Learning to Live with Suicidal Ideations

In my last post, I posed the question what’s “well enough” to leave the hospital. I said that a necessary condition was getting over my suicidal ideations. I wrote: “Until I can stand on a bridge without being aware of the opportunity it affords for suicide, I don’t think I’m ready.”

Yet, here I am at home, still having suicidal thoughts. What happened?

It turns out the medical team at the hospital were focused on a different question, namely, how much can they help? They concluded two weeks ago that I had benefited as much from hospital care as I was going to. In particular, they reasoned that medication adjustments were unlikely to take away the suicidal ideations altogether.

Now, the psychiatrist who broke this news to me asked what at first seemed a deeply puzzling question, viz., why was I so disturbed by suicidal thoughts? To me, that sounded like the question why I find pain distressing: both are things which are per se unpleasant. Surely, I thought, he must never have experienced a “suicide affordance” if he can ask why they are so unwelcome. Our conversation continued, however, and it emerged that there are thousands of people who have chronic suicidal ideations but who have learned to mentally distance themselves from those thoughts. Said the team, I’d have to learn to live with them as well, not letting them bother me so much. (How very Buddhist…)

My dear friend Gustavo noted that this is somewhat like game theorist John Nash, who famously suffered from schizophrenia his entire adult life. Nash wasn’t helped by medications. Instead, as he put it, he gradually began to intellectually reject the delusional lines of thinking. His voices didn’t go away; rather, he somehow managed to consciously resist them.

In the two weeks since I left hospital, I’ve been working on creating the requisite distance. My current technique has three steps. First, I identify the suicidal thought. I’ve given it the name ‘Sue’ for suicide. Second, I note that Sue is an intrusive thought, which comes to me unbidden and from a malfunctioning part of my brain. Third, I stress to myself that Sue fits ill with my overall values. Sue, in short, isn’t me.

It isn’t easy living with Sue, but maybe I can manage it.