There are degrees (as well as different forms) of suicidal ideation, and I want to talk about them. All of them are expressions of pain that a person is finding so burdensome that the thought of not existing is the only positive place their feelings can take them. Below, I will write out the most common points on the suicidal spectrum, there are many more points in between the ones I discuss here. From a prevention point of view, help and support should be provided at the first point on this spectrum. Right now, it often doesn’t begin until the third point on it.
WISHING YOU’D NEVER BEEN BORN:
I’m willing to bet that most people imagine this is just something a kid yells at their parents when they don’t get their way. It’s absolutely true that this is often nothing more than a temporary expression of regret or disappointment. We’re more likely to believe an adult really means it when they say it, but don’t think that there aren’t children who very seriously wish they’d never been born over a sustained period of time. I was one of those kids, and I’m not alone in this.
It isn’t suicidal ideation. You’re already born, you wish you hadn’t been. When someone expresses a repeated wish that they’d never been born (over a sustained period of time), there’s a strong indication that this person has been (or is being) abused. IF this is the case, it’s reasonable to project that they are vulnerable to developing suicidal ideation later on if they remain in an abusive situation or remain untreated for abuse-related PTSD.
Getting help at this point has the highest potential for a positive outcome than any other point on this list. I’m going to drill this home until the point catches on fire. This here is the dividing line between the average person who will experience difficult life situations (such as tragedy or trauma) and work their way through it eventually, and those who are beginning to drown. This here is the line between those who are learning to swim and those who need a life-vest.
Life-vests are much less expensive and time consuming at this point than they are when you’re throwing one to someone in the ER who just attempted suicide.
I WISH I DIDN’T EXIST/WOULDN’T WAKE UP FROM SLEEP:
This is a form of PASSIVE suicidal ideation. Wishing to die, but not necessarily wanting to kill yourself. It can be an indication that a person is getting burnt out dealing with ongoing serious pain and/or stress in their lives. This is something many people experience at some point, and it usually doesn’t last for too long, nor pose a serious suicidal risk.
However, passive suicidal ideation can be a super sneaky fucker. In this instance, a person isn’t expressing the wish to be dead directly, but that IS what they’re ultimately wishing for. It’s an avoidant kind of death-wish. You don’t want to be red-flagged (even in your own mind) so you avoid the word death or suicide. It’s more serious than wishing you were never born, which is something you had nothing to do with that is in the past. This here is wishing to cease to exist in the here and now so that you don’t have to face what you believe will almost certainly be a worse future.
From a prevention point of view, this should definitely be taken seriously by any friends, loved ones, or health-care professionals. It’s a great place to dig in and help a person. It means they are already in a prolonged struggle of some kind from which they do not see escape, help, or improvement. People often get to this point through exhaustion. Real solutions can often be found for people in this state of mind, preventing further mental deterioration. They haven’t yet reached the point where they’re so sure that things won’t improve that the only solution they see is being dead.
I WISH I WAS DEAD/I’D BE BETTER OFF DEAD:
This is another and common form of PASSIVE suicidal ideation that’s objectively less passive than wishing you didn’t exist, and psychologically significant in that it’s getting right to the point now. Existence is cerebral, death is physical. When you go from not wanting to exist (being aware of being alive) to wanting to be dead, you’ve crossed a new thresh-hold of mental/emotional distress. This is still passive because it doesn’t express a desire or intention to take action.
Many people wish they were dead once or twice in their lives, and it doesn’t necessarily mean they’re at high risk of hurting themselves. At bare minimum – it’s NOT a sign of healthy coping when someone wishes they were dead and IS a signal of significant distress. When a person has a history of mental illness and/or suicide, it’s a bigger red flag for a potential serious crisis in future.
From a preventive point of view, this is the last passive point on the spectrum of suicidal ideation. A point at which there are no plans, no actual thoughts of killing themselves, just wishing to be dead. There’s real opportunity here to prevent suicide AND help a person with the kind of deep and long-term help that can keep a vulnerable person from returning to this place over and over. The tendency in healthcare is to put a band-aid on a person’s mental health at this point because it’s not a crisis yet.
The point of this whole post is that there are many stages of mental/emotional distress a person goes through before calling a hotline saying they have a gun in their hand pointed at their own head. It’s cumulative and by the time someone wishes they were dead, they’ve already been bleeding a long time. There’s no band-aid big enough at this point AND if a person doesn’t get substantial help/support at this stage, it will be harder to reach them in the next one.
I WANT TO KILL MYSELF:
This is active suicidal ideation. No more hoping nature will just take you out, no more waiting to see if fate will find a way to put you out of your misery. You now believe you have to become an active intentional participant in ending the suffering you’ve been experiencing for so long you’re exhausted. You’ve lost trust that anyone or anything else can help you, You’re out of hope that there’s ever going to be an end to the struggles you’ve been overwhelmed by for way too long.
This is a desperate dark awful place to be. It truly is. However, people who experience chronic suicidal ideation, whether they’ve ever made attempts or not, tend to get used to being in this state. It never gets comfortable but it becomes a state of being/not-being that you can’t change and so in some senses you simply co-exist with it. The danger is that a person in this state of mind can be triggered suddenly into a suicidal crisis at any time. It’s like having a time-bomb in your psyche. Trust issues are often a huge hurtle in getting help at this point.
From a prevention point of view, almost every mental health professional will red-flag a person when they become aware of active suicidal ideation. They have a number of different criteria to decide how to handle it; what level of intervention/help is called for. There’s no fool-proof way to assess suicide risk because people struggling with mental illness are individuals with widely different experiences and histories. The only wrong move here is for anyone to think they can reliably determine when a person will or won’t follow through with a desire to kill themselves. Always assume it’s a possible outcome and provide support and services NOW.
I’M GOING TO KILL MYSELF/HAVE PLANS:
It does not get more serious than this, where suicidal ideation is concerned. This is the end of the suicidal spectrum. From here, you either get enough help and support to retreat out of this crisis alive, or you attempt it. While attempts don’t always succeed, a terribly large number of them do. Sometimes failed attempts have horrible permanent consequences. Many people DO make multiple attempts, something I’ve heard people say isn’t that common. The Suicide for Beginners Survey suggests otherwise.
People who have both the intention and actual plans to kill themselves needed and didn’t get help a long time ago. There are a lot of reasons why that may have happened, but most commonly they’ve been failed by a lot of people (both in their personal life and by medical professionals) before they got to this moment. There are usually huge trust issues in place as an obstacle to helping someone who’s got a plan in place and the intention to carry it out.
From a prevention point of view, this is the worst point of intervention possible with the least potential for a long-term good outcome. This is supported by the fact that we’ve never had more people involved in suicide prevention than ever before AND the number of successful suicides has never been higher than it is right now. Prevention attempted at the point of crisis is putting a band-aid on an arterial bleed-out.
Prevention must always be awareness-led, and in order to successfully help people in mental/emotional crises, we must all be able to see early warning signs. Hopefully this explanation of the suicidal ideation spectrum can help people understand the progression from needing help to being beyond help. Let’s dig in and catch people before they fall.
The national suicide hotline is 988