Chronic, passive suicidal ideation is like living in the ocean. Let’s start talking about how to tread water.
I wish there was a nicer way to say this, but I don’t always want to be alive. Right now, I don’t actively want to kill myself — I don’t have a plan, I don’t check the majority of the boxes on lists of warning signs of suicide, I have a life I enjoy and I’m curious about the future — but the fact remains, I don’t always feel strongly about being alive and sometimes, on particularly bad days, I truly want to die.
It’s been a long time since that statement felt anything but mundane. In middle school and high school, there were the morbid poems, the self-harm, the overwhelming emotions that everyone dutifully labeled teen angst. In college, there were nights when I drank too much and the protective barriers keeping my depression at bay faded to nothing and the thought came to me unbidden, as seductive as it was scary. I want to die. Eventually, I finally stumbled my way into treatment. After that, I celebrated each birthday with surprise because each age I hit was one I assumed I wouldn’t reach.
At 27, I’ve settled into a comfortable coexistence with my suicidality. We’ve made peace, or at least a temporary accord negotiated by therapy and medication. It’s still hard sometimes, but not as hard as you might think. What makes it harder is being unable to talk about it freely: the weightiness of the confession, the impossibility of explaining that it both is and isn’t as serious as it sounds. I don’t always want to be alive. Yes, I mean it. No, you shouldn’t be afraid for me. No, I’m not in danger of killing myself right now. Yes, I really mean it.
How do you explain that?
In the United States, nearly 45,000 people die by suicide every year, making it the tenth leading cause of death in the country. On average, there are 123 suicides a day. That’s not counting those who survive attempts — estimated to be about 1.4 million in 2017.
And those are just the statistics we can track.
What we don’t know is how many people live in the nebulous gray space between fleeting thought and attempt — those dealing with passive, not active, suicidal ideation. “Research on people who endure passive suicidal ideation is limited by this innate stigma that it’s a bad, wrong thing, so people are less likely to report it,” said Eric Beeson, licensed counselor and faculty member at Northwestern University’s Counseling@Northwestern whose research includes attitudes about suicide. Without self-reports, and in the absence of the hospital visits or attempts that help us track active ideation, it’s nearly impossible to measure.
Say suicide and people don’t imagine your indifference towards life, your passive fantasies.
There’s no single cause of suicidality. It’s a symptom of borderline personality disorder and is associated with mood disorders like depression and bipolar, though not everyone with those disorders automatically wants to die. But that doesn’t begin to cover it — suicidality is also prevalent in those with autistic spectrum disorders, chronic pain conditions, substance abuse issues, and marginalized identities like LGBT youth. And though that accounts for both passive and active ideation, it’s the latter that eclipses most conversations on the subject.
Take how we react to suicides in the news, especially of celebrities or public figures. The outpour of shock and devastation is always palpable. We had no idea they were struggling, if only someone had stepped in, you never know what someone is dealing with. There are calls to action: Reach out to someone, get help, call this number. For a few days, we flood Twitter with reminders that no one is immune to suicide, not even celebrities whose lives seem perfect to us.
This is true; no one is immune. At the same time, the sense of alarm and urgency in these sentiments gives the impression that suicidality is solely standing on the brink, inches from death, waiting desperately for someone to notice and intervene. And that’s how it is for some people.
But for me, and I suspect for countless others like me, the threat of suicide isn’t like being carried over a waterfall — it is like living in the ocean. Not as sea creatures do, native and equipped with feathery gills to dissolve oxygen for my bloodstream, but alone, with an expanse of water at all sides. Some days are unremarkable, floating under clear skies and smooth waters; other days are tumultuous storms you don’t know you’ll survive, but you’re always, always in the ocean.
And when you live in the ocean, treading to stay afloat, you eventually get the feeling that one day, inevitably, there will be nowhere for you to go but down.
I’ve become adept at treading. I know — or I suspect, or I dread — that my legs will exhaust and I will slip beneath the surface, but I don’t want it to be soon. For now, I can and want to keep my head above water. But will is never enough, and so I have learned to surround myself with ways to stay afloat.
Some are like passing driftwood: Living to see the series finale of Crazy Ex-Girlfriend. Finishing that book that’s been taking up brain real estate for years. The prospect that maybe tonight will be the night I meet someone halfway decent on Tinder. They’re shallow motivators, hardly anchors to life, but sometimes you just need something that will get you through the month. Or the week. Or the night.
Others — medication, my crisis safety plan. My cats who depend on me. The awful thought of transferring my suffering to my loved ones — are more sturdy. These are the life preservers.
Chronic suicidal ideation takes so many forms. It can be fantasizing about passing during sleep, developing a terminal disease, dying in a tragic accident. Or it’s background noise, a staticky station whispering taunts you can almost, but never entirely, tune out. It hits some people only in the dead of night or when they’ve been drinking; others completely at random like a flash storm they have to wait out.
“Suicidality exists on a continuum and frankly, we’re all on that continuum somewhere,” Beeson told me. “Some of us are just closer to an actual suicide death than others. But in many ways, we’re all a few life experiences away from a major mental health crisis whether we like to admit it or not.”
Besides, that word is loaded in its own way. Say suicide and people don’t imagine your indifference towards life, your passive fantasies. There is the alarm and the awkward platitudes, given either too seriously or too lightly. And anyone who’s ever broached the topic in therapy might know the ensuing questions of risk evaluation:
“In the past few weeks, have you wished you were dead?”
“Do you wish you didn’t have to go on living?”
“Are you having thoughts of hurting yourself?”
“Are you having thoughts of killing yourself?”
Sometimes I worry that’s what people around me would do if I were honest with someone other than my therapist and a few close friends, about this lack of attachment to life and the sometimes-desire to be rid of it. After they know my default state, will I be self-conscious? Will I regret it? Will they ever forget it, or will it shadow my every move and our every conversation? Will they become too aware, watch me too closely?
But then I think: Isn’t there middle ground between hypervigilance and complete secrecy? Speaking freely need not solely carry the weight of prevention. It can simply be about the comfort of social connectedness and knowing you’re not alone.
What if we acknowledged the possibility of suicidality all around us, normalized asking and checking in? If people talked about feeling suicidal — not joked, as we’ve all started to do online, but really talked — as much as they talked about feeling depressed or anxious, would we finally be forced to see how common it is and start creating space for these conversations? Would it be the worst thing in the world if we started talking about not wanting to be alive, and what might help keep us here?
Of course, even that doesn’t have a straight answer.
“We really don’t know [the impact of] having more casual conversation about suicide,” April Foreman, licensed psychologist and executive board member at the American Association of Suicidology, told me. “Stigma is lower than it’s ever been and suicide rates are as high as they were during the Great Depression. If reducing stigma alone saves lives, the suicide rates should be going down.”
But speaking freely need not solely carry the weight of prevention. It can simply be about the comfort of social connectedness and knowing you’re not alone. Like Beeson told me, the big picture is not as much about preventing suicide as it is about planning life and fostering social connectedness — which, in and of themselves, are major preventative factors.
As for the inherent awkward corners and sharp edges of talking about suicide, I figure if I can live with the discomfort of wanting to die sometimes, people can live with the discomfort of knowing about it.
If it sounds like I’ve accepted my fate, resigned myself to the pull of the ocean floor, I haven’t. But if I had, it wouldn’t be for lack of trying. Outside of anecdotal evidence, scientists just don’t know a ton about passive suicidal ideation — which means they also don’t know much about how to treat it.
“People think we understand more about suicide than we actually do,” said Foreman. “We have invested very, very little into research on suicide, especially on feeling chronically suicidal. But at a certain point, when you’re having that mood all the time, something is happening inside your body. Something’s wrong, and we don’t understand what yet.”
There are some more extreme treatments that can be effective — like electroconvulsive therapy and ketamine — but even with those, research is preliminary and scientists don’t quite know why they work, just that they sometimes do. There’s hope of more effective treatment… just not without money for research or laws that demand a certain standard of care for those enduring suicidal ideation.
Turns out, my method of coping is apparently pretty effective. In the absence of good science, one of the most helpful things you can do for chronic suicidality is curate your collection of flotation devices. According to Foreman, if mental health care can only do so much to reduce our feelings of suicidality and equip us with the tools we need to tread water, then it’s crucial to nourish a life full of things we want to stay afloat for.
I thought I wasn’t allowed to write about this until I made it to the mythical other side. You hear it all the time: When you write about a personal experience, especially one that is dark and unpalatable, you should be far, far removed from that time in your life to process it in writing. You should have a lesson, a realization, a moral, a triumph. An ending.
But I might want to die forever. That’s just how it is. But in the meantime, I need to talk about the treading. Do I hope that one day, I won’t feel like this? Of course. But according to Foreman, it may not be the case that we can entirely eliminate suicidal thoughts and feelings — yet or ever — and I’m done pretending that this is a fight I’m guaranteed to win if I only try hard enough instead of something I can, at least, manage.
Because I can manage it, and the ocean is nice sometimes. The sun comes out and the current calms, and I can find peace in the drifting. Maybe there isn’t hope of land in the distance; maybe sometimes there is. Maybe that’s not the point.
Perhaps what I’m looking for isn’t land at all, but other people out here with me. Trying, and treading, and learning to live in the water.
In the meantime, some life preservers, in case you need them:
If you’re thinking about suicide or just need someone to talk to right now, you can get support from any of the resources below.
National Suicide Prevention Lifeline
Crisis Text Line
Text HOME to 741-741
International suicide hotlines
A comprehensive resource list for people outside the US.
Click Chat Now to access a live online network of volunteers through instant messaging.
TrevorLifeline, TrevorChat, and TrevorText (LGBTQ+ crisis support)
Text “Trevor” to 1-202-304-1200
US: (877) 565-8860
Jails can’t be “reformed”
In 1928, New York City was about to tear down an old, notorious jail and build a new, state-of the-art institution. The old jail, on Roosevelt Island (which was then called Welfare Island), was overcrowded, overrun with rats, and lacked plumbing. The new jail would have a proper hospital, and each inmate would get their own sunny, well-ventilated cell. This jail, located on a 413-acre patch of land in the East River between the Bronx and Queens called Rikers Island, would correct the evils of its predecessor, The New York Times wrote.
Last summer, New York unveiled its plan to close down Rikers’ notorious jail complex. Over the next few years, the city will shift inmates into four new jails and “put some humanity back” into incarceration, Mayor Bill De Blasio said.
New York’s plan is part of a long, ahistorical tradition — the U.S. has been reforming its penal system for centuries and, each time, it ends up torturing people anew. One common thread is an insidious principle of American governance: incarceration must be worse than even the bleakest freedom. No matter how hungry or cold or disrespected or afraid someone feels on an American street, it’s reliably better than they’d feel locked up.
In the late 1700s, the English philosopher Jeremy Bentham codified the idea that the living conditions of people sentenced to punishment should be worse — “less eligible” — than those of their poor but free fellow citizens. A few decades later, 19th-century English workhouses put Bentham’s cruel common sense into practice. Desperate people could enroll themselves to get free nutrition and a roof, but in exchange they had to suffer in other ways. Because the food and shelter in a workhouse were often better than what an independent laborer could afford, those “comforts” had to be counterbalanced, the thinking went.
Workhouse residents were separated from their families, forced to give up their possessions, and compelled to follow joyless routines. Anything better, and the state would be incentivizing its citizens to institutionalize themselves. Given the literally Dickensian conditions poor people faced, workhouses became infamous.
“Into such a house none will enter voluntarily,” reads an 1834 government report on the Poor Laws, which dictated the administration of the workhouses. “Work, confinement, and discipline, will deter the indolent and vicious.”
In the United States, “less eligibility” has never formally defined government policy — the nation hasn’t carefully calibrated the conditions of its prisons in line with living standards of the poorest free Americans. But the U.S. inherited its mother country’s commitment to policing the behavior of “undeserving” poor people, and that naturally follows the logic of less eligibility — like “workfare,” for instance. Poor people who break the law need an even harsher dose of disincentives, the thinking goes.
In 1994, for example, U.S. lawmakers scrapped Pell Grants for college classes for people in prison. Axing inmates’ access to the federal funding was really about neutralizing public anxiety about the growing unaffordability of higher education, among other economic struggles, explained the sociologist Joshua Page in a 2004 paper in the journal Punishment & Society. Conditions inside prisons are inextricable from those beyond their walls — the country’s moral calculus wouldn’t let criminals attend universities when decent folks barely could, no matter what it did for recidivism rates.
As the welfare of most Americans stagnates or declines, the U.S. has stumbled on new ways to deter people from “three hots and a cot” — three warm meals and a bed. The rise in violence in prisons is an integral part of their role in the country’s order, wrote law professor Ahmed White in a 2008 paper in The Buffalo Law Review. Prison conditions are generally better than they used to be, which helps explain the nation’s fatalism and indifference about the violence, he explained. Over the past few decades, inmates won access to (shoddy) health care, among other baseline improvements — today, black men actually live longer in prisons than outside of them. Amid those reforms, the illegal violence inside prisons has helped ensure incarceration remains horrifically punitive for even the worst off free Americans.
“Prison is hell,” wrote White, in “The Concept of ‘Less Eligibility’ and the Social Function of Prison Violence in Class Society.” “But, critically, so are the lives of poor people.”
To be sure, Rikers Island Correctional Facility has long been an especially appalling place to be imprisoned, and the island itself has an almost mythically vile history. The island is mostly made of garbage. Its enormous rats, which came to the island on garbage barges, were said to have killed pigs from the jail’s farm. There was also the legendary fire, borne of the garbage, that burned beneath the earth for about 20 years some 25 feet underground. The fire kept the soil so warm that it melted snowfall. The metaphor writes itself.
But spending $10 billion dollars on new jails will just reset the short time before the logic of “less eligibility” helps drags them back to hell. Rikers was already a mess less than 10 years after it opened.
Inmates in the U.S. will never have adequate security, health care, and paths to fulfillment so long as so many of the country’s free citizens lack those same things, and the debasement of the marginalized will continue to lower the ceiling on prison reform. Meaningfully changing prisons is inseparable from — and impossible without — broader transformations like universalizing health care and making housing a human right.
New York City officials say the planned jails will be modern and humane, and that inmates will have access to proper medical care, therapy, and a quality education. But city officials also currently oversee a school system attended by more than 100,000 homeless children. New York wrongs the innocent and the adorable. Will it plausibly do right by the people society likes least?
Ten billion dollars could buy a lot of good, but history suggests no amount of money can build a righteous jail in America.