All of the above, really. Sometimes, a nanosecond of madness. Sometimes, a cry for help -- and the "cry for help" shouldn't get the negative connotation that it usually does. If someone is going THAT FAR to make it clear that they're in trouble, they obviously need help & sympathy, not derision or condescension that they just "want attention". And sometimes it's just a matter of nerve -- killing oneself isn't easy. We've got a billion years of evolution telling us we're supposed to survive at any cost, but a fucked up brain asking us why bother? Still, it's easier to start small, and work your way up... but even then you'll have moments of regret along the way. Translation: It's complicated. :) Self harm is generally something different. Most self harmers aren't suicidal, they're ... well, trying to regain some control over something, anything -- even if it's only their own pain. Then again, most self-harmers wouldn't call an ambulance either. Or anyone else.