The following article first appeared in Fibromyalgia AWARE magazine, Winter 2008, Vol. 18. We invite you to share this article free-of-charge in your blog, website or any other educational and social media venues. We request that you include the following credit line with the article: © FM Aware All rights reserved. Reprinted with permission from the National Fibromyalgia Association: www.fmaware.org
Up the Down Staircase: Dealing with Fibromyalgia-Related Thoughts of Suicide
By Kenneth France, PhD
Fibromyalgia is both physically and mentally taxing. If the demands seem too much to bear, patients may feel a sense of despair accompanied by thoughts of suicide. Even when feeling so desperate, most individuals would prefer a solution other than death. It can be challenging, though, to change the direction of one’s thinking. For those who find that challenge too difficult and instead continue in a downward spiral, the result may be a premature death.
Whether or not a person eventually dies by suicide, simply having thoughts of killing oneself is troubling. In fact, such turmoil occurs fairly frequently. Among individuals with chronic pain, there is research indicating that as many as one in three have had recent thoughts of suicide. That is an important finding because, as is also true for those without persistent physical pain, the best predictor of life-threatening behavior among individuals with chronic pain is whether the person is thinking about ending her or his life.
Often there is interest in knowing “signs” of such thinking in others. The surest and best way to discover the presence of suicidal thinking is simply to ask whether the person is having thoughts of suicide. Such thinking frequently develops in conjunction with depression and with viewing the painful condition as a catastrophic and hopeless situation. It is easy to understand how individuals can become susceptible to suicidal thinking if they feel profoundly discouraged and tired, while also believing they are utterly helpless to improve what they perceive to be overwhelming circumstances.
The good news for individuals with fibromyalgia is that when such devastating thoughts occur, they rarely last. Among those who have thoughts of suicide, most choose life rather than death, and of those who do engage in life-threatening action, most survive the episode. Having come through such a turbulent time, many can take heart in having eventually handled dire circumstances. If they again face similar difficulties, they can recall how they successfully coped before and can have realistic confidence in their ability to persevere again.
For individuals dealing with fibromyalgia, though, there may be a question as to how safe one can be from future thoughts of suicide. A common analogy is that our ability to predict suicidal thoughts is similar to predicting the weather. We can predict the weather one minute from now with great certainty, one day from now with some certainty, and one month from now with almost no certainty. Consequently, one probably can never be guaranteed a future free of suicidal thinking. The more important issue is, “How will I respond to suicidal thoughts that may come my way?”
If I am thinking about death as an option, I am in a situation that is similar to past times in my life when I have confronted circumstances that seemed both intolerable and unsolvable. So I need to ask myself, “How have I handled such situations?” The answer may contain the seeds for dealing with current thoughts of suicide in ways that are not life-threatening. Life-promoting growth is likely to result when those seeds involve adaptive coping, rather than maladaptive efforts that set me up for future difficulties.
Each person is unique, but some commonly used responses to seemingly overwhelming challenges include: (1) seeking meaning in my religious faith, (2) connecting with those who know me well, and (3) arranging appropriate professional help. (These efforts are likely to have the greatest impact if I come to feel that I am understood, that I am cared for, and that I am in a trustworthy relationship.)
There is empirical evidence to support each of those three types of responses. (1) With regard to religious faith, chronic pain patients who pray tend to have less suicidal thinking than those who do not pray. (As noted above, the use of any particular way of coping is an individual matter. What seems logical and useful to one person may not be a good fit for another. Such variance characterizes all of the research mentioned in this paragraph.) (2) When it comes to seeking out and using social support, research has demonstrated how important relationships can be. For instance, one study found that among chronic pain patients who had made plans to kill themselves, the most common reason for not acting on those plans was their families. (3) Professional caregivers can also play a role, and it may be advisable to get the full range of professional help that is needed. Research has shown that compared to fibromyalgia patients receiving standard care from one medical provider, patients receiving multidisciplinary care typically experience better short- and long-term gains regarding pain intensity, days of pain, hours of pain, mood, and activities of daily living.
Despite the benefits commonly associated with necessary and appropriate professional care, some individuals with fibromyalgia do not use available professional resources. Research suggests that one of the primary reasons for such inaction is viewing the consequences of fibromyalgia as not requiring treatment because they are a normal part of life. There may be some situations in which such thinking is adaptive. That is clearly not the case, however, if there has been an absence of professional care and things have become so distressing that the individual is considering suicide. A downturn like that means it is time to become more open to seeking professional help.
If my past struggles have not led me to discover resources that I want to use again, then I need to think about new possibilities. One of the most frequently used approaches for discovering such options is “word of mouth.” In my search for possibilities I can reach out to my faith community, my family and friends, or trusted professionals, and seek input on where to find new resources to try.
What if both my past coping attempts and my word-of-mouth efforts do not give me the results I want? I might want to try some publicly available sources of information. Although such resources do not include personal endorsements from people I know, they can provide contacts that I eventually judge to be useful. For example, on a national level, both the American Association of Suicidology (www.suicidology.org) and the National Fibromyalgia Association (www.FMaware.org) provide information that is easily accessible on the internet. Locally, I might contact a crisis intervention program or an organization that provides information and referral services.
If I have fibromyalgia and am suicidal, I probably am depressed. So I need to be evaluated for depression, and, if I have that mood disorder, I need to receive effective treatment for it. The exact nature of such treatment is something for me to discuss with appropriate professionals.
If I have established contact with a mental health professional whose scope of practice includes both depression and suicidality, I should be able to openly and honestly share my pain and discouragement with that person. In straightforward ways we should explore my challenges and the emotions associated with them. Eventually we should develop goals to strive for, as well as realistic plans to help me move in those directions. I should have a sense that we are approaching my dilemma as a team, and that there are areas in which I really can make progress.
Finding the right kinds of help sometimes is a trial-and-error process. If I persevere, however, I can be sustained by the hope that my efforts will ultimately result in obtaining resources that meet my needs.
Despite my best efforts, it may take a while to secure the help I need. If I continue to have suicidal thoughts during that quest, there four self-care questions I need to ask myself.
(1) Is my physical condition getting appropriate attention? Since my physical state is one of the primary challenges I’m facing, there may be limits on what can be done. Nevertheless, I should continue to use medical and rehabilitation care that has been available to me.
(2) On the issue of deciding whether to live or die, am I giving fair consideration to the option of choosing life? It may be easy for me to come up with advantages of being dead and disadvantages of being alive, but I also need to spend time considering advantages of being alive and disadvantages of being dead. When I hit upon life-promoting thoughts that resonate with me, I need to make note of them. Later, if I feel the pressure of death-promoting ideas, I can make a conscious effort to turn my focus to those previously identified life-promoting beliefs. If they are not sufficient to change my attitude, I may need to simply muster the courage to postpone any plans for harming myself so that I can first have in-depth discussions with a professional regarding the pros and cons of life and death.
(3) Have I decreased the availability of lethal means for harming myself? For example, if I have firearms in my home, I need to arrange for them to be safely taken to a secure location where I will not have access to them. And if I have medications, their storage and my use of them should be monitored by a third party.
(4) To the extent possible, am I bringing my problem-solving abilities to bear on issues that I do have some control over? In many instances, I can think through a problem and recognize my feelings associated with it, consider options (including things I’ve tried that might be modified or tried again, things I’ve thought about trying, and new possibilities), create realistic plans, engage in planned tasks, and make adjustments as necessary.
With regard to confronting thoughts of suicide, hopefully the previous paragraphs have provided some helpful ideas. Still, you may want more. If that is the case, you might want to consider how past generations have viewed the dilemma of choosing life or death in the context of longstanding physical and emotional suffering. For instance, in Jewish and Christian traditions, there is some memorable guidance in the story of Moses at a point when the people of Israel have suffered in the wilderness for a long time. They are all experiencing physical distress and many have become profoundly discouraged. Recognizing both their challenges and their desperation, Moses says to them, “…I have set before you life and death, blessings and curses. Choose life so that you and your descendants may live….”
If you have religious faith, you can think of God’s love for you despite the “curses” you are now facing. Whether or not you believe in God, you might consider the contributions you can continue to make by choosing life. It is life’s opportunities for such giving that enable many of us find meaning, significance, and courage.
Dr. Kenneth France is a Professor of Psychology at Shippensburg University of Pennsylvania and is the Training Coordinator for the STAR (Steps Toward Advocacy and Recovery) Warm Line in Carlisle, Pennsylvania.
If you are—or someone you love is—in crisis and you need immediate help, please call the National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255).
For more information, go to www.suicidepreventionlifeline.org.
Many people with fibromyalgia also experience migraine and depression; now a study from the Netherlands reports that these two seemingly unrelated conditions may share a genetic component.
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