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’m 48, and I’ve been thinking of suicide for almost 10 years, sometimes more than others. My life is a fucking disaster, I hate everything about it. I’ve never made an attempt it I have been close (gun in my mouth, hammer cocked). I haven’t gone through with it because I don’t want my daughter to have to deal with an experience like that. But it’s harder and harder to hang on in this cesspool a world, everyday. Sometimes I just wish the whole fucking world would just end. I need help, but can’t afford insurance, being a single parent.
It is in my right as the owner of my body and mind to rid this world of myself. With the separation of church and state, the government has no right to dictate whether or not I live or die. The pecking order is Me and then the government and not the other way around (for the people, by the people). The government has forgotten its place and needs to be replaced with The People! Let us put it to a vote and force the elected, yes, elected officials pass it or deny it. A few religious folks should not have the power to make feel like shit on a daily basis. Who are they? And, where in the bible does it say they are obligated to make me suffer? Why is it immoral for a doctor to allow a suicide? Who are you to tell me what’s in my best interest? Egocentric and disgusting elitist. The right to die should not be stopped because “you” think yourself to be better, more educated, and right. Sometimes self-loathing is justified. Who are you to tell me I am not a piece of shit? I own me. I know me. It is no one else’s decision and not to mention, more oxygen for good people that actually deserve to continue living. One less person in line at your favorite eatery.
I’m 56 and for 40+ years my life has been tormented by daily thoughts of suicide, i know by heart many different ways to do it but being a coward i have only tried a handful of times, my attempts have always been stopped, so my torment continues.
Hi Simon
Honestly, I don’t think of not being able to commit suicide as cowardice. It takes guts to even contemplate suicide. Most folks will never experience that. I have, and although I’m not sure I could ever follow through, I know I’m stronger than most, just for the feeling. Depression hurts. I have talked to a few people who admit they wish they had never been born. I fall under that. Some of us just want the torment in our minds to end.
I often wonder that. How must it feel not to think you want to die on a daily basis. I did the math and apparently “I want to die”, “I wish I were dead” and similar thoughts have crossed my mind more than a million times. People that have never suffered from depression could never even begin to understand how it feels to think you’d be better off dead more than 300 times a day.
Hi I’ve had those thoughts of wanting to end my own life I’ve acted out on this at three different times the doctor told me he don’t understand how I was able to pull through but here I am still sufferingand always going through these episodes I’m 51 now is there really any real help
Thank you for the positive impact your blog has on its readers’ lives.
Since February I’ve thought about killing my self everyday…. Several failed attempts, overdoses that increase each time…
Before February I was a very happy person with a lovely fiancé and daughter
Now I just feel pain everyday, I no longer work, I can’t look in the mirror anymore because I hate the way I look…. I was a successful model and now I’m sickened by my reflection
I want the pain to end and this all to be gone
I’m so sorry you have to endure. I too suffer from constant pain and numbness from Transverse Myelitis and think quite often about death and the relief it would bring. If you wish, what is your particular affliction.
I’m trying to work out a situation where my demise hurts my family as little as possible. All the best to you, and everyone of us
Hi Sandra,
It sucks so much to feel that way. I sometimes wish I had never been born. To me life seems pointless and endlessly forced. I force myself out of bed then can’t wait until I can go back to bed so I don’t have to live. I force myself to be and fake my need to be happy and well adjusted. I told my husband that my brain will never be the way it was even 10 years ago.
I hope you have some good days in between bad ones. <3