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.
The entire world situation gets worse and worse and worse. That has heightened my chronic suicidal ideation. Some days it is almost unbearable. Anyone else experiencing that?
You are not alone. I feel this way constantly. The harsh cruel world we live in does not help hinder this pain and idea of escaping from earth. Do you find that anything helps soothe you, even if only temporarily?
Honestly, the only two things that help me are patting and loving on my dog who always loves me back and listening to a you tube video of the ocean – just the ocean and nothing else. It’s an 8 hour video so any time I turn it on it’s there and it never ends before I’m ready to stop listening. I don’t even look at the video, just listen to the audio.
Must tell you that reading your response was a godsend. Just knowing somebody else is in this space with me helps. People tell me to “just shut it off” or “there’s nothing you can do” but I don’t find those responses helpful.
You know what? I feel the same. And I find it harder and harder to ignore the political and social climate in the world. Sadly, there is no easy fix. What helps me is to imagine the world I want to live in and sort of just place myself in that fabricated scenario for a while. No one will ever know, because it is all inside my head.
Yes, I can relate to your suicidal ideation and world events making it worse
“She uses a metaphor of a train passing by: You can sit on a hill and watch the cars of the train pass, or..”
Me: “Or you can jump in front of the train”.
…or you can jump onto one of them and get carried away by it.”
Ah well I guess it’s not coincidence I’m reading this article.
Felix,
You make a great point: the idea of watching a train pass by might not be the best metaphor when someone has suicidal thoughts. I’ll have to consider that some more. Thanks for illuminating the problem so well!
I’ve been struggling with suicidal thoughts probably since I was around 12. My first serious attempt that hospitalized me (and almost killed me) was when I was 13. Due to that attempt, I ended up removed from the school I was going to and finishing school at home, which lead me to never experience what most other people have. It frustrates me so much to know how much I have missed out on and despite being a “smart” (I hate that term, all I did was memorize things) kid it never really lead to anything. So now I’m just a mess of a person, with so much reassurance growing up that I never got into any hobbies or learned any skills, and at this point I think there’s no reason to try to fix myself because the past already happened and changing that is the only way I would ever be happy today. I consider giving up every single night and I’ve given into that urge multiple times to no avail. I can only hope that one day it will work.
Dear Kyle, why fix yourself? You are already an amazing specimen! You are in so much pain and it sounds like you got messages throughout life that you now believe about yourself. Those messages or thoughts are not reality, they’re just thoughts! But as painful as they are, you can use them to motivate yourself. And stay with me here! If you died tomorrow, would there be one thing you wish you did? Like going swimming in a lake or the ocean? Not sure if you can drive, but could you spend 20 dollars on gas to see where you end up? How about petting one dog at an animal shelter? Or bringing flowers to a person who is unable to walk or talk? Or saying hello to 5 people you see? Just do one of those things though! At the end of the day, I think you might feel better about this day. Don’t think it will turn all your thoughts around! Thoughts are persistent buggers! It’s impossible to control them and people who think we can control thoughts are wrong! They’re just thoughts and if you just use today, a day you can see and feel, to feel something, you might feel better at the end of the day. If there’s one more thing you were thinking of wanting to do, you can do it tomorrow.
Thank you very much for this. It means a lot to me that you’re so understanding. I’m going to go for a bit of a drive. Have a nice day.
Gail,
What a kind, supportive, and realistic note. Thanks for helping someone out here and making a connection!
Kyle,
This kind of regret about the past is so painful. There’s a saying that you can’t change the past, but you can change your thoughts about the past. Which is great for people who are able to challenge their thoughts — to talk back to them with evidence that you’re looking at things in an all-or-nothing way, or overgeneralizing, or using some other cognitive distortion, and then making the thought more realistic. And if the thought is already free of distortion, then to address the problem it reflects — e.g., get therapy, practice gratitude for what you do have in your life (working eyeballs, feet, etc.).
These cognitive behavior therapy techniques are great if they work, and they often do, but they also often don’t. And when they don’t work, or if you want to skip them altogether, another path to try is, as Gail says, to cultivate an observing stance toward your thoughts and not regard them as facts and still do what you would like to do in life. That’s the essence of acceptance and commitment therapy.
If you’re open to a self-help book, I recommend the book Get Out of Your Mind and Into Your Life. It’s not a cure-all, but it could enlighten you to a new way of relating to your thoughts, based on Eastern meditation tenets of acceptance, observation, and ephemerality. Maybe try it? You never know!
Thanks for sharing here. I’m sorry you’ve gone through so much suffering, and I hope you experience a salve soon that doesn’t endanger your life. 🙂
i strongly disagree about the changing thoughts about the past thats part of the reason i have csi(chronic suicidal ideation) is my mother was an pharma opiod addict, now my gov puts safe cosumption sites which makes leaving the past buried impossible and my sense of self value is permanently warped no matter what i do i feel no sense of self worth or value and i always mess everything up whether intentionally or not
I see other people talking about their situation, so I wanted to leave mine here as well. I get a lot of demeaning advice because I’m only 17, especially because my problems just sound like I’m having teen angst, but it makes me feel a bit better (if not a bit frustrated at the possibility of my situation being the same when I’m older) that other people of all genders and ages experience this loneliness and “backed into a corner” sensation that I do. I hate hearing about other people’s high school experiences or crazy parties or dumb mistakes for the very simple reason that I never got to experience any of that. I am unbelievably inexperienced in absolutely everything that feels required of an adult.
I’m now realizing how insignificant that is.
Maybe not.
I don’t know.
I feel the need to justify every sentence because I’m still technically a dumb teenager. As if I need to prove that I’m not like the other teenagers. That’s just the effects of stigma, I guess. I’m going to stop typing here before I start retelling my entire life story.
Thank you to the random stranger that took the time to read this. I will post this despite my hesitation in the hopes that maybe it will make someone feel a little bit better about their situation.
Hello, I would like to start off by saying you’re not dumb.There may be things you did not experience , however you are young and time is on your side. Figure out what you enjoy, try new things.You will find your way, you deserve a wonderful life. You have a God given purpose, ask and it shall be revealed to you.
Hayden,
What painful self-talk your mind is subjecting you to! Not only your mind, it sounds like — maybe others have imparted these same, denigrating messages to you (“dumb teenager,” “insignificant,” etc.), and you’ve internalized them? And if your mind came up with them all on its own, that’s not surprising, either. I sometimes think evolution accounts for the way our minds turn against us — people who didn’t doubt themselves and were overconfident were more likely to get eaten by a predator, way back when.
The reality is, being a teen doesn’t make you dumb. I’ve met some teens with more wisdom than the adults I know. Age is a measure of years, not of intelligence.
Another reality: Things change. Whatever dislike you have now for your life and yourself, whatever deficits of information you experience, those can change. (I would add, though, that you’re not expected to know how to do everything required of an adult when you’re 17. Heck, I’m still trying to figure it all out, and I was born in the previous millennium.) It might help you to envision all the selves you’ve yet to become — adult, career person, husband, etc.
One more thing to consider: Have you gotten help? Negative self-talk, pessimism, and low self-worth often are symptoms of depression. I’m not diagnosing you, of course — I couldn’t diagnose a stranger based on one comment on the Internet — but it is something worth exploring. Treatment is available for depression but also for less severe conditions.
Thanks for sharing here — and for actually going through with posting. I do think it helps others to recognize they’re not alone in the way they feel.
Hayden, nothing about your post said “dumb teen”. I basically skimmed over all the comments, and yours got me. I didn’t get a normal high school experience either. Yes there’s an emptiness, but I’ve let it go…it was 35 years ago. I basically wanted to say your not alone. I do have chronic suicidal thoughts, major depression, im alone but do have a dog…and a gun. It’s easy to let the dog loose and eat my gun, I won’t kill him just myself. Something keeps me going and it can’t be explained. Id like to talk with you, and everyone else with the same issues but that rarely happens as most communications on this matter are posted instead of live chat. Anyway im rambling, cant think straight, been severely depressed all day yesterday and into this morning. Suicidal thoughts brought me here to try and help others in need. I hope you got something from your quest for answers. Take care my son and don’t be um…spontaneous. Stay stable and you will make it
I have suicidal thoughts a lot again lately. One would think, I have nothing to complain about. Good job, lots of money to spend, working out, hobbies etc.
However, I feel incredibly lonely. I’m 24 and have never been in a relationship, I don’t even know a girl, like at all. Not a single woman in my life. I feel so isolated, somedays not even human anymore. Everyone just says: “Keep working on yourself bro”, “keep focusing on yourself and all the girls will throw themselves at you” but I start to doubt that be the case. Not going out to bars and participate in senseless drinking in hopes to find a partner is social suicide. My biggest fear is that someday I’ll find a girlfriend and she already had a bunch of boyfriends. The idea of “picking up what’s left” is what drives me insane the most. She will have had all the fun in the world and I’ll just be the one she settles for because she knows I won’t find anyone else. Every time I think about it my heart goes so fast, my breathing gets heavy and my chest hurts, a voice, somewhere in the back of my head suggests to end it, since there is no point in doing anything anymore. Somedays I can’t get out of bed for work because I wonder, why I try so hard. There is no reason to. The last couple of weeks I barely slept beyond four hours a day.
Bruh. I get you. I am in the same situation. Except I’m a girl and I’m 27 years old. I am sure our situations are a little bit different, but overall the same. My brother just had a baby, and that somehow makes me feel even more lonely. I keep wanting to end things, but I don’t want to just give up. I will not let the hardship defeat me. I keep reminding myself that as long as I’m breathing, I am winning. If you want hmu, and we can talk. You can find me on Messenger.
Hello Nina,
thank you for your reply. Sorry that I’m only now writing a response. I usually don’t look into my mails, since it’s usually filled with ads and what not.
Well, I guess, us being in similar situations makes us a little bit less lonely by default. I’m glad to hear that you have the strength to carry on. Sadly I don’t have any Social Media at all, only Telegram and Whatsapp. We can exchange contacts via E-Mail, if you’re still up to talk.