TW: Discussions of suicidal thoughts, suicidal urges, self harm, and irrational thinking. PLEASE think carefully before reading further if these things may trigger you or cause you distress. Please always put yourself and your mental health first.

This, I think, is the first time I’ve written directly about my experience with suicidal thoughts and urges. I’ve mentioned it in relation to the side effects of medication and written around the edges of it but I don’t think I’ve ever talked about it in such detail. I have omitted certain moments and details since it’s been proven that sharing about plans and methods can lead to further suicides but this is as honest as I can manage, even though it terrifies me. But as hard as it is, I’m sharing these experiences because I think it’s so deeply important for people to understand what it’s like to feel this way, to live in so much pain, to feel so desperate. Keeping these stories in the dark only increases the shame and stigma so, even though it’s difficult and uncomfortable and scary, we need to talk about them. It’s the only way the world will get better at supporting people who are struggling.

I’ve experienced suicidal thoughts on and off since I was a teenager but for a long time, they were passive. Walking to school, I’d cross the road and, dreading the day ahead, I’d imagine getting hit by a car. But the thought would leave as quickly as it arrived. I thought it was normal. To quote Ned Vizzini, “Who hasn’t thought about killing themselves, as a kid? How can you grow up in this world and not think about it?” (I may have hated that book but that line really resonated with me.) This was before I was diagnosed as autistic* and I thought everyone felt as overwhelmed by their emotions, by their anxieties, as I did – as I do – but were just better at managing it.

*Autistic individuals, especially autistic women, are at a much higher risk of suicide than the general population; the factors include mental health problems (especially if they go untreated), the impact of a late diagnosis, challenging life events such as bullying and ableism, the burden of masking, isolation, and cognitive inflexibility, which can lead to difficulty in seeing any option but suicide. (x)

(Left: During secondary school // Right: During sixth form college)

I continued to experience passive suicidal thoughts and then, during my second year of sixth form college, I started to struggle with depression and my ever-present anxiety reached all-new heights (although, in comparison to what I experience now, I’d happily go back to it). Almost a decade, multiple diagnoses, and more than twenty medications later, my depression is the worst it’s ever been and I’ve been actively suicidal for almost two years. There have been short periods over the years (always in concert with the times I tried medications other than Phenelzine) where I’ve struggled with suicidal thoughts but, for the last two years, they have been almost constant.

They began in earnest when I started taking Xaggatin for my ADHD (and had to stop taking Phenelzine because my ADHD clinician was insistent that the side effects were unsustainable – I disagreed for multiple reasons but this isn’t the post for that story). I thought the intensity of the thoughts – and their slow, scary manifestation into urges and intentions and plans – was a side effect but it wasn’t long before my depression crept back in, sucking me down. Between that and the other awful side effects, my psychiatrist switched me to another medication, Bupropion, an antidepressant that’s supposed to help with ADHD but it only made things worse: I was so anxious, depressed, and suicidal that I couldn’t function. I tried a few more antidepressants, was traumatised by several more doctors, and had the crisis team called out (although they didn’t do anything, including the things they’d said they’d do). I quit treatment entirely for a while, unable to mentally handle it; I basically retreated to my bed and stayed there. I couldn’t engage with the world: it just hurt too much. But without treatment (I didn’t even have a therapist at this point, another thing that had spun my life out of control), the claws of my depression dug deeper and deeper. I remember one day where I had the sickening realisation that I wasn’t doing anything worthwhile with my life, that I had wasted my time and my education, that I was a complete waste of space. There was another day when I realised that something had broken inside me, something that could never be fixed, and I was no longer the person I had been and would only ever be a defective, inferior version of her. I avoided mirrors for months. On New Year’s Eve of 2021, I stared at the fairy lights in my living room and thought about how I had no desire to survive even the next 365 days. It wasn’t a resolution but I felt it with a quiet certainty. I thought about it everyday but then somehow that dreaded day arrived and I was still here, despite that certainty, despite my plans. I hated myself for it, feeling like a pathetic, weak-willed coward. It was a terrible night, not that I remember much of it given the distress I was in.

Somehow I ended up on Phenelzine again, despite my revulsion at the thought; I still don’t really know how it happened and I still find myself so angry about it that it feels like it might consume me. But, for a while, the chronic suicidality was relocated to the side burner: it was all still there but it wasn’t the only thing in my brain anymore. I could ignore it for sometimes days at a time. But after a while, my depression seemed to billow back in, like ink in water. The suicidal thoughts and urges became – and still are – the constant undertow to my thoughts and sometimes it’s all so overwhelming that I can barely breathe. Self harming has long stopped being an effective coping strategy as it just makes me feel pathetic for not doing more damage. I don’t know why I haven’t acted on these thoughts. I don’t know why I’m still here. If asked, I’d probably say, “because I’m a coward,” even though I know that I’d likely get a verbal thrashing from anyone I voiced that feeling too. I can practically hear my therapist (yes, I’m back in therapy) encouraging me to dissect that feeling. I know it’s not a healthy, rational thought but it is a real one. It’s a weird state to live in and the conflict of planning for a future I don’t particularly want to exist in is disorientating and miserable. It’s exhausting. But I know what my fate is, whether it comes sooner or later, and I have for years.

Following a slightly different train of thought, it’s very strange to me that people can’t seem to tell, just because it’s such an overwhelming experience for me. I feel like I have a massive neon sign over my head: “SUICIDAL.” But then I wouldn’t be surprised if people just don’t comment because they don’t know what to say. The last time I self-harmed, I cut my face because I needed to look as broken as I felt (or inasmuch as I could physically manage, which wasn’t enough – more shame and self-hatred) and almost nobody even mentioned it. (Not that that was the point but it did surprise me. Most of the time I avoided the question. I only lied once: I was in a weird headspace already and the question took me off guard and I just didn’t have the emotional energy to explain.) The cut got infected and took weeks to heal. I’m glad it left a scar but I resent it for not being bigger: the disfigurement doesn’t accurately reflect the feelings, not by a long shot.

(Left: The dressing on my face after I self harmed // Right: The scar after it finally healed, having got infected.)

In some ways, I feel like I’m already disappearing: I struggle to make sense of my face in the mirror and, while I don’t know about this year, there are fewer than ten photos of me in 2022; my autistic masking is so ingrained that the real, brutally honest me who is struggling and suffering (who so desperately needs to be seen) gets locked away so tightly that she might as well not exist, while a socially acceptable and palatable projection of me – the only version of me that people could want, says the voice in my head – takes over my body, acting almost without my permission; I feel like no one knows the real me any more, not after months in bed, besieged by suicidal thoughts and impulses. I feel permanently damaged by it but people are still treating me as who I used to be and not who I am now (not that I think it’s their fault – while the damage feels so deeply clear to me, I know that it’s not visible to anyone else). I remember the old me. I remember the person who could be proud of being different and who advocated for acceptance, even though she still felt broken. It was a balancing act but there was balance. Now the broken feeling has broken the scale. I feel unrecognisable. I noted down somewhere – last year at some point, I think – that feeling like this feels like one elongated near death experience. Almost every day for more than eighteen months, I’ve been so close to death that I can feel it’s presence in the air when I breathe in; I can feel it in my lungs. One decision – one split second – away. Maybe it’s just dying in slow motion. Feeling this way… I don’t know how it doesn’t change you.

I was reading various articles as I both researched and procrastinated this post and, in one of them, the author had written this: “Because depression, as we all know, is almost always treatable.” The statistics vary, depending on where you look, but a high percentage of people (this page claims between 80% and 90%) do eventually respond well to treatment. After ten years, over twenty medications, and more hours in multiple therapies than I can count, I’ve only ever managed periods of being mentally well. The longest period was, I think, two and a half years at the most. Only one medication actually helps and I’ve run out of new ones to try. The other options, according to a consultant in another very distressing appointment, would be the Ketamine trials or Electroconvulsive Therapy, neither of which doctors fully understand (the same could be said for antidepressants). Given how abnormally I respond to multiple medications, I’m terrified of how these treatments might affect me. I’m terrified of how Phenelzine is affecting me. With all of that in mind, I can’t help but wonder – and have wondered for a long time – if I’m included in that small percentage that doesn’t respond to treatment. And if that’s the case, it means that this is forever and that is an unbearable thought.

I’ve spent a lot of time talking with my therapist about this – and no doubt this post will spark multiple new discussions – and we did talk briefly about what I could write for this post, what would feel actually helpful to someone reading (I never figured that out, by the way, so I have no idea if this is helpful or not). She said that the most important thing is to talk about it and that it’s much more dangerous not to talk about it. I agree with the latter part but I’m not convinced that talking about it is helping me; I often feel like I’m just going around in circles and exhausting myself. She asked me what I would say to someone I loved if they expressed all of this to me and the truth is that I honestly don’t know. I don’t know because I’ve never heard anything that’s helped me. I think we all have the knee-jerk reaction to say, “Please stay. I love you and I’d miss you.” It’s true and it’s heartfelt but is it fair to ask someone to live in agony, in unbearable misery, because you’d miss them? We want to say, “Things will get better.” But we don’t know that. We can’t promise that. We want to say, “How can I help?” But it’s unlikely that there’s any one thing a person can do to help, although that one is more specific to the individual person. If someone asked me that, I couldn’t give them an answer because there is nothing they can do to help. It’s so much bigger than one person, than them or than me. Maybe these help some people. For me, none of these things change the reasons I’m suicidal and they’ve only added unhelpful pressure and stress. I’d hate to do that to someone else. I’m not saying the right words aren’t out there. I’ve just never heard them. Or discovered them.

Obviously I haven’t shared everything. As I said, I didn’t want to share things that have been proven to push people passed their limits (although I hope everyone read the warning and acted accordingly and prioritised their mental health) but there are also certain things that are too hard to share, too raw, too loaded. But I wanted to share my experience today, not just because it’s an overwhelming aspect of my life, but because sharing our experiences and our feelings is, as I said in my introduction, one of the few ways (and possibly the most powerful way) that the world gets better at helping people. People can only do that if they understand the battles being fought and the support that’s needed. I hope that sharing my story can help with that, even if it’s just a drop in the ocean.

RESOURCES:

• Samaritans
• Mental Health Foundation
• Mind
• YoungMinds
• Papyrus
• CALM
• Shout