When I began transference-focused psychotherapy (TFP) with my psychiatrist in 2005, I had to sign a contract. One of the items in the contract stated if I attempted suicide, my psychiatrist would do everything she could to save me, then she would terminate treatment.
The contract acted as a deterrent until 2014, when at 53, I made a fourth suicide attempt 11 months after my father passed away. I wasn’t mourning him in the traditional sense. My brother and I had been sharing caretaking duties for several years and I expected to feel a sense of relief when he died. Instead, I was filled with rage and resentment and through my work in therapy — my psychiatrist accepted me back into her practice — she and I concluded these feelings stemmed from the realization that my opportunity to hear from him, “You are good enough,” was lost forever. I’d been chasing his approval my entire life.
In the months leading up to this suicide attempt, I’d become severely depressed and while I was barely functioning at work, I’d entirely withdrawn from any semblance of a social life. I drove an hour each way to my job, and almost every day I drove through a torrent of tears. It was as if I was driving in a rainstorm only there weren’t any windshield wipers. I desperately missed contact with my friends, but I simply did not have energy to spare for socializing. I began to loathe myself and believed I was a burden to all who knew me. In the month before I overdosed, I covered all the mirrors in my apartment with spare sheets so I wouldn’t have to endure seeing my reflection.
Suicide is an epidemic in our country. According to the CDC, over 49,000 people died by suicide in 2023. Suicides rose 37% between 2000-2018 and decreased 5%, right before the pandemic hit, between 2018-2020. However, rates returned to their peak in 2022. People ages 85 and older had the highest rate of suicide in 2023. The group with the next highest rate was ages 75-84.
What is causing older people to take their lives?
A related epidemic in this country is loneliness — or social disconnection, characterized by social isolation and lack of emotional social support. Seniors are especially susceptible. They may have divorced earlier in life, or their spouse may have passed away. The friends may have also passed away or access to them may be limited by illness and/or disability. Their children may live far away, or the relationships may be strained.
Multiple studies weigh in on the risks of being disconnected. Disconnection increases with age. It occurs at its highest levels in mid- and late life and predicts increased risk of thoughts of suicide, suicidal behavior, and suicide. Additionally, older suicide attempters have fewer close friends and are less likely to speak with their children or engage in volunteer activities.
The pandemic exacerbated social disconnection among seniors and led to increased loneliness and social isolation. When community centers and senior centers closed, this disproportionately affected seniors and transitioned large numbers of older individuals to virtual technologies which many either do not have access to or are not savvy with.
As a geriatric social worker who works in New York City, I hear from many of my older clients that they are lonely, but they don’t know how to meet people and make lasting friendships. Meeting and making adult friends is difficult even for younger people. One recommendation for clients is identifying an in-person activity in which they enjoy engaging, where they may meet like-minded people — and to be proactive in introducing themselves.
This recommendation may be prohibitive for some seniors who are limited by mobility restrictions or financial stressors. Many seniors also have vision and/or hearing issues which interfere with venturing out on their own and engaging with people. Several senior organizations offer transportation services within a specific catchment area. I encourage older individuals to attend senior centers in the city, many of which have quite robust offerings. Some clients continue to be apprehensive about leaving the safety of their homes.
The epidemic of social disconnection is a silent killer. Isolation saps hope and exacerbates depression along with comorbid medical conditions, leading to increased disability. For many, suicidal ideation reflects a desire to end the emotional pain they are experiencing in the moment. They have lost faith that their lives can improve. Connection fosters contentment and restores hope in ourselves and others. Sharing our stories involves a risk of making ourselves vulnerable but that risk also comes with the potential for increased emotional intimacy and a more intense bond.
The American Foundation for Suicide Prevention states, “Suicide prevention research has been underfunded by the federal government for a number of years. In order to prevent suicide, a concerted effort and investment in suicide prevention research must be made.”
It’s partially up to us — those who have survived suicide attempts — to raise awareness and fight the stigma of shame that exists around the topic. Since the pandemic, there has been an increased awareness and a decrease of stigma around mental illness but not around suicidal ideation. Suicide is a manifestation of hopelessness and extraordinary suffering when our minds are clouded, and we believe no other option exists. I am relieved that I survived, and I regret the pain I caused my family who, when I was at my worst, lived in fear that I’d try repeatedly until I succeeded.
I have not attempted suicide since I overdosed in 2014. My psychiatrist and I mutually terminated treatment at the end of 2016, and I no longer meet the criteria for BPD. Having been chronically suicidal for so many years, in times of extreme stress those thoughts do return but they arrest at just that point — thoughts — and I remain confident I will not act on them. However, one belief I have maintained about severe psychiatric illness is that there are no guarantees. I’ve learned to be vigilant about my mental health, which includes taking my medication and reaching out when I need help.
At 64, my life has never been better. I’m a practicing licensed clinical social worker and an adjunct instructor at a local college. I’m a published writer on mental health and recovery, and I’m working on my memoir. After three-plus decades of severe and persistent mental illness, I’ve come into my own. I can finally breathe.
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.