In order to break the stigma behind suicidal thoughts and ideations, it's important to first understand what it is. It is not uncommon, in your life, to have at one point thought something along the lines of, “Oh my god, this is so terrible, I want to die.” You would be hard-pressed to find someone who hasn’t casually thought this or something similar, or said as much to a friend, in recent years. Common statements among teenagers today include lines like “I crave death,” “I’m about to end it all,”, or the ever-popular “This is my 13th reason,” a reference to a show centered around the backstory of a teenage girl who has committed suicide. Yet at what point is the line crossed, where a casual statement becomes passive suicidal ideation?
What is Suicidal Ideation?
Contrary to popular belief, though it is not the same as making casual statements about wanting to die, suicidal ideation is still much more common than most believe. One of the key aspects of suicidal ideation is the passiveness of it–suicidal ideation does not necessarily equate to having a plan in mind, or even thinking specifically about ‘wanting to die’. Rather, suicidal ideation can manifest in the form of consistent fatigue, of thoughts of wanting to sleep and never wake up–of looking down from a high point and wondering, constantly and intrusively, what it would be like to jump. It could be when a person considers letting a car hit them when crossing the street, or when thoughts of self-harm reoccur to them when looking at sharp objects. The difference between an intrusive thought and suicidal ideation is the constancy of the thoughts, and the length of time they span.
How can we cope with suicidal ideation?
Though it is used in a multitude of situations today, one of the original intentions of DBT, or dialectic behavior therapy, was to help individuals develop skills to cope with suicidal ideation. In this respect, the four main tenets of DBT–mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness–are all key.
Mindfulness
Mindfulness deals with focusing on the present moment rather than the past or the future, and developing awareness of thoughts and feelings as they come, accepting them without judgment and letting them pass without action. When suicidal ideation translates into self-injurious action, mindfulness can be used to delay the moment between the intense emotion and the impulsive action. Even when suicidal ideation is limited to only mental distress, mindfulness can be used to alleviate self-judgment and distress that may arise around these thoughts.
Distress Tolerance
Distress tolerance is, in a way, a following step from mindfulness, which guides one towards acceptance without judgment. Distress tolerance teaches an individual to cope with the pain that is brought by the uncertainty and unpredictability that often comes with simply living. Thoughts of suicidal ideation may be brought about by any unexpected event in one’s life–distress tolerance aims to create a gap between the initial emotion reaction brought about by the event, the thoughts of self-harm that may follow, and the actions that a person may take following that. This includes learning skills like distracting oneself or finding ways to relax when in distress.
Emotional Regulation
Emotional regulation is an extremely difficult skill to work towards, especially since we are all predisposed to bias towards whatever we are feeling in the moment. Not dwelling on a feeling, whether high or low, can be difficult. As in the name, emotional regulation is aimed towards developing control over one’s emotions, and the actions they encourage, by guiding them towards the understanding that they are not permanent, and that every emotion has a message within it. Accepting what an emotion is trying to tell you, via mindfulness, rather than attempting to judge or get rid of it, is the focal point of this tenet, and it also allows you to process that emotion without wallowing in it.
Interpersonal Effectiveness
Interpersonal effectiveness is meant to help an individual work on their communication skills and encourage them to reach out to others rather than bottle up their thoughts. It can be hard to frankly discuss the types of thoughts brought about by suicidal ideation without making the conversation into a joke, or commiserating in them without discussing how the situation can improve. Nonetheless, it is possible to discuss these things with the people in your life without undue alarm, but also with necessary weight given. The skills learned here are also meant to help set boundaries, in the case that suicidal ideation in encouraged by individuals in your life–encouraging self-respect and emphasizing the value of a simple ‘no’.
Honesty is the priority
It is important to make note of the steps of escalation that a person coping with suicidal ideation may take. These are as follows: passing thoughts, lingering thoughts, thinking about methods, making plans to follow through (writing a note, or giving your personal belongings away), setting a date, and finally, lacking fear towards the idea of death or the pain it may cause you. These are signs to look out for in others as well as yourself, and flags that indicate the turning point where one seeking professional help as well as communicating with family and friends may be advisable.
Regardless of the extent to which suicidal ideation may affect you personally, it is important to be honest with yourself and acknowledge that there are effects on you, whether it is due to the language you use in daily life or the idle thoughts you have. It is also important to be honest with others in your life and express that you are having these thoughts to someone. If they translate into self-injurious behavior, then there is value in finding at least one person you can candidly discuss these thoughts and feelings with.
Consider the source or cause of these thoughts and feelings. They may simply be intrusive–there may also be more to it. Speaking to another person about them may also bring clarity to this, especially if you have yet to seek professional help in the form of therapy. There is no wrong or right in this matter, as there is no bad or good–there is only what hurts you and what helps you. If it is available to you, find a DBT therapist to help you manage your suicidal ideation, and any other symptoms that might be attached to it.