Courtesy warning: Suicidal thoughts, suicide
From a young age, I remember adults asking me again and again what I wanted to be, where I wanted to be, how I planned to make it all happen in the elusive grown-up world. It felt like I had to look beyond who I was to figure out who I could or should or would be—and the shoulds were consistently louder than the coulds. How could I know what I could be? That would take living; it would take time, setbacks, more joy and more pain. But the truth is, I’ve always just had trouble thinking too far ahead.
“What do you want to be when you grow up?” they’d ask. And I would squint my eyes, scan what looked like an empty room, and fail to find myself still around.
The first time I remember wanting to die
There’s a scene I have saved in my memory. I’m standing in front of the garage door of our ranch-style suburban house at age 13 or 14, unable to move, staring at my mother’s tan Toyota Corolla, which she’s left on to heat up before we head out. As we wait for the windows to defrost, I try to stomach a granola bar for breakfast. I’m wearing the drab gray skort-and-polo uniform my family could hardly afford for the private school we definitely couldn’t afford, tears stinging my dry cheeks. I begged my mom, for the third morning in a row, to let me stay home. No luck. In a history class that morning, I thought of the frozen windows of my mother’s car and imagined what it would feel like to freeze to death.
What was going on in my life to lead me to that thought? Some teenage heartbreak, a family death, my father’s sadness. Angst was my middle name, he would tell me in his own, harsher words. And so it became a part of my identity—the angsty, selfish one with little regard for living and a private but dangerous desire for recklessness. A phase of a child’s life parents notoriously dread, but a phase nonetheless.
My friends and romantic partners at the time often considered me intense, a little too dark, a little too serious and exhaustingly sensitive. I wore my heart on my sleeve and let it get torn apart in ten different ways with every measly attempt to be embraced, but each breakdown led to the same clichéd, tear-drenched conclusion: No one understands me.
There was always some kind of hovering pain, be it partly a result of an abusive partner, a neglectful friendship or a newfound isolation. I was convinced by my own voice and by the voices around me that the pain was always of my own making, self-inflicted, my fault—a sensation I couldn’t escape. All I really wanted was an escape. The thought of persevering, of surviving, exhausted me.
That little regard for survival followed me around as I switched schools for the tenth time in my adolescence, and then as I grew into a so-called self-sustaining adult. The questions about future me became more pointed, more demanding, more overwhelming. Where do you want to go to college? became What are you majoring in? What are you doing after college? Are you going to grad school? Will you marry him? When will you have kids? I don’t know, I don’t know, I don’t know. How does anyone know?
The first time I told someone
I fell in love with a boy and told him three of my deepest, darkest teenage secrets:
First, when I lived apart from my parents and with extended family in sixth grade, I’d stolen about $200 from my great uncle’s wallet to buy new clothes from The Galleria mall in Houston. The heist backfired, and I will never forget the shame.
Second, when I was nine, I took my dad’s razor and tried to shave away every hair on my body only to have the razor slip and slice the skin along my upper thighs and stomach. The tub filled with blood, and my scars are still visible today.
And last, that I’m not always attached to living and breathing, and that the thought of leaving it all behind for good has brought me some comfort, though by then I’d never actually made a plan to act on the unimaginable.
At that, the boy I loved told me I was being foolish and dramatic, and he demanded I not repeat what I just said lest it burden the people I love. We eventually went our separate ways, much later than we should’ve. I wouldn’t tell another soul that third secret for years.
The first time things went too far
I was around 26, working in a local newsroom, and there was a potential “Muslim ban” making headlines. My best friend of 10-or-so years and I were no longer speaking for no major reason other than we’d absolutely grown apart, and my heart was a bit broken over that and another romantic falling out. It was the culmination of never-ending bad news, a sense of not belonging in the country I chose to become legally bound to, a sense of doom at the mere thought of our climate collapsing, my then-undiagnosed depression, those other aforementioned personal pains—and my passive attitude toward living—that led me to my first big end-of-life action plan.
I texted the National Suicide Prevention Hotline, and the volunteer who responded to my frantic message misspelled my name. I unraveled, immobile. But I did not act. What shook away the will was a photo of my baby brother and I, a photo I just happened to find while rummaging through my closet, where I’d been looking for pants to wear to the pharmacy. I called in sick the next day and the day after that, and ended up working from my bed for nearly the entire month.
The moment I told my family
It was New Year’s Eve, just a few months after the first time things went too far, and my mom, my dad, my brother, and I sat at a cabin dinner table playing a [censored] game of Cards Against Humanity during a holiday getaway.
Hours later, while my parents napped and my brother binged Netflix in his room, I fell apart on the couch. It was the kind of falling apart that drenches the neck of your t-shirt, the kind where you’re grasping for air, but hoping you ultimately fail.
I felt overwhelmed with guilt, for potentially hurting the people I love, the immigrants who left everything behind to create a more welcoming future for their children. But this time, unlike the first time, guilt did not keep me from actively contemplating the end.
My brother walked out of his room and saw me sitting there, broken. He called my parents down to the living room, where just an hour ago we’d been laughing together. Through tears, I admitted what I’d felt for as long as I can remember: that I had no real desire to live, that I’d never really imagined a future for myself, that I didn’t know exactly why I felt this way. That year, for the first time in my life, I just couldn’t contain the passivity of my suicidal ideation.
The admission to my family saved me that night. It led me to medication and counseling. But it did not rid me of this unreliable attachment to living.
Suicidal ideation is just something I’m learning to healthily deal with, much like my chronic spine injury or clinical depression. After keeping quiet for too long, it’s something I want to share with the world. My best friends know about it, my romantic partners have known and will continue to know, and these days, even my employers know. I have to keep a close eye on its intensity during my most painful bouts of depression or during a particularly heavy news cycle, but most days, I’m just flying, floating, living like everyone else through the good and bad days, only with a clearer focus on the now and a hazier one on the future.
The concept still terrifies many of my loved ones, but the more I seem to talk about it, the more I try to de-mystify it, the more they all tend to—or want to—understand.
Often, I return to this essay by Anna Borges, the only writing I’ve found that explains so adequately how I feel.
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.
How do you describe suicidal ideation to folks who might not know much about it?
Suicidal ideation is comprised of thoughts of death or suicide, active thoughts or passive, not with the plan set out, the means obtained or the desire to act on the thoughts. Therefore, these thoughts can be quite scary. They may feel intrusive and random or they may persist when stressed or even occur at certain times of the day.
What do people often get wrong about the concept?
I think what people get wrong about ideation is that it is not important. Don't get me wrong, it is common and not always cause for alarm, but it is not nothing. When people have these thoughts, they should talk to a friend, seek a professional and not sit alone thinking they are weird. Some people don't tell because they are afraid they will "freak" out a friend or family member. Usually, if these thoughts are delved into a bit more, the underlying issue that needs to be heard can be addressed.
What does it mean for someone to have passive suicidal ideation?
Passive ideation is when a person is thinking, contemplating or holding the thought as a safety valve they don't intend to use. However, passive can turn active and the person can begin to gather the means to attempt or die by suicide. Therapists do not take any suicidal thoughts lightly, they work with them to assist their clients to find better ways to cope with the stress leading to these thoughts. It is not unusual for the thoughts to be associated with the anniversary of an important loss, the loss of a job or health status or during a hard time in one's day-to-day life.
What about chronic suicidal ideation?
Chronic S/I means these thoughts are not really going away and not transient, they stick around and can be quite distressing and interfere with having joy in one's life. They may be associated with depression, bipolar disorder, trauma or a whole host of mental health issues.
What are some signs of ideation we can look out for in ourselves, our friends or in our children?
That is a big question. Signs may be as simple as hearing someone say: my family would be better off if I was dead, or death would be easier than living. It may be more subtle though and be evidenced in behavioral changes such as withdrawing from normal daily living activities or routines, or socially distancing even more than we are doing because of Covid.
Why is it that passive suicidal ideation feels like such a mysterious notion? That some people are not always attached to being alive the way others are?
The notion of death by suicide is scary for most people (even therapists don't want to suffer the loss of someone they care about). That said, your question begs a deeper, existential question which is why do some people feel like life is not always worth hanging on to? There are so many reasons for this; some people due to a history of trauma, epigenetic trauma, depression or a history of oppression or persecution, do not feel like they have the interest or energy to continue to live. Their life force, so to speak, may be blunted.
Can you have suicidal ideation without ever making plans of suicide?
Yes, and you can have suicide without a lot of previous ideation. Both can be true.
How can we differentiate between when our passive, chronic suicidal ideation is dangerous and when it isn't?
To me, it is when you are having discomfort with it, although as I said before, some people just like knowing the out is there, and it is dangerous when it has a life of its own, a plan, the means, the date, the reason and the energy to complete.
Oftentimes, in my experience and in the experiences of some fellow immigrant friends I have, this symptom of having a lackluster interest in living can appear as teen angst or selfishness, a recklessness toward existence. Is this something you notice with your own patients? What advice do you have for patients with suicidal ideation/depression/other mental illnesses to help overcome the guilt of being called selfish or feeling they're to blame?
Good point. Teen angst can look selfish, but I, for one, would not go back to a time that I was trying to define myself and separate when I may or may not have the resources to do so. It is not selfish to be a teen and have a rollercoaster wave of hormonal feelings, to be mad and feel like it’s the end of the world. To be finding oneself is a hard thing to do.
For immigrants, this is further complicated when language, customs or finances make you stand out as different, when all you want is to fit in. I worked with a young man who was a college student who was pretty down and suicidal because his dad had said over and over, that he had to fit in, make money and marry within their affiliation group. He had a lot of conflict in this as he was terrified to disappoint his dad because he was gay. He often drank too much, tried a number of drugs and would take on any dare. He passively thought being gone would be easier on his dad than coming out, which was not okay in the country where he was born, nor the religion he was born into.
So much of my experience with suicidal ideation involves not being able to see myself in the future. For example, I can't imagine myself at an older age, in future phases of my life. It doesn't excite me to think/dream ahead for what's to come, and while I shrug this off as just me embracing the now, when loved ones hear me speak like that, they tend to worry. Is this something you've noticed or can offer feedback on?
There is so much pressure to have the big dreams: job, school, marriage, babies etc. What happens if you prefer to just live in the moment? If you don't want to live past a certain age and are approaching that age, that would scare me more than being more in the moment. But, I would ask you, do you laugh? Have fun? Find joy in the now? Or is it lackluster and what you expect the future to be? The latter would make me suggest therapy to someone.
Do you have any advice on how to explain the sensation of suicidal ideation in general? I tend to pull from Anna Borges' essay, which personally speaks to me: "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... 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."
Her words are beautiful and describe the impossible conundrum one feels when suicide is part of the conversation, even without a plan. We are all programmed to fight for life. If we could ask bigger questions and show curiosity when this topic comes up, I think we could change the conversation and allow people to have their own feelings heard. That said, anyone who wants to share should also agree that if it gets worse, or changes, they will let the people who are carrying this with them know. OR, that they would seek help.
Are you familiar with any research on suicidal ideation in immigrant populations?
What I have seen talks about globalization and immigration being in concert with a higher rate of suicidal thoughts, attempts or deaths, but there is a lot of speculation about why. Different countries in Europe are researching the connection between immigration and suicide and the bottom line is there may be more stressors on immigrants depending on acceptance and equality, job options, language barriers, financial situations etc. and we have to factor all of that in to get a clearer picture.
For someone who might be living with chronic or passive suicidal ideation, what should be the next steps?
Stigma hurts us all. I would say, talk to friends, help them understand, seek professional help to see if there are other ways to approach life. The truth is, when we open our issues to the light, we may make a difference for ourselves and others.
Is there anything else you wish I asked? Anything else you'd like to note?
I think you asked it all. I would note that a few years ago, I got trained to do evaluations for immigration. I did a visa eval for an immigrant who was being abused in this country and was not safe returning to her own country and was so sad, that she had nowhere to run and was at the mercy of the court to remain here. Immigration is a very serious and scary thing for a lot of people. My people came from Ukraine and I watched the difficulty they experienced being unable to negotiate for better work circumstances, were treated with disdain in some places and made a life anyway. Their stories live on in me and inform how I talk to anyone I meet. We all have a story and it is worth hearing.
Thank you, Dr. Hornstein, for your professional insight.
This 2018 literature overview published in the International Journal of Environmental Research and Public Health features knowledge from hundreds of reports between 1980 to 2017 related to suicide risk among immigrants and other ethnic minorities.
Below, you’ll find a handful of findings from the above review, specifically relating to suicidal ideation among immigrants and minorities. As always, a disclaimer that this isn’t an exhaustive list of all existing literature.
Asian American women born in the United States have shown higher prevalence of suicidal ideation and suicide plan compared to U.S.-born Asian American men, as well as foreign-born Asian American men and women.
According to this 2014 study, among Asian American populations, Korean Americans have the highest rates of suicidal ideation—and Indian Americans the lowest.
Among Native Americans, “thwarted belongingness and perceived burdensomeness” have been identified as predictors of suicidal ideation.
A 2005 study involving Black men in the U.S. found “religious well being, and not acculturation, is predictive of suicidal ideation and history of suicide attempt.”
Among Ethiopian adolescents in Israel, having an Ethiopian sense of identity correlated with lower levels of suicidal ideation and alcohol use in this 2012 study.
Hispanic/Latina female students in the U.S., according to this 2011 study, showed a higher prevalence of suicidal ideation (21.1%) and suicide attempts (14.0%) than white and Black students. The risk behaviors associated with suicidal ideation and suicide attempts were: injuries and violence; tobacco use; alcohol and drug use; sexual behaviors and perceived health status.
Among Mexican American migrants and next-gens, a retrospective study found the following risks for suicidal ideation: having a family member in the U.S.; having arrived in the U.S. before the age of 12, and being U.S.-born.
In this study, Mexican migrant women farmworkers in the Midwest presented elevated levels of anxiety, depression, and suicidal ideation. High suicidal ideation was associated with lower self-esteem, family dysfunction, less ejective social support, hopelessness, acculturative stress.
Passive suicidal ideation is when someone may desire death but have no specific plan to act on suicide. But it’s important to note, according to Dr. Hornstein, that even if passive suicidal ideation appears to be fleeting, the risk of a suicide attempt can still be very real.
If you’re experiencing suicidal ideation and have a plan—or if you don’t feel that you can keep yourself safe, experts suggest you call 9-1-1 or go to the nearest hospital.
If you, like me, aren’t comfortable with police, consider calling or texting a hotline or someone you trust. I have personally texted the crisis hotline (text HOME to 741741) with luck many times just to get my mind off of things.
Numbers to know
1-800-273-8255 - National Suicide Prevention Lifeline (can be connected to crisis centers with 150+ languages)
1-866-488-7386 (1-866-4.U.TREVOR) for LGBTQ youth
Now that you know what to do in an emergency, I’m going to list a few ways I cope with the more subtleties of living with passive suicidal ideation, strategies I’ve learned in therapy and in conversations with peers who can relate.
Making small, mundane changes. I don’t know what it is, but moving a piece of furniture around, playing with a website design, cleaning my hard drive, working from different shops/parks, changing up my hairstyle, even waxing my eyebrows—any kind of small change to my physical or digital environment (or my body!) seems to give me a sense of renewal.
Talking about it! This might seem obvious considering how I’ve already revealed my experience on the Internet, but talking about suicidal ideation will always be significantly helpful to me. The friends who take time to understand my perspective, even if that territory comes with some sadness and concern, are the friends I hold closest to my heart. Most of my relationships have only improved after vocalizing my truth. And the ones that fell apart, I’ve realized in retrospect, would’ve fallen apart anyway.
Being intentional about who I spend my energy on. This goes along with the above, but if you know me, you know I am very, very picky about who I let into my day-to-day private life. That’s a way for me to protect myself, and yes it prevents me from being overly trusting like I was when I was younger—which can be a barrier when it comes to new relationships—but actively thinking about exactly who I can and can’t trust has been essential to my well-being in recent years.
Creating. Making beautiful things, sharing beautiful things—that excites me. It can be a meal for a family member, a work of art, an essay or story, even the act of putting together new furniture. Using my hands to create and being thoughtful about the act while doing so tends to be especially fulfilling. It’s a way I find beauty of my own making when I feel most out of control.
Shaking off any guilt. I mean this quite literally. I harbor a lot of guilt for putting myself first in situations where my parents or grandparents would’ve probably made a sacrifice. For example, unlike my mother or my grandmother, I’m not likely to settle on an argument I disagree with just to keep the peace; I’m not likely to live at home in adulthood and I tend to spend my free time on hobbies or with friends, leisures they just don’t seem to prioritize. Adding therapy and “self-care” rituals to my daily routine—not to mention constantly worrying people will view me as being ungrateful for my passive suicidal ideation—just makes it all so much worse. In therapy, both physical and behavioral, I’ve been told my shoulders tend to carry a lot of the guilt I hold. I kid you not, a private little dance party or dance cardio workout helps me temporarily throw off the gloom.
I am not always very attached to being alive (Anna Borges, The Outline): This is my go-to reported essay when it comes to conveying suicidal ideation to loved ones and my go-to for when I need to feel a little more understood. In it, Borges writes about learning to tread while living with chronic, passive suicidal ideation. Read here.
I Had Passive Suicidal Ideation. Here’s What Everyone Should Know (Ziba Redif, Refinery29): Most days, writes Redif, she enjoys her life. “But every now and then, when things were particularly difficult, I wanted to close my eyes and disappear. Thinking about no longer existing was like an emotional reflex, something I sometimes defaulted to when faced with internal pain.” Read here.
5 Ways to Cope with Suicidal Ideation: Tim’s Story (Genomind): “Social withdrawal—a common symptom of both depression and suicidal ideation—became a recurring theme for Tim. ‘I lied to the people who could get through to me about what I was feeling,’ he says.” Some useful coping tips from filmmaker Tim O’ Brien, who lives with depression and suicidal ideation, here.
Suicidal Thoughts Exist on a Spectrum — And Sometimes Involve No Active Plans to Die (Rajvi Desai, The Swaddle): A thoughtful explainer citing how researchers measure risk association for those with passive suicidal ideation as well as anecdotal reporting via Anna Borges, author of the first story on this list. Read here.
What I have learned from my suicidal patients (Gavin Francis, The Guardian): “To feel depressed about the state of your life is to demonstrate capacity to imagine something different, and that spark of imagination can prove a motive to change.” This is a painful, revelatory, graceful and beautifully-written essay that’s absolutely worth your time. Read here.
That’s all, folks. I hope you enjoyed this issue. And if you did, please share it with loved ones.
A big thank you to editing champs Farah and Hanaa’ for contributing your talents—and to Dr. Robin Hornstein for sharing your expertise. Forever grateful to Sustaining Members Hannah B., Safurah B., Alex C., Alma C., Rebecca C., Rodrigo C., Katie H., Liz S., Puja S., Roz T., Diane W. and my mama. Without you all, this work would not be possible.
Foreign Bodies is an email newsletter centering immigrant and refugee experiences with a mission to de-stigmatize mental illness through storytelling. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez and traveling journalist Farahnaz Mohammed. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter @4nbodies or Facebook. Special shout-out to Marissa Evans for Issue 14’s art and Carter Fellow and friend Rory Linnane for that adorable animated logo!