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.
You are leaving out a major group. CHRONIC PAIN PATIENTS. Many patients have coped with their pain using opioids for years and decades. Due to the CDC guidelines, many chronic pain patients have been taken off pain meds without any form of relief. When this happens they have 3 choices. Live in AGONY, buy street drugs or chose to end the pain. The first choice unfortunately leads to the last as unbearable pain 24/7 is not living. The second choice often ends with people purchasing drugs laced with fentanyl causing an opioid overdose and death.
PAIN USED TO BE THE FIFTH VITAL SIGN. Why is it no longer considered important?
Thank you for your comments David. I’ve been in constant pain for almost 18 years and don’t know what else to try to help me. I refuse to think my desire to be rid of this pain somehow make me mentally ill. They just don’t get it, and because of that, I’ll probably be forced to jump off a bridge in 2 to 3 years. I just have to summon the courage to make it happen
I wish I could just die nothing to live for never has been
Let people make their own goddamn decision it is their life we are not fucking cattle
I’ve been in constant pain for close to 18 years. There’s a part of me always thinking about it.
My body is falling apart and am in constant pain. Have prayed about this daily, no answer. I am 70 and a veteran, served 6 years infantry. I have tried to get help from the V.A. but no luck there as I was declined for no reason. I was medically retired for back trouble and have gone too many nights without sleep. At this point in my life I am a lot closer to the grave than ever. I just want it to end.
Please don’t give up I know how much pain depletes joy I’m so sorry you are feeling so sad but your life is so important to lots of people you haven’t even met yet at least give it another 24 hours and try reaching out and sharing how badly your feeling with your family and friends. I care about you I can tell u are a good person we can wait it out together I also am struggling!
Hello Sir! I will happily call you Sir and thank you for your sacrificial service!!! My mom is a veteran as well (Army Reserves) and she taught me to respect those who serve. I see the word “veteran” and I have compassion on them and am thankful to be able to talk or message someone like them. Even though there is that trauma that can happen when enlisted (and after) there is still more of a triumph I’d say in knowing the facts. Yes you have battle wounds, yet you still have the fight! Blessings to you.