Reflecting on My First Suicidal Thoughts

Prevent Self-Harm by Understanding Suicide

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I have never publicly shared these thoughts. At 3am, I woke up in excruciating back pain. I wondered if paralysis was setting in. As a test, I tried to walk. But I couldn’t flatten my feet. What I could do is move around on toes and the balls of my feet without heels touching the ground. Hyperventilating, I made numerous attempts to fix the problem. I closed my eyes, held a chair, and put all of my weight into pushing my left foot down. Failing this strategy, I lifted my desk and shoved my foot underneath. My entire left foot convulsed, refusing to relinquish its position off the floor.

I was incapable of driving. I was incapable of standing still. Walking through the kitchen was an episode of chronic wincing. Add in the insomnia and I was losing control of my mental faculties. For the first time in my life, I thought:

I cannot live like this.

I cannot handle this level of pain.

If this is how my body will be, I will kill myself.

I sat on the floor of my office in an attempt to manage my breath. My mind wandered to how I would kill myself. I thought about my three daughters. I conducted a mental calculation of what they would lose versus gain. I could not be the father I try to be in this condition.

This happened years ago. At the time, I revealed these thoughts to three members of my wise council (that we all need - click here).¹ I received treatment for my back from specialists. As my bodily functioning returned, the thoughts dissipated. But occasionally I reflect on this period - what if my body remained aberrant?

National Suicide Prevention Month

I raise this specter of my past in hopes of normalizing terrifying thoughts, feelings, and bodily sensations that lead too many humans to kill themselves.

Suicide is the leading cause of preventable death in every country.

Fortunately, my suicidal thoughts disappeared. Friends helped me. Being a clinical psychologist, I used multiple emotion regulation strategies to reduce the influence of (somewhat rational) thoughts on my actions. I reflected on a plot twist in my personal narrative and how I could live well if this impairment remained, just differently. It was not easy. It rarely is when these thoughts enter the brain.

Thankfully, in the throes of peak pain, I didn’t transition from thoughts about ending my own life (suicidal thoughts) to making an actual intent to die (suicide attempt). I did possess similar thoughts in another life period. And thoughts may emerge in the future. I am not alone. You might have experienced something similar. At the very least, you know someone who had these thoughts - even though they probably kept them hidden.

Consider this staggering number:

Suicide accounted for over 48,000 fatalities in the United States in 2022 (among the top ten leading causes of death)

Scientists are starting to understand why people kill themselves.

Three Interlocking Risk Factors

Thwarted Belonging

Nearly every non-fiction psychology book mentions the following:

Humans possess a basic, fundamental need to form and maintain strong, stable, meaningful social connections. When this need to feel a sense of belonging is unmet, when friendships are absent, dysfunction is fueled.

Remember that the emphasis is on perceptions - a perceived sense of an unmet need to belong. As perceptions, not realities, be careful about placing blame on survivors.

Perceived Burden

What is the biggest difference between notes of people who are suicidal who kill themselves versus those who don’t? The last notes of people who killed themselves contained greater detail about their burden on other people and society compared with people limited to suicidal thoughts and attempts. A perceived sense of burden was the only dimension distinguishing the letters of these two groups. Other studies replicated these findings.

In general, people rarely kill themselves out of pain intensity and frequency alone. A stronger factor is believing you are an ineffective, redundant, useless element in other people’s lives. Others would be better off without you. You are best classified as a burden. Note that this risk factor is about perception, not objective reality. In this case, “facts” rarely matter.

Acquired Pain Tolerance

What enables a person to stab their heart, ingest poison, or jump off a 7th story balcony (something my beloved grandmother did when I was in my twenties)? It might be controversial to use the word courage, grit, or strength in this context. Yet, a suicidal person must overcome intense emotional distress to complete the final act. Leading suicide researchers speculate that a sense of burden is necessary but insufficient to understand who kills themselves. A person requires the capacity to harm themselves. A person must be highly tolerant of conflict to make room for the mental experiences that arise when working toward the goal of ending life. This distress tolerance must be acquired somewhere along the way. Researchers suggest that the greatest suicidal risk exists when there is :

Thwarted Belonging x Perceived Burden x Self-Harm Capacity

This acquired ability can arise in unusual ways such as:

• exercising to failure and beyond.

• playing violent and extreme sports.

• getting multiple body piercings and tattoos.

• shooting guns.

• getting in physical fights.

• obsessive training at anything from playing the violin to marathons (see the movie Whiplash for a visceral expression)

Repeated “good” and “bad” experiences open a portal to accepting the fear of self-injury. A person might respond positively to items such as “Things that scare most people don’t scare me” and “I can tolerate more pain than most people.”

If you remain unconvinced about the importance of an acquired capacity to tolerate pain, consider sobering statistics. Nearly one in 25 people seeking health care services at a hospital because of self-harm will kill themselves in the next 5 years. Dealing with emotional pain by cutting, burning, stabbing, or intentionally preventing wound healing increases a capacity for self-immolation.

An odd feature about this research is that in other contexts, high pain tolerance is a strength, a gift; a form of psychological flexibility that facilitates greater achievement and fulfillment.

Carefully explore the motives behind someone’s actions because what is an admirable strength in one context is a fatal risk factor in another.

Do not grow weary from stories of war veterans and emotionally distressed kids, teenagers, and adults who commit suicide. Let these stories be a call to action. And we have evidence based interventions that can help.

Suicide Prevention Resources

There are few single markers, in isolation, that predict who will kill themselves. Pay attention to the totality of people you know. While it is difficult to talk about death, know that an unwillingness to notice, listen, and express curiosity perpetuates the stigma concerning mental health problems.

• Call or text the 988 Suicide & Crisis Lifeline for 24-hour, confidential support to anyone in crisis. If you are worried about a friend’s social media updates, contact safety teams at the social media company.

• List of Suicide Prevention Hotlines by Country

• A Toolkit for Parents, Educators, Youth, and Clinicians (click here)

• Informational Resources from Stop a Suicide Today

• Informational Resources for preventing suicide at Talk Away the Dark

Provocation

I encourage you to rethink the aftermath of a suicidal attempt. There is a prevailing belief that a person will be permanently broken and unable to function normally in society. Evidence from our lab and collaborations with colleagues raises questions about this misconception. Read these studies and pass them on to someone who could use this alternative message about what is possible (email me for free PDFs):

Rottenberg, J., & Kashdan, T.B., (2022). Well-being after psychopathology: A transformational research agenda. Current Directions in Psychological Science, 31, 280-287.

Tong, B., Devendorf, A., Panaite, V., Miller, R., Kashdan, T. B., Joiner, T., … & Rottenberg, J. (2022). Future well-being among U.S. youth who attempted suicide and survived. Behavior Therapy, 53, 481-491.

Tong, B., Kashdan, T.B., Rottenberg, J., & Joiner, T.E. (2021). Future well-being among United States youth who attempt suicide and survive: Research recommendations. Behavior Therapy, 52, 1213-1225.

Thanks for reading! If you liked this, forward to someone who’d like it. You can also buy me a whiskey shot. or subscribe to my newsletter.

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Dr. Todd B. Kashdan is the Author of The Art of Insubordination: How to Dissent and Defy Effectively (Avery/Penguin) and Professor of Psychology and Leader of The Well-Being Laboratory at George Mason University.

Read Past Issues Here Including:

1. Be sure to read about the nature of loneliness and being friendless - click here for mistaken ideas about loneliness and here for an ode to the loneliness man alive.