Coping mechanisms for dealing with suicide ideation?
September 11, 2012 4:11 PM   Subscribe

Coping mechanisms for dealing with suicide ideation, when there's no actual intent to commit suicide?

I think about suicide a hell of a lot; and even though I haven't have any actual intent to commit suicide for quite a while now, it doesn't seem like my suicidal thoughts have actually decreased at all. I started therapy about a half year ago, and am transitioning (to a woman; I have been on HRT for around a half year too). Most of the time I feel better/happier/more-hopeful than I've ever felt before, but every so often something minor or stupid thing kicks up, which tends to make me all emotional, and my thoughts immediately jump to suicide so I don't have to deal with shit anymore. WTF is up what that. Usually it goes away after I think about how stupid it is, but it happens a *lot*. And I don't want it to happen anymore. :(

I've spoken to my therapist a lot about it. In fact I feel like that's all we ever talk about, when I would rather spend my time talking about gender or sexuality instead. I just rather I'd stop thinking the way I do, but I don't know how to. It seems like the first thing I think of when every anything bad comes up that I don't want to deal with. Which I can see as just plain stupid -- but that doesn't stop me.

I've gotten rid of my suicide kit, but, I can just as easily think about throwing myself in front of a train or a bus or something. :/ Also, I'm not on antidepressants -- I don't think I feel depressed generally -- and SSRIs/SNRIs have only seemed to cause *more* suicide ideation for me. I'd be willing to explore going back on antidepressants though?
posted by yeoz to Health & Fitness (17 answers total) 22 users marked this as a favorite
Meditation really helped me with this. Suicidal ideation is my brain's default go to when things are bad, or I get bored, or something minor goes wrong. Meditation has let me get space and just observe them. And not react to them as much as I did before.

I posted this question awhile ago on this exact question and maybe you'll find something there.

Please know that I'm thinking of you and it can get better. I've been there/still am there.
posted by kanata at 4:16 PM on September 11, 2012 [2 favorites]

Actually I see in that question doesn't actually solve yours but the idea of distraction really helped from people. And in the end meditation really did prove to be the answer for me. And delving deep in therapy.
posted by kanata at 4:18 PM on September 11, 2012

I do a lot of writing when I'm going through my periods of suicidality. Sometimes poetry, sometimes music, sometimes just babbling on paper. I do a bit of art therapy (even though I suck at art).

I guess what I'm trying to say is I try to put those feeling into a form that is outside of myself. Do what you feel comfortable with. If you ever need a sympathetic ear, feel free to PM me.
posted by kathrynm at 4:25 PM on September 11, 2012

SSRIs/SNRIs have only seemed to cause *more* suicide ideation for me. I'd be willing to explore going back on antidepressants though?

That counts as a common short-term side effect, because you suddenly have motivation for the first time in a long while, but still have the thought patterns of long-term depression.

I very, VERY rarely suggest seeing a therapist (I consider them a waste of money who tell you what you already know, 99% of the time), but you may find it helpful to restart a course of antidepressants and working through the start-up phase of them taking effect with a therapist.
posted by pla at 4:37 PM on September 11, 2012

:-/ (Struggling to figure out how best to say this.)

I attempted suicide at age seventeen and was hospitalized twice for being suicidal, to keep me safe. That was all a really long time ago. I was sexually abused as a child and had an undiagnosed medical condition at the time. So let me affirm that solving your actual underlying sources of stress will help. Presumably, transitioning will make a difference for you.

However, I still am dealing with a lot of stress and I spend a lot of time thinking things like "god should just fucking let me die already. Nothing ever goes right. He's nothing but mean to me." I recognize that as not genuinely a desire to die but more like a lefthanded request for the universe to cut me some slack for a change. It expresses a desire for my current high stress to be over suddenly and completely and also expresses my belief that there likely aren't any quick fixes.

I generally view internal memes as, in some sense, being like dreams: The voice of the subconscious, thus not something to be taken too literally. I did a lot if dream interpretation in therapy and I often discuss repetitive internal monologues with other people, with an towards using at as a clue.

I will also suggest this: For me, this "death wish" theme is also an expression of a desire for the death of my old self, the me which was chronucally ill and sexually abused and hated men, etc. Recognizing it as a kind of symbolic language, the way the Death card in Tarot us symbolic of change rather than predictive of death per se, has made such internal monologues much less frightening and threatening. I recognize it as a form of venting and a form of asking for rebirth, which I am essentially getting.

There is a story about someone watching a butterfly struggle out of its cocoon and feeling sorry for it and snipping the cocoon. The body remained bloated and the wings remained shriveled. It never flew. The struggle was necessary to force fluid out of the body and into the wings so it could fly. I have come to view my emotional struggles in a similar light -- that my problems in one area and my struggles with them are the stuff of which "wings" shall be made. I am less inclined to resent the painful, slow process of struggling through it than I once was.

Perhaps your suicidal ideation is a desire for your male identity to die so that your female identity can be born. Perhaps viewing it that way can help you use such thoughts and feelings to fuel constructive activity towards furthering or quickening the transition. Perhaps your death wish, like mine, is just part one of a desire to rise from the ashes, reborn, like a Phoenix.

I hope that helps.
posted by Michele in California at 4:43 PM on September 11, 2012 [33 favorites]

It can be a habit. You need to break the habit. Actively push the idea away and think of something else. Snap a rubber band on your wrist. Meditate ten minutes a day.

Tell your therapist that you are actively working to not think of it, what your techniques are, that you are not suicidal at all, and that you want to spend THIS session discussing sexuality and/or gender. If he persists, maybe you need another therapist that will allow you to focus on other issues in your life that may be pushing you into thinking of suicide.
posted by BlueHorse at 4:52 PM on September 11, 2012

You're giving these thoughts way too much importance. Like BlueHorse said, they're just a habit. They don't have to have any more significance than that. Of course they're unpleasant, but it seems like the you're more distressed by the fact that you have the thoughts than the thoughts themselves. This is a situation where repeated hashings-out with a therapist can actually be counterproductive, because it's reinforcing the idea that the thoughts are Deep and Powerful and Insidious, and so the next time you have one - which you're going to, I mean you just talked about them for an hour - you're like "Auuggghhh! The Forces of Evil are winning!"

Trying to stop the thoughts will not work and will just lead you down a vortex of futility. Instead, accept that they exist, and they're annoying, but they don't deserve any more mental energy than "Oh....that was weird." Certainly not a whole hour of therapist-time when you'd rather be discussing things that actually matter to you, things that actually deserve your mental real estate. And eventually, as you let their importance fade, their frequency will fade, too. I promise that this will happen. I also promise that you're normal and these thoughts are not going to cause you to commit suicide against your will.
posted by granted at 5:25 PM on September 11, 2012 [4 favorites]

So I have suicidal thoughts all the time, because my brain is fucked up like that. And it is fucked up--brains aren't supposed to do that--but they're passing thoughts with no edge, because my depression is managed well with meds. At this point, it's static, but it's static I get a lot because the radio of my brain is messed up in that way.

I'd just track them and not worry about them unless they feel urgent, in which case get help right away, just as if you were having symptoms of a heart attack.

My own experience is that they don't lessen in frequency, just in intensity and urgency. I think I have as many passing thoughts of suicide now that I'm happy and my depression is well managed as I did when I was actively suicidal; it's just now I can identify them as static, not signal.
posted by Sidhedevil at 5:53 PM on September 11, 2012 [1 favorite]

I have problems with intrusive thoughts as a part of Tourette Syndrome.* When I'm depressed, I have really bad, obsessive thoughts about hurting myself. Here are some methods I've used to stop them.

-As soon as a self-harm thought crosses my mind, I breezily and quickly tell myself "Nope, you don't have those thoughts any more, that's not something you think about, nope nope nope hell nope nopity nope nope!" Similar: "You are not a person who hurts themselves, that's not something you do, that's not you, you don't do that." I know some people get all weepy-eyed about not being able to deal until you wring every tear out of every shitty feeling you've ever had, but this is an intrusive thought that is harming your life and you're allowed to tell yourself to shut the fuck up as soon as it starts.

-My CBT therapist gave me a guided relaxation/breathing tape that instructs me to tense different groups of muscles in my body, then relax them. It sounds super cheesy and simplistic, but it's good for me to have an escape/something to look forward to on spectacularly shitty days; half an hour in a dark room laying almost motionless with my mind empty. I always, always feel better afterward and with a lot of practice it's given me the ability to do some breathing exercises and calm down for when I start freaking out and I'm at work and I can't exactly go lay down for a half an hour on the conference room table.

-When I'm really bad-like, "do I have the will power to throw myself in front of an El train?" bad-I tell myself that I can kill myself when my dog dies, but until then I need to struggle and get through this, because I can't leave that poor dog starving alone locked in an apartment with my corpse, and I can't imagine him as happy with anyone else. I tell myself, "Fine, you're going to kill yourself, but you're going to do it in ten years, and you might as well hurry up and get on with your life because you have another ten years of this to get through."

-DO NOT DO THIS WHEN YOU ARE DEPRESSED, but read some articles and stories written by people who outlived their suicidal loved ones. You can tell yourself "no one would miss me if I was gone," but you will leave a huge amount of anger, guilt, sorrow, and grief behind you. Suicide is a selfish act. Don't be that asshole.

*TS&OCD are neurologically similar with a high rate of comorbidity, and while I have tics instead of rituals I have a lot of symptoms that anyone with "bad thought" OCD would recognize
posted by Juliet Banana at 6:53 PM on September 11, 2012

I've been down that rabbit hole, all the way down, and back out again. There's a vortex of energy there that goes something like, I could solve all my problems if only I could....eliminate them all in one fell swoop by ending this story permanently. There's some kind of unfortunate reward payback in the brain from having suicidal thoughts, like the thought that you would somehow be better off if.....fill in the blank with suicidal ideation...that ends with no more problems at all.
When you look at the scenario you are creating, you are actually telling your body to harm itself, to damage its integrity, which is basically insane in a way. There's an adrenaline rush from that as well which can be a toxic kind of compulsion reward. Meditation helps a lot, exercise helps a lot, disputing your thoughts helps a lot. Like the fact that suicide is rarely successful and often leaves the person attempting worse off or way worse off than before, not to mention everyone close to them. Identifying the triggers is helpful so you can find ways to change or eliminate them. Social isolation is one of mine. When I found myself recently in a stressful scenario for a week, ideation started up for me. I found ways to work around it but it was no fun at all.
posted by diode at 9:54 PM on September 11, 2012

Mindfulness and therapy. Basically the suicidal thoughts are just thoughts; no judgement, nothing but the fact that I am having this thought. There is no action associated, there is no desire, just the thought. I accepted that I had these thoughts in response to certain things and that was it. I required nothing more from myself, just accepting that was a thought, I have no control over my thoughts, only my actions. So that thought is just that, nothing more. I am more than just my thoughts. It gets a little mantra-like and reptitive but it was really useful for me to just accept them as thoughts, fleeting and inconsequential, rather than obsessing over why and what does it mean and surely I'm terribly depressed again etc.

If I'd started planning? Different story. But they are/were just thoughts and in and of themselves held no power.
posted by geek anachronism at 10:32 PM on September 11, 2012 [1 favorite]

I struggle with this too. None of the standard solutions (meditation, therapy, etc.) have worked for me. I'm not sure why. Here's what works for me, sometimes, although it's probably something I'll struggle with for my entire life.

- Accepting that I have the right and power to kill myself if I want to. No moral judgment. It's my life, and I can end it if I choose. No guilt, no shame. It's my choice to make. I can do whatever I want, anytime I want.

- Making a plan for all of the things I'll do *before* I kill myself. I *could* kill myself at any time, but before I do that, I should probably do everything I want to do here on Earth: travel everywhere I've wanted to go, experience everything I've wanted to try, meet that person, see that movie, etc. I should spend every last cent I own and take every possible risk I can: I have nothing to lose! So I start planning a bunch of great adventures and stop worrying about problems and all of a sudden there are good things in my life and I haven't thought of suicide in a few weeks...

- Being loved. Being in a good relationship (something I never, ever thought would happen) has really helped with suicidal thoughts. I disagree with the beliefs of many above (including the OP) who say that suicide is a "stupid" thought. It is not stupid. I was more suicidal before because I believed that I would never be loved. Now that I am loved, whatever its faults and whenever it ends, I am much less suicidal. Not just because I'm happy, but because the (quite good) reason that I wanted to kill myself is not there.

- Gratitude. When my mood starts to dip, I make a mental list of all of the things that I love that can never be taken away from me, sometimes several times per day. I think about my education, about music and science and art, about travel and food and... no matter how awful I am or how little I have, I will have experienced these things.

- Be in places you like, with people you like. Be with people who make you happy. Leave situations that make you unhappy. If you don't like where you are, leave. If you're about to kill yourself anyway, there's no huge cost to getting up and leaving in the middle of a party or skipping dinner plans or leaving work early. You're going to die anyway, who cares? Make your escape without dying.

- Reduce stress. Spend money to buy things that lower your stress. Get a smartphone with maps so you don't get lost. Be okay with replacing broken things right away. Get a good pillow.

- Read Kate Bornstein's book:

It's supposed to be for teenagers, but I found it very helpful. Definitely buy it before you go. A must read.
posted by 3491again at 11:42 PM on September 11, 2012 [2 favorites]

Maybe talk to the therapist about obsessions?

If your thoughts about suicide are obsessive (& it might not be obvious to you that this is the case), then the treatment is different. Chastising yourself, telling yourself you must be screwed up to think like that, trying to push the thoughts away, talking about them with your therapist & dissecting them makes obsessions worse.

The treatment involves exposure - getting used to having the thoughts rather than trying to stop them, & learning to sit with the unpleasant feelings they provoke.
posted by JeanDupont at 1:24 AM on September 12, 2012 [1 favorite]

My input as someone who is occasionally suicidal. First, what 3491again said. I definitely start by accepting that it's my absolute human right to kill myself. Getting away from the thoughts is something I get to after accepting it's my right, with a lot of the aspects 3491again mentioned above. Thought stopping and mindfulness is not a giant part of it. However, I know in advance that there are certain times I am more likely to be suicidal (e.g., after a breakup). So in those moments I am mindful and wait it out. I also imagine I'd reach out to someone if I felt myself to be very close to it. Good for you for getting rid of the suicide kit.

Also 2nding Michele in California. Changing the physical things that make you suicidal can go a LONG way in helping you not feel suicidal anymore. This actually works. You are transitioning. I had a developmental problem and eventually got major surgery ($30,000 and 22 titanium screws in my face later) that changed the entire way I interacted with the world.

The way I consider that aspect is the following: in nature, cells often kill themselves (apoptosis) if there is something wrong or defective. It's a natural process. I had something "wrong" with me, not in my eyes or God's, but in terms of fitting into the world. It was natural that there was some pressure or ideation for me to kill myself. People who don't have something wrong don't necessarily understand or feel that pressure themselves.

The statistics on trans people committing or attempting suicide are pretty staggering. You're not alone in that.

The bright side is that making the transition, for many people, is an incredible way to start to feel differently. So is finding a community you fit into and individuals who accept and love you in the deepest way. If you are moving toward those changes, you are doing the right thing. For me, physically changing the thing about me that didn't fit in (which didn't change my underlying physiology completely but got me to "pass") was indescribably lifechanging. Life is still hard, but the things that were hard before are not the same as the ones now.

Sometimes I can get out of suicidal ideation by accepting that I will commit suicide at time n in the future, and starting to think about what I want to do before then. 3491again mentioned this above. There are a few things I want to hack on and experience before I die. I also want to make it not too stressful for my sister, so I think about how to do that. Then I think about getting my affairs in order. I have gone so far as to get my affairs in order a couple times, which can be so useful because now my apartment is so clean and i have all this extra energy! Other times, I decided that I wouldn't kill myself but I'd erase my brain with drugs. I did that and it was oddly effective; in the future I would consider ECT probably as a preliminary step before suicide. Yes I know this is making me sound like a freak. I have not killed myself yet, though.

Thinking back, another way I can see suicidal ideation, when it happens, is as a process that gets me to thinking clearly about what actually makes me fullfilled and what needs to change. I don't know that it's wholly bad. There is something renewing about deciding, "I am going to commit suicide, but first I am going to do things XYZ," which really brings to light which activities XYZ are the most really personally fulfilling as those are the ones I prefer over dying.
posted by kellybird at 8:32 AM on September 12, 2012

- Accepting that I have the right and power to kill myself if I want to. No moral judgment. It's my life, and I can end it if I choose. No guilt, no shame. It's my choice to make. I can do whatever I want, anytime I want.
Sometimes I can get out of suicidal ideation by accepting that I will commit suicide at time n in the future, and starting to think about what I want to do before then.
This is what I do currently, but, I some how think it might be counterproductive. If i'm going to kill myself later, I might as well get it over with now, to save time and the hassle of wasting the rest of my life. :/
posted by yeoz at 6:02 PM on September 13, 2012

Yeoz -- what gets me past that is usually a person (my sister) who would be pretty devastated. Not sure if there is a thought that usually gets you past it. I imagine it's different for everyone. I just really think from what you wrote that you should give some time to getting through your transition. A few months or years plus or minus is not a huge deal, it's not like you have to waste 60 years miserable! Disclaimer: I am not a pro and it sounds like you could maybe benefit from talking to a trained specialist. But, if it's at all useful and if ever you want to anonymous chat about stuff with an internet stranger, feel free to MeMail me anytime.
posted by kellybird at 6:51 AM on September 14, 2012

Apparently suicidal thoughts are so high in transgender people that 50% have a suicide attempt by age 20... and 2/3 (!!!!) have had suicidal thoughts. Holy lord! It almost sounds like a normal part of going through gender dysphoria. I think there are some trans and glbt hotlines and obviously lots of therapists. Just some webpages that i found on a quick search:

Good for you for asking a MeFi question... from reading a bunch of pages, it seems like people who reach out in one way or another tend to fare better emotionally than those who don't. And it does seem like the vast majority of trans people are able to get through the giant emotional challenges and get to the other side of it. Then again, this is just from reading the internet. No expertise whatsoever. I really really really hope you are able to chat with others who are specialists in the types of challenges you have at the moment.
posted by kellybird at 7:03 AM on September 14, 2012

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