I have chronic passive suicidal ideation. I constantly wish I were dead.

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I have chronic passive suicidal ideation. I constantly wish I were dead.
The author.Courtesy of Casey Clark
  • There hasn't been a day in my life when I haven't thought about ending it.
  • I don't actually have a plan to kill myself; I have passive suicidal ideation.
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I can't remember the last day I woke up and did not think about ending my life. Even as I type this, I'm in the middle of a depressive episode where death seems appealing compared with the dread I feel. Some might call me dramatic, but for people like me who experience chronic passive suicidal ideation, every day can be a challenge.

Think about the last time a friend said something like, "I'd rather kill myself than study for this test tomorrow." Most times they're making a dark joke to cope with difficult times. But I say things like this all the time and mean it: I'd rather die than do pretty much anything at any time.

I don't have a plan

While for much of the day I think about being dead and wanting to die, I don't actually have the intent or means to kill myself.

There's a major and important difference between active suicidal ideation and passive suicidal ideation. "Active suicidal ideation means you have a specific plan," says Dr. Nina Vasan, the chief medical officer at Real. "Passive suicidal ideation means you are thinking about death without a specific plan to end your life."

I deal with chronic passive suicidal ideation. For me, that means I constantly wish I were dead — not because I want to be in pain but more because I want to be free from pain. I think that's the part I wish most people understood. I don't want to die; I want the pain of living to dissipate, even just a tiny bit.

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Therapy helps me deal with my thoughts

Luckily, I'm in therapy to help manage these passive thoughts and feelings — and Vasan says that's the appropriate course of action.

"If someone has passive suicidal ideation, then outpatient care is appropriate for them," she said. "It will still be important to have them complete a suicide safety plan in the event that passive thoughts become active. They also must remain proactive and engaged in their care."

When I told my therapist I didn't want to live anymore, the first thing she asked me was if I had any plans to hurt myself. I told her no, because I didn't, but together we developed a safety plan just in case my thoughts changed. She didn't mention anything about hospitalization or inpatient treatment, but I'm almost positive that would have changed if I had expressed a plan and intent to take my life.

Though my therapist takes my passive suicidal ideation seriously, I think society shuns people like me. I almost feel as if the only way my suicidal thoughts are valid is if I have a plan and want to act on them. But my suffering isn't any less valid, and I want people to recognize that.

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