Whispers of Distress: Unraveling Passive Suicidal Tendencies

Written by: Aajolie (3rd year) Department of Applied Psychology

“Grit your teeth and let it hurt. Don’t deny it, don’t be overwhelmed by it. It will not last forever.” - Harold Kushner, American Author

In August 2022, the report delivered by the National Crime Records Bureau (NCRB) on suicidal deaths in India revealed some unsettling figures. A staggering total of 1,64,033 suicides were reported in the country in 2021. This is an increase of 7.2% in comparison to the previous year in terms of total numbers. With reference to the rate of suicide, India reported a rate of 12 (per lakh population). This rate reflects a 6.2% increase during 2021 over 2020, which is a genuine cause of concern as this reported figure is the highest ever recorded in the country since the inception of reporting of suicides by the NCRB in 1967. In lieu of September being considered Suicide Prevention Month, let us take a moment to take a close look at understanding suicidal ideations and how we can cope with it ourselves and also help others.

Suicidal Ideations: Active v/s Passive

Suicidal ideation is a broad term that seeks to describe a range of contemplations, wishes, and preoccupations with ending one’s own life. It refers to the thought process of having ideas, or ruminations about dying or harboring a wish to die. These suicidal ideations may be of two types: active and passive. Active suicidal ideation refers to when an individual has no motivation to live and they have a clear intent to end their life. On the other hand, passive suicidal ideation refers to when an individual has no motivation to live however they do not have any clear intent and/or plans to reach that result i.e., suicidal ideation without actively working toward that outcome. Passive suicidal ideations may occur to an individual in many forms:

● “I hope someone crashes into my car.”

● “I wish I was never born.”

● “The world would be better off without me.”

The biggest difference between active and passive suicidal ideation is the desire to act on those self-annihilative thoughts or whether there are actual plans to bring the thoughts to fruition. Although passive suicidal ideation may not necessarily lead to affected individuals attempting suicide, it is a serious problem that should not be ignored as these thoughts may evolve and take an active form if left unchecked, leading to potential loss of life. Passive does not mean harmless. This train of thought has the potential to make the affected individual more likely to put themselves in harm’s way. Though passive suicidal ideation may appear to be fleeting as the individual does not have any clear intent or plans, the risk of a suicide attempt is very real as the boundary between passive and active suicidal ideation is a blurry line.

Think of it this way, the only difference between the two is that of standing at the edge of a cliff(active) and standing a few steps away from the precipice(passive). The risk is still present, only that it's less imminent. This is why, all suicidal thoughts, whether active or passive, should be handled with utmost seriousness and care.

Leading Causes/Risk Factors of Suicidal Ideation

While there is no singular definitive cause of why suicidal thoughts occur, the following are some leading risk factors that can increase the chances of an individual experiencing suicidal ideation. These risk factors can include but aren’t limited to:

● Mental Illness: Individuals living with mental health conditions such as major depression may have an increased risk of developing suicidal thoughts. A common symptom of depression is anhedonia i.e., the inability to experience pleasure. It can decrease the affected individual’s motivation to engage in activities that previously provided the experience of joy. It can also lead to negative consequences such as loss of job and relationship challenges. These consequences add additional stress and decreased social support. In some cases, living with undiagnosed depression, anxiety, or other mental illnesses could be a factor in passive suicidal ideation. Without the context provided by a diagnosis, individuals living with passive suicidal ideation may not even realize that their thoughts aren’t ‘normal’.

● Living with chronic illness: Individuals living with chronic or terminal illnesses especially ones that involve chronic pain and/or no treatment options available leading to reduced quality of life. This can result in the patients experiencing hopelessness that may potentially develop into suicidal ideation.

● Traumatic life events: In general, experiencing trauma puts someone at higher risk of having suicidal thoughts. Specifically, childhood trauma, or early-life adversity, is a long-term risk factor for suicidal behaviour. Childhood trauma survivors may struggle with self-esteem and experience negative self-talk. These are both connected to suicidal ideation.

● Challenging life circumstances: Challenging life circumstances such as having financial troubles, getting fired from a job, experiencing the bereavement of a loved one, etc., can put one at risk of having passive suicidal thoughts.

● Experiencing Discrimination or not feeling accepted, etc: Being part of certain marginalized communities such as the LGBTQIA+ community or those who experience racial trauma, may be associated with an increased risk of experiencing suicidal ideation.

According to Dr Ketan Parmar, a psychiatrist and mental health expert at ClinicSpots in India, “There is no one demographic of people who are most affected by passive suicidal ideation. These thoughts can affect anyone at any time, regardless of age, gender, race, or socioeconomic status.”

Signs and Symptoms

Suicidal ideation may manifest differently in different individuals.

● Direct Thoughts: People living with passive suicidal ideation can have direct thoughts about suicide, even if they don’t have a direct suicide plan. For instance, they may think, “I want to d*e,” or “I want to k*ll myself.”

● Indirect Thoughts: These thoughts can also show up more indirectly. For instance:

a. “I hope I don’t wake up tomorrow.”

b. “My life has no purpose.”

c. “I want everything to stop.”

● Someone with passive suicidal ideation may fantasize or frequently think about death and dying. This can include imagining themselves dying in ways other than directly killing themselves. For instance, they might imagine getting into a car accident or a plane crash. ● Risky Behaviours: Passive suicidal ideation can also cause people to take actions that suggest they don’t care about their safety and well-being. This can look like engaging in risky behaviors or neglecting their basic needs, such as:

a. Intentionally not wearing a seatbelt when driving or driving recklessly b. Engaging in risky drug-use behaviors c. Intentionally putting themselves in unsafe situations, like going for a walk at night in an unsafe area

● Actions such as mentioning feelings of guilt, hopelessness, or worthlessness, sleeping more or less than usual and suddenly giving away treasured belongings may be some signs of lurking suicidal thoughts as well.

Coping with dark thoughts

It is incredibly important to recognize that anyone can experience suicidal thoughts and that such contemplations do not represent a weakness, flaw, or personal failure. These thoughts are nothing to feel guilty or ashamed of.

If you are experiencing passive suicidal thoughts, you may follow the following tips to cope:

● Recognizing the signs: As passive suicidal thoughts do have the potential to eventually lead to suicide planning or an attempt, recognizing early signs, such as hopelessness, a sense of being trapped, or feeling like a burden to others, can suggest it’s time to reach out for help.

● Getting professional support: Generally, reaching out to a trained mental health professional is the best way to manage thoughts of suicide as they can offer guidance in identifying possible triggers, exploring treatment options, and creating a safety plan.

● Staying connected: A sense of being a burden or feeling of guilt can lead you to avoid loved ones. In such situations, staying in touch with the people who care about you can make it easier to navigate a mental health crisis. Try reaching out to someone you trust by letting them know, “I’m having a hard time. Can you keep me company?”

● Finding positive distractions: Activities you enjoy could help ease dark or painful thoughts and even rekindle some feelings of joy by helping you remember a few reasons to keep living. Little things like being excited for the next volume in a book series or a new season of a show can serve as a reminder that there are things to look forward to in life. Spending more time with your loved ones may help remind you of their unconditional affection and companionship and that you are loved and needed.

● Focusing on self-care: Although making sure to take care of your physical needs may not necessarily reduce suicidal thoughts, you may find some ease in managing when your physical needs are being met. As best as you can, try to eat balanced meals and stay hydrated, get some physical activity (even basic stretching or moving around your house can help), and aim to sleep 7 to 9 hours each night.

● Working on a crisis plan: Research suggests safety planning can go a long way toward helping you stay safe in a crisis. Safety plans typically involve compiling lists of triggers or early signs of suicidal thoughts, coping tips, and contact information for supportive loved ones or professionals in one place.

The experience of psychological pain and despair might not immediately improve, and addressing suicidal thoughts can take time and professional support. However, taking the first steps toward managing these ideations can help you get enough distance to regain some hope and explore more long-term methods of relief.

Recognizing Suicidal Ideation in others and providing support

An unfortunate but common myth is that when people speak about suicide, it is to get attention. However, in most cases, Suicidal ideation is a broad term that seeks to describe a range of contemplations, wishes, and preoccupations with ending one’s own life.

Oftentimes when a person brings up suicidal thoughts to their loved ones, a common response they are met with is avoiding the subject entirely and encouraging them to think about brighter things. They receive responses that dismiss their distress, such as “How could you possibly feel that way? You have so much to live for.” However, this act of brushing off their internal pain invalidates their distress and may result in them feeling reluctant to share their thoughts with anyone else or reach out for professional support. Instead, they might continue carrying their pain in silence, believing things will never improve, and completely stop confiding in others. While it's normal to feel scared or uncertain of the best response since suicide is a hush-hush topic in our society, shying away from the subject won’t help.

When talking to someone who is having thoughts of suicide, what you say matters. To validate their feelings and offer hope at the same time, try saying, “That sounds so painful, and I appreciate you sharing that with me. How can I help?”, or “I know things seem bleak now, but it can be hard to see possible solutions when you feel so overwhelmed.”

Another common myth is that discussing suicide will encourage the person to act on such thoughts. However, most likely the person themselves had to gather immense mental strength to bring up the topic to you and if you provide them with a chance to share their pain with empathic listening, they may feel some relief from the most overwhelming feelings of distress.

If your friend has thoughts of suicide but no plan or immediate risk, they may feel a little better after sharing their distress. However, this doesn’t mean they’re completely fine. They may continue to deal with suicidal thoughts until they get help addressing the underlying concern. Continue to support them by checking in on them regularly and encouraging them to seek professional help.

Treatment

Therapy is considered the best option for coping with and managing suicidal ideation. Specifically, Dialectical Behavior Therapy, or DBT, has been shown to reduce suicide attempts and self-harm. A therapist trained in DBT can help a person recognize when their feelings or actions are disruptive or unhealthy and teach the person skills that can help them cope more effectively with upsetting situations.

A therapist can offer compassionate guidance and professional support with:

● identifying key triggers or causes, including signs of mental health conditions

● developing a safety plan

● exploring ways to share your thoughts with loved ones

● building new skills to cope with suicidal thoughts, including emotion regulation, problem-solving, distress tolerance, and reframing unwanted thoughts

● talking through possible solutions for overwhelming or distressing life challenges

Medication can also be beneficial for symptom management. Patients experiencing passive suicidal ideation may benefit from medication, but they must be carefully monitored. However, the problem with treating the symptoms with medication is that medication by itself doesn’t always resolve the occurrence of suicidal thoughts. Another issue is that the treatment in some rare cases, provides the energy to carry out the suicide. For instance, let us assume Person A is depressed. One symptom of depression—a condition many suicidal people live with is emotional inertia i.e., the tendency for affective states to be resistant to change. In some cases, when antidepressant medication is effective, it not only makes a depressed person feel better but also provides them with more energy.

Finally, hospitalization or in-patient care becomes necessary for anyone deemed a risk to themselves, but even those who aren’t at risk could potentially benefit from in-patient care.

Conclusion

At this moment, right now, you may feel as though there is no way to escape the immense pain and unhappiness you feel. However, as clichéd as it may sound, it too shall pass. Nothing is permanent and simply waking up and getting out of bed and going through each day is enough.

Opening up to someone you trust is difficult but it is always a good first step and that does not make you weak. When life’s challenges and painful moments feel most overwhelming, remember you’re not alone. Sharing how you feel may not change your situation or completely banish those thoughts, but sharing those thoughts with a loved one or therapist can provide you with enough fuel to get through these tough times.

REFERENCES:

● Angel, T. (2023, July 13). Managing suicidal Ideation. Healthline. https://www.healthline.com/health/suicidal-ideation

● Barnes, M. (2022, October 11). Passive Suicidal Ideation: What it is and what we can do. Psycom. https://www.psycom.net/depression/passive-suicidal-ideation

● Duong, T. V. H., Harmer, B., Lee, S., Saadab

adi, A. (2023) Suicidal Ideation. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/33351435/

● Kerr, M., Raypole, C. (2023, August 29). How to manage thoughts of suicide and get support. Healthline. https://www.healthline.com/health/depression/suicidal-thoughts#managing-active-thoughts

● Raypole, C. (2020, December 16). My friend is talking about suicide. How can I help? Healthline. https://www.healthline.com/health/mental-health/how-to-help-a-suicidal-friend#helpful-resources

● Schuster, S. (2022, September 7). Passive Suicidal Ideation: Why you need to take this suicide warning sign seriously. GoodRx. https://www.goodrx.com/health-topic/mental-health/passive-suicide-ideation

● Singh, O. P. (2022). Startling Suicide Statistics in India: Time for urgent action. Indian Journal of Psychiatry. 2022 Sep-Oct;64(5):431-432. doi:https://doi.org/10.4103%2Findianjpsychiatry.indianjpsychiatry_665_22

Written by: Aajolie(3rd year)

Reviewed by:

Jaya Kumari (Content Team Coordinator| Editor-in-Chief)

Akshita Tanwar(Deputy Content Team Coordinator| Deputy Editor-in-Chief)

Siya Kumar(Associate Editor)