Note: If you are experiencing thoughts of self-harm or suicide that are unbearable, please seek medical help or contact emergency services immediately. 

Suicide is not rare; rather, at times, we encounter it in our lives. Perhaps you have struggled with suicidal thoughts, someone close to you has, or someone close has died by suicide.

A US annual national report survey reveals that in 2021, 4.8 percent of adults in the US (an estimated 12.3 million) seriously contemplated suicide, 3.5 million planned a suicide attempt, and 1.7 million attempted suicide. The percentage was highest among young adults aged 18 to 25 (13 %), followed by adults aged 26 to 49 (5.4 %), and then by adults aged 50 or older (2%)[1]. Another survey among the US military population shows that 519 service members died by suicide in 2021, and 202 military dependents in 2020. Most service members who died by suicide were enlisted, male, and young, under the age of 30 [2]. What these surveys indicate is that suicide is not something far away from us.

While suicide is not uncommon, discussing it is often avoided. There are various reasons why individuals hesitate to talk about self-harm and suicide. One reason is that suicide has been socially stigmatized as cowardice, sin, a lack of willpower, or a sign of weakness. Rory O’Conner, a renowned researcher in suicidal behavior, firmly disapproves of the stigmatization of suicide, stating, “We live in a world where people become so overwhelmed by pain that they see suicide as the only option… Suicide is not about ending your life but wanting the unbearable mental pain to end. [3]” In fact, many individuals at risk of suicide are experiencing immense pain and feel like there's no way out of their suffering. Consequently, viewing suicide as immoral dissuades those struggling with suicidal thoughts from seeking the help they desperately need. 

Another reason why people avoid discussing self-harm and suicide is the concern that discussing these topics could trigger or exacerbate the mental health conditions. However, acknowledging and accepting the genuine experiences occurring in one's mind, including suicidal thoughts, opens up opportunities to explore how to navigate the challenges and pain one is facing. In fact, for many, opening up and discussing suicidal thoughts provides individuals struggling with such thoughts with a sense of relief.

Here are some common misconceptions about suicide:  

Misconception 1:  People at risk of suicide may have a serious mental health condition such as depression or bipolar disorder. 

While it's true that many individuals with mental disorders like depression are at a higher risk of suicide, there are also numerous cases in which suicide occurs shortly after individuals, whether or not they have serious mental health conditions, experience sudden loss and intense stress [3].

Misconception 2: The motivation for suicide is always to get people's attention. 

This misconception could stigmatize individuals with suicidal thoughts and deter them from seeking support. Many individuals resort to self-harming as a means of coping with high stress and mental pain because physical pain can temporarily alleviate mental anguish. Additionally, many individuals at risk of suicide feel like they are a burden to others and believe that ending their lives would benefit those around them. For them, the driving force is often a gesture of caring for others rather than a selfish motivation [3].

What causes suicidal thoughts or suicide?

It is challenging to attribute the cause of suicide to a single factor, as it is the result of a complex interplay of factors. Some of the contributing factors include:

• Genetics

• Feelings of helplessness or hopelessness

• Sudden and intense stress or loss

• Adverse childhood experiences such as abuse, life-threatening accidents, or neglect

• Constant self-criticism or perfectionism leading to shame and guilt

• History of mental illness

• History of physical illness such as chronic pain

Guide for coping with acute self-harming urges or suicidal attempts.

Below is the list of suggested actions you can take to distract yourself from immediate urges to self-harm or attempt suicide. If you've been experiencing persistent suicidal thoughts or engaging in self-harm, please seek professional help. 

Part 1: List warning signs of self-harming urges or suicidal thoughts (e.g., thoughts, images, thinking processes, mood, situations, or behaviors). Ask yourself what you experience when you start thinking about suicide or feel extremely depressed. 

Some examples of warning signs include:

• Thoughts: "I am worthless" or "I am burdening others"

• Feelings: Helplessness and despair

• Behaviors: Isolation, self-criticism, excessive drinking

Part 2: Develop coping strategies. What can you do on your own to help prevent acting on your thoughts or urges if you become suicidal? 

Some examples include:

• Running

• Taking a shower

• Looking at photos of loved ones

• Prayer

• Cleaning

• Walking pets

Part 3: List people and social places where you can distract yourself from unbearable mental pain. 

Some examples include:

• People: friends (phone number 000-000-000), family (phone number 000-000-000), clergy

• Social Places: libraries, coffee shops, places of worship, gyms, or shops

Part 4: Keep your environment safe. Remove means of harming yourself, such as sharp objects, and ask a friend or family member to hold onto your medication.

Remember that feelings are temporary, and distracting yourself from self-harming urges can be crucial in preventing suicide attempts. 

To those who have thoughts of self-harm or suicide, 

Life can be engulfed by overwhelming darkness. What, then, sustains existence? We often encounter individuals who, despite enduring profound pain, speak of the worthiness of life.

Victor Frankl, a psychologist and Holocaust survivor, proposes that finding one's meaning in life and pursuing it serves as a powerful motivator to endure even the most wretched pain. While in a concentration camp, Frankl contemplated his love for his wife through vivid imagination, which became the driving force behind his will to live. Frankl believes that suffering turns out to be meaningful as individuals find a purpose for their lives: “In some ways, suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of a sacrifice.[4]"

Yes, life presents undeniable challenges. Despite life's overwhelming difficulties, the inherent desire to persevere persists within us. It's crucial to reflect on your core life values–what matters most to you–that bring meaning. Consider the small actions you can take right now to align with those values. Acknowledge your own pain; it's common to feel that having suicidal thoughts is inherently wrong, yet accepting these feelings is a crucial step. While answers to life's challenges may not be immediate, acknowledging and embracing them can ease some of the anguish. Moreover, contemplating death or suicide isn't a solitary experience; many others have grappled with similar struggles.

Above all, support and help for life crises are available. It's not unusual to feel hesitant about sharing your pain, including thoughts of suicide, with others due to concerns about burdening them. Having someone outside your immediate circle to discuss life's burdens often brings relief. Mental health professionals can guide you in coping with anguish, processing your emotions and experiences, and exploring the meaning in your life.

References 

[1] Substance Abuse and Mental Health Services Administration (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report

[2] Defense Suicide Prevention Office. (2022). Annual Suicide Report Fiscal Year 2021. https://www.dspo.mil/Portals/113/Documents/2022%20ASR/FY21%20ASR.pdf?ver=soZ94xt2yM905wj9TbwI3g%3D%3D

[3] O'Connor, R. (2022). When It Is Darkest: Why People Die by Suicide and What We Can Do to Prevent It. Vermilion.

[4] Frankl, V. (2006). Man's Search for Meaning. Beacon Press. 

Practical guide for coping with acute self-harming urges or suicidal attempts is based on 

https://www.healthquality.va.gov/guidelines/MH/srb/PHCoEPatientSafetyPlanFillable3302020508.pdf

Written by: EK Seo, Ph.D., LPC (Link)