Redefining Suicide Ideation, #2

I recently read a post from a therapist that said she passes on clients with suicide ideation. It led me to do some research. From my point of view, “passing” on a patient with suicide ideation has issues. The research I did, albeit brief, led to my belief we need a new classification.

Passively and actively suicidal are what we have and how we address it. For many, it is seen a straight line. I am guilty of this myself, with both how I looked at it and how I thought others would look at it.

I always thought there was something wrong with this, but I couldn’t come up with any other way to explain it. I do know it made me fearful in the past of discussing it with my doctor and therapist. “Yes, I am having suicidal thoughts. No, I don’t need to be hospitalized. No, I don’t have any actual plans to hurt myself. Leave me alone.”

I realize now that that, “Leave me alone,” both internally and externally, was inhibiting my ability to get the help I actually needed.

My thoughts on suicide ideation were most recently echoed by a therapist and writer on threads. Stacey Boe wrote, “Most people don’t realize: Suicidal thoughts are often the nervous system in distress, not a true desire to die, but a desperate cry for relief.”

In a recent conversation I had with my Nurse Practitioner, I mentioned the suicidal thoughts were back. Just a passing thing like I have been having for 40 years. She was one of the first medical practitioners that I felt understood what I was trying to explain.

She talked about suicidal thoughts as escapism.

All that made something click inside my brain. I’m still processing it. But if you merge it with the Mayo Clinic’s definition of self-injury/cutting, a larger picture begins to emerge.

“…this type of self-injury is a harmful way to cope with emotional pain, sadness, anger and stress.” It goes on to talk about learning better ways to cope.

Suicidal ideation as an unhealthy coping mechanism?

As I have written, I am guilty of this myself. When I talk about suicide, I say how I have been actively suicidal twice. 20 years apart, there was a plan in place and a rationalization behind the plan.

Suicidal ideation? Hell, I’ve had that for the better part of 40 years.

It began in high school. I thought about it, went through all of the ways to do it, and discarded the idea. Though I knew I was not going to commit suicide, I couldn’t get the thoughts out of my head. It became so common I thought of them as normal, that everybody had them. It was not until I was in my 30’s, talking with another therapist, that I learned it was not normal, that not everybody had them, that I did not need to be having them.

The thoughts would come and go from high school to the present. They were annoying. I likened them to a swarm of gnats on a summer night. I’d wave them away and get on with living. The amount I waved depended.

I could have these thoughts once a day or many times a day. It could be a single day event, go on for months, or somewhere in between. Like I said: annoying. A swarm of gnats. The “danger” sign to me was when the gnats turned into hornets.

Even then…

Like I said, I am still processing new information. I am processing and thinking as I write this.

The first two times the gnats turned into hornets is when I think of myself as going from passively to actively suicidal. But there was a third time, maybe many episodes after that second time. It was different because I was different.

It is a story in and of itself, that can be found in my books, but at the end of 2020 I knew I was never going to commit suicide. I also knew I was in for a very rough ride as I began transitioning my life. The hornets came regularly. For months. Then they disappeared.

A swarm of gnats on a summer evening. Suicidal ideation. Not a thought of committing suicide. Annoying. Me telling the thoughts: “You don’t belong here.”

It is much less frequently, but I still have them. Escapism, an unhealthy coping mechanism, makes the most sense to me. The nervous system in distress and a desperate cry for relief make the most sense.

I am not an expert here. I am only writing from experience and processing new information that I am learning. My hope is that people suffering with suicide ideation and the actual experts begin to process this new information as well.

Can suicide ideation lead to suicide? Yes, I firmly believe that it can.

I also believe, however, that a spectrum should begin to emerge as opposed to a straight line, or perhaps even a new classification. I think of it much the same way Dysthymia was thought of decades ago, a low grade, chronic depression. Was it a part of Major Depressive Disorder or its own disorder in and of it itself?

I wrote about it a long time ago here, “Dysthymia: The Thief of Happiness.”

In the conclusion to the article, first published in Cosmopolitan Espanol, I write how it doesn’t matter how it is classified. It needs to be addressed to bring awareness and addressed differently because of both how it is perceived and how treatments for chronic illnesses require different approaches than acute illnesses.

I am now well used to the stigma and misunderstanding I receive when I discuss my suicidal thoughts with the general population. Unfortunately, I am also well used to encountering the stigma and misunderstanding when discussing them with medical professionals.

We need to do better.