I woke up one Saturday morning and couldn’t stop thinking of killing myself. It was intense, sudden, and jarring. It was December of 1996, and I was fifteen years old.

My life was essentially good — I loved my school, I got good grades, I had great friends — yet some part of my brain ran on autopilot.

I imagined a gun in my hands, the feeling of cold metal against my skin, and what my gravestone might look like. The images were vivid, terrifying, and painful. It was like a video projector playing the worst horror movies on a loop. The movies played often, almost constantly, alongside my everyday thoughts and activities. I couldn’t concentrate on my schoolwork, and even socializing felt empty and sad. Sometimes the thoughts and images were so loud and overpowering that I couldn’t think of anything else. Sometimes it felt like tunnel vision — despite all of the good in my life, I couldn’t see anything but these dark, horrible thoughts. I would wake up too early in the morning, hearing those thoughts like voices shouting in my head. It was a scary, isolating experience to be afraid of my own mind.

I remember sobbing on the floor, in front of my parents, literally crying for help. I was scared of the images in my brain, scared that I would never feel better, scared that I would lose control and hurt myself. No one in my working-class family had ever gone to therapy, yet they desperately wanted to help me. Looking back, as an adult myself, I imagine that they felt helpless, scared, and/or confused. I imagine that they would have done almost anything to get their daughter back.

My mom also worried about the cost of therapy. My school counselor gave me a referral to an agency that offered therapy on a sliding scale, for $27 per session. It still wasn’t easy for my family, especially when I attended twice a week, but they somehow made it work. I started paying the bills myself when I turned sixteen and got my first job.

Therapy helped. A lot of the work I did with my first therapist involved learning to name my feelings. Even as a teenager, I had a tendency to give long, rationalized explanations of what was going on in my head. Therapy taught me that feelings are expressed in single words, not sentences. It was strange, empowering, and cleansing to learn to say “I feel angry” or “I’m so sad.”

I also did a lot of work on learning how to be honest with myself. My journals from late 1996 into 1997 show a huge change in subject matter, as I stopped talking so much about the drama of high-school social life, music and clothes. I started talking more about the inner workings of my relationships, my thoughts and fears and the darkness inside of me, using all of those newfound vocabulary words about my feelings.

Learning those skills helped me, but the suicidal thoughts continued.

I was hospitalized for eighteen days in February of 1997. I feared so much that I would lose control of the thoughts and impulses that tormented me. I was terrified that I would die of a self-inflicted gunshot wound, when I desperately wanted to live. I couldn’t promise my therapist that I wouldn’t go to my friend’s house and use her stepfather’s gun to kill myself. My therapist and I decided together that it was better to check me in, in order to keep me safe. The hospitalization was difficult at times, but I’m glad I did it. I believe that it saved my life.

The hospitalization was nothing like I had feared. I’d envisioned restraints, patients screaming in the hallways, forcibly receiving sedative injections, the stuff of dramatic movies. My hospitalization experience was mostly sedate. It was on a normal hospital floor, albeit one locked for security and with reinforced windows! I was on a ward with about a dozen other teenagers, and shared a room with one other girl. We watched a lot of TV, did daily group therapy (including art therapy and exercise), and did our schoolwork, which was faxed over from our schools. There were also lots of one-on-one interactions with the staff, which gave us opportunities to talk about feelings and challenge our negative thoughts. In ways, it was nice to be able to focus on feelings and communication and getting better, unhampered by the distractions of the real world. At the same time, it was difficult to be isolated from my friends and family, except for fifteen-minute phone calls on a shared phone, and visiting hours in the evenings.

The inpatient stay itself wasn’t so bad, but getting insurance coverage for it was a nightmare. Nurses told me every couple of days that my insurance company wanted to send me home. I was both angered and saddened. Couldn’t they see that I was afraid of hurting myself, and doing the best work I could? Insurance ended up covering much of my stay, but my parents still received a bill for several thousand dollars. They paid it off in $50 increments.

***

The day I was discharged, one staff member advised me never to be alone if I’m feeling suicidal. “Even if you just go to 7-Eleven,” she advised. I’ve kept that in mind over the years, as another tool for keeping myself safe.

When I was released from the hospital, I felt like I’d made a lot of progress. Having spent so much time with other young people with similar issues helped me feel less alone. One of my fellow patients had an extra teddy bear, which she loaned to me. I found it helpful, so my mom and I stopped at Target on the way home, to acquire a teddy bear. (I still have it.)

Going back to school was strange and difficult. I’d only told a handful of friends where I’d been. Telling everyone else felt too vulnerable, so I mumbled something about the flu. My teachers were supportive, but I felt like people were treating me like I was fragile. I didn’t feel fragile; I felt like I’d survived a hurricane.

***

I liked some therapists more than others over the years, but especially as a teenager. While some were human and accessible, others were judgmental and uncreative. During a family therapy session, one therapist told my parents about my adolescent experimentation with alcohol, which wrecked my ability to trust her. Another told me that my beat-up Converse sneakers made me look like “trash,” and suggested that I wouldn’t be depressed if I joined her religion. I’ll never forget the psychiatrist who told seventeen-year-old me that “if [I] don’t stop being depressed, [I’ll] be diagnosed with borderline personality disorder, and then no one will take [me] seriously.” After hearing that, I stayed away from therapy for many years during my young adulthood, during a time when I really could have used the support that therapy provides. I was so afraid of being labeled, judged, and disregarded by people who were supposed to be helping me! Yet, I returned to therapy several times over the years, when my anxiety and suicidal thoughts became too much to handle on my own. My fear of being labeled paled in comparison to my fear of my own thoughts.

I also took medication. I had one psychiatrist, at age sixteen, who kept increasing my dosage of the same medication, over several months, even though it was clear that the drug wasn’t helping me. I wondered, later, whether he had been receiving kickbacks from the drug’s manufacturer. I later tried several different medications, and combinations of medications, before I found one that was helpful.

Medication has never made me numb or docile — it simply quiets down the noise and visuals from the movie projector in my brain. It takes the volume down from about an eleven to a four. I’m still feisty, and still get angry and sad, but I’m no longer spending days in bed crying because I can’t stop thinking about hurting myself.

***

At age twenty-six, ten years after my first round of therapy, I gained a fuller understanding. I was living in another state, visiting another sliding-scale therapy clinic, lamenting that I still can’t stop thinking about hurting myself, even though I’m basically happy with my life. The therapist paused for a moment, then suggested that perhaps I don’t actually have depression, as everyone had assumed, but obsessive-compulsive disorder.

I was bewildered and shocked, and we wrestled with the idea for a while: how could I have OCD? My room isn’t particularly clean, and I don’t wash my hands excessively! She gently explained that there are several different manifestations of OCD. Some people struggle with obsessive or intrusive thoughts, but don’t have outward compulsions.

After that therapy session, I did a lot of thinking, and a lot of reading. For a while, I felt a sense of shame, as if there had been something fundamentally flawed about me for having this diagnosis. At the same time, it helped me make sense of a lot of things, starting from my childhood. The OCD diagnosis explained not only my intrusive suicidal thoughts, but also my health anxiety, fears of accidental poisoning, and religious scrupulosity, all of which first surfaced at around age seven or eight. I’d always lived uneasily with those thoughts, as if they were a strange personality quirk, but the diagnosis felt like pieces of a jigsaw puzzle clicking together.

After that diagnosis, and in the years since, the focus of my therapy changed. We no longer try to talk my brain out of having dark thoughts. Instead, we acknowledge that those thoughts happen, but I don’t need to give them any credence. Indeed, treatment for the intrusive suicidal thoughts based in my OCD has included learning how to give them as little attention and energy as possible, which takes the power out of them. Another facet of treatment involves learning that these thoughts don’t say something about me or express some secret desire; they’re just garbage that my brain produces. One therapist likened it to a tiny yapping chihuahua — it’s annoying background noise that I can disregard.

In the years since, I’ve had periods of anger that my OCD wasn’t diagnosed sooner. For so long, I’d felt like there had to be Something Wrong With Me for not being able to just magically stop being depressed — when it turns out that I wasn’t actually depressed in the first place! I still have those moments of anger, but they are tempered with a gratitude that I have been able to access treatment, and that I did finally receive a diagnosis that helped me understand myself.

***

I have also had periods of actual depression since my initial stint in therapy. My depression can also manifest as exhaustion, irritability, or apathy. My experience is that suicidal thoughts based in depression feel completely different from those rooted in OCD. My suicidal crises based in depression are more time-limited; the intensity of the despair subsides within a few days. (Perhaps this is the type of suicidal crisis my insurance company expected when they refused to pay for more than a few days of inpatient care!) Depressive suicidal thoughts feel like a logical extension of desperate sadness, whereas OCD-based thoughts startle and scare me. Suicidal thoughts based in my OCD often stick around a lot longer, permeating my everyday life but eventually fading away, only to return again in the future.

***

I’ll be forty on my next birthday. My hospitalization was more than half a lifetime ago.

I still have bad days and bad weeks. I struggle with my mood every winter, which leads to increased intrusive and suicidal thoughts. I strive to get enough sleep, eat well, get exercise, and plan both socializing and solitude, because all of these things keep me balanced. Most of the time, I’m in a mental place where it feels natural to ignore those nagging, intrusive suicidal thoughts. The thoughts are often worse when I am under stress and during periods of change in my life. I still go to therapy, generally every 2–4 weeks, and I expect to take medication for the rest of my life.

As I’ve gotten older, I’ve met more people who have been suicidal, and more people who have OCD. Suicidal thoughts and attempts are relatively common, even if they’re not always openly discussed. I also believe that, in the two decades since my initial crisis, our society has become more comfortable with talking about mental health.

I’ve also learned that my OCD, the thing powering the radio station that plays garbage inside of my head, is also the thing that makes me detail-oriented, hard-working, and conscientious. I suppose that’s a bit of a silver lining.

I have been lucky to have had a lot of support, but, in the end, it has always been up to me to save my own life. Because of my struggles with my mental health, especially my obsessive suicidal thoughts, I have learned to find peace within myself. I’ve gained a huge toolbox of coping skills, and am more able to sit with my feelings. I have gained sensitivity and perspective. I have the ability to unflinchingly sit with others who are struggling, without worrying about saying the wrong thing. Friends know that they can talk about their mental health with me, that I’ll never be shocked or judge them.

I love that the work I’ve devoted to my mental health might help someone else who is struggling. I’m glad to tell my story about how recovery isn’t linear and suicidal thoughts aren’t always based in depression, in hopes that it can help someone else out there.

The fight has always been worth it for me.