Wed, 25 Jan 2023
Suicidal (Pt. II)
Note: This is a stand-alone piece, but is also a continuation and elaboration on topics discussed in a prior post. Additionally, and as the title likely implies, here’s a content warning for what will follow: discussion of suicide, self-harm, and depression. If you or someone you know is struggling with suicidal ideation, call or text 988 for support and find additional resources here.
***
Here’s a hard truth: I’ve looked into the past and seen the future. I’ve seen how things end for me—foggy and mutable, sure—but I see the source of my demise. If events follow their current, natural trajectory, the road I’m on only ends one way.
There are, of course, unpredictable elements, unknown unknowns. For all I know, a vengeful and vindictive god could decide to strike me down tomorrow. I could fatally succumb to some unforeseen pathogen next week. A few months from now, some careless motorist might lose control and steamroll me while I cross what I thought was a clear intersection. I could be a victim in yet another mass shooting, which seem to be America’s true pastime, baseball fans’ vain protestations notwithstanding.
The past cannot predict those eventualities, so I cannot speak to them. I can’t account for the chaotic and arbitrary whims of fate. Whatever will be will be when it comes to random happenstance. The past, however, reveals patterns. And patterns hold predictive power. Patterns imply something. Temporal patterns can only be seen in retrospect, but they always point in the direction of the prospective—that which is yet to be.
The better one understands a given pattern, the more accurately one can anticipate what comes next. I’ve looked at these patterns; I am, in fact, intimately familiar with these patterns. I also know that 2 + 2 = 4. One truth has been clear to me since I was about twenty-four or twenty-five years old, and it has only come more readily into focus over the past few weeks.
Unless something dramatically changes, I will die by suicide.
And unless that change happens soon, I will die by suicide within the next decade or less.
***
If you care about me, what follows will be upsetting. I won’t necessarily be communicating anything new, but—believe it or not—I most often include some kind of silver lining or caveats of an aspirational, hopeful bent. I will usually write about the grim, dark, and unsustainable reality of existing and include an undertone or overt statement to the effect of “but here’s why I haven’t completely given up hope!”
That will not be forthcoming here.
To be clear, I do not want to die by suicide; I don’t want to die that way any more than I want to get hit with a stray bullet as I’m fleeing a war zone. On the contrary, I’d like to live. I’d like to grow old. I’d like to live long enough to raise a family and watch that family grow up and do far better than I ever had the chance to.
This is not a question of desire or choice. This is a question of cause and effect. I’m up against the forces of demography and nature and those are not forces you can fight; those forces only respond to finesse, and I’m losing my ability to finesse day by day.
Cardiovascular failure is the leading cause of death for Autistic adults without learning disabilities. Take a wild guess at what comes next in that grim list.
Autistic adults without leaning disabilities are nine times more likely to die by suicide than our neurotypical peers. Our life expectancy is similarly grim, potentially as low as 36 years old. Compared with neurotypicals, Autistics are three times more likely to kill themselves, and potentially as much as ten times more likely.
Parsing through the incredulity of some of these studies and articles was maddening for me for a simple anecdotal reason: I have known for most of my adult life that I will die before I’m forty, and likely by my own hand. There are a variety of contributing factors here, obviously, but it’s really not all that complicated. I cannot continue to live in the way that I’m living.
And no, this is not a suicide note. This is not a cry for help. I have help. I have a great support network of loving friends and family, an affirming and supportive therapist, and colleagues at work who have my back in the same way that I would have theirs.
Rather, this is a frank exploration of a perspective on suicidality that I so rarely see. I’ve heard success stories from people who’ve been suicidal and survived and turned their lives around. I’ve heard tragedies from loved ones left behind after a successful suicide attempt. But my story is neither a success story nor a tragedy. Not yet.
Even though I’ve rarely (if ever) seen or read the perspective I’m about to share, I know I’m far from the first to view these subjects from this vantage point. I further know that someone out there has probably already shared something like this, and in all likelihood, they have probably done so more eloquently than I’m about to.
If nothing else, my hope is that maybe someone who is currently drowning in the way that I am might find this and feel seen. If I had read what follows when I was about ten years younger, I would have made significantly different, more sustainable decisions. I can’t go back and do anything differently myself, but maybe some other depressed and lonely kid out there will see this and get the opportunity to rethink their future.
Or maybe this will get me committed.
In either case, here we go.
***
Perhaps the most chilling thing about suicidality—insofar as my experience with it is concerned—is that when I’m not in the throes of active suicidal ideation, there’s a cold, cognitive understanding of how shit will go down. To wit, I know in broad strokes what triggers my suicidal impulses, I know what factors will also need to be present (or absent) to provide the opportunity and urge to make an attempt, and I know that if I make an attempt, it won’t fail.
I won’t use a blade. That would be far too messy, there’s too much that could go wrong, and I might not succeed. It would take too much time and I might change my mind in the middle, seeing reason at the worst possible moment, feeling compounded shame and horror at what I’m doing. Plus, a blade delivers the wrong kind of pain.
I won’t use drugs for a lot of the same reasons, but also because I don’t like when my mind is chemically altered in certain ways. I don’t want to risk nausea or similar bodily discomfort because, again, that’s the wrong kind of pain. Getting the right sorts of drugs in the right dosages would also require research and planning. If and when I die by suicide, it won’t be premeditated, but a response to stimuli.
I won’t use a gun, once again, for a lot of the same reasons, but primarily because I don’t want to get a fucking gun. I have never wanted a gun. I’ve never been interested in guns as a concept. And the loud noise by itself would be disincentive enough to keep that thing safely locked away.
No, if and when I die by suicide, it will be a fall. I will throw myself off of a point high enough—and onto a surface hard enough—to kill me on impact. Here’s why: it’s the right kind of pain followed by eternal oblivion (i.e. relief).
I’ve mentioned the “right” or “wrong” kinds of pain a few times now. This is important, and is one of the keys to understanding my suicidality.
***
As an Autistic person, I experience the world differently than most. In particular, sensory, cognitive, emotional, interoceptive, and executive functioning differences underlie the causal elements that will ultimately result in my death by suicide, assuming I cannot find a way to successfully navigate these differences. The world is set up in a way that is antithetical (at best) and hostile (at worst) to these differences.
The Autistic brain does not automatically filter data and prioritize a hierarchy of which datum should be given heed and which should be ignored. We must manually do this data filtration. It is fucking exhausting.
An easy example is being at a bar or a coffee shop. When I go to a bar with friends, I don’t get to tune out a single goddamn auditory component of the sensory experience. I hear everything around me all at once and without discrimination. I hear every conversation, every moving dish, every dropped fork, the song on the speakers, the traffic outside, everything. After an evening hanging out with friends at a bar, I have to spend hours in my room alone decompressing and unspooling before I have any hope of restful sleep.
Processing this sensory wildness takes massive cognitive energy, which is not limited to extracurriculars like a bar. I work in an office with an open floor plan. If I am to have any shot at actually doing work, I must control my auditory experience. I wear noise-cancelling headphones and play loud music that matches my level of stimulation or overstimulation. If I have to take a call, I remove my headphones and must put in earplugs designed for noise sensitivity before donning my computer’s headset. Without the earplugs, I cannot pay attention to the person on the other end, but will lose the plot amidst the half a dozen conversations happening all around me.
While at lunch, the cafeteria is a fucking nightmare hellscape of sensory overwhelm. Depending on the day, there will be tons of people, all talking, all at the same time. Various and sundry additional noises emanate from the kitchen to create a cacophonous orchestra of acoustic discord.
(I am fortunately in a hybrid role and do have the option to work from home a few days a week, which is lifesaving.)
In addition to overwhelm induced by the sights and sounds of chaotic, populous environments, I’m also desperately lonely. I’m never lonelier than when I am in a room full of people. I get a front row seat to everyone else chatting with one another, enjoying each other’s company, just connecting as humans. I’ve tried to join conversations before, but I don’t know how. I’ve done it successfully on occasion, but that only makes the miserable failures all the more perplexing and upsetting. Worse: I don’t know what differentiates a successful attempt at joining in versus an unsuccessful one; I don’t behave differently in either case.
So there’s the sensory element and the emotional element, but to pile onto those stimuli, my job requires a significant amount of executive functioning, which is draining on my cognitive energy reserves. It has high potential to become a negative feedback loop, making it harder to cope with any level of sensory or emotional overwhelm.
Then, when you layer on the interoceptive differences, shit gets really crazy. If you aren’t familiar, interoception is essentially one’s sense of what the body is telling the brain via somatic signals. These could be simple, primal necessities, like hunger or thirst, or they could be emotional cues, like “I’m angry” or “I’m anxious.”
Because the Autistic brain is wired differently, the way we experience these somatic stimuli differs significantly from neurotypical people (as well as from one another). I am not well attuned to my body’s interoceptive signals. Oh, I feel them just the same as anyone else. The problem is, there is no automatic understanding of what those feelings indicate.
A helpful oversimplification of this difference might be to say that neurotypicals feel their feelings, whereas Autistics cognitively process theirs.
For example, I will often feel hungry, but not know that’s what my body is trying to communicate until the hunger has reached a level of intensity bordering on crisis (i.e. “Feed me now or you will pass out!”). The same thing happens with sleep or thirst or even the need to go to the bathroom. Each of those is pretty basic and intuitive for most, but they aren’t for me. Now imagine a more complicated set of somatic sensations.
A challenge that arises from this insensitivity to the body’s attempts at clueing me in on what it needs is alexithymia (a difficulty or inability to identify or describe one’s emotions or those of others). If you ask me how I’m doing, I might legitimately have no fucking idea how to answer that question.
Okay, so put all of this together and imagine you’re me, in a busy grocery store let’s say, after a long day at work. You’re overwhelmed by the never-ending to do list (both personal and professional), exhausted by decision fatigue, overstimulated by all the chaos and shamelessly oblivious people around you. You’re feeling anxious because you’re overwhelmed, feeling depressed because you’re lonely, hopeless because the literal and metaphorical noise never fucking stops. All manner of disjointed and unidentifiable emotions swirl around inside you, unsettling and confusing somatic sensations as turbulent as the violence of a sea in a hurricane.
Now imagine you see someone who happens to be the object of a stupid, adolescence-part-two sort of crush and you feel all the feelings of being intrigued by and attracted to someone. You know that beat that your heart just skipped? Your body liked it, but your brain didn’t get the memo. Your brain was befuddled by that excited flutter. It thought that moment your heart leapt in your chest at the sight of your crush was not an anachronistic moment of postpubescent excitement but a sudden spike of anxiety.
Because your brain is already overwhelmed, you tip over the brink and now you’re on the verge of a meltdown (think panic attack if you’re not familiar with an Autistic meltdown). It’s also past what should have been dinnertime and you’re hungry but you forgot to eat enough food because you didn’t know you were hungry until you realized you didn’t have any food at home, which is why you’re even here in this grocery store in the first place. And because you’re hungry, you’re not thinking clearly in general so you spiral and suddenly feel like everyone can see right through you, and it feels like they all fucking hate what they see.
So you pay for your food as fast as is humanly possible and get the fuck out of there. Not for the first time do you fantasize about ending everything, but—quite ironically and fortunately for you—you’re far too deep in executive dysfunction to actualize any fantasies tonight.
***
If you’ve made it this far, I applaud your ability to parse the circuitous and meandering logic of this neurodivergent brain, but at this point, you may find yourself wondering, “What does any of that have to do with different ‘kinds of pain?’”
Great question.
I currently have one—and only one—reliable coping mechanism. In my toolbox of emotional regulation, there is currently only one tool that works well for me and is relatively safe. That tool is running.
For many, running is exercise. One runner might run because they want to go fast and win races. One runner might begrudgingly put in their mileage as a means to some other outcome. One runner might like the feeling of accomplishment or the buzz of that runner’s high. Others might find running meditative. Still others might simply like to strive for goals or cover a lot of ground on the trails or push themselves to their limits just to see what those limits might be.
Sometimes, the only thing runners have in common is that they run.
For me, running is a little of all those things, but isn’t fully any of them. Running, for me, is a release valve more than anything else.
I need a minimum of thirty miles every week to feel okay. And I do mean “okay” in every sense of the word. I’m not thriving on thirty miles a week; I’m surviving. And depending on what else is going on in my life, that might be totally fine. In periods of severe stress, anxiety, or depression, though, the mileage needs are higher.
Autistic folks often engage in what are called self-stimulatory behaviors, which is often colloquially known as “stimming.” Stimming can be virtually anything with a sensory component and, if you know what to look for, I engage in a wide variety of stims. But running, by far, is the most important. It’s also my favorite. The way an archetypal cishet male sitcom character from the 90’s feels about sex is the way I feel about running.
I don’t think I’m capable of experiencing more intense joy than when I’m running. It is difficult to even describe with words. I actually feel incredible pity for anyone who doesn’t experience running in the way that I do because it is fucking orgasmic, if you’ll forgive the crassness.
At least as importantly, though, running allows me to crack open a release valve on the compounded anxiety, depression, and overstimulation that builds up on a daily basis. The physical intensity and low-grade, achy muscular pain over a prolonged period of time (or shorter term, high levels of discomfort if I’m running up a hill or doing intervals), releases the pressure from my body and mind and allows me to approach the day with greater ease. I am better able to adapt to sensory, cognitive, and emotional overload when I’m able to get my daily run in.
Running is the right kind of pain. The dull ache of muscular fatigue, the straining of the lungs, the productive cardiovascular stress, and the activation of the endocannabinoid system all merge into this delightful stew of Zen-like balance, cathartic bliss, and complete equanimity.
Outside of running, there’s only one other “right kind of pain” that I know of: blunt force trauma.
***
Some of my fellow pattern seekers may already see where I’m going with this, but for those of you who aren’t sure, this is the part where I tie some things together.
Routinely, throughout my entire life, I have been subject to the whims of regular depressive episodes. I was initially diagnosed with recurring major depressive disorder because of these episodes. I’ve spent more than a decade trying to understand these episodes, but up until last year, I was operating on incomplete information.
Even without that information, though, I could identify the trigger of each episode. It’s always the same. Always. What’s not the same is the severity or the duration. I am beginning to understand that my level of overstimulation upon the onset of the aforementioned depressive trigger appears to be directly correlated to both the severity and duration. What’s more, my baseline of tolerance for stimulation gets seemingly weaker by the day because I cannot figure out how to fully recover after each episode.
Last year, while I was reeling from the worst episode I’d ever experienced, I went from running an average of thirty miles in a week, to running eighty miles in a week. I would be unable to sleep, so I’d run fourteen miles instead. I’d start to get panicky and run until I felt too tired and worn out sustain any level of somatic awareness of anxiety. I would experience a moment of brief reprieve from wanting to die and I would celebrate by running, the only thing that brought me joy.
And during that week, I understood something.
If I ever find myself in a depressive episode like the one I’m in now, I realized, and if I can’t run when that happens, my risk of suicide will more than just spike, it will skyrocket.
Without the ability to run during such an episode—where depression deprives me of all joy and becomes a black hole preventing me from seeing any worthwhile future beyond that event horizon and where anxiety inflates my body with infinitely expanding excess energy that has no outlet—the insidious promise of suicide will seem like the only way forward, the only way out.
Again, I don’t want to die by suicide. I probably won’t jump right to that. No, first I’d likely turn to self-harm. I might “fall” down the stairs. I might get a rubber hose and trim it so I could flagellate myself without leaving conspicuous marks. I might punch concrete walls and feel the anxiety drain from my mind, mingling with the blood from my broken knuckles.
Ultimately, though, none of that would be enough, and there would be too much shame loaded onto any of those outlets for me to openly partake in them the way I openly partake in running.
Where else to turn?
Well, if I were to throw myself off of a high enough bridge over a hard enough surface, the theory of gravity holds a simple promise. Physics tells me, “If you jump, you’ll feel the right kind of pain one last time; and then nothing forever after.” It is the promise of cracking the somatic release valve one last time, followed by nothing else ever again.
***
I’ve often seen or heard suicide described as selfish. It is not selfish. It is desperate. It’s the last gasp of a soul that has tried everything else it knows to try and has come up wanting. It is not a matter of first resort. Oh, I’m sure there are edge cases, but those are the proverbial exception proving the rule.
The truth is, suicide is more a response to stimuli than anything else. Those stimuli are going to vary from person to person, but at the end of the day, it’s a response, not a decision. The response may be calculated and well thought out, or it might be impulsive and unanticipated, but it’s a response all the same.
In the US, someone dies by suicide once every eleven minutes. I exist as a member of a group significantly more likely to die by suicide than the general population, statistically speaking. Additionally, several of the common comorbidities that make suicide more likely for anyone (whether Autistic or not) are currently present in my life: I’m in a major depressive episode, continuously busy, feeling stressed at work, desperately lonely and isolated, and the coup de grâce?
I am currently unable to run.
***
Thu, 16 Feb 2023
Well, I’m glad I began writing this piece when I did. As of this week, I’m beginning to feel better. That’s a good thing, right? Feeling better? While I’ll admit that, yes, it’s more pleasant, it is not necessarily a good thing. Sure, I may be feeling better, but I am not better. The same underlying conditions and risk factors are unchanged and, as has happened every time since my first depressive episode, I don’t go back to “normal” when I start feeling better. I resume life, find more emotional stability, but my baseline continues to deteriorate. My definition of feeling “good” gets darker after each episode.
Additionally, the more time that elapses, the less real and serious the mortal risk posed to me appears. I start to think I’m better. I start to feel like the worst is behind me. I start to even gaslight myself into thinking it wasn’t actually that bad, or that I was overreacting, or (when I’m in a particularly self-deprecating and ungenerous state of mind) that I was “faking it” for some reason. I lose the sense of urgency and stop pursuing solutions.
And then the next episode hits me like a semi truck, worse than ever, and I am reminded that I effectively have a terminal illness.
It’s a strange and unsettling thing to not feel safe in one’s own brain. I’ve begun to measure my emotional status in the way that a worksite might measure days without an accident: “It has been 10 0 days since Jesse has fantasized about dying.”
I’m being tongue in cheek here, of course, but I recently had virtually that exact thought pop into my head organically and unironically. As I was winding down for bed on the first day I started to feel okay-ish, I realized, “Oh wow. I didn’t daydream about dying even once today. How neat!”
And as I continue to stabilize, I will let down my guard; I will get taken unawares again. And next time I may not be so lucky. From here on, every major depressive episode I survive will leave me wondering whether it may have been the penultimate. Because I may have survived that one, but I know that—if nothing changes—I don’t have many of these left in me. And that’s not me predicting the future; that’s just me applying the lessons of the past and taking honest stock of my own mental and emotional fortitude.