the community struggling to acknowledge that mental suffering can be as tortuous as physical suffering. But how can we expect the public to have the first understanding of mental illness when the sector itself is in crisis, by lack of funding on the one hand and the clash of competing paradigms on the other?

There may be support groups of survivors but there are no bricks-and-mortar self-help groups (that I’m aware of) for those afflicted with suicidal thoughts (if anyone knows of one, please let me know and I’ll mention it. There is an online forum for people who feel suicidal, Suicide Forum). There are plenty of other self-help groups, of course, for the kind of problems that can lead to suicidal thoughts. As soon as you voice a suicidal thought in such a group, a protocol comes into play. This is a good thing – it is evidenced based and its one aim is to stop the person in question suiciding, to keep them safe during the crisis. Suicidal feelings can result in death so must always be taken seriously. But it speaks to the problem of suicide – that it’s difficult for the person afflicted with the thoughts to speak about them. Once you do, the direction of the discussion must change immediately, if not come to a halt. There’s still a taboo.

Part of the problem is that suicidal feelings can actually mean many different things and arise for many different reasons. Lumping them all together could be as harmful as not dealing with their disparate causes.  I’d suggest the following categories of suicidal thoughts arising from mental suffering (I’m not an expert – feel free to offer opposing opinions or some additional categories).

Also, these categories are fluid – some may suffer from a combination of these things.

― Fleeting thoughts that everyone has. The only problem with these thoughts is that the person who has them might decide they were abnormal. I guess the internet makes that fear obsolete. 

Fleeting thoughts of self-harm during a low period are pretty normal as far as I can tell.

― OCD thoughts. The sufferer here doesn’t actually have the desire to commit suicide at all but  afflicted with persistent, disturbing thoughts and images of self-harm – a form of pure OCD known as suicidal OCD. The sufferer is not in danger of committing suicide, but needs treatment for the OCD.

― Suicidal thoughts during periods of an acute mental illness. This would include particular kinds of depression, including bipolar, that push sufferers into extremely desperate states. It might also include a psychotic episode for someone with schizophrenia. Such people might actually realise they are a danger to themselves and ring up a suicide line or admit themselves to hospital. That is, they may know that as a life choice suicide is not what they want – but they fear the illness will take over and make a terrible decision. Anyone suffering from an untreated mental illness could be at risk simply because their mental suffering is severe and they  don’t know how to reduce it.

― Suicidal thoughts provoked by unbearable grief. This can afflict all genders but males are particularly vulnerable because society teaches males to cover up and repress their feelings when they experience loss, for example the loss of the family farm or the breakup of a relationship. Some may find the feelings of grief unbearable or fear that the feelings will never change.

What these people desperately need is help to process their feelings. Often these feelings may be accompanied by unhelpful, unrealistic ideas about gender expectations, so these people may also need help in being compassionate with themselves and letting go of outdated ideas. The latest DSM has been criticised for pathologising grief, but this is perhaps because the idea of a drug for grief is so counterproductive. Perhaps it’s not that the grief itself is pathological, but that sufferers of pathological grief don’t have the tools they need to process and get through it. Help with doing that – if the therapist is willing to ‘suffer with’ the patient – can only be a good thing.

―The suicidal thoughts of someone with mental illness when they have insight. These thoughts are based on the overall quality of life, and the reality of continuing mental suffering. These thoughts could be equally applicable to someone with chronic physical illness or disability, and also their carers.

In particular this reason may merge with the previous one because any kind of illness or disability involves an element of ongoing grief as to the limitations that the illness places on the sufferer (even if some of those limitations are caused by social attitudes). So feelings of quality of life must be dealt with separately from the grief-work that is part of having a chronic condition or caring for someone who has.

What this shows is that there is not just one remedy for suicidal thoughts and impulses. However, if someone feels acutely suicidal then there are urgent things that need to be done regardless of the causes. The appropriate treatment comes later.