Throughout my life, I’ve experienced a myriad of thoughts around suicidal ideation, but I often couldn’t get the help I needed because suicidal ideation is more complex than thinking about dying or killing yourself. That stigma alone — and there are many more stigmas aside from that — stops people from talking about it in more nuanced ways, ways that could bring relief if we spent more time trying to understand it rather than avoid it.
Research shows that suicide is the second most common cause of death among people ages 10 to 34, with the highest death rates among white females, Indigenous or Hispanic males, and those in the LGBTQ community, specifically transgender people.
Survey stats from 2017 also show that an estimated 10.6 million Americans said they had considered suicide. And while women are more likely than men to experience suicidal ideation, men are four times more likely to die by suicide.
The inability to talk about or see solutions to systemic problems can worsen suicidality, according to Araya Baker, a queer, Black therapist and disability justice advocate. This is particularly true of communities facing structural inequity, internalized oppression, and “model minority” pressures.
Other factors, including depression and anxiety, family history, and chronic illnesses, can also contribute to the occurrence or recurrence of suicidal thoughts. For example, during the pandemic, suicidal ideation has increased, with more than a quarter of adults ages 18 to 24 reporting that they have struggled with it.
But it’s also important to understand that suicidal ideation and suicide itself don’t discriminate. Anyone from any background can experience them.
That also means statistics and jargon shouldn’t scare us or isolate us from each other. Instead, these numbers tell us suicidal ideation is a common human experience, one we can help each other with if we share about it more often.
At its core, suicidal ideation (also known as suicidality) is having thoughts about struggling to live or not wanting to live. But contrary to common belief, thinking about dying or no longer existing isn’t a clear-cut sign of being extremely unwell or in danger.
Some normalized statements people make every day could fall under the definition of suicidality, says Andrea Tedesco, a licensed independent clinical social worker. These may include:
- “I’m not doing anything meaningful with my life.”
- “I feel totally useless.”
- “I feel like nobody would care if I were gone.”
- “I want to give up because nothing in my life is working.”
Or it can be total indifference about living, which results in a lack of motivation to fulfill basic needs like feeding yourself.
“In actuality, wishing to die can stem from a deep desire to cease feeling distress, exhaustion, or pain perceived as inescapable or insurmountable — not necessarily a desire for life altogether to cease,” says Baker.
This means that identifying the type of ideation is also important when talking about it. Ideation actually exists on a spectrum, from more passive to active. Passive ideation is thinking about not being able to deal with life, without the intention of acting on it, while active ideation involves more detailed thoughts and plans to die.
“Depending on the person, the downward spiral can present as a contemplative journal entry or a debilitating panic attack. Signs may be noticeable but not alarmingly out of character or self-destructive, which is why it’s important to listen to one’s intuition when assessing signs,” says Baker. “In some people, an onset of suicidal ideation may cause an increased but tolerable level of agitation or social withdrawal, while in others, bar fights and reckless driving.”
Ideation and intent are not the same
The difference boils down to the distinction between ideation and intention. One factor that commonly influences the likelihood of intent, from attempts to completion, is “access to a means,” says Baker. This can include firearms, pills, ropes, and other materials that would allow someone to go through with a more concrete plan.
“The strategizing or enactment of a suicide plan, usually prompted by an emotionally charged mood or intrusive thoughts, is active suicidality. On the other hand, passive suicidality is simply wishing to die — it’s a vague feeling or a fleeting thought, usually precipitated by general, unspecific angst,” says Baker.
Some people may carry these thoughts and feelings more consistently and learn to work around them. For others, suicidal ideation might occur more strongly after a traumatic event or negative experience. Roslyn, a culture writer and anti-rape activist, says her ideation is often passive, but the voice in her head grew louder and stronger after she experienced sexual assault.
“When my trauma symptoms are particularly acute, there’s a voice in my head that grumbles, ‘Ugh, I’m tired. I can’t do this. I don’t wanna be here. I wanna die.’ Depending on how acute those symptoms are and how long I’ve sustained them for, the voice gets louder,” she explains.
Kai, a college student, says a large part of their ideation comes from their oppression. “This world feels unlivable to me, unlivable to my people, as a disabled brown trans lesbian. In a world that feels unlivable, I am trying so deeply to change it, to help build a world where we don’t have to live in such fear. Suicidal ideation for me is how I feel when my fight seems to not make a dent. When the world is unlivable and I’m out of hope that I can change it, I want to disappear,” they say.
However, there are people who find comfort in suicidal ideation and don’t see it as something scary but instead as soothing. For Audrey, a 25-year-old Black woman from Nairobi, Kenya, thinking about death actually lessens her anxiety because it feels like there might be a way out.
“Suicide ideation for me is less about wanting to die and more about not wanting to be alive. I get lost for hours thinking about my own death, and it gives me a little bit of control at the possibility of choosing how and when I want to die,” she says.
People have also described suicidal ideation in these ways:
- “It’s always very passive — I’ve never thought about actually carrying out the act myself, but I have thought a lot about how to put myself in a position where death would naturally arrive. When my anxiety and depression are bad — when they’re nearing close to the cliff of potential ideation territory — it feels like I literally have nothing to look forward to; less of a presence of bad feelings, but a complete and devastating absence of good ones.” — Molly
- “I always thought that I couldn’t be suicidal because I had never made a plan or slit my wrist. I also don’t want to die for reasons like thinking that no one cares about me. I want to stop existing because my life is empty and numb even if people care about me.” — Abbey
- “My brain is wired to automatically turn to suicide as a possible solution whenever I experience pain, and it has taken a lot of conscious work and therapy to change that pattern. To me, suicidal ideation feels like a weight that sits upon my heart, convincing me to lie down and never get up again.” — Delaney
Storylines in pop culture often suggest that only “very sick” people have suicidal thoughts. This media trope contributes to dehumanization and stigma, which furthers shame around ideation and limits the experiences people can have in relation to it.
In fact, because society has not normalized vulnerable conversations about suicidal ideation, people may believe there’s something inherently wrong with them for having these thoughts. This can lead to suicide attempts and deaths that appear sudden because people don’t feel like they can talk about it.
“Suicidal ideation can be pretty simply broken down into a desire for pain to cease. It is an understandable defense mechanism and coping skill to consider suicide as a potential escape from the pain someone might be experiencing,” says Tedesco.
Consider how, for some, thinking about suicide might actually feel empowering because it allows them to feel in charge of their death, in contrast to the way they feel out of control in their day-to-day life.
Again, discussing signs of suicidality is not necessarily the same as attempting suicide. Being able to talk about the lack of control, without judgment, via ideation could help someone feel seen.
“Compartmentalization often becomes second nature,” says Baker. If we talk about ideation as inherently bad, we only add shame to the emotional burden that already exists — and people from marginalized communities might feel extra pressure to mask it, increasing the mental load ideation brings.
“Broaching suicide is no less awkward or taboo for those contemplating it, so the responsibility to address signs, in my opinion, falls on those who observe them,” says Baker of both professional help and support systems. “Being candid and direct — in a curious, nonjudgmental, and warm tone — could alleviate some of the alienation that intensifies suicidality.”
Everyone needs something different, but many who spoke with Greatist about their own ideation explained how unhelpful it has been for people to repeat how sad people would be if they died when they bring up suicidal ideation and difficult mental health conversations. Instead, this is what they found helped:
Find a way to validate the experience or emotion
“I feel supported when someone holds space for this uncomfortable feeling without wanting to fix me or fix whatever they think is causing said feelings,” says Audrey, who can’t pinpoint a particular reason and simply wants to be able to talk about it without causing alarm or being ignored.
“We have to deal with these feelings every day,” she says. “You listening to us once in a while is not a big ask. Personally, for me, I want people to respect my right to wanting not to live.”
Find access to therapy and medication, if possible
For Roslyn, finding trauma management tools like hot yoga helped decrease her ideation significantly. She also got a formal PTSD diagnosis from her doctor, which gave her access to antidepressants and medical cannabis. For many people, consistent therapy, whether it’s cognitive behavioral therapy or dialectical behavior therapy, can help.
Talk to experts online or via phone
Baker also recommends the National Suicide Prevention Lifeline and The Trevor Project, where he’s worked as a crisis counselor. He says counselors undergo weeks of training, learning how to respond to people’s thoughts and concerns and how they can help.
Contacting a crisis line is not quite like getting help from a therapist or a doctor, but it’s still different from talking to friends who might not know what to do or how to handle the discussion.
- Trans Lifeline — a lifeline specifically led by and for trans people in need of emotional and psychological support: 877-565-8860
- The National Alliance on Mental Health — a 24-hour helpline to talk about depression, anxiety, or any mental health issues: 800-950-6264
- National Suicide Prevention Lifeline — a national network of more than 150 local crisis centers, offering free and confidential emotional support to those in crisis: 1-800-273-8255
- IMAlive — a virtual crisis center with volunteers trained in crisis intervention if the ideation becomes more active
- The Trevor Project Hotline — a national 24-hour, toll-free, confidential suicide hotline for LGBTQ youth: 1-866-488-7386
A wellness check consists of calling the police on someone who is actively experiencing suicidal intent or ideation. This course of action can often be more traumatizing than helpful and can pose other barriers to talking openly about suicidal ideation.
Considering that police violence disproportionately impacts Black people and other people of color, this method of crisis intervention often ends up being counterproductive and more harmful, explains Tedesco. “The lack of options for crisis intervention plays a huge part in avoiding expressing suicidal ideation because so many of the options feel more damaging.”
There are ways to de-escalate mental health emergencies if needed. Finding ways to work with community members or other friends to provide crisis intervention for someone who might be in danger can be much better than relying on systems. Psych wards and the police often work against the most vulnerable people.
“Lived experience has taught me more about suicidality than my training as a therapist,” says Baker. “But I improved with a strong support system, the right medication, trauma-focused cognitive behavioral therapy, as well as dialectical behavior therapy — a highly effective skills-based treatment for borderline personality disorder, mood disorders, and chronic suicidality and self-harming behavior patterns.”
Baker stresses that no one is above mental illness or suicidal ideation. It doesn’t mean you’re broken or wrong. It’s a reasonable reaction when you’re in a space that won’t allow you to be your authentic self or punishes you for trying. Being unable to express yourself can make feelings of helplessness worse, which makes it even more important for us to normalize talking about suicidal ideation.
If we can start these conversations with openness and understanding that people want to be seen, even when they’re experiencing hard times, then we may be able to work toward conversations that move past the stigma and, as a community, toward a system that knows how to better care for people who experience suicidality.
Elly is a New York-based writer, journalist, and poet who also loves to host parties for her friends. Primarily, she’s Brooklyn’s resident pun enthusiast. Read more of her writing here or follow her on Twitter.