I’m suicidal, but I don’t want to die.

I do think about killing myself and have even made plans. The clinical psychological term for this is called suicidal ideation. This means wanting to take your own life or thinking about suicide. There are two kinds of suicidal ideation: passive and active. Passive suicidal ideation occurs when you wish were dead or that you could die, but you don’t have any plans to commit suicide. Active suicidal ideation, on the other hand, is not only thinking about it but having the intent to commit suicide, including planning how to do it. Some psychiatrists suggest that passive suicidal ideation can be therapeutic. To know that there’s always at least the option of life or death can sometimes benefit people in extreme circumstances. And while It’s most beneficial to talk to someone or write about what you’re going through. Having a passive thought of an escape plan can offer a bit of relief when you only see the choice of life or death.

Not many people know about my suicidal ideation or its extent. I’m writing about it now because I know it’s something that a lot of people struggle with. I want people to know that they aren’t alone, and I want to remind myself that I am not alone. A staggering 800,000 people die of suicide worldwide each year. And even greater number of people have suicidal ideations at least once.

My hope is to create a dialogue.

I want to show that it’s both acceptable and beneficial to openly talk about mental illness and suicide. This is how we raise awareness and help eliminate stigma. I have C-PTSD, OCD, and panic disorder. These conditions give extreme anxiety, and times where I feel uncomfortable in my own body and mind. I live alone, I don’t have a big family, a lot of friends, or a healthy support system. And so, on my worst days, I often think about suicide. I do have a history of self-harm, and suicidal acts with intention. But I’ve never tried to kill myself, and I can always talk myself out of wanting to.

For those who may not know what it’s like to go through life with suicidal thoughts, I will walk you through my experiences.

For me, most of the time there’s a trigger. Something that makes me sad, angry, or lonely. Something that I can’t easily ignore or change. Physical symptoms often start to occur. Sometimes it starts in my eyes. They get blurry, or I get a dark veil over them. I rub them a lot to try to relieve it, but it doesn’t work. Sometimes I just sit with them closed. I can function in my apartment, but usually, I’ll try to lay down. I might try to wear my glasses or take a pain reliever in case it’s a headache. I don’t always recognize the anxiety and panic at first. My first thought is usually that I’m getting physically sick. Sometimes it starts as a pressure in my head. It feels like my head is being squeezed and might pop. Not like a headache, but a fluid type pressure. I press my hands on the sides of my head, rub my temples, or lay down. Sometimes it starts in my flesh. It feels like my skin is tingling and burning. It feels hot, like it’s crawling or dry. It feels irritated. I shower, use lotion, or open a window just to make my skin feel differently. I’ll take my temperature in case I have a fever. I’ll check my blood pressure. Sometimes I’ll try to eat or go for a quick walk depending on the severity. Usually in this situation I think I’m just having a hot flash. Sometimes it starts in my muscles. My legs get sore and tight. I feel like I need to move them. I get irritable because no amount of movement can stretch out the muscles. I feel restless and have to keep moving. Sometimes this will keep me awake at night. I’ll try to go for a walk or run in place. I’ll try to dance. I’ll try to sit or lay in different positions. I’ll start to exhibit compulsions from my OCD, such as cleaning and organizing. I’ll move as much as I can, to the point of exhaustion. Sometimes it starts in my lungs: my chest and back hurt. I breathe very quickly but can’t get a full breath. I get dizzy. I desperately want a big, deep breath, but I can’t seem to make that happen. I get scared that I’m going to pass out, so I remain still. Unfortunately, the stillness allows me to ruminate. This causes compulsive body scanning, which is never helpful. Sometimes it starts in my stomach, with gurgling sounds, sharp pains, cramps, nausea, and acid reflux. I feel like I’m going to vomit. Sometimes I have diarrhea when it gets bad. I usually take antacids or nausea medicine in this case. I drink ginger ale. I might shower. If it’s day time or the night before an appointment, I cancel my plans. These symptoms are the ones I hate the most because they trigger my phobias. These symptoms always result in a panic attack, forcing me to take medication. It is only at this point I know that I am, without a doubt, having severe anxiety. If my anxiety isn’t extreme I usually think it’s something else entirely. If I don’t have any prescribed medication to take, I am most likely to go to the emergency department during this time.

No matter how it starts, intrusive thoughts eventually set in. It might begin with an idea that I should tell people I’m dying, or that I’m hurt. At this stage, I just want some compassion and empathy, but fear that I won’t receive it if I reach out. I believe this is where the stigma of mental illness comes in. Some people have confused reaching out with attention seeking. This really hurts because these experiences are beyond the control of the one suffering through them. Ignorance of mental illness and its severity at this moment can literally be a matter of life or death. At the very least, are we not all deserving of compassion?

I might start thinking about the process of psychiatric evaluations. They’re long and tedious, but they don’t get the whole picture. Evaluations often leave people feeling scared, and even worse about themselves. I think about trying different medications. I think about taking a break from my own reality. I think about calling the crisis hotline. I think about reaching out to a friend for help. This is usually when I scroll through my phone and social media friend lists looking for someone who will listen. Someone who will understand, not judge, and not tick me off in that moment. Someone who will show up. Someone who will sit with me. Usually, I come up empty handed because people tend to minimize my feelings, or they don’t take me seriously because I’ve done this before. Or they victim blame me, and I just can’t bear to go through that in this moment.

In extreme cases I do call the crisis hotline, or my therapist. But usually they don’t offer much relief from the problem I’m dealing with. Those phone calls are more like band-aids to tell me to calm down, to tell me I’ll be ok, to tell me I can handle it in the morning. But with my mental illness I know there is no quick fix. I know these words are temporary. I know tomorrow morning I’ll wake up to face the exact same thing that left me so exhausted tonight. Lack of support in times like this is what triggers the thought of how alone I am. Going to bed in this mindset makes me feel like I need to do something extreme to get attention. And then I think about how no one would notice if I was dead anyway. By this time my mental illness has already run away with its ideas. My best hope is to calm the negative voices.

This is when I revisit old suicide plans or make new ones.

This is when I might write goodbye letters to loved ones.

This is when I wonder how hard it is to get a gun. I wonder if I could jump in front of a train, or a truck. I wonder if I could walk into the lake and freeze to death or drown. What if I cut deep enough? What if I found a way to overdose? Could I jump from the roof or window? Could I hang myself? This is when I say goodbye to friends or tell people I love them. I don’t offer any further explanation. Sometimes I tell people I’m leaving for a while and can’t be reached by phone. I almost always try to say goodbye though. I desperately seek someone to recognize my pain in these moments. Sometimes this is when I cry, and sometimes I just feel relief and acceptance that soon my problems will end.

Today, though, I decided I’d write what I was feeling as it was happening. Today, I tried something new. I don’t feel cured; the thoughts are still there. But now they’re written. I don’t have to keep ruminating. Today, I didn’t hurt myself. Today, I didn’t take the medications. I didn’t lay down. I didn’t say goodbye to anyone. I didn’t write any letters or call for help. Today I just wrote it down, and let it go.

I guess, today I won.