Don’t Call Me Selfish

Don’t call me selfish.

Now, I know that I am selfish sometimes. I can certainly be self-absorbed and self-centered. I can certainly be worried more about my own stuff some days than anybody else’s. I can certainly fail to love my neighbor. But there’s one piece of me that is so often vilified as selfish. And it’s not.

Don’t call me selfish because I am suicidal. A friend asked me recently what it felt like to be suicidal. I’m glad he asked, because my answer helped me think about it. I actually don’t think there is such as thing as being “suicidal.” I’m no psychologist, and perhaps I’m wrong, but I think suicidal ideation is a symptom, not an ailment. I think that suicidal thoughts and behaviors occur for a pretty simple reason, almost mathematical. We all have a certain level of pain, whether it’s physical, mental, emotional, or spiritual, or a combination. This pain level increases and decreases over time, certainly. And I think the longer the pain lasts, the more it becomes suffering. I think we can all deal with short-term pain far more easily than long-term. And we also all have a certain set of coping mechanisms, skills and resources we accrue over time that help us deal with the pain. Ibuprofen can be a coping mechanism for the pain of a headache. Community can be a coping mechanism for the pain of loneliness. Faith can be a coping mechanism. Hope is a huge coping mechanism. Meditation. Yoga. Exercise. Hobbies. Alcohol. Street drugs. Television. Self-talk. Physical and psychological therapy. All kinds of things, some good, some bad, some neutral.

And I think one’s level of suicidal ideation can be expressed as an equation:

p*t – c = Si

Let me explain. p is pain, and t is time. So I’m defining suffering as pt, the multiplication of pain and time. The higher the pain, the higher the suffering, and the longer pain lasts, the higher the suffering. c is the total amount of coping mechanisms one has. Si is the level of suidical ideation. The higher Si goes, the more likely you will experience feelings of wishing to die. As Si continues to increase, so do the chances that suicidal feelings turn to thoughts, and thoughts turn to behavior.

It’s a simple enough equation. Suicidal ideation occurs when the suffering someone experiences is greater than their coping mechanisms. Increase the pain, Si also increases. Increase the time spent in pain, Si increases. Increase the coping skills, Si decreases. I think the reason why suicidal thoughts and behavior is so often found among those who live with depression is because depression both causes mental pain (p increases), and also depletes our coping skills at the same time (c decreases).

But by no means is suicide connected only to depression. People who experience a trauma can wish to die, especially as time goes on and the trauma doesn’t go away. People with chronic physical ailments can wish to die. Things like fibromyalgia and chronic fatigue syndrome can sap coping skills as well as depression, and as t keeps increasing, it’s normal to consider that death would be preferable to this existence. And I can’t count how many times I’ve heard an older person say, “I’d rather die than be a burden to my family.” The pain there may not be so much physical or mental as emotional, but it’s real. They want so badly not to be a burden, that p level goes so high, and they are actually actively trying to keep c low, refusing to accept certain types of help, because it would feel like failure. No wonder death seems a good alternative.

And that’s what suicidal ideation is. It’s what happens when suffering is greater than coping mechanisms. It’s that simple. Yet I so often hear that it’s selfish to consider suicide, selfish to “commit suicide.” It may be many things: short-sighted, emotional, etc. But it is not selfish. Is it selfish for a mother grieving the death of her child to wish it had been her to die instead? No. Is it selfish for a 90-year-old man diagnosed with cancer to decide not to accept treatment, but instead die sooner with dignity? No. These things are reasonable responses to pain. Just so, it is not selfish for someone with a chronic mental or physical illness to prefer the thought of death, even to act on that.

A friend once said something like this to me: “I would miss you so much if you weren’t here tomorrow, and I would be very sad, but I would understand if you can’t be.” It touched me so deeply. He heard me. He understood that I wasn’t trying to hurt him, or my family, or anyone else. I was trying to cope. And sometimes trying to cope isn’t enough. It was one of the most caring, loving things I’ve ever heard. Because that’s not the usual thing someone hears when they share suicidal thoughts with someone else. Here’s where I’m really going to get into trouble, but honestly, sometimes people can be incredibly selfish when trying to talk someone out of suicidal thoughts. Saying, “You can’t kill yourself. I would miss you too much,” sounds supportive and loving. But here’s how someone contemplating suicide hears it: “I am scared of my own feelings. I don’t care about how bad you feel right now. I’m going to try to take away the last bit of agency you feel you have.” I know that’s not how it’s intended. But that’s really how it can sound.

Now, listen. This is not a plea for help. I’m not saying all this as a way of justifying something I’m planning today. Nothing like that. This is a plea for understanding.

• Understanding that suicidal thoughts are, first of all, normal. My guess is that most of us have them from time to time. There’s nothing to be ashamed of in that. I usually try to hide this, but I’ll be honest: suicide crosses my mind just about every day. I regularly contemplate if things would be better without me here.
• Understanding that going from those sort of thoughts to actually making a plan isn’t a huge leap. It just depends on that equation above, how bad the pain has gotten.
• Understanding that sometimes, the level of pain is just too high for anything else to seem reasonable. Coping mechanisms can be hard to acquire, and hard to keep practicing.

So what am I suggesting you do if someone you love shares suicidal thoughts with you? I guess two things. First, be honest. Tell the person that you’d miss them, and that it hurts you to hear them say that. Don’t make it about you, but be honest with how you’re feeling. That encourages them to be honest as well. And second, just be with them. Don’t try to fix it. Don’t try to talk them out of it. You can’t. People don’t consider suicide on a whim; there’s no argument you can make that will elicit this: “Oh, I never thought about that before.” Trust me, they’ve thought about it. Now, if you can offer them a new coping mechanism, maybe that would help. Offer to take them to therapy (if they’re not already going). Offer to help them research medication. Like I said, maybe this would help, and maybe it wouldn’t. But being there will. It may not prevent their death, but you would give them a moment when they felt seen and loved. And that’s probably more important than anything else.

Thanks for listening.