[George] The Mind Deconstructed: Mental Health and Wellness with Dr. Kaz and George.
[Dr. Kaz] The statements of Dr.
Kaz and George are not a substitute for medical care, and our opinions are our own. If you are experiencing the mental health emergency,
please seek assistance from a professional in your area.
[George] You can contact us via twitter @MindDeconstruct. I'm your host, George, with me is Dr. Kaz.
Dr. Kaz Nelson is an American Board of Psychiatry and Neurology certified psychiatrist
licensed to practice medicine in the state of Minnesota
and an assistant professor in the Department of Psychiatry at the University of Minnesota Medical School.
On today's episode:
"Talking About Suicide." So Dr. Kaz, we recently had
National Suicide Prevention Week, is that correct? [Dr. Kaz] Yep, September 10th through 16th. [George] Tell us a little bit about National Suicide Prevention Week.
[Dr. Kaz] Well, this is a
national advocacy effort that's really taken on global proportions the American Association of Suicidality and many other partnering
organizations
launched this effort to promote understanding and prevention of suicide and to support those who have already been affected by it
[George] Are there any events or anything or what would I have seen during National Suicide Prevention Week? [Dr. Kaz] There was a lot of effort to
spread information about the National Suicide Prevention lifeline.
[George] And what's that number Dr. Kaz?
[Dr. Kaz]  That's 1-800-273-8255,
and everybody should program that into your phone right now, because you never know when you're gonna need it for
you or a friend.
[George] Now Dr. Kaz, there's also been some
recent, very public
instances of suicide popping up in the news. Chester Bennington, Chris Cornell,
Michelle Rounds (who was Rosie O'Donnell's former spouse). [Dr. Kaz] Well, when I wake up in the morning and check what's been going on
nationally in the globe and I see that there's been a death of somebody that people would know or recognize
my stomach always churns instantly.
I worry that people will see that and there can sometimes be a contagion effect where
maybe somebody who's just on the edge sees that a public
person did
this and that it might help,
you know, in a
really terrible way put them over the threshold to suicide. [George] Is that-is that a thing where people get kind of pushed over the edge?
[Dr. Kaz]  It can, yeah, it can be. It's a phenomenon called
'contagion' and that's why news agencies have tried to work responsibly in their reporting to report these things
accurately, but also responsibly in order to not influence people who are
possibly vulnerable or susceptible. [George] Do you think the news media
has been responsible with their reporting? [Dr. Kaz]  I think they've caught on pretty well in a lot of ways.
Well, I can think of Chris Cornell's death there was some controversy they were going to be showing images or releasing photos of
the scene showing some of the items that
he used in his suicide and there were a lot of people pushing back and saying you know is this really necessary
in terms of journalism? Is this a truth that people are entitled to see or is this something that could potentially impact
people in a way that puts them at greater risk? [George] This being close to National Suicide Prevention Week,
what can people do with with this information?
[Dr. Kaz] Well I think there's a lot of effort to teach people how to talk about suicide or
recognize people who may be at risk for suicide and
equip them in opening up the conversation.
I think it goes a little bit in decreasing the stigma around mental
health and wellness and these kinds of risks, and so I really am appreciative of these national and global
advocacy efforts. [George] And I think that rolls into what we're going to be talking about today,
which is
what's the deal with suicide? [Dr. Kaz] When we were identifying topics for the show,
suicide is right at the top of my list, because it's one of the most tragic things that any
person or family can endure is a
suicide, or even somebody who's thinking about suicide or on the edge of suicide,
it's so stressful, and there's so much impact to everyone involved. If we can all
link arms together and chip away at this problem,
I think it will do the world a lot of good. [George] As a loved one, it's hard to imagine
someone that I know and care for personally committing suicide. I think that's
probably one of the worst things to happen to a family, but it does happen every day. [Dr. Kaz] Yes. Yeah,
you know, every day (every minute) and in almost every second there's a death to suicide and
you just really can't
can't know the impact of that until you maybe have been
in that boat or experience that and
those those people who have experienced it just know how painful that is.
[George] And
since you're a psychiatrist,
suicide seems to be
connected to
mental health and pretty closely
(I would assume as a layperson).
You know, why or what mental illness would
cause someone to
consider or commit suicide?
[Dr. Kaz] Well suicide, it's interesting, because we tend to think of depression and suicide as being linked,
but I've seen people with suicide thoughts who have a variety of mental health issues. We see people with schizophrenia or bipolar disorder
who
go on to take their life,
people with serious medical conditions that are
facing a long medical course. They may feel the impetus to take their life.
People without serious medical or psychiatric
diagnosis can sometimes have suicidal thoughts and have the urge to take their life
so we see it go hand in hand with depression commonly, but just because
somebody
is depressed, that doesn't mean that they do have suicide thoughts and likewise,
suicide isn't always associated with depression and can be associated with other phenomena, which is why it's always so
surprising if you see somebody,
learn of somebody, who died by suicide and you say well, "I knew them, they weren't even depressed,
why would they have done that?" Well, it's because sometimes it can
come a little bit more out of the blue and not necessarily be associated with the illness of depression. [George] Is there an age group
that's more prone
to suicide? It always feels like you hear about teens committing suicide.  [Dr. Kaz]  Young people are impacted by this and recently,
some numbers were released looking at rates of suicide that showed that
it's actually increasing in young people, and then also recently on the radar, middle-aged men are
taking their life at higher rates than they have historically and so these
demographics are shifting over time and we're trying to play close attention to learn from
which groups are being most impacted but really,
no group is immune from this.
[George] Speaking of middle-aged men for a moment, in the
national culture that we have currently or in the national news you hear about mass murder suicide
and that being something that's very closely associated with middle-aged men. Is that in the same boat as a standard
suicide? [Dr. Kaz]  So this is where you're talking about where somebody goes into their former place of business or something and
gets out a couple weapons and
kills people in the building, and then turns the gun and kills- [George] Exactly and it's pretty clear
they have no expectation of surviving that encounter so it does feel like a
suicide.
[Dr. Kaz] Right.
That is
clearly one of the most extreme and brutal
forms of suicide. Sometimes you also
have these cases where people will kill family members and then kill themselves and,
you know, we will see this on the news and your your heart just breaks and
you know it's it's hard to know exactly what's going on in the minds of those
individuals, particularly if they don't survive that it's always hard to kind of interview them after the fact and
look back and kind of do a post-incident debrief to figure out what were the factors that led to this, but
there's a lot of people working on what exactly-
what factors work together to cause something
terrible like this so that we can prevent it
but they're rare enough that it's hard to get enough data to know how to exactly present it, but
you know, it's it's obviously tragic and,
you know, gut wrenching when anything like this happens.
[George] So if a loved one has come to you and said that they're suicidal,
what steps do you take?
[Dr. Kaz] If somebody you love confides in you something that's this
personal and this concerning,
the first thing you want to do is create a safe space for that. If you panic or
start getting upset or start crying or start telling them to stop it, or don't be that way you might be creating an environment that
feels tense and that they may not want to continue to engage with you or share when they feel vulnerable.
So I would suggest that you pause, take a moment to calm yourself down, because obviously that's very upsetting and
assess a little bit further
what they're thinking about and what their needs might be. Now, if in the course of that conversation, somebody says,
"I'm thinking of killing myself tonight,"
or, "You can't stop me," or something like that, then of course that is an emergency and probably worth calling 9-1-1
or going to an emergency room and trying to convince somebody to do that,
but if it's short of that, if they're saying, "Well,
this is something I've been thinking about for a while and I might need some help with this,
nothing that I'm going to do today or tomorrow, but I want to
start addressing it," then I would suggest calling a primary care provider or mental health professional or somebody that
you may have a relationship with
in the mental health community to figure out what next steps might be. [George] Dr. Kaz,
what do they do if they don't have a primary care provider or someone that they're familiar with?
[Dr. Kaz] That's I think where that National Suicide Prevention lifeline really comes into play or
in other regions you might have more
local resources
through your county, but the reason why I like that National Suicide Prevention lifeline is if you call it, they'll automatically route you to a
service provider that's near your area, and they can help sort out next steps
and they're extremely competent in doing that. [George] You don't think they outsource that?
[Dr. Kaz] Well in a sense they do outsource that to
local communities who are providing that service, but those are usually the people best poised to provide it. [George] I think we'd call that "insourcing."
[Dr. Kaz] I-ah-
that is not an area of expertise of mine, I admit. [George] Okay.
So as a practitioner then,
since you're a psychiatrist, and we like hearing how psychiatrists operate as part of this podcast,
what do you
do when a person comes to you and says they're suicidal?
[Dr. Kaz] Well, I try to do a little bit like I suggested I try to shut up and listen first of all, and hear exactly where
somebody might be coming from,
what some of the drivers of those thoughts might be and
then once I feel that I've fully understood it, then we can shift to more
problem-solving and try to figure out what protective steps might be put in place in order to help
reduce the intensity of the suffering that this person inevitably must be feeling and
help them feel more equipped to turn their attention to a life worth living and
to really understand where somebody might be coming from. I found this
quote from David Foster Wallace an American writer and university instructor really
useful, because,
you know, if you are really struggling to understand where someone's coming from as they share this with you, then
you're not going to be as equipped to help them and so,
George, I was wondering if you could share this quote from David Foster Wallace and-[George] The whole quote? [Dr. Kaz] The whole quote. [George] That's too-
It's too long. [Dr. Kaz]  It's a long quote.
I think it's worth every word so I'm gonna put you to read the whole thing in
podcast audience if you can bear with us
I think if you can bear with this quote in this perspective from David Foster Wallace who ultimately did go on to take his life,
it will equip you better to understand where somebody with suicidal thoughts might be coming from.
[George] "The so called 'psychotically depressed' person who tries to kill herself doesn't do so out of quote,
'hopelessness' or any abstract conviction that life's assets and debits do not square, and
surely not because death seemed suddenly appealing.
The person in whom its invisible agony reaches a certain
unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise.
Make no mistake about people who leap from burning windows.
Their terror falling from a great height is still just as great as it would be for you
or me standing speculatively at the same window just checking out the view,
i.e. the fear of falling remains a constant.
The variable here is the other terror: the fire's flames.
When the flames get close enough, falling to death becomes the slightly less terrible of two terrors.
It's not desiring the fall. It's terror of the flames, and
yet, nobody down on the sidewalk looking up and yelling, 'Don't!' and, 'Hang on!'
can understand the jump, not really.
You'd have to have personally been trapped and felt the flames to really understand that terror way beyond falling.
[Dr. Kaz] So, obviously a powerful image of somebody standing at a window with burning flames behind them and feeling terrified of
jumping. [George] It does-it does make me, it does help me understand the
why someone would commit suicide especially if they have a family and were providing for that family, it helps you to picture
that it's not that you want to die or necessarily even think that life is worthless,
it's just
an option that was less terrible than what you were currently
experiencing. [Dr. Kaz] In the mind of the person, yes. [George] Yes, in the mind. I'm not trying to-
[Dr. Kaz] Yes. No, I mean
I think that's that's a fair point and the more we can kind of understand that that's somebody's perspective, the better
we may be positioned to help provide understanding in a way that helps them
move out of that frame of mind
which is not actually accurate and what I hear frequently from people who are thinking about suicide is they
feel like there's such a burden on their family and for them those proverbial flames
is the sense that they're dragging their family down and sometimes it takes some communication with the family to say, "No, you,
you know it might be your depression causing you to think that you're a burden, but you're not a burden
and it would be actually be more of a burden if you were to take your life and
kind of dispel the myth in the mind of the person who thinks, "Oh, if I only
took my life I would be less of a burden on my family, and they would get over it with time.
Well,
that's simply not true. That legacy of suicide is
lifelong and many people never recover from that. [George] That is the part that's harder for me to understand is that perspective the,
you know, 'my family would be better off without me.' It's very hard to
picture a scenario,
but obviously, that's where the mental health comes into play. [Dr. Kaz] Mm-hmm.
That's right,
and the individual stressors that that person might be enduring. For many people there's a sense of shame or self disgust that
they feel very powerless and helpless to navigate and
reduce the intensity of those feelings which are unbearable and
we have to get the word out that there are strategies
for enduring that. There are strategies for reducing that intensity there are strategies for survival and we can help make that possible,
particularly if
somebody's willing to
share that this might be something that they're experiencing. [George] One other question that I had was regarding medication, and I
know that you're very sparing with the medication from our other discussions. Does medication help?
[Dr. Kaz] Well, in one sense I'm sparing with medication if it's gonna make things worse or not necessarily help, but I'm
very I feel very strongly about using medications if they're going to be helpful and
successful in in managing these illnesses and so-
but one of the problems is we don't necessarily have a pill per se that makes the suicide thoughts go away,
and I wish we did, because if we did I would probably pass out free prescriptions on the street for a pill like that,
but what we do instead is try to understand is there mental health condition here?
Like depression, for example. If there is, then we should absolutely use medications like
antidepressants if the benefits are going to outweigh the risks of those medications. If it's not depression though, and
an antidepressant might not help, then I might not pursue an antidepressant and I might instead look at medications or other strategies to
address the drivers of suicide and not necessarily the use of medication. For example, if somebody is thinking of suicide because they're
extremely stressed about an
embarrassing
photograph online or something like that, it may make more sense to
solve that problem proactively and reduce the stress rather than prescribing a medication.
[George] Dr. Kaz, we do have a question and that question from one of our listeners is-are some mental illnesses becoming more prevalent,
or are we just better at talking about them now?
[Dr. Kaz] The answer is...both. I
think there's been some really important work at reducing stigma about mental illness and
talking about mental illness and so
one of the nice things is
people are much more willing to talk about
diagnoses they've had or even access mental health care, and that makes it feel more prevalent,
even though the numbers might not have necessarily changed. On the other hand, are some
disorders actually growing in numbers, independent of how much people are talking about it? The answer is probably yes,
in a way, and I think that that can be related some to
stress and some of the technological and other societal changes that are occurring over time. Our
society is sped up,
there's higher stakes, there's higher pressure. It's no longer,
"I've got to
send that letter back and it'll get there in the mail." You might have to provide a response in the next 30 seconds
in order to do your job or communicate with people, and I think that kind of
pressure does actually up the ante and make it harder for us as organisms (who are not necessarily evolved to be that responsive) to
survive in this technological landscape, and so it's really interesting to think about (not a lot of data on it)
but that's just one of my theories and something that I've seen from practicing psychiatry over the last few years.
[George] Does the industry or the
psychiatry field account for the
historical lack of diagnosis available say, back in the 50s? You know, there were-people weren't being
diagnosed necessarily with
borderline personality disorder because maybe that diagnosis hadn't developed yet, so how do you how do you know the numbers from back then versus now?
[Dr. Kaz] Yeah,
epidemiologists are usually pretty good about when they try to measure prevalence of disorders in the community.
They will make note in their research that
something wasn't actually in our Diagnostic and Statistical Manual until 1980, for example,
and so you'd expect a certain lag time before people are billing with it or coding with it and we do develop
labels for
diagnoses (new labels).
For example, in the most recent edition,
the Diagnostic and Statistical Manual,
a disorder of childhood and adolescence
called 'emotional dysregulation disorder,' any estimates of this disorder prior to it being
diagnoseable
are probably more speculative.
[George] Coming back to suicide then,
you mentioned that the rates of suicide are going up in middle-aged men. How is the overall rate of suicide right now?
[Dr. Kaz] Suicide was the tenth leading cause of death for all ages in
2013 and actually our survey data only goes up through 2015
(it's about two years behind because it takes them time to put together the
statistics) so we're always playing catch-up a little bit, but
despite all the advocacy and work that's gone into
decreasing suicide, we haven't seen the kind of
substantial decreases in suicide rates that we'd like to see and then every now and then we see
upticks in different areas that are particularly concerning, and so we've got a lot to work to do.
[George] Well, Dr. Kaz, what are we going to talk about in our next episode?
[Dr. Kaz] Something that I'm very passionate about. It's a
disorder called, 'borderline
personality disorder.' It actually is associated frequently with suicide, and it's not necessarily talked about enough as a
contributing factor to a self-injury or
suicide and so I want to make sure to give a full episode to bring attention to this important
disorder and help educate the public about this. [George] Great.
[Music]
[George] Thank you for joining us today. This podcast was produced by Kaz and George. Music by Paul. [Dr. Kaz] He's the best!
[George] Contact us and send us your questions on Twitter @MindDeconstruct.
[Music]
