The Shame of Suicidal Thoughts
The time we are stigmatized into silence is the time we most need to be heard
Trigger warning: suicide.
This piece is a personal exploration on the topic of suicidal ideation. If you are sensitive to this, please take care of yourself.
If you or someone you love is considering suicide, please call the National Suicide Prevention Lifeline at 1–800–273–8255. You are valuable, and your voice deserves to be heard.
I don’t want to die. I just want the pain to end.
The last time I had this thought is more recent than I care to admit, but the first time was eleven years ago.
The specific details like date, time of day, and even time of year are hazy. It was sometime between my college graduation in June of 2007 and my second neurosurgery in February of 2008.
I remember exactly where I was: on my bed, face-down, clutching my temples.
The physical and emotional pain were unbearable. I considered that only a few steps away was my medication drawer — yes, an entire drawer. Those with chronic illnesses can relate.
The drawer held a few different options, prescribed drugs that might kill me if I took a month’s worth at once. I could get up, open the drawer, and swallow the contents of one prescription bottle, maybe two for good measure. It would only take a second, then I would lay down and slowly fade away. Dying would be like falling asleep. The pain would be gone, and so would I.
For the first time in my life, I was comforted by the notion.
Death wasn’t terrifying. Being alive and suffering was.
I’d been living for over four years with an undiagnosed chronic pain disorder, an additional issue on top of the golf ball-sized pituitary tumor discovered two years before that in 2002.
An arrogant neuroendocrinologist, one of the supposed best in the nation who was managing my pituitary issues, assured me the pain was “completely unrelated” to the tumor. Her declaration set me on a four-year odyssey seeking answers, seeing dozens of doctors in a variety of specialties yet finding no relief.
Four to five times a day, sometimes over ten, my face and head would be seized with unimaginably sharp pain. The muscles at the back of my neck went taut like overtightened guitar strings. The pain squeezed the sides of my head like a vise, and it felt like someone was driving a spike into the left side of my face. The attacks lasted anywhere from thirty seconds to two minutes.
The pain could strike at random, but often it was preceded by a change in blood pressure: if I stood up too fast, if something startled me, or even if a strong gust of wind blew into my left ear.
During my sophomore year in college, less than a year into the attacks beginning, I became agoraphobic. Often, I was hit with an attack in public — in class, walking on the street, spending time with friends — and I would run off to hide myself and my pain.
It was ugly. My eyes slammed shut. My face contorted and turned red. Even with a hand over my mouth, I would elicit an involuntary squeal. I was ashamed of the attacks, as if they were a visible weakness. I didn’t want anyone to see me vulnerable and in pain.
“Hey, are you crying?” friends asked when I returned from the bathroom or wherever else I managed to hide.
“Allergies,” I’d groan, no matter the time of year.
Even when I sequestered myself to my dorm room, I couldn’t escape the attacks. They often came out of nowhere, and my threshold for being startled got lower and lower.
Anything could startle me. The sound of groaning pipes. A door shutting. A sudden crescendo of music in a movie, even if I had the volume on low. It didn’t help that I was majoring in film studies.
At the merciful end of each attack, the pain lingered for an hour or two. The dull ache was welcome. Anything was preferable to the intolerable sharpness.
Once the ache faded, the stage was set anew.
It’s impossible to escape an attack when the target and assailant are both you.
By 2007, I lost hope that I would ever find a cure. I tried what seemed like every possible medication — none alleviated the pain, and many carried side effects that compounded it, like low blood pressure.
I once heard depression defined as an inability to see the future.
I could see the future, but the problem was that all possible versions included tremendous pain. It was all I knew.
After the aforementioned attack in my bedroom, I clutched my temples and contemplated an end to that pain. For the first time, I wanted to do it.
It seemed like the best option.
In January of 2008, I saw a brand new neurosurgeon, after reading about how he pioneered a more efficient surgical approach to brain tumors. My first surgery in 2003 removed a portion of my tumor, but much remained.
I wanted to consider the possibility of a second surgery to debulk what was left. Even if the tumor had nothing to do with my pain, there were multiple other reasons to get more of it out of my head.
On a lark, I asked the surgeon if he thought my pain attacks were related to the mass.
“I think so,” he said, pointing to the MRI. “Right there, your tumor is hitting the trigeminal nerve. The pain you’re experiencing is consistent with that.”
Four years after the pain began, I had an answer.
On February 7th, 2008, I had my second surgery. The surgeon was able to successfully remove a large portion of the tumor, including the piece that was in contact with the trigeminal nerve.
Over the following months, with the help of a skilled pain management specialist recommended by the surgeon, my pain disappeared completely.
As in, it was resolved. Cured.
There aren’t adequate words to express this relief.
I was able to have a life again.
I wish I could say that was the end of my pain and I never had a suicidal thought again, but even before my chronic illness, I struggled with anxiety and depression.
They remained. The illness evolved.
After a few years of decent health with relatively little pain, I was struck by severe gastrointestinal issues in 2011 that appeared almost overnight.
It was another medical mystery, one that has never been fully solved, though I have learned to manage the symptoms.
In 2015, alongside the GI issues, I began experiencing chronic musculoskeletal pain. Soon after, I discovered that for the first time since diagnosis in 2002, my long-dormant tumor was growing.
It was a fun year.
The pain has been mostly controlled — luckily, I had the number for a good pain management specialist — but my health has declined with the tumor’s slow and steady advancement.
I’m scheduled for my third surgery in October, next month. I remain optimistic yet realistic about the chances of it improving my health.
Hanging on until surgery has honestly been a struggle.
Chronic illness refers to ongoing, oftentimes incurable conditions. They need constant management.
It can be like a never-ending game of Whack-a-Mole. You deal with one problem, and two more spring up.
For me, there’s been one issue that always lurks in the background and sometimes jumps forward, a mole that can be impossible to whack.
My current endocrinologist is the first clinician I’ve had who acknowledges and deeply cares about the inextricable link between mind and body.
At our first appointment two years ago, she asked me a question no other doctor had, save for therapists.
“You have a lot on your plate,” she said as a preface. “I must say you’re well-informed, and it seems like you’re on top of everything.”
It felt good to be recognized this way.
“May I ask, how are you feeling, emotionally?”
I hadn’t expected the question. After getting over the initial shock, I gave an honest answer. She listened.
The closest any other clinician had gotten to asking this question wasn’t in person. It was on one of the new patient checklists.
I have never once checked the box for “Yes” on that last one, since I often worried it would trigger alarm bells and a team of orderlies would arrive to take me away.
It was nice to have my endocrinologist, a human, ask about my mental health. She encourages me to discuss it at each appointment, whereas doctors in the past have immediately suggested I see a psychiatrist the moment I breathe a word about anxiety or depression. It’s out of their purview. They want to focus on their specialty.
It’s not surprising. The unwillingness of many clinicians to delve into the mind mirrors the preferences of society.
Anxiety, depression, and suicidal ideation are seen as personal flaws, matters to be dealt with on our own.
We’re told to suck it up, think positively, that it’s all in our heads.
It’s a vicious cycle. Mental health issues make us feel isolated. Instead of reaching out, we try to deal with it on our own, which can exacerbate the problem, further isolating us.
This is especially true about suicidal ideation, whether it’s just a fleeting thought or a calculated plan.
There are some problems in life, certain universal human experiences that cause psychological distress, and we are encouraged to express our emotions about them.
These ‘acceptable’ problems that are fine to discuss openly include loss of a loved one, the dissolution of a relationship, or issues with work.
These are fair conversational game. Many people feel comfortable discussing and listening.
There are, however, problems and experiences that are not openly explored.
These taboo topics are no more or less tragic, but honest discussion is less welcome.
These include sexual violence, miscarriage and abortion, addiction, and suicidal thoughts or attempts.
I’ve often wondered what makes these topics less acceptable, why a person or a loved one dealing with them is less inclined to speak up or ask for help.
I believe it’s because these experiences can carry a painful feeling: shame.
The ‘acceptable’ topics — deaths, breakups, job trouble — they happen to all of us, right?
The second group happen to so many of us, far more than we know because there’s a collective inclination towards silence.
Insidious thoughts can justify the silence.
People will judge me. They will think it was my fault. They will believe I’m a bad person.
The awful paradox is that we’re instinctively silent when the path to healing often includes the opposite: sharing our experiences and realizing that we’re not alone.
Speaking about these experiences can help normalize them, removing the stigma so many feel.
Those who consider or attempt to end their lives can feel isolated and alone, but the reality is that there are so many of us.
This worthwhile piece in Cosmopolitan foregrounds an enlightening and surprising statistic:
“For every person who dies by suicide each year, another 280 people think seriously about suicide but do not kill themselves. . .”
Let’s give that number further context.
Per the American Foundation for Suicide Prevention, each year 44,965 Americans die by suicide.
That means 12.6 million Americans seriously consider suicide every year — almost 4% of the entire population.
One out of every twenty-five people.
It’s difficult to imagine that every one of those 12.6 million people seeks and receives proper support, especially in a nation where 40% of adults with severe mental illness find themselves with no psychiatric care at all.
So what do most of us do? What did I do?
I stayed silent.
The first time I contemplated suicide in 2007, I didn’t tell anyone. I was ashamed. I felt like a failure because the thought had even crossed my mind.
Normal people don’t think about suicide, I told myself. On top of my chronic illness and pain, I felt even more isolated.
I needed to talk, to vent, to tell someone who would listen empathetically, but I was overcome with shame.
I am not ashamed anymore.
At the top of this piece, I said the last time I contemplated suicide is more recent than I care to admit.
I don’t care to admit it, but I will.
The last time I contemplated suicide was very recently. It was yesterday, September 9th, 2018 — the day before World Suicide Prevention Day.
My health hasn’t been good lately, and my recent suicidal ideation began last weekend. I was in Montreal at a friend’s wedding, feeling particularly terrible.
Before I ever gave serious thought to ending my life in 2007, I had experienced occasional obsessive suicidal thoughts.
They weren’t real considerations, but “What ifs…?”
What if I stepped in front of this bus?
What if I veered my car off the road?
What if I jumped out of that window?
Sometimes the thoughts arose at random. Other times they lingered, often when I was in pain — physical, mental, or both.
At the wedding in Montreal, the ceremony was held at the end of the historic Old Port, a high perch overlooking the St. Lawrence River.
My entire body ached. Waves of nausea rolled through my chest — I hadn’t been able to eat the entire day. Despite the pain in my body, my head felt like it was floating several feet above where I sat.
My seat happened to be two feet from the railing, the barrier between me and a sharp drop into the water.
What if I stood up and tossed myself over? It would only take a second.
It wasn’t a serious consideration. I didn’t want to die, let alone ruin what might be the happiest day in my friends’ lives.
Yet, I was troubled that the thought had even occurred to me.
I didn’t make it to the reception. When the ceremony was over, I quietly slipped away, splitting from the crowd as they walked towards the venue, sharing in the joy of the newlyweds.
I went back to my hotel room and passed out, exhausted from a day of ceaseless pain. I needed to rest.
I was doing what was best for me, but I was ashamed, like I had let down the bride and groom. Like I had let down myself.
With my third surgery approaching, my mood has been on a decline.
It’s not the surgery that’s getting me down. In fact, I’m excited for it, since my health improved significantly after the first two.
The lead-up to the surgery is the problem.
The neurosurgeon directed me to stop taking cabergoline, the drug that counteracts my tumor, for three months before surgery. I stopped in mid-July.
Without this medication, I feel awful.
I know it’s temporary, but every week without it is worse than the last.
I’m lethargic. My headaches have returned. Nausea is all-consuming. My moods are strange. Sometimes I’m suddenly enveloped in what feels like an impenetrable cloak of sadness, and I cry. Out of nowhere.
I have learned to cope with depression over the years, but this sadness is more sinister. The defenses I’ve built up — ways of combating depression like exercising, volunteer work, and gratitude inventories, actively reminding myself of all the blessings in my life — seem less effective.
The goal of stopping the cabergoline is to soften the tumor, but it has come at a cost. My slowly declining health seemed to take a sharp drop, not unlike the one into the St. Lawrence River.
When serious personal problems arose in the past week, everything began to feel unbearable and hopeless.
I didn’t want to die. I just wanted the pain, all of it, to end.
The constant aches. The full-body nausea. The sadness. The tension with people I love.
Yesterday, a person in my life who has lately been unapologetically insensitive blamed me for their behavior, saying that I “make it really hard to be empathetic.” Though I can be abrasive while ill, this simply was not true, and it was unfair to place that burden on me. I snapped.
I yelled. I cursed. I said hurtful things. I broke a chair.
Then when I was alone, I had that notion, stronger than I’ve had in a long time, more than a passing thought of leaping over a railing.
In that moment, the idea of nonexistence was not altogether bad.
I reached for my pills. I took just one, a benzodiazepine prescribed for anxiety, to help me calm down.
Though the thought was appealing, I knew it wasn’t the answer.
The storm of desolation and pain and suicidality passed. I allowed myself to feel the sadness rather than push it away. I reminded myself that life was not hopeless.
These days, I talk about these feelings when I have them. I am lucky to have a person, my dad, who listens and understands.
Regarding my actions, I am ashamed that I lost control. I am ashamed of saying hurtful things to a person I love. I am ashamed of breaking a chair.
I am not ashamed that I had thoughts of suicide.
Nobody should be, no matter the size and scope of your problems.
Seriously considering suicide will never be the ‘norm,’ but with it happening to one in twenty-five people, discussing it should be normalized. We should be able to share our experiences without fear of being judged.
If we can talk about it, then those of us who have dealt with it would know we’re not alone.
You’re not alone.
You’re not a bad person for having those thoughts.
You’re not a bad person if you have tried to end your life.
You’re here. You matter. I’m glad you’re alive.
I see you. I hope you see me, too.
We need to be seen. We need to be heard. We don’t need to be ashamed.
That shame might seem inevitable, but if we talk about our experiences, we take a step towards removing the stigma.
What we’ve been through can be isolating, which is all the more reason that we shouldn’t have to suffer in silence.
Tell your story. I will listen, and others will, too. Let your voice be heard.
We’re not alone. We’re still here.