Understanding Suicidal Thoughts: A Trauma Therapist’s Reflections on Pain, Agency, and Healing

Exploring the roots of suicidal thoughts and how trauma-informed therapy can foster resilience

⚠️ Content Warning: This post discusses suicide, suicidal thoughts, and related experiences. Some readers may find this content distressing.

If you are in the United States and are experiencing suicidal thoughts or are in crisis, please call or text 988 to connect with the Suicide & Crisis Lifeline, available 24/7. If you are outside the U.S., please reach out to your local emergency number or crisis hotline for immediate support. You are not alone, and help is available.

I must admit: writing about the philosophical question of suicide is challenging. I’ve restarted this piece several times, trying to find a tone that honors the weight of the subject without glorifying it—and without reducing it to something clinical or dismissive.

Ultimately, what I share here is drawn from my experience as a trauma therapist in Westchester, NY. It’s less about answering why people die by suicide, and more about exploring why our emotions sometimes tell us we shouldn’t exist at all. Both questions resist simple answers, but after a decade of working with individuals wrestling with these thoughts, I hope to offer some perspective that may resonate with anyone affected by suicide in any capacity.

Over the years, I’ve sat with people who didn’t necessarily want to die but didn’t know how to live. I’ve supported clients who felt crushed when their attempt “failed,” and I’ve also received heartbreaking news about those who left treatment in good spirits but later died by suicide. From every one of these experiences, I’ve learned something about the human condition, despair, and resilience.

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Beyond “Look on the Bright Side”: Understanding the Roots of Suicidal Thoughts

I’ve learned equally valuable lessons from each of these scenarios—and from countless others along the continuum of despair. The mainstream explanation for suicide is often that people cannot see a way out of overwhelming pain. While broadly true, this view oversimplifies the experience. It suggests that suffering stems from ignorance of life’s joys, and that reminding someone of “all there is to live for” should be enough to shift their perspective.

In my experience, this well-intentioned approach can actually deepen a person’s sense of disconnection. Many who struggle in this way are already acutely aware of the good in their lives—the love of their children, the beauty of the world, the accomplishments they’ve achieved. Yet despite this awareness, their bodies remain numb or flooded with relentless discomfort.

The internal story then becomes: “If joy and meaning are supposed to help, but they don’t work for me, I must truly be beyond help.”

That’s why it’s important to challenge some common myths about how to respond when someone expresses these feelings. What has proven effective—both in my own practice and in interventions I’ve witnessed—can often feel counterintuitive. Before getting to those, though, let’s take a closer look at some of the reasons I believe suicidal thoughts can arise within human nature.

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When the Nervous System Shuts Down: How Our Biology Interprets Modern Threats

The first path is more tangible, rooted in what we now know from advances in neuroscience about the brain and body. In the simplest overview of the nervous system, we have three distinct categories—or “states”—of defense against threats. These states aren’t just activated in moments of physical danger; we also rely on them to navigate the social world.

Ideally, we use logic and reasoning to collaborate, problem-solve, and find safety in connection. But when that isn’t possible, the nervous system shifts into survival mode. The next options are fight or flight—confront the threat or run from it. And if neither feels viable, the body defaults to its final line of defense: shutdown.

This “freeze” or “collapse” response can manifest as paralysis, dissociation, numbness, or even fainting. What complicates things further is that, for many, the social world can feel more threatening than any physical danger. Yet our nervous system doesn’t differentiate—its ancient survival responses can misfire in response to the overwhelming complexities of modern life, interpreting them as too much or even as inescapable danger.

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Suicidal Thoughts as Symbolism: The Mind’s Search for Meaning in Despair

In my experience, what often lies even deeper than the shutdown response is the sensation of wanting to die. The human mind has a powerful storytelling mechanism—it creates narratives to make sense of our feelings, even if those narratives are painful or damaging to our sense of self. This capacity is what allows us to communicate our inner world to others, to say “I need help” or even to express our experience at all.

If we view the shutdown response as the body’s instinct to “play dead”—a survival strategy inherited from our mammalian ancestors—then perhaps suicidal thoughts represent a symbolic extension of that same defense. They may be the mind’s way of saying: “I need to disappear now in order to survive later.”

Seen through this lens, suicidal thoughts highlight what I believe to be one of our most fundamental traits: symbolic creativity. Just as we are constantly moving toward health and integration, our minds will always seek ways to express the inexpressible—to give voice to what cannot be fully captured in images or words.

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When Neglect Turns Inward: Childhood Roots of Suicidal Thoughts

A second reason I believe suicidal thoughts can arise also falls under the umbrella of symbolism, though in a less tangible form. When enough of a child’s needs go unmet during the formative years, the ego often turns that poor external treatment inward.

A child cannot grasp that adults are responsible for their own struggles. Instead, they instinctively view themselves through the eyes of their caregivers. If they are consistently treated as though they don’t matter—or worse, as if they are already invisible—the child may internalize the belief: “I don’t exist.”

The emotional pain of neglect can be so profound that some young people seek recognition through destructive means. For instance, a child might intentionally get into trouble with the police, not because they want punishment, but because even negative attention feels like proof that they exist. Perhaps the high rates of recidivism and repeated hospitalizations reflect, at least in part, this deep human drive to be seen—even if recognition comes in painful ways.

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The Fight for Agency: Control, Choice, and Suicidal Thoughts

The third reason suicidal thoughts can arise, closely related to the previous idea, is the fight for agency. Next to sleep, water, and food, agency is one of our most basic needs. To have agency means to act as an agent in our own lives—with at least some influence over our circumstances.

I can recall conversations with clients who seemed to find a sense of security in knowing that the decision of whether they lived or died was fully in their hands. It illustrates how, even without physical danger, the mind can register the sensation of death looming when life feels controlled by others. In those moments, symbolism surfaces—urging a person to assert agency, sometimes impulsively.

Consider how children will often do the exact opposite of what they’re told, simply to prove they have a choice. Under chronic stress or trauma, this instinctive defense mechanism can carry over into adulthood. Over time, the yearning to be loved and nurtured may fade, replaced by a harsher inner story: “You think you’ve hurt me? Only I can hurt myself.”

For those who have endured a lifetime of uncontrollable pain, suicidal thoughts can emerge as a way of reclaiming agency—sometimes without full recognition of the permanence of the act, and sometimes with a clear, defiant awareness. Whether it’s a belief that “I cannot be harmed if I harm myself first,” or the ancient nervous system urging collapse as self-preservation, one truth remains: human beings are deeply symbolic, always searching for meaning in even the darkest corners of existence.

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What to Do When Someone Shares Suicidal Thoughts

I hope these descriptions shed light on why suicidal thoughts may exist within our human nature. The next, and often more difficult, question is: what do we do if someone tells us they’re suicidal?

If you’re not in a clinical setting with confidentiality safeguards, it’s important to share the responsibility. Involve a safe, trusted third party so the burden doesn’t rest entirely on your shoulders. If the person appears to be in imminent danger of harming themselves, call 911 or 988, or take them to the nearest emergency department if you feel safe doing so.

But if they are speaking casually about their darker thoughts without immediate risk, you are in a unique position to relieve some of the pressure they’re carrying. In those moments, listening and connection are more powerful than trying to “fix” the situation.

One important rule of thumb: avoid saying, “Think about all the people you’ll leave behind.” While well-intentioned, this assumes they feel valued in their relationships. For many, the very absence of that feeling is why suicidal thoughts exist in the first place.

Instead, it can be deeply supportive to normalize their pain: “Given everything you’ve been through, I’d be surprised if you didn’t feel this hopeless.” This simple statement acknowledges their suffering without judgment and can offer the profound relief of being understood. Sometimes, that sense of shared humanity is the seed that allows hope to take root.

Of course, every individual’s experience with suicidality is unique. There are no perfect words and no guaranteed interventions. The goal is not to change how someone feels in a single moment, but to create an environment where they feel safe enough to connect, reflect, and eventually find their own reasons to keep going.

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The Hidden Risk Behind Sudden Calm

One crucial sign that someone may be at risk is when, after spending a long time “in the shadows,” they suddenly appear much better overnight. They may attribute this shift to external reasons, but in some cases it means something far more concerning—that they feel free of the burden of indecision. If they have resolved to follow through with a plan, that relief can look like an improvement in mood, when in reality it signals greater danger.

It’s important not to shy away from asking directly about suicidal thoughts. Research has consistently shown that direct questioning does not increase the likelihood of someone acting on those thoughts. In fact, it often provides relief. Sometimes people are waiting for someone to “pop the balloon”—to offer the invitation that makes it safe to share their pain. That simple act of asking can open the door for them to vent, feel understood, and possibly avoid a crisis.

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Medication and Suicidal Thoughts: Why Therapy Still Matters

Lastly, it’s important to understand that medication side effects are not simply “injecting” suicidal thoughts into the mind. Planning suicide is not passive—it’s a demanding, adrenaline-driven process that requires energy, focus, and action. In fact, the lethargy and immobilization that often accompany major depression can sometimes be what prevents someone from acting on suicidal thoughts.

Antidepressants can provide a much-needed lift, helping people emerge from the depths of emotional paralysis. But while they can restore energy and motivation, they don’t necessarily touch the core wounds or experiences that fuel despair in the first place. That is why medication alone is rarely enough.

To create lasting change, it is essential to pair psychiatric treatment with psychotherapy—preferably trauma-informed therapy. Medication may steady the body, but therapy helps to reframe the story, address the roots of suffering, and begin the deeper work of healing.

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In the end, suicidal thoughts are not random intrusions or simple side effects—they are expressions of our deepest biology and symbolism. Whether through the nervous system’s shutdown, the echoes of childhood neglect, the fight for agency, or the interplay of medication and mood, these thoughts are part of how the human mind communicates pain.

And yet, just as they can symbolize despair, they can also symbolize our capacity for connection. With trauma-informed therapy, support, and understanding, people can learn new ways to narrate their experiences—ones rooted not in invisibility or hopelessness, but in resilience and meaning.

💙 If you or someone you know is struggling, you don’t have to navigate it alone. Book a free consultation with Sean O’Connor, LMHC to take the first step toward healing in a safe, supportive space.

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About our Scarsdale Therapist Sean O'Connor

Sean O’Connor, LMHC is a licensed mental health counselor and sports therapist at Peaceful Living Mental Health Counseling in Scarsdale, NY. He specializes in sports psychology and trauma-informed counseling, helping kids, teens, adults, and athletes manage anger, anxiety, depression, PTSD, and stress. Sean is passionate about making clients feel seen and understood while teaching practical coping skills for everyday life. He offers in-person and virtual sessions, with early morning, afternoon, and evening availability Monday–Thursday.

Learn More About Sean

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About Peaceful Living Mental Health Counseling

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