Suicide Ideation vs. Suicide Attempts

Important Distinctions for Survivors

Suicide Ideation versus Suicidal Plans and Attempts:

Many may not think about the distinctions between these two terms.

Afterall, they are both about suicide--self harm, death at one’s own hand.

We may think, eh, they’re both about the same, closely related.

Or—all suicide discussion is scary and dark and any thoughts of killing oneself are bad, but isn’t the first one just step one? The second is the action, when you’ve moved on to step two?

It’s all just the awfulness that is suicide. Not pleasant to talk about.

So, to people who don’t experience suicide ideation or have any experience with knowing someone who has completed suicide, this may seem unnecessary to ponder over the differences. Maybe they seem like meaningless distinctions or just word play, but for those with intimate experiences with suicide, it could provide some insights and answers.

I recently an article that helped me further break down the differences between plans for suicide and suicide attempts, versus suicide ideation. (https://www.psychologytoday.com/us/blog/night-sweats-and-delusions-grandeur/202202/the-neurobiology-suicide)

The article from Psychology Today outlines how suicide ideation or thoughts of suicide take place within the (VPFC) or the ventral prefrontal cortex. Whereas the dorsal prefrontal cortex (DPFC) is the part of the brain involved in suicidal actions.

This is an important distinction. If you’re like me, you may have heard of prefrontal cortex but mostly discussed it as one whole, governing body, responsible for “gorilla brain,” and emotional reactions—fight or flight, but not broken down to different parts with separate functions.

The article also noted that the dorsal anterior cingulate cortex (dACC) and insula may act the mediation/transitionary from suicidal thoughts to behaviors. Ie—how you get from thoughts to actions.

I found this intriguing, and from my own experience, and my family’s actions, it gave me pause.

Ie--Why did my mother and I not act on our suicidal thoughts, kept them to ideation? Whereas, my father and brother formed a plan and acted on their thoughts of suicide ideation. Theirs moved from thoughts to a plan for action. They made theirs become reality.

As survivors grapple with survivors’ guilt, and many question: why them and not me, maybe this can help. The two—ideation and attempts—are different. One does not have to lead to another. It is not a next step, or a foregone conclusion.

(Though perhaps for those who experience major depressive episodes or have depression, the differences can also be crucial. After all, depression is a hole, a living hell. And I believe that the worst part about it, as I’ve written about before, is the inability to see before this time and to the future, to a time when you will no longer feel this way. You are unable to position this condition as a temporary state of mind, as a mood. You don’t have that rationality or perspective. It stands to reason that if you exist in that dire of a state for long enough, if your brain succeeds in lying to you for that long, you can start to see how those with major depressive episodes and depression move into suicide ideation.)

It doesn’t mean, however, for those of us who have suicide ideation, that we are going to die, plan to die, or want to die. Ideation doesn’t mean I will attempt or complete suicide. (If it did, I would be long gone.)

These are crucial distinctions between thoughts and actions. With the members of my immediate family, we have all had fantasies and obsessions of death, looking to dying as a release and a ceasing of the pain, the mental torment of depression. I’ve heard all of my family members vocalize this, and many times: the desire to wrap their car around a tree, to put a bullet in their head, many, many statements that it would be better if “I just wasn’t around anymore.”

Yet, my mother and I both did not execute this plan. My brother and my father did.

Why? There are probably, undoubtedly, many reasons. I think the substance abuse acted as a catalyst in their actions. This isn’t the place I want to ponder those reasons.

But—I appreciate articles such as these because they don’t simply label the men in my family, and others who complete suicide, as weaker or more impulsive or having failed at life, to resist. Brains can and do work differently, even those with mental illness, depression and suicidal tendencies (Which I understand to mean both suicide ideation and suicidal attempts). So, maybe distinctions in the prefrontal cortex played into the overall situation, indicating a viable reason why it ended differently for them than for my mother and I.

Now, that said, I do get that the importance of medical professionals to ask patients if they are having thoughts of suicide and self-harm. I applaud the efforts and intentions…But more pressing can be, perhaps should be, inquiring if there is a plan.

Because— 

I have often had conversations with my best friend where we both discuss how—when we’re in depression, read as hopeless and with no ability to see an end to this current state of being/mindset—we have often longed for death; it could seem like a sweet, sweet release. Suicide can become a fantasy when you’re in a dark place, and it can turn into an obsession.

But when we both confide in each other, it helps break the tension. desperation and hard experiences that we’re both enduring, mentally. Simply through the act of sharing. It’s enough for us. And we both know that we aren’t contemplating a method of ending our life. We know that we needn’t be concerned about each other because there is no plan in place to act. We simply have ideation.

And these thoughts are not simply because we necessarily want to die, completely and immediately. I mean, yeah, maybe sometimes it is that, or at least feels that way at the time, but we are aware that it is not an option and that we may feel differently tomorrow or next week or next month.

This ideation is not the same as I am going to die. My best friend often says it’s comforting. And I get it: Sometimes imagining the nothingness of death for those in mental anguish, the pain of depression is the only temporary mental release from the pain, imagining ceasing to exist; it can be a tonic.

And because we can’t sleep all day. And don’t want to become drug addicts and permanently alter our state of consciousness as a coping mechanism.

I guess this is also why people are encouraged to listen for a change in the attitude in the individual of concern, to look for plans of suicidal ideation: giving away prized possessions, a sudden change of attitude or in mood from sad to happy/resolved, or in arranging special or final get togethers.

These tend to be signs of people who have decided. They are about to attempt, to carry out, hoping to complete suicide.

Truly, the difficult part of life is that we cannot know the thoughts, intentions and plans of others, unless they share them with us. We are not privy to their inner monologues. (We’d go crazy if this were the case, perhaps). But still, with those who have relationships with others who are depressed and suicidal, it can become a guessing game because we can’t know their intent.

So, is it good to ask? Of course.

It is better to endure the pushback and consequences, possible offense and bad reactions than the alternative, which is to deal with aftermath--the grief and the corpse and the permanence of that decision of death at one’s own hand.

I wish I had asked. I don’t blame myself. I don’t believe that I knew, that I could have made the distinction between ideation and depression, and a plan for an attempt at that time. I didn’t know to ask, but do I wish I could have tried now, looking back… if I could return to pre-suicides would I ask to see if it could have stopped it? Of course.

Still, for those of us still here, I ponder these differences. And for those of with depression and suicide ideation, and survivors of family suicides, I post this because maybe it can offer support; it can be helpful to process these distinctions to better understand and to live with the reality, the enduring of this constant question on repeat in our minds—

Why them? Why them, and not me?