We Need to Talk About The S Word

Suicidal Ideation in Mental Health Disorders

CW: This article mentions suicide. If you or anyone you know needs help, please call the 988 Suicide and Crisis Lifeline.

Some time ago I published an article explaining how and why neurotypical people will never understand the true nature of mental illness, or what it’s like to suffer from one.

Now, I’d like to complement that article and expand on a specific aspect of mental illness that is often considered too taboo to discuss: suicide. More specifically: suicidal tendencies and ideation in mental health patients.

The Taboo:

Our society seems to have implemented a collective “moral repulsion” of the very idea of suicide, which might just be one of those aspects of Western culture that owes its puritanical nature to centuries of embedded Christian mentality. And, as with many other “tenets” that centuries of enforced Christian thought would have us believe, it actually stems from misinterpretation and deliberate distortion of the actual Biblical text.

Specifically, the Christian condemnation of suicide as an abominable sin stems from Saint Augustine’s personal interpretation of God’s command “thou shalt not kill,” which, in his opinion, should apply not only to others, but to oneself as well — an argument which he “substantiated” by claiming that, if God had only intended it to be directed towards others, and not oneself, the text would have read “thou shalt not kill thy neighbor.”

But enough speculating…

What Science Tells Us:

Suicidal thoughts and tendencies are extremely common in mental health patients. The 2019 study “Diagnosed Mental Health Conditions and Risk of Suicide Mortality” discusses a research conducted on mental health patients who died by suicide and concludes that “half of those who died […] had at least one diagnosed mental health condition in the year before death, and most mental health conditions were associated with an increased risk of suicide.”

Another study, published in the National Library of Medicine, claims that the mental disorders more statistically associated with high suicide rates are Borderline Personality Disorder, Anorexia Nervosa, Depression, and Bipolar Disorder.

So, why — may you ask — are so many mental disorders linked to suicidal behavior? Well, there are many reasons, and some of them are relative to each individual’s diagnosis and personal history.

But the most common reason is the simplest one: suffering from a mental health disorder is an excruciatingly painful condition, regardless of one’s specific diagnosis. A schizophrenic person, a bipolar person, a depressed person, a borderline person, or any other mental health patient deals with a gargantuan amount of stressors, emotional triggers, mood instability and/or dysregulation, among a myriad of other disabling and distressing symptoms, on a daily basis.

Mental health patients who struggle with suicidal tendencies know all too well that neurotypical people, or people who have never considered ending their own lives, could never imagine the intensity of their struggle and pain, and that inability to empathize with and understand the suicidal person leads the latter to feel even more alone and isolated in their pain.

Our Collective Inability to Understand Suicidal Ideation:

All too often in our society, suicide is seen as a matter of will: the same way that one “wills themselves” into a suicidal state of mind, they should be able to “will themselves” out of it. This naive assumption fails to take into consideration all the different elements that contribute to the molding of the suicidal mind, which can include, among other conditions, long-term depression and complex trauma, not to mention more “immediate” concerns such as poverty, lack of health care (whether physical or mental), homelessness, etc.

It also fails to consider the neurobiological basis of suicidal ideation. Many of you may be familiar with the idea that chronic stress and fatigue “rewire your brain,” but most of you will probably be utterly unaware of just how differently the brain of a neurodivergent patient operates in comparison to a neurotypical one’s, and what that may be like for the neurodivergent patient.

Specifically, the case of Borderline Personality Disorder (BPD) may offer the greatest insight into society’s ignorance of the neurobiological basis of suicidal ideation. BPD is a condition that has historically been stigmatized both inside and outside of the medical community, to the point of having Borderline patients being called “attention-seeking and not actually ill” as recently as 2017. In reality, however, PET scans of the brains of Borderline patients have proven that BPD is linked, among other things, to abnormal activities in the amygdala and limbic systems of the brain.

Not surprisingly, suicidal ideation is one of the main symptoms of BPD, and statistics show that as many as 73% of Borderline patients have attempted suicide at least once.

Toward a new understanding of S. I.:

In his 2023 book How Not To Kill Yourself: A Portrait of the Suicidal Mind, author Clancy Martin makes the brave attempt to define suicidal ideation as a long-lasting (in some cases even chronic) disabling condition akin to most other symptoms of mental illness, thus challenging society’s popular interpretation of suicide as a “behavioral” issue: an occasional, one-time “snap” that can easily and quickly be addressed and prevented.

I don’t think there are strict dividing lines between these […] phases of my life or stages of suicidal thinking: they blend into each other in various ways, and sometimes fifty-four-year-old Clancy’s fantasy of ending his life doesn’t seem very far removed at all from the seven-year-old’s.

As Martin clarifies, suicidal ideation and suicidal behavior are not the same thing. One can suffer from suicidal ideation without regularly — or ever — engaging in suicidal behavior. When talking about suicide, we should not exclusively focus on the action itself, or the plan to take action, but also and especially on the very specific mental framework that causes suicide to appear like a desirable outcome in the first place.

The mental state that allows the very idea of suicide to not only be conceived but also to grow and take root in one’s mind is a critically understudied aspect of the issue, and it’s only by discussing, analyzing, and understanding this issue that we can begin to take concrete steps in the treatment of suicidal ideation.

Because society’s focus seems to be on addressing suicidal behavior alone while ignoring the underlying issue of suicidal ideation, too many people afflicted by S.I. do not receive the care that they need up to the point when they take specific steps to implement their suicidal fantasies, because, by society’s overwhelming definition, suicidal ideation alone is not a mental health condition; it is, most likely, a matter of the temporary failure of one’s will, a short-lived worsening of one’s depressive state, and not a condition in and of itself. Society has not developed the right tools to address the issue of suicide, because it has not developed a correct understanding of suicidal ideation as a mental health condition.

Suicidal tendencies and ideation are not rare, individual issues that can be “willed out” of existence. They are a medical issue, as well as a societal issue, because it is up to society’s primary institutions to provide mental health patients with the tools that they need to battle this disabling condition, as well as many others.

Martine Nyx is a filmmaker, writer, and educator. She was first diagnosed with Borderline Personality Disorder at the age of twenty-one. She has been living with BPD for over five years since her initial diagnosis and survived multiple suicide attempts. She is currently based in Toronto, Ontario.

Here are some of her other writings on the subject of mental health:

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