In suicide prevention, people are told to “reach out” and loved ones to “be there.” But what does helping someone with suicidal thoughts really mean?

A little over a decade ago, Deena Nyer Mendlowitz and Susan Messing began a conversation on Facebook Messenger that would grow to more than 5,000 chats and reveal the complexity of suicidal suffering. 
Their conversations – the kind that typically happen in hushed tones, if they happen at all – are full of violent fantasies and fragments of undelivered goodbyes, reflections on the limits of psychic pain and the capacity to heal. There is frustration and discomfort and desperation, but also encouragement, acceptance, optimism.
Susan, 56, a full-time comedian in Chicago, and Deena, 43, a part-time one in Cleveland, punctuate the dark with tragicomic quips on the absurdity of wanting to live but not knowing how.
Deena is chronically suicidal. Since she was a child, the monologue in her head has told her to die. She didn’t have a suicidal crisis, seek help, and see her suicidal thoughts fade away. She thinks about dying daily, even if she doesn’t always have a plan for killing herself. 
Deena says her suicide feels inevitable. Susan says Deena’s death is inevitable – when she goes, how she goes, is not.
Their conversations are not fueled by despair, but by hope. Deena writes because she’s fighting for something she knows she deserves: a future.
And Susan is there, at 10 p.m. and 4 a.m. and at noon, when Deena checks into the hospital and when she checks out, for the breakthrough and the setback, pulling her friend toward life once again.
Deena has been trying not to kill herself for more than half her life. Her pain can be measured in years – the two decades since her first suicide attempt – or by the number of suicidal thoughts she has in a week, when she’s struggling, sometimes thousands. It can be measured by the 60 electroconvulsive therapy treatments, the 11 hospital stays or seven therapists. It can be measured in messages to her friend Susan, thousands over a decade, almost all about wanting to live when her brain was telling her to die. 
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The two met in summer 2009, when Deena flew to Chicago for a week-long improv intensive at the Annoyance Theatre. Susan was her teacher. Deena remembers Susan walking into the room, how her energy – warm yet unapologetic – flooded the space. 
“I’ve had improv teachers who are jerks. Susan was the kindest person but talked in the filthiest way,” she said. “I had just never met anyone like her.” 
Deena made an impression on Susan, too. 
“She was super smart and extremely self-aware, sharp and funny, and she got it right away,” she said. “Sly and dark and dry as dust.”
At the time, Susan couldn’t know that comedy was helping keep Deena alive. Improv’s creative demands gave Deena reprieve from her suicidal thoughts. Improv commanded her to make mistakes, to be OK with them.
Since their first meeting, Deena and Susan have seen one another in person about a dozen times. They’ve talked on the phone maybe 10. Their primary method of communication has been Facebook Messenger.
In the beginning, they talked mostly about comedy, workshops and shows in their respective cities. But on March 15, 2012, their conversation entered new territory when Deena sent Susan a message from the hospital and told her she was about to undergo her tenth electroconvulsive treatment for medication-resistant suicidal depression. 
Natalie Burns, a licensed clinical social worker who reviewed a selection of Deena and Susans exchanges
So many suicidal folks that I work with just feel theres really no space for them to process or to talk with others about suicide because immediately theres a sense of fear. So many people who are struggling with suicidality have really valid and good reasons of why they want to die. Our job is to try to sit with them in that pain, in that suffering, and to validate that suffering and to understand it.
Deena expected Susan to reply as most people did – briefly, hesitantly. But Susan was curious. She asked questions. She wanted to know.
“What’s an ect treatment? DEENA!!! I’m so so sorry-want me to send you something Chicago-like? How can I help-SERIOUSLY? XOXOXOXOXOXO” she wrote. “Baby, seriously, whatever you need-call me in the middle of the night if you want. You’re awesome and I’m so glad that I know you.”
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They didn’t talk again for another six weeks, and it wasn’t until September of the following year – right around the time Deena stopped seeing the therapist who had been treating her for more than a decade – that Deena mentioned she was getting more shock therapy. This is how their communication was at the start. Intimate but occasional.
What Susan would learn is that suicidal thoughts are part of Deena’s daily life. When she’s well, they’re a hum. When she’s in crisis, they’re emphatic. 
“I want to not want to die,” she told Susan.
Susan told Deena her life was worth living, that she was worthy of love and belonging. And she kept telling her, over and over again, with the hope one day Deena would believe it, too.
Deena made her first suicide attempt at 21, five days shy of her college graduation. Before her attempt, she tried to reach out to friends but couldn’t find the words. Not the right ones, anyway. It’s taken a long time to find those.
With Susan, the words came easily. Deena wrote about her pain, her spirals, the coping skills that worked and the ones that grew tiresome. She made jokes, too, and Susan was always game. Comedy became a common language, a way to make the horrible palatable. 
“I’m going bald. Quickly. But on the plus side I’m growing facial hair like nobody’s business. Starting Rogaine for the loss. My life is seriously funny,” she told Susan about a new medication.
“Jesus. Grow a beard – all the hipsters are doing it?” Susan replied.
Deena told Susan about the things that kept her here: performing, helping others, destigmatizing mental illness. She talked about what she held onto: her son. Always him.
Natalie Burns, licensed clinical social worker
Most of the patients that Ive worked with who are chronically suicidal will say there are times where their suicidal thoughts and feelings or actions reach a point that just feels unbearable, but thats not 24/7. In most moments, they are engaging in hope, they are delaying themselves, theyre distracting.
“(He) lost a tooth last night,” she told Susan. “I was in a miserable place thinking about where I was going to kill myself. It was a really really really bad place. And he lost his tooth and went to bed and I was writing him a note from the Tooth Fairy and I just thought I don’t want to not be able to write more notes like this and that was enough and I made it through the night.”
“Thank goodness for the tooth fairy,” Susan replied. “Really. Sometimes it is not about how the moment feels, but about seeing into the future.” 
By summer 2014, Deena began sending Susan more frequent and graphic messages about her suicidal thoughts. Deena told Susan the worst things, things she didn’t even tell those closest to her, the people in Cleveland, the ones she worried could show up at her door if a disclosure went too far.
She told Susan that after a night with friends, driving home, she cried and poked herself over and over with a paperclip. She told her how badly she wanted to get hit by a bus. She told her she wrote her three different goodbye notes. 
Susan, who has worked at several well-known theaters including Chicago’s Second City and the now shuttered IO, had a lot on her plate. She was teaching, traveling, performing a show, “Messing with a Friend,” and taking care of her daughter. But Deena mattered. So she gave what she could, which was more than most.
It was difficult for Susan to hear about the things Deena did to her body, the frequency and severity of Deena’s self-harm, the cycle of self-loathing it produced. She hated to hear her friend tortured. She tried to counter her thinking with healthier alternatives. 
Natalie Burns, licensed clinical social worker
Being connected to someone that has struggled with suicidal ideation on a consistent basis and walking with them through that journey, it does take a toll. … Its crucial that you feel supported in it, too. So maybe its another friend, or maybe it’s a therapist that you talk with about what comes up for you so that you dont get burned out.
When Deena was spiraling, Susan would remind her of the things she could do to get through the moment. Meditate, fold laundry, write her son a book. She reminded her there were always choices other than death. 
It took a long time for Susan to realize how much Deena’s messages had become part of her day to day, how their well-being had become intertwined. Sometimes Susan found she wasn’t OK if Deena wasn’t. 
Aug. 11, 2014, Robin Williams died by suicide. Deena’s crash was swift. Susan was there with her.
Deena learned of Robin Williams’ suicide right before she was about to perform in an improv competition. During her show, she thought she would go home and kill herself. She didn’t attempt, but a few days after Williams’ death, she checked into the hospital.
Deena has always been impacted by suicide loss, which research shows can increase risk, especially among people struggling with suicidal thoughts. It felt like permission, she told Susan, proof of suicide’s inevitability.
In the span of a decade, Deena lost a relative, a friend, two fellow improvisers and several acquaintances to suicide. Williams – a performer she idolized – hit particularly hard. She had his album “A Night at the Met” nearly memorized. 
When Williams died, Deena was dealing with multiple stressors. Five months earlier, she and her husband separated and she moved back in with her parents. In that moment, death felt as real a possibility as ever.
On Aug. 26, 2014, two weeks after Williams’ death, Deena was diagnosed with chronic suicidal ideation, a term to explain the constant thoughts telling her she would be better off dead, and the people she loves would be better off, too. There were diagnoses before, but none fit like this.
When Deena got out of the hospital, her messages to Susan grew unrelenting. Some days she sent hundreds of messages. It often felt like one conversation happening over and over again.
Natalie Burns, licensed clinical social worker
Sometimes it is about (the loved one) being a broken record and continuing to speak truth into someones life: ‘Im going to continue to hold this position that you are deserving of love, belonging, connection, of living a life worth living until you start to feel it. And I dont care how many times I have to say it, I feel so strongly about this and love you so much, that Im okay with repeating myself 900 times and then maybe another 900. But (the suicidal) person also has to be doing other work. They also have to be turning to other things.
Deena said she hated herself. Susan told her she was worthy. Deena harmed herself. Susan said that wasn’t honoring her body. Deena said the voices were loud. Susan offered tactics to quiet them. Deena said she wanted to die. Susan told her she wanted her to stay.
“You’ve already suffered enough,” Susan wrote. “Time for bubble baths and nice haircuts and new jeans and cuddles and good toast.” 
Sometimes Deena’s feelings changed from hour to hour.  At 6 a.m., Deena said she had a good night. By 11 a.m. she’d harmed herself. 
As the messages escalated, so did Susan’s concern. She started to ask Deena about her safety plan. She wanted to know how she was going to stay safe through the weekend, until the next appointment, until the hospitalization. She asked for a Plan A, B and C. “Is your mom home tonight? … Can a friend come over? Did you take your anxiety meds?” she asked.
“I just want to die. I hate me. I just keep typing because it helps. Thank you,” Deena wrote.
“You are wonderful. Your brain just needs a tune up and adjustment in messages because the messages you are hearing aren’t right,” Susan said.
After Williams died, Deena kept looking for good care. She kept hitting roadblocks. 
In some ways, Susan took on a greater role caring for Deena because the mental health system kept failing her.
Deena went through multiple diagnoses, including bipolar, borderline personality disorder and medication-resistant suicidal depression before getting her current diagnosis, chronic suicidal ideation. Deena believes the misdiagnoses stalled treatment. It took forever for clinicians to figure out it wasn’t that she was suicidal because she was depressed but that she was depressed because she was so suicidal. 
She had a psychiatrist and a hypnotherapist who wouldn’t communicate because they were from different facilities. She had an amazing therapist who wouldn’t compromise on price, so she stopped seeing her. She had another therapist who dropped her because she couldn’t handle the intensity of her suicidal thoughts. 
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Susan encouraged Deena to advocate for better care – for a caseworker to manage the load, for a therapist who would take the self-harm more seriously, for clinicians who would communicate. She encouraged her to be more direct with friends and family on what she needed. 
Natalie Burns, licensed clinical social worker
Part of loving someone well and really supporting someone is also at times being honest, and doing that out of love and out of care. … My approach is starting with a cup of validation to a teaspoon of change: ‘I know youre doing the best that you can right now, and you need to do better and try harder and be more motivated.
“Sometimes just not giving up is the heroic act of the day when everything feels so overwhelming,” Susan told her. At one point, Deena thanked Susan for being her “fake underpaid over qualified case manager.” It was a joke. It was true. 
But that fall, Susan’s frustration became palpable.
“I will not engage in your self-hatred anymore,” Susan wrote. “I am here to remind you that it is all worth it, that you are worth it, but I will not engage in your inevitability.”
A year after Williams’ death, Susan knew something had to change. She was scared. She sensed while Deena had a lot of people in her life back home in Cleveland, no one was hearing what she was hearing. 
She was right. 
Natalie Burns, licensed clinical social worker
Some people may say, I just need a place to get out these thoughts. You dont have to respond but I just need a space to say them. That other person has to say, Thats acceptable to me. Knowing that if you say some pretty scary stuff, Im also going to trust that youre going to go back to the work that youre doing in therapy and go back to your safety plan so that that person doesnt feel responsible in these moments where they say, I think Im just going to kill myself. Please respond, and the person is sleeping.
Susan’s words hurt. But Deena knew they were necessary. A month later, she got into the care of a psychiatrist who provided behavioral therapy. Deena continued to write, but with less frequency. Her messages became more cogent and purposeful. She often included, “I’m safe” in her correspondence. 
“I am fighting so hard and feel like I am actually accomplishing my goal of staying here,” Deena wrote in late 2015. “I have resisted writing and I am glad I did because you got this message, instead of the others. One day life will be easier and I am working too hard to not get that reward. Thank you for your generosity. Xoxoxo.”
Deena bought the gun in 2016 while running errands. The shop was next to a bakery called Pick Your Pie.
After she bought it, her first call wasn’t to Susan, but to her psychiatrist, who helped her develop a plan. She would return the gun, go to her therapy appointment and check into the hospital.
But she still wanted Susan to know. It felt important she know. If for no other reason than to tell her she had done the right thing. That she had made the right first call.  
Susan was on her back porch when she got Deena’s message. She weighed her response carefully. She made a joke. She said a sweater would have been a better purchase. She said pie would have been the better choice.
Deena laughed. It felt like hope. 
As time passed, Deena messaged Susan less. At 3 a.m., instead of opening Facebook Messenger, she sat with her thoughts.
“I talk a lot about reaching out, and it matters, it connects us to people, it makes us feel less alone, but it’s not what keeps us here,” she wrote Susan that next year. “What keeps us here is reaching in, going to whatever place we need to inside ourselves and saying part of me still is going to fight this, part of me is going to stay, part of me is going to do whatever I have to, to be here.”
It’s been more than 10 years since Deena and Susan began their conversation on Facebook. Deena’s suicidal thoughts haven’t gone away, but she’s started to believe that maybe she won’t either. 
Susan never thought she could save Deena’s life. And she didn’t. Deena did that. But Susan was the bridge to the next minute, the next hour, through the night. She may not have saved her, but she bought Deena enough time to save herself.
As much as she didn’t want it to be true, Deena’s health got better when she messaged Susan less. She had to learn, is still learning, to care for herself the way Susan cares for her. 
“What I want to get from Susan, I’m never going to … it’s not something that exists,” Deena said in an interview this spring. “That somebody is going to take away the feelings in my head. If I write one more message, this is going to feel less painful … that this was going to heal this part of me that was fractured.”
When Susan reflects on their correspondence, she is in awe of them both. Her capacity to give. Deena’s tenacity, still unyielding. 
“I love her so much. I don’t want her ever to think that she burdened me. It is simply what happened. And I am grateful that I was able to be of service to her. God, that’s going to make me cry,” she said. “I’m grateful, because we are all very selfish. So even if we have just the tiniest temerity of thought to support other people, that can help, and we don’t know how much it can help until you see that she’s gone to her son’s bar mitzvah, instead of me talking at her funeral. She lasted.” 
In April, at the height of the pandemic, Susan’s husband died. Deena texted her, told her she was “holding her in love and light.”
She reached out again on comedian Carol Burnett’s birthday with words on how the comedian said she wants to be remembered: “That I made somebody laugh when they needed it. That at one point, when they needed it, that I made them forget – even if it is just for 10 seconds – that they were hurting.”
Deena told Susan: “I don’t know how you’re doing these days but I hope that at least 10 seconds a day somebody/something is making you laugh and I hope you’re also always remembering all the thousands of times you have given this gift to others.”  
For pandemic-specific mental health resources, head to covidmentalhealthsupport.org.
If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time day or night, or chat online.
Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.
For people who identify as LGBTQ, if you or someone you know is feeling hopeless or suicidal, you can also contact The Trevor Project’s TrevorLifeline 24/7/365 at 1-866-488-7386.
The Trans Lifeline is a peer support service run by trans people, for trans and questioning callers.
The American Foundation for Suicide Prevention has resources if you need to find support for yourself or a loved one. 
The website I Hurt Myself Today has resources on self-harm. 

• You can locate peer support resources at warmline.org. 
• A curated list of online and phone peer to peer support
• The Marco Polo app helps friends and family stay connected
• Ways to stay connected during physical distancing

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Alia E. Dastagir is a recipient of a Rosalynn Carter fellowship for mental health journalism. Follow her on Twitter: @alia_e