The Crisis Line

by Fanjie (Sadie) Shang

art by Vivian Vig

The light from my laptop cuts through the darkness of my London bedroom at 2:47 a.m. I hear the beep of a message from an anonymous texter: “I want to end everything right now. I can't deal with this anymore.” 

The gravity of what these 14 words imply feels like a 40-pound weight on my chest, making me breathe heavily with urgency and desperation. Somewhere in the U.K., someone is drowning in what feels like an eternal wave of hopelessness. With slow, deep breaths, I prepare to handle this situation optimally. 

My training kicks in as I remember the protocol: assess, empathize, validate, connect. Questions race through my mind: What made them spiral into crisis? Will they self-harm? Will this conversation help? Rather than panic, I channel my energy into focused action. While the skills I gained from Shout, a crisis intervention organization, taught me safety protocols, scripts, and risk assessments, I was not fully prepared to understand the inner-workings of our two brains when crisis and response collide. During these chats, I witness the neuroscience of crisis and connection in action. What is actually happening in  the person’s brain as they go through a crisis? How can our understanding of neuroscience guide me and help me provide optimal support? The story of tonight's shift starts here, when two minds begin to intersect across the darkness.

Section 1: The Crisis Brain The texter reached out to me in the midst of a neurological storm. Perhaps it was a distressing conversation, unprocessed grief, or an accumulation of stressors that set off this storm. Within seconds, their brain's main stress system switches on: the limbic system, a group of structures tucked deep in the brain responsible for emotions, memory, and motivation This system initiates the body’s reaction to stress via the hypothalamic-pituitary-adrenal (HPA) axis, the body’s hormonal alarm network, emitting cortisol and norepinephrine [1]. Heart rate increases, breathing becomes faster and shallower, and sweat coats their hands as the body prepares to face the threat. This is the body’s flight-or-fight response, coordinated by the sympathetic nervous system, which is crucial for survival. This state of heightened awareness makes it difficult, if not impossible, to focus on anything else. 

One brain structure central to sparking this response is the amygdala, a structure buried deep in the temporal lobe that processes fear and anxiety. The amygdala shares reciprocal connections with the prefrontal cortex (PFC), the part of the brain which regulates fear and helps distinguish real threats from perceived ones. In high-stress states, real and perceived (like the texter is feeling), the amygdala’s alarm bells ring louder, causing the PFC to lose its ability to inhibit the amygdala's fear signals [2]. This is called “amygdala hijack,” where the brain is in survival mode, blackening out everything else [2]. Amygdala hijacking has implications for suicidal behavior and can cause a person to spiral into thoughts of self-harm as their brain seeks escape from emotional pain (Ahmed et al., 2025). 

Additionally, it is likely that the texter has previously experienced chronic stress or trauma [3]. Over time, the physiological effects from chronic stress diminish one’s capacity to effectively handle crises. The PFC is one brain structure that is particularly sensitive to chronic stress. The PFC is made up of many types of cells including excitatory pyramidal neurons, which receive information through highly branching dendrites. The protrusions along these branches are called spines, and serve as points of connection". By diminishing spine density in pyramidal neurons in the prefrontal cortex, chronic stress weakens receptors linked to logical thinking [4], while the increased spine density of the amygdala leads to more fear. Additionally, increased stress disrupts the balance of inhibitory inputs in the PFC from inhibitory interneurons, which would normally send signals to suppress the overactive fear system [2]. Prolonged exposure to stress hormones, like cortisol and norepinephrine, alters the physical structure of neurons and can fundamentally rewire fear circuitry [5].  This is especially true during adolescence and young adulthood, when the brain is developing and highly sensitive to stressful inputs.

Over time, stress hormones can have chronic, detrimental effects, especially in the PFC [1]. The neural circuits that help people think through problems, consider consequences, and regulate emotions become frayed. This is something I hope to help rewire by building new neural pathways to prepare them to accurately judge and respond to future situations. These neurological maladaptations are why messages from fear circuitry feel so desperate and absolute. When someone in crisis says, "I can't think straight,” they are describing a neurological reality.

The texter trembles as they type, asking for help. The stress response compromises their motor control [6]. Hitting “send” is a grasp for connection when their brain's internal systems have failed. Crisis happens when stress and tension exceed their ability to cope in critical situations [6]. This person has demonstrated incredible courage reaching out for help, and I am ready to provide support.  

From the moment I received their message, my own brain began to mount a neurological response. The practice and repetition of having been exposed to hundreds of messages like this one strengthened neural pathway in my temporal cortex, associating phrases like "end everything" and "can't deal" to specific response protocols [7]. Training taught me to handle crises in a specific order, called “ladder assessment,” first identifying the risks the texter faces, then evaluating them and implementing strategies. I learned to respond, not react.

My analyses of the situation and plan for response starts: threat level, urgency, intervention needed, and suicidal ideation. 

Meanwhile, in my cortex and anterior insula, areas associated with processing emotional pain, empathy, cognitive control, and fear, my mirror neurons begin to fire [8].This activation of my mirror neuron system is why I feel an echo of their distress. Here we have two brains: both stressed, with completely different realities. One is in survival mode, with executive functions offline, the other in response mode, with executive functions on high alert. Ready, I type my reply.

Section 2: Weathering the Storm Together

“Hi, my name is Sadie. I can hear how much pain you are in right now, and it's brave that you reached out.” I press send, and the crisis begins to be addressed as our conversation unfolds. Reading these words activates the left inferior occipital cortex (the region of the brain responsible for visual processing) and left lateralized activation of the texter [9]. Reading these words activates the left inferior occipital cortex and left lateralized activation of the texter [9]. Communicating through texts also provides the texter the privilege of privacy and anonymity. Meanwhile, the empathy and social support from strangers can activate neural circuits similar to those engaged by close relationships, while minimizing activation in areas linked to social evaluation or self-consciousness [10]. The dorsomedial PFC, a region involved in social evaluation and self-referential processing (how humans encode information to themselves), exhibits reduced activation during anonymous disclosure, enabling individuals to be more honest and open when expressing distress. Behind a screen, texters in crisis do not need to be concerned about worried looks on their family’s faces or judgment from a friend [11].

The Crisis Text Line represents an evidence-based approach to crisis intervention that addresses three key needs: immediate access to help, reduced barriers to reaching out, and consistent protocol-driven support [12]. Text-based platforms work particularly well during crises because they bypass a neurobiological challenge: when someone's brain is already overwhelmed, the demands of a phone conversation can feel impossible [12]. The last thing an already overwhelmed person needs is more external stimuli.

Three minutes later, I get a reply: "Nobody understands. I think everyone would be better off without me."

Following Crisis Text Line's protocol, I move through the stages: building rapport, exploring the crisis, identifying goals, and discovering the next steps with which to proceed.

“Thank you for reaching out and sharing this. What's making tonight feel so unbearable?”

The texter opens up, telling me about what led to her breaking point. She feels bad for leaving her daughter and escaping from an abusive husband, but her stress-impaired state cannot see a solution.

"It sounds like you've been holding so much on your own. I'm here with you right now.”

When I ask for details about their family dynamic and current situation, they seem exasperated and exhausted. 

"I don't actually want to die. I just want the mess to stop." 

I help to find local resources, like women shelters and crisis programs and encourage her to speak to a social worker. She pause before replying.

“Thank you, I will reach out first thing tomorrow.” 

The turning point comes forty-two minutes into our conversation, when a sense of hopefulness finally emerges from the texter’s words. 

What is happening in this conversation does not only stay with us tonight. The hippocampus, the brain's memory-forming center, is encoding tonight's conversation as proof that help exists, pain can be shared, survival is possible. The encoding process creates a concrete neurological change, not just abstract hope. When they reached out for help and received supportive, non-judgmental responses, their brain encoded a new association: Crisis + reaching out = connection and relief, rather than Crisis + reaching out = rejection (Kleim and Jones, 2008). Every interaction creates a new neural pathway through a process called experience-dependent neuroplasticity, becoming part of our memories; while these associations are strengthened through repetition, as the texter experiences more help and acceptance, these pathways will strengthen and be easier to access next time a crisis comes. They will be more likely to reach out again instead of spiraling into despair [13]. However, there are limitations from what our chat can do: it cannot modify neural pathways and instantly fix symptoms of underlying conditions, like depression.

Section 3: Recovery

By 3:50 am, something has shifted. I can sense it in the faster rhythm of their responses. I am feeling not just a change in their mood but also in my own neurological state. The texter’s nervous system is undergoing a fundamental shift, from being on edge with the sympathetic nervous system in control (SNS) to the parasympathetic nervous system (PNS) taking the wheel; this is a shift from survival mode to a calm state. The PNS is the branch of the autonomic nervous system that activates in safe and relaxed conditions and is responsible for calming the body down. The PNS sends signals to the body via the vagus nerve, a cranial nerve that regulates heart rate, breathing, and digestive function. Its effects are observable in an increase in heart rate variability (the rhythm between heartbeats), as the body returns to a relaxed state. The PNS forms a bidirectional feedback loop between the body and the brain [14], allowing the PFC to return to normal function. Diminishing cortisol levels allow glutamatergic neurons, specialized neurons in the brain and periphery that use glutamate as a neurotransmitter to send excitatory signals, return to regulatory functioning levels. As the body regains homeostasis, this emission of glutamatergic neurons help restore normal function in the dorsolateral and ventromedial areas, two areas of the brain involved with working memory, learning, and emotional regulation [15]. 

Rational thinking does not suddenly turn on or off like a switch; it is a slower process where neural connectivity restores itself. As the body and brain are reaching their normal state of function, the prefrontal cortex can begin the process of "top-down control" over the amygdala, calming the person in crisis. This happens through inhibitory signals, especially from neurons that release GABA, an inhibitory neurotransmitter that decreases the amygdala's fear response [15]. These biological processes lead to clearer thinking and ability to consider options beyond this present moment.

Now that they have left the dark abyss, we can work on creating a safety plan. Concrete planning engages the executive functions, specifically the regions of the brain involved in prospective memory, which helps individuals remember to perform intended actions in the future and exhibit goal-directed behavior [16]. With each detailed step we outline (I will reach out to my daughter and my mom in the morning, I will contact a social-worker, I can use this hotline if needed) the texter’s rostral prefrontal cortex, an area crucial for maintaining intentions and planning future actions, is activated [17]. The texter now has a new framework and the tools to use in the future.

"Thank you so much for talking with me tonight. I actually think today will be okay, and feel more secure about the future." I smile as I read their final message for the night.

Relief floods my system; this is a surge of dopamine in my ventral tegmental area and nucleus accumbens, the brain's reward circuitry [15]. Despite the relief, I am still alert, as my anterior cingulate cortex, which handles attention, allocation, and decision-making, monitors for potential errors or dangers [18]. This keeps me focused, and we spend another twenty minutes reinforcing their safety plan, identifying warning signs, and connecting them to available resources [19].

What happens after the conversation is important for the texter to create a mental framework, with a model to employ lasting changes. This one-time evening exchange becomes part of the texter’s memory system, being stored in the hippocampus, which organizes and strengthens memories as we sleep. Over the next few nights, their brain will replay and consolidate this event, linking it with emotional meaning. Their amygdala will mark this event as significant: I reached out, and it helped [20]. This emotional tagging means the memory will not fade. This is a new reference point, a reminder that reaching out was a brave step that brought relief, not rejection.

Following intensely emotional situations, resilience forms in the brain as it learns to respond to pain differently. Each time someone feels relieved after a crisis is successfully overcome, certain neural pathways get stronger. The connections between the amygdala and prefrontal cortex become more efficient at regulating emotion, the pathway from distress to help-seeking behavior becomes more established. In neuroscience, this is called Hebbian plasticity, the principle that neurons that fire together, wire together [21]. Every time the texter finds themselves in a crisis, their brain will remind them of the new sequence they just learned: crisis → reach out → connection → relief. Tonight’s conversation pulled the texter’s brain out of the neurological tempest it was in. The next time they are in a crisis, neuroplasticity will remind the texter that the waves of despair did not bring them under; they are strong.

Every conversation with a texter in crisis makes me better equipped to help, as I too, am becoming more resilient. Repeated crisis work induces neuroplastic changes in several systems, refining my mirror neuron network and making me better at detecting emotional cues while maintaining boundaries. My ventromedial prefrontal cortex, involved in emotion regulation and empathy, shows structural changes with repeated empathic engagement [22]. Every time I help someone in a crisis, neuroplasticity makes these emotionally intense chats leave me not just with a feeling of fulfillment, but my brain with lasting neurological changes.

I sigh with relief and fatigue as I close my laptop. Such high-pressure situations show me the value of studying neuroscience. Understanding the innergoings of a brain in crisis allows me to better find solutions, in a more efficient way. Mental health crises are not mysterious emotional breakdowns. They are predictable neurological events that respond to specific, science-based interventions. Tonight, the texter’s nervous system found temporary balance through words, showing me the power that understanding neuroscience brings to helping and handling crises. 

I glance at the clock with heavy eyelids: it is 4:23 in the morning. I head to bed, relieved the texter is safe and will sleep securely, with hope. I will too, knowing that I helped them get through the despair and knowing tomorrow will be easier for them to handle. The ripple effects of crisis support will remain with the texter, making them more open to reaching out for help in the future. As dawn begins to break outside my window, I fall asleep knowing that conversation will stay with them, quietly reshaping how they face the next crisis.

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