Mad In America
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Mad In America

Anatomy of a Suicide:

Stress and the Human Condition

By Sarah Knutson

I remember saying to my therapist that I must be doing something wrong. Life felt so hard. Why was I struggling so much? I would have given anything to fit in with the favored crowd — the commendable, worthwhile, socially entitled, who wear success like a loose garment, bedecked with grace and ease. Why couldn’t I just follow my dreams and the latest instructions from Oprah, Dr. Phil or Martha Stewart Living and pull prosperity casually, effortlessly out of my trendy, warm, chunky, soft-stretch, cable-knit beanie? (Like they presumably did.)

Wasn’t that the point of popular media, celebrity talk shows, and mainstream self-help?

For everyone in the know, this kind of flow is regarded as manifest destiny. For the rest of us, there are coping skills. Either way, respectable people do not lose their shit, not for a moment and certainly not for years or decades at a time.

A hard lesson for me to get in my suicidal journey was that my body was having none of this. I kept pointing to the beautiful tri-fold brochure that the culture said my life was supposed to look like. It was such a great message:

Bountiful living is free for the taking. Personalities, careers, and relationships can all look fabulous. All they need is a bit of shaping, conditioning, and polishing. My existence can be as readily manicured as cuticles and nails.

But my body kept pointing out my real experience. Incontrovertibly, the two didn’t match.

I did everything I could to get myself on board. I tried drugs, self-talk, journaling, yoga, mindfulness, all kinds of therapy and a zillion self-help strategies. Try as I might, my body refused to cooperate. The more I tried to convince her what was good for us, the more she dug in her heels. I would use the most esteemed positive self-talk. She would fart, burp, and break out in impetigo.

So I tried to up my ante. I prodded her, cajoled, manipulated, offered or withheld praise and treats, resorted to shame, blame and outright cruelty. Nothing worked.

In fact, it backfired. At some point, my body just got too upset. She started doing her own thing, whenever, wherever and however she felt like. No matter that my career, housing or finances would be ruined. Some imperceptible line had been crossed, and she slipped out of my reach. On those rare occasions that I could get a rise out of her, she refused to focus or calm down. Try as I might, I couldn’t bring her back.

That was my state three years ago, when I thought I would toss in the towel. It wasn’t my first visit to this realm, but it was probably the scariest and darkest.

We’ve come a long way since then, my body and me. It’s taken considerable study, reflection, and experience to give my body some credit. I now believe my body was a lot wiser than I suspected. I wish I had listened and started taking what she was trying to tell me seriously a lot sooner. I might not have had to sink so deep or stoop so low in so many areas of my life if only I had.

What My Body Wants Me to Tell You

My body doesn’t speak English. She speaks feelings. When she’s upset with me or my life, the language she speaks is stress.

1. Stress is a natural response to threat and overwhelm

The human body has a “surprisingly similar set of responses … to a broad array of stressors.” (Sapolsky, 2004, p. 8.) The same basic templates appear to be hard-wired in all of us — a sort of instinctive pre-programming — for when life gets too threatening or overwhelming. Thus, when certain thresholds are reached, corresponding survival defenses (mediated by the stress response) predictably emerge.

2. The stress response tells me what I care about

Like most modern humans, it’s not just physical survival that I’m concerned with. I want to survive socially, emotionally, and economically too (among other things). As a result, I don’t just activate the stress response when I’m being chased by a tiger. The range of concerns is much broader than that. According to Robert Sapolsky (2004), professor of biology and neurology at Stanford University and world-renowned stress researcher:

We activate the stress-response in anticipation of challenges, and typically those challenges are the purely psychological and social tumult that would make no sense to a zebra. (p. 9)

3. Stress is a response to things that matter

Stress is how my body tells me something matters. It may be tangible or intangible, physical or psychological, material or spiritual, cognitive or behavioral, personal or social, passive or active… Any or all of this (and more) can activate the stress response and its corresponding mental and physical impacts. Again here’s Sapolsky (2004) describing the stress response:

There is now an extraordinary amount of physiological, biochemical, and molecular information available as to how all sorts of intangibles in our lives can affect very real bodily events. These intangibles can include emotional turmoil, psychological characteristics, our position in society, and how our society treats people of that position. And they can influence medical issues such as whether cholesterol gums up our blood vessels or is safely cleared from the circulation, whether our fat cells stop listening to insulin and plunge us into diabetes, whether neurons in our brain will survive five minutes without oxygen during a cardiac arrest. (p. 5)

Thus, the stress response is every bit as complex and multi-dimensional as I am.

4. Stress is about protecting my future

Something does not have to be happening now to stress me out. As a survival strategy, the stress response is always trying to get a head start on trouble. Thus, my stress response thoughtfully alerts me whenever I’m afraid something could happen:

[T]he stress-response can be mobilized not only in response to physical or psychological insults, but also in expectation of them. It is this generality of the stress-response that is the most surprising-a physiological system activated not only by all sorts of physical disasters but by just thinking about them as well. (p. 7)

In other words, I don’t just stress about things that threaten my present survival. Continual uncertainty about future survival will do me in too.

That’s the normal human body.

I’m not saying anything new or radical here. I’m just stating the facts of life about the body I was born with. No chemical imbalance, pre-existing trauma, or genetic defects required. Just my human body, as engineered by evolution, operated according to the instructions encoded in normal human DNA.

So How Do I Get from There to Suicide?

In my own experience, wanting to die is a logical consequence of mounting physical and mental distress. The more overwhelmed I become, the less I am able to function and, as a result, the physical, emotional, and practical fallout progressively rises. Ultimately, this reaches intolerable, seemingly hopeless levels that lead me to want to end my life. Here’s a diagram from the first piece in this series (“The Sisyphus Cycle: How everyday stress leads to suicide”), if you want a quick review:

That’s all good and well, but no sane person is going to give up something as precious as their life for something trivial. So obviously a stress model of suicide requires a lot of stress. Where does all that stress come from?

The question was particularly troubling for me, given that for most of my life I’ve had it easy. My father was a pediatrician. My mother was a kindergarten teacher and stay-at-home mom. They both wanted kids and loved us dearly. They were hard-working, responsible, active in schools and community service. They attended all my athletic events, exposed me to culture, planned interesting and enriching family vacations. They paid for my college education and a significant chunk of graduate school. Time and again, they sacrificed their own needs to make sure my brother, sister and I had every advantage they could afford. In short, they were amazing role models as well as devoted, conscientious parents.

So why was I breaking down?

In my first couple decades of mental health treatment (late teens, twenties, early thirties), the providers I saw honed in on my family of origin. We spent countless sessions examining every possible way they could have been insensitive, overly sensitive, under-protective, over-protective. Obviously something had to have gone wrong.

During that time, I did a lot of blaming and shaming of anyone who affected my path. In retrospect, it is painful to see how desperate I was to find some excuse for the mess I had become and was making of my life.

Finally, in my late thirties, I gave in and accepted the “mental illness” diagnosis. Over the next decade, there were various and sundry incarnations, twelve DSM labels in all, for which I tried over 20 different drugs and many flavors of therapy.

Sadly, but not uncommonly, my downward progression was continual. By my late forties, I was ready to give myself up for lost and accept my “chronic” fate. I left practice as a therapist and owned my status as a “peer.” My decline continued from there, quite possibly because I finally had permission to act as lousy as I felt.

Somewhere along the way, however, the nickel started to drop. Peer status allowed me to have a lot of honest conversations (with both myself and others) that frankly I never could have had as a therapist. As a practicing professional, there simply was too much at stake on both sides of the couch (mandatory reporting, keeping up appearances, boundaries…).

In the peer community, however, I discovered two important things:

  1. How seemingly “normal” the “mentally ill” are when we feel comfortable and are just hanging out with each other
  2. How pervasive experiences of trauma, social injustice, or caring about this happening to others are in the peer mental health community.

Since most of us were getting little relief from the mental health system, I started wondering what happened to bodies in chronic stress. This led me to study the stress response, where I started making connections. Eventually, with a bit of popular science reading on stress physiology and some rudimentary self-observation, I began to make sense of my own mind and body, and how I was responding in the modern world.

The long and the short of it is that I no longer see myself as “mentally ill.” I also no longer need to jump out of my skin from chronic discomfort, regret for my past and fear for my future. What I think I’m up against is the human condition. The stress response is part of that. Like all things human, the stress response is mixed. In the right circumstances, it is a life-saving, life-enriching gift. In the wrong ones, it is a curse that can make my life a living hell.

My hope here is to shed light on how the latter happens and why, for me, it took a suicidal turn. In doing do, I’ll focus on two purely human common denominators:

  1. The normal stressors that everyone has to deal with
  2. The normal stress response that everyone is born with.

I’ll explain how, for me, these two entirely “normal” factors can interact and feed on each other. I’ll share how I believe this turned my essentially “normal” human body into an instrument of torture to the point where it seemed like ending my life was the only reasonable way out. No mental illness, extreme childhood trauma, bad chemistry or genes required. Just the garden variety human condition that all of us are up against every single day.

Before I go further here, however, I need to deal with a sensitive issue. In the process of writing this piece, I became acutely aware of an unpleasant social fact. In reality, all stress isn’t equal. Moreover, some stressors aren’t “normal.” Painfully, there are social misuses and abuses of power that create life-threatening levels of trauma for far too many of us in the modern world. The next piece in this series will address these “unnatural” stressors. Discussed there will be the devastating kinds of social dynamics where someone puts their thumb on the scale in massively predatory ways. It is there, perhaps above all else, that absent active intervention by others of conscience, the rational instinct to suicide becomes abundantly, tragically clear.

But that is then, and this is now. So up next:

The Human Condition

In my own experience, there is a lot going on, outside my control, that has to be reckoned with physically and mentally in this human endeavor of life on earth. Evolution itself tells me how precious, vulnerable, and precarious my existence on this planet actually is.

To be born in the first place, nature ordained a nine-month, specially-designed, comfort-padded, form-fitted, super-insulated, dynamically-adjusted, around-the-clock vigilantly-guarded period of incubation. Highly recommended, after leaving this refuge, are several more years of intensive care, nurturing, and schooling. Most commonly, this is offered by experienced intimates (called parents) who have already survived to maturity in my relevant environment.

In modern society, such mentoring is not only physical but also economic, emotional, intellectual, social, cultural, and spiritual. A logical implication of the need for such extensive care is that the human maturation process is complicated and labor-intensive for all concerned. A lot can and does go wrong.

But even if it all goes remarkably well, from the moment I am born there are a couple of grim realities:

Grim Realities

  1. Sooner or later, I will die.
  2. If I live long enough, there will surely be challenges, setbacks, and losses.
  3. Those I love are subject to these same terms and vulnerability.
  4. Nothing anyone can do can change these basic terms of existence.

This is the human condition.

Here is just a sampling of the kind of thing I’m talking about:

1. Challenges everyone has to face

In addition to the inherent conditions of existence, there is a boatload of expected stuff that no one else can do for me. Included in this are developmental mile markers, established for the culture I live in, as indicators of good and responsible living. Achieving these mile markers invariably requires some level of mastery on my part — both internal and environmental.

No matter how much others want to help me, in the end, it is up to me. I have to figure out, on my own, how to get the mind and body I was born with to comport with some accepted variant of the cultural ideal. If I fall short, then I fail to meet the cultural standard for full membership and perhaps even for full humanity. Even if I can hide my shortcomings, that doesn’t protect me from the pain. Everyone knows the standards, including me. I still know I’m failing even if you don’t.

2. Human needs that we all have

On some level, I’m aware that my most basic survival needs can’t really be protected. Disaster happens, both environmentally and socially. It’s the stuff that newspapers and bestsellers are full of. This awareness is hanging over me all the time. Even if I don’t experience this kind of tragedy directly, social learning ensures that I register what happens to others when tragedy strikes them.

3. Painful facts about society

I’m not saying everything is bad out there. But it’s clearly not all good either. Below are just a few examples of stuff that’s on my radar. Some of it I live with daily, other things affect people I know and love. Still other things I watch from a comfortable distance — grateful, for now, that it isn’t happening to anyone I know…

4. Questions no expert can answer

On top of all this, here comes the real kicker: No one actually has ‘the answers.’

Yeah, there are a lot of theories and philosophies. There is a lot of practical, social, and spiritual wisdom. Clearly, some approaches hold more promise than others. At the same time, on a concrete, measurable, scientific level, no one really knows. As a whole, for the human race, we still have more questions than answers about the stuff that really matters.

A Matter of When, Not If

When I think about it, that’s quite a list. And this is just the “normal” stress that everyone has to deal with. No childhood trauma, natural disasters, freak accidents, or untimely misfortunes.

The point is, there’s a lot to figure out. I am born into a world with few if any certainties. There is a lot going on — mentally, physically, socially, environmentally, existentially — that I have to reckon with. There are a lot of ways to get lost or trip up.

As a result, the probability is high that at some point I am going to get stuck. Somehow, some way, I am going to meet my match in life. A particular challenge is going to lodge itself squarely into the heart of my vulnerability and stop me cold. I will fail to achieve something important to me, or I will lose something or someone I feel like I can’t live without. The more I care, the more vulnerable I am. But, in the end, it’s more likely a matter of when, not if.

The Predictable Progression of Distress

To appreciate what happens next, it helps a lot to understand the Defense Cascade. I wrote about this extensively in a piece called “Traumatic Immobility: Depression as a Stress Response.” For the purposes of today’s discussion, the essentials are this:

The Defense Cascade is a survival framework that evolutionary researchers are exploring as an explanation for extreme states that many people experience. It outlines the progression of defensive strategies that human beings in distress tend to draw on as levels of threat and overwhelm increase (Shauer & Elbert, 2010). Most people have heard about these defenses and think of them in terms of Fight/ Flight/Freeze. But trauma researchers are now developing a more sophisticated model, called the Defense Cascade (graphic below).

To explain how these above defenses map onto suicide, I’m going to make my own chart:

There are three basic levels:

Level 1

A simple way to understand how stress affects me is like a car. Like putting my foot on the Gas Pedal, stress triggers the sympathetic system (Action Central), which responds by rapidly delivering power to the movement centers of my body (muscles, arms, legs). This allows me to amp up quickly, cover a lot of territory, and exert control over my environment in ways that I think will serve my interests.

This is what happens in Level 1. Essentially, I’m surprised, afraid, or excited, and the Gas turns on. After a brief pause to assess options (Attend/ Freeze), the active defenses (Fight/ Flight) kick into gear. At manageable levels of stress, the active defenses are largely adaptive. I notice an issue, examine my options, dodge what I can, face what I have to. Eventually, I escape or win.

HA!! Problem solved. Another notch in the belt.

But what if I’m in over my head? I’ve run my fastest, fought my hardest, but still can’t escape. I’m out of ideas, energy, and options. Nothing I know how to do is working. I have no idea how I got here and not a clue how to fix it.

Level 2

If the active defenses fail me, I proceed to Level 2 (Fright). This is a transitional stage that can go either way.

In these desperate circumstances, my body resorts to a desperate ploy. It slams on the Brake while the Gas is still blaring. This drops my heart rate and blood pressure to the floor and freezes me in my tracks. This “Fright” response buys me time when I’ve already played my best hand, and I don’t know what to do next.

The cost to me mentally and physically, however, is enormous. Because I’m scared, the Gas Pedal keeps revving my muscles full bore. But because of the Brake, I feel totally stuck. No matter how much I want to, I can’t get myself going. Every little movement takes tremendous effort.

The effect is torturous. I literally want to jump out of my skin. But I’m trapped in discomfort, fully aware, unable to move — with nothing to do but watch myself burn myself out working against myself.

However counter-productive this seems, it serves an important survival function. The Brake helps me stay put for safety purposes, even when I’m raring to go. To pick up on my car analogy, the Brake is what keeps me from blowing through a stoplight that I urgently wish wasn’t red.

If I were a rabbit in the wild, Fright might save my life. It’s basically the play-dead response that convinces the fox to put me down and go get a drink of water before making a meal of me. The moment the fox is out of sight, the Brake lifts. I Gas it out of there full bore back to my hole.

If I live in a socially responsive, community-oriented world, Fright has major advantages too. Instead of running around wreaking havoc in a terrified, agitated state, Fright basically holds me harmless when I’m out of my league. My people find me, notice something is wrong, go to get help. They care about me enough to listen to what is wrong. It’s hard to communicate at first and comes out pretty jumbled. But they stay with me and eventually we make sense of the threat together. We all learn something as a community about scary stuff we could be up against. Then everyone puts their heads together. We have the best of our collective knowledge at our disposal. We all learn from this and from each other. This raises everyone’s understanding and awareness and helps me to find a way out too.

In the process, we all get the lovely hormonal benefits of the Tend and Befriend response. Dopamine boosts our motivation and sense of purpose as we work together toward a shared goal. Oxytocin builds our sense of connection and belonging. It strengthens the bonds between us as we walk each other to safety.

Sadly, these days, that is probably not what happens. More likely, I am siloed off to treatment, where I am given antidepressant drugs and a class on coping skills — and then sent back to fight the same old battle I was losing before.

If that happens, there’s a good chance I get worse instead of better. That only stands to reason since my real problem (troubling real-life circumstances/ “stress”) is not being addressed. Plus, energy and resources are being siphoned off to deal with a new problem (“mental illness”) that I don’t actually have.

This explains why for me, all too often, seeking mental health treatment is counterproductive. I come away with fewer resources, not more, to deal with the real-life issues that I went (or was sent) to get professional “help” with. Tragically, if I’m already at Level 2 when this happens, I don’t have any energy or resources to spare. The added weight of “treatment” pulls me under instead of pulling me out.

So I proceed to Level 3.

Level 3

At Level 3 (Flag/Faint), it’s really clear I’m going to lose. I’m out of energy and options. There’s nothing left to do but give up. In Flag, I’m still aware enough to make a conscious surrender. It’s like sitting in my car with the engine running, waiting for the traffic cop to decide my fate. Faint is the literal loss of consciousness. Either I ran out of Gas or someone switched off the ignition.

The lesson from Flag and Faint is that the stress response is tremendously powerful. At extreme levels of stress, people can literally lose consciousness because their brains can’t get enough energy to function.

The Giant Sucking Sound

Chronic stress adds insult to injury. The experience, for me, is like a giant sucking sound. It actually feels like my life energy is hemorrhaging — as if there’s a hole in my being that is being extracted by some nefarious cosmic force.

It took me a long time to realize how close to true this actually is. Stress puts me in a continual high idle and makes it hard to turn that off. From a survival standpoint, there’s a good reason for this. If I’m in the wild or at war with the Huns, I don’t want to let down my guard until I know the danger has passed.

The problem with the Gas Pedal system, however, is that it is only optimal for life-and-death physical challenges that can be expected to be over in about 30 to 60 minutes. After that, my body starts to break down (Sapolsky, 2004, pp. 83–86). You can begin to imagine the toll this takes when a major life problem has no fast or clear resolution.

To really drive this point home, I need to paint the picture in full relief. My Gas Pedal system basically runs on borrowed energy. Like an evil banker, it withdraws massive amounts of energy from the shared pool that benefits my whole body and selectively diverts it to a privileged few. Effectively, it shuts down appetite and digestion, detoxification, immune functioning, and my basic capacity to rest, repair, and replenish myself. It revs up my muscles, putting them on continual hair-trigger alert, making me edgy, tense, and constitutionally incapable of feeling comfortable in my own skin. It rivets my attention on the stuff that’s scaring me, rendering me unable to focus on anything else. It leaves the part of my brain (pre-frontal cortex) that is capable of rational, creative, collaborative thinking totally under-resourced. That puts me at the mercy of habitual patterns (like addiction) and impulsive reactions (like hiding, running, or fighting). The game it plays — thanks to the effects of hormones like adrenalin — is all about power and control. Zero-sum, all-none. Winners, losers. My neck or yours.

It’s the perfect storm, really. With higher-order thinking almost totally offline, I’m pushed relentlessly for resolution. Somewhere deep inside me, the message is unmistakably clear:

Something is urgently wrong. Someone or something is going to go down. Quite possibly it will be me. Go, go, go, go.

This raises a really important question. If digestion is off (among other things), how does the Gas Pedal system keep going for years on end? Where does the energy come from?

Basically, two places:

  1. Brief dips in stress, where digestion kicks in and I wolf down copious quantities of calories. Most likely, they come from sugar and comfort foods that are nutritionally poor but help me keep going, physically or emotionally.
  2. By breaking down my own tissues and using them for fuel.

In other words, the Gas Pedal system is a cannibal. The reason I feel like I’m being stalked and preyed upon is because I am.

The Gas Pedal system is sucking the life out of me in order to fuel itself. It is literally eating me alive from the inside out.

As you might imagine, the physical, mental, and moral depletion that results from trying to operate this way long-term can make it all but impossible to function. I miss things, lose time, or sleep 18 hours at a stretch. I start to boil water, forget about it, come back to a pot in flames. It is nearly impossible to concentrate or track reality, so I basically give up trying. There are months on end of just sitting around, praying that God will fix or kill me.

Coming Full Circle

If nothing changes, nothing changes. Absent active, effective intervention targeted to reversing stress, I tend to get stuck here. Under the influence of the Gas Pedal system, my physical and mental functioning progressively deteriorate. Bodily maintenance, repairs, and higher-order thinking stay mostly offline. As time goes on, mistakes are made, opportunities are missed, and resources diminish accordingly.

Consequently, the same level of effort gets me worse and worse returns. Yet trying harder just keeps burning me out and wearing me down even more. Rinse, repeat. Rinse, repeat. Rinse, repeat. It really is a hopeless cycle once I find myself stuck there.

Eventually, I can’t think my way out of a paper bag. My misery feels all-encompassing. Death is the only escape I can imagine.

This basically puts me back in the Sisyphus Cycle that I outlined at the beginning:

The Deadly Add-On Stress

For me, the mainstream insistence that life is easy (or would be if I were doing it right) is a deadly add-on stress. Due to mainstream denial, I don’t just feel overwhelmed. I feel crazy. Disconnected. Totally alone.

If I’m the deep and thoughtful type, who cares about being authentic and about authentic connection with others, the mainstream denial pretty much signs my death warrant. To all appearances, the things I’m dying to talk about make others acutely uncomfortable. No one else seems to value, or even acknowledge, the life issues that matter to me most and make my heart sing. On the contrary, the responses I get make me feel like a huge downer and social burden.

As a result, we have nothing in common to keep me here. The thing I care about most in life — honest human connection — is neither valued nor acknowledged by my relevant social world. Gradually, painfully, the realization dawns on me:

  • There is nothing I share with others that matters deeply to both of us.
  • There is no way I can make your life significantly better and still be me.
  • There is no way you can make my life significantly better and still be you.

It’s not too big a leap from here to utter futility. Next thing you know, I’ve climbed the last rung on the Sisyphus ladder and bought a rope to hang from.

[ Don’t worry, I’m not going to leave you hanging. There’s three more installments in this series. Before it’s over, I hope we’ll be using that same noose to toss each other an enduring line. If you can’t afford to sit around waiting, there’s a growing community of us who are trying to figure out how to support each other to navigate this territory with dignity, conscience and absolutely no coercion. We hold telephone and online groups that are free and accessible, literally, from around the world. You can find out more here.]


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Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A., & Updegraff, J. A. (2000). Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychological review, 107(3), 411. Retrieved from

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Sarah Knutson

Sarah Knutson is an ex-lawyer, ex-therapist, survivor-activist. She is an organizer/ blogger for Peerly Human (, and the Wellness & Recovery Human Rights Campaign. Sarah organizes free, peer-run, peer-funded opportunities for ordinary people to offer, receive, share and experience the radically transformative power of unconditional personhood and our own authentic, vulnerable humanity.

Originally published at on December 25, 2019.



Mad in America’s mission is to serve as a catalyst for rethinking psychiatric care globally. We believe that the current drug-focused paradigm of care has failed our society, and that a more humane and science-based model of treatment is called for.

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Mad In America

Mad In America

Mad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States and around the world.