Ologies with Alie Ward - Suicidology (SUICIDE PREVENTION & AWARENESS) with DeQuincy Meiffren-Lézine

Episode Date: September 11, 2024

Give yourself a hug and take a deep breath and let’s chat with renowned Suicidologist Dr. DeQuincy Meiffren-Lézine. He is an absolute wonder and helps us understand the risk factors for suicide, prevention strategies, socio-economic factors, gender statistics, LGBTQ+ suicide prevention, what happens if you call a hotline, thoughts on hospitalization, how to support loved ones who have ideation, mourning those lost, learning to take care of yourself and your mental health and how living through the worst means by definition, shit gets better. ** IF YOU ARE CURRENTLY EXPERIENCING A CRISIS, PLEASE CONNECT WITH THE 988 SUICIDE AND CRISIS LIFELINE. CALL OR TEXT 988 OR VISIT 988LIFELINE.ORG FOR MORE INFORMATION. OUTSIDE THE UNITED STATES, CONSULT WITH FINDAHELPLINE.COM **Follow Dr. Meiffren-Lézine on ResearchGate, Instagram and LinkedInBuy his book, It is My Blood to Scribe: Poetry of a Suicide Attempt Survivor, on Bookshop.org or AmazonMore books by Dr. Meiffren-Lézine available on AmazonA donation went to Active MindsMore episode sources and linksSmologies (short, classroom-safe) episodesOther episodes you may enjoy: Dolorology (PAIN), Molecular Neurobiology (BRAIN CHEMICALS), Addictionology (ADDICTION), Traumatology (PTSD), Eudemonology (HAPPINESS), Awesomeology (GRATITUDE FOR LITTLE THINGS)Sponsors of OlogiesTranscripts and bleeped episodesBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, hoodies, totes!Follow @Ologies on Instagram and XFollow @AlieWard on Instagram and XEditing by Mercedes Maitland of Maitland Audio Productions and Jacob ChaffeeManaging Director: Susan HaleScheduling Producer: Noel DilworthTranscripts by Aveline Malek Website by Kelly R. DwyerTheme song by Nick Thorburn

Up top, this episode, of course, contains discussions about suicide ideation, completion, and prevention, though not graphic details. Now, if you're currently experiencing crisis in the United States, please connect with 988, the suicide and crisis lifeline. You can call or text 988 or visit 988lifeline.org for more information. Put it in your phone, tell friends. Outside the United States, consult with find a helpline.com. People have dedicated their lives to saving yours because you deserve to want to live.

Oh hey, it's your friend who completely gets it that sometimes you feel like garbage. And I'm happy you're here for this honest, scientific, and trust me, very empathetic ride through the research of suicidology. Honestly, it's a surprisingly friendly and upbeat chat at points because of its frankness and its lived experience, so stay tuned. Now September is Suicide Prevention Awareness Month and honestly, it's relevant year-round and I hope you'll share this whenever it's needed, which is again, every day. So the World Health Organization reported last month that globally more than 720,000 people die due to suicide every year, and that the reasons for suicide are multifaceted.

We'll go into them. Now, in the United States, more people die by suicide than car accidents. So chances are that if you are listening, you or someone you know has thought about or maybe even completed it. Now, I was going through the 2024 National Strategy for Suicide Prevention literature and I found this opening dedication that said, to those we have lost to suicide, to those who struggle with thoughts of suicide, to those who have made a suicide attempt, to those caring for someone who struggles with thoughts of suicide, to those left behind after a death by suicide, to those in recovery, and to all those who work tirelessly

to prevent suicide and suicide attempts in our nation every day. Honestly, I'm just stealing that dedication because it's really good. So this episode is dedicated to you, to us. And thank you to everyone on Patreon who submitted your stories and questions for this. Thank you to everyone who leaves reviews for the show. I read each one, including a three-star review this week from PRS Pastor who wrote, I really like the show and the content, but I wished the hosts, it's just me here, wouldn't drop the F-bomb and curse needlessly.

A shame. PRS Pastor, hi. Hello. So we have a sp-off show called Smologies, which you can find anywhere you listen to podcasts. Smologies, the logo is green. It's kid-safe and classroom-friendly. So enjoy that. You're welcome. Someone tell PRS pastor in case they don't hear this. Now on a more positive note, Sarah Prater, thanks for leaving your review of saying that ologies can make you feel connected to humans and that some of us need content like this. I'm on it with an important and honestly this is a scary one to make because I want to do the topic justice. I've wanted to do this one for years. I also want to be real with

you about some of my own experiences so we'll get to that. But yeah, suicidology it's a very real word and discipline and has been for the last half a century. And a suicidologist studies risk factors, suicidal behaviors, statistics and demographics, and of course, suicide prevention. So thisologist has been on my radar for at least four or so years, and I haven't covered it in all that time because it was really important to me that we chat in person. And the last few years for me have been a little bit unpredictable with my dad's passing and such. I got really sick. You know that. Maybe, maybe you don't. But the time was right and he ventured from his home in California's Central Valley about three hours north of me to my place to hang

out in our recording studio with a Grammy listening in as a producer. And he got his bachelor's at Brown University and a PhD in clinical psychology at UCLA, as well as a postdoc in public health at the University of Rochester, and has authored several books and papers on the topic of suicide prevention, including The Way Forward, Pathway to Hope, Recovery and Wellness with insights from Limp Experience.

He also wrote eight stories up, An Adolescent Chooses Hope Over Suicide, a poetry volume titled My Blood to Spill, which is a beautifully raw first-person account of his own mental health, alongside footnotes about the epidemiology of mental health concerns. And he wrote a resource guide addressing a popular TV show, which we're going to get to in a bit. And he served as a chair on multiple committees for National Suicide Prevention Alliances and is currently the director

of the Lived Experience Academy, which seeks to transform suicide prevention by supporting post-suicidal growth. And his 25 years in the field have earned him a Lifetime Achievement Award from the Substance Abuse and Mental Health Services Administration. So please get comfortable, Give yourself a little hug. Take a deep breath.

And let's get in and understand the risk factors for suicide, trigger warnings, nomenclature, prevention strategies, socioeconomic factors, gender statistics, LGBTQ suicide prevention. What happens if you call a hotline? Hospitalization, supporting loved ones who have ideation, mourning those lost, learning to take care of yourself and your mental health, and how living through the worst means, by definition, shit gets better.

With psychologist and professional suicidologist, Dr. DeQuincy May from Luzine. He, him. Doctor, correct? Yes, correct. How long have you been a doctor? I got my PhD in 2005. 2005? You look too young for that.

It feels like a long ago now. Yeah, thank you. I appreciate that. And can you tell me a little bit about what suicidology deals with? This was news to me that it was a field and then I really wanted to talk to someone about it. Can you tell me a little bit about what someone who is in this field does?

Yeah, sure. So, suicidology, study of suicide, the word was created by Ed Schneidman at UCLA after studying suicide for quite a while and coming up with something that wasn't quite psychology, wasn't psychiatry, wasn't sociology. He wanted it to be really specific. My interest came after my own suicide attempts and then getting involved and trying to figure out what was going on, trying to figure out how to help other people and reading a lot of Schneidman's work. So Dr. Edward S. Schneidman also studied psychology at UCLA and while working with schizophrenia

patients became interested in veteran suicide rates, trying to find commonalities in the notes that they left behind. Now in the late 60s and early 1970s he founded the journal Suicide and Life-Threatening Behavior as well as this nonprofit called the American Association of Suicidology, which helps its members get more insight into the latest trends and issues and increase ways for prevention. And for Dr. Mayfran Luzine, becoming a member was pivotal.

And then becoming a suicidologist by joining the American Association of Suicidology and just reading lots of stuff, and then ended up just having that as a specialty going through from college all the way through postdoc. Do you find that a lot of people who gravitate toward this field have been through it either with a loved one or through themselves? Quite a number. I'd say at least 60% if not more. And then the other ones most likely have had a close client or somebody that they've been

taking care of who's died by suicide or who has had multiple suicide attempts. And then the last like maybe 10% or so of people are ones who just have an interest in it. But most people have some kind of direct connection to it. And you said died by suicide, and I wanted to clarify that right up top, that people used to say committed, and the field has definitely moved away from that.

How long have we changed that wording? Yeah, let's see. So I'd say probably the switchover happened sometime between 99 and 2000, something in that range. And the way that I try to explain it to people is usually we use the word commit in two different circumstances. One is really positive, like being committed to something and just going straight for it. And we don't want people to be committed to suicide.

That's a very good point. And the other one is when people have committed some kind of crime. So commit homicide, commit murder, commit crime, commit suicide. We don't want it to be associated with criminality and we also don't want it to be associated with the positive one. So we just say died by suicide, which is a lot more plain, a lot more just matter of fact about what's happened. Yeah. Also, I think that there's religious stigma as well in terms of

committing a sin or on top of the anguish that you're going through. P.S. you're also destined for a terrible afterlife or something. Yeah, definitely. I also wanted to talk a little bit up top about content warnings and trigger warnings, because I know, I feel like in the last few years, I've seen that on social media more. And when it comes to the use of the word suicide, I see it sometimes with an asterisk,

I see it, you know, unalived or yeeted sometimes. When it comes to couching it in a way that's less harmful. Do we find that content and trigger warnings help or does it add to the stigma at all? I've seen it for more when there's going to be some kind of graphic depiction of it as opposed to just being mentioned. We know for sure through the research that just having a mention of it doesn't do anything to people. So I looked into this a bit and a 2023 study titled,

A Meta-Analysis of the Efficacy of Trigger Warnings, Content Warnings, and Content Notes, found that, quote, existing research on content warnings, content notes, and trigger warnings suggests that they are fruitless, although they do reliably induce a period of uncomfortable anticipation. Although many questions warrant further investigation, the paper continues, trigger warnings should not be used as a mental health tool. Now researchers from a 2022 study in the Journal of Trauma, Violence, and Abuse titled, Pulling

the Trigger, a systematic literature review of trigger warnings as a strategy for reducing traumatization in higher education have noted that trigger warnings, quote, can in fact be harmful to students. Now their paper found that in a randomized controlled experiment of 450 trauma survivors, providing trigger warnings before the reading of distressing literature caused the participants to view trauma as more central to their identity, which was harmful. Now, others argue, however, that these warnings could give people with certain traumatic backgrounds

a sense of agency to dip, which is what the trigger warnings are made to do. But so far, research is favoring the, oops, double exposure to the content does not help data. But as for what it takes to be a suicidologist, people who publish research in that field typically have a PhD or an MD, maybe a doctorate in social work, or have clinical degrees, like a licensed clinical social worker.

And yes, many have intimate knowledge or interest in the topic. And you were studying at Brown, from what I understand, and you were going through ideation and attempts of your own. And you bring that to your work a lot. And I imagine as people are looking for resources, you having that firsthand experience brings a lot to your work and also to the way you communicate. Do you want to explain a little bit about what was happening with you

when you were going through that, or how you feel in hindsight that kind of culminated? Sure. I think there were so many things going on. And I think that being somebody who has had that experience going through my career, I've always been able to kind of put together what I'm reading about or learning about

compared to my own experience. So I feel like now it would just be so huge to try to describe all the stuff that was involved. Of course. But I'd say the main things would be starting to have symptoms of bipolar disorder, being away from home environment, both pros and cons for that.

So away from social circle, which meant I didn't have my usual social network, away from family, and I was really close to my brother, but then also not so close with other family members. So pros and cons there too. And then just trying to fit in in college and trying to grapple with what had been in the past. I think having space away from things allowed me to review things in my mind and think through things that is really hard to do when you're just totally in it. So that whole combination of things, I think really took me to the place where things were pretty dark.

And I know for sure coming out of LA, it seemed like the peak was getting to Brown. And so that's what was my main thrust all through junior, senior year of high school, all through that summer. So once I got there, I didn't really have much of a future beyond that that was in mind. So missing a future, feeling like this experience that I was having might not ever change. And that experience being really poor, all of that kind of combined together to make me feel

more suicidal, make me feel like life was not worth continuing. Did that process get you essentially like the diagnosis of bipolar? Did that shed a lot of light on what you had been going through? Yes, but it didn't happen right away. So at first I got the diagnosis of clinical depression, which happens quite a lot because the thing that usually gets people into the door is those down periods. Usually it's not the upswings. It wasn't until I already had the diagnosis and medication for depression that later when

I was talking to a psychiatrist back in LA, she reviewed things and we came to the conclusion that probably bipolar disorder fit better. Then more and more as we reviewed family histories and other experiences, it definitely felt like that was the diagnosis that fit a lot better. With many medical diagnoses, the time between symptomology and diagnosis and hopefully treatment can be critical and frustratingly long.

Now, one paper, Polarity of the First Episode and Time to Diagnosis of Bipolar I Disorder, said that patients may wait as long as five to 10 years from the onset of illness before the diagnosis is confirmed and that those delays carry huge social and economic burdens as well as a much higher risk of completed suicides. Now in case you're unfamiliar with bipolar disorder if you've never heard of it, it was once called manic depression. It's no longer and there are two main types. There's bipolar one disorder which is defined by manic episodes lasting at least a week with symptoms including things like faster or increased talking, less need for sleep,

a usually elevated mood, making a lot of plans, maybe some impulsive choices or fears that might be a little on the delusional side. And then that may cycle into a depressive episode that lasts at least a few weeks. Now bipolar too tends to have hypomanic episodes interspersed with the depressive ones. So less severe manic episodes. But not knowing what is happening chemically can be very confusing for folks. And the right diagnosis really informs therapeutic plans

and medication strategies. Now, according to the National Institute of Mental Health, up to one in 25 people will experience bipolar disorder in their lives. 1 in 25 people, but a staggering 1 in 5 may complete suicide. And those without proper diagnoses and treatment are obviously at a higher risk. A diagnosis also helps people understand themselves and how common and not their fault these medical conditions are. And knowing all of that definitely did help, especially with being able to just talk to

other people who had had similar experiences. And then you're in the right crowd. The stigma of it too, when you're talking about the right crowd, the stigma of having been in that place, I find it's very difficult to talk to people about it with the fear of getting rejected. And especially if you do feel a lot of self-rejection already, the notion of getting rejected by people who might be able to help you is enough to really make you recede a lot.

Do you think that in that process of finding a little bit more community, did your science brain that was already there start to piece together commonalities? Hmm. I think regarding the stigma part, I lost a lot of friends and lost a lot of support people and support networks and felt like I faced a lot of stigma and discrimination and just like loss around that.

So it didn't feel like I had a whole lot to lose at that point in being more open and in talking to folks. There was a lot to gain and not a lot to lose. So that really influenced how much I got involved in things. Do you see a lot of similarities with people who have ideation or do you see every case as like having its own ideology and own rhythm to it? Yeah, kind of both. Okay.

So I'd say the commonality is getting to this point where it feels like continuing life is worse than ending it. And so this picture that the life going forward is not gonna have the same quality that you want it to have. It's that difference between what you expect life to be like and what quality you're actually gonna have, that perception, I think, really comes down to what makes people feel like they want to die.

So like Thomas Joyner will say it's desire, suicidal desire, and the capability and their intent. So Dr. Mayfran Luzine brought up another prominent suicidologist, Dr. Thomas Joyner, who's a professor of psychology who runs a laboratory for the study of the psychology and neurobiology of mood disorders, suicide, and related conditions at Florida State University. Now, Dr. Joyner is also the author of the Harvard University

Press book, Why People Die by Suicide and Myths About Suicide. He's also the editor of that journal we mentioned, Suicide and Life-Threatening Behavior. And Dr. Joyner wrote in his 2005 book, Why People Die by Suicide, something called an interpersonal theory of suicide, which is a combination of thwarted belongingness, which is the feeling of disconnection from others, loneliness or isolation, along with to a perceived burdensomeness.

So the feeling that you have nothing to offer and as Dr. Joyner writes, you're worth more in death than in life. That is a perceived feeling. Now things that can contribute to that feeling of being a burden are having medical issues that can require care or going through unemployment. And it should be noted again, it's a perceived feeling as typically as humans, we are all here to help each other and we do. Now these two feelings are what can produce that desire to die. And the third and final component is the ability, which involves

a drop in fear of death and maybe a desensitization to pain or violence, plus the means to carry out the act. So if one were to think back, say to your darkest times, you might see that commonality of a disconnect from the rest of society or a lack of community or belonging. Even common fandoms can provide people with a healthy source of belonging or a person. And I have known many dear folks who have grappled with suicidal ideation and looking back

can see how periods of isolation or a sudden loss of drive or purpose that previously motivated them could have contributed. But also think back to when friends have asked you for help and how honored you may have felt to be someone that could be trusted in such a tough time. So that burdensomeness is very much perceived in people going through ideation. But yeah, suicidologists look for these patterns to help understand how to prevent suicide attempts.

So there's lots of commonalities in any of the theories or any of the concepts or frameworks around suicide that can be applied. I think that where things are different for individuals is what they consider to be high quality life, what they consider to be the most meaningful things that are in their particular life. And it is when those things are taken away and they feel like they can't get those things back that they start feeling like maybe life is not going to be worth it. Mm-hmm. Do you see that certain periods of people's lives or certain losses of people in their lives

or job losses or relationship losses, do those tend to precede those events? Or do you think that they tend to be more of a biochemical sort of cause? I think you have both. Yeah. And I say that a lot, don't I? Yeah, no, no, no. That makes sense.

This part really stuck with me. I think that transitions are really tough. And so if it's transition away from home or transition because of loss or transition because of losing work and losing all the people who are attached to work or moving away from a home country or home city. I think any of those transition periods put a lot of stress on us no matter who we are. So if the things that we are dealing with internally really make it tough to deal with stress because they might be not going so well that anytime there's going to be a major stressor, it's going to push on that.

So I think that what happens with the biology side is that that impacts how people are going to react to stress no matter what that stress is and how much tolerance they have for the stress, like where their thresholds are, where it's going to really impact them. So then when we all have the impact of stress, some of us are going to react differently to whatever that stressor is. And then that comes back to the individual side about what are the things that people feel are going to be most impactful for their quality of life. And so when the stressors match that, and you add onto that some biological vulnerability,

then it really does have that type of possibly suicidal impact. I've recently heard mounting stress called trigger stacking. So let's say that you've had, I don't know, pneumonia and are isolating, so you can't get out an exercise. And money is stressful because you can't call out sick too much, maybe you don't wanna ask anyone anyone to help you too much because you feel like you're

always having problems, so it seems. And then on top of it, it's like the anniversary of a tough thing that happened or you're switching medications at the time. Or maybe you're going through a breakup and feeling like you're losing part of the family or you've moved. Or maybe you have COVID and you don't know who to ask to get you soup because you're contagious. And on top of that, you can't get a refill on your usual medication. These things may feel like an absolute tower of shit. And when they happen all at once, thinking of them like a stack of triggers is helpful

for me. I had this great friend who told me that he looks out and tries to figure out how high that stack is and how many he can control or remove. Can you postpone a deadline? Can you see if the pharmacy delivers? Can you reach out to someone and let them know you're feeling alone and give them the opportunity to show up for you? Can you remind yourself that the isolation is temporary or that life is always changing

and will change for the better. That there are so many clubs and groups and hobbyists and new friends or even religious communities or knitting circles or oligites or chugolos, I don't know, where you can feel belongingness. So what triggers can you take off starting with physically for yourself? Also volunteering anywhere you'd like to be can be a huge life changer. And for more on that, you can listen to our field trip, How the Natural History Museum of LA Changed My Life, which we put out a couple years ago.

Your people are out there and your presence is welcome. And everyone deserves care. Do you see commonalities in terms of the things people are looking for for their quality of life? Is it community? Is it food security? Is it safety? Like, what are those things that we can't see ahead to having? Yeah, I was thinking about that on the way down, actually. And I thought, you know, what I'd say is love.

And it's the experience of love. Wow, wow, wow. And it could be love, like, from a person. It could be love from, wow. And it could be love from a person, it could be love from pet, but it could also be just the things that we love. So when somebody is like, I love my sport, I love my job, and watching the Olympics and culture, I love doing this.

That experience is what really has the most meaning for us. And so when those things start to break, I think that that impacts the quality of life, the things that people experience as love and joy. And when those things get taken away and get broken, that's when people start to really have that deep impact that can rise to the level of being suicidal. So transitions can be really hard and give yourself and give others a lot of

grace. Love is vital, not just how much you get but also what you give. What do you love? What do you love to do? What do you love to watch? Try to identify those things and experience them as medicine for the sake of yourself. They're not treats. They are vital. How do you feel about the way that people call it a selfish act? I feel like we hear that a lot. We hear it almost as a deterrent to someone who is feeling suicidal.

And people who are surviving loved ones who have died suicide, might be tempted to call it that. How is that looked at in the field by survivors? Yeah, it's mixed. Yeah. I think to a certain degree, you could say it is, because it's not regarding what's going to happen to other people. It is about the self. And to a certain degree, it's not, because usually when we say something is selfish, it means it's beneficial to the self.

And this is obviously self-harm, it's self-destruction. So it's not beneficial to the self. And I feel like for a lot of people who have gone through a suicidal experience, the internal side of it is that the continuing life of pain pain is for other people and it's not for themselves. They're like, if it's just for me, then I wouldn't be here. I'm just living for other people. So then it's like, okay, now I'm going to do this for myself because I can't do anything else or this is the only thing I can do for myself. So in that way, it kind of is. But in the way that we usually think of being selfish, which is like getting something

beneficial out of it, it's not. I think that partially it just shows how connected we all are to each other, so that if somebody is taken away from our social fabric, then we all feel that pain, that loss. And in that way, it feels selfish because it's like it has impacted this whole network, this whole community or this whole group. And then we feel that and we don't know what to call it. And we know who was like basically responsible for it.

And we know what happened, but we don't really have a good language for describing it. But I think for sure calling it selfish also allows folks to not really think about the other things that might have played a role. It allows it to just be placed onto the person who has died. So complicated? Yeah. I feel like there's a lot of stigma to either asking for help for this

or telling someone that you've been through it because the idea of being labeled like a drama queen or toxic or ill or selfish, ultimately it's such a heavy topic that the fear that you're going to take away from someone because you need help is, I'm guessing, a common fear with people. And I'm going to try not to cry a lot during this episode.

But, you know, I feel like most people, unfortunately, in this day and age, know someone who's died by suicide, or they know someone who has had an attempt, or they've been through it themselves. So full disclosure, I have been through this myself, and it scared me. I knew I was having thoughts that didn't line up with what I wanted for myself.

And honestly, I didn't know about 988, or international hotlines, so I took myself to the ER alone, not even telling my partner, because I was so worried that I would be a burden or seen as dramatic. I didn't tell my immediate family or some close friends for fear of being rejected or judged.

I did not know what to do. And my biggest fear was making people mad at me and casting me away or being a problem. So how do you suggest people get help? At what point do they need to seek help? Because I know there's ideation, there's attempts, there might be intrusive thoughts without a plan. At what point should someone say this is beyond what I can handle or beyond what my loved ones can handle and I need to get medical help for it. Yeah, I'd say probably one of the best things that folks can do, out of all the

possible options, is calling 9-8-8 and just talking to one of the counselors who's picking up the phone. Again, 9-8-8 works in the United States and findahelpline.com can direct you to helplines globally. And it's not just phone calls. And now there are a variety of ways that people can contact 988, including chat and text. And they'll help to walk through how much risk there might be and what options people might have in their local communities. But in terms of triaging, I had mentioned Thomas Joyner's model before.

And one of the things that he has that ended up being kind of a guidance for the suicide prevention lifeline was this combination of suicidal desire, suicide intent, and suicide capability. And the desire is just the wish to die. The intent is actually thinking and planning and getting ready to die. And the capability is having acquired the mental and physical preparation for doing something as drastic as trying to end your life.

And when all three of those are happening at the same time, that's like red flag, full alarm, fire. When it's just capability, that would be a whole lot of people, but they're not suicidal, so you don't have to be concerned about the suicide part of it. If they just have desire, but they're not intending,

then we would say, okay, let's talk about the things that are going wrong in life, but you don't need to worry about whether or not somebody's going to immediately die by suicide, most likely. And then the intent, you kind of have to take that as seriously as possible. So that's probably one of the main factors is if somebody is saying that they want to do it, and they're going to do it and they have a plan and then as it gets more and more specific, we should get more and more worried about it because that makes it a lot more possible to be an imminent type

of thing. So we really go on the strength of somebody's intention and how much pain they might have, like psychological, emotional pain they might have, as well as kind of, is it kind of more of a passive, I don't want to be alive, or is it a really active, hey, I'm going to do this on this date? And so that is a lot of what goes into that type of risk assessment. What about warning signs for yourself or for other people? Some people say something happened absolutely without warning, they seemed fine.

Maybe people mask really heavily, or maybe they push people away because they don't want someone to stop them. They don't want to seek any kind of intervention, versus maybe people look back and say, you know, they mentioned it, but I didn't think they were serious. Yeah, warning signs ends up being one of those kind of controversial topics in some circles just because either they're not super predictive of a suicidal act. And some people feel like

if they've lost somebody to suicide, then if they hear warning signs, they might think, oh, you're trying to blame me for missing these things. And it's usually not trying to blame anybody for something that has already happened. But I think that the main idea for warning signs is that there's been some radical change in the person's demeanor and behavior. And that indicates that perhaps something is going wrong.

According to the American Psychological Association, that may include a lack of social connectedness, trouble eating or sleeping, increased substance use, maybe giving away possessions, which mean a lot to them, making a will, mentioning dying or suicide, a lack of interest in grooming or hygiene, trouble coping with or adjusting to losses, and or withdrawal from people. And I'm sure many of us are hearing that and wearing yesterday's sweatpants and wondering how red of red flags those are. And I like to call them just signs that something's going wrong. And maybe they're going to indicate a warning for possible suicide, but maybe they're just going to indicate a warning for things are just really crappy.

Yeah. And in either of those cases, you'll want to have them get some kind of help. But maybe the type of help is going to vary in how much you engage professionals or how much you engage a whole social network. But either way, you're going to want to try to take some action. So all the warning signs, whether they're like increased use of substances, changes in sleep patterns, it's giving things away that used to be prized possessions, dropping out of activities that they used to care about, pulling away from people, so withdrawing. Any of those

won't be really great predictors about whether or not somebody's going to attempt suicide, but they are indicators that something's wrong. And that's the main thing about them is just noticing that something is going wrong and somebody who you care about, whether or not they're planning suicide, if they're giving stuff away, something's not right. They used to care about these things. Maybe it's just they're grown out of it. That's fine. But maybe it's also like, they're saying goodbye. And that's not so fine. So it's just taking those things seriously enough to ask some questions, show some concern, and find out more about what's happening to that person. Well, I was going to say Marie Kondo really threw a wrench in

that because people are giving their stuff away left and right. Hello, I'm Marie Kondo. Kondo's method of decluttering seems simple. Keep only the things that speak to the heart and discard items that no longer spark joy. Everyone's like, all right, time to send things to Goodwill. But you're talking about possessions that mean a lot that they're almost gifting and sort of like bestowing on someone or which I understand. But what about populations who are most at risk? Or are the numbers going up?

Are they going down? Not to reduce people to statistics, but I'm sure that you need a wider, more objective lens sometimes, but what populations are most at risk? Well, let's see. The numbers have been going up, unfortunately. They dipped a little bit during the pandemic,

but have then gone up again. So overall, the pattern is that the rates have been increasing, the numbers have been increasing. For example, high school age youth have had an increase recently. We've seen increases in black youth and Hispanic youth and some in Native American youth as well. And we've also seen some declines in some places that have had really great youth suicide prevention programs. Oh, wow. So that's positive. So there's all these possible patterns in there. And like in terms of the numbers of people, it's folks who are in their middle ages, working age people, tend to make up the vast majority of suicide deaths. Dr. Mayfran Luzine says that

it's tough to generalize because nationally the rates and the methods really differ on a local level from urban to rural to Canadian statistics and international statistics, and that suicidologists really focus on what's happening nearby for prevention methods. In this case, Fresno, California, which is a central valley city in the middle of a kind of rural agricultural valley, I passed through it on the way to see my mom and sisters. You know, I was driving through Fresno and I saw a bunch of 988 billboards and I was like I wonder if that was you. But you had to put up some proposals for those and maybe those those are just becoming more well known which is great. Those billboards literally taught me

that there was a number I did not know until this weekend. How about culturally? You mentioned Canada and the US. Has suicide changed in terms of stigma or attempts over time or is it does it happen more in maybe countries with fewer resources? I feel like we hear about Japan's rates a bit, but I don't know if there's as much suicide in the global South where there's fewer resources or more colonization. So do we see that across cultures, big differences? We do see a lot of differences across cultures in how many people die for one thing

because of access to lethal methods. And the lower that access, the less people are going to end up being fatal from a suicide attempt. For example, access to firearms. But what we've seen is that it really is that difference between how people feel about the circumstances that they're in and feel about their quality of life. So somebody can have

hardly any resources, but feel like they have an awesome quality of life because of their family and because of their culture and their community and because they have good food and they enjoy each other. And then other people can have all the resources in the world and everybody's looking at them and they're like, you're a super celebrity and you're like a billionaire, what would you have to worry about? And they could be super, super lonely and feel like they can't go anywhere or feel like they're oppressed at home and they can't talk to anybody about it

or they're thinking about past experiences with family or there's all these things. And so it comes down to the individual person's experience about how their quality of life compares to what they want to have, and if they think that that's gonna change. Now, as a personal aside, again, there are many people in my life

who have contemplated, struggled with thoughts of, attempted, and even completed suicide. Now, a few of them have been the wealthiest people I know who have lost their purpose in life or felt alone or were dealing with chemical or medical issues that affected their mental health or they've been transitioning from addiction or mental health issues and found that their social network has changed. But according to the World Health Organization's latest statistics, again, over 720,000 people worldwide die by suicide every year. And 73% of global suicides occur in low and middle income

countries. But Dr. Mayfran Luzine also says that one challenge in looking at global statistics is the lack of data collection in places with fewer resources or less mental health infrastructure. But from what we know, according to data from 2019, the global suicide rate is over twice as high among men than women, with alarming stats in military personnel.

And a 2021 study out of Boston University found that over 30,000 active duty personnel and veterans of the post-9-11 wars have died by suicide. 30,000, significantly more than the over 7,000 service members killed in post-9-11 war operations. That's four times as many military members dying by suicide than by combat. And I've known a few of them, one who left young children behind. Now I asked Dr. May from Luzine what might be behind this. You know, one of the differences that we have between when somebody is veteran as opposed

to when somebody is active duty is their social network. Active duty, you're with your group and you are with them all the time. And then when somebody becomes a veteran, maybe they lost connection to those groups. Maybe they're now in a circumstance that they're just unfamiliar with. They don't feel like they fit anymore. And that's what I've seen a lot in terms of the experiences that are related by veterans is that contrast between being somewhere where you know your purpose, you know what's happening, you know the structure, you have friends, you have connections, you have meaning, and then going into civilian life, maybe that's there, but maybe not. So having it not be there and then plus having access to firearms usually, that combination

can be really deadly. What about genders and also LGBTQ? We've heard a bit about trans youth and work like the Trevor Project is doing. Do you see, in terms of your clients, big differences in that? Definitely. So for death rates, it definitely is more male and we see

that across the world. And for suicide attempts, generally speaking, more female than male. But part of what we're running into in terms of LGBTQ is that a lot of the information about how people identify and about their orientation are not captured on death records. Wow. So for example, in the official coroner reports and on death certificates, it just says biologically male, female, as best as you can determine it.

And then that's it. That's the check mark. So we don't know. We do have information about suicide attempts and about suicidal experience because of surveys and some because of hospital reports from emergency departments, but a lot of what we're missing is because

the data's not being recorded, so we can't report on it. But overall, we do see a lot of pressure and it flows down in a lot of different ways that are showing up in substance use and in mental health struggles for our LGBTQ youth and some for adults as well. For the adults, a lot of times I've heard frustration because a lot of the attention and resources are going towards youth.

Oh, wow. And then the adults are like, well, what about us? We still have our own needs. So there's that aspect. But I think part of what we struggle with in the field is they're not capturing the data. But for what we do have, there's increased risk for those groups.

And again, one organization that is doing surveys is the Trevor Project. And their 2024 US national survey on the mental health of LGBTQ plus young people found that more than one in 10 LGBTQ plus young people attempted suicide in the past year, with higher numbers for trans and non-binary people and youth of color. Now, 90% of LGBTQ plus young people said their well-being was negatively impacted due to recent politics. Now, 45% of transgender and non-binary young people reported that they or their family have considered moving to a different state because of LGBTQ

plus related politics and laws. So that's what's going on in the US. But on the upside, 54% of transgender and non-binary young people found their school to be gender affirming. And those who did reported lower rates of attempting suicide. And LGBTQ plus young people living in really accepting communities attempted suicide at less than half the rate. Do they find that a lot of deaths by suicide are impulsive or well planned?

Or does it really just vary on the person? I keep giving you all these binaries. I'm like, is it this or this? And you're like, it's neither. It's complicated. It's both. In other words, how are we laughing about this? We've been through some shit. So the actual time in between when somebody decides to die by suicide and when they take action

can be a matter of minutes. It can be super, super fast. But that usually doesn't happen with somebody who hadn't been in the super high risk category already. Yeah. So if somebody had been considering it and had been really wrestling with things and they're already in a really despondent and depressed place and are already pretty hopeless, and then they decide, the time period between them deciding and trying to do something

might be really small. So in that way, it seems impulsive. But usually there's a lot that's behind the scenes that was there that lasted for a lot longer. What we see is for younger people for sure, there's less planning involved. And then as folks get older, as with lots of things, there's more planning, there's more ideas about it, there's more strategy involved in it, more considerations. And so the level of planning definitely goes up with age and with maturity.

Yeah. What about those intrusive thoughts? We had a lot of questions about people who picture it or want it sometimes, but wouldn't go through with it. And they're not sure how concerned they should be about themselves. Is that something to just monitor in yourself or would you suggest people take a step back and ask themselves,

is there a lack of connection? Is there a lack of love in my life? Are there stressors that feel insurmountable, that are temporary, things like that. Yeah, I would say a lot more in that direction. Main thing is that the thoughts won't kill you, right? Only the actions can kill you. So having the thoughts themselves is not the dangerous part. And then once we get past that, then we can start thinking about what are these thoughts really representing?

Because usually they're kind of more of a proxy for something. They're when we hit the point of feeling tremendous relationship loss, or when we hit the point where we feel like our career is completely going down the drain, like there has to be something that ends up flipping the switch in our mind

so that we end up thinking about suicide at that point. And when people can identify that, then it becomes more of when I have this feeling, this experience that before I would call I'm feeling suicidal, now becomes that I'm feeling like I don't have enough time for myself. So what precipitates those thoughts? Is it that you don't know anyone in your new town? Is it the loss of a friendship? Is it burnout? Is it lack of rest? So what precipitates the thoughts? What is behind it? And then once that can be identified, then just using that feeling is more just a flag for that thing is going wrong. And then you can take action based on that. But I think

more and more that our mind associates being suicidal with that particular feeling that has happened. The more it's going to happen that folks are like, oh, I just feel suicidal and I'm not sure why. And, you know, I have these thoughts and usually they're connected to something. And now our brains have become wired to the point where we think that those things are the same. But if we can disentangle them, I think that that is the most helpful part. We hear sometimes legends or myths or anecdotes about people who have survived an attempt and say as soon as they embarked on it they regretted it. But as someone who has survived this and has worked with a lot of survivors,

what perspective have you gotten from that? Yeah, I've seen that explanation happen in two circumstances. One is if folks are being interviewed for some program or something which is usually a suicide prevention program or suicide prevention book. So, of course they're going to say, I want it to live. The other is when somebody is talking to folks who are then around them. So family, friends, they're going to say, yes, I totally want it to live. I completely regretted this happening. And then when we're just ourselves in our little group, might say, I felt really conflicted about it.

Some people have regrets that they didn't die, honestly. Some people feel like, I don't know what to do now. So it's really mixed I think but for sure a lot of people do have the feeling like I know that I wanted to end this pain and suffering But I didn't want to actually do this to it. And so then that's that's the regret is I Wish that I had taken some other kind of action to deal with this agony. But I think that part of what I would want to not get missed in the reports about how people feel after having jumped off the bridge or after having done something else that was really regrettable

really regrettable is that they had this emotional experience inside them. So they're saying that they regret the action, but we can't forget the pain that led to the action. I think sometimes that gets lost and we just look at the regret part. So the regret definitely is about the action and perhaps how extreme it was, perhaps that they didn't give more time to something different, perhaps that they took it at all and that they wished that they had talked to somebody instead. But yeah, I would focus more on the pain and the hurt that we really need to address for them. Yeah. What tactics of suicide prevention are most effective? So for suicide prevention, just straight suicide, lethal means reduction, probably lethal means

some will say reduction, restriction, changing access, reducing access to lethal means, lots of different variations on that. But basically if somebody can't access a lethal method, then they can't die by suicide. So that is going to be the top version of not being able to die by suicide. In terms of addressing that suicidal desire, a lot of those can come down to brief interventions like safety planning or like there's a motivational interviewing approach to suicide prevention. There's cognitive behavioral therapy for suicide prevention and dialectical behavior therapy is really great for suicide prevention as well. So we have a lot of therapies that are geared towards that,

some super brief, just like a session or two, and then some that are much longer and more involved like DBT. So, CBT stands for cognitive behavioral therapy, and it's considered to be the gold standard of psychological therapies, as discussed in the 2018 Frontiers in Psychology paper titled Why Cognitive Behavioral Therapy is the Current Gold Standard of Psychotherapy, which notes that though there is room for improvement in CBT and the field is ever-evolving, CBT is the most researched form of psychotherapy and that no other form has been systematically superior to CBT.

Now, it may not be right for every individual's situation, and your doctor will determine that. But CBT targets the unhelpful thinking patterns at the root of a lot of depression and anxiety symptoms and disorders. So it helps reevaluate those thought distortions and correct them. And it also stresses better coping mechanisms and confidence and mind and body calming skills and better comprehension of how others may be motivated. So CBT targets thoughts and beliefs. Now DBT is dialectical behavioral therapy.

It was developed by a psychologist, Dr. Marsha Linehan, in the 1970s to treat borderline personality disorder. But it's now been adopted by many psychologists to help with a wide variety of emotional regulation issues by using things like mindfulness and learning distress tolerance and giving help navigating interpersonal relationships so they don't hit quite as hard and don't hurt so much. Now it's said that CBT uses logic like the Stoics relied on, and DBT is more rooted in Zen practices. And these are just two tools in suicide prevention therapy. And then I definitely focus on what happens

after we get past that. So one of the struggles that I've had in my career in suicidology has been that for the longest time, the gold standard was no suicides. And they say, nobody goes into therapy with their therapy goal being no death. No therapist says, hey, here's what we should have for your therapy goals. Don't die. And then that's just it. We always have more goals, right? We always have more hope and more dreams. We always have things that

we're trying to accomplish for our mental wellness, for our mental wellbeing. And sometimes I think those get forgotten once suicide enters the picture, and then it just becomes about risk and not dying. But the person wasn't thinking about death mostly, they're thinking about how life sucks. So we need to address that part. And then once we address that part,

we can also go back to the, how do we make your life better? So that's why I've started focusing way more on post-traumatic growth and what I call post-suicidal growth and maximizing what we can learn in a way that helps them to move forward after that, as opposed to focusing on the suicide prevention part of it, which I think we've gotten pretty good at stopping the death part, when those programs have a chance to really get out there and work.

But we need to go beyond that. Can I ask you some listener questions? Totally. Okay. We have great ones. But before we get to your wonderful questions, first, a donation to a more than worthy cause. This week, the doc chose Active Minds on Campus. And Active Minds on Campus was launched by Alison Malmon

after her brother, Brian Malmon, died by suicide while she was in college. And two decades later, it's the nation's leading nonprofit organization promoting mental health awareness and education for young adults. And Dr. Mayfran Lizine has volunteered as a mentor in the past and says it has grown into an international

student mental health organization with fantastic programs. So you can learn more at ActiveMinds.org. And some other great orgs that Dr. Mayfran Lizine mentioned were the American Foundation for Suicide Prevention, that's AFSP.org, where people can get most easily involved. You can find resources for professionals at the Suicide Prevention Resource Center, resources for policymakers at the National Action Alliance

for Suicide Prevention, and for those in need, there's the crisistextline.org or findahelpline.com, which we mentioned. There's also this program called neverabother.org, which was mentioned by a patron and a fellow suicidologist, Darcy Pickens. And NeverAbother.org, it's on all the social media platforms, you can find it, and it's a campaign co-created by youth from the ground up. They have free resources for youth who are struggling, for friends who want to provide

support, and for adults looking to support a youth in their care. So that's neverabother.org. Again, in the US there is a 988lifeline.org. And if you're feeling inspired, the 988 Lifeline Center's website says that they're looking for empathetic volunteers, employees, and interns to serve as crisis counselors, answering phones, chats, and texts, as well as managers with advanced degrees. So we'll link all those orgs at aliward.com slash ology slash suicidology, which is linked in the show notes. Okay, thanks to sponsors of the show

for making that donation to Active Minds on campus possible. Okay, let's get into your questions submitted via patreon.com slash ologies. This first one is for anyone who has suffered the loss of someone that they love. Kayla Clark wrote in today and said, oof, I lost my sister last month to suicide, so I appreciate this. How does grief for loved ones change for a suicide or an unexpected death versus a death that's expected?

Do you have any advice for people who have lost someone? Yeah, I think first I just say really sorry for the loss. Yeah. You know, it hurts a lot to lose somebody that we're close to, especially really suddenly. We'd never had a chance to say goodbye. We never had a chance to grapple with what's gonna happen internally with that loss.

How is it going to impact our social structure? It's so different grappling with that compared to something that is expected, which is still a huge and heavy loss. It's the ability to grapple with it and to talk to somebody and to ask questions and to interact with them is just taken away. There's just this immense weight that is there that's just indescribable. And then a lot of folks who have survived after a suicide, so lost survivors or bereaved by suicide, some of the terms that get used also have this really painful type of reality where the person that you've cared about is both the actor and the victim.

So usually we can blame one part or feel bad for one part, but it's super hard when both of those are together. And so a lot of people who have lost somebody to suicide have all these mixes of emotions. So that is super normal to have if some people feel kind of guilt, but then also angry and then also wanting to yell at the person, but also wanting to cry with the person. And so having this huge mix is really normal. So if you're experiencing those types of things, totally normal to have that. And then it's really great to be able to talk

to other people who have had that type of loss. So finding a loss survivor support group, finding a bereaved by suicide support group sometimes can be super useful to be able to talk to other people who have had to grapple with that type of loss. But it's different than dealing with other kinds of loss because of all of those factors. The American Foundation for Suicide Prevention also has listings of US and international suicide bereavement support groups as a public service to loss

survivors. And then there's the Alliance of Hope for Suicide Loss Survivors. And they have resources like lists of books and support groups with specific ones for parents and those widowed by suicide and an online forum. So we'll link all those on our website as well, naturally. Speaking of nature, a lot of listeners, Tiger Udy, Nick, Sienna, Janika Maki, Ren S, Sharon Tender, Daisy Moser, Annabelle, and Tomcat asked essentially about animals. Do we see this in the animal kingdom? Do we see that self-harm or a fatal self-harm in the animal kingdom?

Yes. We do. There are some animals that definitely do that. Really? Yeah, it's interesting, one might say. But there are multiple circumstances where we might see that. And they kind of come down a lot similar to how humans experience that, where it can be just the amount of pain compared to their life, and so them doing things that end up really accelerating how fast they're going to die, basically. But then we also see times where it's

self-sacrifice. So that could be anything in ants. Some will leave if they have something that might impact the rest of the colony, they might leave. So they have decided in whatever ant way that they can, that it's better off for the colony for them to not be there. And then just the general maternal instinct to hold over, right, to cuddle with youth and babies if there is some external possible danger, right? And so then there it is protecting and valuing that future group and being willing to sacrifice oneself in order to do that. So, the story of Lemmings, tiny, adorable Arctic rodents

flinging themselves off cliffs in acts of mass self-destruction is flim flam. Big myth, not true. Busted flim flam. And other ethologists and animal behaviors will debate hotly the notion of self-harm in animals because it does beg deeper questions about the comprehension of self-harm in animals because it does beg deeper questions about the comprehension of self

and mortality. However, as discussed in the Delphinology episode about dolphins, a few captive cetaceans have reportedly ceased breathing under times of stress or separation from a partner. And there are small captive primates who have inflicted head trauma on themselves under extreme duress in captivity. And yes, of course, there is fatal defense behavior in colonies of social insects, which gets deeper into the notion of self-harm versus self-sacrifice. So it's just that balance between weighing one's own life versus what might be more important than one's life.

And so I sometimes say to folks when they're wondering how that could possibly happen for somebody who's suicidal that we see it all the time in ways that are more socially accepted though. So when a firefighter rushes into a burning fire, they know that they might die, but they are doing an act of service to try to get somebody out. When somebody serves in the military, they know they might die,

but they are doing it in service of country or in service of something else. And so society says, well, that is okay then for you to feel like you can put your life on the line for this, this is socially acceptable. But if somebody wants to do it because they are experiencing tremendous psychological pain, that's not socially acceptable. So in that circumstance, we frown on it. So I say the animal models are very much that comparison, that simple, simple comparison between what

is going to happen if I stay alive compared to what is going to happen if I stay alive compared to what is going to happen if I die? And is there more perceived value in the idea that I'm not there? And so then that's like Joyner's idea of perceived burdensomeness, which is, am I creating a burden or am I not adding value to this world? And if so, then what am I doing? And just weighing those two things. So yeah, it happens in animals as well as in people. And again, while we're talking animals, our managing director, Susan Hale, wondered if

service animals can be used for suicide prevention and if having a pet reduces suicidal ideations? Susan, that's a great question. And according to a 2022 paper, role of pets and animal assisted therapy in suicide prevention in the animals of medicine and surgery, quote, the benefits of animal assisted therapy include improved self-worth, increased verbal communication, decreased depressive and anxiety symptoms and loneliness, increased motivation, and enhanced social skills. And it even featured a graphic showing that the affection and non-judgment received from an animal plus the knowledge that the animal relies on your care is kind of a one-two punch to a few suicidality factors. And a 2021 paper titled,

A Social-Emotional Learning Program for Suicide Prevention Through Animal Assisted Intervention, found that a pilot program called the Overcome Animal Assisted Intervention, which involved group therapy sessions for adolescents struggling with suicidality, plus two golden retrievers hanging out, found reductions in suicidal ideation, suicide plans, and non-suicidal self-harm. And it also caused a greater predisposition to seek help as well as reduced intensity of mental pain. So emotional support animals, definitely a thing. It worked. And we discussed in July's disability sociology episode, people who might abuse that because they just don't want to pay for their Shih Tzu to fly in cabin, how to navigate that ethically.

Also, there are organizations like Service Dogs Saving Lives, which helps train dogs to assist people with mental health challenges and prior suicidal tendencies. Now, speaking of risky tendencies, somehow, this felt like a good time for a rant about shame and stigmas. Now, having gone through a very dark period myself, an anxiety attack that left me hospitalized, I have thankfully come out the other side so much healthier and happier than I would have been had I not gone through it. But it's something that absolutely scares the shit out of me to discuss publicly.

This episode, very scary for me to do, very important. I hope. But then, you see guys riding motorcycles so fast, cutting between lanes, doing parkour on a skyscraper, getting in a wingsuit. They could take other people down with them. And I'm like, why can't I talk about my experience, but this guy gets a Red Bull award for it? What is going on? And so it's interesting how many people who are grappling with thoughts of self-harm or

not being able to see a future that's better than what they had are so shamed into silence, but you can literally ride a motorcycle in Arizona with no helmet at 120 miles an hour. Yeah. I think that goes back to the social part that I was talking about. It's about what our society wants to promote. And it could be promoting it because they see some entertainment value to it, or they see some sales value to it. Honestly, that's kind of what it is, right? And so for the example of soldiers, our country finds value in that. And so in that circumstance,

yes, put yourself in harm's way, because we have value for that. But in the event of us feeling suicidal, society does not want that. They're losing. And in that case, they want to have that not occur. The whole situation of it being considered a sin, churches were running into the circumstance where people wanted to go to heaven sooner. And so, they would die by suicide and they had to figure out, what do we do for this? And so, calling it a sin and making it a horrible, horrible sin

to even think about suicide helps to protect the parishioners and helps to stop the whole thing about people dying. So, it was intended to be stigma to stop people from dying. And then now we have to deal with the repercussions of that, which is that a lot of church communities, although there have been huge changes in the last couple of decades for faith communities really coming on board and supporting suicide prevention, but for the longest time,

the church community felt like the stigma should be there for it. And so they did not wanna let go of the stigma of like committing a sin, committing suicide, because that helped to promote the thing that they wanted to promote, which was people staying alive until just like more of a natural death.

But yeah, it's that socially acceptable, societally wanted. So somebody riding a bike super fast, they'll put that on YouTube and get millions of hits. And so it's different in that way. And then that's why they penalize the people who are feeling like, I want to die, just me, as opposed to, hey, look what's happening

while I put my life on the line. Yeah, yeah, I think the shame and the not reaching out and the feeling like the very thing that you need, which is connection and love, is going to be withheld from you if you say that you need it. That is such a terrible cycle to get into. And of course, it's hard to see out of that because the more you ask for help, especially if you come from a background of

trauma, the bigger the fear that you'll be denied more because you've asked. And a few people asked about clusters, including Sarah Berman, Iris Butterfield, and Kendall M. mentioned the show 13 Reasons Why. There was a massive controversy and worry about the show leading to copycat deaths. Olivia asked about copycat suicides as well. A few people mentioned Kurt Cobain's death and Lember Butt McCubbins, real name I'm sure, said my university had a cluster and lost quite a few students. So how does this happen and how can places respectfully, in their words, handle individual cases while also not potentially causing more? Wow, that's a lot of layers in there. I know, I know.

My bad. Sorry. Is it, does suicidal ideation or conclusion tend to be contagious? So, no. Clusters are actually super rare, but they get a lot of attention because they're really rare and really high impact. So for example, we had some youth suicide clustering happening in Fresno, which led up to the Fresno Suicide Prevention Collaborative

being formed and that's in charge of those 988 signs that you've seen. But in the years since then, the number of youth deaths has been really low. It was just a spike during that time period. So it tends to be fairly rare to have that happen. But if we think about just the circumstances that might lead to youth or lead to a certain group, let's say a certain small town or something, some tight-knit social circle, something that is going to be highly impactful for one person because the other people are very like that person in many ways is probably going to be impactful to them as well. be highly impactful for one person, because the other people are very like that person

in many ways, is probably going to be impactful to them as well. So similar people might have similar circumstances, might have similar reactions, especially if transitions and a lack of connection are common. And Dr. Mayfran Luzine elaborates. So let's say there's going to be a delayed graduation or there's something that happened at the school that's really penalizing or something if there's somebody who has died by suicide Because of that or or that contributed to them anybody else who's like them

Which is going to be a lot of people because they're all together in one circumstance are also going to have that impact So it's not necessarily that it's like a copycat type of thing. It's more like a lot of people who are pretty similar are in that group, and if there is something that's more of an environmental as opposed to individual impact, it's going to impact all of them. And in that case, if somebody has been considering dying by suicide and they've been thinking, well, what might I do for this? And then they see something that happened for that, they might go, oh, okay, so then that is easy for me to just pick up and try to do the same. But it's not necessarily that

they would have done that in the event that they hadn't already been in a risked state. So that's the really tricky thing about that. But not that many clusters that we've seen. In the event of 13 Reasons Why, things did go up. And part of that was there were multiple issues with season one of 13 Reasons. I haven't seen it, but I trust you. Oh, my. Oh my. Oh dear. So this was the 2017 Netflix series about a high school girl who dies by suicide, but

leaves a series of cassette tapes. I'm not sure why cassette tapes. I didn't watch it. Outlining why she made that choice and essentially who was to blame. Settle in, because I'm about to tell you the story of my life. More specifically, why my life ended. And if you're listening to this tape, you're one of the reasons why.

When it came out, there was a huge reaction in the suicide prevention community, and I binge watched it in like four days or something, and then wrote a book about it, and then self-published to get it out there to just say here's some of the things that people might be seeing in this violence and sexual assault and self-harm behaviors. And in fact, suicidologists did research and there was a 2020 paper titled, Association Between the Release of Netflix's 13 Reasons Why

and Suicide Rates in the United States, an Interrupted Time Series Analysis. And the researchers found that after adjusting for other factors like annual seasonal trends, the overall suicide rate among 10 to 17 year olds increased significantly in the month immediately following the release of 13 Reasons Why, up to 28 percent and mostly seen in boys. And as a suicidologist, Dr. Mayfran Lizine also was so disturbed by this that he even wrote a book in response titled 13 Answers for the 13 Reasons Why, an episode by episode mental health resource

guide for parents. And in addition to those graphic visuals, the show also featured very poor depictions of shitty psychologists and professionals getting things wrong and failing. So is all those messages put together that ended up being really not so good? Yeah. So there was increases, particularly in people who used the same method as the way that they showed it

in the show. Kurt Cobain as well had some spike there, but then we've seen a lot of the more recent suicides. After folks have had the media guidelines about how do you handle a celebrity suicide and then it doesn't have the same effect that it used to. So you have the reporting, it's not glamorous, it's not super dramatized, and then there's information about how to get help if you're failing the same way. I'm glad you brought up resources too and hotlines. A few people asked about that. Ashley Oki asked, how do you feel about involuntary

hospitalizations being a core of American treatment methods? Nikki asked, as someone with chronic anxiety and depression with intermittent passive ideation, I have a couple of questions. What's the data on efficacy of hotlines and other crisis resources, and 988 especially? So if someone is going through this and let's say that they call 988 or they call one of those hotlines, can you tell me a little bit about what happens on the other end? Sure. So 988 is a network of crisis centers throughout the country.

So hundreds of crisis centers. Some are really big, some are really small. And your call gets routed to whoever is the closest center who's part of the lifeline network who can answer the call. So again, in the US, 988 is available 24-7, 365. Conversations are free. They are confidential. And what happens first is a quick pre-recorded message.

And then a counselor will pick up and say hi. They may play some whole music until they route you to say someone who speaks Spanish or to LGBTQ plus services or a veteran's line. And they'll ask about your safety. And they'll chat to offer support and perspective and resources that you might need. And Dr. Mayfran Luzine does give a heads up

that there might be a wait, but there are backup centers that they route calls to and hundreds of centers if the local one is swamped. And I was looking up some statistics and the wait time for calls can be like 30 seconds. So stick it out. But overall, considered nationally, it's been super effective. We have lots of data showing major positive impacts.

And that was part of the reason why 988 got put forward and got extra funding for the country as a national network. We've had great successes and folks who are up in our Canadian neighbors and their line, the Australian lines, and then the U.S. lines. All of them have shown high efficacy with being able to help people. But again, for 988, because it does vary to some degree, might have to endure a little bit longer wait times. So we're getting more and more centers online for it. So we can answer them faster, but not as fast as we would like.

And we're trying to just always increase the standards and standards. You get new phone systems, recruit new people. So there's lots that they're trying to do. So I just encourage people to call because most likely, you're going to get one of the better centers. If they can't answer, then they're going to get routed to the regional.

They're always checking, always auditing, always trying to encourage the centers to be able to answer more calls, always trying to give extra resources and extra training capabilities. So they're trying their best and most likely, always trying to give extra resources and extra training capabilities. So they're trying their best and most likely folks will be able to get some help from now calling 988, there's texting, there's chat, there's a vet subnetwork, there's now an LGBTQ subnetwork, there's a Spanish subnetwork, and there is also one where it's more video-based.

And they also have resources for deaf and hard of hearing folks as well. So if you get in touch with 988, you can do phone, you can send a text to 988, you can use ASL now, you could do a video call, depending on what your abilities are. They have different methods of communication. Now, if you need the Veterans Crisis Line, you can send a text to 838-255. Also for anyone who has struggled with ideation in the past and wants resources you can use in case it comes up again, there's a template you can fill out for yourself at mysafetyplan.org, which is super helpful. You can even download a blank one if you want to give it to friends or have it printed out for you. And it helps you identify triggers, it helps you identify soothing behaviors, warning signs,

points of contact for support, environmental conditions that might make things safer for you. So no matter how alone you might feel, or if you think that you're the only one who has felt this way and there's no way to get through it, there are people literally waiting to talk to you to help. Who's on the other line when you call? Like who picks up? Is it a volunteer? Is it a clinician? And how are they affected? Do they just help you through an anxiety spike or as someone who hasn't called before, what's it like? So I think most of the center's staff is paid staff.

Some centers have more volunteers. Almost all, or pretty much all, have folks who've gone through 60, 80, sometimes 100 hours of training before they're able to answer calls. And then even once they're able to start answering calls, most are shadowed for a while by a senior counselor who will provide feedback, sometimes hop on the line if necessary. So that'll happen for the first week or two weeks,

sometimes first month. So there's lots of ways that they're trying to make it so that everybody is on board with having the highest quality possible for answering the calls. Actually there's not, the majority of calls are not about suicide. The majority of calls are about other kinds of mental health needs. Sometimes they might get routed to the disaster distress network if there's some major event

like there were responses to the hurricanes or other things like that. And the counselors have to be ready to pick up for anything. 24-7-365, they have to be open to whoever's on the line if they're calling for themselves or if they're calling for a friend or family, that's also a possibility. If you're concerned about somebody else and don't know what to do, they handle those calls as well. They have to be able to possibly transfer over or be able to answer for like 211 types of calls where people are looking for information about something. So they have to be trained in all of those capabilities. So if you have a stained futon

and are wondering when the large garbage pickup day is, don't call 988 about it. That's 311. 211 is free info and referrals from Community Health and Human Services. So you can call 211 for that. And on our website, we'll also link to the Substance Abuse and Mental Health Services Administration's

Disaster Distress Helpline for disaster issues. Now, the Trevor Lifeline provides support to LGBTQ plus youths and allies in crisis or in need of a safe and judgment-free place to talk. And there are also substance abuse helplines available locally, so you can look for any of those. But if you call 988, here's what to expect. And what happens is a call, a person answers,

there'll be some initial dialogue, and they will just talk to the person about what's going on. If it comes up that somebody is feeling suicidal, then they might move into something that's more like a risk assessment. They try to have their least restrictive and least active intervention possible. So it's super rare that they have to try to initiate some kind of emergency rescue or

something. If there is the event they have to initiate some kind of emergency rescue, most of them will use mobile crisis outreach if possible. So that's usually connected to the crisis center. And it'll be like a small team of people will go out on site to try to work with somebody. And then at the final level, they might involve something like an emergency rescue team involving like law enforcement

or ambulance or something like that. But that is really like the very, very, very last thing that's on the list of the interventions that the counselors try. And what about in Ashley Oki's words, how do you feel about involuntary hospitalization? Sigwani Dana said, I recently almost took a grippy sock vacation and is doing much better now after getting meds adjusted. When it comes to getting help from a medical facility, is that effective? Are certain tactics there more effective than others? There might be medical treatment or medication adjustment that needs to happen as well.

But yeah, when it comes to hospitalization, does that tend to be helpful? This is a really tough subject for anyone who has experienced an involuntary stay at the hospital for mental health, which can happen if medical staff determine that you may be a danger to yourself. I can tell you on record, it was the worst experience I had.

And I went to an excellent psychiatric facility, top notch, and it went to an excellent psychiatric facility top-notch and it was still Not good. Yeah, it's only usually a few days maybe ish Possibly a week the main function is the same as means restriction it's just to take away the possibility of life ending method and usually there's not much that happens that is about all the circumstance that led up to it. So then the person leaves

and they're just right back in the thing that their situation, the social aspect, the environmental aspect that was there right before. So it's probably not great. Yeah, a lot of us are not in favor of involuntary hospitalization. It's like, it's similar to talking about law enforcement intervention where it's like the very, very, very, very, very last thing. So if it's not particularly calming and you may not get a ton of actual psychological

care from a doctor, it depends on the facility. Then what is a 5150 involuntary psychiatric hold in a locked hospital setting for? What conditions is that right for? Usually it's there as a way to, honestly to make clinicians feel better. Because that safety aspect is kind of there, the same with lethal means interventions.

But there's so many other possibilities. The only thing that is in my mind beneficial about hospitalizations, and I do not like involuntary hospitalizations at all, the only thing that's possibly beneficial is a chance to intervene in plans happening. So get that delay aspect and have a good comprehensive assessment. Sometimes it's useful for when somebody has substances involved so that there's a chance for detox to happen. And then you're able to do a more in-depth assessment that you couldn't get to otherwise. So in the immediate, for some people, a 5150 hold can be life-saving by preventing access to the means and help them get through an acute distress period so that they can rethink that.

But aside from those really rare circumstances, most things, I would say the vast majority of cases where somebody has been suicidal could have been handled outpatient very well. But part of the problem is that there's a lot of our mental health professionals who have not had a chance to get great suicide prevention training. A lot of them haven't had any courses at all on suicide. I know when I was going through school, I provided the courses for suicide. I provided the lectures for suicide because I was a suicidologist coming through. The same when I was at the state psychiatric hospital. I did the teaching, the grand rounds for suicide prevention because I was the specialist. But without that, there were years and years and years where there wasn't a particular training for it.

So without the trainings, a lot of clinicians don't feel comfortable with having somebody's life in their hands. And who can blame them, right? But the more that we're able to change that, the more clinicians are able to get training and increase their level of competence and confidence, the more we're able to have it so that outpatient facilities and perhaps something like a crisis respite or something like that where it's a lot

more like home environment and it's voluntary. It is a chance for people to interact with others, and it's a lot less hospitally. Yeah, or jail-y. Yeah. Everybody who I've talked to who has had an inpatient experience has identified with my inpatient experience, which was there's a lot of sitting around, there's a lot of doing nothing, there's a lot of groups with people you don't know, and then possibly you're talking to more people and just doing the same assessment over and over again, and perhaps they're gonna give you a

medication, but you're not gonna have a chance to the medication to really take place, so they're not gonna have a chance to really see whether or not you have side effects or anything happening with the medication. So the benefits that could possibly be there, most of them aren't there. So we just need better ways to handle that. Yeah. Wayla had a great question. For those who survive suicide, how much do they want to talk about it? I have a brother who had attempted suicide. He's doing well now, but we've never talked about it. And yeah, wondering for someone who has

contemplated it or been through an attempt, is it better to address it never? Or I mean, it depends. I mean, I feel like pretending like it never happened and ignoring that whole part of someone's mental health and a crisis, pretending like it never happened, could instill some shame, but also you don't want to re-traumatize someone. But if someone broke their femur, you might say, hey, how's your leg doing? Yeah. So I'll offer two things there.

The first thing is, I've seen a lot of benefit for providing positivity to people without requesting something. So the difference between saying, hey, how are you versus, hey, I hope you're well. Whereas I hope you're well just conveys how I'm feeling about you and you don't have to say anything for it.

You don't have to tell me about how you've been or anything. And the other part is providing an invitation. So if you're like, I heard that you were there, and that sounds really hard. Anytime you want to talk about it, I'm here for you. That provides an invitation for them. And if they want to take you up on it, then they can. But it also didn't put it out there that you're like in their face.

And you're like, well, tell me all about your experience. And in that case, if they don't want to talk about it, now they feel like they're put on the spot for it. So it's just providing that comfort and that idea that I am open to talking about this. And if you're able to present it in a nonjudgmental way, that's like, hey, let's just talk about this thing if you want to.

I think that that provides the opening and then it allows them to choose. And perhaps they'll choose right away. You could also say anytime. In that case, they might think about it and then come back. But if somebody feels comfortable and they feel like you're an approachable person and somebody who cares, a lot of times they will talk about it and talk through it because there was usually so much going on. just having the possibility of talking to somebody who's not going to judge it really has a huge impact that's positive for the person.

And what about Pearl Ramon and several others had questions about how to support someone while also not draining yourself maybe? Pearl says living under the threat of a spouse who's made suicidal gestures in the past has been traumatic. What's the best way to navigate a spouse that has indicated suicide while still making sure that you have the resources enough to help them? Yeah.

You definitely have to take care of yourself. And that involves sometimes recruiting extra help for it. I know when I was going through my toughest periods at Brown and I was talking to my best friend about it, at some point she said, I can't do this by myself. I'll go with you. Let's go to psych services and talk to somebody. I've had others who I really want to help you. I want to make sure that you have great help for this because it's super serious. Let's call the lifeline together. Let's call 988 together. So that togetherness aspect

helps them because they don't feel like you're just abandoning them and leaving them all alone, but you're also recruiting somebody else. And then that provides help for both of you. I think that it's really tough to try to deal with something by yourself, particularly if it feels like there's, and we would say an instrumental purpose to having somebody feel suicidal, right?

So that used to be called more like, like manipulative. And now what we say is it's instrumental because they're trying to achieve something with it. So once you can get to the what is that that they're trying to achieve, then you can get to the point where you can, you know, intercept that. It's like, you don't have to go to this extreme in order to get me to pay attention to you or to hang out with you or something, or to take you seriously, or to listen to your concerns or something.

And that really provides a lot of relief for them too, because they're like, I don't have to go to this extreme to do this. That is fantastic. And then I think sometimes people don't even realize that they've become attached to suicide as a way to cope with something. And in those events, somebody is so used to having suicide be the thing that they go to, that

it just becomes more and more and more automatic. Time to go kill myself. But once that can be interrupted as being an automatic thing, so you make it a conscious awareness thing, like what is all the things that are going on that are leading up to this, then it becomes more of an analysis of what are those initial factors, and then you can address those. So asking what is prompting that impulse to want to end things. And the more that you can address those, the more that the suicide part of it can just

get pushed out of the way, the more that that's just not even part of the discussion because you've done the things that are before what happens then. Mm-hmm. And I mean, the biggest question, of course, is identifying some of those things that lead you to think that's the only option, or you jump over what the actual problems are

and what your actual emotions and your pain are into just relieving the pain. If you can stop yourself and ask yourself, what am I feeling? What am I going through? What am I afraid of? What is some advice that you would give people who are struggling with this or how to identify

what they're actually feeling and where to find some hope that it's worth living. I'd say first thing is taking a break, pause. And that could be just rest. It could be sleeping, could be meditating. It could just be sitting and just breathing, could be watching a show or doing something else. Just having that time,

because usually the dramatic intensity that would be there for somebody feeling suicidal that is so high that they would take some action, usually that doesn't last a really long time. So once that has subsided, then we're able to really focus on things more and take action, right? It's just like if you hide your hand and you touch something that was super hot,

the very first thing you're going to do is pull away from the hot thing. And then once that has happened, you can figure out what you're going to do from there, like put some ice on it or put something else on it. And on the topic of ice, this is helpful. You can also use ice to interrupt a panic spiral. So according to a 2018 study, effects of cold stimulation on cardiac vagal activation in healthy participants, randomized controlled trial, that found that

cold stimulation at the neck region would result in improved heart rate variability and lower heart rate, leading to stress reduction. So if you're starting to have an anxiety attack, literally put yourself on ice to freeze it out. Sour candy can also be grounding because it gets you immediately into your body. And another good grounding exercise is this five-point checklist you may have heard of. You can look at five separate objects and think about each of them for a few beats. Then you can listen for four different sounds, figuring out what they are and where they're

coming from. Touch three things and feel the temperature and the texture. I like to think about how many people may have led to them being right where they are today. Who made it? Who touched it? Who sourced it? Who shipped it?

Who owned it before I found it at the thrift store? So that's touching three things. You can use your snooter to then smell two things from the guy blasting a cig down the block or maybe your shampoo in your hair and then identify one thing you can taste. And for me, it's the curly fry that I ate earlier. Another grounding exercise is deep breathing, which is not just in your head. I was very opposed to deep breathing because I was like, what does that even do? Turns out it's in your guts too. It actually works scientifically and physiologically. So a full

breath affects the way that your diaphragm moves and it stimulates something called your vagus nerve, helping your brain say, okay, if we're breathing deeply, we must not be running away from a bear or something. So those deep breaths stimulate the nerve that tells your brain, it's OK, clearly we are chill. Now, in fact, the 2018 paper Breath of Life, the respiratory vagal stimulation model of contemplative activity, noted that the vagal nerve, which involves the parasympathetic nervous system, is the prime candidate in explaining the effects of contemplative practices on health and mental health and cognition, things like meditation

and deep breathing. So deep breaths do help scientifically and they are free. So take a deep breath and ask yourself or whomever is going through it, things like have you eaten? Have you had too much caffeine? How is your sleep? Have you changed anything with your medication recently? Which of those things can you correct immediately

to help your brain's overload? Also, I find asking if someone's changed their medication is a lot nicer than saying, did you go off your meds? Just in case you're looking for a way to phrase that, I'm speaking from experience for myself. But the initial part is the part that we're talking about for feeling super suicidal. And once we can get past that,

then we can wrestle with the other parts. So the first thing is taking a break from it. And the second thing is finding somebody else who you can talk to about the things that are leading up to that, and about the experience, if possible. And I think one of the things that folks will wanna do is distract.

Distraction is really good. It's not something that requires really high involvement about whatever has been distressing. And yet it gives your brain a chance to rest from that analysis about whether or not things are going to be okay in the future and is this going to be something that's going to be terrible for the rest of my life and all of that stuff is really heavy stuff. So taking a break from that allows you to kind of reset. And then if somebody is still feeling suicidal after that,

at that point, at least the intensity is lower. So then they can talk to an aid or talk to a friend or talk to a counselor or talk to somebody else and try to figure out the issues that are underneath that. But definitely the first thing is just pause, do nothing. Katie Payne asked, how can we better advertise that suicidal ideation can be a symptom of OCD and bipolar and is capable of being eliminated through medication?

And Katie writes, I spent 10 years actively suicidal and it wasn't until my second attempt that I was accurately diagnosed with bipolar II and prescribed lithium, which immediately stopped my suicidal ideation. And Allie and Julian mentions, I lost my best friend who was on medication to treat bipolar, and they're not the only one who's lost someone.

I have lost a friend to suicide who had bipolar disorder, and you mentioned your experience with that, and so much of that can be chemical. Do you have any advice for anyone who is in a depressive state with that, or how to support someone who is in that state? Yeah, I think one of the things to know is that there's ways for it to get better.

There's lots of options for things to get better. And sometimes we might try something and then it doesn't work and then folks might give up. But there's so many things to try. I'd say give multiple things a try, give multiple people a try. If you're not clicking with the current therapist, give another therapist a try. There's lots of possible options. Sometimes folks might need to switch to a different psychiatrist or switch to a different medication provider or switch to a different

medication. What is my hot tip as a person with so many friends who have been through this and as someone who has had really tough side effects from hormones and switching to a different antidepressant, you ask? My hot tip is tell people in your life that you switched and ask them to tell you if you're seeming different for better or for worse. Also according to the 2023 paper, Utility of Pharmacogenic Testing to Optimize Antidepressant Pharmacotherapy in Youth, a Narrative Literature Review, it turns out that current research suggests that having an informed knowledge of genomic characteristics could be expected

to enhance the treatment and recovery from mental illness. What do those words mean? Looking at your genome might help people figure out which medications could work better for you and improve your mental health. So perhaps look into it, ask your doctor about genetic testing to help narrow down which medications work better with your brain. Also, one proven treatment for alleviating

some symptoms of depression and anxiety is exercise. Do whatever it takes to make time for a walk every day if you can. Maybe it's to walk to a newsstand and look at trashy magazines for a bit, or to get a coffee in the morning, or to look at a certain tree you like. Moving can be medicine too.

There's just so many options. I think keeping options open is the main thing because that allows for hope that things are gonna change. I think that the depth of depression is one thing, and that's a certain type of pain and suffering, but it's the idea that that's not gonna change and that there's no way for this to get better that leads that into more of a suicidal space.

And the way that our brains operate for depression, there's so many different things that can happen that go wrong for that. So it could be a thyroid issue, it could be a serotonin issue, it could be something in the norepinephrine or in the dopamine system. There's just so many systems that are involved in regulating our moods and in regulating how we're feeling about things and processing things. For more on this, you can see the molecular neurobiology

episode on brain chemicals, or the three-part ADHD episode, and my recent mystery surgery episode about what happens when hormones go low haywire. And each one of those systems is going to have multiple types of medication that can be applicable for it because they're all going to function a little bit different ways. And we're not really great at this point in being able to figure out what's the specific thing that people have that's going on. Do they not have enough of this neurotransmitter or is it that they have too much of it? So all of those different things are going to impact a different medication. The better

and better we're getting about trying to figure out what's happening there, the more targeted we'll be, but that seems like quite a far off. And so at this point, it's just talking to the psychiatrist or talking to the psychiatric nurse practitioner and being as descriptive as possible about the different symptoms that are happening and as wide as possible. So if it just feels like a physical symptom and it feels like that has nothing at all to do with my depression, still talk about it because that might help them to be able to figure out which system it is, because the systems are so throughout the body. So that, I think, is the thing that I try to emphasize the most to people, is that there's tons of stuff for us to try.

Don't give up on it. That, I think, will give people a lot of hope. That's really good to hear. I always ask people the worst and the best things, and I don't even know where to start with someone who is a suicidologist, the worst part of your job. I imagine it must be healing to deal with this and to know that you're changing lives,

but is it hard for you seeing people have struggles that you've struggled with or to die by this? I mean, what is the toughest part? I will edit that and say it more eloquently. Maybe I won't and I'll leave it in to people. No, no one's perfect. Oh, good. Oh, good.

The hardest part actually is trying to get through a lot of the systems and issues that block things and trying to get people to maintain hope about suicide prevention and what can happen after suicide prevention. That to me is the most daunting part of it. I'm actually really comfortable now sitting with the death and despair part, which leads into the best part, which is seeing that turnaround,

to be able to see somebody go from the point where they feel like everything is absolutely horrible, so horrible, in staying alive that they would rather just not do it, to a point where they are embracing life and enjoying life and being part of others' lives. that turnaround is incredible. And being able to fit with somebody who is in that raw state, which sucks, but then also is so open and so vulnerable and so honest is incredible. Then you really get to see and be with just humanity. And there's something really incredibly sensitive and delicate and intimate about being at that level with somebody.

And then there's something wonderful about seeing that part get embraced and pushed forward. That's just the most wonderful thing in the world to see that happen. Yeah, so that's definitely the best part. Your work is so important and that you chose to do this and chose to talk about it and let us share it is really, really meaningful to me. I never thought that I would be on the other side of it myself. I never thought that I would go through it and I never thought that I would be on the other side of it myself. I never thought that I would go through it. And I never thought that I could get through to the other side

to see exactly what was behind my thoughts of it and why an escape hatch seems like the only option. And that perspective that you're giving people is really, really valuable. I think the thing that I talk about, which I've called post-suicidal growth, is just that aspect where a suicidal crisis forces us to stop.

It forces life to come to a halt. And that provides then the opportunity, if you will, for us to then examine what the hell has been going on. And to learn from that, what does this say about me? What does this say about my life? And if we can learn that, then it provides such great depth for moving forward. Dr. Mayfran Lazine notes that we often might get inspired by other people's suggestions or new perspectives or whatever mental health stuff is in the zeitgeist, but so many people who have survived a mental health crisis

wind up experiencing changes beyond what they anticipated. I am one of them. And while it was the worst thing I've ever been through, my life would not be what it is now without that. And my life ended up better than ever because I had to really sift through the bullshit and make it through a scary transition. It doesn't have to get to that low, but making it through the transition any way you can is rewarding.

But once we get to that raw, authentic level about what matters the most to us, being able to build from that into growth is an incredible gift. I think that that has so much power and so much capability, so much possibility in that. Yeah. And when you do get through it, your life has the potential to be much better than it was before. because it does force you to see what does bring you any kind of connection and happiness and realize that's what I got to focus on. This has been amazing.

Thank you so much. Awesome. Thank you. I'm so glad I got to finally meet you. Again, only cried twice. So ask lovely people vital questions because talking helps and stigmas literally kill. Thank you so much to the wonderful, wonderful Dr. DeQuincy May from LASIN. You can find out more about his work at the links in the show notes as well as phone numbers and website lists to get support if you or someone you know needs it.

Also, we have a ton of links to the research and to those help lines we mentioned at alibore.com slash ologies slash suicidology, which is linked in the show notes. Please don't feel like a burden. And please know help is out there waiting. I was looking through something that my husband, Jarrett Sleeper, wrote about my dad.

Side note, Jarrett has a podcast called My Good Bad Brain. He hasn't updated it in a while, but he's very frank about mental health and that too. But Jarrett wrote something after my dad. Side note, Jarrett has a podcast called My Good Bad Brain. He hasn't updated it in a while, but he's very frank about mental health and that too. But Jarrett wrote something after my dad died of cancer in 2022. And Jarrett was with us all through hospice, helping my dad, Larry, at all hours of the day, in all manner, very difficult physical challenges. And after he passed, Jarrett wrote, there is only honor in being allowed to lend a hand to a man so strong and proud. Life will lay us all low. May we always offer our strength to those that could benefit. May we always know we are allowed to accept the love of others help.

And he continued, There's a truth I've taken from this, from Larry, a truth I feel utter confidence standing on and spreading. When something fills you with a love that've taken from this, from Larry. A truth I feel utter confidence standing on and spreading. When something fills you with a love that controls your whole being, let it. And if you can, let the light of that love spread to every part of you. Let it fill all your dark corners. Let it make you better than your instincts and fears. Let it pour from you, sloshing out of you like an overfilled cup. You will never know who is open and ready

to receive the endless bounty of that love with which you have been gifted." So thank you to Jarrett for writing that and getting me and my family through such hard times. I think it's so true. Life will lay us all low. And as he said, may we always offer our strength to those who can benefit and may we always know we're allowed to accept it as well. Again, thanks, Jarrett. And thank you to long time friend and pretty much sister, Erin Talbert, who manages the Ologies podcast

Facebook group. Thanks, Aveline Malik, who makes our professional transcripts. Kelly R Dwyer does the website. Susan Hale has been a friend for decades and is our amazing managing director who keeps the ship on course every week. Noel Dilworth is not only a ballerina, but also my second brain and scheduling producer. Jake Chafee is a kind heart and a skilled editor and putting our pieces together from the snowy north is lead editor

Mercedes Maitland of Maitland Audio. Nick Thorburn of the band Islands made our theme music. And now if you stick around until the end of the episode, you know, I tell you a secret every week. Sometimes it's something embarrassing, sometimes it's something gross, sometimes it's something helpful. And this whole episode honestly has been probably the most publicly vulnerable I've ever been. Yeah, I mean, definitely. But yeah, you might as well know. So I was coming off of Vexer to try a medicine for ADHD. Woo! Boy howdy, hot damn. That was wicked compo. And if you remember last summer, I also had pneumonia. So between the isolation and the chemical shit storm and a burnout from a lot of work

travel, I had that panic attack and my brain kept imagining situations I did not want to do for myself. I knew I couldn't stop picturing. So Jared was out of town. I went to the ER and took myself there because I didn't want anyone to even have the burden of coming with me. And I spent a few nights in the hospital.

It was not comfy. I didn't tell even my mom and sisters what had happened for several days. And honestly, I don't owe anyone my story. I don't even owe you my story. And recording this is a bit scary because I know I won't be able to lend an ear to everyone who needs one. But I want you to know from your dear corny internet dad who has such a fortunate life

that the external circumstances and what we have to cherish are sometimes really hard to see through the fog and the absolute murk of a mental health situation like that. And the truth is that if you hate yourself or if you are convinced everyone hates you and you don't belong and that no one wants to help, it's just not true. I guarantee people love you and care about you.

Some of them might be strangers you haven't even met yet who are waiting to help. And my life versus a year ago is night and day because, like Tequensie said, it forces you to look for the things and the people you love. It forces you to untangle what is keeping you from loving yourself, whether it's chemicals that need adjustment or there are some trauma that taught you untrue things about yourself.

And it's funny, after that panic attack that was so about other people being mad at me, I was afraid I couldn't do my job well or I was afraid that I'd disappoint listeners or I'd make someone mad and have everyone suddenly hate me. A doctor recommended this workbook called The Self-Love Workbook, a life-changing guide to boost self-esteem, recognize your worth and find genuine happiness. It's by Dr. Shiana Ali.

And this doctor asked me to complete it over a weekend. So I had this assignment, I made myself hunker down. And honestly, it is so corny. You would think it would not work, but it helped me so much to understand how I saw myself and the lens that I was looking at myself through and why that was so harmful. So please, you know, reach out to a helpline, talk to a doctor, ask someone you trust to go with you to a doctor, find a support group, find a therapist, get a

new one if you aren't fiving, look into DBT or CBT or EMDR, have someone help you find free community resources, even if it's a food bank if you're broke. And know that you're worth the fight. Don't let people who haven't worked through their own shit or capitalism telling you you're never enough steal your life. My neighbor Donna, who I love, has always had this saying,

don't let anyone steal your joy. And I think about this saying, don't let anyone steal your joy. And I think about that often. Don't let yourself steal your joy. Don't let anyone else steal it. OK? OK. Take care of yourself. Take care of each other.

You never know how much your presence means to others on either side. OK? Chill secret. Good job. Nice, easy secret this week. OK. OK.

Bye bye. Hacodermatology, homology, cryptozoology, lithology, nanotechnology, meteorology, pathology, nephology, serology, pseudonyms. If you're going through hell, keep going.