January 29, 2025 • 26 mins
The episode discusses the hidden mental health crisis within the massage therapy profession, spotlighting alarming suicide rates and the pressing need for open dialogue and community support. By exploring the complexity of suicidal ideation and the current model we use to understand suicide, we aim to equip listeners with tools to recognize and address these critical issues.
Suicide hotline: call or text 988
International Suicide Hotlines
Register for the Community Processing Event on February 25th
CDC Article: Suicide Rates by Industry and Occupation
Healwell Class: Empowering Individuals to Navigate Crisis
Integrated Motivational Volitional Model of Suicidal Behavior
Entrapment Scale
Boring Books for Bedtime Podcast
PBS Documentary: Facing Suicide
When It Is Darkest: Why People Die by Suicide and What We Can Do to Prevent It
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This episode contains discussions about suicide.
If you or someone you know isexperiencing suicidal thoughts
or a crisis, call or text 988 onyour phone to reach the Suicide
Hotline in the United States.
For hotlines outside the UnitedStates, click the Lifeline link
in the show notes.
Most people listen to podcastswhile they do other things, like
(00:20):
driving chores, or if you're amassage therapist, turning over
your room between clients.
This episode contains someheavy and potentially upsetting
information.
If suicide is a topic you thinkyou might find triggering and
you aren't in a place where youcan put down what you're doing
and perform some care of self,please wait to listen to this
episode and remember we can dohard things together.
(00:41):
Can do hard things together.
Welcome to the Rub, a podcastabout massage therapy.
I'm your host, kori Rivera,licensed massage therapist and
(01:01):
information magpie, and todaywe're talking about suicide
statistics for massagetherapists.
I wish this episode wasn'tcoming out at this particular
moment in time, but here it isand here we are.
I don't wish to add to yourburdens, but the problem we're
talking about today existswhether we talk about it or not.
(01:22):
Our hope is that, by affirmingthat you are not alone in your
thoughts and experiences, we canbuild a community that can
support its members and work tosolve its problems.
In December of 2023, the Centersfor Disease Control published a
report of industry andoccupational suicide rates for
the year 2021.
The CDC has published reportslike this before, but this was
(01:43):
the first time occupation wasrequired on all death
certificates.
Previous reports included 12and then 39 states, which makes
it hard to draw national-levelconclusions.
The industry and occupationrates only seem to be released
every four or so years, so thereis no more information yet.
The CDC report includes 254industries, which are very broad
(02:04):
categories, and 492 occupations, which are specific jobs within
an industry.
The report separates theinformation into male and female
categories.
The occupation of massagetherapy ranked fourth highest in
the country for females, theindustry of beauty salons ranked
fourth and the industry of nailsalons and other personal care
(02:25):
ranked fifth highest for females.
Both of those industries employmassage therapists.
So, out of almost 500occupations, massage therapy had
the fourth highest suicide ratefor females in the year 2021.
And, out of 250 industries,massage therapists potentially
work in the industries that hadthe fourth and fifth highest
suicide rates for females.
(02:46):
The next important question ishow much higher is this rate
than average For massagetherapists as a group including
men and women, the rate was 25.8per 100,000 in the year 2021.
That is nearly double thenational rate and it is four
times the national rate forfemales.
That's important becausemassage therapists are at least
(03:07):
85% female identified.
Healwell has slowly told peoplein the massage therapy
profession about this statistic.
One of our staff membersdiscovered it last July while
looking for statistics aboutveterinarians.
People have had many reactions.
Some people get very quiet andstill Some people try to
verbally process immediately.
Some people get very quiet andstill Some people try to
verbally process immediately.
Some people outright deny it atfirst.
(03:29):
Any reaction you're havingright now is valid.
Remember, we can do hard thingstogether.
On February 25th at 7 pmEastern Standard Time, healwell
will be holding an onlineprocessing and community support
session with the help oflicensed social worker Jen
Brandl.
Admission is free, but you willneed to register at the link in
(03:51):
the show notes We've alsoincluded a link to a class Jen
Brandl made for HealWell thatyou might find helpful.
If you or someone you know isexperiencing suicidal thoughts
or a crisis, call or text 988 onyour phone to reach the Suicide
Hotline in the United States.
For hotlines outside the UnitedStates.
Click the Lifeline link in theshow notes.
(04:14):
In this episode we're going totalk about what suicide is, some
ways to think and talk about itand what to do if you or
someone you know is in a crisis.
There is never a single causeof suicide.
The question of why thatfollows a death by suicide can
never be fully answered becauseit is so complicated.
But despite the things we can'tanswer, there are things we do
know.
Over the last decade,researchers have developed an
(04:36):
understanding of how suicidalbehavior happens and what
contributes to it.
We have strategies forintervention and supporting
people who are experiencingsuicidal ideation.
When talking about suicide, weused to use the phrases
committed suicide and successfulsuicide.
Committed comes from a timewhen suicide was considered a
crime and in some places itstill is.
Successful is no longer usedbecause a success is a good
(05:00):
thing and as a society we canunderstand suicide and have
empathy for people who die by it.
But the word success isill-fitting at best.
The phrases died by suicide orended their life are used more
often now because bothacknowledge the agency of the
person who died without addingjudgment.
One of the biggest struggles ofwriting this episode has been
(05:21):
the urge to focus on telling youhow to help other people, how
you, as a massage therapist, cansupport people struggling with
suicide.
Most of our education asmassage therapists is focusing
on helping others.
Our self-care classes are oftenabout ergonomics or meditation,
partly for our own health, butmostly so that we can avoid
physical or mental injury andkeep working, keep helping.
(05:43):
But this episode is about you,not your clients.
It is astoundingly easy to slipinto language that other people
struggle with suicide, how tohelp them.
It's human nature to find waysto rationalize why something bad
can't happen to us, why we'reprotected when someone else
might not be.
A common myth is that people whotalk about suicide are not at
(06:05):
risk.
I'm here to tell you frompersonal experience that talking
about it doesn't create arisk-free zone, but not talking
about it doesn't make us safereither.
Another common way to justifyfeeling safe from suicide risk
is whether or not we suffer frommental illness.
70% of people who attemptsuicide have a documented mental
(06:26):
illness, but the vast majorityof people who have a mental
illness will never make anattempt and, conversely, 30% of
people who attempt suicide haveno history of mental illness.
People who attempt or die bysuicide are people exactly like
you and exactly like me.
Suicide is not a weakness or amoral failing.
People who die by suicide areexperiencing unbearable, searing
(06:50):
emotional and psychologicalpain.
Suicide attempts are less aboutwanting to be dead and more
about not being able to imaginea future without this pain.
This inability to imagine adifferent future is known as
cognitive constriction or tunnelvision.
It can be difficult tounderstand why another person
would choose suicide, but, asone of the books I read stated,
(07:12):
what you see is not what theysee.
As a person who has persistentsuicidal ideation which is what
we call the experience of havingthoughts about suicide I can
tell you that what I see isdifferent thoughts about suicide
.
I can tell you that what I seeis different.
After I learned about cognitiveconstriction while I was
researching this episode, Ibegan to notice when my vision
narrows and when all of mypotential futures condense into
(07:32):
a single, unbearable pathway.
I can also see when theconstriction eases and the
present once again feelstemporary, and the future feels
both blurry and changeable.
About a decade ago, a model wascreated to explain how suicidal
ideation develops and how it canturn into action.
The model is called theIntegrated Motivational
(07:56):
Volitional Model of SuicideBehavior.
I know that's a mouthful.
I'm the one who just said itand it took me three tries.
The model is important becauseit allows us to discuss suicide
as a series of happenings,instead of some dark, mysterious
fog of the unknown.
It allows us to understandwhere people are in their
experience of suicide and how wemight be able to help.
I want to take this moment totell you that I use academic
(08:20):
names for things on this podcastbecause it is the fastest way
for you to find more informationon a topic.
The phrase tunnel vision isimmediately understandable, but
a Google search of those wordswill come up with a wide variety
of topics, including a loss ofperipheral vision and a clothing
line.
Doing a search for cognitiveconstriction will take you to
suicide prevention resources.
(08:41):
Okay, the integratedmotivational volitional model.
The model has three phases,which can be described as
vulnerability, motivation andaction.
Vulnerability is the firstphase.
It covers the backgroundreasons you might have an
increased risk of suicidalbehavior.
We're going to talk about thisin the next episode because it
(09:03):
is a very, very large topic, andtoday I think it's more
important to talk about thesecond and third phases where
intervention needs to happen.
Factors of vulnerabilityinclude things like your life
history and the environment youlive in.
The second phase, motivation,covers thoughts about suicide.
The third and final phase istaking action.
So vulnerability, motivation,action Each phase has different
(09:30):
factors that contribute to it.
This means that whatcontributes to thoughts of
suicide is different than whatcontributes to the act.
It is also important to knowthat not everyone will move all
the way through the model.
Having suicidal ideation doesnot mean you will make an
attempt.
The point of the model is to beable to identify where people
are, what might increase thepossibility of them taking
(09:51):
action and, most importantly,what we might be able to do to
interrupt or stop their progresstowards that action.
So the first phase isvulnerability or risk, and we'll
expand on that in the nextepisode.
The second phase of the model,motivation, is primarily driven
by feelings of inescapabledefeat.
These feelings of defeat leadto a feeling of entrapment,
(10:13):
feeling like there's no way outof the situation you're in.
Entrapment can then lead tothoughts of suicide.
Remember, suicide isn't aboutwanting to die, it is about
escaping unbearable pain.
So, to repeat in phase two,feelings of defeat lead to
feelings of entrapment, whichlead to thoughts of suicide.
There are several factors thatcan increase or decrease
(10:37):
feelings of defeat.
Factors that affect feelings ofdefeat are psychological.
They include things likeproblem solving, coping, memory
bias and rumination.
When those things are goingswimmingly, they decrease
feelings of defeat.
When they're going badly, theyincrease feelings of defeat.
These things are alsointertwined.
If you struggle with memorybias or tending to remember bad
(10:58):
things and forgetting good ones,that can make problem solving
difficult.
We rely on past experiences tohelp us solve current problems,
but if you can't remember thetimes you succeeded, it's a lot
harder to repeat that success.
You feel more defeated becauseyour mind can't find the
solution.
So defeat leads to entrapmentand entrapment leads to thoughts
of suicide.
(11:20):
There's a simple questionnairecalled the Entrapment Scale that
helps assess feelings ofentrapment.
There's a short version of itthat contains four statements.
Those statements are one Ioften have the feeling that I
would just like to run away.
Two I feel powerless to changethings.
Three, I feel trapped insidemyself.
And four I feel I'm in a deephole that I can't get out of.
(11:43):
The first two statements referto a feeling of external
entrapment or feeling trapped byyour circumstances.
The last two statements areinternal entrapment.
Those last two feeling trappedinside myself and being in a
deep hole are more dangerousbecause they are more likely to
lead to suicidal ideation.
The factors that affect thefeeling of entrapment are
(12:04):
motivational instead ofpsychological.
Things that increase thefeeling of entrapment are
motivational instead ofpsychological.
Things that increase thefeeling of entrapment include
things like feeling like you'rea burden, feeling like you don't
belong, having few positivethoughts about the future, not
having social support andlacking resilience.
Again, feelings of entrapmentare not always going to turn
(12:25):
into ideation.
The third phase of the model isabout what increases the
likelihood of suicidal ideationturning into a suicide attempt.
These factors involve a person'swill and they run the gamut of
being psychological, social,physical and environmentally
based.
They include access to means,having a plan, exposure to
suicide, impulsivity,fearlessness about death, mental
(12:48):
imagery, sensitivity tophysical pain and past behavior.
Let's break those down.
Fearlessness about death,mental imagery and sensitivity
to physical pain are allstraightforward.
If you have no fear of death,taking the step to act on
ideation is a much smaller step.
If you experience mentalimagery of yourself after death
(13:09):
or of you taking a suicidalaction, it can act as a kind of
mental rehearsal, which makes itmore likely that you'll
complete the action.
Conversely, if you have a highsensitivity to physical pain,
you are less likely topurposefully harm yourself.
Let's talk about access tomeans, having a plan and
impulsivity together.
The act of suicide happens in awindow of time.
(13:30):
This window is when thefeelings become their most
intense and people take action.
The window lasts between oneand ten minutes.
It may happen again in a minuteor an hour or a day, but the
overwhelming urge is short-lived, although it feels like an
eternity.
It is also possible that thaturge might exist in a sustained,
low-grade way.
If a person already has a planand has the tools to complete
(13:54):
that plan, it is much easier totake action during this window.
If they have impulsivetendencies, it also increases
the chance of acting in thewindow.
This is why the existence offirearms is an incredibly
important factor in suicide.
Attempts involving anythingother than a firearm are 5 to
10% likely to be completed.
Attempts with firearms are 90to 95% likely to be completed.
(14:18):
If you are experiencingideation and have a firearm in
your home, please follow gunsafety procedures or ask someone
you trust to keep it for awhile.
This is also something you cando with other means.
If you have a plan, remove youraccess to the things you need
to complete it.
If you or someone you arespeaking with has a specific
(14:38):
plan and access to the means andisn't sure they can keep
themselves safe, it is time tocall a professional.
That might be a generalpractitioner, a mental health
expert or emergency services.
Okay, the last two factors thatincrease the likelihood of
moving from ideation to actionare past behavior and exposure.
The best predictor of a suicideattempt is previous self-harm,
(15:02):
whether it was meant to belethal or not.
However, like many things inthis episode, this does not mean
that everyone who engages inself-harm will attempt suicide,
just like a large number ofpeople who attempt or complete
suicide have a diagnosed mentalillness.
But most people with mentalillness will not make an attempt
.
Exposure is the last factor andit is the one that has worried
(15:26):
me the most while researchingand writing this episode.
There is evidence that having afamily member or someone close
to you exhibit suicidal behaviorcan increase your risk.
However, the evidence does notshow a direct line.
Remember, suicide always,always, always has more than one
reason or risk factor and likehaving passed self-harmful
behavior or a mental illness,the vast majority of people who
(15:47):
are exposed to suicide willnever attempt it.
While the evidence shows a link, we don't understand how that
link works.
It could be that seeing someoneelse's action eases the mental
friction of the idea, allowingit to become less taboo and more
of an option.
It may increase our likelihoodof modeling that behavior
because it was done by someonewe perceive to be like us or
(16:08):
someone we can relate to.
When Robin Williams died, themedia ignored the rules and
guidelines about reporting onsuicide.
They included the words suicidein headlines, discussed details
, romanticized the event andfailed to provide resources for
their readers.
According to a report byColumbia University, there was
an estimated 10% increase insuicides after that reporting.
(16:28):
But everything that I readagreed there was no contest
between not talking and talkingresponsibly.
Talking responsibly is vital tosuicide prevention.
Talking responsibly is vital tosuicide prevention.
In the last part of this episode, we're going to discuss actions
you can take to keep yourselfand others safe.
If you or someone you know isexperiencing suicidal thoughts
(16:50):
or a crisis, call or text 988 onyour phone to reach the Suicide
Hotline in the United States.
For hotlines outside the UnitedStates, click the Lifeline link
in the show notes.
Let's talk about you first.
Things are hard right now.
If you're experiencing defeat,entrapment, suicidal ideation or
attempts, there are things youcan do.
(17:11):
Call the helpline.
It only exists for one reasonand it is to help you.
If you feel like you or someoneelse is in immediate danger,
call emergency services orcontact a general practitioner
or mental health professional,as mentioned earlier.
Remove anything that you wouldconsider using in an attempt.
Ask someone you trust to holdon to it for you.
(17:32):
If you are experiencing thatwindow where thoughts feel like
they could become actions.
Don't be alone.
If you don't have a person, youcan go to, go to the library or
other place with people.
You don't need to interact.
Just don't be alone.
Even if you're not in thatemergency place, seek out help.
General practitioners or localmental health clinics are good
(17:52):
places to ask, because both willknow what resources are
available in your area.
You can tell both places thatyou are having thoughts of
suicide.
You don't need to sugarcoatanything.
They are professionals and theycan help you much easier if
they understand the gravity ofyour situation.
We don't have good tools topredict suicide attempts.
Any screening tools we've triedto develop are about 50%
(18:14):
reliable.
So just as your generalpractitioner shouldn't rely on
those tools to find the truth,neither should you rely on those
tools to tell your doctor thetruth.
For longer-term treatment, talktherapy can be a very powerful
tool.
Some kinds of talk therapy aremore general, like dialectical
behavioral therapy or DBT, whichfocuses on balancing the need
for change with acceptance, orcognitive behavioral therapy,
(18:38):
cbt, which focuses onchallenging dysfunctional
thoughts and behaviors andlearning new skills to navigate
problems.
Other types of therapy arespecific to suicide prevention,
such as CAMS, collaborativeAssessment and Management of
Suicidality.
The goal of CAMS is tostabilize people and engage them
in the management of their ownsafety.
Talk therapy might be veryhelpful for you, but sometimes
(19:01):
finding a therapist to work withcan be a challenge, either
because of limited access orbecause of personality
mismatches.
All massage therapists arefamiliar with how important the
therapeutic relationship betweentherapist and client is and how
much can be accomplished ifthat relationship is a good one.
Your prevention plan mightinclude something called a
safety plan.
A safety plan is a documentthat you fill out with a mental
(19:24):
health professional.
It spells out steps you mighttake in order to stop you from
acting on suicidal feelings.
It asks you to write downwarning signs, coping and
distraction strategies, peopleyou can ask for help, including
professionals, and how to makeyour environment safe.
It is important that you fillit out with someone because
there might be unexpectedchallenges to your solutions.
For example, if going for a runmakes you feel better but it
(19:46):
isn't safe to run at night.
The person assisting you withthe plan will help you think of
other plans for when it's dark.
And, lastly, get some sleep.
Really, it sounds simple, butsleep is a key factor in suicide
and self-harm prevention.
Not sleeping can increaseimpulsivity and mental disorder
and decrease emotionalregulation and decision-making
power.
I start feeling bad in lateevening.
(20:07):
I get anxious, I worry aboutthings I did or said that day, I
start panicking about the stateof the world, and now I
interpret this as the start yourbedtime routine signal.
My brain tends to be loud, so Ihelp it out with a pair of
headphones wrapped in a headbandand excellent podcasts like
Boring Books for Bedtime.
I highly recommend theWildflowers Worth Knowing
(20:29):
episodes.
Finally, what can you do to helpother people?
The most important thing isdon't leave someone in a crisis
alone and call the helpline.
The next thing is how can yourecognize when someone is
thinking about suicide?
There are a few red flags.
Have you noticed a change intheir behavior, like eating,
(20:49):
sleeping, drug taking or risktaking?
Are they acting out ofcharacter or unpredictably?
Do they talk about beingtrapped or having no future?
Do they talk about being aburden to other people?
Are they sorting out their lifeaffairs or giving away
important possessions?
Are they having a hard timedealing with stressful life
events like loss or rejection?
And, counterintuitively, hastheir mood suddenly improved?
(21:12):
If you know someone who isstruggling with thoughts of
suicide and their mood improves,check in on them.
Unfortunately, an improvement inmood doesn't always indicate
someone is out of the woods.
They may check in on them.
Unfortunately, an improvementin mood doesn't always indicate
someone is out of the woods.
They may actually be more atrisk.
Their mood lift might bebecause they have made a
decision to take action and arefeeling relieved or they may now
have enough energy to take anaction.
(21:32):
You are not, and are notexpected to be, a mind reader.
Some people are very good athiding their distress.
Sometimes there are noindications that someone was
even considering suicide orself-harm.
You can only know what peoplechoose to share with you.
Recently, while I was at thegrocery store, I received a text
(21:53):
from a friend that said I feelpowerless Because I've been
writing about this topic forseveral months.
I realized this statementindicated both defeat and
entrapment.
I immediately moved my cart outof the flow of shoppers and
called my friend three times ina row until they picked up.
Then I simply said talk to meFor the next 35 minutes.
I stood in the middle of thebaked goods and talked to my
friend.
We spoke about beingoverwhelmed by the news, feeling
(22:15):
helpless and frantic at thesame time, and worrying about
friends and family.
Overwhelmed by the news,feeling helpless and frantic at
the same time, and worryingabout friends and family.
I told her what I was doing tocope limiting my news intake,
calling my representatives andsearching for an organization
local to me where I can behelpful.
I also watch a lot of Star Warsand I'm planning a toast party
which is a potluck centeredaround fancy toast.
We talked until my friend feltbetter.
(22:37):
If they hadn't seemed better bythe end of the conversation, I
probably would have asked themto have their kind and loving
spouse join the call so thethree of us could talk about
what might need to happen next.
My friend is not having suicidalideation, but there is no
reason to wait until someone hasreached that point to start
interventions.
You can directly ask someoneare you thinking about killing
(23:00):
yourself?
I know it seems like it couldcause a problem, but there is no
evidence at all that askingthat question will put the idea
into someone's head.
In fact, asking the questioncan protect the person, because
being able to tell someone is arelief.
But keep in mind, once youasked, it is now your job to
listen and you will need tolisten very, very carefully.
(23:22):
As massage therapists, we havean instinct to help, but trying
to solve someone's problembefore you understand what
they're experiencing isn't goingto be helpful.
Don't brightside, don't try totalk them out of feeling bad or
dismiss what they say.
Phrases like everything happensfor a reason or it could have
been worse are harmful.
Also, if they don't want totalk to you.
(23:42):
Don't be insulted.
Tell them you're concernedabout them and ask if there's
someone else they'd feel morecomfortable talking to.
If a person says they don'twant to talk and you continue to
worry about them, send them apostcard.
Seriously, in a randomizedcontrolled trial, the University
of California sent atwo-sentence letter four times a
year to people who had beenseen for severe depression or
(24:03):
suicidal thoughts.
Compared to the control group,deaths by suicide dropped
significantly, especially in thefirst two years.
The letter said things like ithas been some time since you
were here at the hospital and wehope things are going well for
you.
If you wish to drop us a note,we would be glad to hear from
you.
Tell the person you're worriedabout that you're glad they came
(24:25):
into your office, or glad thatthey're your friend and that
you're looking forward to seeingthem again soon.
Sometimes a small gesture isthe thing that stops someone
from taking an action.
Being kind to the people aroundyou, even and maybe especially,
in simple ways, is a form ofsuicide prevention.
In simple ways is a form ofsuicide prevention.
Being a massage therapist is afulfilling, important, hard job.
We work our bodies, minds andsouls in the service of others.
(24:47):
We hold people in a caring wayfor a long time.
Every time we go to work.
We care about other people allday, and then we go home and
care about our plants and ourpets and our kids and our
parents and our partners.
We care, but opportunities forus to connect in community with
each other are rare.
It can feel lonely out there,and if you're lonely and if
(25:11):
you're feeling trapped and ifyou're feeling like you would
rather not be here anymore,you're not doing it wrong and
you are not alone.
You can find us at thecommunity processing session on
February 25th.
You can join us in the HealWellonline community at
communityhealwellorg.
You can find other massagetherapists near you and do
something simple like having tea.
You do not have to do thisalone.
(25:33):
Please do not try to do thisalone.
You are loved, you areimportant.
You are not alone.
Thank you for listening.
This episode contains discussions about suicide.
If you or someone you know isexperiencing suicidal thoughts
or a crisis, call or text 988 onyour phone to reach the Suicide
Hotline in the United States.
For hotlines outside the UnitedStates, click the Lifeline link
in the show notes.
Most people listen to podcastswhile they do other things, like
(00:20):
driving chores, or if you're amassage therapist, turning over
your room between clients.
This episode contains someheavy and potentially upsetting
information.
If suicide is a topic you thinkyou might find triggering and
you aren't in a place where youcan put down what you're doing
and perform some care of self,please wait to listen to this
episode and remember we can dohard things together.
(00:41):
Can do hard things together.
Welcome to the Rub, a podcastabout massage therapy.
I'm your host, kori Rivera,licensed massage therapist and
(01:01):
information magpie, and todaywe're talking about suicide
statistics for massagetherapists.
I wish this episode wasn'tcoming out at this particular
moment in time, but here it isand here we are.
I don't wish to add to yourburdens, but the problem we're
talking about today existswhether we talk about it or not.
(01:22):
Our hope is that, by affirmingthat you are not alone in your
thoughts and experiences, we canbuild a community that can
support its members and work tosolve its problems.
In December of 2023, the Centersfor Disease Control published a
report of industry andoccupational suicide rates for
the year 2021.
The CDC has published reportslike this before, but this was
(01:43):
the first time occupation wasrequired on all death
certificates.
Previous reports included 12and then 39 states, which makes
it hard to draw national-levelconclusions.
The industry and occupationrates only seem to be released
every four or so years, so thereis no more information yet.
The CDC report includes 254industries, which are very broad
(02:04):
categories, and 492 occupations, which are specific jobs within
an industry.
The report separates theinformation into male and female
categories.
The occupation of massagetherapy ranked fourth highest in
the country for females, theindustry of beauty salons ranked
fourth and the industry of nailsalons and other personal care
(02:25):
ranked fifth highest for females.
Both of those industries employmassage therapists.
So, out of almost 500occupations, massage therapy had
the fourth highest suicide ratefor females in the year 2021.
And, out of 250 industries,massage therapists potentially
work in the industries that hadthe fourth and fifth highest
suicide rates for females.
(02:46):
The next important question ishow much higher is this rate
than average For massagetherapists as a group including
men and women, the rate was 25.8per 100,000 in the year 2021.
That is nearly double thenational rate and it is four
times the national rate forfemales.
That's important becausemassage therapists are at least
(03:07):
85% female identified.
Healwell has slowly told peoplein the massage therapy
profession about this statistic.
One of our staff membersdiscovered it last July while
looking for statistics aboutveterinarians.
People have had many reactions.
Some people get very quiet andstill Some people try to
verbally process immediately.
Some people get very quiet andstill Some people try to
verbally process immediately.
Some people outright deny it atfirst.
(03:29):
Any reaction you're havingright now is valid.
Remember, we can do hard thingstogether.
On February 25th at 7 pmEastern Standard Time, healwell
will be holding an onlineprocessing and community support
session with the help oflicensed social worker Jen
Brandl.
Admission is free, but you willneed to register at the link in
(03:51):
the show notes We've alsoincluded a link to a class Jen
Brandl made for HealWell thatyou might find helpful.
If you or someone you know isexperiencing suicidal thoughts
or a crisis, call or text 988 onyour phone to reach the Suicide
Hotline in the United States.
For hotlines outside the UnitedStates.
Click the Lifeline link in theshow notes.
(04:14):
In this episode we're going totalk about what suicide is, some
ways to think and talk about itand what to do if you or
someone you know is in a crisis.
There is never a single causeof suicide.
The question of why thatfollows a death by suicide can
never be fully answered becauseit is so complicated.
But despite the things we can'tanswer, there are things we do
know.
Over the last decade,researchers have developed an
(04:36):
understanding of how suicidalbehavior happens and what
contributes to it.
We have strategies forintervention and supporting
people who are experiencingsuicidal ideation.
When talking about suicide, weused to use the phrases
committed suicide and successfulsuicide.
Committed comes from a timewhen suicide was considered a
crime and in some places itstill is.
Successful is no longer usedbecause a success is a good
(05:00):
thing and as a society we canunderstand suicide and have
empathy for people who die by it.
But the word success isill-fitting at best.
The phrases died by suicide orended their life are used more
often now because bothacknowledge the agency of the
person who died without addingjudgment.
One of the biggest struggles ofwriting this episode has been
(05:21):
the urge to focus on telling youhow to help other people, how
you, as a massage therapist, cansupport people struggling with
suicide.
Most of our education asmassage therapists is focusing
on helping others.
Our self-care classes are oftenabout ergonomics or meditation,
partly for our own health, butmostly so that we can avoid
physical or mental injury andkeep working, keep helping.
(05:43):
But this episode is about you,not your clients.
It is astoundingly easy to slipinto language that other people
struggle with suicide, how tohelp them.
It's human nature to find waysto rationalize why something bad
can't happen to us, why we'reprotected when someone else
might not be.
A common myth is that people whotalk about suicide are not at
(06:05):
risk.
I'm here to tell you frompersonal experience that talking
about it doesn't create arisk-free zone, but not talking
about it doesn't make us safereither.
Another common way to justifyfeeling safe from suicide risk
is whether or not we suffer frommental illness.
70% of people who attemptsuicide have a documented mental
(06:26):
illness, but the vast majorityof people who have a mental
illness will never make anattempt and, conversely, 30% of
people who attempt suicide haveno history of mental illness.
People who attempt or die bysuicide are people exactly like
you and exactly like me.
Suicide is not a weakness or amoral failing.
People who die by suicide areexperiencing unbearable, searing
(06:50):
emotional and psychologicalpain.
Suicide attempts are less aboutwanting to be dead and more
about not being able to imaginea future without this pain.
This inability to imagine adifferent future is known as
cognitive constriction or tunnelvision.
It can be difficult tounderstand why another person
would choose suicide, but, asone of the books I read stated,
(07:12):
what you see is not what theysee.
As a person who has persistentsuicidal ideation which is what
we call the experience of havingthoughts about suicide I can
tell you that what I see isdifferent thoughts about suicide
.
I can tell you that what I seeis different.
After I learned about cognitiveconstriction while I was
researching this episode, Ibegan to notice when my vision
narrows and when all of mypotential futures condense into
(07:32):
a single, unbearable pathway.
I can also see when theconstriction eases and the
present once again feelstemporary, and the future feels
both blurry and changeable.
About a decade ago, a model wascreated to explain how suicidal
ideation develops and how it canturn into action.
The model is called theIntegrated Motivational
(07:56):
Volitional Model of SuicideBehavior.
I know that's a mouthful.
I'm the one who just said itand it took me three tries.
The model is important becauseit allows us to discuss suicide
as a series of happenings,instead of some dark, mysterious
fog of the unknown.
It allows us to understandwhere people are in their
experience of suicide and how wemight be able to help.
I want to take this moment totell you that I use academic
(08:20):
names for things on this podcastbecause it is the fastest way
for you to find more informationon a topic.
The phrase tunnel vision isimmediately understandable, but
a Google search of those wordswill come up with a wide variety
of topics, including a loss ofperipheral vision and a clothing
line.
Doing a search for cognitiveconstriction will take you to
suicide prevention resources.
(08:41):
Okay, the integratedmotivational volitional model.
The model has three phases,which can be described as
vulnerability, motivation andaction.
Vulnerability is the firstphase.
It covers the backgroundreasons you might have an
increased risk of suicidalbehavior.
We're going to talk about thisin the next episode because it
(09:03):
is a very, very large topic, andtoday I think it's more
important to talk about thesecond and third phases where
intervention needs to happen.
Factors of vulnerabilityinclude things like your life
history and the environment youlive in.
The second phase, motivation,covers thoughts about suicide.
The third and final phase istaking action.
So vulnerability, motivation,action Each phase has different
(09:30):
factors that contribute to it.
This means that whatcontributes to thoughts of
suicide is different than whatcontributes to the act.
It is also important to knowthat not everyone will move all
the way through the model.
Having suicidal ideation doesnot mean you will make an
attempt.
The point of the model is to beable to identify where people
are, what might increase thepossibility of them taking
(09:51):
action and, most importantly,what we might be able to do to
interrupt or stop their progresstowards that action.
So the first phase isvulnerability or risk, and we'll
expand on that in the nextepisode.
The second phase of the model,motivation, is primarily driven
by feelings of inescapabledefeat.
These feelings of defeat leadto a feeling of entrapment,
(10:13):
feeling like there's no way outof the situation you're in.
Entrapment can then lead tothoughts of suicide.
Remember, suicide isn't aboutwanting to die, it is about
escaping unbearable pain.
So, to repeat in phase two,feelings of defeat lead to
feelings of entrapment, whichlead to thoughts of suicide.
There are several factors thatcan increase or decrease
(10:37):
feelings of defeat.
Factors that affect feelings ofdefeat are psychological.
They include things likeproblem solving, coping, memory
bias and rumination.
When those things are goingswimmingly, they decrease
feelings of defeat.
When they're going badly, theyincrease feelings of defeat.
These things are alsointertwined.
If you struggle with memorybias or tending to remember bad
(10:58):
things and forgetting good ones,that can make problem solving
difficult.
We rely on past experiences tohelp us solve current problems,
but if you can't remember thetimes you succeeded, it's a lot
harder to repeat that success.
You feel more defeated becauseyour mind can't find the
solution.
So defeat leads to entrapmentand entrapment leads to thoughts
of suicide.
(11:20):
There's a simple questionnairecalled the Entrapment Scale that
helps assess feelings ofentrapment.
There's a short version of itthat contains four statements.
Those statements are one Ioften have the feeling that I
would just like to run away.
Two I feel powerless to changethings.
Three, I feel trapped insidemyself.
And four I feel I'm in a deephole that I can't get out of.
(11:43):
The first two statements referto a feeling of external
entrapment or feeling trapped byyour circumstances.
The last two statements areinternal entrapment.
Those last two feeling trappedinside myself and being in a
deep hole are more dangerousbecause they are more likely to
lead to suicidal ideation.
The factors that affect thefeeling of entrapment are
(12:04):
motivational instead ofpsychological.
Things that increase thefeeling of entrapment are
motivational instead ofpsychological.
Things that increase thefeeling of entrapment include
things like feeling like you'rea burden, feeling like you don't
belong, having few positivethoughts about the future, not
having social support andlacking resilience.
Again, feelings of entrapmentare not always going to turn
(12:25):
into ideation.
The third phase of the model isabout what increases the
likelihood of suicidal ideationturning into a suicide attempt.
These factors involve a person'swill and they run the gamut of
being psychological, social,physical and environmentally
based.
They include access to means,having a plan, exposure to
suicide, impulsivity,fearlessness about death, mental
(12:48):
imagery, sensitivity tophysical pain and past behavior.
Let's break those down.
Fearlessness about death,mental imagery and sensitivity
to physical pain are allstraightforward.
If you have no fear of death,taking the step to act on
ideation is a much smaller step.
If you experience mentalimagery of yourself after death
(13:09):
or of you taking a suicidalaction, it can act as a kind of
mental rehearsal, which makes itmore likely that you'll
complete the action.
Conversely, if you have a highsensitivity to physical pain,
you are less likely topurposefully harm yourself.
Let's talk about access tomeans, having a plan and
impulsivity together.
The act of suicide happens in awindow of time.
(13:30):
This window is when thefeelings become their most
intense and people take action.
The window lasts between oneand ten minutes.
It may happen again in a minuteor an hour or a day, but the
overwhelming urge is short-lived, although it feels like an
eternity.
It is also possible that thaturge might exist in a sustained,
low-grade way.
If a person already has a planand has the tools to complete
(13:54):
that plan, it is much easier totake action during this window.
If they have impulsivetendencies, it also increases
the chance of acting in thewindow.
This is why the existence offirearms is an incredibly
important factor in suicide.
Attempts involving anythingother than a firearm are 5 to
10% likely to be completed.
Attempts with firearms are 90to 95% likely to be completed.
(14:18):
If you are experiencingideation and have a firearm in
your home, please follow gunsafety procedures or ask someone
you trust to keep it for awhile.
This is also something you cando with other means.
If you have a plan, remove youraccess to the things you need
to complete it.
If you or someone you arespeaking with has a specific
(14:38):
plan and access to the means andisn't sure they can keep
themselves safe, it is time tocall a professional.
That might be a generalpractitioner, a mental health
expert or emergency services.
Okay, the last two factors thatincrease the likelihood of
moving from ideation to actionare past behavior and exposure.
The best predictor of a suicideattempt is previous self-harm,
(15:02):
whether it was meant to belethal or not.
However, like many things inthis episode, this does not mean
that everyone who engages inself-harm will attempt suicide,
just like a large number ofpeople who attempt or complete
suicide have a diagnosed mentalillness.
But most people with mentalillness will not make an attempt
.
Exposure is the last factor andit is the one that has worried
(15:26):
me the most while researchingand writing this episode.
There is evidence that having afamily member or someone close
to you exhibit suicidal behaviorcan increase your risk.
However, the evidence does notshow a direct line.
Remember, suicide always,always, always has more than one
reason or risk factor and likehaving passed self-harmful
behavior or a mental illness,the vast majority of people who
(15:47):
are exposed to suicide willnever attempt it.
While the evidence shows a link, we don't understand how that
link works.
It could be that seeing someoneelse's action eases the mental
friction of the idea, allowingit to become less taboo and more
of an option.
It may increase our likelihoodof modeling that behavior
because it was done by someonewe perceive to be like us or
(16:08):
someone we can relate to.
When Robin Williams died, themedia ignored the rules and
guidelines about reporting onsuicide.
They included the words suicidein headlines, discussed details
, romanticized the event andfailed to provide resources for
their readers.
According to a report byColumbia University, there was
an estimated 10% increase insuicides after that reporting.
(16:28):
But everything that I readagreed there was no contest
between not talking and talkingresponsibly.
Talking responsibly is vital tosuicide prevention.
Talking responsibly is vital tosuicide prevention.
In the last part of this episode, we're going to discuss actions
you can take to keep yourselfand others safe.
If you or someone you know isexperiencing suicidal thoughts
(16:50):
or a crisis, call or text 988 onyour phone to reach the Suicide
Hotline in the United States.
For hotlines outside the UnitedStates, click the Lifeline link
in the show notes.
Let's talk about you first.
Things are hard right now.
If you're experiencing defeat,entrapment, suicidal ideation or
attempts, there are things youcan do.
(17:11):
Call the helpline.
It only exists for one reasonand it is to help you.
If you feel like you or someoneelse is in immediate danger,
call emergency services orcontact a general practitioner
or mental health professional,as mentioned earlier.
Remove anything that you wouldconsider using in an attempt.
Ask someone you trust to holdon to it for you.
(17:32):
If you are experiencing thatwindow where thoughts feel like
they could become actions.
Don't be alone.
If you don't have a person, youcan go to, go to the library or
other place with people.
You don't need to interact.
Just don't be alone.
Even if you're not in thatemergency place, seek out help.
General practitioners or localmental health clinics are good
(17:52):
places to ask, because both willknow what resources are
available in your area.
You can tell both places thatyou are having thoughts of
suicide.
You don't need to sugarcoatanything.
They are professionals and theycan help you much easier if
they understand the gravity ofyour situation.
We don't have good tools topredict suicide attempts.
Any screening tools we've triedto develop are about 50%
(18:14):
reliable.
So just as your generalpractitioner shouldn't rely on
those tools to find the truth,neither should you rely on those
tools to tell your doctor thetruth.
For longer-term treatment, talktherapy can be a very powerful
tool.
Some kinds of talk therapy aremore general, like dialectical
behavioral therapy or DBT, whichfocuses on balancing the need
for change with acceptance, orcognitive behavioral therapy,
(18:38):
cbt, which focuses onchallenging dysfunctional
thoughts and behaviors andlearning new skills to navigate
problems.
Other types of therapy arespecific to suicide prevention,
such as CAMS, collaborativeAssessment and Management of
Suicidality.
The goal of CAMS is tostabilize people and engage them
in the management of their ownsafety.
Talk therapy might be veryhelpful for you, but sometimes
(19:01):
finding a therapist to work withcan be a challenge, either
because of limited access orbecause of personality
mismatches.
All massage therapists arefamiliar with how important the
therapeutic relationship betweentherapist and client is and how
much can be accomplished ifthat relationship is a good one.
Your prevention plan mightinclude something called a
safety plan.
A safety plan is a documentthat you fill out with a mental
(19:24):
health professional.
It spells out steps you mighttake in order to stop you from
acting on suicidal feelings.
It asks you to write downwarning signs, coping and
distraction strategies, peopleyou can ask for help, including
professionals, and how to makeyour environment safe.
It is important that you fillit out with someone because
there might be unexpectedchallenges to your solutions.
For example, if going for a runmakes you feel better but it
(19:46):
isn't safe to run at night.
The person assisting you withthe plan will help you think of
other plans for when it's dark.
And, lastly, get some sleep.
Really, it sounds simple, butsleep is a key factor in suicide
and self-harm prevention.
Not sleeping can increaseimpulsivity and mental disorder
and decrease emotionalregulation and decision-making
power.
I start feeling bad in lateevening.
(20:07):
I get anxious, I worry aboutthings I did or said that day, I
start panicking about the stateof the world, and now I
interpret this as the start yourbedtime routine signal.
My brain tends to be loud, so Ihelp it out with a pair of
headphones wrapped in a headbandand excellent podcasts like
Boring Books for Bedtime.
I highly recommend theWildflowers Worth Knowing
(20:29):
episodes.
Finally, what can you do to helpother people?
The most important thing isdon't leave someone in a crisis
alone and call the helpline.
The next thing is how can yourecognize when someone is
thinking about suicide?
There are a few red flags.
Have you noticed a change intheir behavior, like eating,
(20:49):
sleeping, drug taking or risktaking?
Are they acting out ofcharacter or unpredictably?
Do they talk about beingtrapped or having no future?
Do they talk about being aburden to other people?
Are they sorting out their lifeaffairs or giving away
important possessions?
Are they having a hard timedealing with stressful life
events like loss or rejection?
And, counterintuitively, hastheir mood suddenly improved?
(21:12):
If you know someone who isstruggling with thoughts of
suicide and their mood improves,check in on them.
Unfortunately, an improvement inmood doesn't always indicate
someone is out of the woods.
They may check in on them.
Unfortunately, an improvementin mood doesn't always indicate
someone is out of the woods.
They may actually be more atrisk.
Their mood lift might bebecause they have made a
decision to take action and arefeeling relieved or they may now
have enough energy to take anaction.
(21:32):
You are not, and are notexpected to be, a mind reader.
Some people are very good athiding their distress.
Sometimes there are noindications that someone was
even considering suicide orself-harm.
You can only know what peoplechoose to share with you.
Recently, while I was at thegrocery store, I received a text
(21:53):
from a friend that said I feelpowerless Because I've been
writing about this topic forseveral months.
I realized this statementindicated both defeat and
entrapment.
I immediately moved my cart outof the flow of shoppers and
called my friend three times ina row until they picked up.
Then I simply said talk to meFor the next 35 minutes.
I stood in the middle of thebaked goods and talked to my
friend.
We spoke about beingoverwhelmed by the news, feeling
(22:15):
helpless and frantic at thesame time, and worrying about
friends and family.
Overwhelmed by the news,feeling helpless and frantic at
the same time, and worryingabout friends and family.
I told her what I was doing tocope limiting my news intake,
calling my representatives andsearching for an organization
local to me where I can behelpful.
I also watch a lot of Star Warsand I'm planning a toast party
which is a potluck centeredaround fancy toast.
We talked until my friend feltbetter.
(22:37):
If they hadn't seemed better bythe end of the conversation, I
probably would have asked themto have their kind and loving
spouse join the call so thethree of us could talk about
what might need to happen next.
My friend is not having suicidalideation, but there is no
reason to wait until someone hasreached that point to start
interventions.
You can directly ask someoneare you thinking about killing
(23:00):
yourself?
I know it seems like it couldcause a problem, but there is no
evidence at all that askingthat question will put the idea
into someone's head.
In fact, asking the questioncan protect the person, because
being able to tell someone is arelief.
But keep in mind, once youasked, it is now your job to
listen and you will need tolisten very, very carefully.
(23:22):
As massage therapists, we havean instinct to help, but trying
to solve someone's problembefore you understand what
they're experiencing isn't goingto be helpful.
Don't brightside, don't try totalk them out of feeling bad or
dismiss what they say.
Phrases like everything happensfor a reason or it could have
been worse are harmful.
Also, if they don't want totalk to you.
(23:42):
Don't be insulted.
Tell them you're concernedabout them and ask if there's
someone else they'd feel morecomfortable talking to.
If a person says they don'twant to talk and you continue to
worry about them, send them apostcard.
Seriously, in a randomizedcontrolled trial, the University
of California sent atwo-sentence letter four times a
year to people who had beenseen for severe depression or
(24:03):
suicidal thoughts.
Compared to the control group,deaths by suicide dropped
significantly, especially in thefirst two years.
The letter said things like ithas been some time since you
were here at the hospital and wehope things are going well for
you.
If you wish to drop us a note,we would be glad to hear from
you.
Tell the person you're worriedabout that you're glad they came
(24:25):
into your office, or glad thatthey're your friend and that
you're looking forward to seeingthem again soon.
Sometimes a small gesture isthe thing that stops someone
from taking an action.
Being kind to the people aroundyou, even and maybe especially,
in simple ways, is a form ofsuicide prevention.
In simple ways is a form ofsuicide prevention.
Being a massage therapist is afulfilling, important, hard job.
We work our bodies, minds andsouls in the service of others.
(24:47):
We hold people in a caring wayfor a long time.
Every time we go to work.
We care about other people allday, and then we go home and
care about our plants and ourpets and our kids and our
parents and our partners.
We care, but opportunities forus to connect in community with
each other are rare.
It can feel lonely out there,and if you're lonely and if
(25:11):
you're feeling trapped and ifyou're feeling like you would
rather not be here anymore,you're not doing it wrong and
you are not alone.
You can find us at thecommunity processing session on
February 25th.
You can join us in the HealWellonline community at
communityhealwellorg.
You can find other massagetherapists near you and do
something simple like having tea.
You do not have to do thisalone.
(25:33):
Please do not try to do thisalone.
You are loved, you areimportant.
You are not alone.
Thank you for listening.
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