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.
I just can’t wait until it’s finally over. One way or the other – gone. And then in a very short while, it will be as though as I was never here at all. Out of this body, out of this ridiculous world, out out out.
I get it.
Same here, this whacked out world is pointless.
I have decided to give myself one last chance at being alive. If I can’t find anything that makes me happy within the next year, this will be it. I just can’t take being sad all the time any longer. I had an argument with my friends a while ago, they always treat me like sh*t, bail on me, do stuff without me, all that kind of stuff. When I told them I feel disrespected, they told me I am not worthy of being respected because I don’t have a wife and kids and still go to college. I’m so tired of being everyones punching bag, only called when they need help with something. I really tried so hard the last couple of month to improve my life, I overcame my anxiety and talked to people, I went outside everyday and even spoke to a girl. But for some reason, there is always a voice, telling me I’m not worth being happy and I constantly want to cut myself. In these moments, my breathing gets heavy, my knees and hands feel very weak and I want to cry but nothing happens.
Dear DeathRowCook,
It is good to hear that you have tried to improve. At least, that means that a part of you wants to fight. But your post makes me sad for you. What you feel is a completely natural response (IMO) to those fake ass bitch friends of yours not treating you like…well, a friend. You need new friends. And I totally get the no wife and kids thing (I don’t have any of that either). But don’t worry. The world is overpopulated anyway.
Don’t hurt yourself. That is not the right thing to do. If you were here in front of me, I would give you a giant hug and cook you dinner. Don’t give up. You can do this. Hold on.
We all share the same mentality and therefore wish every one of you could feel the love and understanding from each other. I love all of my fellow tormented extended family, even if we don’t know each other.
Does anyone know the prognosis for someone with chronic suicidal ideation? Do I get to look forward to having these thoughts forever? Do most of us never follow through?
I can go away, but that doesn’t mean it will. I actually don’t know the statistics and stuff, so please don’t lynch me. But I know it can go away because I had it, and I’m on a fast track away from it. It still pokes it’s head sometimes but I politely shove it the fuck back down to the deepest boiler rooms in Hell. Don’t give up hope and never follow through. You may feel useless now, but if you are dead, it will all have been for nothing. The world is better with you in it…unless you’re cruel to animals in which case you can fuck right off, politely.
We’re all going to dead someday and for the vast majority it’s all going to be for nothing. How would you know if the world would be a “better place” if anyone stayed or not?
Dear Bo,
Thanks for your reply. But that is not what I meant. If you give up now, you will never achieve any of the things you want – it can be family, career or something else. It doesn’t matter if you “make the world a better place” as long as you make it a better place for YOU.
Some people don’t want anything anymore exept to be in peaceful eternal nothingness.
I don’t believe that. If you want nothing in life and you basically don’t have a soul anymore – if nothing makes you feel good…or even less bad (for instance a movie, friends, daydreaming, sleeping), then why are you fighting to stay?? There is a part of you (albeit, possibly a very small part) that believes that your life can get better and wants to fight. And that is the part you should listen to.
Nina, (chuckling), I was feeling rather shitty and suicidal again and then I read your reply
to Sara , had a good laugh and snapped out of it for a moment, thanks.
Thank you for this article.
I find myself alone and in constant pain frequently. I’ve come to count on two senior rescue dogs I always have around. They make life worth living at least for now.