It's Suicide Prevention Month, and I HAVE THOUGHTS.

An essay on mental health and what it feels like (to me) to feel .

If the title of the post didn’t clue you in, please consider this a content/trigger warning about the content of this essay, which will cover suicidal ideation. Take care of yourself while reading; if you need to skip this one, that’s good, too!

Secondly, as I mentioned last week, I’ll be moving more extended essays, like this one, to a paid subscriber tier. This piece, as well as one essay per month, will remain free.

Most pieces won’t be this serious, but it will be more personal work than my usual weekly post. Thanks for reading!

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Thanks, I hate it

The first time I wanted to die, I was eight years old. I wrote it in an old-school diary that had a little lock and key and a shiny white cover with holographic hearts. I don’t know what incited such despair, just that in loopy, sloppy handwriting, little me wrote that she didn’t want to be alive anymore.

The first time I told someone that I wanted to die, I was 13, and I told my youth group leader at church. She told me that I didn’t have anything to be sad about: my parents loved me (true), I had food/water/shelter (true), and other people had harder lives. After praying for me and reminding me of the biggest blessing of all — God’s love — she sent me on my way with a reminder not to be dramatic.

After my failed cry for help, I devised an elaborate plan to steal money so I could buy a gun. The next entry was apologizing to Jesus for daring to think about stealing and begging for forgiveness.

That should tell you everything you need to know about me — what a journey! Forget the fact that I do not want to exist anymore — please, Jesus, forgive me for my imaginary thievery! I do have anxiety and religious trauma, thank you for asking.

The first time I tried to die, I was 21, and in a stage of life that I didn’t see a way out of. Then, I told a therapist who answered my call on my HMO’s crisis line. I chose to call instead of going to the hospital because I’d invited people over for dinner and it was too late to cancel. I made some delicious chicken enchiladas while explaining to a kind woman that I didn’t want to be alive anymore. I promised her I would hang on until Monday when I could see her in person. Her name is Sharon, and I credit her with saving my life and giving me the tools to keep saving it.

It’s hard to talk about what it’s like to have chronic suicidal ideation and about suicide in general. As a rule, I’ve found that the best way to bring a room down is to tell everyone you wish you weren’t in it. It’s not the kind of comment I want to make over dinner or at happy hour.

I first felt less alone about this particular struggle when I read Anna Borges’ piece, “I am not always very attached to being alive.” It begins:

“I wish there was a nicer way to say this, but I don’t always want to be alive. Right now, I don’t actively want to kill myself — I don’t have a plan, I don’t check the majority of the boxes on lists of warning signs of suicide, I have a life I enjoy and I’m curious about the future — but the fact remains, I don’t always feel strongly about being alive and sometimes, on particularly bad days, I truly want to die.”

I was at the doctor for a check-up recently and I had to fill out a routine mental health questionnaire called the PHQ-9. Everyone does. I could fill one in with my eyes closed by now — it’s a series of questions about if you’ve been depressed/hopeless/anxious over two weeks. When I filled mine out most recently, my scores were high (BAD) and we had a conversation about mental health.

After I reassured her that I was aware that I was struggling and that I had support in place (a therapist, medication, a strong support system), my doctor said, “The thing that’s hard about patients like you is that you seem normal.”

I don’t know if I’d say I appear normal, but I knew what she meant: I’m happily married, I’ve been in the same career for nearly 20 years, I have close relationships, and I make jokes and laugh a lot. I don’t present as a sad person, and I don’t seem like the traditional “depressed” person.

I loathe the lists of warning signs that circulate during these sorts of awareness months. The lists are reductive and repetitive: the person seems sad, they are giving away their possessions, they experience crying jags, they are withdrawn. As a person who is exceptionally good at faking it, considers throwing things away a religious experience at all times of life, cries both easily and not at all depending on the circumstance, and is introverted, using these signs as a traditional “suicide watch” would be the most confusing experiment ever.

People who struggle with mental health are not a monolith.

A few years ago, I did esketamine treatments for chronic depression. I was seeing a new psychiatrist who saw me pretending that I was 😀 JUST FINE 😀, looked me square in the eye, and said, “You’re working really, really hard to even want to be alive, aren’t you?”

It was the first time someone had acknowledged something I’d never said out loud. She arranged for me to start esketamine treatment the week after. Esketamine is a treatment that has significant success for people with depression, even though it’s not exactly clear how it helps or why. Most people do a series of 12 treatments to “cure” their depression. I did 48 before I was finally considered to be a patient “in remission.” Not very normal.

I saw improvement slowly but steadily, but it took a long time for me to stop engaging in suicidal ideation. My therapist likened my experience to walking on a well-worn hiking trail: my brain would gravitate to those thoughts simply because they were familiar. Learning to think of different options and develop other coping strategies took practice.

It remains a practice.

The things that make up my practice are non-negotiable: sleep, sharing my true thoughts and feelings with Other Amy and a few trusted friends, moving my body, connections with others, working, writing, medication, therapy, and a solid routine that includes alone time. It took me a long time to learn that I need relationships with people who can and will be gentle with me if I need to cancel or reschedule because my brain isn’t thriving, that I need to write most days, and that as annoying as it is, moving my body nearly always makes me feel better.

What I find most challenging about being someone with this sort of brain chemistry is the shame I feel for having it. I feel like I should have evolved beyond this by now — I shouldn’t need therapy, meds, and the tools I use.

I was telling my beloved therapist about this feeling recently. Like me, she has worked in education for a long time, and she reminded me that when we find support that helps students, we don’t take it away once the student finds success. Instead, we give them continued access and expand and contract the intensity of the support depending on what they need at different times.

She gently reminded me that no shame is necessary for utilizing my tools.

Right now, I’m using them. I’m showing up for spin, I’m starting an esketamine tune-up soon, and I’m trying my best to stick to a routine that feels good to me. Most of all, I’m trying to be gentle with myself for needing it.

When I read posts about, I see the same things mentioned repeatedly: check on your “strong friends,” “it’s okay not to be okay,” and the importance of the news “not providing information about method” in case it gives someone an idea. I’m not saying that those things aren’t true, but I despise being “checked on,” platitudes about being “okay” make me want to vomit, and believe me, most people who are suicidal already know all of the methods and where to find new ones. Talking about suicide is more common than it’s ever been, yet research shows that suicide rates haven’t changed much. Removing the “stigma” about discussing suicide isn’t the key.

If I had to write a list of actual prevention methods or help for people who have suicidal ideation, it wouldn’t include any of those things. It would mostly be about developing ways to hold yourself up when the thoughts and urges return — and acknowledge that, for many of us, the feelings do return. And that we can build up tools to use, and recognize when we need to access them earlier than we have in the past, so we don’t fall as far.

My list would include therapy, even when things feel fine, so you have a third party to talk to. I feel lucky to have someone I consider the best therapist on earth. She is kind, thoughtful, and funny — she also challenges me to be honest about how I’m really doing. I always feel that she genuinely likes me (in my dreams, I am her favorite client, and she wishes we could be friends), which matters quite a bit when you’re being transparent about your struggles.

It would also include medication. Few things raise my hackles faster than reading posts that shame people for taking medication, suggesting natural remedies in lieu of pills, or urging people to avoid prescriptions because “doctors write them for everything these days.” If you needed glasses, would you resist? If you were ill, would you only use natural remedies?

In terms of what you can do for someone you love who is struggling, I would urge you to be less scared of screwing up. Foster a connection, even when they’re not “fun” to be around. Invite them to things, and keep inviting them, even when they say no. Instead of looking away when they tell you they’re having a hard time, listen — even when they’re telling you about feeling like they don’t want to be alive anymore. Don’t rush to judgment or insist that they be hospitalized — but also be aware of when they might need more help than you can provide. Mostly? Be there. Remind them that they’re loved and that they matter. Contradict the thoughts in their head that tell them they’re a burden.

Also? Let them be there for you. Don’t walk on eggshells. People who have struggled are capable of empathy and want to feel like they can care for you, too. Laugh with them. Help them bear the agony of being known by letting them know you, too.

To close, once again, Anna Borges:

I thought I wasn’t allowed to write about this until I made it to the mythical other side. You hear it all the time: When you write about a personal experience, especially one that is dark and unpalatable, you should be far, far removed from that time in your life to process it in writing. You should have a lesson, a realization, a moral, a triumph. An ending.

But I might want to die forever. That’s just how it is. But in the meantime, I need to talk about the treading. Do I hope that one day, I won’t feel like this? Of course

…

The ocean is nice sometimes. The sun comes out and the current calms, and I can find peace in the drifting. Maybe there isn’t hope of land in the distance; maybe sometimes there is. Maybe that’s not the point.

Perhaps what I’m looking for isn’t land at all, but other people out here with me. Trying, and treading, and learning to live in the water.

Isn’t that what we all want? People alongside us? Trying and treading. My dear friend Jess calls this “abiding with” people, and it’s such a beautiful phrase. Growing up in the church, I heard the word “abide” all the time, but I like Jess’s meaning better. To abide with someone means to sojourn with them, to remain a stable and fixed presence, to reside with them.

It doesn’t mean pulling them out of the water that Borges so beautifully uses as a metaphor; rather, it means being willing to get in the water and bob along, no matter the current.