Levels to Suicidality?

We all know that there’s suicidal ideation and there’s actively suicidal. But what about when you’re in between?

I live daily with some level of ideation, at its most basic where more days then not I’ve got intrusive thoughts of what if I jerked the car this way? Or took this combination of that? Those are the good days.

I’ve definitely had active suicidality where I have made either concrete plans or full on attempted.

I’m in the process of getting help again because I’m really doing bad again for some reason. And they ask every time- are you suicidal? And it’s like yes and no. So then they are like okay so ideation? Kinda? But it’s worse than before. Way worse, like making plans worse. Okay so you’re actively suicidal as in we need to hospitalize you today because when you go home you’re doing it? Well no, that’s not quite right either.

Because I’m the level of suicidal where it’s playing on my mind all day long but I *can’t* act until after my brothers graduation because I would just be an asshole if I marked his good thing with something so rude. Graduation passes and I want to act but I promised to do photos for this girl and she’s counting on me to follow through and it would be rude to not. But then I’ve got to edit the photos and get them sent to her, because I would be shit if I held her stuff hostage like that.

Then there’s birthdays and end of school year events for kids and it’s like I’m holding on tight to some sort of sanity and all I want to do is say f*ck it and f*ck everyone so I can get some relief because i absolutely hate my life. But it’s never the right time. Because I know no one will miss me or anything like that, they’ll move on just fine without a second thought. But I feel like if I act too close to a birthday or event for someone that that will be a forever mark of look how shitty and selfish she was even into that. Last year I picked a random day for January but I chickened out and then some things in life were starting to pick up but now it’s just even worse. So much worse.

I have had a fair amount of passive ideation but not recently. I do often question if life is worth it. I have a pretty full plate, I have ptsd from childhood abuse, autism ( I just had a full evaluation and I am waiting for the results but it is pretty obvious), a 28 year marriage to a covert narcissist and I have a degenerative brain condition. Winner, winner, chicken dinner! Anyway, a lot of stuff to deal with but what am I to do? I have been through tough stuff before and life has always been better on the other side but I question it this time. I have no answers.

It’s shit - sorry that’s where you headspace is right now.

One of the things that’s been really valuable to me in the past is having a T that I can be open with about my suicidality. Experienced Ts learn to navigate these conversations quite well, but it’s also helpful to bring in your own past experience to these conversations because it’s definitely relevant to your level of risk on any given day.

For me, regular thoughts about how I’d prefer to not be alive? Is not great, but not all that unusual for me. It gradually steps up from there in terms of risk: the persistence of the thoughts, thinking through the steps I’d take, making active plans, taking steps towards those plans.

There’s also a degree of distress I need to factor in, because there’s been active suicidality for me in the past that has been quite spontaneous (not much time planning, more a random moment where I simply decided “I’m done”), but they were preceded by high levels of distress about my SI. I’m usually quite good at using thought diffusion to coexist with my SI, so when it starts to become distressing for me, I need to pay attention to that (because my experience is that even sometimes planning, I may act spontaneously).

These types of things are all relevant to the conversations that I have about my suicidality. It’s not a perception science, but given my SI is chronic, there’s no point hospitalising me every time it comes up (tried that, it didn’t work for me!). At the same time, there is a point where I legitimately might need to be hospitalised, because I’m a high risk when I get really unwell. It’s totally appropriate for those types of decisions to be made based on conversations with you about how SI transitions to actively suicidal for you personally, based on your experiences in the past.

It can also be a major confidence booster to have a realistic plan in place. What are YOUR signs that it’s getting too risky? And what steps can (and will you commit to) take at those various levels? That will help you retain some control over what happens when.

OceanSpray said:

We all know that there’s suicidal ideation and there’s actively suicidal. But what about when you’re in between?

I live daily with some level of ideation, at its most basic where more days then not I’ve got intrusive thoughts of what if I jerked the car this way? Or took this combination of that? Those are the good days.

I’ve definitely had active suicidality where I have made either concrete plans or full on attempted.

I’m in the process of getting help again because I’m really doing bad again for some reason. And they ask every time- are you suicidal? And it’s like yes and no. So then they are like okay so ideation? Kinda? But it’s worse than before. Way worse, like making plans worse. Okay so you’re actively suicidal as in we need to hospitalize you today because when you go home you’re doing it? Well no, that’s not quite right either.

Because I’m the level of suicidal where it’s playing on my mind all day long but I *can’t* act until after my brothers graduation because I would just be an asshole if I marked his good thing with something so rude. Graduation passes and I want to act but I promised to do photos for this girl and she’s counting on me to follow through and it would be rude to not. But then I’ve got to edit the photos and get them sent to her, because I would be shit if I held her stuff hostage like that.

Then there’s birthdays and end of school year events for kids and it’s like I’m holding on tight to some sort of sanity and all I want to do is say f*ck it and f*ck everyone so I can get some relief because i absolutely hate my life. But it’s never the right time. Because I know no one will miss me or anything like that, they’ll move on just fine without a second thought. But I feel like if I act too close to a birthday or event for someone that that will be a forever mark of look how shitty and selfish she was even into that. Last year I picked a random day for January but I chickened out and then some things in life were starting to pick up but now it’s just even worse. So much worse.

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I'm sorry you're going through this and hate your life. Many of us feel the same way you do. And you're right, the SI isn't as cut and dry as it seems to some others. I know exactly what you mean. Do you really feel that no one would miss you? It's not a fun place to be. I'm sorry things have turned worse for you. If you want, you can reach out to me. Take care.

The Presuicidal Syndrome - Centre for Suicide Prevention The presuicidal syndrome first described in 1958 relates to that specific psychic state of mind that leads to suicidal acts. It is an alarm signal indicating a tendency to suicide. There are 3 principal components: constriction; inhibited aggression turned toward the self; & suicidal fantasies. It is proposed that this syndrome provides a basis for better judgement of the danger of suicide, makes focused prevention possible, & is an aid in the disclosure of factors in society leading to suicide.

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If I have all three I know it is very serious again. In that moment it is all you feel but it is important to at least know rationally that there are other states and that even the next day you can feel very different.