To Beat the Devil

by Ana Marie Cox

Note for readers: This essay contains discussions of suicide and suicide attempts. 

The anti-gun violence group Moms Demand now makes suicide prevention as much a part of their campaign as protecting people from outside threats. It may sound callous to put it this way, but suicide should probably be an even bigger focus. We are wracked with grief every time there’s a school shooting, but, statistically, those under the age of 18 are far, far more likely to commit firearm suicide than they are likely to die in a school shooting: Since 1970, fewer than 700 children have lost their lives to a gunman at their school. Between 2016-2021 (the latest data I found) ten times as many children used a gun to kill themselves.  

Suicide rates track gun availability with sickening inevitability. The United States has the highest number of guns per capita in the world; suicides make up six of every ten of firearm deaths. This proportion, especially among young people, is growing. Last year, gun homicides were down and gun suicides increased to an all-time high. Moms Demand's urgency on this issue is welcome. Restricting the availability of firearms is vital. It is also treating the symptom and not the cause. 

The causes of suicide—the root of the desire, not the method—are, understandably, hard to study. You can only interview survivors, after all, and there might be some significant difference between those who use more effective methods and those who don’t. Or maybe we’re missing something huge because the people who use guns aren’t actually typical, just unluckly enough to live in America. 

“Depression” can’t even be said to cause  suicide with as much certainty as you might think. One researcher I spoke to pointed out that 30 percent of us are diagnosed with depression at some point in our lives; the number of people with undiagnosed depression is suspected to make depression doubly common. The experience of extreme grief or loss is damn near universal. Yet only a tiny sliver of people flee from hopelessness into oblivion and no one knows exactly why. What’s more, there is yet another thin slice of folks for whom suicide seems to lurk at the edges of their mind even when they don’t conform to any clinical definition of depression. When I pressed the researcher on this blank spot in the literature, all he could offer is that “some people are less influenced by our culture’s strict taboo on suicide.” Some people, he said, might just be able to consider it in a way that other people refuse to. 

The mystery of why some people lean toward suicide while others don’t is also an explanation: It’s why prevention policy can’t move beyond blocking access to means and creating sheer delay. Apart from that, we have no specific solutions. Make mental health care more widely available and, sure, yes. Let’s do that.

It’s National Suicide Prevention Week. I’ve talked about my own attempts because I believe in destigmatizing a taboo subject. No one should think that they suffer alone. However, almost any public discussion of suicide—even in the context of prevention and sympathy—risks engaging “the contagion of suicidal behavior.” This phenomenon is well-documented at both the individual and public health level. It’s why news organizations have become so diligent in adding helpline information to any story mentioning suicide. Here, let’s do that now: If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting "988." 

I couldn’t find any studies as to whether these text boxes mitigate the risk. Crisis lines themselves don’t seem to be as effective as we’d like to believe and research on the effectiveness of trigger warnings—a cousin to those signposts to the 988 number, surely—suggests the text boxes probably aren’t effective, either. The contagion phenomenon is strongly linked to sheer prevalence of coverage. Studies have shown that when media covers the method of a notable suicide, attempts using that method increase. Tone can matter, but with agonizing irony. Country-level analyses show cultural tendencies to pathologize suicide (depicting it as abnormal and wrong) will inhibit national rates; countries whose media is more “accepting” of suicide victims have higher rates. (There’s a good overview of evidence regarding “contagion” here.) 

I’m going to tell you my story because related studies suggest one way that popular portrayals of suicide can contribute to a decrease: When the narratives are about those who have faced ideations and emerged from the trial without an attempt. The dogs that didn’t bark.

In my case, it was a dog that stopped barking. Ideation was a constant presence for me, with long periods of dwelling on the idea and passive planning. Three times, along the way, I attempted to take my own life. This is not the usual profile of a suicide attempt survivor; a full 90 percent of all survivors wind up never reaching that breaking point a second time. 

Another difference: Most suicide attempts are impulsive. Studies in Houston, Germany, and Australia found that the period between ideation and action could be measured in minutes, often in single digits. Mine stretched out.

That most ideations are temporary and mostly non-recurring shapes almost every aspect of suicide prevention policy: Get people out of acute crisis, make the most statistically effective suicide methods harder to implement, interrupt incipient plans for long enough that the person withstands the temptation until the crisis is over. The passing nature of suicidal ideations is also why the, uh, silver bullet of suicide prevention policy is simply to make guns less available.

At this point, you probably want me to tell you what I did that helped. If you’re suffering, especially, you might be on the edge of your seat to hear it. If you’re a policy wonk, you’ve got your grant-writing pen ready. More than anything in the world, I want to tell you how it is that I’m still here. But I can’t. The list of the things that didn’t work is a long one. What worked is a moving target, which is kind of my point.

For most of my life, people had advised me to fight my thoughts with lists. Lists of reasons to live, gratitude lists, lists of things to look forward to, lists of the people who loved me, lists of times in my life that I’d been happy before.

That helped. And then there were those three times it didn’t. I was in my addiction for all three attempts and my list-making ability impaired. When I put the sharp object to my wrist, when I swallowed those pills—the act wasn’t impulsive. It was a surrender to a demand I’d held off for as long as I could.

My last attempt was thirteen years ago but in 2021, the thoughts became as insistent as they had ever been. During 2022 and 2023, I spent whole days laying in bed making those lists in my head. The call to do something stupid echoed in my skull. I had periods of remission, primarily from ketamine treatment, followed by regression to bleak stasis compounded by a sense of betrayal. “Flowers for Algernon,” but for wanting to die. I walked up to an edge (usually metaphorically) a thousand times. 

I stayed honest about it. I told people what I was going through; I promised (and I think I meant it) that I would call 911 before I did anything “really bad.” I don’t know if that’s exactly true. I just kept not attempting suicide. I stayed sober, which some people find surprising or laudable. But the appeal of death was its finality; if I had a drink, I’d just wake up to a life that was even worse than before.

Over time something did change and I can’t explain it but I can tell you I stopped keeping lists. I stopped fighting the impulse. I didn’t succumb to it. Slowly and not consciously, my perspective shifted: Maybe wanting to die was less like a problem to be solved and more like, well, a feeling. It was a sensation, like hot or cold, like allergies or indigestion. Thus, like all feelings, it might eventually pass. Looking back at the years of survival, I took in the breadth of my courage and determination. I had felt hopeless many times, but look at all those breaths I took, all those mornings I woke up: Something inside of me wasn’t hopeless. I had told people I was on autopilot but… I built that autopilot. Whether I acknowledged it or not, a part of me wanted to live and it was not giving up.

Acknowledging the hope inside me that I did not feel unlocked it.

The long list of what I’d tried and hadn’t worked wasn’t a list at all; it was a map. A map of a country I might never leave for good, but just one country in an interior world with a thousand different places to visit...I’d been to some of them before and they might welcome me again. (Hope, that’s what that feeling of possibility is called. Hope.)

My journey this year has been circular, a spiral. I went back to what I’d tried before, sometimes. I doubled and tripled back. I tried to forget what hadn’t worked or just to become willing to try it again. A therapist recommended I use a mood tracker to measure the effects of various drugs or methods and I suppose there’s a utility to that (you can forget the times when you’re less miserable, for sure) but in the end, I believe that for me, lists and measures are just another way to find myself lacking. 

The thing about making a list of pros is that it is human nature (or my nature, at least) to pair it with cons. All that time I’d spent combating my dark thoughts, I thought relief would come when I won the argument. Or if I lost it. I thought if I could wrestle the monster down and kill it, I’d be free. Or, possibly, it would kill me. Mostly, I wanted the contest to be over. Today, the contest is over because it is not a contest any more.

I don’t pressure myself. Twelve-step meetings are useful to me because you don’t have to talk but also if you just say the same thing every day for a week, no one complains. When I feel like there’s no point or I am just too fucking tired, I rest. When I feel like nothingness would be better, I do something that gives me just a little bit of physical pleasure (whether that’s eating ice cream or smelling my dog’s corn chip toes) to remind me that pleasure exists. This past winter, I decided that coffee was a good reason to get out of bed—but I could get back in if I really needed to. I put one foot in front of the other and have collected whole days, whole weeks, even a couple of months where death didn’t call to me once.

Now, I wonder if the black beast and I aren’t in a fight but something more like a dance. Or he (and it is a he, how funny) is an occasional visitor whom I can ask to leave. I worry this metaphor will worry my loved ones, who have worried enough for multiple lifetimes. 

But if you’re someone who has struggled as I have struggled, I hope I am speaking a language that you understand: The search for permanent relief will take you to the only relief that is truly permanent. Stick around for the things that don’t last and you will stick around for a long while.