Harvard Psychologist Matthew Nock: 20% of People Experience Suicidal Thoughts! (Spot the Signs and Ask THESE Questions That Could Save a Life)

Episode Transcript
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Speaker 1 (00:00):
Suicide is one of the leading causes of death around

(00:02):
the world, taking the lives of about a million people
each year around the world, taking more lives than all wars,
all homicide combines. We're each more likely to die by
our own hand than we are by someone else's.

Speaker 2 (00:14):
The family of the teenager who died by suicide alleges
of Open AI's chagipts to play blackmailed with AI generated
nude photos that he died by suicide.

Speaker 1 (00:23):
Doctor Matthew Knock, a world renowned expert on self harm,
pioneering new ways to understand and treat these behaviors.

Speaker 2 (00:30):
What's the biggest myth about suicide that you think it's
important to dismantle.

Speaker 1 (00:35):
If someone really wants to die, then we shouldn't try
and help them. It's destiny, not at all true. Ninety
percent of people who try and kill themselves say I
didn't want to die per se. I wanted to escape
from seemingly intolerable How.

Speaker 2 (00:48):
Many people actually moved from suicidal thoughts to making a plan?

Speaker 1 (00:52):
In the US, about fifteen percent of people think about suicide.
One third of people who ever think about suicide will
ever make a suicide attempt. Those who attempt and survive.
One in five will make another attempt.

Speaker 2 (01:03):
For those people who have attempted suicide but then survived,
do they regret it?

Speaker 1 (01:09):
Three quarters said the first thing they thought was they
regretted it immediately.

Speaker 2 (01:13):
Two thirds of people who died by suicide told someone beforehand,
why aren't we catching those warning signs earlier?

Speaker 1 (01:24):
The number one health and wellness podcast.

Speaker 2 (01:27):
Jay sheid seelyet, Hey, everyone, welcome back to On Purpose,
the number one health podcast in the world. Thanks to
each and every one of you that come back every
week to listen, learn and grow. Now you know that
our mission is to make the world happier, healthier, and
more healed. And today's guest is someone who has dedicated

(01:49):
his life to do just that through his work. I
had the fortune of speaking to our guest a few
months back when I was interviewing him for a book
that I was writing, and this is the next book
that I'm working on. And while I was doing that,
I was so fascinated by his story, his research, the
insights he was sharing that I said I had to
have him on the podcast. Today's guest is doctor Matthew Knock,

(02:13):
a professor of psychology at Harvard University and director of
the Laboratory for Clinical and Developmental Research. Doctor Knock's work
focuses on understanding why people engage in self harm, with
a particular emphasis on suicide through large scale surveys, lab experiments,
and clinical studies. His research aims to uncover how suicidal

(02:36):
behaviors develop, how to predict them, and most importantly, how
to prevent them. Please welcome to On Purpose, doctor Matthew Knock. Matthew,
it's great to have you here.

Speaker 1 (02:47):
Thank you so much for having me. Really really appreciate
you having me on the show.

Speaker 2 (02:50):
Yeah, this is such an important issue. It's an issue
that I think is underspoken about. It still feels taboo.
It feels like it's stayed far away from the mainstream
and lessen until something happens in the space that then
puts a spotlight on it, and then it seems to
disappear again. I wanted to ask you what brought you

(03:11):
to do this work? How did you become passionate and
committed to doing this work in the first place.

Speaker 1 (03:17):
This is a big problem. It's been around for a
long time. We don't talk about it a lot, so
just want to stay from the outset that I really
really appreciate you shining light on the problem of suicide.
I wasn't looking for it. I was actually I was
an undergraduate twenty years old, and I was studying, actually
in London, doing a semester abroad, and I was placed
in an externship sort of clinical practical placement in psychiatric hospital.

(03:40):
And I was assigned to a unit with self injurious, suicidal,
violent patients. And I was just really struck and captivated,
overwhelmed by the problem of suicide and self injury. And
there are patients there who were cutting themselves, burning themselves,
trying to kill themselves. And I was really alarmed. I
was confused, perplexed, inspired by the work of the staff,

(04:01):
and at the time wanted to be a clinician. I
wanted nothing. I do a lot of research now didn't
didn't like the idea of research. And I thought, if
I can understand suicide and know how to better treat it,
this is really, you know, for me jumping in the
deep end of the pool. Everything else should be easier
after this. And I, you know, fast forward thirty years later,
I haven't gotten out of the field. Well kept you
in it, but there are so much work to be done.
I mean, it's such a challenging problem, and it's it

(04:26):
grabbed me philosophically. I was a philosophy biology interested young
person and found psychology and suicide touches so many different
disciplines epidemiologically, public health wise, it's a huge taker of life. Philosophically,
it's something that virtually every major philosopher is focused on.
Camu called it the one truly serious philosophical problem, and scientifically,

(04:48):
there's just so much work to be done, and so
much impact to try and have, and so many people
to try and help, and so much suffering underlying all
of this. I got pulled into it and have not stopped,
and I feel like I can't stop, and we can't
stop because there's so much, so much more work we
have to do.

Speaker 2 (05:04):
What's the biggest myth about suicide that you think it's
important to dismantle before we dive in.

Speaker 1 (05:09):
One of the biggest ones is there's so many One
of the biggest ones is that if someone really wants
to die, then we shouldn't try and help them. That
you know someone wants to die, it's destiny and they're
going to kill themselves not at all true. Most people
who try and kill themselves are ambivalent, they don't want
to die. And I've talked to this point thousands of

(05:30):
people who've been struggling with suicidal thoughts. Ninety percent of
people who try and kill themselves say I didn't want
to die per se. I wanted to escape from seemingly
intolerable pain. And for most people, they're able to work
through that and survive. And most people who try and
kill themselves don't end up dying by suicide. So there's

(05:50):
a lot that we could do to better help people
who are having suicidal thoughts and who are a risk
for suicide.

Speaker 2 (05:56):
How many of the people that attempt to commit suicide
actually not only go through with it, but ultimately complete
complete the belief.

Speaker 1 (06:07):
I'll walk through the pathway. So about in the US,
about fifteen percent of people think about suicide. They say
they've had serious thoughts of suicide at some point in
their life. About five percent of people try to kill
themselves they make a suicide attempt, So only about one
third of people who ever think about suicide will ever
make a suicide attempt. Of those who attempt and survive,

(06:29):
twenty percent or so one in five will make another attempt,
and a small percentage we'll end up dying by suicide.
Some think five percent or se of five to ten percent.
So there's a lot more suffering with suicidal thoughts and
a lot more non lethless suicide attempts than there are
suicide deaths. At the same time, Suicide is one of
the leading causes of death in the US and around

(06:49):
the world. One of the most staggering facts, and I'll
mention too one is suicide takes more life than all wars,
all homicide, all interpersonal violence combined. So if you think
about it, we're each more likely to die by our
own hand than we are by someone else's, which every
time I think about that, everything I say is startling.
We worry a lot about you know, in the news,

(07:11):
there are wars happening. We lock our doors, we lock
our windows, We're concerned about people coming for us and
attacking us. We're more likely to die by our own
hand than we are by someone else's, And that continues
to really perplex me.

Speaker 2 (07:24):
And how many people who attempt suicide will do it again.

Speaker 1 (07:28):
About twenty percent of people who make a suicide attempt
and survive will go on to make another attempt, and
it's often within the next year. So when someone first
has thoughts of suicide in their life, that next year
is the highest risk time for making a suicide attempt.
When someone makes a suicidettempt, if they're going to make
another attempt, it's going to come right after that. And

(07:48):
the highest risk time for suicide death ever is in
the weeks after a person leaves a psychiatric hospitalization for
the treatment of suicidal thoughts or behaviors, which is little counterintuitive,
so you would think that a person just got treatment,
they should be okay, they're out of the woods. Not so.
A lot of times people go into the hospital and
get maybe an antidepressant does take two to four weeks

(08:09):
to have any effect, and people are discharged from the
hospitals today in a week or so. And we're good
at finding people at risk, we're not good at getting
them fully treated in the short period of time the
hospitalation is typically happening. So I would say keep a
close eye on people if someone you know or if
you yourself have been hospitalized for suicide risk. Just because
a person's release doesn't mean that things are totally fine.

(08:31):
Now keep an eye on them, stay in touch, engage
in treatment, make sure they're engaged in treatment.

Speaker 2 (08:36):
Yeah, can you walk me through the different stages of
suicidal thoughts and behaviors and action so we can actually
understand it from a more detailed perspective, because I think
for anyone who's not aware, like myself, it seems like
there's suicidal thoughts and then there's the act. But what

(08:56):
does it really mean?

Speaker 1 (08:57):
Like, so as we as researchers as clinicians think about
a few steps in the pathway to suicide, and the
big sort of sign post or stopped along the way
is first people think about suicide, so having suicidal thoughts
or what we call suicide ideation, having ideas about suicide,
and that's a big outcome we focus on. We try
and understand what gets some people to think about suicide

(09:19):
while others don't. Next is suicide planning, so actually formulating
a plan to kill yourself more intentional. Some people have
suicidal thoughts and it's really aversive to them, and they
don't have plans. You just have the thoughts. They might
have them involuntarily and be really spooked by them, but
some go on About a third go on to make
a suicide plan. They think of a place, a time,
method to kill themselves. And then the next is engaging

(09:42):
in behavior, engaging in a suicide attempt, taking steps to
intentionally end your own life. And as I mentioned, a
lot of people will do that and not die by suicide.
And then the next is, of course, dying by suicide.

Speaker 2 (09:53):
For someone who dies by suicide, the making a plan
piece makes it believe that there is preparation and then premeditation. Yeah,
it's not something that happens at random.

Speaker 1 (10:04):
There often is. There's a lot of variability here. So
some people will die by suicide in a really planful way.
They'll make a plan, they'll leave a note. Often the
notes are very practical. I made the last mortgage payment,
and so you know, here's where the keys are very
practical and to the point, not always, but a lot
of the time, a huge percentage of the time. They're
more impulsive. A person might have thought about suicide and

(10:27):
it's only in a few hours before the event that
they make a decision they're going to end their life.
It's rare that it comes out of nowhere that a
person's walking along living their life and all of a
sudden they have a thought of suicide and die by suicide.
It usually is a much slower build up that there's distress,
there's depression, there's anxiety, there's thoughts of suicide. Sometimes the

(10:47):
thoughts of suicide can last years before a person takes action.
Most of the time, though, if someone's going to make
a suicide attempt, it's within the first year after onset
of suicidal thoughts, so that the thoughts come on as
as the highest risk time, but it's not always planned out.

Speaker 2 (11:03):
What are some of the most Looking at each of
those areas, what are some of the most common reasons
people find themselves having suicidal thoughts?

Speaker 1 (11:12):
Far and away, the biggest reason is escape. If I
had to give one message and try and demystify suicide
for those who are struggling with who haven't had suicidal
thoughts and are struggling with understanding, why would someone ever
think about suicide again? Nine out of ten times it's
I don't want to be dead, per se. I want
to escape from this seemingly intolerable pain. People describe it

(11:33):
often like trying to get out of a burning room.
I don't want to die, I just I can't I
don't think I can take this pain anymore. And so
that guess people thinking a lot about suicide a lot
of the time. And what is that pain a lot
of time? It's depression. So depression is one of the
strongest predictors of having suicidal thoughts. And depression takes many
forms and manifests differently. Some people describe it as having

(11:53):
like a weighted vest on, some people describe it as
as just really psychological pain, as despair, But it is
one of the biggest drivers of having thoughts about suicide. Interestingly,
the things that predict who acts on their suicidal thoughts
are different. Depression doesn't really predict acting in your suicidal thoughts.
What does is anxiety, aggressiveness, poor behavioral control, drug use,

(12:14):
alcohol over alcohol use. These things predict acting on suicidal thoughts,
and it's the combination of these things that we think
really puts people at risk.

Speaker 2 (12:21):
The symptoms of someone thinking about suicide are the different different, yeah,
to the ones that actually act on it.

Speaker 1 (12:27):
Yeah, And I'll go a step further. This is one
of the more interesting findings I've come across. Your parent's
history of depression. If you have a parent with depression,
that increases your risk of thinking about suicide, and it
actually increases the length of your suicidal thoughts, the persistence
in years of your suicidal thinking, but doesn't predict you
acting on your suicidal thoughts. What does is your parent's

(12:49):
history of antisocial behavior panic disorder, so hyper arousal tendency
to act impulsively. This predicts you acting on your suicidal thoughts.
So we think these different pieces of the pathway to
suicide might be passed down differently, genetically familiarly.

Speaker 2 (13:05):
When you talk about those almost extreme feelings of escaping, Yeah,
that idea of running out of a burning room. Is
there a correlation between that feeling and money more or
relationships or like life situation or is it across the
board And we don't have clarity on that yet.

Speaker 1 (13:26):
Yeah, we don't have a lot of clarity. I think
pain manifests differently for different people. And one thing about
suicide is there are sociodemographic factors that predict who becomes suicidal.
For instance, for gender, women are more likely to have
suicidal thoughts and engage in not only though suicidal behavior.
Men are likely to die by suicide by a ratio

(13:47):
of about four to one and that's true and virtually
every country around the world. There's a lot of other
things that go into suicidal thoughts and behaviors that put
a person at risk, that lead to that sort of
that feed that fire. And it's different for different people.
So relationship problems predict, legal problems predict, but suicide knows
no bounds. Where it comes to income, there aren't buying

(14:10):
large big financial differences. People at all income levels are
almost equally at risk. So socioeconomic factors, education levels, income levels,
suicide doesn't really discriminate. It's a problem for all, almost
all members of society.

Speaker 2 (14:25):
What does that tell us?

Speaker 1 (14:27):
There's a lot of roads leading to rome. I mean,
there's a lot of ways to put a person at
risk for suicide. And again, I've been trying to figure
out what is the thing, what is the motivator? It's
this burning room, it's this fire. So that's where I
usually start scientifically and where I start clinically. I'm a
licensed psychologist, so I have worked with patients over the
years try and figure out the motivation and what is

(14:48):
it for this person that's leading them to want to escape?
What are they trying to escape from? What is the
pain for this person. I think attempts to try and
find a silver bullet of Oh, its relationship or oh
it's finance, or oh it's a mental illness are a
little bit misguided. They're one piece of the puzzle. I
think we've got to start or I think it's helpful
to start with. What is a person's experience is? What

(15:09):
are they trying, what's making them suicidal, What's what's making
them not want to live anymore? What is it for them?
Let's try and understand that and see if we can
figure out some way to solve that problem, help them
tolerate with their experience without dying, and then work backwards
from there.

Speaker 2 (15:25):
Yeah, that makes a lot of sense, Like the idea
of seeing everyone's experience is unique to them and recognizing
what their burning room is right and not projecting an
external value or belief onto that and why it exists. Yeah,
you spoke a bit about this a couple of moments ago.
What are the key differences between how men and women

(15:46):
think and approach suicide?

Speaker 1 (15:48):
As I said, there's big gender differences. So women are
much more at risk for thinking about suicide and for
engaging in suicidal behavior. Men are much more at risk
for dying by suicide, and we think that's that different
is due to women being much having much higher rates
of anxiety and depression, which are more closely linked with
suicidal thoughts, men having higher rates of alcohol and drug

(16:10):
use disorders and aggressive behavior and impulsive behavior being more
linked with impulsive aggressive action, and we think those are
two of the big drivers of why we see those
gender differences and why they persist almost everywhere everywhere around
the world. There are some common allities across genders. In
terms of age, suicide is pretty rare in young people

(16:31):
meaning children in every country we've looked at around the world,
and we've looked at dozens of them. Suicide rates and
rates of suicidal thinking skyrocket and adolescents every country. They
even out in young adulthood, and then they go up
again later in life, and that increase later in life
is especially prominent among men. We think this is because women,

(16:54):
these are generalities, tend to be more socially connected, have
more friends, have more close relationships, tend to have fewer
of them, and later in life, when people hit retirement age,
men tend to be less connected. And we think this
lack of social connectedness, lack of reaching out for help
is what leads people to have this increase in suicide
later in life.

Speaker 2 (17:14):
Wow. And so looking at the different ages, the first
was adolescens. Yeah, and the key reasons for that was we're.

Speaker 1 (17:20):
Still trying to figure it out scientifically. What is it
about adolescence that increases risk. One of the leading explanations
is this imbalance that we see in adolescence in brain development,
where this is a little bit of an oversimplification. Parts
of the brain involved with emotionality, impulsive action, the limbic
system are ramping up in adolescence, but the breaks the

(17:41):
prefront the cortex isn't fully online until early adulthood, and
so we see huge increases in risk taking behavior, aggressive behavior,
alcohol use, drug use in adolescence. We also see huge
increases in depressed illness, anxiety disorders. We also see increases
in bipolar disorder, which is a huge contribt ter to
risk psychotic illness. So inadolescents, aspects of adolescent brain development

(18:05):
are coming online, likely leading to increases in psychopathology, leading
to increases in suicide risk.

Speaker 2 (18:13):
Is there any difference between countries and ages, and.

Speaker 1 (18:17):
No, there's differences in rates. So rates of suicidal thoughts
and behaviors and suicide death vary around the globe, and
we're still trying to understand why they're not explained by geography.
They're not explained by high, middle low income countries, so
we're trying to understand how, undoubtedly religion and culture player role.
There's also differences in reporting, so a lot of the

(18:40):
numbers we have, we think aren't completely accurate. Suicide is
still illegal in many countries around the world, and that's
going to influence how it gets reported.

Speaker 2 (18:47):
Do you think we should be talking about suicide at
school because I was thinking about an analogy that you
gave around being in a burning room. Yeah, and I
was thinking that we were all trained what to do
in the event of a fire. We were all trained
what to do if you live in a country that
experienced earthquakes, And again, those two things are pretty not

(19:13):
many people are going to experience those, but we train
people because we believe it's a possibility. Yeah, when you're
saying fifteen percent of people are going to have suicidal thoughts,
do you think it's important that we almost equip everyone
with a safety plan or with the idea of what
to do when that happens.

Speaker 1 (19:31):
Yeah, I do. You know, you look at what's happening
with school shootings in the US, and it's you know,
training of what to do. If there's a shooter, it's
more likely there's going to be someone who's suicidal, was
going to die by suicide, who's going to try and
kill themselves. So there's going to be a suicide cluster,
a number of kids who try and kill themselves. Again,
we know that asking about suicide, talking about suicide does
not make people suicidal. There are programs that go into

(19:54):
schools and do a little mini educational module about suicide
in health class or out of how class. Here's what
suicidal thoughts are, here's the suicidal behaviors are. Here's what
you can do to keep yourself safe. Here's effective interventions.
Here's what you do if someone you know is struggling
with suicdal thoughts. It's something that is being done on
a small scale. Now I think it'd be wonderful to

(20:15):
see it done on a much larger scale. Could help
save lives.

Speaker 2 (20:18):
Yeah, it just sounds like because it's something that fifteen
percent of people are going to think about at some point,
and if you thought about any of the other things
we get trained to do. It just feels like it
would be useful. Absolutely, it would be really absolutely.

Speaker 1 (20:34):
I think again, it's taboo, it's stigma. It's fear that's
keeping it away from more more common use. And we've
shown over and over again there's no reason to be scared.
It's where it's not going to do harm. And again,
continued experimentation will be our friend here and we can
see are there some versions of this that do harm?
If so, then we won't do them. Are there ones

(20:54):
that work and help keep kids safe and prevent loss
of life due to suicide? Wonderful. Let's expand those and
make them available that people don't needlessly lose their kids
to suicide, or their friends or their loves.

Speaker 2 (21:20):
When you talk about adolescents, I mean, I just came
across this story in the New York Times a couple
of months back. I'm sure you saw it, but it
was the family of a teenager who died by suicide
alleges open Aiyes, chat GPT is to blame. And for
those who don't know, I'm reading from the New York
Times article. It says the parents of Adam Rain who

(21:41):
died by suicide in April, claim in a new lawsuit
against Open AI that the teenager used chat GPT as
his suicide coach, and it goes on to say that
you know, after the suicide, they were searching through his
phone desperately looking for clues about what could have led
to the tragedy. They say, we thought we were looking

(22:01):
for Snapchat discussions, or Internet search history or some weird cult,
but they were led to find his conversations with CHATGBT.
I mean, I can't it's so tragic. And you know,
when you see Adam, it's this picture of him, it's
so hard to wrap your head around it. And when

(22:24):
I was reading that, I was just thinking, I can't
imagine being a parent right now where you're already scared
about bullying and how that affects children. You're scared about
online bullying to the level of whatever this gentleman was
sadly going through then leading to actually using AI as

(22:46):
his suicide coach. Walk me through how you think about
that when you read something like this.

Speaker 1 (22:54):
It's tragic. As I mentioned, I think, as a parent
of three, I find it difficult to imagine anything more
tragic horrible than gut wrenching than losing a child to suicide.
So that's the first thing that comes to my mind. Always,
still having worked in this area for over twenty five years,
it's still a gut punch and a feeling like we

(23:15):
need to do more. It's an interesting time to be
a little cliche, but in terms of the possibilities of
machine learning, of generative AI, of all the data points
that we're getting, I think there's huge promise in these advances,
but there's also a lot of dangers, and for me,
it's very early days and it's tragic when we see

(23:38):
instances like this where and if you read through the
article which I saw as well, you can see pretty
clearly how the AI went, how things went awry, and
how things were missed, and how it's amazing how human
like these technologies currently are, but they're not human, and
they're missing things and in some cases. There's a number

(23:59):
of two or three store is this week on this
topic in the New York Times and other leading outlets.
The AI right now often gets it wrong, misses opportunities
to jump in humans missed them to but misses pretty
clear ones and in some cases encourages people and says, yeah,
it's based on what you're experiencing. It sounds like this
is a logical solution to your problem. And so it's

(24:20):
grewing up majorly and I think huge changes are needed
and how it's being used general of AI. Again, I
know it sounds cliche, but it's true. Is a tool,
and like a sharp knife, it can be used to help,
but it could be used to harm. And we haven't
yet figured out how to use generative AI to help

(24:40):
in this instance, and in some cases it's harming, no doubt.
In a lot of cases, generative AI large language models
are helping people one problem with suicide or problem with
one problem suicide. Overall, it's a huge taker of lives
and many people don't have access to care, and so
there's great potential here to use gener of AI to
help people, but it's not developed for this purpose and

(25:05):
it's going awry and it's contributing to the problem in
many cases.

Speaker 2 (25:08):
I've seen so many people who heard of so many people,
have so many friends who use CHAGPT as therapy and
finding it very useful, finding it very smiful, and finding
very practical. And then you see this side and it
almost seems like there's a great need for guardrails connecting
to a human as soon as possible. I mean, yeah,

(25:29):
finding care before it goes away, because.

Speaker 1 (25:31):
Yeah, there's from my perspective, there's a need for research.
So as in any area, everyone here I'm sure is
well intended. I'm sure open a high as well intended.
And a lot of the digital mental health startups that
are popping up all over the place are well intended.
But intentions in themselves don't always leave the positive outcomes,
and there's instances. I'll mention one platform that I won't
mention the name of had this wonderful app where it

(25:54):
could find people online who were suicidal and it would
inform their friends reach out to this person their struggle.
Very well intented, very logical. It was pulled down in
just a few days because it's totally backfired and it
was finding kids online who were being bullied and informing
people in the network, including the bully who is then
bullying them more. I see your suicidal, you should go
and kill yourself. And so the platform, to their credit,
pulled it down pretty quickly. Just one instance of the

(26:17):
contentions are good, the idea is a good one, but
without testing without experimentation, lots of bad stuff is going
to be put out there, and lots of ineffective things,
lots of harmful things. So this is where I think
science has to come in to evaluate things and see
what's working, what's not working. Let's pull down the things
that are not working, improve the things that are, and
get them to people so they can be helped.

Speaker 2 (26:37):
Yeah, I mean, bullying isn't a new issue, but I
was reading some statistics that I was saying that cyber
bullying makes someone over three times more likely to contemplate suicide,
and then general in person bullying makes it two to
nine times more likely to consider suicide. It seems like humans,

(26:57):
especially at the adolescent age, when I feel like bullying is,
you know, the most prevalent. Sure, it seems like we
still haven't figured out a way to help young people
curb their desire to bully others.

Speaker 1 (27:09):
No, it's a it's a I'm sure a perennial issue,
a timeless issue where we see it in non human animals,
where adolescent elephants will bully other elephants and the bully
other animals if there's not parents around constantly. Zoos have
sort of address this when it occurs. So it's a
problem and a lot of animals, a lot of organisms.

(27:31):
It's not new then it's not caused by the Internet
and AI, but it manifests in new ways, and it
manifests in ways. Bullying manifests in ways that parents don't
really know about. What kids are doing online is unknown
to parents, and the bullying now is taking new forms,
and it's undoto clinicians, it's undoto parents, and so it's
more insidious, and it's more around the clock it used

(27:53):
to be when I was young. Perhaps when you were young,
you go to school and you get bullied, or maybe
you bully or and then you go home and it's over.
And now it's round the clock, and that lack of
ability to escape, we think can be really problematic for
a lot of kids. And so here too, it's a tool,
and we've got to figure out how to best use
it and how to use it for good and for

(28:13):
improving well being and for improving mental health. We did
a qualitative study with suicidal adolescence in a local hospital
and we asked them about their social media use, their
online use, and what they describe was, yeah, there's bullying
there's social comparison. I see what other people have and
I don't. I feel really bad about myself. I'm learning

(28:35):
new ways to cut myself in ways that it can't
be discovered. So there's a lot of bad happening, there's
just as much good. And they're saying I'm learning skills,
I'm learning how to be mindful. I'm learning about ways
I can help calm myself down when I'm upset. So there's,
as with any tool, there's good and bad happening. We
just need to do a better job clinically, parentally, societally
scientifically at catching up and learning how to use this

(28:57):
in ways that are helpful and can improve mental health
and decrease with guardrails or otherwise the harms that it's
clearly doing.

Speaker 2 (29:05):
This was the other one I saw on AI that
was heartbreaking. Was teen was blackmailed with AI generated nude
photos of himself. Then he died by suicide, and so
Eli died by suicide on February twenty eighth, twenty twenty five,
after receiving alarming texts to send a threatned to send

(29:26):
AI generated nude photos of the sixteen year old to
friends and family if he didn't hand over three thousand
dollars in the led sextortion scam. Sextortion often targets teens
and children and is becoming increasingly dangerous. According to the FBI.
The article read and so, yeah, it's such a I
mean again, I think as a parent, it's such a

(29:49):
stressful time. What have you seen have been What are
things parents can do to help to be involved in
the conversation, to be useful. What have you seen through
research that parents can shift and change about their behavior, attitude.

Speaker 1 (30:06):
It's a great question. Reach out and have the conversation.
So talk about suicide. Talk with your child about suicide,
about what they're experiencing about their mental health. Suicide is
still incredibly taboo, and one of the biggest myths that
I hear is if I talk about suicide, if I
ask my child, or ask my spouse or ask my
friend about suicide, it's going to give them the idea

(30:28):
and make them suicidal. And so I'm not going to
say anything. And that's been shown experimentally time and again
to not be true. Oh, it doesn't does not happen.
And people have done experiments where they ask some kids
if they're suicidal and don't ask others and follow them up.
Kids who get asked about suicide, middle school students, high
school students, adults are not more distressed, They're not more suicidal.
If talking about suicide, asking about suicide made someone suicidal.

(30:53):
I've been talking about every day for the past twenty
five years. Our team has clinicians have I've talked with
my kids about suicide. It does not. The research shows
does not make people suicidal. So I would encourage parents
to have these conversations. I'd encourage any younger folks listening
have these conversations. If you think someone might be at risk,
ask them. Even if they're not at risk, ask them.

(31:13):
Have the conversation, and it signals. It communicates to your child,
to your friend, but it's okay to talk about this,
and that I'm a person that you can come to
and talk about what's happening with you, whether it's suicide
or mental health.

Speaker 2 (31:23):
More broadly, what age did you have that conversation?

Speaker 1 (31:26):
You have three kids?

Speaker 2 (31:28):
Three? Okay? Three? Yeah? Are they old teenagers?

Speaker 1 (31:31):
Our youngest is twelve, our oldest is nineteen, probably around
ten or so.

Speaker 2 (31:37):
Wow, that's WoT.

Speaker 1 (31:39):
It used to be the common thinking that kids can
even contemplate the idea of death until age ten twelve.
We're now seeing suicide among younger people, among children increasing dramatically,
and the US National in Student of perilf has put
a call for research on this problem with child suicide
to try and figure out what's happening and why is

(31:59):
it that younger people are now thinking about suicide and
dying by suicide more than they have been historically. And
so it's probably around h ten or so. I let
my kids know what I do and have conversations about
them and ask them questions about have they ever had
feelings of depression or anxiety or thoughts about suicide, perhaps

(32:20):
earlier than other parents. This is what I study, and
so this is what's on my mind a lot. But
I also have had instances personally professionally, I've seen instances
of people missing, missing the opportunity to talk to someone
about suicide, losing someone to suicide, and as we all
do if you've lost one to suicide, torture ourselves thinking back,
could I have said anything I, should I have asked?
Should I have done something differently? And knowing that it's

(32:42):
not harmful to ask someone about suicide it's not going
to increase their risk, just as it wouldn't if you
ask someone are you thinking about killing someone? If they're not,
they're very unlikely to now go out and want to
kill someone because you raise the idea. It's the same
kind of situation.

Speaker 2 (32:58):
Well, how did that conversation go? Because I can imagine
that maybe when kids attend they maybe I've been listening.
Of course, you're a researcher and an expert in the field.
What about when kids are kind of like I don't
want to talk about that. Mom and dad like I'm
not interested in having this conversation with you, which seems
like a natural teenage response. I'm thinking, Yeah, if my
parents had asked me that at fourteen fifteen, i'd just

(33:19):
been like, what's wrong with you?

Speaker 1 (33:20):
Yeah? And so my kids never want to talk to me,
So it's hard to tease that one. Yeah, I think
that's okay. I think it again. It still signals that
you're open to having that conversation with them. So even
if it seems to not go well and your child
says or your friend says, I don't want to talk
about it, you've at least let them know that it
is okay for them to come to you and that

(33:41):
you're someone who's open to talking about this. I've also
seen instances of kids saying I'm thinking about suicide and
the parents that we're not going to talk about this,
or you're just doing that for attention. That's a missed
opportunity to talk. And if the child's doing it for attention,
if I need to tell you that I'm going to
hurt myself or kill myself to communicate my pain, maybe
it's pain worth attending to and talking with the person about.

Speaker 2 (34:03):
So even if someone's joking about it or laughing about
it or puts it in that kind of frame, it's
not something that should be disregarded because it's so extreme.

Speaker 1 (34:10):
I'd follow up. I'd ask about it. About two thirds
sixty six percent of the time when people die by suicide,
they told someone ahead of time. They mentioned I'm thinking
about death, they might have joked about it, They've talked
about it in some way. So people are putting those
signals out there. I think it's worth following up and
asking someone, are things so bad that you're actually thinking

(34:31):
about suicide? Have you thought about taking your life? Even
if they're joking you don't need to every time. If
it's a clear joke, it's a clear you know it's
a joke. But if you have the thought, have the
feeling to ask about it, I would ask about it. Yeah,
it's hard. Admittedly it's still hard to do. I've been
doing this for decades and it's still I still have
a little hesitation before I ask friends, family members. But
I ask because I know the consequences of not asking,

(34:54):
and I know the statistics, and I know that we've
done studies asking people who've tried to kill themselves. Is
there anything that could have prevented you I'm trying to
kill yourself, And the top two things people say are
if there was some way to make the pain go away,
and if I was able to talk with someone else
about what is experiencing. So I know firsthand and I
know scientifically that lack of connection, that lack of communication

(35:14):
can be deadly. And so push through the anxiety, pushed
through the uncomfortability of asking someone and ask them. Invariably,
in almost every experience I've had, I can't think of
one where this hasn't been the case. It's gone well
and the person has either said yes, I am thinking
about it, and I'm glad you asked, or no, I'm not.
And now they know that if they do have those thoughts,
or if those thoughts intensify, I'm some one they can

(35:34):
talk with. And I think the bigger the network of
people that one has, the more likely they are to
not die by suicide.

Speaker 2 (35:42):
So let's say parents or your friend, You've had the
conversation with them. Yeah, you're worried about them. Yeah, what
do you do next? And where should people go? Parents
or friends of kids teens who are listening right now,
and yeah, they go, I think someone's struggling. I don't
fully know what do I do?

Speaker 1 (35:57):
Yeah? I like to think about Acronyms can be helpful
giving a person air ai R. So ask the question,
if you think someone might be at risk, ask them,
initiate a conversation, initiate support. There's a tendency for people
to pull away and the person who asks and not
to follow up and are for refer. Don't try and
do it all on your own, refer them. So aire

(36:19):
ask the question, and I usually try and ease into it,
and I ask, and we teach us our doctoral students
who are learning to be clinical psychologists asking a calm,
dispassionate demeanor. Are things so bad that you've thought about suicide?
And I'll lead into it with think asking about depression.
Have you have thoughts of death? Have you have thoughts
of suicide? So you can ease into it, and if so,

(36:40):
initiate a conversation. Initiate support. As with death, as with funerals,
people get uncomfortable and they don't want they don't know
what to say, and so they pull back, lean in,
initiate a conversation, initiate support, be there for the person,
but also always refer. Don't try and do it all
on your own. Bring a person to professional care. There
are hotlines. There are crisis lines in most countries around

(37:01):
the world. In the US it's nine eight eight. You
can find these easily on a search online. A lot
of them operate twenty four seven. You don't need to
bring a person to the hospital. You can if the
person's thinking about killing themselves today, I would take them
to the hospital and have them I'm getting evaluation. But
you can call nine eight eight, you can call it
a you can text the text line. Refer the person

(37:23):
for help. A lot of Probably the most common thing
I've seen is a person will say, yeah, I've thought
about suicide, but please don't tell anyone. Promise me you
won't tell anyone. I wouldn't promise. I would say I
care about you and I want you to stay alive,
and I value your life even more than I value
our friendship. And if you're not going to be my
friend anymore because I shared someone, then so be it. Again.
I can't emphasize enough how important it is to try

(37:44):
and take that step, and how got wrenching it is
to lose a person to suicide and to struggle with
the question of could I have done more? Should I
have taken one more step?

Speaker 2 (37:53):
Yeah, Matt, Why are suicide rates especially high among white men?

Speaker 1 (38:00):
It's a great question. That's there's a lot about suicide
that are sort of perennial statistics that we just don't understand,
and and this is one of them. So I mentioned
the men part of that. We think that the rates
are higher among men than women because men tend to
use tend to be more aggressive, more impulsive, to use
more lethal means. In the US, much more local use

(38:20):
firearms than women are. Women tend to use means that
tend to be less lethal cutting, overdose, and so on.
Why white men, we're not sure. That's been a statistic
that's been prevalent in the US for a really long time,
and we don't fully understand it. Another really striking statistic
is the rate of suicidal behavior among black teens in

(38:43):
the US is skyrocketing in the past few years, among
black male youth in particular, And that's not the one.
We don't fully understand, and there's ideas about why this
might be. But there's a lot of science happening right
now to try and better understand this.

Speaker 2 (38:57):
It's such important research and so needed. Is this area
of research underfunded.

Speaker 1 (39:02):
It's wildly underfunded. Suicide is one of the leading causes
of death in the US. Around the world, it's the
second leading cause of death among people ages ten to
thirty four, behind only accidents. So among young people, it
takes more lives than anything other than accidence, and overall
the fourth leading cause or contributor to years of life

(39:25):
lost because it takes so many young people of all
causes of death, Yet it is almost at the end
of the list in terms of funding. There's about a
we need to triple the funding for suicide research to
even become close to the causes of death that surround it.
So there's just an incredible dearth of scientific research being

(39:47):
done on suicide relative to the scope of the problem.
And it's not for lack of want. I think it
has to do with stigma. That again, people don't like
talking about suicide. It's a taboo topic. There's a fear
that if I talk ab about it, if I shine
a light on it, it's going to make things worse. And
I think this trickles down to funding as well, and
so we're not funding it at the rate that we
should be. Another myth about suicide is it's an epidemic.

(40:10):
The rates have skyrocketed. They haven't. The suicide rate in
the US now is virtually identical to what it was
one hundred years ago. Contrast that with many of the
other leading causes of death that have dropped precipitously over
the past hundred years, heart disease, accidents, tuberculosis, pneumonia, HIV, AIDS,
most recently COVID. We dedicate science to these things. We

(40:33):
do medical research, we disseminate the results. We're really good
humans are really good at applying scientific studies to big
problems and decreasing the mortality rate. We haven't done that
to suicide. The suicide rate is pretty flat over one
hundred years, and so I loved why. I'm really excited
that you're focusing on this problem and bringing attention to it,
shining a light on it. We need more research on

(40:54):
this topic because there's these huge questions about why young
black males, why older white men, how can generative aib us,
on and on and on. There's so much opportunity that's
not realized because we don't have enough research on the topic.

Speaker 2 (41:07):
Yeah, if you are advising AI companies right now, how
would you encourage them to think about it?

Speaker 1 (41:14):
A commitment to the scientific process. Again, it's one thing
to have a good idea, a really clever idea, a
good idea and well intentions. You have to do the research,
you have to do the experiments. I would encourage AI
companies to collaborate with scientists, academic researchers who are independent,
're working closely with and do studies on the best ideas,

(41:35):
see what works, see what doesn't, Disseminate the things that work,
and drop out the things that don't. One thing that
give me great hope about the problem of suicide and
the potentials that there. This is although it's a leading
cause of death, it's a low base rate problem, and
we have been able to predict it and target it
for treatment because we've had a lack of data. It's

(41:55):
kind of like I often think about tornado prediction or
hurricane prediction, where tornadoes hurricanes have been around as long
as the earth has been here, and for a long time,
we have these sort of mystical religious explanations for why
they exist. And as we've got more and more data
and better science and better statistical models, we can predict
them and we know when they're going to occur, and
we get warnings weeks ahead for hurricanes, hours ahead for tornadoes,

(42:17):
and we save lives. We now have a lot of
data on people. We all have cell phones and wearable devices,
and we're online and there's all these digital breadcrumbs all
around us. We can predict and we can tailor using
genera AI two people better than we ever could in
human history. And so there's so we're right there. I
think we've got all the tools to be able to

(42:39):
have a big impact, but we're not doing it. So
I could send a message to the big AI companies
and be collaborate with researchers on this, lean into the
problem and experiment and find ways to use the incredible
tools that we now have to help young people to

(42:59):
improve health, to decrease suffering, to save lives.

Speaker 2 (43:03):
I also saw that new mothers can actually struggle with
suicidal thoughts. Yeah, yeah, that fascinated me.

Speaker 1 (43:10):
Yeah, it's a really interesting pattern in the data where
new mothers have huge increases in suicidal thoughts, which you're
having young kids to be stressful. It makes sense that
you have perhaps increased depression, post part of depression and
anxiety and thoughts of suicide. Young mothers have a huge
decrease and risk of suicide death. So I think there's
reason to not take your life if you've got young kids.

(43:32):
And so although there's an increase in suicidal thoughts, there's
a decrease in suicide death. Having young kids is protective.

Speaker 2 (43:39):
Yeah, I feel like and that I can't imagine how
much stress that puts on someone, Like the reason you're
having suicidal thoughts is because there's some sort of extreme
stress in your life. Yeah, I'm assuming there's then an
associated stress of having suicidal thoughts. Almost like the double
guilt and shame of Yeah, I can't believe I'm having
suicidal thoughts. I just gave birth, or I can't believe

(44:00):
I'm having suicidal thoughts. Have to take care of my family,
and that almost feels like a vicious psychle Yeah.

Speaker 1 (44:05):
Yes, And people often feel really isolated and they pull
back from others because they're afraid to tell other people
how they're feeling. And if I've got a young child
at home and I'm thinking about suicide and communicate that
someone else, are people going to fear for the safety
of my child. There's a lot of guilt, there's a
lot of shame that people report when they have thoughts
of suicide. Many people often also often report relief when

(44:27):
they have thoughts of suicide, almost like imagining a vacation
from their problems, imagining an escape from their situation, and
so it brings temporary relief to someone, so it's reaving.
The thoughts can be reinforcing, and we think lead them
to persist.

Speaker 2 (44:40):
But overall, you two sort of thoughts are dangerous even
if they're seen that way, or.

Speaker 1 (44:45):
They're dangerous insofar as they can lead to suicide death.
But again fifteen percent of people have thoughts of suicide.
Two thirds of people who have thoughts of suicide will
never act on them, so they in themselves they're incredibly distressing.

Speaker 2 (45:02):
Is the goal to never have a suicidal thought? Again?
For someone who's having suicidal thoughts.

Speaker 1 (45:07):
I think that would be the ideal goal is to
not have suicetal thoughts to begin with. Interestingly, most treatments
that most psychological treatments that show an effect for preventing
suicidal behavior, they don't work by decreasing suicidal thoughts. They
work by decreasing people's likelihood of acting on their suicidal thoughts.
So we're not really good yet scientifically clinically at getting
people to not think about suicide. What we can do

(45:30):
through psychotherapy is get them to not act on those thoughts.
Targeting depression, target anxiety doesn't seem to work as well
as you thought it would for getting rid of suicidal thoughts.

Speaker 2 (45:38):
What does that program look like? Yeah, to stop that transition? Yeah.

Speaker 1 (45:44):
So some of the best evidence we have is for
interventions like cognitive therapy, cognitive behavior therapy or a newer
version called dialectical behavior therapy, which is basically cognitive therapy
but with an Eastern Buddhist influence. Cognitive therapy is a
lot about change dialectical behavior. The your DBT is acceptance
and change, so accepting the thoughts, the feelings that you have,

(46:05):
noticing them and not acting on them. And so those
interventions are a lot about helping people to understand when
their risk is increasing and what skills they can develop
and use to get through those periods and try and
ultimately decrease the likelihood of having thoughts of suicide. But
our interventions aren't quite there yet, So they're teaching skills

(46:26):
of distressed tolerance. When you have thoughts of suicide, when
you feel that fire, when you feel that intense pain,
what can you do to try and tolerate it, What
can you do to try and distract from it, either
by using some skill cognitive reframing, taking a shower, going
for a walk, reading, doing some mindfulness practices, or reaching
out to someone else, getting good at reaching out to

(46:49):
your friends, your family when you're at risk, or taking
a step further and reaching out for professional help when
you're at risk.

Speaker 2 (47:11):
Not for those people who have attempted suicide but then survived,
do they regret it?

Speaker 1 (47:18):
Most do, so there are some data on this, and
about three quarters of people who there's one study on
the Golden Gate Bridge, which is if you jump from
a really tall bridge, it tends to be lethal, so
people who jump off and survive are rare. And there
was an interview done with people who jumped off and survived,
in three quarters said the first thing they thought when

(47:39):
they jumped was they regretted it immediately. And when we
followed up and asked people who have made to au
set attempts and survived how they felt afterwards, the majority
report feeling shame and guilt and disappointment that they had
made suicidal they had engaged into a side of behavior.
And so that's a message that I would hope that
could be heard by people who are thinking about those

(48:00):
who have taken the step to try and kill themselves.
Most immediately regret it, and in the longer term continue
to regret it and feel bad and wish they didn't
try and kill themselves, And the majority verbalize that they
wish they had someone they could have talked to, or
wish they talked to someone about what they're experiencing ahead
of time. And some people say after the fact, when

(48:21):
they're in the hospital. They didn't realize how much people cared.
They didn't realize how much treatment is available and how
much better things could be. So I would hope that
if people are listening to this who are struggling with
thoughts of suicide, that they would keep that in mind
that there is help out there. People who have taken
these steps wish they hadn't, So please do reach out
for help.

Speaker 2 (48:41):
Now, are you seeing people who die by suicide have
a mental health disorder? Is that a connection that you see.

Speaker 1 (48:49):
It's a huge connection. So ninety to ninety five percent
of people who die by suicide had a diagnosable mental
disorder before they died. So depression, anxiety disorders, bipolar disorder.
Twenty percent of people with bipolar disorder will die by
suicide one in five. Psychotic illness. Is virtually every mental
disorder in the DSM, all the ones that we study

(49:10):
on a regular basis, increase risk of suicide when they
start to pile up. Risk really increases when a person
having two disorders we call comorbidity, three or more disorders
multi morbidity. Multi morbidity is associated with a huge increase
in risk of suicidal behavior.

Speaker 2 (49:26):
It's clear what people are experiencing when it comes to
suicidal thoughts. You talked about the connections that you make
to actually people who die by suicide, that it's hard
to predict.

Speaker 1 (49:39):
It really hard to predict. Another thing that gives me
optimism is we're getting better at prediction with the increasing
amount of data that we have. We'll give a few examples.
Fifty percent five zero of people who die by suicide
saw a clinician within the month before their death. People
are coming at half of people who die are coming
in to a clinic, to a hospital, primary care doctor.

(50:02):
They're psychologist, psychiatrist, social worker. They're not always saying actually,
they're rarely saying doctor, I'm going to kill myself. They're
coming in saying I'm depressed, I can't sleep. Sleep problems
are strongly linked with suicidal behavior. Something's just not right.
So half the people are coming in. We're really bad
clinically at knowing which people coming in at high risk.
But here's where I have hope. With a switch to

(50:23):
electronic health records. It used to be you go see
your doctor and they write down some things on a
piece of paper and they put it in a folder
and put it in a filing cabin. Now it's all digital.
We can use machine learning algorithms to find in the
huge amounts of data we have on every patient who's
at risk for suicide, and we can identify for thing
about predicting suicide as like looking for a needle in
a haystack. We can put patients into risk bins, and

(50:47):
the top five percent of patients account for fifty percent
of all the suicides are going to happen. So we
can find these concentrations of risk where we have patients
who are really high risk for suicide, and so we
can target them with interventions. We're also doing a lot
of work now over the past almost ten years, giving
patients apps on their smartphones and asking them questions each

(51:09):
day about how they're feeling, how they're doing, collecting passive
data with their consent from their GPS, from their accelerometer,
or getting sleep information, and we're getting pretty good at
predicting among patients at risk who's going to make a
suicide attempt in the next few days. So we're getting
better identifying which patients are at risk and now most
recently in the past few months, when they're at risk,

(51:29):
and we now have apps that we can, with people's consent,
give them on their phones that help decrease risk of
suicide in time and place, so we don't have to
have someone coming into the hospital when they're at risk.
We still want people to do that, coming in to
see their clinician once a week, whatever the case is,
we still want them to do that those in between
times when risk increases. What does a person do. We're

(51:51):
getting better at identifying when those are going to happen
and how we can help keep people safe.

Speaker 2 (51:56):
Yeah, because all of that is what you hoped. There's
clinicians did afterwards. Fifty percent of those people but by suicide,
right whereas.

Speaker 1 (52:06):
But it's hard to know. It's hard. So I mentioned earlier,
two thirds of people who die by suicide told someone
ahead of time they were thinking about suicide. What I
didn't mention is seventy eight percent of those people explicitly
denied suicidal intentions in their last communication before dying. And
this is a really common pattern that people will say
I'm thinking about killing myself, and then they'll recant and

(52:28):
say I'm no longer thinking about killing myself, and a
lot of the cases they're not. It's really hard to
know when is a person who has suicidal thoughts going
to act on those thoughts. And when we do studies
where we interview people and ask when did you know
you're going to make a suicide attempt, it's usually the
hours before. So people have thoughts of suicide maybe for
a year or so, and it's the same day that

(52:49):
they make a decision they're going to kill themselves. So
if you see your clinician once a week, once every
two weeks, and twice a week, those in between times
we haven't had access to. But now again with smartphones,
with social media platforms, social media apps, we now have
people in the in between times. And there's a lot
of people saying these are it's bad, we're on our
phones too much, we're on social media too much, and
there's a case to be made there. But these they're

(53:11):
tools and they can be used for good, and they
can help us find people when they're in distress, and
we're getting better at doing that and reaching out to people.

Speaker 2 (53:18):
What have you found of the top reasons why people
don't tell people they are having suicidal thoughts.

Speaker 1 (53:25):
I thought I could handle on my own. I didn't
want anyone to bring me to the hospital, call the
police to make a big deal out of it, depending
on population. College students are afraid they're gonna get kicked
out of school. We do a fair amount of work
with with the military, and a lot of service members
fear that, and police fear they're going to have their
firearm taken away from them, They're going to lose their job,

(53:45):
they're going to get demoted. I don't want my health
insurance company to figure out are my rate's going to
go up? So there's a whole plethora of reasons that
people don't tell others. It's logical. It makes sense that
you know, if you fear bad things are going to happen.
If I tell someone this, I'm going to try and
handle it on my own and muscle through it. I
understand that why people would do that, but they're missing

(54:06):
an opportunity to get to get help.

Speaker 2 (54:08):
And it's hard because it's how do you convince that
individual to seek help and be okay with me?

Speaker 1 (54:15):
Yeah, and admittedly our care could be better. We have
a long way to go. I mentioned we have interventions
that can decrease people's risk of suicidal behavior. A lot
of them have waitlists, a lot of Our focus right
now is if someone's at risk for suicide, we bring
them to the hospital. We're just learning now that hospital
treatment for people at risk for suicide does seem to

(54:36):
help some people, it's less helpful for other people, and
it seems to potentially harm some people. They get worse,
have to get hospitalized. This is a study published just
in the past year. So we're in the process of
trying to get better and figure out how can we
better help people, how can we tailor interventions to people
to figure out who's likely to benefit from which intervention.
So again, we're making progress, but there's still a long

(54:59):
way to go.

Speaker 2 (55:00):
Are there some careers that are predisposed to suicidal suicide?

Speaker 1 (55:04):
It's hard to tease apart from race and ethnicity. So
physicians are at high risk. Police officers are at high risk.
There's a big concern. A few years back, there was
a spike in suicides in New York City police officers.
We did study on this. New York City police officers
are mostly white men, and there was a blip up
in one year, but it came right back down. Actually,

(55:25):
female police officers had a higher risk, even when accounting
for age and race and ethnicity, occupations where a person
has access to means. This is another explanation for why physicians,
why police officers, why soldiers, army soldiers, service members do
have a significantly higher risk of suicide. Access to means,
we think, we think plays a role. Access to access

(55:48):
to lethal means, firearms, medications.

Speaker 2 (55:53):
Yeah, and that, of course, yes, sadly is widely accessible
as well, right, and yeah, I.

Speaker 1 (56:00):
Mean there's also big geographic differences in the US, So
suicide rates our highest out west, if you look sort
of north and south of Las Vegas. People call this
a suicide built there's access to firearms, there's not ready
access to good hospital care, good treatments. You might have
to drive three four hours to go see a clinician.

(56:20):
And there's low population density, so you don't have contact
with a lot of people day to day. So if
you're having thoughts of suicide and you don't have people
right around you, you don't have access to care, and
you have access to firearms, we think this is a
pretty lethal. Cocktail rates are lowest historically in New York,
New Jersey. From New Jersey, I think this might be
high quality of life. People might disagree, but there's high

(56:41):
population density and there's a lot of people around. It's
pretty easy to find a hospital, to find a clinician
where you can get treatment. So we think these factors
to play a role, so not just occupation, but where
you live and what access you have again, which is
another reason why I think online care generative AI has
a great role to play here. If you can access

(57:03):
the Internet, you can now access care and so this
changes the playing field quite a bit, or has the
potential to.

Speaker 2 (57:08):
Matthew, I know when we spoke on zoom a few
months back, you shared a personal story with me that
really resonated with me because of the incredible work you do,
but then the personal experience you have. Would you be
comfortable sharing that with us? Sure, because I'd love my
listeners to just recognize just how complex and layered this
subject is not just for you, but in the experience

(57:31):
of it for anyone who goes through as well.

Speaker 1 (57:34):
When I first became interested in suicide in the hospital
in tuting back in London Springfield Hospital, I didn't know
anybody who was suicidal. It was a clinical human interest.
Over the years, I've had friends and Filamy members who
have struggled with thoughts of suicide and have died by suicide.
And actually one of my best friends, Dan Dan Eisenbud

(57:56):
I met in London when I was working in this
hospital and became very close friends. We became roommates where
roommates through my graduate studies, and just a few years
back we lost him to suicide and it it wrecked
me and I continue to struggle with with the loss.
He was one of my dear friends. And I went

(58:17):
back and looked at my notes and looked at my emails.
He was living in Israel working as a journalist, was
planning and coming back to the US, and I was
reading over his emails. Hey, I'm coming back. Maybe I
moved to Boston looking for apartments? Can you help me out?
And I was looking for any clues what might I
have missed? Nothing I didn't. I didn't see anything in
the emails. But it was I think, just an example
of how difficult it can be, not just to lose someone,

(58:40):
but then to struggle with, you know, wanting to have
done more for him, for his family, for for his friends.
It's a tough problem. It's a perplexing problem, it's a
gut wrenching problem. And I think just for me, it's
motivation to do better and to not rest and to
keep trying to get better at doing this.

Speaker 2 (58:59):
Thank you for sharing that. How do people even begin
to recover from that feeling that they let someone down
or that they missed a sign or that they could
have done more? Because I imagine that's a very heavyweight
to carry, and it can be really difficult when, like
in your case, there were no signs that you could spot. Yeah,

(59:22):
and you're someone who's trained to do that. Yeah, when
we're not trained.

Speaker 1 (59:26):
I think giving yourself that grace that I would say,
you know, those of us who I've been trained to
do this, I've spent the past few decades of my
life trying to do this. I can't do it. I
can't predict accurately who's at risk and who's not. If
I can't do it, chances are those among us who
haven't spent their life trying to do this probably can't
do it either. So don't expect that you should have

(59:46):
been able to do it. People grieve differently. There's a
lot of misconceptions about the stage. There are stages of grief,
and we almost go through them in this linear way
that's not true. We all grieve differently, and I think
it's important for people to do what's right for them.
Here too, I would say reach out to others. There
are groups of survivors. There's an organization, the American Foundation

(01:00:07):
for Suicide Prevention AFSP dot org has survivor groups support
groups in every state in the US. These exist in
other countries around the world, where you can go as
you want and meet with other people who have lost
loved ones to suicide, or do this online, or do
this among your friends and family, but use the supports
you have around you to try and work through whatever

(01:00:29):
way makes sense for you. But here too, again, I
would encourage people to reach out and to communicate with
others about what they're experiencing. It can be powerful to
know other people who have been through what you've been
through and to share with them.

Speaker 2 (01:00:45):
When someone dies by suicide, what does it do to
their family? What have you seen happen to people friends
and family? From a research perspective.

Speaker 1 (01:00:53):
Yeah, losing someone to suicide increases the risk, So having
a family member died by suicide increases a relative's risk
of suicide death. It's not destiny, but there is statistically
an increased chance of suicide, and it just leads to
often not always, a lot of psychological distress is an

(01:01:14):
understatement turmoil. There's a loss, as there is if you
lost someone to a car accident, So there's a tremendous
loss of life, and that is gut wrenching to anyone
who's ever lost a family member. It's disorienting. It changes,
it can change people are different, can change your whole world,
your world orientation, your own mental health. When someone dies

(01:01:35):
by their own hand, it's often so much worse because
there's there's often guilt. There's questions about should I have
done more? Could I have done more? Did I play
some role in this? Was? Was I not nice enough
last time I saw the person? Did I not reach
out enough. There's a lot of second guessing, a lot
of beating oneself up. So it can be really, really difficult.

(01:01:55):
But again, people people respond differently. Some people respond by
never talking about it, respond by getting closer to those
around them. Some respond by becoming an advocate and trying
to decrease the likelihood that this happens to other people
in the future, which always always blows me away and
I find really inspiring.

Speaker 2 (01:02:12):
Is there any truth in the feeling that people who
die by suicide believe that everyone will be better off
without me or is that a man?

Speaker 1 (01:02:21):
Yeah, not a myth feeling like. There's a brilliant psychologist
named Thomas Joyner who's got a wonderful book called Why
People Die by Suicide? And he lost his file to
suicide and as a leading scientist in this problem, and
in his theory on suicide, he says, feeling like a
burden to others is a key piece, and you feeling

(01:02:42):
like you don't belong is the other key piece, and
that those two things together, I'm a burden to others.
They'd be better off if I wasn't here, and I
don't really belong with anyone or to anyone. Those things
get a person thinking about suicide. And then the other
piece of the puzzle from his perspective is what he
calls an acquired ability to die by suicide. It's not

(01:03:03):
an easy thing psychologically to take your life, and it
takes he says in his book, he used to call
it courage, but courage isn't quite right, and now he
calls it an acquired capability that we have to build up,
an ability to like we have the bill up and
ability to hurt someone else, to hurt ourselves. And this
is why he thinks maybe physicians and police officers, prostitutes

(01:03:25):
are at higher risk. That it's if you've been injured,
if you've injured, you've now acquired the ability to hurt yourself,
and that this increases a person's risk. Feeling a burden,
feeling you don't belong certainly resonates, and there are good
data on this that this does increase a person's risk. Again,
thinking about the pathway, this increases your risk of thinking
about suicide but not acting. You need this other component

(01:03:46):
to get you to act.

Speaker 2 (01:03:47):
It's interesting that you said that suicide rates haven't really
gone up, because I guess we'd assume that because of
social media, because of online bullying, because of the news cycle. Yeah,
there's almost so much much more overexposure to depressive, negative,
difficult thoughts. Yeah, why is that? How do you even
explain that?

Speaker 1 (01:04:07):
Yeah, the suicide rate does ebb and flow. If you
look back and we've mapped it out over the past
one hundred years, you see a little up and down,
and it's crept up in the past twenty years, but
it crept down the twenty years before that, and people
will say, well, it's because of social media breakdown of
the field. There's always post hoc explanations we can give,
but again, it's the same now as it was one

(01:04:28):
hundred years ago, and I don't think the explanation is
as simple. As we now have social media. Social media bad,
it's making kids suicidal. I think it's a tool and
things that happen on social media can put people at risk.
There are things that happen on social media that can
also decrease risk. And so again I think it's incumbent
upon us to try and figure out how do we
use these tools that are here to stay for good

(01:04:51):
and allow them to be used for evil.

Speaker 2 (01:04:53):
Not to thank you so much, it's been so useful
and insightful talking to you today, and thank you for
your work. And I look forward to hoping our listeners
support your work, whether it's sharing it with a friend,
passing this episode on to a family member, or directly
supporting the work that you're doing there in the lab.
So thank you so much. I'd be really grateful for
your time and energy.

Speaker 1 (01:05:12):
Thank you so so much for focusing on this problem,
for shining a light on it, and I'm hoping that
this podcast and the work you're doing can help save lives.
So thank you.

Speaker 2 (01:05:21):
I've learned so much today, man, And it's one of
those subjects that I feel like needs to be talked about,
needs to be trained in, needs to be spoken about.
Just with I mean with the couple of new stories
I shared today, one more as well that I saw
was I think this was like, Yeah, dad struggling with

(01:05:41):
money pressures, leaves behind wife, baby son, after taking own life,
you know, battling with financial stress, everything turned upside down,
the family said, and then eventually led to that like
when you see the multitude of reasons, even in the
couple of stories that I've found and shared, Yeah, it's
an area that I just feel like we can't leave

(01:06:04):
in the dark anymore, because, like you said, the fact
that you can't predict it perfectly means we should be
more vigilant and more aware because someone literally could appear
to not be struggling at all and then, you know,
potentially take their life.

Speaker 1 (01:06:23):
Absolutely, closing our eyes to it is not making it
go away. That's not going to solve the problem. We're
getting better at predicting it. We can't predict it perfectly,
but that doesn't mean we should stop again. You think
about the weather app that's on your phone. It can
tell us with a startling degree of accuracy when it's
going to start, raining, when it's going to stop, what

(01:06:43):
the temperature is going to be in any time and place.
That's a model. It's a simple analogy. But there's a
lot more we could do. There's a lot greater accuracy
we could have in predicting who's at risk and when,
and there's a lot more we could do to try
and keep people safe. We just need to try and
stop the stigma around it, talk about the problem more,
and allocate resources to try and get it done.

Speaker 2 (01:07:05):
Has there been a not wanting to sound reductive in
any way, but has there been Seeing as you've spent
decades studying this, now, what keeps you going, what motivates you,
what allows you to feel potentially positive about the future
of this.

Speaker 1 (01:07:22):
I'm increasingly hopeful about our ability to better understand, predict
and prevent suicide because of the people who are doing
this work, the people who have lost loved ones to suicide,
who support research on suicide, the clinicians, the researchers, the
progress that has been made in the past ten to

(01:07:43):
fifteen years. I mentioned, we're now better able to identify
who's at risk and when they're at risk. Our interventions
are getting better and more numerous. There's newer interventions coming
out all the time. So we're seeing a lot of traction,
a lot of positive progress. So that keeps me optimistic.
And I also continue to see people die by suicide
and continue to see how big of a problem it is,

(01:08:07):
and I see the opportunity for us to do a
lot better. And so those things together, how bad we're
doing and the instances what we're losing life, but also
the positive steps we're making give me hope that with
more of a push, with more resource, with more effort,
there's reason to be optimistic. There's reason to be hopeful.
And this is a problem where we hopefully in the
coming years, can start to see the needle bend and

(01:08:31):
the suicide rate drop, especially given how connected we all
are now we have the ability to find people at risk.
If we can just figure out how to use these
tools in a more positive way, I think we'll really
make an impact.

Speaker 2 (01:08:46):
Yeah, Matthew, thank you so much. Is there anything I
haven't asked you that you think would be important to
ask you about this, So, anything you haven't shared that
you think would be useful for us to know.

Speaker 1 (01:08:54):
I think no. I think we covered a lot of
the most important things. I think the most important thing
is what you're doing, which is shining a light on
the problem, talking about it, encouraging others to talk about it.
Knowing that their resources out there, and knowing what to
say to someone or having a sense of what to
say to someone who you think is at risk, you
can take steps to try and help them.

Speaker 2 (01:09:15):
Yeah, any other resources or any other directions or practices
that you'd recommend that we got to share with people today.

Speaker 1 (01:09:22):
So if people want to get involved in support this
cause in some way, there's a number of ways to
do so. I would definitely recommend reaching out to the
American Foundation for Suicide Prevention AFSP dot org, which supports
research on suicide and also supports educational programs. They have
great resources if you've lost someone to suicide, if you're
looking for a support group, So I would definitely look

(01:09:42):
at them as a resource. And if you want to
give to support research on suicide, we'd be grateful. If
you did, you can do so by reaching out to
Harvard University. You can reach out to our lab directly
and donate through our labs website. If you google my
name or look at knock Lab fas dot Harvard edu,
you can support our works work directly. You can also

(01:10:05):
support the Center for Suicide Research and Prevention at Harvard
University in Nationeneral Hospital, which is a center devoted to
conducting research on suicide to try and prevent the loss
of life due to suicide. So any of those would
be amazingly helpful to support this work.

Speaker 2 (01:10:22):
Amazing Yeah, very usefully. I'm sure there's so many people
who've been affected directly indirectly by someone in their life,
and I'm sure i'm sure there'll be people who want
to support. So thank you for sharing those And yeah,
I'm really grateful for the work you're doing and the
light you're shining on it, and just your ongoing commitment
and dedication. If you love this episode, you'll enjoy my
interview with doctor Daniel Ahman on how to change your

(01:10:44):
life by changing your brain.

Speaker 1 (01:10:46):
If we want a healthy mind, it actually starts with
a healthy brain. You know, I've had the blessing or
the curse to scam. Over one thousand convicted felons and
over one hundred murderers and their brains are very damaged.

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