This essay is about chronic suicidal ideation as a symptom, not an expression of current intent.

I realized that suicidal ideation is like tinnitus for me.

Because of Meniere’s disease, I have tinnitus in one ear. When I was having severe attacks, every morning I woke up hoping the ringing had miraculously disappeared. Every morning, the moment I opened my eyes, it came roaring back. It was a loud, high-pitched sound that was always present. The louder it became, the more likely it was that a severe attack was coming. Even now, I feel anxious whenever I hear the high-pitched sound they use in horror movies to signal that something ominous is about to happen.

Fortunately, my Meniere’s disease went into remission, and I no longer have severe attacks. Some residual symptoms remain. I have lost most of the hearing in one ear. I lose my balance easily. And I still have a constant, low-grade tinnitus in my deaf ear.

Most of the time I am not consciously aware of it, but it is always there. Occasionally it grows louder, and I slap the side of my head with my palm, as if I could reset it. When everything around me is quiet, I hear it.

I have had suicidal ideation since I was very young. The impulse has always been with me. It is just a thought, and I have never seriously acted on it, but I hear a voice saying, “Jump. Jump. Jump.” My mind automatically imagines ways I could kill myself. Sometimes that voice becomes very loud.

After decades of therapy and simply reaching a certain age, I realized that it was never a wish to die.

I once watched a film about an actor who overdosed after a scandal destroyed his career. Did he intentionally kill himself, or was it an accident? The film suggested another possibility: perhaps he simply wanted to sleep deeply, wake up, and reboot his life.

I understood immediately.

What I really wanted was to be free from the roles assigned to me by other people—to stop being a character in someone else’s story. I wanted to begin my own life, free from relational trauma, outside the architecture of my family, free from expectations that had been imposed on me.

When I reached that realization, I proudly told my psychiatrist that my suicidal ideation had disappeared.

But it came back.

Not as loudly as before, but like tinnitus, it is always there. Sometimes it gets a little louder and I notice it. Most of the time it fades into the background and I ignore it. But it is always there.

Perhaps my nervous system developed this pattern because of the life I lived. It is simply following an old neural pathway.

Perhaps what I need now is not to fight it, but to patiently teach my nervous system that I am free.

Help is available

If you’re having thoughts of self-harm or suicide: call, text 988, or start a live chat with Suicide & Crisis Lifeline. It’s free and confidential. You’ll reach someone who is trained to listen and support you.