Suicidal ideation: Before the far end of the scale
Trigger Warning: Thoroughly discusses suicide
This is a theory based on my own personal experience as well as my experience as a therapist of people with suicidal ideation. This is not intended as medical advice or advice tailored to any individual.
If you’ve ever filled out paperwork to start mental health care services, you may have been asked if you have experienced or are experiencing suicidal ideation. In response, I usually hear “uhhhh…no?” This question is so important. It tells me how severe a client’s state of mind is. It tells me that the treatment plan must include routine monitoring of depressive symptoms. It gives me insight to the pain you must be in. This is how I explain it to my clients.
Think of suicidal ideation to suicidal intent as a scale. On the right end of the scale, we have what you see in movies - someone with a plan in place and the will and means to carry it out. This is suicidal intent. What we often don’t see are the left and middle parts of the scale portrayed - the numbness, the idea that this is what adulthood is like and you have to learn to tolerate it, and the intrusive thoughts. So how do people get to the far end? My clients often sit on the left and middle parts of the scale long enough to normalize their thoughts. Once those thoughts become part of their baseline emotional state, they can move on to having thoughts about a plan to end their suffering.
On the left side of the scale are the thoughts related to feeling overwhelmed by depressive symptoms. “I wish I was never born.” “I wish I just didn’t wake up.” “I wish I could just take a break from life.” Clients that regularly experience these thoughts often feel exhausted, unable to sleep at night, have little motivation, and feel emotionally dulled. This stage is where hope is waning and true joy may be challenging to see.
The middle of the scale includes intrusive thoughts like “what if I let this car hit me” or “what if my brakes malfunctioned and I drove off this bridge.” Some people have described these thoughts as intrusive, coming out of nowhere and unwelcome. For those that daydream about these scenarios, they tend to take the responsibility of fate mostly out of their hands but still provide an out, which may feel relieving. These clients almost always tell me that they would never act on these thoughts. At this stage, I would expect every day activities to feel like a struggle - getting out of bed, hygiene practices, deciding what to eat. Many clients still push through the numbness and function, but are at least becoming aware of the dread that the thought of a new day may bring.
Finally, ideation turns to intention. A plan begins to form and the thought of it may bring temporary relief. Clients with low self esteem added in to the mix may also have thoughts about loved ones accepting this decision because “they would be better off without me.” The “what ifs” turn into finality. If this is you, there are options for help.
If you find yourself in any of these descriptions, now is the time to ask for help. Mental health care isn’t reserved for those at the right end of the scale. It’s for everyone. Reach out to someone today.
988 is the suicide and crisis hotline, available in English and Spanish, and open 24/7. Therapists can be found on a multitude of platforms - Psychology Today offers a database of mental health providers with a variety of filters to choose from. Open Path Collective offers low cost therapy, from $30-$70 or $80 for couples per session. If you’re a woman in Texas looking for virtual, private pay therapy, I have openings in my practice, Higher Ground Counseling. In a crisis where you’re considering ending your life, the nearest emergency room or crisis center can help.