Chronic Suicidality | Strategies & Challenges for Treatment & Prevention

This video answers the question: Can I take a look at the different treatment strategies and different modalities that are designed for chronic suicidality? Chronic suicidality is really much different than acute suicidality in terms of clinical work.

Chronic suicidality has been associated with a number of disorders and populations including borderline personality disorder and women who have been traumatized.

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Menon, M., Quilty, L., Zawadzki, J., Woodward, T., Sokolowski, H., Boon, H., & Wong, A. H. (2013). The role of cognitive biases and personality variables in subclinical delusional ideation. Cognitive Neuropsychiatry, 18(3), 208–218.

Finch, J. R. (2006). Review of Therapeutic and Legal Issues for Therapists Who Have Survived a Client Suicide. Psychiatric Rehabilitation Journal, 29(4), 325–326

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[debbieporter]

I have suffered from chronic suicidality for over 20 yrs. I also have been dxd with BPD, MDD, anxiety, and treatment resistant depression. It is so awful living with this every day. Plus I have outside problems with financial instability, no support system, and I lost the one therapist who ever helped me 10 months ago. Thank u for this video.

[Magdalene]

One thing I find with suicidal ideation and depression is usually it's attributed to a mental problem or personality disorder. I spent half my life feeling that way, then found out I have hypothyroidism. I wanted to die because I felt sick all the time. Every symptom I had was treated like a mental disorder - ie. my hair started falling out, so it was thought to be stress. I think I was close to going into a coma by the time I found a doctor who believed I was physically ill, and wasn't a hypochondriac. I also have an in-law who has the same condition and she was given shock treatment because she was diagnosed with depression because no one considered there could be an underlying medical issue. I think sometimes underlying diseases and physical illnesses should be screened for, because sometimes a physical illness can present with similar symptoms as a mental illness.

[teresahowick]

How can I like this a gazillion times? I’m so glad I found you.

[KuruContinuum]

Sending love to everyone experiencing this, it's been 5 years for me. xxx

[jenniferloretto]

Thank you for everything you do. After my 30 year old son killed him self 5 years ago, I located his journals and discovered he had suicidal ideation for about 9 years before that. So, this discussion is very important. I read a book called Suicide and the Inner Voice. Very helpful.

[LOdmaric]

“they are best served by clinicians who can actively engage them”
This.

When I’m acutely suicidal, the one thing that would truly help me is to be able to openly speak to my Dr (not some helpline) who knows me. If only she could debate with me, not be emotional (I am not emotional at those times)... but my Dr’s only option is to send me to a locked ward, where truth be told, I’m more likely to take action. So I lie... and she knows it. It’s an awful state of affairs for all involved. I know of patients who have lost drs/psychologists when admitting to suicidal ideation.... it’s quite common.

Clinician’s, talk to your patients... as individuals. We all have different needs and shouldn’t have to experience this alone. Get training if you need it. It’s part of your job.

[elisamastromarino]

With some exceptions, (particularly young people); I don't think anyone should have to stay alive any longer than they want to. Whether suffering from physical or mental afflictions for a long time, I believe it's a person's right to decide when to go. I don't know a lot about some of these illnesses, but I know about depression. And it's not really sadness like some people think. It's really a loss of vitality for life. And if that's gone on for a painfully long period of time for someone, maybe it's okay to give them their moment of clarity - a moment to know better than I do, or even doctors do - as to when it's okay to let go.
Either way, its a sobering subject. Thank you Dr. Grande. 👍🌹

[TheOptimistikChic]

As person with mental health issues, as well as years of chronic suicide ideation, this video is what should be told. It's not a pleasant topic, and it's certainly not pleasant to live with, but if more physicians and mental health workers had an attitude similar to that of yours - I think we would be much better off. Thank you.

[juliejackman]

I ran a counseling office for a while. I am not a counselor. I was the only one in the office one day and a lady called and said she was out driving around in her car and wanted to drive off a cliff or some other kind of crash that would cause her suicide. I planned on having her talk with one if the counselors and kept her on the line as I tried to reach one. No one answered. So here I was almost 2 months to the day since my own young brother (he was 36) had taken his own life. And now it was up to me to try and keep her from doing the same thing. Such a difficult situation! I prayed and just kept being a broken record in trying to get her to go to the ER. This went on for a while, then she got off the phone. I tried about 20 min later to check on her and it just went to voicemail. So I left a message. A while later her mom called me back and told me that she'd driven to the ER and they admitted her. I was SO relieved! Even though that doesn't change my brother being gone, it did feel good to have someone choose life when given the choice.

[amandapark]

I felt suicidal off and on since my early teens. In my better moments I used to feel like you that all lives were worth saving. The older I get though and the more I’ve experienced I’m starting to think that life might not be all that it’s cracked up to be. Really existence itself might not be this grand and inspiring thing if we all end up dead anyway and lost to time with the eventual burning up of our sun. It’s getting harder not to think of suicide as a valid option rather than tough out however many years or decades you have left. Maybe some of those years could have had some joy, but is the net gain worth it? Maybe not to some. At least that’s where my thoughts have been taking me for a while.

[markchristiansen]

You are one Dr. That should be teaching. And as with alot of your viewers have said if there were more like you alot more people would seek the help they need !

[freeatlast]

There aren’t words to describe how moved and impressed I am with you, Dr Grande. You saved this woman’s life. And did it with so much compassion and honesty. Thank you for all you do.

[kristina]

I lived in a state of chronic suicidality for over a decade, and made several attempts to end my life. Despite excellent mental health care, it was persistent. I am Bipolar 1, and now stabilized on medication. I am so grateful that I am alive. Thank you for an insightful video. I can't imagine the toll that it takes on caregivers and families. I still believe in the right that one has to commit suicide, but I also believe in hope. Because for me, my life did improve. I am now 69 and have 7 grandchildren. I have been stable for a decade. I would have missed so much had I ended my life. Thanks to you and all of those fighting on our behalf as we face the challenge of mental illness.

[sionnaich]

I was diagnosed with schizoaffective and a few other things when I was around 12 (very young, I know) after over 5 stays at mental facilities within a couple years. Every time was because I tried to talk about a school counselor about my suicidal ideation, and every time it just made me worse being stuck in those places.

Thank you for pointing out that hospitalization isn't always the answer.

[GavinsMarineMom]

Compassionate, brave, wise, with an abundance of bridled strength, are you. Thank you for this, Dr Grande.

[birdnerd]

You can save someone from a burning building, but saving them from themselves is a whole other thing.

[Falcon-xytk]

Great video! Agree with all of that you said. Except that family thing. Some families aren't suportive, and don't love you. Some families are one of the reasons of someone's suicidality.

[EllenDScott]

Dr. Grande, I think you are great. This has to do with my personal experience with therapists at the VA.

Why is it so hard for a therapist to say "That sounds really hard. I can see why you feel the way you do...." BEFORE implying that the patient needs to learn to increase distress "Tolerance" - as if they haven't tolerated enough already.
Some young girl therapist told me that and, even though I am quiet and shy until I can;t take it any more, I almost yelled out "BI%tch you have no idea how much distress I've tolerated. Now you want me to tolerate MORE? Toleration is what MAKES me this way!

It truly seems like everyone is ready to hop on and invalidate the behavior without even seeing the patient, not to mention understanding that the patient is that way FOR A REASON, not because they like being suicidal.

[theresar]

Thank you! Hospitalization at the mere mention of the word suicide was probably the most significant reason I hated therapists and distrusted them for so long. To anyone who is a therapist or plans on being one, listen to this guy. To everyone here because the first searched the word on youtube, listen to this guy also. All I wanted from therapists was to actually talk about it with me, and not automatically hospitalize. I couldnt exactly speak honestly with friends or family without freaking them out. Also, believe me, I don't know of any suicide you would cause by mentioning it. We already have numerous twisted scenerios going through our heads most of the time. Walking through a store? How easy would it be to slip right here and fall on this fixture and have it impale the back of my skull? It would look like an accident, and my family would get some money I bet. We've thought of it all.

[queen-yzux]

I’m only 26 and have woken up every day wishing I was dead for the last 16 years. At this point I have no hope that it will go away.