5 things I tell anyone with suicidal thoughts, as a psychiatrist who has been there too

I am a Black, queer, psychiatrist, and I live with a history of suicidal ideation and two suicide attempts.

When I first experienced suicidality at age 13, I was sure I was going to die. At the time, the discrimination I was facing felt like a reality I would never escape, and my mind seemed determined to offer me only one way out. I hid my suicidality, ashamed that my mind was apparently so weak that it had turned to thoughts of death. I strove to present the perfect face to everyone so no one would know that each day felt like a nearly insurmountable struggle, one where I went to bed each night wondering if I would survive the next day.

Over the years, I learned to manage my suicidal thoughts, and I’m currently in remission. The process was trial and error. Some techniques I used are ones I still turn to when my suicidality recurs. Others were discarded because they didn’t work or actually made things worse. Eventually, my suicidality transformed from this overwhelming, esoteric force into a part of myself that I understand and empathize with.

As a child and adolescent psychiatrist, I meet kids and young adults when it’s their first time experiencing suicidality. And because talking about this is still seen as taboo, this may be their first time disclosing that they have thoughts of not wanting to be alive. Together, our work becomes about understanding their mind, their suicidality, and how to help them survive and learn to thrive. Through that work, I’ve noticed a few recurring themes that have helped both me and my patients.

Here are five things I tell anyone living with suicidal ideation.

You are not alone in experiencing suicidality.

I’ll never forget the day one of the young adults I work with said he didn’t know anyone who felt like this. He was going through his third depressive episode with suicidal thoughts. Tears came as he talked about the loneliness he felt. He was essentially telling me: No one talks about this. It’s lonely to sit alone with this. We don’t talk about this enough as a society.

Then he said the words, “I don’t know anyone who lives with suicidality.”

After some quick mental deliberation, I decided to self-disclose my own history with this patient. In a safe and ethical way, I told them I lived with suicidality too. The tears stopped, and something changed in our work together from that point on. Although we look nothing alike, our shared commonality of living with suicidality has led to him being more engaged in his care (he’s doing quite well now).

So, in case no one has told you, you are not alone in experiencing suicidality.

Since I started sharing my story online, I’ve received numerous messages from people who live with suicidality too. Some have experienced it only once, while for others it’s chronic. Others, still, have had multiple bouts of suicidality and now are in remission, like myself. There are far more of us than I once would have imagined. When I say “You’re not alone,” I mean that you are not alone in experiencing suicidality and we are here together in this.

Anchor to your dreams.

I’m often asked what helped me survive my suicidality. I tell people that my dreams kept me alive. By that I mean I anchored myself to every single dream I could.

In college, I bound myself to the dream that my friends and I would make the world a better place. In adult psychiatry residency, I focused on my dream of creating a clinic for kids facing discrimination. Those dreams gave me hope for a brighter future and reminded me that I still had work to do.

That said, I realize that anchoring to future aspirations when you’re suicidal can sometimes seem impossible, thanks to the unhelpful cognitive distortions that often come with suicidality. So if dreams seem too out of reach, try asking yourself: What are some small goals that can center me?

These can be as simple as taking a shower every day or going for a walk once a week in nature. Or they can be “shoot for the moon, land among the stars” goals, like the dream that has stuck with me since my very first suicidal thought: to find a way to help other people experiencing suicidality.

Let yourself dream further than far enough.

Tell someone you’re feeling suicidal.

I hated myself when my suicidal thoughts first started. Part of that self-hatred came from the discrimination I was facing, from being called gay slurs and the n-word. Part of it came from shame and the misplaced notion that I should be “strong enough” to handle this. I thought burying the suicidal thoughts would get rid of them. My fervent hope was that not talking about it would make it go away.

Instead, it only grew.

When I told someone for the first time in medical school, relief spiraled through me. I felt free. Like I was no longer alone, trapped in my mind with thoughts of killing myself. Someone I trusted now knew and was by my side.

These days, the second my suicidality comes up, I tell someone. Several people, in fact. I have a list that includes my roommate (a brilliant fellow psychiatrist), my career mentor, my therapist, trusted people in my local community, and a couple of friends from college who have been on this journey with me since the beginning. I tell them, “Hey, my suicidality has come back because of ____. I’m safe and I know what to do.” It’s a small way to let them know I’m struggling, that I would appreciate touching base every once in a while, and that I’ll keep them up to date as I heal.

Don’t hide that you’re suicidal. I’ve heard from many people that they’re scared of getting admitted to the emergency room if they open up about their suicidality. I’ve also heard that they’re afraid of the police being called, especially because law enforcement can be dangerous for minoritized people and those living with mental illness. These concerns are valid, and there is a great risk in keeping this to yourself. (On that note, if someone tells you they are having thoughts of suicide, your first instinct should be to get curious, not jump to hospitalization.)

If you are having passive thoughts of suicide (like thinking “I don’t care if I wake up tomorrow” but no intent or plan to act on it), one way to tell someone is, “I’m having passive thoughts of not wanting to be alive. I’m safe right now, and I just needed a friend to talk to.” Saying this to a trusted friend or mental health professional can open the door for support, resources, and regular check-ins.

For people with active suicidality that does not subside, it’s important to get professional help immediately. That can look like telling a trusted person, “I’m having thoughts of killing myself with a plan, I need help.” Or, if you aren’t sure who to tell, you can call 988 to speak with a trained crisis counselor 24/7. If you have a healthcare or mental health provider you trust, ask them what facility they recommend so you can get the care you need. And, as uncomfortable as it seems, going to the nearest hospital is one of the fastest ways to intervene in a moment of crisis. If you or someone else will be calling 911, make sure law enforcement knows that this is a mental health call for someone experiencing suicidality and that they do not have any weapons.

Don’t suffer through suicidality alone. There are people out there—including this psychiatrist—who care about you and are here to support you.

You don’t have to pretend everything is OK.

During my second episode of suicidality in medical school, I found myself slipping into a reflexive state of false positivity. I said that everything was great when it wasn’t. Even the classmates and administrators enacting discrimination were “doing their best.” I did the same thing years later when I experienced emotional abuse from an intimate partner. I would say, “I can tell they’re trying to do better,” (they weren’t). “They’ll change if I find the right words,” (they didn’t). “They’re wonderful and clearly I’m doing something wrong.” I told myself that some of the most horrifying moments of my life were “not that bad.” I thought if I pretended hard enough that everything was OK then things magically would be.

There’s actually a word for this process: masking. It’s what we do when we mask our true feelings, stating that everything is “fine” when really we’re suffering. But instead of manifesting a better reality, this toxic positivity is actually burying a part of you that needs to be vocalized. It can also add to your cognitive load, because it’s exhausting to put on a persona that isn’t you.

It took years of unlearning the conditioning we have as a society to say things are “fine” when they’re not. These days, I’m far more honest about my feelings. And what a relief that has been. Now with my patients, we say that F.I.N.E. stands for “Feelings I’m Not Expressing.”

You don’t have to pretend everything is OK. It’s OK to tell people you trust precisely how things are going. I’ve seen how those types of conversations can lead to deeper connections and love.

Map your pathway to suicidality—and to safety.

My first experiences with suicidality were chaotic. I couldn’t tell what precisely had brought it on, and I thought that if I could just figure out the single trigger, I could stop myself from ever being suicidal again. So I set out to find that trigger. This meant tracking how my suicidal thoughts showed up, when they showed up, what preceded them appearing, and what I did after they occurred each time. What I was doing was keeping a thought log to help me discover the source of my suicidal thoughts.

The result is what I now call my “Pathway to Suicidality.” It’s a map of precisely what leads to me experiencing suicidal thoughts. For example, discrimination leads to me feeling more anxious. If I can’t manage the anxiety, then depressive symptoms arise. If I don’t manage the depression, my suicidality comes as a “way out.”

Just as importantly, I plot all the various intervention points along my pathway, such as telling friends I’ve gone through a discriminatory moment, taking my antidepressant, going to therapy, going for more walks. Along my path to suicidality, I created a hundred ways to intervene. With the help of others and years of practice, I learned to outsmart my personal brand of suicidality.

You aren’t alone in experiencing your suicidality, but your pathway and interventions will be unique to you. I urge you to get curious, ideally with the help of a licensed mental health professional, to learn what factors influence your suicidality and what interventions help bring you back to safety. What is your pathway to suicidality and where can we intervene?

The bottom line: You are loved and needed here.

Living with suicidality changed my life. It’s changed how I exist as a Black, queer person in America. It’s changed how I practice. It’s a part of who I am.

While I’m not exactly grateful that I’ve experienced eight episodes of depression with suicidality, I am grateful for how those moments have led to deepened conversations with the people I love and has helped me more deeply empathize with others going through suicidality.

Through all of the times I’ve been suicidal, I remember the support, the kindness, and how I grew from those instances. Most of all, I remember how my friends and family looked me dead in the eyes and said “I love you.” Their love has been life-changing and life-saving.

So I’m saying this to you all now if you live with suicidality: I love you.

Don’t give up hope. We’re all here with you.