Among the emails I receive daily are suicide notes.

Some women just write to express their fears about having thoughts of suicide. Others are in full-blown distress, ready to give up on this world.

When I first began receiving emails like this, I felt panicked. I was not trained in even the most basic psychology. I had no experience with women who were reaching out. I had no idea what I could do or say to make a difference.

But when that first one arrived, I had little I could do but respond, and fast. I actually DID call a suicide hotline and asked them what to say and do. I learned some very important things, and I share those as well as ideas that are specific to us–the mothers of lost babies.

First, there are two categories of thoughts about suicide: passive and active.

Passive thoughts include just wishing for death, considering how others will handle your suicide, and feeling the need to ease the intensity of your emotional and sometimes physical pain. You might research suicide on the Internet or look over books about it. You are just thinking about dying. These are normal and happen to everyone in times of depression or distress.

Active thoughts include considering what method of suicide you might use, counting pills, locating a gun in the house, or making any sort of plans. This is a stage where you actually DO things. If you get this far–then it’s time to get help NOW. The quickest and simplest is to stop everything, pick up your phone, and call 1-800-SUICIDE.

I think it is fine to reach out to anyone who will listen when your thoughts are passive. Most of the women who write me are frustrated with family and friends who are not understanding. I know now that all they need from me is validation that their feelings are real and serious and difficult, that their baby was wonderful and the loss is impossibly hard, and that it’s a long road to recovery, not the three or so days others believe it should last. You can find this sort of help at a pregnancy loss group, on bulletin boards on the Internet, or even among your friends who have had miscarriages that you didn’t know about.

When you get to the active stage, however, you simply cannot rely on friends and family anymore. They may not get it. They might not see. Their failure to take this seriously or to listen will compound your depression and can even trigger you to act. It’s critical you find someone, anyone, who can guide you to professional help.

When I wrote Tina’s suicide attempt into the book, I tried to show how passive thoughts can morph into active ones. Most of the time we can see the shift, as long as we know ahead of time that there is a difference. For Tina, though, it happened too fast. The post-pregnancy hormone changes don’t help, making every system in your body less able to cope.

Here is her segment of the novel. 

On that day she came home from the hospital, all Tina knew was that her baby was dead, her boyfriend gone, and she’d soon be booted back to the horror of public school. Leaning over the sink in her bathroom, she washed her face and hands and the gleam of water on her white wrists seemed too pristine, too pearl. The razors lay neatly in the chest of art supplies and she stopped thinking, stopped rationalizing anything at all. The act wasn’t about killing herself, not in that moment, or about escaping, it was about marring the perfection of her arms. She was tainted, her baby had died, she was unloved and unwanted. She felt she should be marked by this–that her physical body should bear the scars of the death of her happiness.

She leaned her pale arm against the sink and didn’t hesitate once. 

The main thing I wanted to get across today to those of you who have googled miscarriage and suicide, or miscarriage and wanting to die, which are very common combinations that bring you to this blog, is there is an important difference between thoughts of dying and thoughts of how to do it. If you are still in the first category, keep reading, keep reaching out, keep healing. You will get there. If you start to shift, if you sense your thoughts moving toward plans or funerals or even revenge–ACT. Act NOW.

Email me.
Go to Psych Central, an amazing website for mental health and an online community
Or call 1-800-SUICIDE.

But do something. Life the way it is now is not the way it will be a year from now. I once contemplated taking my car off a cliff and into the fog about two weeks after my baby died. We had found out the genetic testing had failed, our marriage was falling apart, and we were fighting like we never had.

I didn’t know then that less than twelve months later I would give birth to a healthy little girl and a few years later to a second. I’m glad I hung around to find out.