I have consistently evaluated my life to be worse than nonexistence over the years, something that medications and therapy haven’t fixed. This has made suicide tempting, but I have just as consistently found it out of the question. My choice is to live, but I’m demotivated and distracted from taking steps to improve my life by fantasies of finding out that I’m terminally ill. How can I let go of the unrealistic hope to die so I can focus on living?
I’m not going to try to help you make your life worth living; I assume that if therapy and medication don’t help, and you’ve also tried the other obvious things, there’s nothing I’m going to tell you that would help.
I have a short-term solution and a long-term solution.
Short term: A technique many anxious people find useful is setting aside ten to fifteen minutes each day as “worry time”, and when they try to worry at other times telling themselves firmly that they can worry about it during worry time. Do you think that would work for you? You can set aside a daily “fantasies of being terminally ill” time, and when you fantasize about other times, inform yourself firmly that you can fantasize about it at the designated time. It’s important to keep the promise to yourself to actually sit there and fantasize at the dedicated time: you have to trust yourself that you’re going to fantasize eventually, just not when it disrupts your work or other activities.
Long term: it sounds like you might be helped by radical acceptance. I really liked Tara Branch’s book Radical Acceptance (be warned, it’s very Western Buddhist, and if that’s not your thing you may not like it). But here’s a quick summary of it.
Many times, in life, we don’t want to face that we are in horrible situations we cannot change. A common, minor example of non-acceptance is many people’s attitudes towards traffic jams. We get angry at the traffic and honk. We rationalize to ourselves that we’re not going to be that late, probably the traffic will let up really soon now, even when we have no reason to believe it. We fret endlessly about when the traffic will stop. We fantasize about not being in traffic. In general, we make ourselves miserable.
None of those things have any effect on the traffic jam. You don’t actually have any control over the traffic jam, and getting angry or worrying won’t change anything. Pretending to yourself that the traffic jam is going to go away soon won’t change anything about the traffic jam.
I think something similar is happening with you. You are stuck in this awful, unchangeable situation: your life is not worth living, you don’t think your life is going to become worth living, and you can’t die. It’s natural for you to seek a way out, to want to pretend to yourself that the situation is not what it is. But no matter how hard you pretend, the situation is what it is.
It might seem easy and obvious to say that, but it’s genuinely really hard to internalize it. When you do, it can feel like a release of tension, or like something clicking into place. Often, there is grief: lack of radical acceptance is often caused by not wanting to grieve the awful, awful situation that you’re in. But it’s a purer, more unmixed sort of grief.
I’m a rationalist, and some of my friends in this situation like thinking about a poem called the Litany of Gendlin:
What is true is already so.
Owning up to it doesn’t make it worse.
Not being open about it doesn’t make it go away.
And because it’s true, it is what is there to be interacted with.
Anything untrue isn’t there to be lived.
People can stand what is true,
for they are already enduring it.
About that “there to be interacted with” — that’s a major benefit of radical acceptance. You can’t figure out a way to cope with something if you’re putting all your energy into pretending it doesn’t exist. Worrying or fantasizing or getting angry about the traffic jam hides from you the thing you can affect about the traffic jam: your own response to it. You can decide to turn on some music or a podcast you like and try to make this traffic jam as pleasant an experience as possible. And as long as you’re refusing to accept that the traffic will move at a crawl no matter how upset you are by it, you will make yourself miserable being angry or worrying.
Things that are real are things you can affect. You often cannot make changes in your life without fully and completely accepting the way that things are.
So that’s the acceptance part. An equally important element of radical acceptance is self-compassion.
Radical acceptance can seem harsh: the world is a cruel and horrible place, why did you ever expect anything different, stop whining about things being the way they’ve always been. But that’s not it at all. The world is the way that it is — and sometimes it’s awful. To make radical acceptance work, you have to be able to be kind to yourself, at least a little bit.
Because — the situation you’re in is awful! It is, definitionally, some of the worst misery a person can experience — misery that makes your life worse than death — and you have no realistic expectations of it being over soon. I’m so sorry. This is not a thing that should happen to anyone. And there is all kinds of pain on top of it: the loneliness of not having anyone you can share your feelings with, the fear of burdening other people, the dread and despair about the possibility that it will just keep going. It is brave of you to face the endless days and days and days of misery, and strong of you to keep going, and so so admirable that in the wake of all this you’re thinking not just about how to survive but about how to improve your life.
It’s totally normal to go “that sounds fake but okay” when you read that paragraph, but I promise it’s true.
Imagine the way you’d feel if someone else told you about your problems: the compassion, the sympathy, the understanding, even the pity and the horror. Can you conjure up those feelings for yourself, even a little bit?
It is hard to be kind to yourself, if you are the sort of person who wants to die. It can help to imagine talking to someone else about your problem. A close friend or loved one, perhaps. If you’re religious, you might imagine your deity. An author of a book you adored. A fictional character. A celebrity. Imagine telling them about your problem, and imagine what they would say to you.
If you can really, honestly, truly say to yourself “my life isn’t worth living, this is true, and it’s awful and I’m so sorry,” I expect you will have many fewer fantasies about wanting to die.