I knew I was in real trouble. I’d felt overwhelmed, trapped, and alone before. I’d wanted to die before. I’d even had a plan before. But it wasn’t until I was dressed only in a hospital gown, sitting on a hospital bed in the ER watching a security guard go through my wallet, that I realized how ill I was.
That was one of the scariest, most humbling days of my life. It was Monday, and I’d gone to a therapy appointment with a new trauma therapist. Just 30 minutes into the session, she told me she was unwilling to let me leave unless someone came to take me to the ER. If I refused, she would “5150” me — have me involuntarily hospitalized for 72 hours.
My best friend braved nearly two hours of Los Angeles rush hour traffic to come get me and take me to the ER. Upon arrival, I found myself almost slurring my words as I weepily told the receptionist why I was there: “I’m actively suicidal.”
Fortunately, the entire ER staff was exceptionally kind and competent — from that receptionist, to the doctors and nurses, to that security guard who catalogued all my belongings and knocked on the bathroom door every 30 seconds to make sure I was still alive.
I was one of the lucky ones. I survived the night. My rights and voice were respected at the hospital, and I was allowed to go home and sleep in my own bed. I followed up on my action plan the next day. I removed lethal objects from my home, got back on my meds, and leaned on two of my besties who helped keep me alive until the meds kicked in.
I’m part of a growing demographic. In the United States, 48,000 people die by suicide every year. That’s 14% higher than the number of people who die in vehicle crashes. For every person that dies by suicide in this country, 24 attempt, and 315 seriously consider it. The suicide rate has increased by 30% since 1999 and is the third cause of death of youth ages 15 to 24 (after accidents and homicide).
I’m part of a growing demographic. In the United States, 48,000 people die by suicide every year. That’s 14% higher than the number of people who die in vehicle crashes.
I’ve been suicidal four times: my senior year of high school, my second year of graduate school in my early 30s, and twice in middle age. I’ve lost 1.5 friends (the .5 is for an incomplete attempt) and one immediate family member to suicide.
I’ve hesitated many times about writing this article for public consumption. While we’re becoming more comfortable with naming trauma, talking about mental illnesses, and discussing neurodivergence, there are still deep taboos around suicide, and persistent prejudices about the suicidal. We still say those who die by suicide “committed” suicide, as if it were a crime. We still see those who take their own lives as selfish, morally deficient, or deviant.
But as it’s National Suicide Prevention Month, it felt like time to say out loud: me too. Time to say: here is the darkness that needs the light. To say: here I am, one of many who are misunderstood and condemned.
I’m also here to say: here are five phrases I hope to never hear again. If we can shift these words and the thinking behind them, I believe we can promote better healing, and save more lives.
1. “If you’re struggling, please reach out. I’m here.”
When someone dies by suicide, I often see their colleagues or acquaintances post the news on social media, urging readers to “reach out” if we, too, are “struggling”. But asking someone with life threatening depression to “reach out” is like asking someone with two broken legs and two broken arms lying on a freeway shoulder to flag down a car.
What these well-intended folks don’t understand is either (a) we have reached out, or (b) we can’t reach out. Most of us do reach out — to say hello, to talk, to ask for a favor, or to hang out. But often people don’t respond, they’re too busy to make plans, or they’re more present to their phone or their own stress when we get together.
Also, many of us who are depressed or suicidal got that way through relational trauma where we were trained to attend to others’ needs at the expense of our own. We were taught that asking for help was selfish or weak. Or we learned that asking for help or showing a need would be met with silence, rejection, or even abuse. Even when we’re already on a healing path, when we’re acutely ill we may not feel safe or resourced enough to risk asking for help.
But sometimes we simply can’t reach out. Severe depression and suicidal ideation mess with our brain. We’re seriously impaired. We may be so dissociated, overwhelmed with negative thoughts, or even delusional that reaching out doesn’t occur to us, or we physically can’t.
Asking someone with life threatening depression to “reach out” is like asking someone with two broken legs and two broken arms lying on a freeway shoulder to flag down a car.
- A more effective phrase: “I’m sad I wasn’t there for this person who died. From now on, I’m going to pay closer attention to the signs of suicidality in my friends and coworkers.” Then educate yourself about those signs and keep your word.
2. “I know what you’re going through. I’ve felt down before, too.”
This is a well-intended attempt to show empathy. However, it’s as insensitive and misguided as telling a paraplegic that you understand how they feel because you experience occasional foot numbness.
Mental illness is not the same as normal human emotions. Sadness is not depression. Worry is not GAD (General Anxiety Disorder). Severe mental illnesses are debilitating nervous system diseases caused by trauma — in childhood, adulthood, our family history, our cultural or racial lineage, or all of the above.
Those of us who live with mental illness have a disability through no fault of our own. As a child and adolescent, I didn’t get what I needed to properly develop emotionally, psychologically, and socially. Due to their own trauma, the adults around me caused trauma and deficits in my nervous system. This dysfunction grew over time as my underdeveloped, unhealthy nervous system caused me to do behaviors and engage in relationships that compounded the harm. It also grew as I was continually exposed to institutions, environments, systems, and norms that are harmful to human beings, with no time or space to recover.
Like everyone else, I’m doing the best I can with what I was dealt. I take responsibility for my choices. And I happen to need medication to survive, like an asthmatic needs an inhaler or a kid with diabetes needs insulin.
My disease is as life-threatening and unjust as cancer. But I’m constantly and subtly told mental illness isn’t serious, or that it’s my fault. The weekend after ending up in the ER, I had a short road trip planned with a friend. We lost the money we paid Airbnb because the travel insurance policy stated: “we will not pay any loss … caused by, or resulting from: mental, nervous, or psychological disorders.” It didn’t matter that I had discharge papers from an emergency room. But if I’d gotten COVID, I would have received a refund.
- A more effective phrase: “I have no idea what you’re going through, but it sounds awful/painful/scary. I care about you, and I’ll help get you through it.” Then take action and follow through. We need your competence, not just your caring.
3. “I don’t think you really want to die.”
This phrase is not only insensitive and misguided, it’s dangerous. It’s like telling someone who says they have gunshot wounds to the chest they’re going to be fine because you can’t see the holes. It’s the bystander’s trauma response, expressed as denial, which then prevents them from taking life-saving action in service of the suicidal person.
Many who are suicidal or live with mental illnesses are experts at masking for self-protection. According to family stories, I was about three when I started displaying an extraordinary ability to appear calm and poised under very stressful or embarrassing circumstances. Many of us learn early on to cope with distress by feigning strength or indifference, compartmentalizing pain, and denying our needs. Over time, we become so skilled at masking that we mistake these learned coping strategies for our personality, and we fool everyone else into thinking those behaviors are all of who we are.
This is why those of us who are “high functioning” mentally ill are particularly vulnerable to not being taken seriously. However, we should be taken especially seriously because the effort it takes to disclose might be the only warning sign we give.
Bystander denial can take more subtle, but equally dangerous forms than “I don’t think you want to die.” Saying “let me know if it gets worse” is like telling a woman who’s being stalked to file a report if the stalking gets worse. In both cases, “worse” is usually death. Or saying, “well, I’d miss you if you do [take your own life]” is like telling a person floundering in your swimming pool that you’ll miss them when they drown.
Treat anyone’s mention of wanting to die like a bomb threat — as serious. Treat it like a threat of terrorism and respond in kind. The exception is when a person has made multiple mentions over many years but refuses to pursue treatment for their illness. We are mentally ill, but when we’re not acute, we can make choices for which we are responsible.
Treat anyone’s mention of wanting to die like a bomb threat — as serious. Treat it like a threat of terrorism and respond in kind.
- A more effective phrase: “I hear you saying you want to die. I care about you and I’m very concerned! Do you have a plan to end your life?” Then take action to get help (see below).
4. “Look at all you have to live for!”/”But s/he had so much to live for!”
When a person who is a skilled masker or beloved celebrity dies by suicide or attempts to kill themselves, the shocked community often responds with this pernicious phrase. Tinged with indignance and shaming, it’s the equivalent of telling someone with four broken limbs and two gunshot wounds to the chest that they’re in no danger and have no right to their pain because they have a nice family, a good job, and an attractive face.
When Stephen “tWitch” Boss died by suicide last December, a part of me died with him. Not only had I adored his artistry, work ethic, and personality for over a decade, the public contempt unleashed in the wake of his death hurt so much it felt personal. People called him “selfish” and declared him undeserving of suffering. After all, he had a beautiful wife, loving family of origin, three healthy children, a gorgeous home, financial success, well-deserved fame, and wide popularity. Naysayers all but said outright: “How dare he! He has nothing to complain about.”
Such reactions really weren’t about tWitch, but the critics’ own trauma. An appropriate response to his death would have been: “Oh my God. What deep suffering and great burdens that soul must have been carrying, that he wanted to die despite all the good things in his life.”
Naysayers all but said: “How dare he take his life! He had nothing to complain about!”
An appropriate response would have been: “Oh my God. What deep suffering and great burdens that soul must have been carrying, that he wanted to die despite all the good things in his life.”
We don’t know what lurks inside the mind, heart, and soul of another person — especially a public figure. But if they died by suicide, or want to die, we should recognize that their suffering was far greater than any of the external trappings we tell people should be enough.
- A more effective phrase for the living: “I hear you saying you want to die. I care about you and I’m very concerned! Do you have a plan to end your life?” Then take action to get help (see below). A more effective phrase for the dead: See above.
5. “What do you need? What should I do?”
Asking a suicidal person to help you figure out what to do is like asking someone with a brain tumor what treatment options they have. A well person asking someone with severe mental illness to tell them how to help is like a white person asking a Black person how to be anti- racist.
Placing the burden of solutions on the person most harmed or debilitated by the situation is ineffective support and allyship. Asking us to help you help us not only adds to our stress and trauma load, it increases our sense of aloneness.
We don’t just need your caring. We need your competence. I was suicidal for eight months — and saw two therapists — before that new therapist finally asked me the two most important questions:
- Do you have a plan? (If yes, what is your plan?)
- Do you have the means to carry out the plan?
In eight months, no one asked me whether I was still taking the medications that had kept me stable for 17 years (during the last three months, I wasn’t). No one asked me about the firearm in my home — even those who knew I was a gun owner.
People who are suicidal or living with mental illness don’t just need your caring. We need your competence.
More effective questions:
- If someone mentions wanting to die, ask: “Are you thinking about killing yourself?” Use those words.
- If they say yes, ask the above two questions. Then take action!
- Another question that helped me: “What’s keeping you here (alive)?
Immediate action if your loved one is in crisis: call 988.
Pro-active (non-crisis) actions:
- Google! If you have a friend living with mental illnesses, learn about their illnesses. Educate yourself about suicide, the danger signs, and effective responses.
- Connect with your local NAMI chapter. Read their materials, get involved, take a class, join a group. Learn about the mental health organizations and suicide prevention resources in your community.
- Prepare for future crises with your loved one using these guidelines.
- Take a Mental Health First Aid class.
People who are suicidal or living with mental illness don’t just need your caring. We need your competence.
Today, most people know how to prevent car accidents, what emergency equipment to keep in the car, and what to do when an accident occurs. Many are familiar with the terminology, symptoms, and accommodations needed for neurodivergent people with autism spectrum disorder (ASD) or ADHD. Most know what to do to cure the flu, or how to prevent and treat COVID.
But we remain dangerously clueless about mental illness that kills more people than car accidents and is more deadly than COVID. We’re too often incompetent in the face of neurodivergence that — like ASD and ADHD — isn’t the person’s fault.
After my trip to the ER, my two besties were caring and competent. One dropped everything to take me to the hospital. The other kept saying, “this is temporary”, and “the most important thing right now is to get you through this.” After the ER trip, she noticed signs of severe dissociation over the phone and urged me to call my other bestie who lives in town. I did, and she let me come over and stay the night. Both checked on me daily until I stabilized. But they also treated me like a normal person and didn’t walk on eggshells. They continued to share about their own lives, and one even prefaced her share about her own stress by saying, “not to compare to your situation at all…”.
The caring and competence of my friends, as well as the ER staff that night, saved my life. Eliminating these five phrases from our collective vocabulary when faced with suicide is one way to combine caring with the competence that might save even more.