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How To Be There For Someone Who Is Having A Mental Health Crisis

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One of the challenging things about a mental health crisis is that often, even the people that care about you aren’t quite sure how to be there for you. After getting diagnosed with bipolar disorder, I lost a lot of friends during a time when I most needed support from them.

In some cases, the real issue wasn’t a lack of caring — I believe that some people simply didn’t know how to respond to what was happening. That’s perfectly understandable, but I truly wish that more people had at least tried to be there for me. Here are a few of the things that friends did that meant a lot to me, as well as some things I wish more people would have done:

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Alexithymia: The Emotion-Processing Dysfunction That Makes It Hard to Identify Emotions 

At some point in our lives, most of us have answered the question, “How are you?” with an honest, “I don’t know.” 

It’s natural to struggle with knowing how we really feel from time to time. Sometimes life is going so fast that we don’t have a moment to slow down and check in with our emotions. Other times, we’ve been cycling through so many emotions at once that we don’t know which one is affecting us most.

But for people with alexithymia, identifying and processing emotions isn’t a now-and-then kind of struggle. It’s something that can feel next to impossible the majority of the time.

What Is Alexithymia?

If you’ve even heard the word “alexithymia” before, it’s likely because actress and Disney alum, Alyson Stoner, opened up about her struggles with it earlier this year. But if you haven’t heard of it, you’re in good company. 

Though alexithymia is fairly well-known in clinical circles, it’s not as well known outside of them — perhaps because it is not an official diagnosis recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Alexithymia can best be described as an emotion-processing dysfunction. 

“Alexithymia is essentially a dysfunction in the normal emotional awareness processes that make it difficult for people to put a name to their feelings,” John Richey, Ph.D., clinical psychologist and associate professor in the department of psychology at Virginia Tech, told The Mighty.

According to the Journal of Neuropsychiatry, psychiatrist Dr. Peter Sifneos coined the term “alexithymia” back in 1973 to describe patients who struggled to identify their emotions and therefore had trouble engaging in certain types of psychotherapy. 

The lack of emotional awareness people with alexithymia experience can sometimes also affect their ability to empathize with others. One studyfound that participants with alexithymia were less able to recognize emotional expressions in faces than people without alexithymia. 

“A child or adult with alexithymia often struggles to understand his or her own self experience,” Deborah Serani, Psy.D., who specializes in treating depression, said. “Individuals with alexithymia have difficulty understanding how others feel and think too.”

At the moment, there isn’t much research on alexithymia, so experts aren’t able to definitively say what causes it. Dr. Richey told The Mighty there is still much to explore when it comes to alexithymia, but he felt reasonably confident in the belief that alexithymia could be impacted by how much emotional labeling was modeled, and reinforced or punished in childhood.

Who Can Have Alexithymia?

Anyone can have alexithymia, but it’s slightly more common in men than women. Dr. Serani told The Mighty approximately 8% of males and 2% of females will experience this emotion-processing dysfunction.

Alexithymia also shows up in people with certain mental health conditions, most notably, post-traumatic stress disorder (PTSD) and depression. In addition to people with mental illnesses, some studies have linked alexithymia and autism. 

In their piece, “Am I Ready for an Autism Diagnosis?” Mighty contributor Anonymously Autistic wrote about how alexithymia made it difficult to describe their experience of autism in therapy:

I have alexithymia. It is part of my autism that makes it hard to describe my autism. I have had to teach myself to describe my feelings because if I don’t consciously ask myself how I feel, I don’t know. Before I started asking myself this question, I never would have been able to explain what I was feeling because people always told me how I was feeling growing up.

If the description of alexithymia sounds similar to your experience, you’re not alone. There are tangible ways to work on expanding your emotional repertoire — we’ve outlined a few of them below.

Treatment for Alexithymia

Though there isn’t a treatment out there that targets alexithymia specifically, people with alexithymia can benefit from existing forms of therapy, including cognitive behavioral therapy (CBT). CBT can help individuals focus on identifying and understanding the connection between thoughts and emotions. For people with both alexithymia and depression, this can be particularly useful.

“When someone with alexithymia says, ‘I’m depressed,’ it could be that he or she is very sad. But it might also mean frustrated, lonely, disappointed, mournful, empty, fatigued, lost, helpless,” Dr. Serani explained, adding:

Much of depression can be reduced with shifts in thinking and feeling. So, it’s vital for a person who has depression to become well-versed in the textures of their own symptoms to know what techniques to put into action. While it can be very challenging for those who struggle with alexithymia to broaden their emotional awareness, psychotherapy greatly reduces [the struggle].

Dr. Richey also encourages people with alexithymia to pay attention to the physical sensations that accompany the emotions they do feel. For example, you might notice your heart beat faster when you feel angry or upset. You might notice your body feels sluggish when you’re sad. You might notice yourself sweating when you feel embarrassed or anxious. Learning to link your physical sensations to emotions takes time, but as you work on emotion identification, it will slowly get easier.

Whether you have alexithymia or not, struggling with identifying and processing your emotions can be difficult and sometimes discouraging. While your feelings are always valid, we want you to know there is hope. 

“The best thing I could say as a word of encouragement is that you’re certainly not alone. There are many people who struggle with alexithymia,” Richey said. “There are also many people who are thinking about it from a research perspective. So I think there is a community of people who are very interested in understanding this problem and developing better treatments.” 

If you’re struggling, we encourage you to reach out to a trusted mental health professional. If you don’t have a therapist or don’t know where to look for one, check out this handy therapist finder tool. And as always, if you need support, you can always turn to our community by posting a Thought or Question on The Mighty with the hashtag #CheckInWithMe. Our community wants to support you, no matter what you’re facing.

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23 people Explain What It’s Like to Have Suicidal Thoughts When You’re Not Suicidal


1. “It’s like randomly imagining what life around you would be like if you didn’t exist anymore. It’s like having random daydreams about dying in different ways. It’s not always looking both ways when you cross the street, not because you want to die, but because you don’t not want to die… it’s having this numbing ache inside you don’t know how to mute.” 

2. “Sometimes my anxiety causes me to feel trapped and overwhelmed. Thoughts of my death (not necessarily suicide) are a fantasy of escape. And escape where you don’t feel guilty, scared or pressured anymore.” 

3. “I have intrusive thoughts about suicide, even when my moods are relatively stable. I sometimes have images and thoughts popping up. These thoughts feel obsessive some days. I am grateful I don’t actually feel like doing any such thing that would end my life.”

4. “I once told my therapist I never pictured myself as an old person. That I didn’t think I’d ever make it there. Some days I just want to disappear. To escape the voices in my head telling me how awful I am, how I’m such a burden to everyone, how fat I am, etc. The cacophony is enough to make you want to rip your brain out of your head.” 

5. “The best way I’ve found to describe it is that suicidal *thoughts* can be fleeting. In fact, I’ve met many people who have never been suicidal who have wondered what it might be like. The problem for those of us who have been suicidal is that the *thought* of suicide brings up all those old emotions, sort of like PTSD. Even writing this response has made my thoughts turn to — “Well, I *could* just go ahead and do it…” But right now, I’m not suicidal, and I actually am in a pretty good place with regard to my mental health. So why does this voice go on in the back of my mind? Because I’m sick, y’all.”

6. “Think of it like getting a cold. You can drink orange juice and take vitamins and take care of yourself as much as you possibly can, and you might be in the healthiest shape of your life. And then you start sneezing, and your nose starts running. You never know when or where it’s going to happen; it just does, and there’s often little you can do to prevent it. So you just keep moving on, accepting it’s a part of you or that it’s simply not something you can control. That’s all we can do.”

7. “It’s less about killing myself and more about ceasing to exist. I want the people around me to not be bothered by my incompetence, insecurities and the trouble I feel I cause them. Sometimes it’s just a call for momentary relief.”

8. “They’re fleeting but frequent thoughts that attack you even when you feel completely fine. Sorta like an annoying fly buzzing around you constantly.”

9. “I am so overwhelmed and stressed out by what seems like everything. The world is just crashing down on me. I just want the stress to be gone. My chest just aches like it’s getting crushed. My mind is like having 100+ internet tabs open and one of them has an ad that is playing music so you gotta rush to find it to make the ad stop, but all you find is more random tabs with no ad (if that makes any sense). My mind is all over the place, and all I want to happen is for it to stop. Freeze. Be calm. Don’t want to die. That’s too permanent. To be able to pause or disappear away from everything though is a nice thought.”

10. “I often describe it as being passively suicidal. I wake up in the morning and wish I hadn’t, I close my eyes at night hoping it’ll be the last time .. It’s not like I want to end my life, like when I’m actively suicidal, but I don’t want to live. It’s lonely and it’s scary and something that goes through my head every single day.”

11. “It’s overwhelming. You know you don’t want to kill yourself, but the thoughts just won’t leave your head. I battle this every single day of my life. I have everything to live for yet the thoughts don’t want to move from my brain. It’s like being trapped in a brain you’re unfamiliar with… it’s like walking into a room full of family and only seeing complete strangers.”

12. “It’s almost like this nagging feeling or voice. You’re out living life. The sun is shining, your favorite song is playing but something feels off. You suddenly get a brief flash of ‘What if’ and it passes so quickly you don’t really process it. Until the music stops. Then it comes again. And lingers. Kind of like when your phone keeps going off and distracting you. Until eventually you have to answer it. (Or in this case, dwell on the thought.)”

13. “Being angry with hope. Being frustrated with faith. Resenting the reasons to stay alive… Self-hate. Self-hate. Self-hate. People hate. People hate. People hate. Guilt. Guilt. Guilt. Futility, oh my god, the overwhelming futility. Knowing it’s not futile. Arguing with yourself over whether or not it is. Not wanting to die but not wanting to feel worthless any more. Not wanting to die but not wanting that tight aching physical pain in the heart/stomach/head any more. Not wanting to die but not wanting to be living in fear forever…. What if I get ill and die now because I’ve wished myself dead? (I don’t want to die, I don’t want to die, please don’t let me die!)”

14. “It’s like going into an art room full of beautiful paintings, and then the lights turn off and written in invisible ink everywhere are these dark thoughts… then as soon as the lights come back on you see just beautiful paintings — although you know hidden somewhere are these suicidal thoughts and you’re just waiting until they resurface.”

15. “Some of my worst points was the ‘other me’ in my head shouting at me, feeling like it was attacking my brain physically…  Another version of this would be like it is trying to slyly coax me into doing this things, like the snake in ‘The Jungle Book.’”

16. “It’s not really the thought, ‘I want to kill myself,’ but more, ‘I don’t care if I die.’ Situations that most people would have fear in don’t always bother me. Or I imagine things happening that would cause death. But these are just passive thoughts, they may always be there, but I am learning to fight them.”

17. “I have a lot of intrusive thoughts, regardless of how stable my mental health is. It’s like everything will be OK, and I’ll be happy and content or at the very least, I’ll be feeling relatively neutral, and all of a sudden my brain will say something like, ‘Just swerve into the concrete barrier,’ or, ‘You could jump off these stairs right now.’ In these moments, I don’t want to kill myself, but the thought of doing so is always there. It’s like a tiny switch in my brain — it isn’t triggered all the way so as to cause a suicidal crisis, but it’s just nudged a little bit so that it’s almost on.”

18. “Suicidal thoughts are a daily occurrence for me, even if I’m not totally low or really wanting to die… They’re passive thoughts, but they’re always there even when I’m having a good day.”

19. “It’s intrusive thoughts that make no sense to you, but they refuse to leave. It’s a feeling that sweeps across your mind like a fog. An evil inner self-voice that taps you on the shoulder and whispers in your ear on your darkest days. It’s pondering different ways and scenarios you could do it, but never actually planning it. Just because I don’t want to actually go through with killing myself doesn’t mean my mental health isn’t affected by these intrusive thoughts that insist I would be better off if I did. I know how much it would hurt those I love, and all I want is the thoughts of wanting to harm or end myself to be gone. When you struggle with mental illness, anxiety, depression etc., sometimes thoughts invade your mind without even wanting them.”

20. “It’s like being behind a one-way mirror. You can see the world around you going about their daily lives, but you aren’t present in it. You’re merely a spectator. And no one even notices you because all they see is their reflection. All they see (care about) is themselves and the world around them. They never see you, and you feel they don’t care about you. And then your mind begins to wonder. Is my existence significant? I’m already living like I don’t exist, so why should I continue living? It’s one of the most frustrating feelings because you want to be on the other side of the mirror. You want people to notice and to care. It’s this dull aching in your heart that never goes away and you just want it to stop.”

21. “One of my favorite quotes about this: ‘Depression is the inability to construct a future.’ That’s completely true. Even if you aren’t actively looking to end your life, you can’t imagine going on. Every day you feel like it’s too much and that you don’t belong, hoping that some outside force might just end it for you.” — Stacy T.

22. “For me, it’s like the annoying devil character on your shoulder… like you are fine but this dark annoying thing keeps whispering into your ear these awful thoughts. And sometimes it’s not thoughts, it’s just images. Like I will be just going about my day and I will get these random suicidal images in my head. Almost like someone mis-filed a photo in your daily slideshow.”

23. “It’s a spectrum. Suicidal thoughts aren’t always actively planning your death. Sometimes, it’s a random, uncontrollable thought that you’d rather not be alive. Sometimes it’s an impulse to do something self-destructive. Sometimes it’s ‘playing’ with the idea while telling yourself you’re not serious about it. ‘Suicidal thoughts’ encompasses a wide range of thoughts and ideas.”