Are you sure you want to do this?

| May 1, 2024

Content note: This essay was originally delivered as the keynote speech at the 2024 Out of the Darkness Walk, an annual event designed to engage young adults in the fight to prevent suicide. It discusses suicidal feelings.

Hi everyone and thank you so much for allowing me to speak here today. As mentioned, my name is Rachel, I’m from Toronto, Canada, I’m a master’s student in the Department of Mental Health at the Bloomberg School of Public Health where I am doing research as part of the suicide prevention working group, and I am an aspiring physician-scientist hoping to work in the field of mental health and suicide prevention as someone with lived experience.

When thinking of how to share my story today, I thought of the journal prompt “If you wrote a story where the first and last sentences were the same but had different meanings, what would it be?” My story consists of more than what can be told in a 5-7 minute speech, but here is a piece of it, structured to this prompt.

Are you sure you want to do this?

It’s a question I’ve been asked repeatedly. Yet it started as a question I asked myself. Sitting alone in my room questioning my place in this world, are you sure you want to do this?

For the first seven years that I asked myself this question, the answer was no. Yes, I wanted to do this, but no I was not sure. My anxiety had me think through every scenario.

Option 1. I die and the immense pain I feel gets transferred to my family. I didn’t want that.

Option 2. I try to die but survive and have to deal with the consequences. I would be forced to face more doctors and therapists who always left me feeling worse. I didn’t want that either.

Option 3. I live in silence. Keep my thoughts and feelings to myself so I don’t hurt anyone and no one can hurt me.

Option 3 kept me alive from 12 to 18 years old.

Then at 19, I found myself in rock bottom’s basement and the answer to my question became an undoubted yes. Yes, I was sure. I was sure that I hurt more than I could handle. I was sure that this was my only option. I was sure I wanted to end my life.

In October 2020, while on a leave of absence from university, I was admitted to a Toronto hospital’s psychiatric unit as a voluntary patient. As the nurse was getting ready to take me up, she asked, “Are you sure you want to do this?”

No, I was not sure. My brain was screaming at me to say no. But the nurse didn’t ask my illness. She asked me. And while my illness and I had almost completely morphed into one being, a little bit of me was left.

“Are you sure you want to do this?”

Yes. I want to be admitted.

My will to live was non-existent. I was convinced something was broken in my brain that talking couldn’t fix. Given this, the doctor suggested I try electroconvulsive therapy, ECT. I was willing to try. I knew I wasn’t going to be allowed to leave the hospital any time soon in my current condition and ECT required no effort from me – perfect since I had no effort to give. We were ready to begin, and I was asked, “Are you sure you want to do this?”

Again mental illness said no, but Rachel said yes. I had nothing to lose.

I spent two months in the hospital undergoing treatment. I kept a journal at this time and the tone of my entries started to change. I was by no means cured but my will to live had returned. The question, “Are you sure you want to do this?” re-entered my mind. But now the “this” I was referring to wasn’t dying but fighting. Yes. I am sure. I am sure I want to beat this.

I got discharged in December and wanted to return to school for the spring semester.

“Are you sure you want to do this?” I was asked yet again.

I was told to consider transferring to a school closer to home. Or if I was insistent on staying at Emory, at least switch to an easier major or career path. I’ve always had a love for school. My illness had taken so much from me but I wasn’t prepared to let it take my academic aspirations. I deserved a chance to make it work.

“Are you sure you want to do this?”

Yes. I am sure. I am sure I want to try this.

The next ten months were incredibly difficult. Every day I asked myself “Are you sure you want to do this?” Much of the time the answer was no. Fighting was too hard. I didn’t want to continue. Yet by force of an unwavering support system, I was able to keep going and make it through.

While in the hospital, the doctor told my parents I needed to be tested for autism. Again: “Are you sure you want to do this?”

This diagnosis comes with a label for life. A label that most would see as negative and limiting. But this label is ultimately what changed my life. Almost a year after my admission, at 20 years old, I was officially diagnosed as being on the autism spectrum and everything clicked. I found professionals who knew how to help and for the first time when I shared experiences they were validated. I learned that my presentation was quite textbook for a high-achieving female. There was nothing wrong with me. I wasn’t the problem. My brain just works a little differently. I started understanding how my brain works and what I need to be well. For the first time in maybe 10 years, I felt good. It was strange. I didn’t know how to be happy. I had struggled in silence for most of my life and felt a newfound pride in what I had just survived. I wanted to share my story.

I told my mom that in a couple of weeks, on the one-year anniversary of my discharge, I was going to do just that. “Are you sure you want to do this?” she asked.

I had never been more sure.

“Wait until you are settled in a career” was her response. Her concern was valid. As someone hoping to attend medical school one day, I was warned about attaching my name to topics like these. Suicide, autism, inpatient treatment, medical leave of absence.

“Med schools won’t want to take the risk, you’re a liability.”

I don’t care. I am sure I want to do this.

When I started high school, I was sure I wasn’t going to live to graduate. When I was consumed by depression at 19, I was sure I wasn’t going to make it to 20. Now, at 23, I am sure there is nothing I want to do more than create change. To use my story to advocate for those getting lost in the mental health care system. To raise awareness and support those who feel as I once did.

I know there is stigma surrounding the illness that nearly took my life. I know that even though I have come out the other side, it will be hard for some people to look beyond my past. But we will never break the stigma by continuing to give in to it. This is my story. This is my life. And while I wish it didn’t have to have been so hard, it was, so I might as well make some good of it. My lived experience isn’t baggage, but rather an asset.

So despite the fear and the warnings cautioning me against doing so, I am going to share my story. My answer will always be yes. No matter how many times I’m asked, “Are you sure you want to do this?”


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