Content note: This article discusses suicide and suicidal ideation in-depth.
On August 5th of last year, I tried to kill myself.
The police were called. I was restrained, patted down, taken to the hospital, and held on a 5150. I was there for two days before they left me go.
The term “5150” is the California legal code for “involuntary psychiatric hold.” It is used by law enforcement and medical professionals when “a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled.” It’s very broad. You can be held for up to three days, and that hold can be extended if it’s deemed necessary. While this particular code is specific to the state of California, it’s a protocol many governments share.
The practice of the involuntary hold is problematic for a number of reasons: when it’s used and on whom, how it’s implemented, where they take you, what treatment you do or don’t receive, and so on. For many held under this law, the 5150 is a traumatic experience, fraught with abuses and inappropriate or inadequate treatments. The effects can be devastating, especially to people who are already on or over the brink.
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Mercifully, my own experience was not nearly so damaging. I didn’t feel myself to be in danger at any point, and that alone is saying something. Things could have gone very differently if I were dark-skinned, if I were aggressive, if there had been a communication barrier, if I had not been in a relatively affluent neighborhood, or had I not had an advocate. I could be in jail or dead.
Instead, the hold mostly served its purpose. I was separated from any potentially endangering stimuli and removed from the unsafe situation I had been in. The environment was clean and calm, the day was highly structured, there was plenty of food, the caregivers were helpful and polite, and my fellow patients seemed to be mostly comfortable.
At first, I struggled immensely with feeling isolated and cut off from my support system, but eventually my sense of panic subsided, and I came to appreciate the highly insulated environment. I was baffled by the total absence of one-on-one therapy and other non-psychiatric treatments (group discussions don’t count), but overall my experience was good.
Now I am finding that my experience also offered me a lot of insight about suicidality in our society. Suicidal episodes are deeply misunderstood, stigmatized, and swept under the rug. Many treat the subject as taboo.
This creates a climate of shame, fear, and rejection that is a stubborn barrier to healing as well as a source of further harm. The antidote is to create a culture of openness, dedication, and information.
To that end, here are 14 things I realized about suicidality and how to survive it when I was 5150-ed.
1. Suicidality is different for everyone.
People tend to have a specific idea in their minds of what suicide looks like, and this makes it much harder to identify when someone is suicidal. I was in denial about the urgency of my condition because it didn’t fit the bill for what I thought of as “real” suicidality.
Some suicide attempts are calm and collected, while others (like my own) are sudden; full of rage, terror, or other heightened emotions. Some begin with more passive ideation, like wishing you had died in an accident. Never assume that suicidality must be present in a particular way. Take all suicidal thoughts seriously.
2. Suicide can be accidental.
Many suicidal people don’t want to die, myself included. If I ever did complete suicide, it would be something my illness did to me, not something I wanted to do to myself. In this respect, it would be an accident, because I’m constantly working to keep it from happening.
Handling a potentially deadly item while in a state of heightened emotion greatly increases the chances that an accident will happen. All it takes is a slip of the wrist. Guns, for example, go off accidentally all the time.
While someone may think about or try to take their own life, once the crisis has passed, they can feel relieved that they survived and horrified that they brought themselves so close to death.
3. It’s not enough to say you’re there for someone — you have to prove it.
If someone you care about is suicidal, check in with them. Give them affirmations. Find out how they’re really doing. Push past superficial answers they may give you like “I’m fine.”
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Create and hold space for your loved one. Allow them to feel safe enough to vocalize their thoughts and feelings, then invite them into that space. Take the initiative and help them take action on some of the items on this list. Don’t assume that if they seem happy again, they must be fully recovered.
4. Suicide attempts are themselves traumatizing.
Any time a life is in danger, whether it’s your own or another’s, there is potential for post-traumatic symptoms to develop. It’s critical to recognize how this applies to suicidality, both for you and those around you, and to stem any symptoms before they develop further.
Hospitalization can also be overwhelming, both while you’re there and when you get out. Take all available steps to hold additional space for these traumas.
5. Reaching out is a risk you have to take.
People need you more than you think. This means they’ll also be sadder than you know if you die.
Many people understand your experiences better than you might imagine. Some would help you if they only knew how badly you need it. However, you can’t build that awareness without interacting with folks first.
State your needs, and be honest about your symptoms. Don’t hide or cover them up. This will enable people to help you better when they otherwise may not know how. The alternative is isolation, which will absolutely, inevitably worsen your condition.
6. Suicidal episodes are dangerous to others as well.
When I was triggered beyond control, I could have really hurt someone. I endangered the physical safety of others just by holding a weapon while in a heightened state. Beyond physical harm, I know for a fact that I caused psychic injury by exposing others to my internal violence.
Bearing in mind the real harm I can cause others is helping me address my internal problems with greater urgency.
7. You can’t fix everything overnight.
The idea of starting fresh is appealing, but it’s often a lot more complicated than just making one or two big changes. Similarly, survival is just the beginning of your journey. After survival comes healing, and that is often the greater challenge.
Don’t be dismayed if your progress seems slow. It’s a lengthy and difficult process that’s bound to take a long time.
8. It takes a village.
It is extremely difficult to recover from suicidality while relying on just one person, or even two. It’s also unfair because it puts a huge amount of pressure on that person and can cause a relationship to become toxic or abusive.
You need to reach out to many people and establish a network of supporters. Building community while you are relatively well will help to ensure you have a well-rounded support system when your symptoms are acute.
9. Planning is paramount.
The first step is learning to recognize acute suicidality when it arises. It’s those moments when suicide isn’t just a thought, but something that might actually happen.
The second step is developing protocols for what to do once you realize what has happened. Developing multiple plans is best so you can be ready for different scenarios.
For example, having a calming box could be invaluable for when you’re extremely heightened, whereas person-to-person interaction might work better for when you’re terribly low.
Finally, know when and how to proof your living space by removing all potential weapons and unsafe objects — even ones you have never thought about using. Seriously. You never know what might pop into your head while in crisis.
10. Self-care should be turned up to an eleven.
Sleep, food, schedules, and time out of the house are never more important than now. Never stop your treatments during a suicidal episode. Write, draw, take photos, do whatever you can to create; making art will be your saving grace.
Each of these actions alone may seem like a drop in the bucket, but it’s the little things that will set you up to make big changes.
11. You’re gonna learn who your real friends are.
During the course of this situation, I had people turn their backs on me who I thought never would. People I literally trusted with my life; people I considered family. I could have died as a result.
Meanwhile, people I barely knew lent their emotional support, checking up on me and going out of their way to help make me safe. Walk away from those who are indifferent, and open your heart to people who are more caring.
12. Get all the rest available to you.
You need a dedicated period of recovery in the aftermath of suicidality. If you can’t rest your body, at least rest your brain. Do not allow yourself to be overstimulated and drained by unnecessary inputs. Silence is crucial.
Take a break from social obligations if you need to (although beware of isolating yourself too). Don’t feel pressured to recount what happened again and again. It’s extremely draining.
13. Protect yourself proactively.
Set boundaries and stick to them, even with people who are trying to help.
Shut people down when they are triggering you. Don’t let them use casually violent language in your presence, and separate yourself from them if they won’t stop.
Be proactive with yourself, too: learn to identify toxic thought patterns and cut them off before they gain control. In particular, don’t let yourself replay violent memories, especially images of self-harm. In fact, avoid violent imagery altogether. You never know when an image might get stuck in your head and become dangerous.
14. If you can’t let go of an impulse, delay it.
This is extremely important to know: acute suicidality is often highly temporary, almost fleeting. Even when it’s not, the following trick can get you through the darkest of moments.
Distract yourself. Go somewhere, meet someone, play a game.
Call a hotline and explicitly ask for a distraction. It’s okay if you find the content of the conversation generally unhelpful; the point is to get your mind on something else for just a little while. That will weaken the impulse and give you time to take healing measures and seek further assistance.
These measures won’t cure your suicidality. But they will help you survive it.
[Feature Image: A person stands outdoors with their back against a grey building. They have long brown hair and are wearing a black knit hat and black shirt. Source: Pexels]