Every now and again, the universe tells me in no uncertain terms that it’s time to write about a certain topic. This is one of those times. Between talking about my own dark time as part of the RA multimedia project and reading this heartwrenching and beautiful post from my friend RA Guy about his trip into the abyss earlier this year, suicide has been on my mind.Thoughts of suicide and RA

Chronic illness and depression go hand-in-hand and so it is with RA. According to Johns Hopkins, chronic pain exacerbates depression and from an intellectual standpoint, it’s not surprising that some of those people who are depressed consider suicide. And some do more than consider. But this is not an intellectual post that delves into the research. This post is very personal.

Nine years ago, I was in the middle of a horrendous flare and waiting for funding so I could start a biologic. Nine years ago, the only way I could get through each day was to set a limit on how long I would have to endure the pain that enveloped me like an oil slick every minute of every day. I set a limit of six months, promising myself that if things weren’t better by then, it would be okay to do a voluntary exit. To kill myself. I didn’t want to die, but I could see no other way out.

I didn’t talk too much about how deep my depression was and not just because it didn’t feel like depression — it was too deep for that. I had only enough energy to get through each day and that only barely, so there wasn’t much left over for talking. In the last week, I have found out just how complete my silence was — several people who were then, and are now, closest to me had no idea. I’ve wondered why I didn’t say anything and have come up with two reasons.

First, from a purely practical perspective I didn’t want anyone to know. If they did, they might take away my codeine. It was a really important part of my pain management, but more than that, I was saving it up to use if I had to go. Without my codeine, I would no longer have the option that was the only thing that kept me going through the hell my life had become.

Second, and much less practical, facing something as stark and profound as the end of your life is a very solitary experience. When you are saying goodbye to all the small pieces that make up your life, one at a time, slowly and for real, it’s not something in which you can have company. Going deep within small moments, absorbing them, experiencing the importance they’ve had and finding a way to let them go is something you can only do on your own. There are a few experiences in this life that are supremely and completely individual and dying is one of them. When you are that close to the edge, distractions obscure your focus and other people’s presence are a distraction.

In retrospect, I should have told someone. In the bright light of day and out the other side of the abyss, I look back upon that time and know that had I shared how I was feeling, help would’ve been right there. Maybe my rheumatologist could have expedited the funding — nothing as motivating as a suicidal patient, one should think — or maybe she could have found something to bridge me until the money was available. Prednisone could have been an option, in some cases a necessary evil and that situation certainly justified it. My family doctor could have offered antidepressants, bigger painkillers and referrals to mental health professionals. My friends and family could have offered even more support than they were already giving me.

What pulls us out and away from the bridge, from the edge of the subway platform and what makes us leave the rope or pills behind is different within each of us. For me it was finding a medication that worked. For RA Guy it was trusting his husband (and I am so grateful for still having my friend). For others, it’s a small inside voice that says get help, now.

And this is what I hope I have learned from living through it: that should I ever get back to that place of darkness again, I will ask for help. Even if I can’t imagine anyone being able to help me — because you don’t, when life is that desperate — I will ask for it. And I will continue asking until I get it.

If you are in the dark place and feel the only way to end the pain is to end your life, please seek help. Tell your doctor, tell a loved one, call a suicide prevention hotline (see below). I know it may not occur to you to seek help or it may scare you to get help, but do it anyway. I can tell you from personal experience that once you get that help, you’ll be glad you did.

Find your local suicide prevention hotline anywhere in the world at befrienders.org

Lene is the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain. Her new book is 7 Facets: A Meditation on Pain.