By Kelly Brogan, MD, ABIHM (originally published on madinamerica.com)
We have been conditioned to look upon the tender topic of suicide with horror. Perhaps because it represents a failure of our varied systems of control. Perhaps because we are, collectively, far from being at peace with the complexities of death as a part of the human experience. Perhaps because we have to pretend that we have never personally felt anything like suicidality in order to maintain the illusion that the experience of suicidality is pathological.
Suicidality is not one thing. It is not a symptom of genetic illness. It is not rare. And it is not simply a desire to end one’s life.
In college at MIT, I worked a volunteer suicide hotline called Nightline and spent many nights on the phone with people on the brink.
I learned that suicidal thoughts can be a desire to disappear. To not be instead of being. They can be a crisis of faith and a perception that everything is terminally wrong. They can be a deep grappling with whether the universe is fundamentally a benevolent or a hostile place. They can be the stuck belief that things will always be exactly as they are now.
I believe suicidality to be a nearly requisite expression of urgency for change that must be met with the promise of such change being possible. These feelings express the need for deep transformation that feels like a rebirth, replete with the labor pains and expressions of anguish and overwhelm. They are a scream that says, “This way of being, of living, cannot go on one second longer!!!”
Suicidality as a symptom of awakening
I know that you have helped a lot of people, but I just can’t do it. I’m done. I have nothing, my life has been struggle and suffering and I need this to be over.
And she meant it. Sonia was six months past her last dose of Effexor—a medication she had been on since she was 15. She is now 42.
At any given time, about 30% of my practice is actively suicidal. They know that I am comfortable with this. They know that I never have called 911. Never put them on a patronizing suicide watch. Never have drawn up some promissory note-type contract. I have never implied for one second that they don’t have what it takes to move through this.
They know that I am not scared of them or their feelings.
Rather, I perceive that something in them needs to die in order for them to be reborn and that this is their raising of the white flag. This surrender is the end of the end and the beginning of the beginning, if only we let the pain come up, come out, and leave. And it does. It moves. It changes. And often, what comes in its wake is exactly the kind of shift that could never have been prescribed, taught, or suggested. It’s deep spiritual growth.
In my taper process with patients, I aim for a strong, resilient physical foundation, first through a one-month commitment to self-care. I tell them that I am here to help support their body’s stress resilience and to offer them a taper process as free as possible from rashes, hair loss, menstrual abnormalities, electric shocks, body pain, and the myriad bodily signs of psychotropic withdrawal. But I am not here to make it easy or even tolerable on a psycho-emotional level. This is because I know that transformation is a necessary part of the alchemy of a successful taper. The part of them that believed in medication needs to be shed. But that part rarely goes quietly.
Transformation requires the death of an old self. Of old beliefs. Of old forms of security and identity. Transformation is disorienting and even terrifying.
Psych med-induced suicidality
The transformation process reflects a conscious grappling with suicidal feelings. These patients interact with the most existential of questions—to be or not to be. But psychotropics can also induce impulsive violence against self. Anytime I hear of a completed suicide in the media, my first thought is, “What were they on?” As in the case of Kim Witzack’s husband, Woody, who never felt suicidal a day in his life and was found hanging in their garage five weeks after initiating Zoloft, psychiatric medications have a poorly understood capacity to induce a dissociation from the soul. In fact, many of those who commit suicide in the setting of akathisia-induced impulsivity describe a sense of disconnection from their body and go on to hang themselves.
It is my belief that psychotropics can marry impulsivity and agitation with a mysterious rupture in consciousness, such that these acts of self-extermination make sense and are often completed.
In their description of psychiatric drugs as substances of chemical influence, Moncrieff and Cohen state: “…psychiatric drugs are, first and foremost, psychoactive drugs. They induce complex, varied, often unpredictable physical and mental states that patients typically experience as global, rather than distinct therapeutic effects and side effects.”
How to help in the moment of crisis
1. Show what’s possible.
As Biggie would say, “If you don’t know, now you know.” It is particularly important to represent the possibility of medication-free recovery to those who are on meds and suicidal (or are recently initiated on them). Share these videos of radical healing, many of which depict histories of suicidality. Make sure those struggling know that suicidality can be an integral part of the experience of self-healing, and that moving through the portal of change can lead to something so grand and so much more incredible than their scared mind can show them in this moment.
2. Have no fear.
Check your own baggage at the door, please. Worry and concern are my least favorite words, you know why? Because when you worry about someone, you are dumping your unmetabolized fear into their already full lap. When we are in crisis, we need to be held in the light of possibility. We need to be reflected two things: “It’s going to be ok” and “You’ve got this”; not “I’m worried about you” and “I’m gonna call the police.” Fear-based escalation of this delicate situation is not going to help your loved one. Neither are more medications, the inevitable outcome of professional intervention.
Do you know how healing it can be to feel seen and heard? Many who are suicidal struggle with a sense of existential invisibility at best and deep shame at worst. They feel wrong inside, perhaps permanently. They feel like exceptions, aliens, freaks of the human experience who simply can’t hack it. An unexpected antidote to that feeling is having their reality received. Quietly and completely. This is empowering because, through you, they can have a lived experience of the possibility that their ugliest truth is not too much. It’s not grotesque. They can see that you can handle it, receive it, and reflect back to them that you’ve really listened and heard them. Leave room for pauses, reach out a hand if that feels right, and if they are open to an “exercise,” set a timer for three minutes and just try to hold each other’s locked eye gaze. It sounds strange, but it’s the fastest way I know to drop into the heart and out of the mind. Within even one minute, they are likely to have an emotional release of some kind from this simple experience.
4. Normalize and contextualize the experience.
So far, you may have noticed that I haven’t recommended a lot of talking, advice, or guidance. In fact, when someone is in this kind of a fear state, their childself wounds are likely hemorrhaging all over the place. They don’t have access to their “rational” prefrontal cortex, the managerial capacity of the brain, because they are in their reptilian limbic system. Use simple phrases, the way you would speak to and soothe a child (without being patronizing). It can also be helpful to speak in visuals. Symbols are powerful, so normalize this inflection point in their lives with the invocation of a metamorphosis image. . . .Refer to the way a caterpillar must feel, all gooey and disoriented in the dark before it has to squeeze out of the tight hole in a chrysalis to be reborn.
I tell my tapering patients: this is what it’s supposed to feel like. Change is confusing, overwhelming, and often terrifying. Your ego hates change and it is likely freaking out because it knows that a part of it may be about to slough off. It almost has to feel this way in order to lay down new tracks for a radically expanded experience.
5. Find meaning.
If you know this person well, you might invoke the power of meaning-making. I have observed that suffering ends where meaning begins. And that beyond normalizing the archetypal nature of self-initiation and transformation that feelings of suicidality can attend, the meaning of this particular juncture in their life can bring great organization and solace to the emotional chaos.
What do you know about them that they need to let go of? What’s not working? Can you reflect that they can handle this and that they are ready to move through the tight part of the birth canal? What programs, beliefs, and voices are criticizing them? Can you encourage them to turn toward the pain and personify it as their childself, or even just a small same-gendered child that is terrified and confused?
Often the suicidal “part” of someone is the internalized critic/parental voice admonishing them with shame-inducing epithets. When we individuate from our parents (energetically), when we try to reclaim our power and look at old programs that no longer serve, often this punishing voice rages. . . simply because it knows it may be silenced for good.
6. Remind them that they are simply feeling.
As a nation, we have very little experience with feeling. In fact, it terrifies us to encounter the raw power of unbridled emotions like anger, grief, and shame. The lengths we go to in order to avoid feeling subtend and define our modern day addictive lifestyles. But what if someone who is feeling that they can’t go on another day is simply a sentinel of a new kind of humanity? What if they are leading us all into a new way of courageously relating to the shadow, to our dark parts, and holding that in witness consciousness and love? It’s possible that the pain they feel is all of our pain. . . and the rest of us are simply numbed out.
Remind them, though, that they are simply feeling a feeling; probably an ancient feeling that they were told wasn’t safe to feel early on in their lives. Feelings are energy and they, by definition, transform and change.
Encourage them to reflect on the last time they felt crushing soul pain. Did it transform? Of course it did. And once it does, we have that lived experience to draw on the next time life brings us to our knees, so it will never quite feel this blinding again. It’s the experience that a naturally birthing woman has—almost every naturally birthing woman: that she wants to give up the moment the baby’s head is crowning and about to emerge. And then the baby is born.
Part of really feeling is acknowledging that we are not in control. To truly feel a feeling, we must surrender to it. The moment we do, it releases. But if you lock horns with it, the limbo state of resistance can generate a kind of ongoing misery that would naturally lead someone to want to opt out. So encourage this person to say “Yes, ok,” to the feeling as a starting point.
7. Move into service.
This may not appeal to all types, but it certainly has helped me in my darker moments. When I’ve been at the brink, I’ve taken great solace in the fact that the simple experiencing of my own pain will help me to help others in the future. This is because there is no shortcut to empathy. You can’t take a class on it, you can’t watch someone else experience it. You have to get in the muck and see what being that dirty actually feels like. And then, as a lasting gift, you are forever deeply connected to others who visit that place you were in. You become the wounded healer.
It can’t be a coincidence or an accident that so many of those who fully recover from psychiatry go on to serve others as healers. I had to create a peer support arm of Vital Mind Reset simply because these individuals wanted to pay it forward, and recognized the diamonds they had collected from their own coal mines. Those who can transform suicidality into service are some of the most powerful sources of healing on this planet.
8. Offer gentle support.
Language is powerful. That’s why we have been so careful with it up until this point. If you succeed in offering this person a glimpse of ok-ness, you might want to give them something to take them through the following hours. A simple mantra like “I can do this,” or “I’m ok,” or “It’s going to feel different soon,” repeated hundreds of times an hour can help to create the conditions for a shift in perspective. Similarly, encourage them to visualize themselves free of this pain—whole, healed, strong—to invoke the power of a seeing-it-into-being potential. A tapping exercise for suicidal thoughts, a meditation for crisis, and/or flower remedies for the dark night can also be a secondary line of support after you have established a connection.
Let’s evolve the conversation on suicide
Even if you don’t have someone near you struggling with this, open yourself to a new perspective on suicidal feelings. We must, as a collective, reorient around the crisis of self if we are ever to mature beyond our dysfunctional habits of unconsciousness. Together, we can hold individuals who are plumbing the depths of their pain and help them to transform it. We can show them that there is another, med-free way to accept themselves and that there is precedent for what it looks like to break free from psychiatry, its labels, and consciousness-warping chemicals. We need to turn toward this elephant in our sociocultural room and make room for dark feelings to be felt without reflexively freaking out, maligning, or pathologizing. When feelings are truly felt and accepted, they lose the capacity to translate into violence.