Life has hardly been easy lately. COVID-19 has catapulted even the mentally healthiest among us into fear or anxiety, and some warn that a global mental health crisis is looming. I consider it a gift, then, that it’s been a long time since I thought about not wanting to live.
Passive suicidal ideation — thinking about, but not planning, one’s own death — became a familiar coping mechanism between my late teens, and it persisted into my late twenties. I’ve never actively wanted to die. Most days, I enjoyed my life. I was invested in my plans and looked forward to the future. 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.
What is passive suicidal ideation?
Passive suicidal ideation is characterized by thinking about dying or a desire to be dead, without actively making a specific plan to carry out those thoughts. The issue is not formally tracked, so we know very little about the true magnitude of passive suicidal ideation, but: “From clinical experience, I would say that it’s far more common than people think it is,” says Dan Reidenberg, PsyD, a psychologist and the executive director of the Suicide Awareness Voices of Education.
“A combination of factors usually underlies passive suicidal ideation”, according to James Overholser, PhD, a suicide researcher and professor of psychology at Case Western Reserve University. “These include severe or persistent depression, feelings of loneliness or rejection, and hopeless expectations for the future.”
Passive ideation manifested in my life as a blunted ache that rippled in and out of focus, usually accompanying periods of undiagnosed depression. Thinking about no longer existing served as a way to field overwhelming emotions — a temporary coping strategy that morphed into a patterned response to pain. When things felt viscerally bad, I imagined relief in going to sleep and never waking up again. But I never truly wanted to die.
Do passively suicidal thoughts require treatment?
The short answer is yes. Like most psychological phenomena, passive ideation can occur on a spectrum, ranging from indifference towards being alive to questioning one’s existence to a gnawing feeling that life isn’t worth living. The wish to die doesn't inexorably mean you’re going to end your life. But there is evidence that even fleeting and seemingly innocuous thoughts can be a risk factor for suicidal behavior.
A lack of therapeutic intervention, therefore, can be risky, Reidenberg says. People who endure the persistent hum of passive ideation may believe that they’re able to manage the problem on their own, that they’ll never really act on it, or that it will eventually go away. But these thoughts can evolve into something life-threatening.
“Clinical anecdotes suggest that passive suicidal thoughts can turn into active plans,” Overholser says. “If a person has spent time thinking about their own death and then a distressing event happens, they may begin to feel they have no choice but to end their own life.”
Accepting the severity of my thoughts and understanding their potential as a starting point for suicidal behavior was a catalyst for me to pay attention and start thinking about getting help. Which leads me to my next point:
What keeps people with passive suicidal ideation from seeking help?
People might be unsure about how to describe their thoughts. They may downplay their severity, or worry about the stigma their admission could face.
In my own experience, the idea that I wasn’t in any immediate physical danger caused me to remain silent for a long time. I thought what I was going through was, essentially, “just a feeling”. Sharing it and potentially triggering alarm bells somehow seemed irresponsible. I doubted whether I had any right to speak out.
This is not uncommon. When researchers from the University of Michigan asked 165 college students who were at elevated risk for suicide what kept them from seeking treatment, 66% pointed to a perception that they didn’t need it — that their problems weren’t “serious enough to warrant professional help,” the study authors wrote. But there doesn’t have to be a hierarchy whereby only thoughts of a specific content are deserving of support. Suicidal ideation in any form shouldn’t be taken lightly.
Other systemic barriers to getting treatment exist too. These include lack of insurance, lack of funding to pay for services, and poor quality of services, including a dearth of options that feel safe, which is an especially big problem in the Black community. Therapy can feel like a privilege that’s inaccessible to many. Even in the UK, where I’m based and where free healthcare is available through the NHS, patients often find themselves facing agonizingly long wait times.
“We need to do a better job of recognizing the warning signs of suicide and passive ideation is included in that,” Reidenberg says. “Anyone who expresses such thoughts needs to be heard by others and to reach out for help.” Individuals who are passively ideating suicide are often lost in the cracks, and by overlooking them, clinicians might be missing out on a chance for early prevention.
A silver lining to the current pandemic is that it has led to an uptick in telemedicine mental health services. Therapeutic services such as Talkspace and peer support chat platforms like Supportiv may be an option for people who can’t access or afford traditional therapy and have no one talk to about how they’re feeling. If you’re considering using an online company, though, do your research and ask questions to ensure that your privacy is protected and that practices are conducted ethically.
How can I help loved ones with passive suicidal ideation?
“Many family members and friends are reluctant to discuss suicide risk openly with a troubled friend,” acknowledges Overholser. “These thoughts and feelings can become ‘bottled up.’ It can be helpful to allow the distressed person to talk, as it gives them an opportunity to hear how concerning these ideas seem, to themselves and to others.”
Studies have shown that asking someone if they’re thinking about harming themselves doesn’t “put the idea into their head” or goad them into action — but it might provide a much-needed release valve.
Personally, candid conversations about my mental health, while riddled with vulnerability, have been empowering. Acknowledging and naming my distressing thoughts in the presence of another person for the first time was deeply cathartic. Shorn of their secrecy, they no longer felt so onerous. And the more I shared, the more I realized I wasn’t not alone in the chaos.
Before reaching out to a friend about suicidal thoughts, make sure you’re in a mentally healthy place yourself. "It is difficult to help others if you are in significant distress. Make sure you are engaging in self-care strategies," Neda Gould, PhD, a clinical psychologist and director of the Mindfulness Program at Johns Hopkins, told Refinery29 in a previous interview.
It’s also important to use constructive language when speaking with someone who has passive suicidal ideation. And while you’re not responsible for “saving” or “fixing” your friend, you can point them in the direction of helpful resources like the National Suicide Prevention Lifeline or the Trevor Lifeline, and encourage them to seek therapy. Loved ones can also call the NSPL themselves for support and resources.
Sparking a dialogue on passive ideation whether in real life or online can help us build bridges and forge a sense of interconnectedness, which are powerful antidotes to this estranging experience. Now more than ever, it’s important for us to find and create safe communities and forums where we feel witnessed and heard, validated and believed.
How can I manage passively suicidal thoughts?
Seeking therapy is a crucial step. Passively suicidal thoughts should be discussed openly with a professional to ensure they’re not trivialized or normalized, but processed in a way that’s conducive to wellbeing, Reidenberg says. Talk therapy can serve as a place of refuge. A space to breathe and get some perspective, and to sort through our most challenging and confusing experiences.
A therapist may also suggest making lifestyle changes. Some people may find medication, such as antidepressants, helpful as well. Everyone’s treatment path will look different; the first step is simply asking for help.
The good news is that with therapeutic support, people can learn how to cope with chronic thoughts of suicide, explains Reidenberg, and for some, these thoughts can also go away entirely. With a solid support network, strong coping skills, and a commitment to therapeutic relationships, individuals can make changes in their attitudes and gradually move towards more balanced and hopeful views of life.
Passive suicidal ideation wasn’t jettisoned out of my life overnight. Through a combination of therapy, honesty, connection, and lifestyle changes, the intensity and frequency of these thoughts lessened over time, as they receded into the background.
Cognitive Behavioral Therapy (CBT) was a vehicle to challenge my beliefs and personal narratives, and re-learn healthier ways to reflect on my pain, while hypnosis and meditation continue to help me moderate my emotions. I developed the capacity to compartmentalize and step back from my thoughts before getting mired in them.
Sometimes I consider that the process might not be over. I’m a strong proponent of full recovery, yet there’s something relieving and nurturing about giving yourself space to heal without expectations. Perhaps, passive suicidal ideation, like depression, can resurface in times of crisis — in which case it’s essential to develop strategies for managing these thoughts in the future.
If you are thinking about suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Suicide Crisis Line at 1-800-784-2433.