Trigger warning: This story explores suicide and includes details of self-harm. If you are at risk, please contact the U.S. National Suicide Prevention Lifeline at 800-273-8255 or the Crisis Text Line by texting 741741. You can also locate peer support resources at warmline.org.
Jess Stohlmann-Rainey cries everyday. And it's not when she's feeling suicidal.
On Monday, she cried because she woke up with hip pain, saw a one-eyed chihuahua and a video of bats swimming. She cried because she was so thankful for her husband Jon. She cried thinking about people she loves who killed themselves and those who wanted to but didn't.
Jess cried because she had a nightmare where, in a twist of modern eugenics, anyone with a psychiatric history who caught COVID-19 was left to die. Another day she cried when a refrigerated truck pulled up to a Denver hospital and she wondered if it was for bodies.
During the pandemic, Jess, 34, who has attempted suicide twice and lives with chronic suicidal thoughts, sometimes struggles to ward off despair. Working toward a better world is how she keeps herself wanting to stay in it. But now that reimagining can feel achingly out of reach.
The pandemic has taken a toll on everyone, especially the millions of Americans who think seriously about suicide. Calls to suicide hotlines in some parts of the country have spiked. In March, when the stay-at-home directives began, the Crisis Text Line saw a 26% increase in text volume from the previous month.
Life stressors and recent or impending crises are known to contribute to suicide, the Centers for Disease Control and Prevention reported in 2018.
Many mental health professionals can't conduct in-person appointments, and not all patients can access virtual therapy even when it's offered. On social media, chronically suicidal people are sharing how fear, uncertainty and isolation are fueling their thoughts of dying.
"Almost overnight, half the people I know lost their therapists," said Jess, director of program development at Rocky Mountain Crisis Partners in Denver. "If you rely exclusively on that to get by, things are going to get really bad for people really quickly."
There is some evidence that suicides increased in the U.S. during the 1918-19 influenza pandemic and among older people in Hong Kong during the 2003 SARS epidemic, The Lancet reported.
"We're about to face all kinds of challenges that we already know are hard for people, but they're going to come all at once," Jess said. "Increasing poverty and houselessness, increasing difficulties accessing health care. ... Basically everything that's a social risk factor for anything is crashing down on us right now. If you don't have a network for supporting yourself, I don't know how people will survive it."
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The pandemic has revealed what many suicidal people know and others may have taken for granted: human connection is life-saving.
Jess is alive, in part, because her life is threaded to others. Her sister, her friends, her fellow survivors - these are the people who love her, listen to her, validate her and make space for the heavy and sometimes terrifying without devolving into terror themselves. They do not judge her or hold her worst moments against her. They are the ones who know why she cries.
This is a look at Jess's support network. This is how she and her peers - people who have struggled with suicide - survive:
Someone with the 'biggest picture': The sister
In September, Jess cried because her sister Jenny was visiting and she was so happy she was there. She cried when Jenny left.
It was the last time they saw each other before the crisis began. They don't know when they might see each other again.
"I miss her," Jenny said.
They talk on the phone most weeks, and the conversations are long. Sometimes they text, but more often they're on Instagram sharing animal memes.
Jenny is not the person with whom Jess shares her most intense suicidal thoughts. Jenny is the person she reaches for to talk about everything else. She's the one who knows her fully. Perhaps knows her best.
Jenny bore witness to some of Jess's worst years. Jess began to hear distinct voices in middle school, telling her if things got too hard there was a way out. She was eventually diagnosed with schizophrenia, which carries a heightened risk of suicide.
"As she got older, she became distant in a lot of ways, which was challenging for me as her sister in a house where we loved each other," Jenny said.
Jenny remembers the wounds on Jess's body - the self-inflicted cuts and burns. She remembers the time she attempted suicide at school, and the hospitalization after.
Jess made two serious suicide attempts in high school.
"There was this sort of closeness I had with death in that period, where it was just more compelling than being alive," she said.
Jenny wanted to help her sister. Back then, she didn't know how. A few years after Jess left, when Jenny was a senior in high school, she experienced her own crisis - worry about her sister loomed, there was financial stress at home, she was over-committed at school and a fellow student killed himself in September.
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On the last day of Thanksgiving break, Jenny made her own suicide attempt.
"Everybody around me was in crisis and it felt like, 'Wow, life is really, really hard,'" she said. "For a long time I didn't even consider it a suicide attempt. I wasn't really trying to die, I was just trying to figure out if I wanted to live."
A 2016 study in the American Sociological Review showed characteristics of communities can contribute to teen suicide clusters.
Jess and Jenny are bonded not only through shared history but also through a common experience of suicide that is, for each, deeply particular. Jess was trying to end her life when she made her attempt, and she's thought about dying many times since. Jenny wasn't sure what she wanted, but the attempt clarified death was not it.
As adults, they've worked to unravel these differences, to move through grief, resentment and mistrust. On one of Jenny's visits to Jess at college, Jess gave her a poem.
"I know she depends on me, too," it read. "We are sisters. After all."
"I remember thinking about the poem as a symbol of the way we were united beyond being born to the same family ... that she had empathy for me," Jenny said.
During these uncertain times, Jenny knows she can't take Jess's pain away, so she doesn't try. Instead, she simply listens.
"She's someone who just understands me," Jess said. "I feel like she has probably the biggest picture of anyone. I always feel compelled to call and just talk about my life. And I always want to know what's happening with her. … I trust her implicitly."
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Jess cried because her friend's grandfather died during the pandemic.
Dese'Rae L. Stage, a suicide attempt survivor who founded the site Live Through This, had to say goodbye to her "Poppy" over FaceTime.
Amid the swelling crisis, Des grieved her grandfather's death, feared for the health of her mother, who has a respiratory illness, and her brother, who works in a restaurant, and lost her therapist. All while quarantined at home in Philadelphia with her wife and two kids under three.
Sometimes the stress and uncertainty can overwhelm.
"I spent so much of my life wanting to die and now I want to live. Well, even sometimes I still want to die but most of the time I want to live," she said. "And so it's like the prospect of not having control over that, of potentially dying and leaving this world that I finally was able to build that I love, that's so scary."
But Jess and Des have each other. Brought together through suicide prevention work, they've since formed a friendship where they talk openly, frequently and often irreverently about their suicidal thoughts. They spend hours discussing death without feeling like it's a downer, and share outrage about how people pathologize their pain rather than question why the world may not always feel worth living in.
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The intractability of suicide has led some people to believe it's a problem that can never truly be understood or solved. Numbers released in January from the CDC show 48,344 people died by suicide in 2018. Since 1999, the suicide rate has climbed 35%. But many suicidal people say for all that remains unknown about suicide, it is clear that connection saves lives.
In the early days, as the virus showed what it was capable of, Jess and Des and many of their suicidal friends understood they would need one another more than ever.
"We've always needed other people," Stage said. "We just haven't had to make quite such a concerted effort in the past ... People are finally seeing more intentionally how important it is to stay connected."
Suicidal people without in-person peer support, or who can't access it during social distancing, can build connections online. The Internet is home to everything from formal support groups to impromptu suicide social hours.
Des says the Internet has been key to her own survival. The connections she's forged online, she said, make her uniquely suited to the pandemic.
"This has been like my Superbowl," Stage said. "I've been practicing for this my whole life. I've been on the Internet since I was 14 and seeking out connections that whole time."
Jess and Des's relationship is, in large part, made possible by the Internet. They live across the country, so hanging out means getting on Zoom together three or four times a week. They also host a Facebook Live series called Suicide 'n' Stuff.
"We had a ridiculous contest early on where the prize was a vial of Jess's tears and a list of what she cried about for a week," Des said. "She is a very sensitive person, and she is very sensitive to the world and what's happening in it."
When Jess in crisis, she seeks out Des. On a bad week, thousands of exchanged texts trumped the thousands of miles between them.
Des also knows Jess's boundary that must never be crossed. After several traumatic experiences with involuntary hospitalization, Jess under no circumstances is to be hospitalized without her consent.
"Jess has been very clear. Do not hospitalize me or I will kill myself," Des said. "If it were to come to a crisis point I know enough of the people in her immediate support network who are local to her that I can reach out and go, 'OK, what do we need to do? How do we keep her safe?'''
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Someone by your side: A work friend (who is so much more)
Jess cried often at the thought of her dog Marty dying. Then cried in April when he did.
Jess sent a group text after he suffered several strokes. Some friends said they would go with her to euthanize him, but there was only one offer of help she accepted.
Her friend Carly Larson messaged her privately: "Do you need me to drive you?"
"Yes," she replied.
Other than her husband Jon, Carly is the person in Jess's support network in closest proximity. Jess and Carly are neighbors and work together at Rocky Mountain Crisis Partners. Jess can't hide from Carly, who also is chronically suicidal, and she says she never has to.
"She would literally drop anything to do anything for me anytime," Jess said. "I would never feel bad or like a burden to ask anything from her."
Carly knows what it's like to feel like a burden. She was born to a single mother who struggled with drug use, and learned to fend for herself from a young age.
"By the age of six I knew that I should have never have been born. I knew that my mom didn't want to have a kid," she said. "That's kind of where my suicidality comes from."
For a long time, Carly said the message she got was that feeling suicidal was not a reasonable response to the pain she was experiencing.
"When somebody is suicidal, it gets really isolating, and not in the way that we tend to discuss," she said. "People are really scared, shamed, into hiding that they're suicidal. What I really like is in our friend group it is so normalized."
But during the pandemic, Carly has said she's felt strangely well. Zen, almost.
"It was basically like all of my little problems got absorbed into this big problem that I can't fix," she said. "It has shoved me into the present moment and I'm not worried about other stuff because, like, who knows?"
The coronavirus crisis has created challenges for many suicidal people that go beyond emotional needs. Jess and Carly's local friend group, made up of mostly people who are or have been suicidal, have a text chain where they talk about how to pool resources amid the lockdown.
They discuss who has cash, who has a car, who has the Netflix login. Survival is more than a state of mind, it's access to basic needs like shelter, food, safety and autonomy.
"For me, I'm like, 'All right. I have plenty of first aid materials. I have plenty of canned food,'" Carly said. "And I am notorious for having a full freezer all of the time. I have 20 different types of homemade soup in my freezer, guys. Don't worry. We will have lunch for a while."
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Someone who shares values: A comrade in activism
Last month, Jess cried because in Denver, where she lives, many homeless people don't have a safe place to shelter that isn't fraught with risk of infection.
As Jess witnesses the virus's toll - especially on the most vulnerable - the emotional intensity of her suicidal thoughts gather. She shares them with her friend Leah Harris.
Jess and Leah, a mental health activist, met through suicide prevention work. While both have survived multiple attempts, they say their friendship is predicated less on shared experience and more on shared values. They believe part of the responsibility of being alive means working toward a world that works for everyone.
"I feel like she's someone I can always count on to know what is right," Jess said.
The pandemic has been a nightmare for Leah. She has been reporting on COVID deaths in psych wards. Leah has been hospitalized, so the work touches on personal wounds.
Sensations of panic and terror sometimes overwhelm her, and often at inconvenient times. She recently gave a keynote with Jess on white supremacy at the American Association of Suicidology's annual conference, and says feelings of intense fear inundated her just before the session began.
Friends are getting sick and she has lost loved ones to the virus. She grieves for them all.
"I wake up daily with a sense of dread and foreboding," she said.
Last month, Leah put out a call on Facebook to see if anyone wanted to do a Netflix viewing party for "Crip Camp," a documentary on disability activism. It's a film befitting the pandemic, which has disproportionately impacted vulnerable populations including people with disabilities, low-income workers and racial minorities.
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Jess raised her hand, which Leah says was no surprise.
"It's rare to find a friend who gets you as a person, and also understands the causes that drive and define your life," Leah said. "For us, the divide between the personal and political doesn't exist."
When Jess feels overwhelmed, Leah is the one who validates her feelings that bad things are happening. When shegets apocalyptic, Leah helps her distinguish anguish from paranoia. She does not offer mantras about positivity or hopefulness, which are in abundance. She reminds Jess that working toward a better world always matters, even when you have to squint to see it.
"Leah has been doing activist work forever, and is used to losing but still fighting," Jess said. "She inspires me."
Nearly six months into the coronavirus crisis, unknowns about the pandemic abound. But for Jess, some things are certain: Having say over her own fate is non-negotiable. So is being open about her life - dark thoughts she's having, voices she's hearing - even when it unsettles people.
"I feel like I'm living more authentically now than I ever have," she said. "That keeps me from wanting to die, because I get to actually be who I am. The idea of escaping in that way is a lot less seductive than it used to be."
The people who love Jess, who are loved by her, hope she stays. Her family, especially, who were there from the start, through the crisis years, the anarchy, now relish the relative calm. Jess has created for herself a life worth living, a feat impossible to accomplish alone.
"If you want to have a life that makes you want to stay, that makes you want to live, you need other people," her sister Jenny said. "Everybody does."
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Peer support resources
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
Mental health resources
For pandemic-specific mental health resources, head to covidmentalhealthsupport.org.
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 may also be interested in:
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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
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This article originally appeared on USA TODAY: Suicide and coronavirus: How peer support can get you through a crisis