April 27, 2016
My suicidal ideation stems from bipolar disorder, but many other conditions, including anxiety, depression, obsessive-compulsive disorder (OCD), borderline personality disorder (BPD), anorexia nervosa, and bulimia nervosa, also can cause a person to have ongoing self-destructive thoughts. According to research cited by the American Foundation for Suicide Prevention (AFSP), studies show that "the overwhelming majority of people who die by suicide--90% or more--had a mental disorder at the time of their deaths. Often, however, these disorders had not been recognized, diagnosed, or adequately treated."
Both internal and external stigma can stand in the way of people with a mental illness asking for help, receiving the care they need, and sticking with a treatment plan.
It is an established fact that suicidal thoughts and actions are often symptoms of mental illness. But stigma tells us that when we display suicidal behavior--especially in public--we are seeking attention or misbehaving. If we are in crisis, it is because we are too weak to control ourselves. If we have lost control, it is because we want to create drama. Stigma makes sure we know exactly how we have failed, no matter how hard we tried to help ourselves.
When I have bipolar disorder symptoms, something in my brain insists that suicide is inevitable, that I must do it to solve my problems, and help my family and friends. It tells me I have nothing to live for, no matter how fortunate I might seem to others.
What does it feel like to have my brain tell me such dangerous lies? From my bipolar perspective, suicide and self-harm are closely related to intrusive thoughts, anxiety, and compulsive behavior. When I'm in a mixed state of hypomania and depression, especially, the self-destructive thoughts are loud and clear, and there is no escaping them.
I find these thoughts terrifying and comforting at the same time. Whatever is going on in my life---negative or positive--intensifies, and I obsess about suicide plans and cutting or burning myself in response to these overwhelming emotions.
How do I know that suicidal ideation and self-harm are not just normal for me? How can I be so sure that these are symptoms of an illness rather than personal failings? For years, I didn't know.
From the age of eleven, I criticized myself as broken, needy, and melodramatic. Fear had me sweating under the covers every night, refusing to pull the blanket down even far enough to breathe. I was frightened of the solid nothingness that represented death to me, but I couldn't stop thinking about it until I finally passed out each night.
When did I realize that it was possible to overcome the fears and compulsions? When did I realize that suicidal feelings were not me; that they were happening to me? The respite between major mood episodes helped me see that it was my "normal," or my baseline. Unfortunately, I blamed myself for losing touch with this sense of normal, making each subsequent mood shift a little more difficult. This is internal stigma.
Most of the time, when I am in a mood episode and feel like I want to die, I understand that it is a temporary desire. It may come back again next week, next month, or next year, but it does subside. Having these thoughts are beyond my control, and they do not represent my true wishes. They are the twisted ideas of my illness. If someone treats me harshly because I've injured myself, she has mixed me up with my bipolar disorder. If someone tells me that if I want to die so badly, I should make sure it works next time, he is condemning me for having life-threatening symptoms of an illness. This is external or societal stigma.
I only recently began sharing my experience with bipolar disorder. For the most part, it has been empowering. The scary part, though, is revealing my long history with suicidal ideation and self-harm, including two suicide attempts. I didn't plan to talk about this aspect of my bipolar disorder until much later in this advocacy journey. I realized, though, that people struggling with chronic suicidal thoughts can't wait for me--for us--to be more comfortable with the topic. We can't continue to let internal and external stigma keep us quiet.
Yes, talking about suicide can be awkward at best. The closest most people come to discussing suicide is making cracks about how they're so stressed, they will kill themselves. I know they mean it in a lighthearted way, but I can't laugh it off. I cling to my sense of humor, even when I'm struggling the most, but this is one topic that simply is not funny on any level.
To reduce stigma, we must be clear in our conversations that suicide is never a joke or a weakness or a failing. It is a devastating premature death that causes profound pain to the family, and friends left behind. Suicide survivors are filled with unanswerable questions and a unique kind of grief, one that has strong undercurrents of guilt and anger. They are at greater risk for dying by suicide, too.
To reduce stigma, we must support suicide attempt survivors. The fact that they are alive is a reason to celebrate, not an excuse to treat them with harsh impatience. They've emerged from one of their darkest times. Let's help them embrace a life that once seemed unlivable.