Ask Me Anything About Suicide

Note: Even though World Suicide Prevention Day is over, I’ll keep answering questions that are sent to me on this post.

For World Suicide Prevention Day, I tweeted that people could ask me anything about suicide. Thanks to everyone who already sent me questions – they’re really good ones! If you want to submit a question, tweet it to me (@DrKathrynGordon) or e-mail it to me (kathrynhgordon@gmail.com).

If you’re in crisis, please contact the National Suicide Prevention Lifeline or the Crisis Text Line. The responses below are my opinions and should not to be taken as professional advice. More suicide prevention information and resources are available here.

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Added September 11, 2019

Anonymous asked: What criteria do mental health professionals use when deciding whether someone should be admitted to a hospital involuntarily for suicide risk?

Laws vary by location, and the criteria depend on the particular mental health professional, client, and situation. The typical criteria for involuntary hospitalization is that the person is at imminent or immediate risk for suicide. The field has a lot of work to do to get better at predicting when someone is at immediate risk for suicide (e.g., see Franklin, Ribeiro, et al., 2016). Some factors that therapists tend to view as indicative of immediate risk for suicide include (e.g., see Chu et al., 2015):

  • a clear, resolved plan and/or preparations made for suicide, intent to act on the plan, and access to lethal means (or plans to acquire lethal means)
  • multiple past suicide attempts (especially if recent)
  • the therapist and patient cannot create an alternative plan for safety (e.g., staying with a friend, temporarily storing lethal means elsewhere, identifying ways of coping with emotional pain that don’t involve suicide)

The mental health professionals who I have interacted with over the years tend to be eager to find alternatives to involuntary hospitalization. They seek to respectfully and collaboratively create a safety plan with their clients. However, I know from listening to other people’s stories that it’s not always the case. For example, Rudy Caseres is a mental health advocate who has spoken and written about these issues, and I recommend checking out his website here.

Published September 10, 2019

@ToWit12 asked: Let’s go worst-case scenario, where I encounter someone already with a gun to their head or about to jump off a bridge. What is the right (or rather, least wrong) thing to say/do?

Most people in that kind of emergency situation are experiencing pain, loneliness, and hopelessness. Individual situations vary quite a bit, but this would be my default:

I’d ask them to put the gun away or step away from the bridge, so we can talk (to increase safety). I’d talk to them in as calm and warm of a tone as possible. I wouldn’t endanger myself in this process, say they’re bluffing, or ignore them. I’d call for help if I could (911). I’d tell them I care about them, and that I’m there to listen and not to judge them. If I had struggled in my life, I’d let them know that (to increase a sense of connection). I’d commit to helping them find resources for addressing their problems (to increase hope).

For more on this topic, I recommend listening to this Story Corps segment about a police officer (Kevin Briggs) who helped a man (Kevin Berthia) who was about to jump off of the Golden Gate Bridge. It’s also worth watching Kevin Berthia’s TEDx Talk, The Impact of Listening and listening to this NPR segment, Mental Health Cops Help Reweave Social Safety Net in San Antonio for their approaches in mental health crises.

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Anonymous asked: I developed PTSD in the course of supporting a suicidal friend. Now other people’s suicidality is triggering to me, and I expect it to be that way for a while. I want to support friends who need it, but I want to support them at arm’s length. I’m in no position to be in the front lines of anyone’s mental health support team. This has been a problem: having gone to bat for one suicidal friend, I seem to be socially marked now as a person who will be supportive, even among people who are intellectually aware that it traumatized me. I’ve been somewhat beset by men, in particular, who demand that I provide womanly sympathetic listening without regard for my own mental health. Dealing with this gently while managing my PTSD symptoms is challenging.

World Suicide Prevention Day is coming up and I dread it. This is the kind of season in which I’m approached directly for mental health support that I’m not in a position to give.

I want to set very firm boundaries about how much mental health support I’m willing to do, preferably without hurting or antagonizing extremely sensitive people or getting into any arguments about whether I’m an ableist who’s contributing to stigma. How do I do that?

First of all, I’m very sorry that you had to go through such a painful experience. I hope that you have been able to find effective treatment for your PTSD.

Secondly, in my work as a therapist, I’ve heard a useful analogy used about helping others. When you’re on an airplane next to a child, they tell you that you need to put on your own oxygen mask in an emergency situation before assisting the child. If you don’t, you could suffocate while trying to put the mask on the child, and then neither of you will survive.

Right now, it sounds like putting on your own oxygen mask first means not being available to others in suicidal crises. I would say something like this, “I see that you’re in a lot of pain, and I really feel for you. I can’t be the one to support you right now. I’m struggling too, and to be well, I really need to focus on working through that first. If you can’t think of anyone else to talk to, you can always contact the National Suicide Prevention Lifeline. I hope you find the support that you need.”

My hope is that most people would respond to that in a positive, understanding way. However, if they perceive your response as ableist, stigmatizing, or anything else like that — it’s important to stick with your boundaries anyway (repeating what you said, if necessary). We can’t control what other people think of us, but we can do our best to live according to our values and strive to be okay with our own decisions. Your mental health matters, and good friends should support your decisions to take care of it.

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Zach Clement asked: How can I support a friend who is considering suicide while keeping myself emotionally healthy, and how do I disengage with them when my relationship with them becomes unhealthy for me?

I recently was trying to give support to someone because I knew they were having a hard time, and they had said that they thought about killing themself. However, as time went on, they started attacking me and my relationships with others. I realized that my only reason for talking to them was that I knew I would feel guilty if I didn’t. Eventually, I told them that I wouldn’t talk to them anymore if they continued to attack the things that I valued, and they didn’t stop, so I told them I would just ignore them. I offered to help them find a therapist when I cut things off with them, but I still sometimes feel like I should have done something differently.

This is a really tough situation, and I don’t think these potentially complicating factors are included enough in public discussions of suicide. It sounds like you told the person how they were affecting you and gave them chances to apologize and change their behavior. Unfortunately, the person didn’t. A natural consequence of someone attacking you and your relationships with others is that you’re going to want to distance yourself from that person. And no amount of the other person’s pain gives them a right to be abusive toward you.

Honestly, I think I would have done the same thing that you did. I’d tell them that I couldn’t keep being around them if they treated me like that, but that I wanted to help them get connected with a therapist. The fact that you offered that was very kind and above and beyond what most people would do. I might give them some additional information like the National Suicide Prevention Lifeline. If I knew someone else close to them – and it fit with the situation – I would mention that the person brought up suicide before and that you’re concerned.

I’d probably feel a bit unsettled about the situation, because I’d worry if the person hurt themselves I’d feel responsible. From my perspective though, you can’t allow someone to treat you like that repeatedly because you feel guilty. It sends the message to the person that it’s okay for you to be treated that way or that it’s okay for you to suffer because they are. So, then I’d try to cultivate some acceptance about the limits of what I can do for the person. It sounds like you made a healthy and correct decision for yourself. I hope the person pursues professional help and that you feel at peace with the way you handled it.

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Tyler Pritchard asked: Who are your top 3 influences in suicidology research and/or practice?

  1. Without a doubt, the most influential person in my scientific and clinical work is Thomas Joiner. He was my research mentor during undergraduate and graduate school. Thomas also directed my graduate program’s training clinic and played a huge role in my development as a therapist. His compassion, intellectual curiosity, and direct approach are all qualities I admire and strive to bring into my work.
  2. Marsha Linehan created a therapy for people who were traditionally excluded from clinical trials (e.g., high suicide risk, multiple mental health issues) with an empathic, skills-based approach. Her courage, irreverence, and dedication to helping people build lives worth living inspires me.
  3. It’s hard to pick the third person, so I’ll say my former grad school labmates as a group (e.g., Kim Van Orden, Tracy Witte, Jill Holm-Denoma, April Smith, Ted Bender, and Mike Anestis). They’re brilliant scientists and clinicians and also exceptionally kind people. Conversations with them over the years have helped me to understand suicidology at a much deeper level than I would without their friendship and collaboration.

Even though I already exceeded the 3 with that last one, I’ll also mention David Klonsky. The way he thinks about science and his 3-step theory of suicide have influenced me a lot too.

There are a bunch of others that come to mind, but you didn’t ask for my top 300, so I’ll stop here. 🙂

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Mike Heady asked: I’m not sure you have an answer for this but here it goes. I’m looking for data on how many people present or are admitted to hospitals for suicide risk when in fact the person is having intrusive self-harm OCD.

Unfortunately, I didn’t have any luck finding data on this either. This is a great question though, and I want to discuss the meaning of it for any interested readers out there.

Obsessive-compulsive disorder (OCD) often includes unwanted, distressing images or thoughts (referred to as intrusive thoughts). Sometimes, these thoughts are about contamination with germs, hurting others, or hurting oneself. You can see what this looks like in this video of an adolescent being treated for self-harm OCD symptoms.

Many people — even those without OCD — have experienced a self-harm image or thought come into their mind, even when they are not suicidal. For example, Hames et al. (2012) asked a college student sample (n = 431) if they ever had an urge to jump when in a high place. They found that it was fairly common, including among participants with no history of suicidal ideation (see the table below).

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For some individuals with OCD, their thoughts about self-harm are alarming, distressing, and feel like no part of what they would actually want to act on. They are not typically at high risk for suicide, because they usually try to decrease their anxiety about intrusive thoughts by taking extra safety measures (e.g., not handling knives). They’ll say that the thoughts are disturbing because they really do not want to die.

For other individuals with OCD, they may be struggling with their symptoms and considering suicide, because they believe it would be an escape from their pain. This type of situation is more worrisome.

Clinically, I’d look at the context of their suicidal thoughts to make my best judgment about their risk and whether hospital admission is appropriate. The presence of any of the following would put them at higher risk for suicide: a lack of distress or even a sense of comfort when thinking about self-harm, a history of self-harm or other suicidal behavior, a suicide plan and lack of fear about carrying it out, access to lethal means (e.g., an unsafely stored firearm), sleep disturbance, agitation, social withdrawal, severe mood disturbance, or significant weight loss.

For more information, check out this blog post: When People with OCD Fear Harming Themselves.

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Anonymous asked: Suicide is a concept I am ambiguous about. When I am distressed over something after a day, or when I feel I don’t belong in society or I will never be able to function normally like other people would, I feel or think that suicide is an escape route. Like, if all else fails and pain is too unbearable to take, I could choose it. That way, I would get rid of all the things that are troubling me. 

Or sometimes, I think that I am not courageous enough to pull the last act for suicide. When I brought this up during one of our sessions with my therapist, she told me that suicide is not about being courageous it is about cowardice.

So, my question is,

1 Is suicide about courage or cowardice? Does it take courage to commit suicide or does it means cowardice? Well, of course if doesn’t have to be one of those, but saying it’s cowardice feels like it’s underestimating the pain underneath. What do you think how should we look at this?

2 What do you think about the existence of the idea of suicide lingering in your head as an escape route as a comforting idea? Is it healthy, if not what can I put in its place?

1. Suicide is not an act of cowardice. Though there are different pathways to suicide, most people get there because they see no other way to escape excruciating emotional pain. They often mistakenly believe that they are doing others a favor by not living any more. Even very brave people are vulnerable to, and die by, suicide when afflicted by this pain. It’s not a sign of weakness (more about this on an NPR segment, Deconstructing Myths about Suicide).

In terms of courage – that’s not the word that I tend to use, because of it’s kind of value-laden. I prefer to describe to the ability to die by suicide as others have: capacity, capability, or fearlessness (about the pain and injury involved in suicide). For someone to kill themselves, they have to override a very strong human survival instinct. That drive to live is protective and life-saving for many people. Tragically, people who die by suicide break through that.

So, I don’t think suicide is an act of cowardice or courage in the vast majority of cases. It is an outcome that occurs when people are intensely hurting and don’t see another way out. Suicides hurt those who are left behind, even if that is not what the person intended to do. In the eyes of the bereaved, I would be surprised if they see either cowardice or courage in the situation — just heartbreak.

2. I have spoken with people personally and professionally who think about suicide to decrease painful emotions. If you’re interested, there’s some research on it in this paper called Daydreaming about Death: Violent Daydreaming as a Form of Emotion Dysregulation in Suicidality.

First, I want to say that there’s nothing to be ashamed of and that you’re not alone in doing that. It’s valid to want to decrease your emotional pain. However, I do suggest that people find other strategies for feeling better. My concern is that fantasizing about death might increase suicide risk. It could potentially reduce the protective fear that surrounds suicide and strengthen the links between positive feelings and death.

In terms of what to put in its place, you could try to imagine feeling better and that your problem is solved. If that doesn’t feel authentic or practical for you, I recommend finding ways to remind yourself of your ability to cope from past situations, that you can take things one day at a time, and that you find other ways of dealing with distress. For example, there are some ways listed in this post here that include distraction and finding emotional uplifts (e.g., watching comedy, intense exercise, seeking social support, etc.). If it’s relaxation that you are looking for, this website has some nice audio recording options that are worth trying instead. I hope you find some of these other approaches helpful and comforting.

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Coral More asked: Do you see another model than assess & refer to 911/hospital given what we know about trauma resulting from police encounters and hospitalizations/emergency rooms? I know it’s a very tricky one but I never see folks talking about it.

I’ve been on both sides of this, feeling the need to call emergency services but also voluntarily presenting to the emergency room and being absolutely traumatized by the dehumanization and cruelty there.

I personally have recommended calling 911/the hospital in certain (though very few) situations where other options were exhausted and there’s urgency. These include situations where: 1) the person already hurt themselves or 2) they’re at immediate risk of self-harm. This pathway can be lifesaving, appropriate, and beneficial (though experiences vary a lot, as you said above — people can also have horrible, terrifying experiences that are detrimental to their well-being).

There are many, many more situations where I have collaboratively worked with someone to find an alternative suicide prevention approach. My default is to collaboratively create a safety and coping plan. This includes reducing access to lethal means, identifying supportive people (I often try to call at least one friend or relative with the consent of the patient, and this tends to go well), and listing methods for reducing emotional pain (e.g., emotion regulation skills, crisis survival strategies for distress tolerance). In addition, I provide them with emergency numbers, and we identify when they would need to go to the hospital or call 911 (e.g., if their suicidal thoughts escalate to suicide planning or preparation).

Part of the discussion also includes ways to intensify treatment without using the hospitalization or emergency services route. For example, increasing the frequency of therapy sessions or attending a partial hospitalization program (where people go in for treatment during the day, but sleep at home).

This article is good for looking at suicide risk as a continuum with a variety of interventions that correspond with severity: Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update.

I like what Marsha Linehan says in this video about hospitalization (keeping a person alive through constant monitoring) versus taking a risk by not always hospitalizing at any threat of suicide, so they can have a chance at building a life worth living.

I also recommend listening to Rudy Caseres, a mental health advocate, speak about his views and experiences with hospitalization in this interview.

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Suicide is Not Reducible to Simple Explanations

It is unlikely that any one theory can explain phenomena as varied and complicated as human self-destructive acts. At the least, suicide involves an individual’s tortured and tunneled logic in a state of intolerable, inner-felt, idiosyncratically-defined anguish. 

-Edwin Shneidman, founder of contemporary suicidology

When criticizing aspects of society, some people amplify their arguments by saying that those aspects cause suicide. Typically, the claim goes something like this, “____ is so bad that it leads people to kill themselves. Therefore, it’s urgent that we stop ____.” You should be skeptical when you hear these kinds of claims, because suicide is not reducible to simple explanations. It hurts to think about people grieving a suicide loss and then hearing that there was a simple fix all along. This is especially painful when there is little or no evidence that ____ substantially increases suicide risk. Additionally, if an empirically-weak claim receives enough public attention, limited suicide prevention resources can be squandered in the wrong places.

How to Evaluate Causal Claims about Suicide

Suicide is complex, and it’s extremely challenging to conduct research that yields results with causal implications. The closest we have to experiments may be randomized controlled trials designed to reduce suicidality. Keeping in mind that the majority of suicide research is correlational, here’s one set of criteria that you can use to evaluate whether ____ causes suicide.

1) temporal precedence: If ____ causes suicide, ____ must occur before the suicide (or a societal change must precede changes in suicide rates). Non-experimental research can speak to this criterion through longitudinal studies or other examinations of suicide rate data over time. However, it’s important to look at long-term trends rather than capitalizing on specific time points with fluctuations that are consistent with the claim.

2) covariation: If ____ causes suicide, then changes in ____ must accompany changes in suicide rates. I often see partial demonstrations where someone will say, “Here are higher suicide rates coinciding with more of ____,” but then leave out the necessary counterpart of establishing correlation: less of ____ should also be associated with lower suicide rates. Both are required to meet this criterion, and you don’t need experimental studies if you examine it through naturally-occurring differences. For example:

-Looking at World Health Organization suicide data, do countries with more of ____ have higher suicide rates than countries with less of ____?

-Do demographic groups who experience more of ____ have higher suicide rates than groups with less of ____ over the same time period?

If the answer is “no,” then the covariation criterion has not been met.

3) nonspuriousness: If ____ causes suicide, then the relationship must persist even after ruling out alternative explanations. This criterion is arguably the most difficult to prove without experimental studies, but there are some correlational data that you’d expect to see if the claim is true. Questions to ask of such claims include:

-What else increased aside from ____ during the time period of increased suicide rates? Is there research linking those other factors to suicide, and could that better explain the observed pattern?

-Do people experiencing more of ____ also experience more of something else empirically-linked to suicide that could better explain the observed pattern?

Here‘s a strong example of someone evaluating an alternative explanation for an observed pattern using correlational data on a completely different topic (specifically, the part on self-censorship).

I wrote this post to share a framework for evaluating causal claims that I learned in grad school, and I hope that you find it useful. Even if it’s completely unintentional, when people use unsubstantiated claims about suicide to magnify societal concerns, it can feel exploitative of a group of people I care deeply about. Fortunately, this is outweighed by incredible, compassionate work reflecting the complexities and multiple pathways to suicide. I’ll link to some of my favorites below:

American Association of Suicidology

The Best Way to Save People from Suicide

The Interpersonal Theory of Suicide

Live Through This

Suicide Prevention Social Media Chat

The Three-Step Theory

We Tell Suicidal People to ‘Get Help.’ But What Happens When They Do?

Thank you for reading! Here’s a post with more information and resources about preventing suicide.

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Suicide Prevention Information & Resources

This week involved a lot of heartbreaking suicide-related news. We tragically lost Kate Spade and Anthony Bourdain to suicide. We also learned that U.S. suicide rates increased substantially over the past several years. If you want to learn and do more to prevent suicide, I want to help you out by linking to some good sources. I hope you find them useful.

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If you need help:

National Suicide Prevention Lifeline

Trans Lifeline

The Trevor Project (for LGTBQ+ youth)

Veterans Crisis Line

Find a Therapist

Find a Support Group for People Who Have Lost Someone to Suicide

Listen to a Hopeful Music Playlist Made by College Students

Research-Supported Treatments for Adults

Research-Supported Treatments for Children

Feeling Good: The New Mood Therapy by David Burns

How to help others:

Warning Signs

How to Help Someone Who is Suicidal

Take a Mental Health First Aid Training Course

Get involved:

Call Your Representatives and Tell Them to Prioritize Policies linked to Suicide Prevention (e.g., access to quality healthcare, funding for research)

Participate in an Out of Darkness Community Walk

For information:

Suicide Statistics

Suicide Prevention Social Media Chat

Live Through This Photo Project

Wil Wheaton Essay about Mental Health

Rudy Caseres, Mental Health Advocate

Robert Vore, Mental Health Advocate

It Gets Better Project

Why People Die by Suicide by Thomas Joiner

Myths about Suicide by Thomas Joiner

Guns and Suicide by Michael Anestis

Cracked Not Broken by Kevin Hines

Speaking of Suicide by Stacey Freedenthal

Brother Ali’s Song about Losing His Dad to Suicide

I’ve seen Minneapolis-based rapper Brother Ali in concert several times, and he strikes me as someone who’s as kind as he is talented. When I told him at a Chicago show that I had previously chatted with him in Orlando, he tried to remember me. He told me that he doesn’t recall faces due to albinism-related vision issues, but he recognizes people through reminders of previous conversations. He rapped about his experiences in “Us”: And I go with the feeling from the start/Blind in the eye, so I see you with my heart/And to me all y’all look exactly the same/Fear, faith, compassion and pain.

All of this is to say that I’m a Brother Ali fan and my expectations were high for his 2017 album, All The Beauty In This Whole Life. I think it’s a musical masterpiece, and “Out of Here” is a standout song. The lyrics are a detailed expression of his feelings and thoughts after losing his dad to suicide. In this post, I included all of his lyrics (in bold) and my comments (in italics) with some links to relevant research.

I recommend watching his performance of the song before reading the rest of the post:

Okay so it might appear
To an outsider that you found your way up out of here
They’re saying you died of suicide
People who are suffering may view suicide as an escape from a painful life. I like how Ali phrases the third line, because it removes the stigma associated with other phrasing (e.g., commits suicide).
That’s the last thing I want to hear
They tell me that it’s hardly fair to blame myself
What a hell of a cross to bare
You didn’t say it in your letter
But the fact that I failed you is loud and clear
Suicide can be a particularly painful kind of death to grieve because 1) it means someone you love was deeply hurting and 2) there may be more of a sense that you could have prevented it, if only you had acted differently in some way. It’s a common response for people to tell you that someone’s suicide is not your fault, and yet, it can be hard to refrain from blaming yourself for not stopping the person.
Found out the amount of fear
You would drown when you found yourself naked staring down a mirror
And partners are supposed to lay the cards bare
I left you playing solitaire, and I promise you that I’m sincere
When someone dies by suicide, it might feel like there was a misunderstanding or even a kind of dishonesty between you if you didn’t know the person was contemplating suicide. I think Ali is saying that his dad might have been trying to tell him how he felt (‘lay the cards bare’), but that Ali felt like he failed him by leaving him ‘playing solitaire.’ Powerful imagery.
If you’re looking for some judgment, you won’t find it here
Let’s be honest here
I can’t say I’ve never known that kind of despair
When the clouds appear, how’s life fair
Some people erroneously perceive people who die by suicide as selfish or weak. However, Ali feels compassion and humbly links it to his own experiences. He may also be fearful about his own future (e.g., will his suicidal desire increase to the levels that his dad’s ultimately did?).
I just want to draw you near
As he sorts through the different feelings, there’s a basic desire just to be close to his dad again.
Not to make it about me, but how could you check out
Before you really allowed me a chance to sit down and hear?
I think I would’ve listened
Or were you saying it all along and I just missed it?
You sang your swan song, we all dismissed it
Ali acknowledges that the suicide isn’t about him, but feels a frustration about his father leaving without trying to ask Ali for help first. He then changes course and tries to look for signs that his dad *tried* to reach out, but that Ali missed or ignored it.
Because you filled the room with laughter
I watched when you thought no one was looking at you
In hindsight, I wonder where your smile went
When the party ended and you swallowed it
I saw you swallow it
Sometimes, people who have lost someone to suicide say they saw it coming, but others feel completely shocked. It can also switch back-and-forth in the mind of a person as they try to make sense of it.
Okay so it might appear
That you took yourself up out of here
How many cries soak through your disguise
Before you drown in your silent tears?
Okay so it might appear
That you took yourself up out of here
How many times can you fight for your life
Before you throw that white flag up and volunteer? (x2)
Here, Ali seems to be trying to figure out the threshold that was crossed before his dad killed himself. I don’t know if this is Ali trying to understand if his own life obstacles and past suicidal ideation might ever exceed that threshold or if he is trying to understand his dad’s experience better (or both).
I’ve had car accidents
Where everything is slow motion no matter how fast it’s happening
Every second that pass stretches so that you can watch it unraveling
But can’t always react to it
Your whole life might flash before your eyes
The minute when you transition to the other side
But what can actually happen in that time?
In-between the leaping and the moment you collide
In-between the trigger and the blast
In-between you let go of the wheel and you crash
In-between the moment when you swallow the last pill in the bottle
Turn out the lights, roll the dice on tomorrow
Is there a moment to reflect, can there be regret?
Is there a wait, not yet, let me reset?
Or is it just too painful to accept?
That maybe death just seemed best
I think Ali is trying to imagine what his dad was going through at the time he died by suicide since he cannot ask him about it. He’s wondering if he crossed his dad’s mind or any reluctance emerged that could have prevented his death. Or was it more like an uncontrollable-type of experience where he felt like he was watching himself but could not change the outcome?
Suicide prevention researchers, such as Thomas Joiner (1,2), have argued that an innate drive for survival and fear of death saves the lives of many people who desire suicide. I have heard Joiner describe this as a ‘flinch’ that people might experience right before or during a suicide attempt. He has presented compelling anecdotal evidence of this through stories of people who survived suicide attempts. Kevin Hines, a suicide attempt survivor from the Golden Gate Bridge, said he felt instant regret after he jumped. Along with others, suicide prevention researcher Mike Anestis, has proposed that this window maybe an opportunity to prevent some suicides through means restriction during high risk periods
I heard this as Ali arguing for not taking one’s life, even in the face of repeated, seemingly unjust hardships…’you can go down swinging.’
Okay so it might appear
That you took yourself up out of here
I’m trying not to resent you
But you left me defenseless in the life we share
Every man before me in my fam died by his own hands
How am I supposed to understand my own role in the plan
When nobody who grows old stands a chance?
Ali lost both his dad and his grandfather to suicide. He’s wrestling with sympathy for his dad and his own feelings about being left behind.
What about this mysterious dance
Made you cut the cord to the curtain in advance?
But these are questions I can only ask
The person looking back in the looking glass
Ali recognizes that he is full of questions that now must go unanswered.
I’ll close by saying that I am truly sorry if you’ve lost someone to suicide – this post is dedicated to you. I’m especially thinking of a friend who is going through this now. Research by Julie Cerel and colleagues suggests that each suicide affects a large number of people (even larger than previously thought). It’s imperative that we increase the effectiveness of suicide prevention efforts. If you need support, please consider some of the resources below.
Resources
You can find a therapist through the Association of Behavioral and Cognitive Therapy, and you can find a support group for survivors of suicide loss through the American Foundation for Suicide Prevention website.
The National Suicide Prevention Lifeline has an online chat option, and their phone number is 1-800-273-TALK.

A Note to Chris Cornell Fans from a Chris Cornell Fan

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Chris Cornell in Minneapolis, October 2015 (photo credit: Samantha Myhre)

When I learned about Chris Cornell’s death this morning, I was filled with disbelief and sadness. Chris was a remarkable musician

and a humanitarian.

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When I learned that he died by suicide, I couldn’t help but think back to how painful it was to learn of Kurt Cobain’s death by suicide years ago.

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a bench turned memorial outside of Kurt Cobain’s former house

If someone you don’t know can have such an impact on your life, it’s hard to fathom how much pain Chris’ loved ones are experiencing right now. My heart goes out to them. I hope they receive all of the support, respect, and privacy they need in the face of their tragic loss.

There will be (and already are) amazing pieces dedicated to Chris’ legacy as a musician, as a humanitarian, and his personal impact in his roles as a friend, father, and husband.

What I want to focus on here is something that came to mind as I recalled MTV’s interviews with people about their reactions to Kurt’s death. In particular, I was thinking about people who had suffered from their own mental health problems and looked to Kurt as a symbol of hope. I know there were people who looked at Chris, who had been open about past mental health struggles, in the same way. When you see someone you look up to survive and thrive in the face of mental health struggles – it’s inspiring. When you lose that person, it can dampen your own hope.

To the Chris Cornell fans out there:

First, I am so very sorry for your loss and all of the hurt that goes with it.

Secondly, I want you to know that mental health problems are treatable and that suicide is preventable. Please take care of yourself – reach out for help and support. There is strength in seeking help, and mental health struggles are nothing to be ashamed of. You matter – please stay.*

For information about suicide warning signs and suicide prevention, please go to the American Association of Suicidology website.

A useful resource for finding mental health help can be found here.

If you are having thoughts about suicide, please contact the National Suicide Prevention Lifeline.

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*#STAY is a t-shirt campaign for suicide prevention started by Live Through This. You can find out more about it here.

13 Thoughts on 13 Reasons Why

**WARNING: SPOILERS APPEAR IN THIS POST.**

I watched the new Netflix series 13 Reasons Why (based on a book with the same title). This post sums up my reactions, and I am also in the process of recording detailed Jedi Counsel podcast episodes on the series with my co-host. Some people say this is art and entertainment, and therefore, exempt from social responsibility. Nonetheless, many people will watch this series, and that makes it important to view it critically and to consider its implications. My thoughts aren’t fully formed yet, but I wanted to post something as the series came out without waiting until I had it all sorted out. My feelings and opinions may develop more as I process the material for a longer period of time. I’m open and curious about other perspectives.

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  1. The series is set up as a mystery that quickly pulled me into the story. I finished the whole series within a few days. The framework for the series is that an adolescent, Hannah Baker, has died by suicide and left behind audio tapes detailing every component that she believes led up to her death. In addition, she has a methodical plan for the specific people who should listen to the tapes, how they should be listened to, and the order in which people hear them. While this is a compelling way to reveal a mystery, I believe that it contributes to stigma by painting the picture of a woman who ended her life for the purposes of getting attention from the individuals she believed ruined her life. The tone of her delivery is blaming and feels vengeful. I worry this perpetuates the myth that suicide is typically driven by desire for attention, selfishness, or revenge…which it most certainly is not.
  2. There is a scene that is explicitly blaming of one of the few kind (though not perfect) people in the series (Hannah’s friend and love interest, Clay). Hannah’s friend, Tony, tells Clay that Hannah would have been alive if he had acted differently. He later softens his tone, saying it is not Clay’s fault and Hannah is responsible for the choice that she made. Still, the blame message is there in a scene where Hannah tells Clay repeatedly to leave her alone. He reluctantly leaves the room. The show then depicts a parallel universe where the “right” things happened: Clay insists on staying despite Hannah clearly asking him to leave her alone, he turns the conversation around through persistence, Hannah feels loved, and suicide is prevented. In light of the violations of consent elsewhere in the series (including two rape scenes), I was bothered by Clay being painted as having done the wrong thing when he honored Hannah’s wishes to leave her alone.
  3.  Hannah decides, as her last attempt at help-seeking, to reach out to her school counselor about her suicidal thoughts and being the victim of rape. The counselor, insensitively and against best practice guidelines, implies she may be partially to blame (e.g., asking if she verbally said no to the perpetrator, asking if she had been drinking) and jumps right into telling her that her only choices are to: 1) report the assault or 2) to move on. She leaves the office, and he doesn’t follow-up with her in any way. He doesn’t ask for more details or conduct a suicide risk assessment, and he does not try to reach out to her parents to prevent her from harming herself. Of course, there are some counselors out there who might act in this irresponsible way. However, the vast majority would not. In a show that is viewed by a lot of young people, the depiction of the counselor matters a lot. People are already reluctant to reach out to mental health professionals. I worry people would feel even more discouraged from seeking help after seeing this terrible, judgmental, unethical interaction.
  4. The series accurately portrays some of the risk factors for suicide: social isolation, loneliness, and disconnection from others (including in the painful forms of bullying), perceiving herself as a burden (e.g., she describes herself as a “problem” for her parents and especially feels burdensome after accidentally losing some of their money), family conflict (her parents argue about issues including finances), witnessing and then being a victim of sexual assault, and hopelessness about her future (e.g., with regard to college and other plans).
  5. I appreciated the series emphasizing how crucial social connections are for health and talking about different types of loneliness – including individuals truly isolated and those who feel “lonely in a crowd.” It seemed to make the point that even apparently popular people (like Zack) can feel lonely. I believe this sends the message that anyone is vulnerable to loneliness, and we shouldn’t assume people are doing well just because they appear that way on the outside.
  6. One of the themes of the series is that – at any point – one person listening, reaching out, or doing something differently could have prevented Hannah’s suicide. Ultimately, this is a positive message. Unfortunately, I think it’s lost and distorted because it is used to blame people for their failures to save Hannah rather than demonstrating that one person could have made a difference and changed the story to a hopeful one. If the counselor or one of her parents had connected with Hannah and supported her in seeking help for her struggles, this point would have been much more persuasive. Instead, the story feels more demoralizing than inspiring to me.
  7. Hannah’s death scene is a graphic depiction of her cutting her wrists with razorblades in a bathtub. In a documentary-type episode made about the series, they said that it was to show the painful and hard-to-look-at nature of suicide. To me, it feels like a choice to make a dramatic, visually startling conclusion to the story rather than to deliver a lesson. It makes sense – this is a series meant to be watched and to get people glued to their screens- not a PSA. It’s possible that an individual who feels suicidal might see that and be afraid; however, it’s also quite plausible that an individual feeling suicidal might mistakenly view it as an end to all of Hannah’s emotional pain and problems. Anecdotally, there are cases of suicidal individuals watching scenes of suicide building up to taking their own life.
  8. There are warnings in the beginnings of episodes where there are graphic scenes (e.g., sexual assault, suicidal behavior). It would have been helpful if the episodes had information about resources, such as the National Suicide Prevention Lifeline and the American Foundation for Suicide Prevention, embedded in them too. It would be a simple way to reach a lot of people. Again, the series created a separate short documentary-like episode with mental health professionals and resources in it. However, it appears completely separately from the series (rather than as the 14th episode, for example). It would reach more people if it was connected to the full series.
  9. The pain Hannah’s parents experience after her death is excruciating. I feel this is one of the most realistic aspects of the series. It shows their horror, their confusion, their regret, and their desire to prevent other suicides from occurring. In the documentary afterwards, they suggest that this might show individuals who feel suicidal about the pain that others would experience if they died. I think this may be the case for some, but for certain individuals, tragically, they might imagine that people wouldn’t feel the same way about their death. That’s the cruelty of perceiving oneself as a burden – people struggling with mental health problems may not see how the world is better with them in it.
  10. Related to the second point, several characters clearly violate Hannah. Marcus and Bruce grab her, Tyler and Justin take and share revealing pictures without permission, and Bryce rapes her. When Hannah and Clay are starting to kiss, Clay asks, “Is this okay?” I really liked this scene because it shows how asking about consent is natural and enhances, rather than ruins, the moment. It also shows a welcome contrast in that Clay genuinely respects and cares about her feelings and perspective. Sadly, this positive point gets diminished when the scene turns into Hannah yelling for him to “get the hell out” and the suggestion that if he had only ignored her wishes, he would have saved her life (as described above).
  11. From one perspective, it seems like a point of the series is to teach bullies that their actions can lead to someone dying by suicide. However, most people who are bullied do not die by suicide – people are often remarkably resilent in the face of great adversity. It’s important that people who are on the receiving end of bullying know that. Secondly, most of the people on Hannah’s tapes are more concerned about protecting their own secrets (e.g., that Courtney is attracted to women, that Justin allowed Bryce to rape Jessica, that Ryan published Hannah’s poem without her permission) than how they hurt Hannah. If the message is supposed to be an anti-bullying one, I don’t think it really connects with bullying people in the audience. I guess that it would resonate more with people on the receiving end of bullying who feel a sense of hopelessness about the bullies having any potential for empathy and a sense that there is no help available to them.
  12. On two occasions, two adults (the counselor and the communications teacher) state that the warning signs for suicide include withdrawing from friends and family, changes in appearance, and trouble in group projects. This was a great opportunity to share the real warning signs for suicide, but unfortunately, only the first one really maps onto the list.
  13. A lighthearted, sweet aspect of the series is that Clay is different from his peers in that he cares relatively less about what other people think of him. He still cares what people, including Hannah, think of him to some extent, but he doesn’t try as hard as his peers to be something he’s not. He feels nervous around Hannah, but doesn’t ever really pretend to be someone else. He doesn’t let other people’s opinions make him feel bad about himself. Again, Clay’s not perfect (he says some mean things to Hannah and looks at a revealing picture that Tyler took without consent). But, overall, he’s smart, sensitive, caring, a good student, interested in the world beyond the walls of his school, helps others, takes reasonable caution in his decision-making, and likes geek stuff like Lord of the Rings and Star Wars. During one exchange, Hannah says to Clay, “Wow. You’re an actual nerd. There’s courage in that.” Most of the other characters in the series view themselves and their worth in terms of what their peers think of them. This generally rings true with regard to this developmental period in adolescence. It’s refreshing to see someone who has some self-acceptance and a sense of what’s right in the midst of all of the tragedy.

You can check out our first podcast episode on this series here and our second episode here.

If you or someone you know needs help, please reach out. There is hope and help is available here.

Ronda Rousey’s Fight with an Eating Disorder

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I recently read Ronda Rousey’s book My Fight/Your Fight. In case you’re not familiar with her, I will list a few of her accomplishments: she is a former UFC champion, an Olympic bronze medalist in judo, and an ESPY Award recipient of both the Fighter of the Year and Best Woman Athlete awards. A few of the personal reasons that I connect with Rousey’s story are that I also started judo as a young girl and am a black belt in it (unlike her, I am not currently in my prime fighting condition); I, too, moved from a warm-weathered coastal city to a smaller town in North Dakota; and, like her, I really value authenticity both for myself and in other people. I admire Rousey for the numerous difficulties she has overcome, her position as one of the most dominant athletes of all time, and the barriers that she broke through by not letting people stop her from pursuing her dreams in a male-dominated field.

The two aspects of Rousey’s book that are most relevant to our lab’s research are related to her father’s tragic death by suicide and her past with an eating disorder (she reportedly had bulimia nervosa that began when she was an adolescent). Rousey speaks openly and compassionately about her father and how his death by suicide impacted her. I recommend reading about it in her own words in detail in her book or briefly in a piece she wrote at this link. Here, I will focus on three points about eating disorders from her book:

  1. There is a common misperception that people with bulimia nervosa are fragile.  I can’t imagine that anyone would describe Rousey as anything other than exceptionally mentally and physically tough. You can see it in her judo matches and UFC fights. She is remarkably resilient despite the numerous hardships she has experienced (born with her umbilical cord around her neck, overcame a significant speech problem, lost her dad, and much more). Despite her obvious and immense strength, she suffered from bulimia nervosa for years before recovering. Her openness about her past helps to decrease public perception that eating disorders result from weakness.
  2. Rousey offers insight into the factors that she believes contributed to her eating disorder, and they are consistent with what we know from scientific research. Being an athleteholding perfectionistic standards, feeling dissatisfied with her body, having low social support (which she experienced when her bulimia nervosa started), and fasting (which Rousey did to make weight for competitions) all elevate the risk for developing and continuing to have an eating disorder.
  3. In her book, Rousey states that she no longer binges or purges, no longer fasts to cut weight, that she typically maintains a healthy weight (rather than striving for an unhealthy low competition weight, as she did in the past), and that she now has a positive view and appreciation for her body. Like Serena Williams and other female athletes, people have attempted to criticize Rousey’s body by saying that she looks masculine. She responded to this by saying that her body was “badass” and “there’s not a single muscle on my body that isn’t for a purpose…” She raised money for a charity that focuses on mental health issues including body image, and her positive message about body image is spreading. Beyonce played the speech where Rousey said these things during a performance, and Demi Lovato (who also recovered from an eating disorder) has also expressed admiration for Rousey. There is hope for recovery and thriving after an eating disorder. If you or a loved one needs treatment for an eating disorder, there is help available: 12, 3, and 4.

I will conclude with a fun fact for us folks who live in North Dakota. Ronda Rousey’s first full sentence was, “I like North Dakota more than California.” (p.18 of her book)