Living with Suicidal Thoughts: 11 Insights for Navigating Pain and Finding Hope

3. Understand the Impact of Chronic Pain on Mental Health

Wally lives with chronic physical and emotional pain, stemming from childhood abuse, multiple traumatic brain injuries, and a life-altering fall during military service.

As Wally recalled:

I basically broke every bone on my body from my skull to my right knee… Within a few months, it had become chronic.

Pain affects Wally daily:

• They rate their average pain level as a 7 or 8 out of 10.
• Waking up each day involves battling what they call the “pain body.”
• Morning routines include mindfulness to challenge trauma-based thoughts.

Chronic pain can be an overlooked risk factor for suicidal ideation, making it essential to treat both physical and emotional suffering together.

4. Use Personalized Tools for Daily Mental Health Management

Wally doesn’t just talk about surviving—they have created structured systems to manage their mental health proactively. One of these is a daily mental health inventory, adapted from AA materials:

Wally’s Daily Check-In Includes:

• What do I like/dislike about myself today?
• What is my greatest strength and weakness right now?
• Am I staying in alignment with my values?
• Am I backsliding?

As Wally described:

I call it a check-in and an inventory because it just sees where I am.

This self-awareness practice helps Wally take an honest look at their mental state before it escalates.

5. Learn and Practice Grounding Techniques

Wally credits mindfulness and breathwork as life-saving tools they use regularly:

As Wally shared:

I can bring my heart rate from like 200 on a bad anxiety attack down to 60 in about 20 minutes, just with my breathing.

These techniques help regulate their nervous system, particularly since brain injuries have impaired their thermoregulation and heart-rate control.

Other practices they use include:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Mindfulness meditation

6. Develop a Suicide Ideation Assessment Plan

Wally uses a three-tier personal assessment system to gauge when they need more support:

1. Flirting with the idea – Feeling low but no concrete thoughts or plans
2. Active ideation – Thinking about dying and spiraling into toxic thought loops
3. Red alert – When managing ideation becomes a full-time job, Wally activates a safety plan

As Wally explained:

If managing my suicide ideation becomes what I call a full-time job, I activate my plan.

Having this internal “early warning system” helps Wally act before thoughts escalate.

7. Ask Better Questions When Someone Opens Up

One of Wally’s biggest messages is that unsolicited help isn’t always helpful. Instead of reacting with panic, try asking clear, respectful questions.

As Wally poetically noted:

Unsolicited help is not help. It’s an assumption inhabiting a spot better filled with questions.

Questions Wally recommends:

• What kind of suicidal thoughts are you having?
• Are you planning, or just thinking about it?
• Do you have an emergency plan?
• Do you have someone you trust you can talk to?

These questions open the door for meaningful, nonjudgmental conversation.

8. Acknowledge That Some People Live With These Thoughts Daily

Wally’s honesty reminds us that for some, suicidal ideation is not a crisis—it’s a constant. They manage it the way someone else might manage diabetes or chronic pain.

As Wally clarified:

I ideate nearly every day: the pain is that bad. I’m not suicidal at that point. Don’t try to save me… I manage it.

This doesn’t mean they’re in danger—it means they need support, tools, and acceptance.

9. Set Boundaries When Supporting Others

Wally deeply values supporting others in crisis, but also recognizes the importance of boundaries.

As Wally explained:

If they’re suicidal, then I say, do you want to get some help on this? Because I can’t help you with this… I have boundaries.

While empathy is essential, burnout and vicarious trauma are real. It’s okay—and necessary—to know your limits.

10. Encourage Conversations That Make Space for All Emotions

Wally sees value in sitting with others through hard conversations—not to fix them, but to witness and validate their pain.

As Wally expressed:

There’s just no practice on how to talk about these things.

Creating a world where suicidal thoughts can be talked about without fear can:

• Save lives
• Foster belonging
• Replace shame with support

11. Know When to Escalate for Safety—and When Not To

Dr. Anita Sanz urges therapists, doctors, and loved ones to respond proportionally to suicidal ideation:

As Dr. Sanz emphasized:

Just having thoughts and ideation does not mean that a person is actively suicidal or needs to be immediately hospitalized.

When professionals and peers overreact, it can cause people to hide their distress. The right response might be:

• A hotline call (e.g., 988 in the U.S.)
• A therapy referral
• A safety plan—not always hospitalization

Final Thoughts

This episode doesn’t offer easy answers—but it does offer honesty, clarity, and hope. Wally’s story stands as a reminder that even amid immense pain, it is possible to develop a meaningful life, one grounded in routine, self-awareness, and purposeful dialogue.

We see how tools like mindfulness, mental health check-ins, and open conversations can allow people like Wally to live—not just survive. These aren’t miracle cures, and they don’t erase the pain. But they do make space for healing, choice, and agency.

Their courage to speak openly—despite stigma, misunderstanding, and chronic suffering—is not just brave; it’s generous. It teaches others how to hold pain without judgment, how to build systems that protect life, and how to meet people where they are.

As Terry eloquently put it:

If someone else is struggling, take the time to listen.

The invitation is simple, yet radical: talk about it. Listen. Be present. You don’t need all the answers. Sometimes, showing up and asking the right question is enough to shift everything. This episode reminds us that mental health conversations don’t always have to be emergency interventions—they can also be everyday acts of connection, compassion, and care.

If Wally’s story resonates with you, or if you know someone who navigates similar waters, let this article be a starting point for dialogue. Let it encourage you to check in—on others and yourself—with curiosity and kindness. and yourself—with curiosity and kindness.

Key Takeaways

• Suicidal ideation is a spectrum—not every thought requires hospitalization, but every thought deserves compassionate attention.
• Wally’s approach includes structure—from breathwork to daily inventories, they build systems that help them cope and check in.
• Boundaries are essential—especially when supporting others. You cannot pour from an empty cup.
• Words matter—avoiding panic and using direct, gentle questions can create safer space for honest discussion.
• Stigma silences—and Wally encourages us to bring these conversations out of the shadows.
• Pain is real, and so is resilience—Wally’s daily management of their ideation is not just survival—it’s a form of activism.
• Shared experience can be powerful—Hearing from others who live with suicidal thoughts reduces isolation and creates connection.
• Tools can be learned and practiced—Skills like CBT, DBT, and mindfulness are not just buzzwords; they can be lifelines.
• Community and support are critical—Even when professional help isn’t available, trusted friends and mutual check-ins can make a difference.
• Conversation is prevention—Being willing to talk about suicide openly and without panic could save a life.