September is Suicide Prevention and Awareness Month

 September is Suicide Prevention and Awareness Month. Somehow, it’s fitting that this month also commemorates the anniversary of the 9/11 terrorist attacks; because, in discussing suicidal thoughts and ideation, I always use the illustration of the many individuals who tragically jumped from the World Trade Center towers to escape being burned alive when fires resulting from the plane crashes turned the interior of the buildings into an unbearable inferno. While in that case, the New York City medical examiner’s office officially classified those deaths as being caused by the attacks and not suicide, the reason nearly 50,000 people commit suicide in the United States each year isn’t much different than the reason these 9/11 attack victims jumped—the fire is just coming from the inside instead of the outside. No one who had gone to work that morning in the World Trade Center likely had any previous desire to jump out of the building, or, as a split-second decision forced their feet from a window ledge, felt that jumping was a “good” choice to make. They simply thought it was better than the alternative. Conditions and circumstances had changed so drastically for them in an instant, due to forces completely outside of their control and beyond their ability to change; they assessed that there was no hope for survival and chose the lesser of two evils. The main difference between this example and the vast majority of suicide victims is that while, in the case of the World Trade Center, victims were tragically correct in their assessment that there was truly no escape possible for them, the perceived impossibility of escape for those suffering from the mental, emotional, and spiritual fires of depression and anguish is merely an insidious and deadly illusion. Those suffering in a state of severe depression and anxiety also tend to inadvertently delude themselves into thinking that they cannot withstand the fire. In this way, similarities exist between those who follow through on suicidal ideation with an attempt, and those who struggle with substance use disorder, which, unless overcome by sustainable recovery, can ultimately end in a process of gradual and unintentional suicide of sorts by the victim. No one endeavors to become an addict; disordered use of substances results from reliance on them as a coping mechanism to numb or escape feelings and physical sensations resulting from trauma that are persistent and unbearable. The key difference here is in the physiological aspect of substance use disorder, which causes chemical changes to the brain over time and leaves victims vulnerable, if deprived of their coping mechanism, to both agonizing sensations of withdrawal and to facing the resurgence in awareness of the original trauma wound which spawned the disorder in the first place. The feeling or sensation is so uncomfortable and so unbearable that the person with substance use disorder will do absolutely anything (often manifesting in criminal behavior or acts of self-sabotage that seem inexplicable to outside observers) to make it go away. In a similar way, suicide often appears to make no sense to outside observers (how many rich and famous people who seemed to have had it all have ended their lives?); but, in the victim’s perspective, it was a choice that was seen as the only option for making the unbearable feeling or sensation go away. This is a conclusion that is come to in the victim’s mind sometimes suddenly, upon a traumatic loss of a loved one or a relationship, or sometimes gradually, the culmination of years of persistent sadness or hopelessness. Sometimes the catalyst is external—the basis of reality itself is undermined by sudden and drastic change of life circumstances causing grief and devastation that seems insurmountable; and sometimes it’s more internal—feelings of guilt, shame, regret, or unworthiness fatally undermine one’s sense of self to the point that the victim actually believes that the world would be better off without him or her. In either case, suicide is an act of desperation, of seeking relief from pain, which is perceived by the victim as an unbearable fire. For the suicidal person, it is only when that primal yet ultimately self-sabotaging instinct to escape the burning is overridden by some internal or external intervention, or the urge is at least delayed (sometimes the best one can seem to do is delay) that it is discovered that the flames may indeed be extremely uncomfortable; but they are not unbearable after all. Continuing to choose life, to choose hope, or to at least choose to believe in hope, sometimes only on a moment-by-moment basis, tends to open up doors that we did not even realize were there—doors that lead to cooler passages where we are not quite so engulfed in the flames, and perhaps even one that allows us, eventually, to escape the fire completely. The first step is always to seek help. This can be difficult for some, due to shame, stigma, and the fear of being judged by others. However, it’s OK and actually helpful to let the right kind of fear guide the decision to seek help in these circumstances. It’s natural for the threat of losing something valuable to inspire fear, and your life is extremely valuable--it’s more valuable than the opinions of other people. If you have experienced suicidal thoughts or ideation, whether or not this included planning or any attempt, it’s crucial to tell someone. The best place to start is often a peer support group, which offers a non-judgmental environment in which honesty is encouraged and pretending to be OK is not. Your pain is very real and your story matters. Your life is valuable. All of these are true, and peer support can help you discover the truth—and, that by choosing life and hope, moment by moment, discover that you may just be able to walk through fire.  Sarah DrummondDepression, Anxiety, and Suicidal Ideation Peer Support Group LeaderMalorie’s PlaceMaiden, NC