The popular image of someone who is in danger of suicide goes like this: A person has suicidal thoughts. It’s a crisis. The person gets help, and the crisis resolves within days or weeks.
That’s the popular image, and thankfully it does happen for many people. But for others, suicidal thoughts do not go away. Their suicidal thoughts become chronic.
The pattern of chronic suicidal thoughts is similar to that of a person with any other kind of chronic condition: For some people, there are flare-ups where the condition is far worse than normal, and then the symptoms subside, but only temporarily. And for other people, the symptoms never subside. Those people live with their symptoms – in this case, suicidal thoughts – every day.
Who Is Prone to Chronic Suicidal Thoughts?
Chronic suicidal thoughts are especially common in people with borderline personality disorder, an illness characterized by unstable emotions and identity; impulsive, often self-destructive actions; and turbulent relationships. The psychiatrist Joel Paris notes that, for many people with borderline personality disorder, “suicidality becomes a way of life.”
However, chronic suicidal thoughts can occur in concert with other mental illnesses, such as recurrent episodes of depression, or with no illness at all.
Many people who regularly have suicidal thoughts have considered suicide for so long that it feels normal to them. Some have thought of suicide ever since they were young children. And some have made multiple suicide attempts, sometimes so many that they lost track long ago.
Why Chronic Suicidal Thoughts Persist
Often, intense, ongoing psychological pain fuels chronic suicidal thoughts. But even seemingly minor challenges can intensify the wish to die.
Frank King captures this dynamic well in his TedX talk, A Matter of Laugh or Death. Although King is a comedian, he provides this example in all seriousness:
“See, people don’t understand. Let’s say my car breaks down. I have three choices: Get it fixed, get a new one, or I could just kill myself. I know, doesn’t that sound absurd? But that thought actually pops into my head… It’s always on the menu.”
Some people say it comforts them to know they can die by suicide if ever the pain of life gets to be too much for them. The soothing nature of having an escape has led some experts to refer to “suicide fantasy as life-sustaining recourse.”
As the philosopher Friedrich Nietzsche stated, “The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night.”
The Danger of Chronic Suicidal Thoughts
Even if suicidal thoughts provide some form of escapism and relief, it does not mean that chronic suicidal thoughts are harmless. The more someone thinks of suicide, the more they might get used to the idea. This can weaken their inhibitions and fears about suicide.
Also, chronic suicidal thoughts typically indicate that an unhealed wound needs healing, whether that wound arises from past trauma, mental illness, grave loss, or some other cause.
Even for people who do not view their recurrent suicidal thoughts as a problem, it certainly is better if they can come up with other escape fantasies besides death. Better yet, they can be helped to develop problem-solving abilities, coping skills, hopefulness, and reasons for living that will make the option of suicide unnecessary.
Therapy for Chronic Suicidal Thoughts
For someone with chronic suicidal ideation, therapy tends to take longer than it does for someone in an acute crisis. The goals of therapy are not only to keep a person safe, but also to help them develop the skills and resources that will weaken suicide’s allure. Dialectical behavior therapy has been effective at reducing suicide attempts and suicidal ideation in people with borderline personality disorder and chronic suicidality.
Often, it is not a realistic goal for a person with longstanding suicidal thoughts to stop thinking of suicide. Suicidal thinking has become a habit. And nobody can control what thoughts come to them, only how they respond to the thoughts.
One way for someone to respond constructively is to observe their suicidal thoughts with curiosity and detachment. Some of my therapy clients say to themselves something like, “That’s not my real self talking. That’s my depression (or stress, or post-traumatic stress, or some other condition) talking.”
Mindfulness can be especially useful. The psychologist Marsha Linehan, PhD, developed DBT, which essentially is a form of cognitive behavior therapy combined with principles from Zen Buddhism. She uses a metaphor of a train passing by: You can sit on a hill and watch the cars of the train pass, or you can jump onto one of them and get carried away by it.
When to Panic – and Not to Panic – about Chronic Suicidality
So if you know someone with chronic suicidal thoughts, you don’t need to respond as though it is an emergency every time they think of suicide. That would be a lot of emergencies. Chronic suicidal thoughts often are manageable and the person stays safe in spite of them.
Danger occurs when the suicidal thoughts have intensified to such a degree that the person is intent on acting on their suicidal thoughts within hours or days. That is an emergency.
If the person is simply having the same thoughts that they have had for many years, don’t panic. Instead, compassionately listen and empathize with the person. Ask how you can be of help. Talk with the person about resources they can use, like the 988 Suicide & Crisis Lifeline (988 or 800-273-8255) or the Crisis Text Line (741741). Also talk about how they can keep their environment safe, like by removing firearms from the home.
Chronic suicidal thoughts are not ideal, but they also are not a crisis if there is no intent to kill oneself soon. As odd as it sounds, the option of suicide might be the very thing that helps some people to stay alive.
This post originally appeared in slightly revised form at insurancethoughtleadership.com/understanding-person-with-suicidal-thoughts/.
Copyright 2018 by Stacey Freedenthal, PhD, LCSW. Written for SpeakingOfSuicide.. All Rights Reserved. Updated Feb. 12, 2023.
Yes This is me. No one has said it so clearly. Not my psychiatrist or psychologist. Been looking for answers for such a long time. I relate to everything you say.
I’m not sure you really get it and it’s not that I’m special because I’m not there are probably thousands of people like me with chronic suicide issues who are “living on the edge”, yes I have tried suicide multiple times but I’m getting closer to getting it right! Yes I’m in therapy and have been for years but I must not have the right therapist yet this one is my 3rd and now starting on 4 Monday if I make it through the night. The meds I’m on sure I feel a little better but I still get those daily thought “Is today the day?” I’ve been unable to work due to injury for 15 years and yes I suffer from PTSD because of multiple brain surgeries and PNES along with other issues. I thought heavily about ending it tonight and I may but writing this makes me feel a little better along with the chance of I might find the right therapist to talk to tomorrow makes me think twice,,,just not sure I’ve been let down so many times by the medical community there is not a lot of trust left sad.
Greg,
That sounds like a really scary place to be in mentally. I’m glad typing it out made you feel a bit better. Even if it’s just out into the anonymous internet there is something about talking about these dark thoughts that helps. You sure have been thru a lot.
This is so me. It’s my son, too. In fact, we have a pact to not kill ourselves for the sake of the other. In my case, the ideation gets better on antidepressants. Like without them, I’m thinking about suicide every day, and then once they kick in—poof!—those thoughts are gone. Or at least they diminish in detail and urgency.
Anyway, thank you for describing my reality. :/ And for the resources.
What meds finally helped? Struggling here.
Thank you for this article. The times of suicidal thoughts have grown more frequent and intense these past 2 years. I’ve never heard the term chronically suicidal but it is a comfort to know others have understanding of the condition and it definitely describes what is happening. It’s also was helpful to hear that it can sometimes not need to be taken as an emergency because that would be a lot of unnecessary emergencies. I’m learning one cannot just ignore it either as I do feel it increases risk. It’s so hard to know what’s right to do when feeling that way. Especially now that it’s more frequent. The suicide hotline has been helpful so I’m glad to see it throughout the website.
Meredith,
I’m grateful the article was helpful to you; thank you for letting me know. Also grateful that the suicide hotline has been helpful to you, and that you recognize that chronic suicidal thoughts shouldn’t be ignored. I hope you’re getting help.
You might also be interested in the website chronicsuicidesupport.com. They have a forum where you can chat with others. And also, The Suicidal Thoughts Workbook by Kathryn Gordon could be a help to you.
Thanks again for sharing!
❤
At last a place where I can be open about my suicidal ideation. I had it really severe until I was 28. I actually can’t remember a time when I wasn’t depressed. After it ended I went on to build a successful life. I am a licensed mental health professional and I know the best suicide prevention for me is having lots of love and a support system. And up to March of 2020 it worked most of the time. Yes, I had bouts of severe depression and some suicidal ideation but I got through it. I have been responsive to meds, done lots of therapy, some EMDR, psychedelic medicine, TMS. Just at the start of the pandemic my sweetie of 7 years got diagnosed with terminal cancer. He lived an hour away and he was alone a lot of the time due to the restrictions and it was total agony to hear his acute pain and especially when I had to protect myself to see him. Unfortunately he was not very responsive to pain medication even though he got the best of care. I spent days and days with him, and was frankly pissed off that he didn’t want assistance with dying. Watching him die was the most painful thing I have ever experienced. His ex was a retired palliative care doctor who came back into his life to coordinate his care. While this was all going on my longest term friend was dealing with terminal lung cancer and I couldn’t see her. And two other friends were also terminally ill and my sweetie’s sister in law was also. Most of these people died in the fall of 2020. When 2020 hit I was having a lot of pain from a botched bunion surgery and could barely walk. My surgery had been re-scheduled for March 2020 but got postponed to June. I was alone for months. My psychiatrist and I decided that this was not really a medication issue: that my coping mechanisms that had worked so long had failed because it was too much. After I got better at 28 I spent years scared that the overwhelming daily depression and ideation would return later in my life and then finally convinced myself that I had done everything I could to build a support system. And then age age 67 it came back. The bitch is I had decided a while back that I could not kill myself because I can’t do that to other people in my life, especially my clients. And I’m angry about that, too. As usual it’s all about other people’s needs first. One of the other bad things that happened was that I was so depressed the first few months that I stopped eating and became very weak, even having trouble getting out of bed but living alone and working part-time (which was good as the structure helped). One day I fell down a flight of concrete stairs and ended up on my side. No injury just the same. Then I asked when I had felt this level of exhaustion before and I remembered when I did I was anemic. As soon as I addressed that at least some physical energy came back. But still the tape about killing myself, how was I going to get through all of this sorrow with lots of sorrow to come up in the future because of my age and the age of those I love. I wanted to find a reason to go on besides not hurting other people and taking care of someone I promised to take care of. I have tried to focus when things were lightening up some and my body was healing again on starting to do small things that gave me pleasure – like kayaking or being in nature, playing the piano. A month after that I badly injured my neck and shoulder and could not sit up for 6-8 weeks because of the intense pain. I felt very discouraged and that I couldn’t go on like this. I have been full of rage about a lot of what is going on in the world, racism, sexism, climate change, and especially the last administration. The pandemic is an overlay that’s there. And now even going out in nature is somewhat problematic. I live where we have had wildfires since 2016 and the smoke still drifts in. There is all this unhealed trauma from the fires (I did not lose anything but being in this community while this was happening was very traumatic) and now we are on edge every fall, that it will happen again. And even though I live in one of the most beautiful spots in the country, the air looks awful. I was doing better but I am so sensitive to getting triggered. When I can stay distracted it’s easier but when I can’t I get easily triggered. This weekend has been what would have been my sweetie and my 8th anniversary and I have sunk down into it again. I think I screwed up changing medications and I may be undermedicated so I’m hoping that will help some. And I finally got appointed Executor and its a mess and there’s lots of work to do that involves thinking of him. Yes to be able to safely type these words and know other people will understand and no one will call the cops which not only won’t help but would probably be the last straw for me – to enter the public mental health system. Being a highly respected mental health professional it’s hard to find a safe place to be open about my experiences but I also feel that I need to be – that holding this dirty secret isn’t helping me. But therapists have laws about reporting people if they have reason to believe they are at serious risk and lots of therapists over-react. I’m glad I found this site and Stacey and her coming out story is inspiring. Thank you for reading this.
Karin,
Oh my gosh, you have experienced more loss in the last couple of years than many people do in a lifetime. I’m so sorry for your losses and for the pain you’ve experienced.
I appreciate knowing that it helps you to be able to share here. And I’m certain it will help others to read about your pain and to not feel so alone in theirs. (I know that sounds weird that someone might “enjoy” reading about someone else who’s hurting, but our common experience of pain links us to each other.)
Thanks for your kind words about me. I know many mental health professionals experience the pressures you describe – to be there for clients, to not get entangled in the public mental health system, to not disclose suicidal thoughts to someone who might panic and call 911. I wish fewer therapists were quick to panic like that.
You are, of course, welcome to post here again, and you might also be interested in ChronicSuicideSupport.com, which has a forum where people can share their stories and thoughts with each other.
Thanks for sharing here!
Thanks Stacey. Right now I want to send this to the people in my support pod. This is the best articulation I have heard that clicks about what goes on for me. Just because I have intense pain does not mean I want to kill myself at least not in this moment. When things are so bad and I become overwhelmed my brain goes to this. And yes the knowledge that I have this option is important to keeping me here. Unfortunately in the past my way out was the possibility that things would get better. I don’t believe that anymore. Yes they change but not necessarily for the better. I feel like I’ve had a pretty amazing life even with chronic depression and sometimes intense ideation. So why go on when things in the world are horrible. Those I love are all over 75. My own body is breaking down.
If you want another safe place to open up Sanctioned Suicide is really good
Sanctioned Suicide is another safe place
Karin, Wow.. you spoke so clearly about the the overwhelming amount of pain and loss, and good coping skills just not an effective match for all you are having to deal with, the fear of police if you speak your truth, and therapists overreacting. Thank you. Your sincerity and vulnerability are powerful. We are out here with you, and wish you well in your journey.