Mon, 12 Sep 2022
Suicidal; or, Postponement is not Prevention
Apparently, September is Suicide Prevention Awareness Month, so this is my contribution. A few notes to get started:
First—and the title likely implies this, but because clarity in communication is my love language—I want to lead off with a trigger and content warning. What follows is a frank discussion of suicidal ideation, depression, and both of these will be addressed with as much honesty and bluntness as I can manage. Do not read on if you are not in the right headspace to engage with such information; feel free to come back later, or not at all.
Second, this is not a cry for help; it is intended to raise awareness and hopefully provide a vulnerable glimpse into one experience (mine), which may or may not be representative of others' as well.
I've written about this subject before, but never in depth and usually as an example cited to inform other tangential discussions. When I have talked about suicide, I've gotten a number of messages of love and support, which I greatly appreciate. At the same time, and because I anticipate this post being heavier than usual (yes, even for me), I want to state right out of the gate that I'm not at any immediate risk. In fact, that's part of the reason I'm able to even write this at all. If I were at risk of suicide in this moment, the last thing I'd be doing is writing about it.
I’ve spent the better part of the last three months setting up systems, support networks, contingency plans, and the like to mitigate my risk in this area.
Third, if you or anyone you know is dealing with suicidal ideation or similar, know that there are resources available such as reaching out to 988 if in a moment of crisis, as well as other nonprofits and organizations that can be helpful such as an org started by a colleague and friend of mine called Keep Choosing Life.
Fourth, suicide is often (though not always) the ultimate result of a long period of sustained mental illness, anxiety, or depression that has gone unaddressed. Therapy saves lives. I am currently in therapy and I recommend this for literally everyone who has access, whether you’re struggling with acute mental health issues or not.
With this lengthy disclaimer out of the way, let’s get on with the show.
***
Suicide is something of a taboo. Many (maybe most) of us know someone who has been deeply affected by the issue—whether a friend or family member they know has taken their own life, or tried to; or maybe they know someone whose loved one did the same, etc.—but most of the stories we seem to hear about suicide are the extreme cases wherein someone actually went through with an attempt. If unsuccessful, they talk about how grateful they are their attempt failed or, if successful, we hear from a friend or family member talking about how much grief it caused to lose someone they cared about in such a manner.
Often, these stories are laden with value judgments and problematic victim blaming, but even when they aren't burdened by overt toxic messages, there's this ulterior undertone that you shouldn't kill yourself because either a) you don't really want to, and/or b) it's a selfish act that will harm your loved ones. Both of these may contain elements of truth to some degree (although, I vociferously object to the selfishness claim), but the problem insofar as I can see is that they skip to the end of the story, which is either a tragedy of succumbing to the darkness or a tale of triumphing over the darkness.
In either case, suicide is the climax of a much longer story. It's almost never a solution one takes up as a matter of first resort. It's the collapse of all support structures after, often, a lengthy battle to stay alive. A friend shared an Emile Cioran quote with me somewhat recently that said, "Only optimists [die by] suicide, optimists who no longer succeed at being optimists."
So while I'm sure there are edge cases, folks who die by suicide didn't get to that point overnight, generally speaking. I’ve written about this before. I am an optimist. I am also intimately, uncomfortably familiar with suicidality.
Because I can only speak for myself, that's what I will do. What follows is one person's unique experience and should not be construed as an attempt to paint all folks who encounter suicidal ideation with the same broad strokes.
That said, I'm sure there will be more than a few commonalities between my story and that of others (especially other Autistics), so it's probably safe to assume that mine is not the only story like this.
***
I wasn't always suicidal, but I have almost always been depressed. Growing up, I was drawn to melancholic music, books, and movies or tv shows. I found sad endings resonated more than happily ever after. In fact, I did and still do find it challenging to relate to happy people. I don't understand what chronic happiness could possibly look like. The lives of happy people look miserably alien to me.
Recently, I saw a friend asking the interwebs something to the effect of "What's your go-to song to improve your mood when you’re feeling down?" I reject the premise of the question.
There are no songs that can improve my mood in a depressive episode. There is nothing that can improve my mood when I'm in a depressive episode (save for running, but that’s for another post). When I'm in the throes of depression, the best I can hope for is to simulate connection in some way—because it's connection I crave, and the lack thereof that plunges me into depression.
So when I'm depressed, I need things with which I can connect, and I cannot connect with joyfulness, particularly in such moments. So for me, I don't seek out a song to improve my mood; I seek out songs that understand my mood and let me know I'm not the only one to have felt this way. Can you tell I'm a lot of fun at parties?
Joking aside, though, I remember my very first major depressive episode. It was incredibly scary. I didn't actively want to kill myself then, but the seeds of suicidality were planted even so.
It was the day of my cousin's wedding and it started out fine. I helped set up chairs and whatnot early in the day, but once the setup concluded, there wasn't much to do until the ceremony began so I just wandered around the grounds for a bit.
Throughout the day, I felt increasingly off, but not in a way I could possibly have put into words, and I barely even really noticed the slow shift itself because it was so gradual. But then, I looked down the road and saw a couple doing together what I was doing alone: wandering around, killing time. I didn't (and don't) know these people, but I could see in their body language that they were very happy and loved each other.
Two things happened simultaneously in that moment: first, I knew that I wanted a connection like that with someone; and second, I knew that was something I would never have; I was not capable.
I didn't understand where that second idea came from, but I deeply understood its perceived truth and I believed it. My chest imploded and became an emotional black hole. And this is something a lot of non-depressed people often seem to struggle to understand: I did not feel sad; I didn't feel. I was empty, hollow, void. I looked inside and there was nothing. Not only that, but the future seemed foreclosed, as though this crushing, all-consuming, vacuous singularity of unfeeling would be everlasting.
I struggled to sleep that night and, because mental health was not a concept I had any awareness of at the time, the only framework I had to navigate this episode was spiritual and religious. So I prayed. For hours, I begged the god I believed in at the time for this to end, for relief. I just wanted to feel again. I eventually fell asleep much, much later and I hoped that when I awoke in the morning I would see improvement.
I didn't. I felt the same way—at the same level of intensity—for at least three days. It took around two weeks before I felt “normal” again. I was also deeply ashamed at the time because I thought it demonstrated a moral failing on my part—as though I didn't trust Jesus enough and that's why I felt so lonely, isolated, and empty. So I hid the depression from everyone and wouldn't even let myself name it.
Over the years, things got considerably worse and I eventually opened up to a friend of mine. Even when I did finally open up, though, I couched it in an abundance of qualifying language, downplayed my experience, and hedged how I spoke about it because the shame ran so deep. At one point, toward the end of my disclosure, I said, "I'm not clinically depressed or anything, but I—
"Hold up," my friend interrupted me. "Maybe you are and maybe you aren't, but you should let a professional make that call."
It was the first time anyone had ever given me permission—indeed, the recommendation—to approach the idea that I might actually be experiencing an untreated and undiagnosed mental health condition and that maybe I wasn't just a failure, or worse, a malignant narcissist faking depression to get sympathy or manipulate people (which is a fear I've had before).
I didn't immediately begin seeking therapy, but there was an important shift in my thinking. I didn't rule therapy out as something "for people with real problems" in the way that I did before.
***
My first run-in with suicidal ideation was my first wake up call. I was in the midst of a depressive episode, feeling lonely as ever, isolated as ever, and utterly dead inside, unfeeling and terrified that this would be all I would experience forever.
I had just finished work for the day and was pedaling my bike home and I came to the only significant downhill stretch of the ride. Commuter traffic on the road was heavier than usual and a thought occurred to me: "If you time it right, a sharp left turn might just end all of this under the tires of the oncoming cars."
The thought brought with it the singular implied promise of relief through oblivion. If I'm not going to feel, and if I’m only going to feel bad when I do feel, I might as well not exist.
All of this went through my brain in a split second, and in the split second immediately following I realized what it was I was entertaining. I made it home without any rash decisions and resolved then that I would find a therapist.
In therapy, I got a diagnosis (Major Recurring Depressive Disorder) and began developing tools to mitigate these depressive episodes, with varying degrees of emotional success. At a minimum, though, therapy allowed me to assign a name to what I was experiencing and allowed me to see episodes coming in advance (most of the time), which greatly diminished the fear-factor and helplessness associated.
Mission accomplished, no? Suicide prevented, right? Well, no. Not really. I bought myself some time, but postponement is not prevention. With that borrowed time, I also came by a false sense of security, thinking that I was out of the woods. I was wrong, and I wrote about that realization here.
Since then, I’ve learned key information about myself that explains the way my brain does and doesn’t work, and reveals the limitations of the aforementioned tools. Namely, I have since learned I am Autistic.
Upon this discovery, I dove into as much information about Autism as I could get my hands on (and am constantly looking to learn more about my neurotype), which is kind of funny by itself, honestly. I saw someone take to Twitter a while back with something along the lines of "autism being an autistic person’s special interest is the most autistic thing ever." Very meta, indeed.
Special interests aside, I'm going to share a few things I’ve learned about my neurotype that have shed the beautiful light of context surrounding my history of suicidal thinking. The long and short is, suicidality is all too common amongst those who share my neurotype (or who are similarly neurodivergent). That’s the bad news. The good news is that maybe it’s possible to make changes, to avoid becoming a statistic.
First, however, I want to explain the trajectory of my thinking. I've already discussed a bit about some of the specific moments that were pretty monumental in terms of my mental health journey so I’m going to take a step back in specificity and talk more about the general trends at play.
***
For most of my adult life—even when I'm not actively contending with suicidal ideation—I've understood one thing with crystal clarity. For many, this will seem very grim, but for me, it's just a part of the realistic mental landscape, as intuitively logical and inevitable as solving for “X” where 2 + 2 = X. And what I've understood is this: barring an act of god, such as environmental catastrophe, unexpected terminal illness or pestilence, and assuming no act of human violence or freak accident, the most likely cause of my eventual death will be suicide.
As long as nothing does the job for me, I've known for a long time that I will die by my own hand, and almost certainly before the age of forty. That is, unless something fundamentally changes.
I know I don't actually want to take my own life, that there are many people and possibilities for which I would like to remain alive, that suicide would traumatize my loved ones, and that I would be missed. Here's the thing, though: it's incredibly easy to forget all of that when all you’re capable of experiencing is the suffocating exhaustion of existing. In fact, at times, it is impossible to remember any of those things.
When there is absolutely no way of finding relief in waking life, suicide not only seems like a viable solution, it seems like the only option. I've heard suicide described by way of a particularly resonant analogy.
It's like being in an upper story of a tall building. The room is on fire and the door is blocked; you can either wait for the flames to consume you entirely or you can jump out the window and just get it over with. I cannot tell you how deeply I understand that. It's not that I want to die, it's that living is overwhelming and all hope of rescue appears vanishingly distant and improbable.
Okay, now that folks are probably thoroughly concerned for my mortal wellbeing, let's get into some explanations.
As I mentioned earlier, I am Autistic. Because I've lived nearly three decades in the dark about this, I feel like I am significantly behind the eight ball. One thing most (if not all) Autistics will understand is the concept of masking, especially those who identified their Autism as adults.
Masking is something that many groups do—not just Autistics—and there are a lot of facets to what masking is and how much each individual engages in masking behaviors. But at the core, masking is adopting a persona (or personas) that the masked individual uses to fulfill the social expectations of them—perceived or real—at a given moment or in a given group.
For me, this presents in a variety of different ways, but one obvious example is the matter of my personality. I mirror the behavior and speech of others, especially when I first meet them. And, as a general rule, once I've established the way I interact with someone, I cannot deviate from that without significant anxiety and stress. So those first few conversations are very important for me to establish what personality traits seem to be the best traits to adopt with that particular person.
One of the many problems with masking is that it's a desperate attempt to connect with people I don't understand. I'm terrified of social isolation and being ostracized so every part of my unconscious mind is geared toward averting as much risk of that outcome as possible.
Unfortunately, by not allowing myself to be myself, there are a few consequences that naturally follow: a) even if I am well liked, I can never know if someone likes me or my masks, b) I miss out on true connection because any connection I do manage is predicated on a version of myself that I think is expected and not the me that actually is, and c) I lose touch with who I actually am apart from my masks and struggle with identity. In addition to all of that, the energy expenditure required makes me vulnerable to Autistic burnout, which is what happened in spectacular fashion a few months ago.
Here’s one example of how everyday masking looks for me:
The salutation "How are you?" is often triggering for me. Every time I'm asked this, I have to run a specific calculus in the span of a few seconds. It usually follows a sequence like this: "How am I doing? Hmm. Not well right now, actually. But do they really want to know? Or are they just asking because it's the polite thing to do for some reason? If I tell them how I am, will it become uncomfortable? If it does become uncomfortable, will I be able to mitigate the discomfort so I'm not seen as weird or moody or that I'm oversharing? If they don't want to know, how can I answer without lying? If I say, 'I'm doing well', will they know I'm lying? Will I be able to sell it? And if I don't sell it and they can tell I'm lying, will they then think I don't trust them? Will they be hurt by my dishonesty? Which would be worse? The discomfort of honesty? Or the duplicity of lying?"
All of this (and often more, depending on the exact context) must occur in mere seconds because too lengthy a pause is also a problem and could single me out as socially inept. Nothing hurts more than answering honestly only to immediately realize they didn't actually want to know. Why the fuck would they ask if they didn't want to know? It's a social nicety that I will never understand and, no matter how many times I am asked, it takes the same amount of cognitive energy as every other time.
If you hear me say, "Hanging in there!" in response to "How are you?" that means, "I don't know if you actually want to know and I find lying to be immensely distasteful so I've decided to say something vaguely positive that isn't an outright lie, but the truth is I'm in bad shape right now."
Because of the differences between my Autistic brain and the brains of many neurotypicals, it is hard for me to find genuine connection. And when I do manage to feel connected, there's always the asterisk of whether it's me they connected with or if I am masking and that's why they like me.
***
All of this leads me to the statistics that prompted this post in the first place. I came across information that indicated the following:
Autistic adults are 9 times more likely to die by suicide than the general population, and Autistic children are 28 times more likely to contemplate suicide than their neurotypical peers. In addition, Autistic adults who do not also have an intellectual or learning disability are at shockingly (but not unsurprisingly) high risk of suicide, which this studyindicates is the second most leading cause of death amongst Autistics with comparatively low support needs. (Note: I don’t love the language used in the study, but the data itself was enlightening.)
When I read this, it resonated immediately. It’s difficult to describe the loneliness that comes with being an Autistic person in a neurotypical world, especially when you don’t know you’re Autistic. I have been lonely my entire life. I have many loved ones—family, friends, people I can come to in time of need, folks who are unequivocally in my corner when I’m in crisis, as well as folks for whom I would drop everything in the event they needed me. I still feel lonely. Virtually all the time.
This is due in large part to the fact that I am always trying to speak in the language of neurotypicals (and usually failing to do so with perfect fluency), but neurotypicals are seldom able or willing, as the case may be, to communicate with me on my natural wavelength. There’s a disconnect and, prior to being identified as Autistic, that disconnect was impossible to bridge.
This impossibility led to my resignation to the belief that I will die young, and by suicide, within the next decade because I simply cannot continue to exist like this. Now that I know I’m Autistic, I feel like I have a fighting chance at better understanding my needs and making informed choices about how I manage and mitigate the tendencies described above.
And while the statistics I’m citing to are in regards to Autistic individuals, these are trends that exist within many marginalized communities. Social exclusion or social disability put folks at uniquely elevated risk of taking their own lives. It’s not just a matter of inconvenience or feeling left out, it’s a matter of feeling like one’s existence is more trouble than it’s worth.
That’s the crux of why I'm writing this today: thus far, my suicide has not been prevented; it has been postponed. When I look into the theoretical future, I used to see only foreclosure. It has been very challenging for me—historically and contemporaneously—to visualize the possibility of a worthwhile future.
For arguably the first time in my adult life, though, I now believe the possibility of suicide prevention exists for me. It's going to require a lot of changes in how I choose to expend my mental, emotional, and cognitive energy, and in the process I fear I may learn exactly who likes me vs. who likes my masks.
Even so, I've not given up, and I’ll be damned if I do so before I’ve exhausted all other avenues. My whole life has been an invisible struggle to survive, and thus far I have succeeded in that endeavor. I've been given a beautiful gift: the idea that maybe there are solutions to that struggle, that maybe my future includes old age.
It's not enough to postpone suicide. Suicide prevention is not a one-and-done conversation. It cannot be relegated to a single month or day of the year. It's an indefinite commitment to the mental and emotional wellbeing of oneself and/or one's loved ones who are struggling. Suicide prevention cannot be accomplished in a day because suicide itself is a response to long-term suffering or unaddressed trauma.
If you're wading through the morass of suicidal ideation right now, I see you, I’m with you, and you can get the help you need. If you're not currently or have never been suicidal, I envy you. I had my "break glass in case of emergency" moment this year. I'm doing everything in my power to ensure I continue to exist. I truly want to, even while I sometimes forget.
And ideally, I'd like nothing more than to repair and restore my mind to such a degree that I can assist others in attempts to do the same.