When Suicidal Thoughts Do Not Go Away

The popular image of someone who is in danger of suicide goes like this: A person has suicidal thoughts. It’s a crisis. The person gets help, and the crisis resolves within days or weeks.

That’s the popular image, and thankfully it does happen for many people. But for others, suicidal thoughts do not go away. Their suicidal thoughts become chronic.

The pattern of chronic suicidal thoughts is similar to that of a person with any other kind of chronic condition: For some people, there are flare-ups where the condition is far worse than normal, and then the symptoms subside, but only temporarily. And for other people, the symptoms never subside. Those people live with their symptoms – in this case, suicidal thoughts – every day.

Who Is Prone to Chronic Suicidal Thoughts?

Chronic suicidal thoughts are especially common in people with borderline personality disorder, an illness characterized by unstable emotions and identity; impulsive, often self-destructive actions; and turbulent relationships. The psychiatrist Joel Paris notes that, for many people with borderline personality disorder, “suicidality becomes a way of life.”

However, chronic suicidal thoughts can occur in concert with other mental illnesses, such as recurrent episodes of depression, or with no illness at all.

Many people who regularly have suicidal thoughts have considered suicide for so long that it feels normal to them. Some have thought of suicide ever since they were young children. And some have made multiple suicide attempts, sometimes so many that they lost track long ago.

Why Chronic Suicidal Thoughts Persist

Often, intense, ongoing psychological pain fuels chronic suicidal thoughts. But even seemingly minor challenges can intensify the wish to die.

Frank King captures this dynamic well in his TedX talk, A Matter of Laugh or DeathAlthough King is a comedian, he provides this example in all seriousness:

“See, people don’t understand. Let’s say my car breaks down. I have three choices: Get it fixed, get a new one, or I could just kill myself. I know, doesn’t that sound absurd? But that thought actually pops into my head… It’s always on the menu.”

Some people say it comforts them to know they can die by suicide if ever the pain of life gets to be too much for them. The soothing nature of having an escape has led some experts to refer to “suicide fantasy as life-sustaining recourse.”

As the philosopher Friedrich Nietzsche stated, “The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night.”

The Danger of Chronic Suicidal Thoughts

By Dese’Rae Lynn Stage

Even if suicidal thoughts provide some form of escapism and relief, it does not mean that chronic suicidal thoughts are harmless. The more someone thinks of suicide, the more they might get used to the idea. This can weaken their inhibitions and fears about suicide.

Also, chronic suicidal thoughts typically indicate that an unhealed wound needs healing, whether that wound arises from past trauma, mental illness, grave loss, or some other cause.

Even for people who do not view their recurrent suicidal thoughts as a problem, it certainly is better if they can come up with other escape fantasies besides death. Better yet, they can be helped to develop problem-solving abilities, coping skills, hopefulness, and reasons for living that will make the option of suicide unnecessary.

Therapy for Chronic Suicidal Thoughts

For someone with chronic suicidal ideation, therapy tends to take longer than it does for someone in an acute crisis. The goals of therapy are not only to keep a person safe, but also to help them develop the skills and resources that will weaken suicide’s allure. Dialectical behavior therapy has been effective at reducing suicide attempts and suicidal ideation in people with borderline personality disorder and chronic suicidality.

Often, it is not a realistic goal for a person with longstanding suicidal thoughts to stop thinking of suicide. Suicidal thinking has become a habit. And nobody can control what thoughts come to them, only how they respond to the thoughts.

One way for someone to respond constructively is to observe their suicidal thoughts with curiosity and detachment. Some of my therapy clients say to themselves something like, “That’s not my real self talking. That’s my depression (or stress, or post-traumatic stress, or some other condition) talking.”

Mindfulness can be especially useful. The psychologist Marsha Linehan, PhD, developed DBT, which essentially is a form of cognitive behavior therapy combined with principles from Zen Buddhism. She uses a metaphor of a train passing by: You can sit on a hill and watch the cars of the train pass, or you can jump onto one of them and get carried away by it.

When to Panic – and Not to Panic – about Chronic Suicidality

So if you know someone with chronic suicidal thoughts, you don’t need to respond as though it is an emergency every time they think of suicide. That would be a lot of emergencies. Chronic suicidal thoughts often are manageable and the person stays safe in spite of them.

Danger occurs when the suicidal thoughts have intensified to such a degree that the person is intent on acting on their suicidal thoughts within hours or days. That is an emergency.

If the person is simply having the same thoughts that they have had for many years, don’t panic. Instead, compassionately listen and empathize with the person. Ask how you can be of help. Talk with the person about resources they can use, like the National Suicide Prevention Lifeline (800-273-8255) or the Crisis Text Line (741-741). Also talk about how they can keep their environment safe, like by removing firearms from the home.

Chronic suicidal thoughts are not ideal, but they also are not a crisis if there is no intent to kill oneself soon. As odd as it sounds, the option of suicide might be the very thing that helps some people to stay alive.

Stacey Freedenthal, PhD, LCSW, is the author of “Helping the Suicidal Person: Tips and Techniques for Professionals.” This post originally appeared in slightly revised form at insurancethoughtleadership.com/understanding-person-with-suicidal-thoughts/.

Copyright 2018 by Stacey Freedenthal, PhD, LCSW. Written for SpeakingOfSuicide.com. All Rights Reserved. Photos purchased from Fotolia.com.

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  1. This is my first time visiting your blog and I am glad to have found you. It will help me as a psychologist to keep this issue in the forefront. I also teach DBT skills group to people in a private practice setting. Tamara Suttle informed me of this blog so I have her and you to thank for being here.

    • Stacey Freedenthal, PhD, LCSW says:

      Loren,

      Thank you for visiting my blog. DBT is good for people with chronic suicidal thoughts, so I’m glad you found your way to this spot.

      It’s apt that Tamara Suttle led you here, because the site would not exist without her. I took her wonderful online workshop, BlogStart for Therapists, and she was basically an expert midwife. 🙂

  2. Milestiba says:

    I am at a total loss. My latest “flare up” has seemed to span the length of almost nine months. Everyone has there own theory (which they are more than happy to share with me) of what I “really” believe or “really” feel after I explain exactly what I believe or feel and… well, I am fed up with it.

    I was going to kill myself (or at least give it one more “college try”) in June… on my 40th birthday. It didn’t happen. Everyone… again with the “everyone” (that is worse than the infamous “they” who will do Lord only knows if “they” ever find out)… I have talked to gleans their own true understanding of why I am really still alive when I tell them my actual answer. Now, I no longer want to kill myself for the reasons I originally had… I just am so exhausted and furious hearing what people determine is “really” the case. And I am tired of lying so they will leave me alone. Why can’t anyone listen to me, believe me, and really help me?

    I don’t expect anything out of life anymore. The only person that I ever thought really loved me because of how they showed it ended up utterly destroying my life. She was supposed to be my therapist. We got spun into the most codependent, volitile, emotionally charged relationship (which I later found out she chose to continue even when she came under investigation of the Board of Psych) and when I got browbeat into reporting her… well, her family retaliated hard – which was easy as politically and legally connected as they were. No matter how many times I disclose this to new counselors… it seems to cause problems that I have issues in therapy and keep up tons of defenses and walls.

    Anyway, I am alive only because one person has demanded it. You may think family, close friend, lover, spouse, child…? Nope. A crisis counselor I clicked with and developed an attachment to in the course of recurrent calls and talks. I am alive because of a voice on the phone. Due to my disorder… I have not been able to determine to whom I will develop an attachment. I can only recognize it and choose what to do following that. But based on how damaging some recent past attachments have been when I revealed them, I don’t much anymore. I did try to tell this person and others, but everyone tells me that the truth is I, myself, want to live and I am fighting extremely hard and yadda yadda. But lying around being horribly, utterly depressed while continuing to breathe doesn’t take much effort. Calling and dealing with her awful colleagues who long ago wrote me off and trying to tell them what is going on takes effort – especially when they hang up, or are dismissive, or tell me things that are argumentative, or all the other awful things they put me through because I promised I would call before irreparable harm is done or before I attempt to die by suicide again. If her colleagues leave me wishing I had just killed myself, I am to wait and try another day to see if she is in. Personally, I don’t want to live. I have no hope of ever getting better. My life – despite hard, intense effort to build back up – has progressively gotten worse over the last 13 years or so. But there is this unexplainable attachment. I am compelled to do absolutely anything requested by such individuals. It used to get me into trouble because others would ask for something and couldn’t get it the way they saw so-and-so get me to do something.

    I think the root of why comes from being raised by a woman who received no treatment for her paranoid schizophrenia and my family saw the effects living with her was having even as I was a young child, but chose to do nothing because they were scared. Someone thought it was a good idea to confirm this when I was an adult. They left me there to live with a woman whose rages made the wrath of God in the Old Testament seem like something that would be most welcome. Child Protection did nothing because there were no bruises, so the laws twenty something years ago stated that I was not abused due to a sense of physical marks. And I was left in a place where only my mother and I lived for years going to bed every night wondering if she would lose it tonight and kill me before she realized it. I swung like a pendulum between wanting her to just get it over with and desperately wanting someone to step in and save me. Too many professionals made it personal and tried to save me. They broke rules, demanded their own secrets with me and actually made things worse. This all I disclose in attempts to get help and counseling, but to no avail end up with a huge mess and misunderstanding.

    So I have a voice. A voice that demands I must stay alive even though the quality of my life is akin to a corpse. And that voice belongs to a real person who gets to go home to her family and friends and gets to enjoy whatever life has brought her through her hard efforts. I will never get to meet that person. Details of her personal struggles and triumphs will never be discovered. In order for that to happen, she’d have to become unprofessional and then I would suffer worse in the end. No, all I will have is a voice. Until there is another connection or attachment that I build. But, I don’t even want to leave my house. Conversations above and beyond ordering food or chatting with the cashier at the grocery store are way too much to deal with now. No contact with people means no new connections.

    Of course, if I choose not to call and don’t have contact with the voice, the attachment might fade and the next time I step out to attempt suicide, I won’t care what that voice wants. If only I had not already had the conversation about how even putting myself into the conditions where suicide becomes more probable is in its own essence… choosing to attempt suicide.

    I feel held hostage in this world. People care less and less about the quality of my life and many times in an effort to just make sure I am at least alive, the result is that my quality lessons. Sometimes quite dramatically.

    Maybe I truly do have a Russian soul. Because I think all this belief that a change is “just around the corner” is just bollocks.

    I almost bought this book to send it to the voice. I love this blog. I like the directness, the honesty, the willingness to engage in tough debate on a tougher topic than most. But I had included a message that our contract is null and void. That was a BPD impulse. So I cancelled it. Maybe one day I can find a counselor whom I get to see in person and this book can be a way to get some good talking going. One day… IF I keep choosing to breathe, live, or more accurately… if I continue to just barely exist.

    All that to say… I love the blog. Here I find some solace and if you’ve read this whole thing, I believe it has been established that I definitely need solace. So, thank you.

    • Stacey Freedenthal, PhD, LCSW says:

      Milestiba,

      I did indeed read the whole thing, and I hope fervently that you get more solace. Your description of what you’ve gone through, both as a child and more recently, is heartbreaking. I’m grateful that you connected with the voice – and the person who possesses it – on the phone. I hope that there are other voices for you to connect with, too, whether in person, on the phone, online, or wherever. I hope that you will keep trying even though your efforts have too often been met with pain or betrayal.

      You’re also a great writer. Have you thought of writing for TheMighty.com? Here’s a link for more information: https://themighty.com/submit-a-story/

      And if you need numbers or information about more places where there might be someone you connect with, please check out the site’s Resources Page.

      Finally, thank you for your kind words about the blog. I’m grateful that it gives you some solace.

      Please feel free to drop back in and let us know how you’re doing.

  3. Patti says:

    I think you are totally off base with your ‘theories’ about chronic suicidal thoughts. I’m not the only one who thinks life is overrated, and look forward to it being done. In my early confrontation with the decision to live or die, I just couldn’t believe it was random and meaningless, theres got to be more to why we’re here. So, I don’t think humans are capable of making a choice of that magnitude. It compelled me to make life the best it can be, if I’m going to be alive. And I have. But I’m always looking forward to getting it over with.
    I don’t have BPD, I DO have lifelong depression, I don’t make attempts, but I have reached a point where I truly feel like there isn’t any hope. I just wish It would end, someone shoot me, cancer, etc. I’ve done my part for years, I’m tired of the effort it takes.

    • Stacey Freedenthal, PhD, LCSW says:

      Patti,

      Thanks for sharing. What you have to say is very important, and I’m sorry that life has been so meaningless for you.

      I’d love to hear more about why the theories in this post are “totally off base,” because what you wrote here seems pretty consistent with what’s written in the post. Is it that you think it’s off base to attest that people can learn to cope better and develop reasons for living?

      Whatever the case, I hope you will check out Speaking of Suicide’s Resources page for people who have suicidal thoughts. It’s possible that one of the resources listed there could be of help to you.

  4. Randall P. Robinson says:

    In her marvelously insightful book, My Bright Shining Star: A Mother’s True Story of Brilliance, Love & Suicide, the late Rhonda Sellers Elkins (who, herself, died of suicide), made the poignant decision to publish the suicide note of her daughter, Kaitlyn, who perished, also of suicide, less than a year-and-a-half earlier. I had actually encouraged Rhonda to include it for publication in her book since I felt that it gave incredible insights into the mind of a chronically and persistently depressed suicidal person. It remains, in my judgment, the most beautiful, insightful, and eloquent suicide letter ever penned.

    In her departure letter, Kaitlyn, an intellectually gifted high school valedictorian and then 23 year-old student in her third year of medical school at Wake Forest University, wrote, inter alia, “I am so dreadfully sorry for the unimaginable pain and hurt that I have caused you by taking my life. I am sorry for hiding from you that I was so deeply sad. I am sorry for not letting you know that I felt like I simply no longer wanted to live my life. I am sorry that I didn’t let you in on the perpetual despair I lived in. Depression is nothing new to me, I can’t remember a time in my life in which I didn’t feel like I was barely treading water. I never told you how pervasive it was because I wanted to protect you from it, and I wanted to protect myself from it. But I have finally decided that I’d rather just not exist. I have found myself happy on occasion, and I have had many pleasurable things in my life, but mostly I feel overwhelmingly sad and exhausted from the weight of it. I would just rather not endure it any longer. I would have died years ago, but I couldn’t bring myself to cause you such sadness and heartache. I still can’t bear to think of the hurt this brings you, but I just can’t go on.”

    Elsewhere, in the same note, she continued, “I know I had such a seemingly bright future, and I know I would have been such a successful doctor and wife and mother. But all I have ever desperately wished for is to not feel like not existing would be preferable to being who I am and living the life I live. But that’s never been true. And that’s deeply sad and horrible and possibly terribly unfair. But that is how I feel and how I’ve felt for longer than I can remember. It may be inadequate and it may not justify my action, but it is the best explanation I have.

    I hope you will forgive me. I hope you can be happy again. I hope you can find the strength to endure this burden I‘ve placed upon you. And I hope you will never doubt how much I love you.”

    Kaitlyn’s last written words are a powerful testimony evidencing the thoughts and mind processes of a person who has struggled with chronic and persistent suicidal thoughts. As a society, we must redouble our efforts to make it easier for those who suffer from chronic suicidal thoughts to express their inner turmoil and make it known to others so that, as you say, Dr. Freedenthal, “they can be helped to develop problem-solving abilities, coping skills, hopefulness, and reasons for living that will make the option of suicide unnecessary.”

    • mic says:

      “As a society, we must redouble our efforts to make it easier for those who suffer from chronic suicidal thoughts to express their inner turmoil and make it known to others so that, as you say, Dr. Freedenthal, “they can be helped to develop problem-solving abilities, coping skills, hopefulness, and reasons for living that will make the option of suicide unnecessary.”

      And make it easier for them to just die, if the person feels that such would be the best course of action for them. Not every case of suicidal ideation can be solved in the way that you’ve described, and people deserve to have the right to exerise autonomy over their own existence.

  5. Nightsong says:

    I’m glad you mentioned that chronic thoughts of suicide aren’t always from Borderline Personality Disorder. In my experience, being mislabeled with BPD led to a reluctance to hospitalize me even when the thoughts were so intense & unbearable that I legitimately could not keep myself safe. For the extensive amount of time that I’ve been coping with suicidal thoughts, Al’s ChronicSuicideSupport.com forum has been invaluable in being able to talk about how I’m feeling when things are difficult.

    Yes, the option of suicide can sometimes be the only way to survive- when things seem so out of control and you can’t make anything better, at least you’re in control (ish) of suicide…

    I’m not sure if I’ve already shared this with you, but I gave a sermon at my church about my journey with depression & suicide that you may be interested in: https://www.youtube.com/watch?v=AftiXHnDu2U&t=4s

  6. Michael Hutton says:

    I was told by a doctor even though I talked about suicide I would never do it and they told me just keep taking your antidepressants you will be fine regardless to whether I will or not the thoughts are still there however I have stopped taking my meds as my dumb doctor has put me on Sertraline 100mg, which the side effect causes my heart to speed up this would be fine if I was not on beta blockers for my heart to slow down

    • Janice Taylor says:

      Oh my Gosh Michael Hutton how on earth can a doctor put you on medications with contra indications that one makes your heart to speed up whilst another to slow it down, do some doctors know what they are doing. There are some anti depressants that do not speed your heart up and it may well be worth your while to change your doctor and go on to something that will help with depression, as being totally without any treatment for depression might not be a good idea unless you are sure the depression is not a problem anymore which for most of us it is a chronic condition especially when suicidal thoughts have been a lifetime habit, I have had suicidal thoughts all my life and been on anti depressants since I was 24, I am 62 now and I have researched all these subjects to do with medications and depression etc. Anyway this is just my 10 cents worth, and I hope you get the help you deserve. from Janice

  7. Al Jones says:

    Well, Stacey it took you long enough to get to this entry! 🙂
    I love Frank Kings comment because it’s a natural for me. Now I know where I got that, I’ve used it myself a few times.
    Oddly I’ve heard this from several people – the Suicide Prevention Hotline doesn’t know how to work with those of us who have decided that suicide is an option. One person I know who was getting stressed was asked if they could hold for a few minutes while the hotline took care of a emergency.
    And, on that note, I like this article and will, of course, point my forum members to it, so I think you can expect more input from them.

    • Stacey Freedenthal, PhD, LCSW says:

      Thanks, Al! You also might be interested in taking a look at my book. I write about the need for professionals to validate the wish to die, to acknowledge that suicide is an option, to encourage acceptance and observation of suicidal thoughts, to not engage in a power struggle, etc. – all actions that likely would be a welcome change for many people with chronic suicidal thoughts.

      I look forward to hearing from your forum members at chronicsuicidesupport.com.

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