For every person who goes through with it, there are 280 who decide not to. Listening to them could be life-saving.
In a small tent in the middle of the Panamanian jungle, Carly Schwartz clutched a plastic bag in her hands, wrestling with the idea of killing herself. She sat cross-legged on a makeshift bed, her body shaking as tears streamed down her cheeks.
Yes, she decided. She wanted to die.
When Schwartz arrived in the Tres Brazos jungle just over a year beforehand, life had looked dramatically different. She had just turned 30, quit her job as the deputy editor at The Huffington Post, booked a one-way flight from New York to Mexico City for a microfinance fellowship, and set off on what she calls her "solo Latin American adventure."
She spent her days interviewing women in mountain villages, biking around the city, and making friends from across the world. Her Spanish got better. For the first time in a long time she felt fulfilled and free.
One opportunity led to another, and Schwartz moved to Panama to help a friend open a journalism school in the jungle. "I'd never felt more inspired, more capable, more interesting," she says. "I felt like I was reinventing journalism education. I also fell in love."
Schwartz had been taking antidepressants since college, but as time went by, she became convinced that Panama had cured her, so she abruptly stopped taking her medication, never questioning the decision or whether her depression could come back.
At first, she was fine.
Then, a few weeks later, she wasn't.
She started spending 24-hour stretches in bed pretending to be sick. Work felt daunting and she began to doubt her teaching abilities. She'd break down crying out of nowhere and at anytime. Once, when her sandal broke, she sobbed about never being able to buy another pair. Another time, she set out to clean the communal bathroom and wound up bawling on the floor, convinced she'd never finish the task.
Schwartz went back on her antidepressants, expecting her mood to improve. She waited. For weeks. It didn't.
"It just felt like I belonged nowhere and that's the loneliest place—feeling like you don't even belong on this planet," Schwartz says. "My suicidal thoughts started to get really loud and real. I told myself that I could end everything and not be tortured by my own mind anymore. I started looking around for painless ways I could do it."
One day, as she wandered around the campsite in a daze, she saw a discarded plastic bag. That's when the idea slipped into her mind: Suffocate yourself.
Schwartz grabbed the bag and snuck into a nearby tent. It was a Thursday afternoon and everyone was swimming at the local river—no one would be looking for her. She sat for nearly 20 minutes, thinking how much easier everything would be if only she could turn off her thoughts. "I just wanted to go to sleep forever," Schwartz says.
She leaned her head into the opening. She took a few breaths. Then she froze.
"I instantly wanted to be alive," she says. "There was this moment that clicked: I didn't want to die. I just wanted help."
The fever pitch of her struggle fizzled as quickly as it came—the deflated plastic bag, limp on the ground, the only evidence of what had almost happened.
Media coverage of suicide often slants towards the sensational. The back-to-back deaths of Anthony Bourdain and Kate Spade earlier this year dominated the press, which didn't hold back on the details—a phenomenon that research shows can lead to even more suicides. (After Robin Williams killed himself in 2014, the national suicide rate spiked 10 percent over the next four months.)
"When someone in the public eye kills themselves, it models the most negative way of coping with the most overwhelming emotional pain," says John Draper, Ph.D., executive director of the National Suicide Prevention Lifeline. "If you feel suicidal in the moment or feel vulnerable and desperate, and you're drawn to a news story about the sudden, shocking loss of a person who was admired, you think, Well, if this happened to them, what hope is there for me?"
But some stories about suicide are hopeful: For every person who dies by suicide each year, another 280 people think seriously about suicide but do not kill themselves, according to data from the CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA). Schwartz is one of them. Those near-suicide experiences hold extraordinary power, mental health experts say—and can even save lives.
"Our best answers as to why suicides happen and what we can do to prevent them are not found by focusing on the one person who died by suicide, but by focusing on the living—the other 280 who survived," Draper says. "Few of them are being asked—and fewer still are talking—about their struggles through suicidal experiences. Not talking about one's lived experience of coping through suicidality maintains the stigma that is the enemy of hope and healing."
The day after Schwartz sat in that tent contemplating suicide, she was on a flight back to New York for mental health treatment. When friends asked why she'd left Panama early, she shrugged it off, mentioning something about her depression. "I never said I was dealing with suicidal thoughts," she says.
Many people who seriously consider killing themselves cope with the aftermath silently and alone, too embarrassed to talk about their experience for fear of losing friends, family, career, reputation.
In her early 20s, while working as a research chemist in Philadelphia, Heidi Bryan found herself in an unhealthy relationship: "I was so lost and unhappy," she says. "I hated myself. I didn't know what to do with all of those feelings and tried to drink them away."
One day, after yet another fight with her boyfriend, she stood in the kitchen holding a glass of red wine, watching him storm out. Bryan had been seeing a psychiatrist and taking antidepressants, and in that moment, her first thought was to swallow her medication. She opened the bottle and poured dozens of small pink pills into the palm of her hand, then slid them into her mouth, holding them between her cheeks as they started to melt. She waited a full minute. Then she spit them out.
It wasn't until years later that she realized her experience wasn't one of shame, but of strength—an epiphany not just life-affirming for her, but potentially life-saving for others.
"People see stories all the time about those surviving breast cancer, heart disease and stroke, and we know what that recovery looks like—it helps people who are experiencing it, or someone whose mom just got diagnosed," says Shelby Rowe, a youth suicide prevention program manager for the Oklahoma Department of Mental Health and Substance Abuse Services. "So many people go through their suicidal crisis feeling completely isolated and alone, because they think they're the only ones. But they're not. There are millions of healing and recovery stories—they just haven't been shared."
For many people who seriously contemplate killing themselves, choosing to live is just as complex as wanting to die. Sometimes it's a sudden shift: The person on the verge of financial ruin sees a way out. Other times, there's a flash of hope, like getting a phone call from a friend or hearing a meaningful song on the radio.
Forty-eight hours after the news of Bourdain's suicide broke, Amanda Wang stood in the back row of her nieces' piano recital, her 2-year-old son playing at her feet, wondering if she would kill herself that day.
She'd spent the week mired in thoughts of suicide. The night she heard about Bourdain, she emailed her therapist: "He was very human and I could, in a way, relate to him. And he didn't make it. I don't know. I can feel the anguish. I just feel really awful. Sad. And compelled to kill myself." The idea of suicide kept rolling around her mind—a gun pressed to her temple, a rope jerking against her neck.
As Wang watched the recital, feeling heavy with grief and hopelessness, a girl performed the song "So Big/So Small" from the musical Dear Evan Hansen. "It was about a mother wanting to be there for her child," Wang says. "The son was afraid the mom would be taken away, and she reassured him she wasn't going anywhere. That reverberated inside of me." She looked down at her son, who was playing with a bubblegum wrapper, and started to cry.
"I realized I wasn't going anywhere either, because I have a son," she says. "The immense suffering is hard to manage at times, but when you're not feeling bad, you do everything you can to build up that reservoir of hope and resilience so that when you are in that time, you have enough to get you through it."
Bryan, too, found her way out—spitting out those pink pills—but it took her a long time to understand how to stay in the mindset of wanting to live. Years later, when she was happily married and sober, her brother took his own life. The loss devastated her and she felt a profound desire to die.
"Whatever was going through my brother's mind at the time—that our family would get over it, that we'd be better off—I wish I could have told him he was wrong," Bryan says. "It dawned on me: If that applies to him, it applies to me. If he was wrong, I'm wrong, too. I had evidence in front of me that I had to go on living."
One of the greatest tragedies around suicide prevention is that surviving a suicidal moment doesn't have to be a stroke of luck—there are techniques to cope and come out the other side. Many just don't know about them.
For years, Wang went from "psychiatrist to therapist to therapist" seeking support for her suicidal thoughts and depression. Nothing worked. Since her teens, she'd woken up many mornings wondering if she'd have "enough courage to die today," she says. She often thought about how to turn ordinary scenarios, like waiting for the subway or crossing the street, into suicide attempts. Once in her 20s, while drinking beers with friends at a stadium, she imagined falling over the edge of a balcony.
It took three hospitalizations for a doctor to finally suggest Dialectical Behavior Therapy (DBT), which treats self-harm and attempt behavior by teaching behavioral skills, such as mindfulness, that patients can use to manage painful emotions and navigate crises. "It taught me how to live with suicidal thoughts and urges," says Wang, who relies on distraction techniques like taking a cold shower, doing push-ups, and naming a fruit and vegetable for each letter of the alphabet if her mental health starts to spiral.
Wang was one of the fortunate ones.
"It's mind-bending how there's such a gap between what works—suicide-specific treatments based on the best scientific support—and what's actually done, which is to hospitalize and medicate," says David Jobes, director of the Suicide Prevention Laboratory at Catholic University and a clinician for more than 30 years. Mental health professionals, he says, worry about malpractice claims they might face if someone who hadn't been hospitalized completes a suicide so they tend to take "a better-safe-than-sorry approach" and have patients admitted.
Jobes developed a method that targets and treats problems that make people want to kill themselves called Collaborative Assessment and Management of Suicidality (CAMS), but he says it's just one of "a handful of effective psychological treatments that aren't widely used by should be."
Another treatment, Brief Cognitive Behavioral Therapy (BCBT), is a 12-session talk therapy for those who attempted suicide that focuses on how they respond to stressful situations and manage their emotions. "Suicidal individuals tend to make decisions that get them into trouble—unhelpful choices, whether drinking or withdrawing or choosing relationships that are harmful," says Craig Bryan, executive director of the National Center for Veterans Studies at the University of Utah, who has received millions of dollars in federal funds to study treatment for suicidal veterans, including BCBT. "We say, 'These thought processes and choices you're making aren't helping. They're causing you to feel stressed, and that's driving your desire to kill yourself, so let's look at the choices and what you tell yourself and let's change it.'"
Yet only half of psychological trainees and less than 25 percent of social workers are trained in suicide prevention, according to a 2012 American Association of Suicidology report. "Most therapists practice general counseling stuff—be nice, be warm, nod your head, ask the patient how certain things make them feel," Bryan says. "But they're not trained in more advanced methods proven to be effective for treating suicide risk."
It also takes 17 years for a proven treatment to get into clinical practice, Jobes points out. "That's a long uptake after science proves something works."
And even though many mental health professionals would classify suicide as a public health crisis—it's the 10th leading cause of death in the U.S. (second among 10- to 34-year-olds), according to the CDC, and rates have risen in every single state except Nevada since 1999—studying it is not always a priority. Last year, the National Institutes of Health spent more money researching asthma than suicide and suicide prevention.
Ashley Womble learned to manage her suicidal thoughts using cognitive behavioral therapy (CBT), which is similar to BCBT. A decade ago she was living her dream, working as a journalist in New York City, far away from her tumultuous childhood in rural Texas, when a close family member was diagnosed with a serious medical issue. He was refusing treatment and homeless, and she felt personally responsible. She couldn't focus at work, and when she wasn't in the office, she lay in bed, the duvet pulled over her body, imagining what it would feel like to be dead. "The fantasy of being gone was so alluring," she says. A couple months later, those fantasies morphed into real-life plans. What prescription pills would she need? How many? Would anyone miss her?
Eventually her boss pulled her aside and asked her what was wrong. The next day, Womble saw a psychiatrist who diagnosed her with depression and put her on medication. "It took awhile for that to kick in. It wasn't magical," she says. And she still struggled with her mental health. Learning CBT was a turning point—it helped her identify her triggers and disconnect from negative thoughts. Whenever it rained, Womble's gut reaction was to worry about her family member—was he out there alone, drenched and freezing? "CBT helps me think, It's just raining here. It helps knock those triggers down."
The mental health community may be slow to change, but there are more people than you realize—a friend, a coworker, a neighbor—who have faced down their darkest moments and are taking their stories into their own hands.
"I told my best friend about what happened in Panama and she burst into tears," Schwartz says. "I was like, this is far too morbid to tell anyone else." And for a long time, she didn't, but then: "One of the things that struck me most about Anthony Bourdain and Kate Spade is that nobody in their lives really knew. It's just so fucked up that we live in a society where talking about mental illness is so taboo and those are suffering in the darkest of places...are doing so in silence."
So Schwartz speaks out through the Jed Foundation, a mental health nonprofit aimed at helping teens and young adults, and talks openly with her friends and co-workers about her struggles. "No one treats me any differently," she says. "It takes that perfect storm of voices to slowly reduce the shame. I'm not brave. I'm just a person talking about what I deal with."
Bryan has spent the last 20 years doing the same thing. She co-founded Prevent Suicide Pennsylvania, a statewide suicide prevention organization, and works as a suicide prevention trainer and speaker. "I didn't even know there were other people like me," she says.
There are, and their stories are worth telling not because of how they end—but because they didn't.
If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.
Abigail Jones is an award-winning journalist and bestselling author in New York City. Most recently, she was a senior writer at Newsweek, and she's held staff positions at The Forward, The Daily and The Atlantic. She has received two Front Page Awards, one for best magazine interview in 2016 for her Newsweek cover story on long-term trauma survivor Michelle Knight, and one for best medicine/health reporting in 2017 for her Newsweek cover story on cancer and sex. She co-authored the New York Times and No. 1 Boston Globe nonfiction bestseller Restless Virgins.
