When we talk about suicide prevention, we focus on crisis.
What warning signs should we look for?
What should we say?
Who should we call?
I wonder if we're starting too late.
People can experience increasing emotional distress without knowing how to identify it, express it, communicate it, or ask for help. By the time everyone recognizes the problem, the person may already be in crisis.
Perhaps there's an earlier problem we should be trying to solve:
How do I communicate that I need help before I reach the point where I can no longer see another way out?
Introduction
Creative expression may be a possible earlier intervention. Expression may help turn what's difficult to understand inside us into something we can recognize and communicate. I talked with Dr. Diane Kaufman, a psychiatrist, poet, artist, and founder of the Hold On Campaign for Suicide Prevention. Diane brings an unusual combination of perspectives to this question. She spent her professional life in medicine and psychiatry. She's also a poet and artist.
She also survived a suicide attempt herself. Her story made me wonder about everything that happens before a crisis. Emotional pain usually doesn't begin at the moment someone becomes suicidal. Something happens before that. Perhaps we're frightened. Ashamed. Angry. Lonely. Depressed. Overwhelmed.
Perhaps we don't understand what we're feeling or understand it and don't know how to say it. Perhaps we don't believe we can tell anyone. As the pain increases, our ability to see possible solutions begins to narrow.
Instead of asking the question:
How do we stop someone from attempting suicide?
I want to begin earlier in the process by asking:
How can I recognize and communicate what's happening inside me while I'm still able to ask for help?
That changes the problem we're trying to solve, and it gives us more opportunities to solve it.
Problem: I Don't Know How to Say What I'm Feeling
Diane was in medical school when she attempted suicide.
She hadn't yet been diagnosed with bipolar II disorder. She was experiencing depression, was in an unhealthy relationship, felt ashamed of some of her behavior, and became increasingly angry with herself.
She left a record of what was happening.
She was writing poetry. One poem described herself as flotsam floating away from a shipwreck. Another imagined leaves falling from the sky and asked them to teach her how to fly.
Shortly before her suicide attempt, the writing changed. She wrote a poem consisting largely of stark conclusions about herself: She was worthless. Nobody loved her. Nobody ever would.
Looking back, Diane recognizes something she couldn't recognize at the time: She believed those thoughts were true. She wasn't looking at what she'd written and asking, Is this true? She wasn't showing it to someone who might have asked that question for her. She was expressing what she felt. She wasn't communicating it.
Maybe there are two separate problems.
First: Get It Out
We tend to think of creative expression as something artists do. Poets write poems. Musicians write songs. Painters paint pictures.
What if creativity has another function?
What if the purpose of writing a poem isn't necessarily to produce a good poem, it's simply to give something happening inside us somewhere else to go? Diane isn't suggesting everyone become an artist. Quite the opposite. Thinking that you need artistic ability may interfere with what we're trying to accomplish.
If I tell someone, write a poem about how you feel, they may ithink:
I'm not a poet.
I don't know how to rhyme.
I don't know what to write.
The objective isn't to write a poem.
The objective is to express something you're having difficulty expressing. Don't start with, write a poem. Start with questions:
Where are you?
How are you feeling?
What are you afraid of?
What don't you want to happen next?
What would you like to happen next?
Don't worry about making the answers sound good. If what you're feeling is: I want to scream, and I'm afraid the neighbors will hear me, then write that. That's more informative than writing, I'm sad.
The next sentence might become, I have to swallow my scream. Now that's begining to sound as poetry. Poetry wasn't the objective. Expression was.
Why Get It Outside Your Head?
Diane said something during our conversation that stayed with me: The page is accepting. You can put anything on it.You can keep it. Hide it. Rip it up. Show it to someone. Turn it into a song. Or never let another person see it.
That creates an intermediate step between feeling something and telling someone. The first problem may be getting what's happening inside you into a form you can see. Once it's on the page, you can look at it.Maybe you notice something you hadn't noticed before. Maybe you can put a name to what you're experiencing. Maybe what seemed like one monumental feeling turns out to contain several different problems.
Maybe then you can begin asking questions about it.
Why do I believe this?
Is it true?
What happened that made me feel this way?
What do I need?
What could change?
It Doesn't Have to Be Writing
Diane described an expressive-arts workshop she attended years ago. Participants received three blank sheets of paper and were told to use their non-dominant hand to scribble.
Not draw. Scribble.
They looked at what they had made and asked:
Do I see anything in this?
There is no artistic standard to meet. The drawing was simply a way to start externalizing something. You could write.Draw. Scribble. Sing. Play an instrument. Record yourself talking. Make something.
The medium isn't the important part. The problem we're trying to solve is: How do I get what's happening inside me into a form I can recognize and potentially communicate?
Diane Was Writing—and It Didn't Save Her
This is where we have to be careful not to confuse a tool with a solution. Diane was writing poetry before her suicide attempt. The poetry didn't save her.
If our conclusion were, creative expression prevents suicide, Diane's story would challenge it. She was expressing herself. The expression remained largely private. Which suggests another step is necessary.
Expression may need to become communication.
A private thought can become a sentence. A sentence can become a poem. A poem might become something you can show another person when you can't figure out how to say it aloud.
Maybe you hand someone the page.
Maybe you text what you wrote.
Maybe you tell someone:
I wrote something and I think you need to see it.
Problem: I Think What I'm Feeling Is True
There's another clue in Diane's story. She wasn't merely thinking, I feel worthless. She believed: I am worthless. Those are different statements. One describes an internal experience. The other makes a claim about reality.
When you're inside an intense emotional state, distinguishing between the two may be extraordinarily difficult. Once the thought has been expressed, it can potentially be examined.
I feel like nobody loves me.
Is that true?
I feel like nothing will ever get better.
How do I know?
I can't continue feeling like this.
Now we've identified the actual problem:
This pain feels unbearable.
That's different from:
My life needs to end.
And that distinction may be enormously important.
The Problem May Not Be Wanting to Die
One of the important ideas from my conversation with Diane was that someone experiencing suicidal thoughts may not want death for its own sake. They want something else.
They want the pain to stop. When emotional pain becomes overwhelming, the person's ability to see alternatives can narrow. If the problem becomes, I have to make this pain stop, suicide can begin to appear to be a solution. A catastrophic and irreversible one.
Perhaps we need to ask a different question: What other ways can I change what I'm experiencing?
That doesn't make the pain imaginary. It doesn't mean telling someone to cheer up. It doesn't mean writing a poem is a substitute for mental-health treatment.
It means we've changed the problem from:
I want to die
to something closer to:
I'm experiencing pain I no longer believe I can endure, and right now I can't see another way to make it stop.
Those aren't the same problem. Changing the problem may allow us to see solutions that weren't visible before.
Problem: I Don't Know How to Ask for Help
Even recognizing that you're struggling doesn't mean you know what to do next.
Saying:
I need help
can be remarkably difficult. Maybe you're embarrassed. Maybe you think your problem isn't serious enough. Maybe you're afraid of what will happen if you tell someone. Maybe you simply don't know how to explain what's wrong.
That's another place where expression can become useful.
You don't have to begin with:
I think I'm becoming suicidal.
Perhaps you begin with:
This is what I wrote last night.
Or: I've been feeling something I don't know how to explain.
Or: I'm having thoughts that are scaring me.
The objective isn't finding the perfect sentence. The objective is opening the door. Expression can provide the first sentence when you don't know how to start the conversation.
What Happens When I Finally Tell Someone?
There's another problem we need to acknowledge. Communicating what you're feeling doesn't guarantee the other person will know how to respond. One of the saddest parts of Diane's story involved her father. After her suicide attempt, he responded with anger and humiliation rather than the emotional support she needed. Decades later, he apologized for something painful he had said following the attempt.
During our conversation, we wondered why someone might respond that way. Fear can look like anger. Helplessness can look like frustration. Someone tells us something frightening and we immediately try to fix it, dismiss it, argue with it, or tell them what they should do.
That doesn't excuse a hurtful response. It raises anotherpoint:
The first person you tell may not know how to help you.
That doesn't mean communicating was a mistake. It may mean you need to tell someone else. A friend. A family member. A therapist, physician, or psychiatrist. Someone better equipped to understand what you're trying to communicate and help you determine what to do next. The objective isn't simply to express the feeling. It's to get the help you need.
Don't Wait Until You Need the Tool
We don't wait until a building is burning to teach someone where the exits are. Why wait until emotional pain becomes unbearable to learn how to express it? Maybe this is something worth practicing when we're not in crisis. Write down what bothered you today.
Instead of simply saying:
I'm upset,
ask:
What am I upset about?
What am I afraid will happen?
What do I wish were different?
What do I need from someone else?
Draw something. Scribble. Record yourself talking. Then look at what came out. The objective isn't to diagnose yourself. It's to become better at recognizing and communicating what's happening inside you. Those skills may be much harder to learn for the first time when you're already overwhelmed.
Expression Isn't the Treatment
I want to be particularly clear about one thing.
Creative expression isn't a substitute for professional help when professional help is needed.
Diane's own story demonstrates that. People who write, paint, compose music and create extraordinary art still experience mental illness and still die by suicide. A poem isn't medication.A drawing isn't a psychiatrist. A journal isn't emergency care. We're asking creative expression to solve the wrong problem if that's our standard.
Maybe its job isn't to prevent suicide. Its job is earlier in the process:
Something is wrong → I express it → I can see and understand it better → I can communicate it → someone else can see that I'm struggling → I can get help
Don't Wait Until Crisis Is the Problem
If I'm in crisis, the problem is immediate.
How do you stay safe?
Who can help you right now?
If you believe you may hurt yourself or are in immediate danger, call 911 or go to the nearest emergency room. In the United States, you can also call or text the 988 Suicide & Crisis Lifeline at 988 to reach a crisis counselor.
Don't try to get through that moment alone. Reach another person. A friend. A family member. A doctor, therapist, or anyone you trust. Tell them what's happening and that you need help.
Closing
The point of this article is to ask what we can do before we get there. If you don't understand what you're feeling, get it outside yourself. If you don't know how to describe it:
Write, draw, scribble, sing, speak—find some way to express it.
If your thoughts are telling you something frightening or hopeless. don't assume everything you're thinking is true. We are often wrong about what we think. Put those thoughts somewhere you can see them, question them, and reconsider them. Consider letting someone else see them.
If you don't know how to tell someone:
You don't have to explain everything. Show them what you wrote. Show them what you drew. Play them what you recorded. Find the first sentence.
Maybe it's simply: “Something is wrong and I don't know how to explain it.”
If the problem has become: “I'm afraid of what I might do,” the problem has changed. Don't try to solve that one alone. Get another person involved and seek professional or emergency help. If you are are not able to and need immediate help, call 911 or 988 (the Suicide & Crisis Lifeline).
None of this guarantees that someone won't reach a crisis. That's not a claim we can make. This simply gives us more places to intervene before crisis is the only problem left to solve.
The goal isn't to write a poem that saves your life. The goal is to find a way to communicate what's happening while there is still time for someone to help you change it.
The better question isn't, how do we save someone once they've reached a crisis? It's, how do I get help before I reach one?
Sometimes the first step toward saying, “I need help” may be finding a way to say, “This is what I'm feeling.”
Editor’s Note:
This article is based on my podcast interview with Dr. Diane Kaufman. The ideas discussed here originate from that conversation. The structure, emphasis, and commentary are my own. Any errors or interpretations should be attributed to me, not to Dr. Diane Kaufman.
This article is intended for general informational purposes and is not medical, psychiatric, or therapeutic advice. Creative expression is not a substitute for appropriate professional care. If you are struggling with your mental health or have concerns about your specific circumstances, seek guidance from a qualified medical or mental-health professional.
If you are in immediate danger or believe you may hurt yourself, call 911 or go to the nearest emergency room. In the United States, you can also call or text the 988 Suicide & Crisis Lifeline at 988 for crisis support.
About the Author
Daniel Stih (danielstih.com) is an aerospace engineer, software engineer, indoor environmental consultant, and author of 12 books. For more 30 years, he has investigated complex problems spanning engineering, technology, the built environment, and human decision-making. His work explores how evidence, assumptions, and systems shape the conclusions we draw—and whether we're solving the right problem. Learn more about his approach in Why I Think This Way.
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The episode with Dr. Diane Kaufman on the Daniel Stih Podcast: