When the pain is not going to stop

Thoughts of suicide that grow out of constant physical pain, or out of living with a long-term condition, tend to get filed in one of two drawers. Either they are "really" a mental health problem, or they are a rational response to an impossible situation. Most of the time they are neither, and services that only answer one half leave the other half untouched.

This page is for you if the pain does not stop, if a diagnosis has changed what your life can hold, or if you are worn out by a body that will not settle.

The bind many people end up in

There are two versions of it, and some people get both in the same month.

In the first, you say you are in despair and are told it is understandable given your illness. That is true, and it is also a way of closing the conversation. If the distress is treated as a normal side effect, nobody ends up responsible for treating it.

In the second, you say the despair is serious and the pain gets quietly re-labelled as part of it: low mood, anxiety, "how you are coping". Now nobody believes the pain.

Being disbelieved about pain is not a minor insult on top of the real problem. It is a cause of despair in its own right. It tells you that the thing consuming every hour of your day is not real to the people who are meant to help, and that you are on your own with it. If that has happened to you, the isolation you feel is a reasonable result of how you were treated, and it is worth naming out loud.

When the conclusion feels like plain logic

Some people do not feel confused or out of control. They feel clear. The pain is not going to stop, the future looks like more of the same, and ending it seems like the sensible reading of the facts.

We are not going to argue with your reasoning or pretend the situation is easier than it is. Here is only what many people recognise afterwards.

• The conclusion tends to arrive during the worst stretch, when the pain is loud and you are exhausted.
• Severe pain and long exhaustion narrow what anyone is able to imagine. Not because you are weak, but because that is what they do to a mind.
• The state in which the decision looks obvious is itself part of what needs treating. It is a symptom of the load you are carrying, and it can be addressed separately from the condition.

None of that says your pain is smaller than you think. It says the picture from inside the worst of it may not be the whole picture, and that it can change when the load is shared.

The fear of telling a clinician

Many people with long-term pain stay silent about suicidal thoughts for a specific reason: they are afraid that saying it will cost them. That it will change how their pain is treated, or that they will be read as someone who is exaggerating, or as someone who is only after relief.

That fear is real, and you are not being paranoid for having it. We cannot tell you how any particular clinician will respond, and we are not going to promise an outcome we do not control.

What you can do is say the fear first, so it is on the table instead of silently steering the appointment: "I want to tell you something, but I am worried it will affect how my pain is treated." A good clinician will want to hear that sentence. It gives them the chance to answer the worry directly.

Wording you can use →

What to ask for, in words

You are allowed to ask for a particular kind of help, not only a particular service. Some things that can be said:

• "I would like the pain and the despair treated as two separate problems, both taken seriously, not one explained away by the other."
• "Who is responsible for which? Who looks after the pain, and who looks after how I am coping with it?"
• "Can you write down who I should go back to, and for what?"
• "I would like a review, not a discharge. I do not feel I am in a position to manage this on my own yet."
• "I do not feel believed about the pain, and it is making this worse."

Surviving a waiting list → · Getting a first GP appointment →

A bad day, or a change

When you live with pain, bad days are normal, and a flare can feel almost identical to a crisis. That makes it hard to know which one you are in.

The most reliable guide is your own pattern, written down while you are relatively steady. Think about:

• What a flare looks like for you, and how long it usually lasts
• What is different when it is something more: thoughts that stay after the pain eases, a sense of finality, pulling away from people, stopping the things that normally hold you together
• Whether the thoughts of suicide have started to feel like relief, rather than a passing weight

If the second list starts to look familiar, treat it as a change rather than a flare, and tell someone that day, not once it has become unbearable.

Mapping your early warning signs → · Building a safety plan →

If you are the person beside them

You do not need to fix the pain, and you do not need to win an argument about whether life is worth it. Believing them about the pain is already a large part of it.

Supporting someone →