By Geralyn Datz, Ph.D.

(Editor’s Note—The recent CDC report on suicide was alarming. Suicide rates have increased in nearly every state over the past two decades, and half of the states have seen suicide rates go up more than 30 percent. While the CDC didn’t release any data about what’s happening in the chronic pain community, most observers believe that the increased suicide rate is at least partially due to an increase in more chronic pain patients taking their own lives. We asked Dr. Geralyn Datz, a psychologist and former head of the Southern Pain Society to share a few thoughts.)

The topic of suicide itself has a huge taboo around it. The challenge in discussing suicide is always to acknowledge the vulnerability of the individuals that suffer from this type of thinking, as well as to address mischaracterizations of these individuals as weak, selfish, or simply “crazy”. In the life of a mental health professional, suicide is an occupational hazard that is haunting and challenging. While all suicides cannot be prevented, the number of them can be reduced through education.

For people who suffer with pain, suicide may be viewed as an escape from the unsolvable problem that is chronic pain. Depression and anxiety also often co-occur with chronic pain, further adding to the mental obstacles in the life of pain patient, and making escape from reality, and suffering, all the more tempting. Finally, access to adequate pain treatments, including opioids, is very challenging, adding to the pressure and anguish that exists for pain patients today.

When applied to the problem of chronic pain, for a large subset of people with pain and suicidal thinking the issue is not that they want to die, it’s that they don’t want to feel pain and suffer any more. And suicide can unfortunately seem like a reasonable option.

One common myth that surrounding suicide is the thought that the person wants to die and can’t be helped. One study that explored the desire to escape suffering vs the will to live is a famous study of individuals who jumped off the golden gate bridge in attempt to commit suicide. More than 3,000 people have leapt to their death from San Francisco’s Golden Gate Bridge, but out of the 26 people who survived the jump, all 26 reported that the moment they leapt from the bridge, they regretted their action and wanted to live.

Another myth is that asking about, or talking about suicidal thinking with the person experiencing it, increases the likelihood suicide will happen. The vast majority of suicide-related research—including a very well done study in 2014—suggests that open conversations about suicide are unlikely to increase suicidal ideation and may actually decrease it.

Sometimes suicidal thinking is the result of interactions of factors. Genetic factors, like a personal or family history of psychological diagnosis, or of attempted suicide or completed suicide, can influence a person who has come to the point of contemplating suicide. Childhood trauma, of any sort, physical, emotional, sexual, and parental neglect, can also affect the development of suicidal thinking.

However suicidal thinking has developed, and the circumstances that surround it, it must be confronted. The following are some recommendations for dealing proactively with suicidal thinking:

Don’t isolate, reach out. Be it talking to a friend, family member, faith community member, medical provider or calling a therapist, break the silence and shame feelings that are often present with severe depression and anxiety. Call or text a crisis hotline. Suicide Prevention Lifeline (1-800-273-8255) or Crisis Text Line (text HOME to 741741). If you feel you are in immediate danger, call 911, go the ER or local 24-hour psychiatric facility for admission. Safety first. If you are feeling like a threat to yourself, remove any harmful means from your home, and ask someone to help you monitor or co-administer your prescription medications to reduce the likelihood of overdose. Develop a safety plan. Write out your plan for action in a crisis. Also, the My3 app is a safety planning and crisis intervention app that can help develop these supports and is stored conveniently on your smartphone for quick access. It is difficult to plan and think clearly when in crisis, and having a plan can give you support. Get help. Suicidal thinking is a sign of severe depression and also anxiety. Schedule a consult with a mental health provider, psychologist, psychiatrist, counselor or primary care doctor. If you are without insurance, find your community mental health center that offers low cost assessments. Consider psychotherapy to develop coping skills for navigating this difficult period in your life. Medications can also be helpful for addressing mood disturbances, sleep difficulty, and panic attacks that often accompany suicidal thinking.