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The standard advice you’ll hear if you express suicidal thoughts is to call a suicide hotline or check yourself into the hospital. Trained volunteers, such as those at The Samaritans, provide an invaluable service to severely depressed people who call or email them in desperation. But for some of us, suicidal thoughts can be present for many months or years, and we can’t hang out on a suicide hotline or live in the hospital psych ward indefinitely. We have to learn how to become our own trained professional who helps us tease apart our thoughts until we arrive at the truth that will keep us safe from harming ourselves.

The most difficult thing I’ve ever done in my life is to resist taking my life in the midst of severe, intense, chronic suicidal thoughts. I try to remind myself every now and then that no matter what I do from here on out, I am already a success because I am alive. I somehow managed to resist the incredibly convincing messages of my brain — the forceful urges of my psyche — to make an exit out of this world. As I mentioned in another blog, not taking your life in the midst of intense suicidal thoughts can be like not sneezing when you have an urge. Everything inside of you thinks that disappearing from this world is the only way that the pain will subside, so you listen and follow the cues without thinking.

Suicidal Thoughts Are Like Hiccups — Symptoms of a Condition

I don’t like to write about my suicidal thoughts, especially as they are happening in the present, because I am ashamed of them. They don’t fit into the Zen picture that I am trying to create for myself — all the mindfulness exercises I do, the nutritious diet and yoga, and trying to live, without judgment, in the present moment. I’m afraid they mean that I’m not aware and grateful of all the many blessings in my life — which fills me with immense guilt.

But talking about suicidal thoughts saves lives. I know this. Because people realize that other good, grateful, Zen-attempting people experience them, too. The thoughts that try to convince you to leave this world simply come with severe depression. They are mere symptoms, like hiccups, of a brain condition or fragile chemistry that feels at times too painful to endure. Just as chills, nausea, and fatigue are symptoms of the flu — and you wouldn’t blame a person inflicted with that condition — the chronic ruminations demanding a fast exit from here are symptoms of acute depression and anxiety. They mean you are sick rather than “bad.” They are not an indictment of your character.

You Want Relief From Pain, Not From Life

The best thing I have ever read on suicide is called Suicide: Read This First on Metanoia.org, hosted by Psych Central. The page has had over 23 million visitors, if that gives you any indication of how many people consider suicide. “Suicide is not chosen,” Martha Ainsworth writes. “It happens when pain exceeds resources for coping with pain.” It’s a simple formula that makes so much sense and puts things into proper perspective. She explains:

When pain exceeds pain-coping resources, suicidal feelings are the result. Suicide is neither wrong nor right; it is not a defect of character; it is morally neutral. It is simply an imbalance of pain versus coping resources. You can survive suicidal feelings if you do either of two things: (1) find a way to reduce your pain, or (2) find a way to increase your coping resources. Both are possible.

Ainsworth offers five important things to think about, like recommending that you delay your decision by 24 hours or a week, and insisting that people do get through this. She includes some great resources, including various articles, books, support groups, and websites that will help you feel less alone. Her third point involves a tweak to our thoughts that is life-saving:

People often turn to suicide because they are seeking relief from pain. Remember that relief is a feeling. And you have to be alive to feel it. You will not feel the relief you so desperately seek if you are dead.

Making that distinction has saved my life on countless occasions: I don’t want to die. I simply want a reprieve from my pain. I must trust that the relief will eventually come because all of our feelings and thoughts — and especially our most excruciating pain — are impermanent. They can’t last forever because nothing does. So taking our own life is a permanent action for a temporary problem.

Do the Thing Right in Front of You

During this past depressive episode, the suicidal thoughts have been incredibly intense — probably because I’m getting such little sleep, and sleep deprivation alters your perspective on everything. Recently while standing in line at the grocery store, I started doing “death math,” the kind of arithmetic to determine how long I have to stick it out before arriving at a natural death based on the average deaths of my ancestors. When I realized it was a good 40 years, I burst into tears in front of the cashier. I knew I absolutely couldn’t hang on for that long. In fact, I was sure I couldn’t hold on for one more day. I was filled with a crushing desire to be done right now, and that feeling of panic overwhelmed me: “How do I get out?” As if I were trapped in an airplane bathroom and the door won’t budge.

“I can’t. I can’t. I can’t go on,” I said to myself. Every muscle and gland in my body tensed up as I continued to bawl my eyes out in front of this poor woman scanning my items.

Then I remembered something that a friend told me the night before: I don’t have to worry about making it through an entire day. Hell, I don’t even have to tackle a whole hour. All I have to do is the thing right in front of me. In that moment, it was loading some groceries onto the belt. That’s all. If I still existed once they were all on the belt, then my next step was paying for them and hauling them to my car. “Do the thing right in front of you,” she reminded me. “Nothing else.” Everything you need is in the present moment, she said.

Your Only Job Is to Stay Alive

“All I have to do is stay alive for this moment,” I said to myself over and over again as a kind of mantra as I walked out to the car with a cart full of food, trying to be grateful for the groceries but failing once again at gratitude. That was my only job — staying alive.

That’s the only job you have if you’re wrestling with the kind of intense suicidal thoughts that accompany severe depression. Your only responsibility is to keep breathing. One long breath after another. “As long as we are breathing,” explains meditation teacher and best-selling author Jon Kabat-Zinn, PhD, in one of his sitting meditations that I listen to every day, “there is more right with us than wrong with us.”

Your only job is to keep breathing, one moment at a time. You will eventually see that the painful thoughts, as convincing as they are, are a season and won’t last forever. Like all emotions and feelings — and everything in this life — they are impermanent.

“Holding on to anger,” said the Buddha, “is like drinking poison and expecting the other person to die.”

I don’t know about you, but I feel the venom coursing through my veins when I’m ticked off, tightening all my muscles, activating the sympathetic nervous system to prepare for the gorilla that is not about to attack me, and tagging my amygdala (fear center), saying, “You’re it!”

For me, anger can be a good thing, a sign that I’m alive and I’m invested in this world. I guess I’m feeling well enough lately that unkind remarks bother me more, things that I would have never cared about back when I was doing death math all the time, not paying attention to what came out of people’s mouths because my sole focus was on getting to the grave.

But holding on to resentment is no good either, the broken record that keeps on playing the same tune over and over, and it’s not Let It Go from Frozen.

My good friend and writing mentor, Mike Leach, called me up yesterday and said, “I have never seen you use so many capitalized letters and exclamation points in apiece. Are you okay?”

I knew it was time for the Angry Octopus.

Angry Octopus is a 15-minute meditation for children, one of four stories on a CD called Indigo Ocean Dreams, by Lori Lite. My daughter and I would listen to it almost every night two years ago when she was having major sleep issues. The first time I heard it I laughed hysterically. But when I realized it could do my brain some good I paid more attention. Unlike Homer’s Odyssey, this was a story in which I could actually follow the plot.

This octopus wakes up to find his seashell rock garden is a mess. The lobsters traveling across the ocean floor have bumped into it and destroyed it. He is furious. He feels all of his muscles getting tighter and is so irate that he thinks he is going to explode. And then he does! He releases a purplish-black ink into the water.

The poor ocean creature is frustrated and doesn’t like that he is not in control of his body or feelings.

A sea child (mermaid? Still haven’t figured that out) swims by and asks him why he is so angry and why he is sitting in a dark cloud on such a beautiful day. After his five-minute psychiatric intake, which I have no doubt was not covered by insurance, she says to him, “I will show you how to be the boss of your body and your anger.”

Focus On the Breath

First they work on his breathing. She tells him to breathe in through his nose and out through his mouth, taking deep, slow breaths.

This is good advice, because of all the automatic functions of the body — cardiovascular, digestive, hormonal, glandular, immune — only the breath can be controlled voluntarily. The sea child doesn’t quite explain it that way to the octopus, or quote Richard P. Brown, MD, and Patricia L. Gerbarg, MD, but I am going to inject this part because what they write in their book, The Healing Power of the Breath, is quite interesting:

By voluntarily changing the rate, depth, and pattern of breathing, we can change the messages being sent from the body’s respiratory system to the brain. In this way, breathing techniques provide a portal to the autonomic communication network through which we can, by changing our breathing patterns, send specific messages to the brain using the language of the body, a language the brain understands and to which it responds. Messages from the respiratory system have rapid, powerful effects on major brain centers involved in thought, emotion, and behavior.

Tense One Muscle At a Time

Next the sea child tells the octopus to tense and squeeze his toes and feet as hard as he can, to hold the tension as he inhales, and then to release the muscles as he exhales through his mouth.

Next he tightens his legs, then his hips, stomach, and back — always tensing with the inhale and releasing with the exhale.

He tightens his shoulders and neck, then his arms and hands, and finally his jaw, lips, nose, and the rest of his face.

The sea child then helps the octopus to repair the seashell garden. This makes himvery happy. You are left with a few minutes to just breathe deeply with the octopus and the sea child, and it is very peaceful. You wish you had fins.

Dig Deeper

Progressive muscle relaxation techniques and deep breathing do have the power to change our thought process. However, if we still keep getting stuck, it can be helpful to do some prodding at what lies beneath the anger. For example, ever since I’ve had to fundraise for my foundation, I have become an angrier person. Yesterday I realized what it is. I’m going beyond my comfort zone, which is not a good thing. It’s hard enough to post articles about my struggle with depression on this blog and on Facebook where people other than my depression community can read them. But by getting in people’s faces and asking for money, I am left way too vulnerable. The rejection or lack of response hurts too much. So what I need to do is scale back the vision for the foundation to fit within what I can do without having to write to friends and family for money.

Return to the Second Agreement

Yesterday, as I was spouting off to my mentor about the hurtful remark that triggered all this rage, he said very calmly, “But who he thinks you are has nothing to do with who you really are.” It was a reminder of the second agreement of Don Miguel Ruiz’s classic, The Four Agreements, which is, Don’t Take Anything Personally.

Ruiz writes: “Whatever happens around you, don’t take it personally … Nothing other people do is because of you. It is because of themselves. All people live in their own dream, in their own mind; they are in a completely different world from the one we live in. When we take something personally, we make the assumption that they know what is in our world, and we try to impose our world on their world.”

Even when a situation seems so personal, even if others insult you directly, it has nothing to do with you. What they say, what they do, and the opinions they give are according to the agreements they have in their own minds.

And if all of that fails, just think to yourself how lucky you are not to be an octopus who inks outside his seashell garden.

How embarrassing.

A new study from the University of Oxford finds that mindfulness-based cognitive therapy (MBCT) is just as effective as antidepressants for preventing a relapse of depression. In MBCT, a person learns to pay closer attention to the present moment and to let go of the negative thoughts and ruminations that can trigger depression. They also explore a greater awareness of their own body, identifying stress and signs of depression before a crisis hits.

The study is wonderful news because the relapse rate for major depression disorder is as high as 50 percent for persons who have experienced one episode and as high as 80 percent for people who have experienced two episodes of depression. As my psychiatrist said in our last session, it usually takes less medicine to keep someone well than to get someone well. So that means people can wean off antidepressants with a kind of security net under them, without the high risk of relapse.

However, I’m going to risk the backlash of readers and go against popular opinion when I say that I don’t think mindfulness is a cure-all for depression. It has gotten so much buzz lately that I fear that some severely depressed people out there may make the same mistake I did.

Last year this time, I was immersed in an eight-week intensive Mindfulness-Based Stress Reduction (MBSR) program at Anne Arundel Community Hospital. The course was approved by and modeled from Jon Kabat-Zinn’s incredibly successful program at the University of Massachusetts. I was familiar with Zinn’s writings and had read about the many miracles that mindfulness had brought to his patients, from helping with diabetes and arthritis to heart disease and chronic pain. People with insomnia were sleeping through the night, and diabetics were improving their blood sugar.

I salivated over his pages.

I wanted a miracle, too.

I had been unable to break free of chronic “death thoughts” (“I wish I were dead”) for over five years, and was growing disillusioned with traditional psychiatry, as I had tried countless medication combinations that didn’t seem to do much beyond gift me with lovely side effects, and had been in therapy off and on for 20 years. The only thing that did help was aerobic exercise, so I was swimming more than 300 laps some days to escape the thoughts.

There were three people in our small group of 15 that were clinically depressed at the time, or at least were willing to talk about it. During the sixth class, when the instructor was talking about how to let your thoughts be, I became a little agitated and raised my hand. “Are there ever times when your thought process is so distorted that mindfulness and meditation can’t help you?” I asked.

“You can always shift to another object of attention, like from your breath to sound,” she replied.

“No, I mean, like sometimes if you simply get too frustrated trying to meditate, isn’t it better to go watch a movie or do something that will distract you?” I was thinking of the introduction to The Mindful Way through Depression, when authors Kabat-Zinn, Mark Williams, John Teasdale, and Zindel Segal write:

“It may be wise to not undertake the entire program while in the midst of an episode of clinical depression. Current evidence suggests that it may be prudent to wait until you have gotten the necessary help in climbing out of the depths and are able to approach this new work of working with your thoughts and feelings, with your mind and spirit unburdened by the crushing weight of acute depression.”

I finally quoted Zinn, the Dalai Lama of the MBSR world, to get my point across, and then she agreed with him. But I was relieved when one of my other classmates who had experienced the same kind of debilitating depression I had whispered to me, “I don’t think she has ever been depressed like we have.”

He confirmed what I was thinking during that moment and what has been my experience: mindfulness is better at keeping a person from getting depressed than from pulling a person out of depression.

I say this because I gave the program everything I had. I meditated everyday for 45 minutes for more than eight weeks, read everything I was supposed to for the class, went to a weekly three-hour class, and participated in a retreat. But, upon graduating from the program, I drove home still fighting those damn death thoughts.

I felt like a complete mindfulness and MBSR failure.

What went wrong?

In hindsight, I wish there was more than one paragraph in Zinn’s book about when mindfulness isn’t the solution, about when it’s better to swim laps or ride your bike into town or call a friend you haven’t talked to in a while. I still would have taken the course — and I do feel like I benefited immensely from it — but I would have been more forgiving of myself that it didn’t “work” like everyone else’s magic.

Today I am more aware of my stress reactions and am proactive about reducing my stress before I start wilting. I can identify the thinking patterns that lead to depression, like the inner critic and jumping to the future. Especially beneficial is locating tension in a certain region of my body, and trying to relax it. All of this I learned from the class. And I still meditate — actually it has morphed into prayer, which is a more natural form of meditation for me, and more beneficial (for me).

Mindfulness and meditation may very well keep me from relapsing from depression, now that I am finally without the death thoughts.

I hope so anyway.

But I don’t attach to it the magical properties that I did before, and I think we need to be careful in our optimism.

There are many, many tools to help those of us who are at risk for depression relapse.

Mindfulness is one.

Stuck thoughts. Painful ruminations. Unrelenting obsessions. They are the curse of depression — among the most excruciating symptoms, in my opinion. “When a child gets lost, he may feel sheer terror,” explains Byron Katie in her bestseller Loving What Is. “It can be just as frightening when you’re lost inside the mind’s chaos.” I can usually gauge the severity of my depression based on the intensity and frequency of my stuck thoughts. Sometimes they can outright debilitate me. One seemingly benign thought — often a rumination about a decision I have made in the past, a regret of one form or another, or sometimes something that makes no sense at all — is packed with panic and plays over and over again in my mind, keeping me awake at night and besieging me with anxiety during the day. More than any other symptom of my depression — more so even than unrestrained tears and bawling my eyes out in public — the stuck thoughts make me feel truly insane, scared to be living inside my body and mind.

In my post 9 Ways to Let Go of Stuck Thoughts, I offer some tools to deal with obsessions. But since I’ve been imprisoned by this insanity as of late, I thought I’d share more of them with you that have helped me escape, if only for a few minutes, to a place of peace.

1. Rely on Other Brains

In the state of severe ruminations, your brain is toast. You have to fully admit that — it’s the first step of most 12-step programs. You can’t rely on your logic or any of the content that’s streaming through your neurons, because it’s all inaccurate. You need to rely on other brains to help you sort out the stuck thought and tease it apart until you arrive at the truth. Fortunately, I have a handful of friends who know the insanity of ruminations and have walked with me through this in the past. They know it’s what I do when I get depressed. I get hooked on one thought and use it to beat myself to the ground until I feel absolutely worthless. So I have to believe in their logic. They remind me of why I made certain decisions, why they were the right ones, and why that decision has absolutely nothing to do with the panic that is raging through my body.

When I’m on the phone with them, I write down everything they say like a newspaper reporter, because I will need that information handy for when the thoughts come — and I can’t afford to bother them again. I have a journal filled with the reasonable logic of my friends, and sometimes (not always) accessing their truth calms me down as if I’m talking to them again. I try to trust them because I know I can’t trust my own brain.

2. Investigate the Thought

“I have never experienced a stressful feeling that wasn’t caused by attaching to an untrue thought,” writes Katie. “Depression, pain, and fear are gifts that say, ‘Sweetheart, take a look at what you’re thinking right now. You’re living in a story that isn’t true for you.’” In her book, she explains what she calls The Work, a way of inquiring or investigating your thought with four simple questions:

It it true?

Can I absolutely know that it’s true?

How do I react when I think that thought?

Who would I be without the thought?

Then you turn the thought around. You rewrite your statement as the opposite. If you said, “I am a failure,” your turnaround might be, “I am a success.” And you find three genuine, specific examples of how the turnaround is true in your life.

If my ruminations are severe, this strategy doesn’t always work. As I mentioned in my other piece, sometimes it’s better not to analyze the thought. But just asking myself the first question, “Is this true?”, can sometimes forge a little distance between the rumination and my symptoms of anxiety or be a reminder that I’m caught in a story that isn’t accurate.

3. Visualize the Thoughts as Hiccups

Ruminations are symptoms of depression just as nausea or fatigue are symptoms of the flu. If my fever spiked or I developed a bad case of hiccups, I wouldn’t berate myself for those symptoms. Yet I feel totally at fault for my stuck thoughts, as if they are a weakness of my character, which further pushes me down the rabbit hole of despair. One of my friends recently yelled at me over the phone, “THEY ARE NOT YOUR FAULT!!” when I told him that all the mindfulness exercises I had been doing were making me feel even worse — as though I were creating the ruminations by not being able to let go or detach in the right way. He reminded me that when they reach a certain intensity — when they are making me hyperventilate over the phone to a friend as I was doing, or they totally disable me — mindfulness doesn’t work. At this point, I’m better off imagining them as physical symptoms of an illness and say, “Here they are again .…” rather than to constantly try to meditate them away or release them in the zen fashion that I would like.

4. Use a Mantra

“When my thoughts become intense,” a friend told me recently, “I will use a mantra as a kind of racket to hit the ball back.” Repeating a mantra helps her be prepared for the thoughts when they come. She told me to look through Scripture and find something that resonates with me. I chose “Be not afraid,” as it appears throughout the Bible more than any other phrase, and is also my favorite hymn — one that I would sing all the time as a young girl when I was scared — based on my favorite psalm. A mantra doesn’t have to be religious, of course. It can just be a simple phrase, like “Peace be with me.” Or “I am okay.” Or “This will pass.”

5. Do the Thing in Front of You

I said this recently in my piece on suicidal thoughts. When I’m battling severe ruminations, my head is usually trapped in the past or in the future, fretting a decision I’ve made a month ago or worrying about something a week or a year from now that may never even come to be. The thoughts engulf me in a world that is not real and spin panic everywhere I look. At this point, I can’t handle a day’s worth of concerns, or even 15 minutes of them. What helps immensely is to concentrate only on the task in front of me. If I’m working, this means trying my best to craft a sentence that makes sense. If I’m with the kids, it means helping with their math problems or making a snack. Sometimes it helps to have an anchor to the present moment, such as concentrating on my breath or tuning into my senses. But when mindfulness doesn’t work, I try to tell myself that all I have to do is the thing I am already doing.