A Recovery College Course on Living with Suicidal Thoughts

The Canadian Mental Health Association (CMHA) has a program called the Recovery College, and I will be volunteering there. See https://cmha.ca/what-we-do/national-programs/recovery-colleges/. In particular, in conjunction with CMHA employees and other volunteers who have experienced mental illness, I will be creating a course on living with chronic suicidal ideations.

I presently envisage the course having three segments.

The first will address the question of why having suicidal thoughts is so disturbing. In fact, this question sounded absurd to me when I myself was first confronted with it, posed as it was by a psychiatrist in the mental hospital. It rang as odd as “Why is intense pain so disturbing to you?” Indeed, at the time I found the thoughts of suicide so distressing that I preferred to die than to continue having them. Ultimately, though, I think the question calls for an answer beyond “The thoughts are per se awful”. Part of the answer, in my own case, is that having suicidal thoughts makes me feel pathological – mentally ill: “normal people”, or so it seemed to me, weren’t regularly bombarded by salient opportunities for killing themselves.

The second segment of the course would highlight a surprising fact, namely that having suicidal ideations is very common, and many, many people simply learn to cope with them. Just as some patients simply live with voices in their head, some people somehow live with thoughts of serious self-harm. How many people? We are doing some web-based research on the actual numbers right now, but I expect them to be high. Firstly, because my psychotherapist Dr. W estimated in a recent session with me that about 30% of her patients over 50 suffer from them chronically. Secondly, in my initial discussions of the topic with friends, a large portion who seem otherwise mentally fine have told me in confidence that the option of suicide occurs to them at least occasionally. One perfectly healthy friend told me, for example, that she had undergone an especially tough day dealing with her students and was struck, that afternoon, by the thought that if she leaped off the university bridge into the Thames River, she wouldn’t have to put up with the annoyance anymore. I was gob smacked. Another friend told me that she finds herself weirdly compelled to jump off subway platforms and apartment balconies. She’s very uncomfortable in either situation, though she’s otherwise “normal”.

I want to stress this fact because, given that there’s a taboo on talking about one’s own suicidal tendencies, the commonness is little known. And, as I say, knowing about it makes me feel more “normal”, less damaged. (We might include a segment on why the taboo exists. Is it simply shame? Is it that people don’t want to alarm their friends and family unnecessarily?)

The third and final segment would take on the issue of how to live with suicidal inclinations. I’ll want to include here my own recently discovered technique. As discussed in a recent blog post, I achieve an appropriate distance from the dark thoughts by:

– giving them a name, specifically ‘Sue’ for su-icide

– telling myself that they are invasive thoughts, coming from a malfunctioning part of my brain

– saying, as a mantra, that Sue does not reflect my overall values.

In brief, I recognize that the thoughts really are mine in a sense: it’s not as if someone else planted them in my head. But I also recognize that they don’t reflect my genuine self. Beyond my own, we will try to include other tips from patients living with suicidal thoughts.

If you, dear reader, have also found yourself having suicidal ideations and have been shy to talk about them, I’d be grateful to hear from you. Your correspondence will help, anonymously, with crafting the Recovery College course.

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.