Why Suicide Ideation is My ‘Flight Response’ to COVID-19

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It’s too quiet in my apartment but inside my head things are loud. I haven’t moved in awhile. I feel like I can’t move. There’s no escape. I’m trying to find words in my head to write what I’m thinking and feeling but words dart away and dissolve into ashes before I can latch on; everything feels foggy. I feel trapped and abandoned. There doesn’t seem to be enough air in the room, I know there must be yet still I struggle to ease my breathing. I’m starting to wonder if I ever will see anyone in person again. Talking to people through screens doesn’t seem real to me. I feel so closed off and everyone is too distant. I need a hug desperately and there’s no one here. How much longer will it be like this? I can’t seem to stop myself from asking that question over and over. Intense emotions mingled with trauma memories are threatening to erupt and I’m feeling the edges of all it and I’m terrified because I can’t stomach the pain and despair I’m feeling today. I’m falling into something that feels bottomless and it worries me. I try to tell myself I can do this because I AM doing it and to keep taking it day by day but that’s not working right now. I need to accept that I’m not okay today rather then criticizing myself for feeling this way.

COVID-19 is a scary time for all of us but for people who were already struggling with mental health, physical health and/or past trauma it’s almost too much to bear. Isolation. Uncertainty. Fears of sickness and death. Instability. Each of these on their own is a huge challenge but together they create a perfect storm for anyone who was already fighting to survive, clinging to hope that things would get better. I worry about how I will hold up as each week goes by and I worry about other people who may be doing battle with themselves, feeling alone and without resources or stuck inside with abusers. My brain constantly scans for the next threat and right now COVID-19 and all the ways it’s impacting life is the thing my brain is focused on. All day and night my brain tells me I’m in immediate danger. In response, suicide ideation ramps up in an attempt to protect me from the threat.

If you’re experiencing suicide ideation, you’re not alone. You’re not bad or broken for having those thoughts. Those thoughts are very likely trying to protect, calm and save you. Understanding how those thoughts function can make a difference in how you manage and the power those thoughts hold over you. I can’t speak to anyone else’s experiences but I can share my own and I hope in doing so can provide some comfort, support and understanding to anyone else who is struggling.

In the past, it was too dangerous for me to know how much danger I was in. I couldn’t take in my entire reality because I needed to survive. As a child I was dependent on others to care for me, and sometimes the people who were supposed to look after me were good and other times they were bad. That didn’t make sense to me. I adapted to that environment out of need and went on in life to expect everything to be unpredictable. Uncertainty represented a threat. I was frequently in distress but it couldn’t be safely voiced. Growing up, I frequently wished I would die and imagined my death in many different ways, often fantasizing about it, borrowing stories from the many books I read to embellish those daydreams. I wrote tragic poetry and journaled my pain, frequently destroying anything I wrote to protect myself. I never thought much about it at the time, it’s just how I was. I developed an eating disorder very early in life and struggled for many many years with it, very often “living” on the edge of death. It was another way I sought to communicate what felt uncommunicable. Again I didn’t know why I was engaged in what was really a slow suicide attempt, I just thought that’s how I was. In my 20s I made several serious suicide attempts, one of which landed me in the hospital for a number of days. There were so many tubes stuck in me and machines around, and always someone standing watch. I didn’t fully understand what had pushed me to that point. All of the other maladaptive coping methods I was using, starving myself, drinking too much and self-harming, were no longer providing any relief. I had moved out of province to attend graduate school, away from the abuse I had experienced for so long only to fall into an abusive relationship. I don’t even think I realized I was desperately trying to escape, and had been for awhile. I didn’t realize that old patterns were playing out. I was not prepared for the waves of remembering without really knowing. I didn’t understand re-traumatization and re-enactments. I had no idea why my life was suddenly out of control. I didn’t realize my body and brain were trying to tell me stuff, trying to push me towards healing. I hit rock bottom over and over. And every time some part of me fought to keep going.

I think I’ve known for awhile that my suicide ideation is a protective measure. Its dialogue, sensations, emotions and thought processes a familiar hum in my mind and something I could always count on to be there when I needed it the most. I could get away if I needed to and save myself, and no one could stop me. My suicidality was a comfort when nothing else was.

It’s only recently, before social distancing and isolation measures took hold in NYC, that I became aware of the healing power of expressing suicide ideation from a place of safety and to someone knowledgable about my past experiences and attuned to me in the moment. I’ve been working with my current therapist (who specializes in trauma, dissociation and somatic experiencing) for four years now. It took awhile to get to this point. When I first started seeing her I didn’t even realize that I was living every single moment of life wrapped up in complex PTSD responses and couldn’t even see that suicide was always in my back pocket. I don’t even know what I was experiencing. There were so many sessions where I barely said anything and many where I dissociated the entire time. It took awhile to build trust, but gradually I did. My therapist was patient, understanding and knowledgeable and I’m very grateful for her.

Along the way I accepted that I had DID, which also meant accepting my trauma history, and from there I began to learn that there were a few parts that held the most painful emotions and were more prone to self-harm and suicide ideation. This is partly what allowed me to continue on as though nothing was the matter and not even realize how badly I was struggling; there were also many times when what those parts were feeling flooded the entire system. For awhile the parts that were in the most pain seemed to operate from behind a wall, not trusting that it was safe to be completely out as well as other parts fearing what they held and felt and shutting them out. The road to accepting parts without fear or judgment is a long one. The first time Rue finally came and stayed for a therapy session it was overwhelming and gut wrenching. She poured out her desire to no longer exist, threatened the body, expressed the pain and turmoil she was still living in and begged for it to end or for her to be sent to a hospital. For over a year the intensity with which Rue expressed everything she was feeling, putting her suicide ideation into words over and over for the first time ever, shook me to my core and we struggled to decide whether hospitalization in a trauma program might make sense. Sometimes things got so bad that my therapist requested I sign a safety contract. Sometimes I needed to check in with her every single day until those thoughts and urges lifted. I could be smiling and laughing with friends earlier in the day and plunged into crisis later that evening. I was scared I wouldn’t be able to withstand it, scared I’d give in. And I worried it was going to be this way forever. But the past few months I’ve noticed that the intensity of those suicidal thoughts have lessened. There’s less energy behind them now.

I’ve learned from talking to my therapist and doing my own research that suicide ideation is a common symptom of complex PTSD, representing a reaction to traumatic circumstances that often did not get verbally expressed. Often when something in the present triggers me and reminds me of something from the past, even when I cannot name it specifically, the go-to response is suicide ideation because in my limited toolkit at the time that was what kept me alive. Knowing I had a way out, even at my own hand, represented hope to me. I used everything at my disposal as a child to not know or feel in order to manage distress and terror (e.g. restricting food, dissociating, self-injuring, stopping bowel movements, dis-regulating breathing, shutting down completely etc.), and suicide ideation provided the ultimate distraction for anything that felt unbearable and gave me a sense of power, control and comfort. This is a very normal response to an unhealthy situation.

“The trauma survivor’s self-destructive patterns come out of the intensity of the child’s instinct to be attached in order to survive. As children, our clients lived within this terrible paradox. The only survival mechanisms available in childhood persist onto adulthood where they are counterproductive and therefore pathological. It is only by looking at suicidality through the eyes of a child that we can understand that wanting to die and thinking about ways to die are a means for a child to survive the torment of being trapped within a traumatic paradox. It is as if the child is saying, “If I can die, then I can live another day. When there is no hope of rescue, suicide becomes the rescue plan.” (Joanne Zucchetto, Simone Jacobs, and Ly Vick Johnson in “Understanding The Paradox of Surviving Childhood Trauma: Techniques and Tools for Working with Suicidality and Dissociation”, pp. 41–42)

As an adult who has put so much work into being recovered from a 30+ year eating disorder and fully committed to trauma recovery, it’s easy to become frustrated and reactive when thoughts of suicide enter my head. But I’ve learned that the angrier and more upset I get about their presence, the louder they get and the more overwhelmed I feel. Telling them to go away, pushing them down or ignoring them doesn’t work to quiet those thoughts. The only way I’ve been able to ease them is by saying the words out loud or writing them, or sometimes in the past putting everything I was feeling into a collage or painting.

It’s not surprising that during this coronavirus pandemic, as I remain in isolation with so many unknowns spiraling around me and so many fears, emotions, memories and beliefs stored up inside me, that my brain would rush towards suicide ideation as a release. It’s very easy for me to slip back into the past or start catastrophic future thinking. When this happens, there are 3 things I ask myself to help stay present and manage those thoughts.

1) Am I okay in this moment? When I ask this it’s important that I don’t go inside myself but instead look around my apartment and notice that there is nothing dangerous or scary. I have to open up my vision as much as possible, scanning the periphery. Eventually my body recognizes what my eyes see and I can sense that I am okay.

2) What’s true now versus what what was true back then? If I was in a session, this is where my therapist would have me name the ways I’m more resourced now than I was as a child or young adult. Naming and noticing brings me back to the present and helps me recognize that I’m better positioned as an adult and have the ability to take care of myself and keep safe.

3) And once I feel present enough I ask, What is suicide rescuing me from? This helps me understand why I’m having the thoughts I’m having, what those thoughts are trying to do versus what they are actually doing. Asking this question also removes some of the shame I feel about suicide ideation because it helps me understand why those thoughts are there in the first place and how they were meant to function as a protective mechanism. When I understand their purpose and acknowledge I didn’t have a choice in their creation it makes me feel less burdened by them. I can even appreciate how suicide ideation helped me survive in the past.

Anger towards abusers and frustration at feeling so helpless, ongoing and intense emotional pain, physical pain and health related issues, mental and physical exhaustion, foreboding sense of the future, feeling alone/unseen/unheard, feeling stuck and/or trapped, and believing I have no control or options are all part of what drives thoughts of suicide for me, and many others. Suicide ideation is a flight response gone into overdrive and a faulty stress response.

People often confuse suicide ideation with acute planning for suicide and it’s important to know the difference. Expressing suicide ideation in therapy, for example, can be a sign of healing whereas someone who is actively making a plan or is ruminating on suicide is in more immediate danger. From the outside it can be very difficult to know how much danger someone is in because there is no one way someone acts right before attempting suicide. In eating disorder treatment I remember explaining to my therapist that the quieter I became and the more inward looking I became, the worse things were for me. I think this is still true to some extent but even still how I appear to others can be very different from what’s going on inside. It’s sometimes hard for me to assess myself although I’m much better at than I was. I have built up my window of tolerance, got more skills on board to cope with intense emotions and thoughts, and in general trust myself to reach out for help if things get to be too much. I’m more aware of my resilience than ever before.

I believe all talk or actions towards suicide should be taken seriously, but how things are handled needs to vary depending on a range of factors. For example, when the part of me known as Rue expressed her desire to no longer exist it was important for my therapist to hear her feelings and experiences and not become overreactive, which would have undermined the trauma work we are doing. Some therapists might have ended the session immediately, called 9/11 or had me admitted to a hospital on the spot but my therapist realized that Rue’s suicide ideation was linked to the past. This is not to say she didn’t take it seriously, she did. There was enough trust in the relationship at this point for her to know if she asked us not to do anything, we wouldn’t. Rue promised she would see her the next day, and she did. There are huge amounts of trust in both sides of the relationship to be able to engage in this work safely. There have been other times in the past, however, when my team wouldn’t work with me because my eating disorder was too active and I was too much of a danger to myself. In those instances, my team had to set very tight boundaries to ensure I received a higher level of care inpatient or in residential. For me and many others, when my eating disorder becomes very active my brain goes offline and I’m not able to keep myself safe. One very important component to being able to deal with isolation during the coronavirus pandemic and to continue doing trauma work is making sure I eat consistency and stay hydrated. I’ve also found that self-care and mothering myself can in fact reduce suicidal thoughts because I feel cared for and in control of my well-being.

I don’t believe the vast majority of people who end up dying by suicide really want to die. I believe a dark moment felt like an eternity. I believe they were carrying too much for too long without any reprieve. I believe they weren’t able to access appropriate help and lacked much needed resources. When I look back at very dark moments in my life I always try to remember that the darkest moment is just that, a moment and if you wait out the darkest moment (even if things only lighten a little) you can find some part of you that knows it needs to hang on. Things never stay bad forever. Like all things in life there are ebbs and flows. No one should struggle with this on their own; fighting yourself and/or being with all of it alone is too much for anyone to bear.

I wish I could remove the shame and stigma people face when they speak up and seek out help and also from those who unfortunately are unable to hang on any longer or get pulled into the hopelessness. There are so many societal barriers that seriously can impact a person’s ability to heal. Access to resources, connections, skills, past experiences, physical health, mental health issues, identity, timing, and luck all play a role in someone’s ability to secure help and move towards recovery. And on top of all those things, we now have COVID-19 making it even more challenging to cope and receive care in the ways we are most accustomed too. Like everyone, I feel very shaken up by the coronavirus pandemic. The world no longer feels familiar and everything feels scarier. But I’m doing the best I can, taking it day by day. In an act of self preservation I moderate how much time I spend consuming news reports and limit my time on social media. I reach out to others, I make time to create and I constantly remind myself that it won’t be like this forever. Structuring my day helps me to manage any chaos I feel inside. Even under isolation, I have things to do everyday, places to be (e.g. a Google hangout meeting at work, a FaceTime call with a friend) and people to show up for (e.g. writing for The Mighty). My thoughts cannot harm me, and neither can yours. Brains are malleable. We can all teach ourselves new ways to mange in these uncertain times. It won’t be easy, but together we can all help each other through this as we listen to one another, share knowledge and resources, and show empathy towards one another.

To anyone struggling, things never stay dark forever and the world needs you to be here even if you don’t see your place in it yet. You aren’t alone and everything you feel is valid. You will feel safe one day. It might take time but you will find your way

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