It’s been over five months since S-Town, the Serial podcast series, was first released. It captivated so many listeners with its compelling story about a bright, unique, complicated man named John McLemore. Even though the major media hype about the show has kind of passed, I chose to write about S-Town in honor of World Suicide Prevention Day. My goals are to highlight some of the main risk factors featured in S-Town, to place them in the context of related empirical research, and to increase awareness about suicide prevention resources. If you want to avoid spoilers for S-Town, please stop here, go listen to it in rapid succession, and then come back in 7+ hours to read the rest.

As a bit of background information, I listened to all of S-Town in two or three days. The first time I listened to it was all about being absorbed in John’s story – experiencing all of the painful aspects, struggling with mixed feelings as complexities were revealed, and fitting puzzle pieces together. I walked away from it for a few days to process my emotions and thoughts about it all. Then, I listened to it a second time through the lens of a suicide prevention researcher and identified risk factors that I think may have contributed to John’s tragic death. My understanding of John is limited by what the folks at S-Town chose to include in their framing of his story in their seven episodes. In addition, I am attempting to extract general suicide risk factors from one person’s story (as best as I can I know it) and that necessarily involves speculation. With those limitations in mind, I have listed some of the risk factors below:

Demographic variables. John’s age (49), race (White), and sex (male) placed him in the highest risk group for suicide in 2015, the year that he died. Alabama has a suicide rate that is somewhat higher (15.1/100,000) than the national average (13.8/100,000). John also told Brian Reed that his sexual orientation was “semi-homosexual” and suggested that he was secretive about it to avoid discrimination. Research with lesbian, gay, and bisexual youth suggests that they have higher suicide attempt rates than their heterosexual peers, and that this is linked to more frequent exposure to stressful experiences (e.g., stigma, being threatened with violence, institutional discrimination). These stressors may have been particularly prevalent where John lived. As a reflection of the local attitudes, S-Town points out that the county that John lived in refused to issue same-sex marriage licenses following the Supreme Court decision to legalize same-sex marriage nationwide. Importantly, there is evidence that less discriminatory state law is associated with fewer suicide attempts.

Mood disturbance. John told Brian, “I guess if I sound like I’m disinterested today, it’s firstly because I’m tired and wore-ass out. And secondly because, you know, I just—I’m not the most cheerful person. You know, I spend most spare time now either studying energy or climate change, and it’s not looking good. So yes, sometimes it’s hard for me to get focused back on something when the whole goddamned Arctic summer sea ice is going to be gone by 2017. And we’re fixing to have heat waves in Siberia this year, and sometimes I feel like a total idiot because I’m worried about a goddamn crackhead out here in fucking Shittown, Alabama. So yeah, that’s just a personality disorder of mine. You know, sometimes when you call me, I’m kind of in an upbeat mood. And sometimes, like today, you caught me in one of these tired, somber, you know, reflective moods, where I’ve been, you know, sitting there mulling over climate change for about the past 10 damned hours.”  That quote is characteristic of many of John’s quotes with similar themes throughout the series. Relatedly, Brian makes an observation about John in the first episode, “No positive comment, no matter how innocuous, survives his virtuosic negativity.” However, John’s long-time friends later tell Brian that John used to be “idealistic” and joyously participated in community events (e.g., the Christmas parade). Per their report, he had not become consistently irritable and dysphoric until closer to his death.

While it appeared that John had long struggled with untreated mood problems (with the exception of brief treatment for depression in college), the series posited that his condition deteriorated markedly over time due to mercury exposure. Brian presents compelling evidence that John may have been experiencing “mad hatter syndrome” and it is presented as a primary factor in his suicide. John knew the dangers of mercury exposure, but chose to continue working with it without safety precautions. It is unclear if this choice was due to a devotion for utilizing what he viewed as the best approach to fix antique clocks, if it was some kind of neglectful, self-destructive behavior related to his mood problems, or both.

While mercury exposure in itself is rare in modern times, mood disturbances and mood disorders (regardless of cause) generally increase the risk for suicidal thoughts and behaviors. Therefore, it’s of the utmost importance to seek evidence-based treatments to effectively combat mental health problems, prevent suicide, and to improve quality of life.

Loneliness. John also told Brian, “But I think the thing that’s happened is I’ve gotten myself in an almost prison of my own making, where all my friends have died off. Because I only had contact with people much older than me. Even when I was a kid in school, I didn’t want to hang around other kids. Because kids are talking about getting girls, or deer hunting, or football. Whereas I was interested in the astrolabe, sundials, projective geometry, new age music, climate change, and how to solve Rubik’s cube.” This quote and others like it (including John discussing his romantic hardships) suggest that John felt he was alone, which is a major risk factor for suicide. One of many surprising turns in S-Town occurs when Brian learned that John actually had a number of people that cared about him. He also had a solid group of friends that he spoke to on a fairly regular basis. John was arguably closest to Tyler at the end of his life and apparently begged him to not leave him alone on the night that he ended his life. This happened right after they had spent the whole day together affirming how much they meant to one another. This speaks to a key, painful point about suicide – feeling disconnected from others leads people to want to end their life EVEN if they actually are loved by many people.

Hopelessness. John blamed himself for his misery and attributed it to never leaving Woodstock, Alabama (i.e., S-Town). He expressed insight when he told Brian, “I need to get out of my depression. I need to get over this attitude problem I’ve got, that nothing can be done.” In the last decade of John’s life, he faced multiple stressors that could have contributed to his sense of hopelessness: his dad died, he had a falling out with a close friend, he was heartbroken when the man he loved stopped returning his calls, and he was caring for his aging mother. He also seemed to suffer from a broader sense of hopelessness about the injustices of the world related to climate change, the legal system, and a variety of other issues. He expressed a particular pain in feeling like he was the only one so upset about it all. The combination of pain and hopelessness are particularly linked to suicidal desire. Finding ways to build real hope (e.g., through connecting a person to a mental health professional) can be important for decreasing suicide risk.

Plans and preparations for suicide. Most of John’s friends knew that he planned on killing himself at some point. He spoke of his suicide plans matter-of-factly, kept a lengthy suicide note on his computer, left a list of people to contact after his death, and had access to lethal means for suicide. John’s resolved plans and preparation were particularly dangerous in light of his apparent fearlessness about suicide. Many more people consider suicide than ever attempt or die by suicide, in part, because of a survival instinct that protects people from acting on suicidal thoughts. Under these circumstances, one powerful suicide prevention action is to remove their access to lethal means (e.g., store their gun, pills, or other possible means safely).

Nonsuicidal self-injury.  Toward the end of S-Town, we discover that John went from despising tattoos and piercings to asking Tyler to regularly tattoo and pierce him. Eventually, John was covered in tattoos and would ask Tyler to pierce and re-pierce him and even use the tattoo needle on him without any ink. Tyler told Brian that he thought it was John’s version of cutting, with the purpose of distracting from emotional pain with physical pain. In my opinion, based on the information available, it sounded like a form of nonsuicidal self-injury. Tattoos and piercings are not typically considered nonsuicidal self-injury because they are culturally sanctioned, but the way that John experienced them was atypical and extreme. Nonsuicidal self-injury is associated with higher suicide risk, and this connection is thought to be, at least in part, due to the experience of nonsuicidal self-injury increasing an individual’s pain tolerance while reducing fear about self-inflicted harm.

In the interest of keeping this post relatively brief, I focused on what I view as some of the major risk factors for suicide present in S-Town. There is so much more to John’s story. One of the most moving and painful components of S-Town was hearing John’s loved ones struggle with his death. Many of them experienced self-blame, regret, and wondered if they could have done anything else to prevent it – all feelings that are common for people who have lost someone to suicide.

I thank you for taking the time to read this post. Below are some suicide prevention resources that I hope you find useful:

-The American Association of Suicidology website has a list of warning signs.

-The National Suicide Prevention lifeline has contact information for people in crisis.

-The American Foundation for Suicide Prevention has tips for helping someone who is at risk for suicide.