The author discusses denying suicidal ideation to avoid hospitalization, a common client behavior that complicates clinical assessment. Clinicians primarily rely on self-report, while clients often fear being hospitalized if they openly discuss suicidal thoughts. The author’s own attempts were driven by profound hopelessness, feeling like a burden, and isolation.
The text introduces Suicide Crisis Syndrome (S.C.S.), a proposed diagnostic condition marked by „frantic hopelessness“ and feeling trapped. Research indicates S.C.S. screening significantly reduces hospital readmissions for suicidal ideation. With over 49,000 suicide deaths annually, current detection methods are insufficient; S.C.S. offers a promising new avenue for improved prevention.
In the weeks prior to my most recent suicide attempt 11 years ago, I denied I was suicidal to anyone who asked. I was in a partial hospitalization program (PHP), and my thinking was that I needed to get back to work, and that I did not want to be admitted to the psychiatric hospital—which is certainly what would have happened because not only was I thinking about suicide, but I had a definitive plan and time frame.
In their book, Secrets and Lies in Psychotherapy, co-authors Barry Farber, Matt Blanchard, and Melanie Love state that concealing or hiding thoughts about suicide is the third-most-commonly reported lie that clients tell their therapists, with 31 percent of one study’s respondents answering positively to this question.
There were times when I first started working with my psychiatrist, Dr. Lev, when I was honest about my plans to die by suicide. This was around 2005 to 2007, when I had less at stake: I wasn’t working and I was on Social Security Disability payments. I had fallen into a severe depression and talk of suicide dominated our sessions. I already had a history of two previous attempts and when I started describing a detailed plan, Dr. Lev had no choice but to hospitalize me.
How does a clinician discern when clients are telling the truth about being suicidal and when they are not? Currently, the only method we have is client self-report, including suicide screening tools such as the Columbia-Suicide Severity Rating Scale (C-SSRS).
Talking about suicide can be difficult. I know that when I was a client my biggest fear was that my therapist would hospitalize me when all I wanted to do was talk about how it felt to consider suicide as an option. To have a therapist who could comprehend the difference between that and being actively suicidal, especially 40 years ago, was a gift.
One of the enduring questions around suicide is what allows some people to cross that line from contemplation to action. For me, the final step was a confluence of feelings, the most prominent being a total loss of hope and a certainty that circumstances would not improve. And also, the feeling that I’d been trying with everything I had but had failed miserably and had let all the people around me down. That I was a burden to all the people in my life, and couldn’t do anything right, so they would be better off without me.
I’d wake up in the middle of the night, the sky obsidian black, and feel alone in the universe. This is when the switch in my brain flicked from off to on and I moved from thinking about suicide to acting on it. Loneliness and isolation served to exacerbate all the feelings that had been bouncing around in my brain and now I just wanted to get it over with.
A recent New York Times article, “When People in Distress Deny Being Suicidal, Should They Be Believed?” discusses a proposed a new diagnostic condition called suicide crisis syndrome, or S.C.S.: “Suicide crisis syndrome is considered the last of a four-state mental progression toward suicide that often begins with ongoing problems like alcoholism and the lingering effects of childhood trauma. When these issues are combined with character traits like perfectionism or impulsivity as well as stressful life events and thoughts of being a failure and a burden, it creates a perfect storm. To be diagnosed with S.C.S., [Igor] Galynker, the director of the Suicide Prevention Research Lab at Mount Sinai in New York City, said, patients must have a ‘persistent and intense feeling of frantic hopelessness,‘ in which they feel trapped in an intolerable situation.”
There is some evidence, the Times reports, that screening for S.C.S. is effective: “In 2024, Dr. Fred Miller, an emergency psychiatrist in the Chicago area, and his collaborators published a study showing that when E.R. patients were diagnosed with S.C.S., and admitted to the hospital with moderate to severe suicidal ideation, they were about 75 percent less likely to be readmitted to the hospital than patients with the same level of suicidal ideation who did not have S.C.S.”
I can see now that at least two of the times I attempted suicide, factors in my life had coalesced to form that “perfect storm” Galynker referred to. Issues with work, my relationship with my therapist/psychiatrist, challenges with my eating disorder and my perfectionism, and more, all fused to confound my thoughts and feelings into an intractable sense of hopelessness.
According to the CDC, over 49,000 people died by suicide in 2023 while 1.5 million people attempted suicide in the same year. In 2023, suicide was among the top eight leading causes of death for people ages 10-64, and was the second-leading cause of death for people ages 10-34.
I’m grateful that none of my suicide attempts were fatal. But what we’re doing clearly isn’t working. Suicide crisis syndrome may offer hope for improved detection and prevention.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
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