The Myths and Truths Around Suicide
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Summary
You might think we re heading into a low time of year for suicides because they peak during the cold, dark months of winter, but in fact, suicide peaks during the spring and early summer. This is just one example of the popular beliefs around suicide that turn out to be myths. Here to unpack more of these myths, as well as the truth around this poorly understood subject, is Rory O'Connor, the leader of the suicidal behavior research lab and the author of When It Is Dark: Why People Die by Suicide and What We Can Do to Prevent it.
Transcript
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barrett mckay here and welcome to another edition of the art of manliness podcast
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you might think we're heading into a low time of year for suicides because they peak during the
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cold dark months of winter but in fact suicide peaks during the spring and early summer this
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is just one example of the popular beliefs around suicide that turn out to be myths
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here to unpack more of these myths as well as the truth around this poorly understood subject
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is rory o'connor the leader of the suicidal behavior research laboratory and the author of when it is
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darkest why people die by suicide and what we can do to prevent it today on the show rory discusses
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possible reasons for why suicides go up in the warmer months and why men die by suicide more
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often than women he explains that suicide doesn't happen without some warning signs and why someone's
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improved mood might be one of them in the second half of the show rory walks us through the real
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reasons people move from having suicidal thoughts to acting on them and what works to prevent suicide
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after the show's over check out our show notes at aom.is slash suicide
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all right rory o'connor welcome to the show thank you i'm delighted to be here brett so you are a
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professor of psychology who researches suicide and suicide prevention i'm curious what led you down
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this career path well that's an interesting question like many things in life this path
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was serendipitous so as an undergraduate student in belfast in northern ireland i've been studying
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depression and i thought i was going to continue my undergraduate work into looking at depression
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rather than suicide itself but then as things happens i got a call in the summer of i think it
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must have been the summer of 1994 so quite a while ago and the person who turned out to be my phd supervisor
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told me that there was an opportunity for a funded scholarship phd program on suicide and so that's where
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it all began just that phone call and i decided that that's the direction i would go and i suppose what
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it's quite interesting from my point of view is that well clearly suicide is the most devastating of
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outcomes from depression and other mental health problems but i suppose i didn't quite envisage
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where this that journey would take me and in particular that man that phone call my phd supervisor
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the person without whom i wouldn't have done the research on suicide sadly some years later he took
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his own life and i often think back to that phone call and really what i often wonder what was in his
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mind at that time why did they ask me he wasn't a suicide researcher so it's just funny how these
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things happen but i'm incredibly grateful to him because it genuinely was like a sliding doors moment
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which changed my life what did your family think when you told them i'm gonna do my phd
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and suicide well well my mother in particular um she was quite concerned because she knows me as a
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person and she just knew that everything i would do i would put my heart and soul into and so her big
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concern was the impact on me on my own mental health and so yeah so one of the first questions
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you asked me was my god you're not going to kill yourself are you that was her genuine fear that if i was
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so immersed in this and i suppose that question was really important question to ask and something
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i remind myself of daily of reminding myself to look after my own mental health as well as now the
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mental health of the people i work with here my team in glasgow so you've written a book called when
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it is darkest why people die by suicide and what we can do to prevent it which is a book where you've
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taken the research you've done on suicide and suicide prevention and presented it for a lay audience
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we're going to talk about this book but before we do i think it's important to talk about how to talk
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about suicide i'm sure a lot of people have noticed maybe in the past decade or so when we talk about
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suicide or someone who's taken their own life we say you hear people say he died by suicide instead of
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he committed suicide why that shift yeah i mean it really has been a marked shift i would say in the
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last 20 years so and the reason for the shift is because the term committing suicide it harks back
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to a time in many countries where suicide was illegal and so it harks back to that criminal sort of
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undertone that was seen as a criminal offense and indeed in the united states and in the uk
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thankfully suicide is no longer a criminal offense but there are still many countries in the world
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in which it is a criminal offense and i just know from speaking to countless people who are bereaved
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by suicide or people who've been suicidal themselves they often are quite upset about that criminal
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over undertone so for that reason i think we shifted and be much more careful in our language because to my
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mind we can talk about people dying by suicide it conveys the same message and it's not going to cause
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distress to those who are bereaved so in all the work that i do i avoid the term committing suicide for
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that reason what's the state of suicide in the west today are rates increasing or decreasing
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in in some senses there's no simple answer to that question so maybe try and answer it in a couple of
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ways if i look at the suicide rates say over the last 40 years now if i take a global perspective
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first so on a global perspective the suicide rates have decreased by about 30 percent or thereabouts
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over the last 40 years or so however if you try and disentangle then where the decreases have happened
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you see that much of the decline in suicides happened in asian countries in india and in china and
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other asian countries largely in china and so that tells you a pattern yes in a global context in those
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low and middle income countries historically the suicide rates have been decreasing now if i take then
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the last 20 years and focus in on say the united states or the united kingdom you see a different pattern
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so indeed in the united states you've seen this upward trend in suicides and then if i look in
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the uk say over the three or four years before the pandemic hit similar to the united states the
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suicide rates were increasing and in australia new zealand other western countries in those recent
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years the suicide rates have been on the increase now when the pandemic hits many of us working in the
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field of suicide research and suicide prevention were really really concerned about the potential
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impact of covet 19 on the suicide rates now thankfully our concerns were not realized because
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the suicide rates broadly speaking did not increase in basically in a global context and indeed with a
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colleague jane perkis from melbourne university she led this big international initiative of 33 countries
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across the globe and it covered the first i think it was 15 months of the pandemic and within those
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first 15 months broadly speaking the suicide rates did not increase now there were some exceptions for
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example japan there's some signals now that the suicide rates might be increasing in japan
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but the broad picture is that the pandemic did not see the increase that we feared but now my concern is
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and we're starting to see this in the united states in the uk and other countries is now with the cost of
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living crisis and the sort of potential economic turmoil and the ukraine crisis and other things going on in
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the world our concern is that suicide rates are starting to go up again so we're at this period of sort of when
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they didn't increase during the pandemic we need to be really really vigilant moving forward
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are there demographics groups that are more susceptible to suicide say by age or sex
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yes well if we just focus on western countries or high income countries suicide rates are significantly
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higher in men than a woman in the united states and in the uk about three quarters of all suicides are
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by men but then if you look to other countries to low middle income countries we see less of a disparity
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between males and females but in i think it's like every single country in the world men outnumber women
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in suicide now if we look then at age profiles again you have the nuances there's slightly different
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patterns in different countries but broadly speaking suicide is rare before puberty and then when puberty
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hits and those periods through from puberty right up to your mid-20s you see this increase in
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suicidal thoughts behaviors and deaths by suicide and again there's slight differences in countries
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but in the uk for example the leading middle-aged men are the group most at risk of suicide and then
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other countries older age men are increased risk or the highest risk group but the concern many of us
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have is that we're starting to see this increase in young or youth suicides again and that really
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reminds me of when i first started researching this field in the 1990s the biggest risk group were young men
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and if we think back to the 1990s we just all emerged from a recession or real economic turmoil
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and my concern now is we have a similar pattern we've gone through a recession a few years ago
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we know of this cost of living crisis and the sort of broader uncertainty in the world and like my
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concern is that young people are being maybe even more at risk and that their suicide rates may start
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to increase faster so we need to be so so careful and protect our young people speaking to the the sex
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breakdown something that i've read and i want to see if this is true is it true that women attempt
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suicide more often than men but men are more likely to actually take their lives because they use more
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you know lethal means yes that broadly speaking that's a correct statement i agree with that is
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that yes women are more likely to engage in non-fatal suicidal behavior however the explanation for that
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differential isn't as straightforward as saying it's all down to the method that's been used that's
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certainly part of it we know that men are more likely to use more lethal methods and obviously
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therefore more likely to die say on a first attempt but it is more complicated than that and i think
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we need to look at issues around masculinity what it means to be a man in today's society issues around
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the way we structure and tailor treatment so the question i often ask is we know there are effective
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treatments psychological treatments which reduce risk of suicidal behavior but the question is do
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they work for men and are they tailored for men and that's linked to the fact that the way men help
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seek is perhaps different from women and we know that men are less likely to seek help for mental health
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problems and so what we should be asking is instead of blaming men for not seeking help which
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sometimes is part of the narrative we should be saying actually perhaps the treatments and support
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coupled with the stigma around help seeking mental health masculinity these are all contributing to
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a situation i think a perfect storm of factors together with the increased use of more lethal methods of
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suicide and that's really the complexity is the answer to the question of why there are more male suicides
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than female suicides what are some of the biggest myths around suicide and how can those myths get in
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the way of helping people who are susceptible to suicide to my mind one of probably the single most
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common myth that i have come across is that if you ask somebody whether they're suicidal it will plant
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the idea in their head and it's really important that we scorch that myth because there is no evidence at all
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that by asking somebody whether they're suicidal that it actually will make them suicidal there's just no
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evidence however there's no quite a bit of evidence showing the opposite showing that actually if you ask
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somebody that question and i agree it's a difficult question to ask but if you ask that question ask
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somebody directly whether they're suicidal there's evidence showing that actually it can get them the help
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that they need and i often describe that question as being potentially the start of a life-saving
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conversation so that would be myth number one then another myth i think i often think it's important
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to highlight brett and that is this idea that and it's just it comes from a place of real sadness and
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heartbreak is that the number of people that i have encountered over the years who both loved ones as well as
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health professionals who have come up and told me the story that the person who they've lost to suicide
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had seemed okay had seen well in the days and weeks before they died and so the myth is that if somebody
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if there's this improvement in mood that's associated with reduced risk that's a myth because it's the
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opposite in too many cases and i suppose to clarify and i'll make it clear what i mean in a second
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so what the work or the research and sort of evidence suggests is that if there is an unexplained
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improvement in mood it could mean that the person has resolved to end their life and because they've
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resolved to end their life as a way of dealing with their pain their mood lifts because they found
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the solution to their pain a solution to their problems and the reason it's concerning is as a
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person's mood lifts their cognitive capacity their motivation their ability to plan and carry out the
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suicidal act increases so the message on that myth is if there is any unexplained improvement in mood if
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somebody has been in a depressive episode please check in with them to try and understand
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why their mood is lifted now of course it could be their mood has lifted because their treatment has
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kicked in either their medication or their psychosocial treatment has kicked in or their crisis
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has abated but the concern is if somebody seemingly improves in mood and emotional well-being and you
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don't know why always always check in to ensure they're doing okay okay so if someone's mood improves
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it can actually be a danger sign because they may just be feeling relieved that they've made the decision
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to stop struggling and take their own life and another related myth is that someone will always be
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depressed before they die by suicide mental illness is correlated with suicide but sometimes someone
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hasn't been depressed and we're going to talk more about this later but they haven't been depressed
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but then they experience some sort of you know big setback or humiliation that leads them into this
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spiral of suicidal thoughts and these things relate to another myth which is that there aren't any
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warning signs before a suicide and you know a lot of time when someone takes their own life their
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friends and family you know they're shocked and they say they didn't you know they didn't see any
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signs it was coming but your research shows that there are typically signs they can just be hard to
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recognize the sad reality is that um warning signs for suicide are difficulty spots but there are warning
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signs and so the things i would often highlight are changes in behavior so that could be changes in
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eating sleeping drinking like sleeping in particular because we know that disrupted sleep sleep problems
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are associated with suicide risk because obviously anything if your sleep is interrupted that's your
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that's a basic and biological terms we would describe it as a basic homeostatic function if you don't sleep
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well your problem solving is affected your mood is affected your self-regulation is affected so changes in
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these sort of basic processes are important to look out for but other things like and this is certainly
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only probably applies to some cases people who are starting to get their life in order their life affairs
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in order that would be another warning sign that's something that person may have resolved
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to die by suicide and then obviously if somebody has been bereaved by suicide themselves or they've
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experienced a marked loss either in status or in relationships things like that who's marked
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changes can have an impact so again i would be checking in with somebody as well also people
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who are talking about feeling trapped and hopeless and feeling a burden on those around them because we
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know that sense of burdensomeness is at the heart of the sort of suicidal thinking the person feels
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actually if i end up my life the people around me would be better off if i was dead and so those are
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sorts of things i would highlight as sort of the warning signs but the reality sadly is like our
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ability to predict suicide is no better than chance it's no better than the toss of a coin it's really
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difficult to predict who will die by suicide but we should be still checking in with people if we are
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concerned of course is there a seasonality to suicide uh because i think maybe there's a common belief
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out there that a lot of suicides happen in the winter because it's dark and cold um you know maybe
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the holidays make people feel sad is is that true well the holidays bit is is probably true but not
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necessarily the winter bit so that again the best evidence if you try and bring together all the
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evidence from across the world the best evidence suggests that suicides actually peak in spring
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summer time so the increase in that period and actually in december they're low and actually
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lowest on christmas day but then they peak on new year's day and so the question is well why do you see
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this seasonal effect and the short answer is we don't know for certain part of it could be due with
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as we move seasons there's a change in our sleeping patterns and our physical activity it could
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be maybe linked to if we look at sort of occupations at risk of suicide as you move into spring perhaps
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there's increased work related stress say if you're working in the agricultural sector if you're farmer
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or whatever it may be so you can see increased stress and risk there but it could also be the fact
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that as we move into spring and summer and the brightness and sort of vitality of spring and summer
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if you're struggling with your mood there's that mismatch or that dissonance between your internal
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world and your external world and perhaps that's part of the explanation as well so yes there are
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seasonality effects we need to do more research to understand why they persist you know one i saw this
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article in the atlantic this is speculative but a factor that might contribute to that seasonality is
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in the spring there's allergies and inflammation can contribute potentially contribute to depression and
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mental illness again this is speculative but i thought that was interesting i saw that in a
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couple months ago no absolutely and i may have read that same article in the atlantic actually
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and no i think we need to look at the allergens and the rule of allergens because as you say there's
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growing evidence that impact on how they can activate some of the obviously biological systems which
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are associated with mental health problems like depression so i think that's an area we need to look at
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in much more detail because remember like one of the things that certainly i've recognized more and
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more as i've studied suicide and suicide prevention is is and i often describe it as historically we have
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either been too focused on the individual or too focused on the context in which an individual lives
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without bringing those together so so those people who do work on brain imaging and biology that's all
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great and those people who do work on social contexts and cultural factors that's brilliant as well but
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ultimately as john sort of done said that idea of no man is an island we need to recognize that each if
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we're to understand suicide risk we have to understand the individual in their context and that context
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includes these wider environmental factors that you've mentioned as well as of course things closer to home
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like obviously relationship crises mental health problems bullying unemployment and so on we need
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to look at the environmental context as well and we'll talk about some of these factors because you've
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developed this model the integrated motivational volitional model of suicide behavior maybe we can
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talk about some of those factors in that model but just broadly speaking big picture why do most people
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decide to take their own life well so the answer to that question i often give is people people end their life
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as a way of managing unbearable pain and so for whatever it is 703 000 people who die by suicide each year
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there's a whole complex set of reasons which will lead to each one of those individuals dying by suicide
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but i think the common thread is that those people feel trapped by unbearable pain which is can be caused
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by a whole range of factors it could be caused by the fact that your relationship ended or the fact that
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you were had experienced trauma as a child or the fact that your mental health problems are really
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really unbearable but the key driver is seeing suicide is the ultimate solution to your pain and for
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like edwin schneidman who's like a founding father of suicide prevention from the united states often talked
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about this idea of seeing suicide as a permanent solution to what are often temporary problems and so for
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for me to answer the question of why people die by suicide the answer to that question is we need to
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understand what are the drivers to the mental pain by which an individual feels trapped by and they see no
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alternative no way to end their pain no solution to that pain and the only solution is the ultimate
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solution and that is to take their own life so it's like the person in essence doesn't want to die
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they just want the pain to stop they just can't bear the pain and and maybe we're going to go on to talk
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about my model of suicide that's at the heart of my model that sense of entrapment and and then just say
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the sort of key premise of the model is that so suicidal thoughts emerge so they come out of
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this sense of entrapment but that sense of entrapment is triggered by feelings of defeat
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and humiliation and those feelings of defeat and humiliation are often triggered by loss by shame
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or by rejection and so although that's the common spine to understand the emergence of suicidal thoughts
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then the question goes for every one of us who becomes suicidal the pathways to defeat the pathways
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to entrapment are unique we're going to take a quick break for your words from our sponsors
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and now back to the show so let's dig into the integrated motivational volitional model of suicide
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behavior that you develop that can help practitioners but also other people loved ones
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or even individuals who might be experiencing suicidal ideation help them figure out like where
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they are in that path towards suicidal behavior and the first part of the model is the pre-motivational
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phase what are the factors there that can influence whether someone decides to take their own life
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yeah so the pre-motivational phase is part one there are three parts to the model so the pre-motivational
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phase the motivational phase and the volitional phase and so the pre-motivational phase is like the
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background context in which suicidal thoughts or behaviors may emerge the motivational phase is a
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central the middle bit of the model and that's really trying to understand the emergence of suicidal thoughts
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and then the third bit of the model is called the volitional phase and that's trying to understand
00:25:47.720
who is more likely to cross the precipice from thinking about suicide to acting on your thoughts
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so going back then to the pre-motivational phase the pre-motivational phase is really trying to
00:26:00.640
understand what vulnerabilities do we all carry so for example we all have different vulnerabilities
00:26:06.520
they could be biological vulnerabilities so for example there's evidence that people with low levels
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of serotonin and other metabolites and its metabolites and other sort of neurotransmitters are
00:26:18.400
associated with suicide risk so that's a potential vulnerability factor but it's never an
00:26:23.060
inevitability it's just a vulnerability factor like another vulnerability factor we've done quite a lot
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of work on is on different types of perfectionism and there's one type of perfectionism which is
00:26:36.640
described as socially prescribed or just simply social perfectionism and what that is is that if you're
00:26:44.920
high on social perfectionism and i speak as somebody who is also high on social perfectionism is that
00:26:51.240
we're overly concerned about the expectations of others such that we continually we live our life
00:26:59.620
thinking that we're letting others important people in our lives down and i describe it in the book when it's
00:27:06.360
darkest i describe people who have this high social perfectionism as basically having thin psychological skin
00:27:14.420
such that when the bows and arrows of life come at us when negative events occur our skin is much more
00:27:22.340
likely to be pierced sort of metaphorically and so that's a sort of pre-motivational phase because
00:27:28.000
the concern is that people who are high in social perfectionism are much more likely to feel defeated
00:27:34.340
or humiliated when stuff happens to them the social perfectionism is interesting is that uh will store we had
00:27:41.440
him on the podcast talk about his book about social status he wrote an article about male suicide and he
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talked a lot about this social perfectionism and the role of that plays as well as status defeat in men
00:27:54.620
can play in a man's susceptibility to suicide yeah no absolutely i know will will's a good guy and
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actually will store interviewed me as part of that article and then obviously initially it was an article
00:28:08.280
and then and then the book or one of his books and he's exactly right which is that social
00:28:13.540
perfectionism is a really useful framework for us to try and understand as will has done understand
00:28:19.440
male suicide but the way i've tried to conceptualize it is try to understand well how does it increase risk
00:28:25.580
in my case from a psychological perspective and i think that idea of the the thin skinness is a useful
00:28:32.400
way to think about that so we've got that vulnerability aspect and then the other two bits are
00:28:37.560
environmental influences and negative life events they're the last two parts of that pre-motivational
00:28:43.720
phase and the environmental influences are really recognizing that this idea that we know that there's a
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social socioeconomic gradient to suicide and that basically people from more socially disadvantaged
00:28:56.780
backgrounds are much more likely to die by suicide some estimates are you're three times more likely to die by
00:29:03.900
suicide if you're from a socially disadvantaged background compared to a more affluent background
00:29:09.720
and now that's not to say that people from more affluent backgrounds don't take their own lives because
00:29:15.420
they do but the risk is higher when there's more social disadvantage and then the last bit on the
00:29:20.920
pre-motivational phase is we know that people who die by suicide or attempt suicide have experienced a
00:29:27.760
disproportionate number of negative life events and that's both in childhood as well as across the
00:29:34.580
lifespan and actually when you look at the sort of psychophysiology of suicide risk we also know
00:29:41.660
that people who attempt suicide or die by suicide their stress system their cortisol system remember
00:29:47.960
cortisol is like the fight or flight hormone we need to sort of help us either defend ourselves or flee
00:29:54.340
a threatening situation the people that who are suicidal their cortisol system is dysregulated it's
00:30:01.960
not working as well so it adds to the vulnerability okay so the pre-motivational phase these are just sort
00:30:08.000
of the background factors that are already in place in someone's life that could make them more vulnerable
00:30:14.140
to suicidal thoughts they won't necessarily lead to suicide but their potential vulnerabilities so you move
00:30:20.240
into the motivational phase of this this is when ideation and intention formulation occurs yeah and i think
00:30:25.900
you said what usually kickstarts the ideation is some sort of defeat whether you know you lose a
00:30:31.740
relationship you lose a job etc yeah absolutely so i touched on the motivational phase when i was
00:30:38.340
answering one of the previous questions that central idea that suicidal thinking is driven by or it grows
00:30:47.160
out of feelings of defeat and humiliation from which you cannot escape and it's that sense of mental
00:30:53.860
pain that entrapment which drives the emergence of suicidal thoughts and again when we think about
00:31:00.700
what then drives or causes defeat or humiliation that'll be unique for all of us it'll be different
00:31:06.840
for every one of us and defeat and humiliation again are often also driven by loss rejection or shame
00:31:15.500
so i think when we're trying to understand risk at an individual level that's a really helpful way to
00:31:21.880
think about it is asking ourselves what are the potential drivers to somebody feeling defeated or
00:31:27.960
humiliated and ultimately what are the drivers to them feeling trapped and then if we can identify
00:31:34.020
those drivers the causes of defeat the causes of humiliation we can hopefully hopefully intervene
00:31:42.280
either to change the thing that's leading to the defeat or humiliation or if we can't change that
00:31:48.660
thinking of ways to support the individual through that sort of crisis time well in this part of the
00:31:54.840
model you have this idea of i think it's threat to self-moderators and motivational moderators what are
00:32:01.260
those yeah so they're psychological factors so we're trying to understand so if we think about the
00:32:08.120
model as a sort of horizontal line going from on the left hand side you've got defeat and humiliation
00:32:14.720
and then if you move from left to right you move from feeling defeated to feeling trapped
00:32:20.080
and then you move from feeling trapped to suicidal now so what the threat to self-moderators and
00:32:27.660
motivational moderators are psychological factors which we hypothesize sort of facilitate
00:32:34.400
or impede the movement from left to right so that includes things like if you're a really good
00:32:41.660
problem solver social problem solver and you're feeling defeated well actually if i'm feeling defeated
00:32:47.980
and i can solve the problem i'm less likely to feel trapped so that's like an example of where good
00:32:53.860
problem solving will sort of arrest or stop the movement from left from defeat to entrapment or for
00:33:02.060
example if you're feeling trapped what increases the likelihood that you might become suicidal well
00:33:06.820
if i'm feeling trapped and i'm really socially isolated or i feel that i'm a burden on those
00:33:13.500
around me or if i feel disconnected i'm much more likely to feel suicidal and so that sense of being
00:33:20.540
a burden that sense of support or isolation there are these motivational moderators which help us
00:33:26.580
understand who is more likely to move from feeling trapped to suicidal and so although often in the
00:33:34.120
model we frame it as risk so the presence of all these factors lead to risk the motivational moderators
00:33:41.000
and the threat to self-moderators help us identify what we describe in psychological terms as targets
00:33:47.720
that we could focus on which will hopefully protect somebody from moving from defeat to entrapment to
00:33:55.060
suicidal thinking so there's the motivational phase you have the defeat or humiliation which
00:34:00.540
leads to entrapment which then could lead to suicidal ideation and intent what causes someone to start
00:34:07.540
shifting over from just ideation to i'm actually going to do something so we're moving to the volitional
00:34:12.460
part of this yeah so the volitional phase which is the third part of the model and it's our attempt
00:34:18.220
to try to identify what we think is about 30 percent of people who have thoughts about suicide we think
00:34:26.200
about 30 percent move from thoughts to suicidal acts and and that includes fatal as well as non-fatal
00:34:34.900
suicidal behavior and so according to the model there are eight key factors which i call volitional
00:34:41.780
moderators or volitional factors which increase the likelihood you make that transition you act on
00:34:48.160
your thoughts and they include things like having access to the means of suicide so it stands to reason
00:34:54.120
if i if i'm suicidal and i have ready access to the means of suicide well i'm more likely than to act
00:35:01.380
on my thoughts and because if it's ready access it means that the environmental constraints
00:35:07.540
on you accessing that method are reduced or low and anything which leads to reduced constraints
00:35:15.280
on access to means increases the likelihood that you'll engage in that behavior and indeed if you
00:35:21.060
look at the evidence for what works at a public health level to prevent suicide it is interventions
00:35:27.200
which are focused on restricting access to the means of suicide that's like for example having
00:35:34.860
barriers in places of concern not having ready access to medication and so on so that's one of the
00:35:42.320
volitional factors others include exposure to suicide so what we mean by exposure is that if you know
00:35:49.880
somebody else who's died by suicide and again it stands to reason that if i have having thoughts of
00:35:56.140
suicide and i know somebody who's died by suicide i'm more likely to act on my thoughts and that's because
00:36:03.580
the mechanism could be that if somebody close to you who has died by suicide that method of death
00:36:10.380
is potentially more cognitively accessible or it could be that if that person is like you
00:36:16.380
you model you're modeling their behavior or it could be that it legitimizes the behavior for you
00:36:24.200
because if a loved one uses that method of coping with a distressing situation well maybe that's
00:36:30.240
something you would consider so that's that's the one of the that's the volitional moderators i'll just
00:36:34.860
say there's eight of them but i won't go through all eight i'll do a couple more impulsivity is one of
00:36:41.400
the volitional moderators so again the idea that if you're having thoughts of suicide and you're impulsive
00:36:47.160
stands to reason you're more likely to act on your thoughts and then just maybe two last ones
00:36:53.820
second last one in the list if you if you read the model is basically this idea that's having mental
00:37:01.420
imagery around dying or death so so what we think happens is if somebody is having thoughts of suicide
00:37:08.640
and they're picturing themselves either dying or dead that's perhaps like a rehearsal mechanism or it
00:37:16.440
could be it could act as a sort of habituation of making death less scary so that so then the presence of
00:37:23.300
both thinking about suicide and imagery around death increases the likelihood that you'll act on your
00:37:30.400
thoughts and then one very last one is past behavior the single best predictor of any future behavior
00:37:38.920
is whether you've engaged in that behavior in the past it's exactly the same for suicidal behavior
00:37:45.580
so the evidence shows that if you've engaged in suicidal behavior in the past you're statistically
00:37:51.580
more likely to engage in suicidal behavior in the future or sadly die by suicide it's important to
00:37:58.860
put that in context because although past behavior is one of the strongest predictors of future suicidal
00:38:05.760
behavior the majority of people who say are suicidal or have attempted suicide in the past won't do
00:38:12.980
again in the future and will never die by suicide okay so that's the integrated motivational volitional
00:38:19.260
model of suicide behavior and what this allows you to do as a practitioner or anybody there's points
00:38:26.060
where you can see where you can start doing some preventative things i'm going to start working here
00:38:31.060
in the motivational part or i'm going to start working here in the volitional part so based on your
00:38:34.980
research not only do you research suicide but you research suicide prevention what's the best thing that works
00:38:40.740
in suicide prevention so i'll answer that in two ways so you've got large-scale public health
00:38:48.040
interventions have been shown to be effective that's things that as i mentioned earlier on the
00:38:52.800
restricting access to the means of suicide anything which restricts access to the means of suicide
00:38:58.660
has been shown to be effective in reducing suicide so that's good news that's really good news
00:39:04.040
that's challenging for example in the united states that's challenging when we think about
00:39:09.860
firearms that's a really complicated topic to address given obviously the constitutional implications
00:39:16.560
and so on so that's a sort of big public health type example but if i focus in on the sort of
00:39:22.160
individual level so over the last 20 years there's been growing evidence that sort of psychosocial
00:39:28.260
intervention so these are like talking therapies things like cognitive behavior therapy have been shown to
00:39:34.580
be effective in reducing suicidal behavior over time so that's good news there's a growth in the evidence
00:39:42.000
base for those sorts of talking therapies there also has been a lot of interest and focus on sort of brief
00:39:48.760
interventions things like safety planning and safety planning is an intervention that we've done some work
00:39:55.240
with ourselves over here in the uk but safety planning was developed by barbara stanley and greg brown in the united states
00:40:03.280
and it's an effective intervention but it's a simple intervention and it really focuses in on the
00:40:09.040
volitional phase so if you think about cognitive behavioral therapy or cbt it's more focused on the
00:40:15.020
motivational phase it's trying to understand the complex factors that lead to defeat and entrapment and
00:40:21.160
suicidal thinking and so on but a volitional phase intervention like safety planning is trying to
00:40:27.580
interrupt suicidal thoughts so somebody doesn't cross the precipice from suicidal thoughts to suicidal acts
00:40:36.200
and it's very very simple so the intervention basically it's it has six steps step one is you work
00:40:44.580
collaboratively with somebody who's suicidal to try to identify the warning signs that a suicidal crisis
00:40:51.740
might be escalating so hopefully if you can identify in advance you can intervene and do something
00:40:58.080
to keep yourself safe and then in steps two three four and five it helps the individual identify people
00:41:07.680
or places or organizations that they can go to either to distract themselves as the suicidal thoughts
00:41:16.220
might be escalating or if they feel they cannot keep themselves safe somewhere to go in crisis or somebody
00:41:23.940
to contact in crisis and then step six is the last step of this intervention and it's working again
00:41:31.780
collaboratively with the person to help them keep their environment safe and by keeping their environment
00:41:38.400
safe what we mean is basically to increase the distance between them and a method of suicide
00:41:45.160
if they thought about how they might end their life what can we do to ensure that when that crisis
00:41:51.280
escalates again they do not have ready access to the means of suicide so something like that i would
00:41:57.800
really focus in on that safety planning it's only one example as a sort of brief intervention but a
00:42:03.800
really important one because it's something which intuitively makes sense brett but something we can all
00:42:08.680
be thinking about and then also on individual level if you know someone who you're worried about
00:42:14.440
we talked about this earlier don't be afraid to ask them if they've thought about taking their own
00:42:19.460
life because it's not going to implant that idea in their head to do it it's just that could actually
00:42:24.320
be the thing that could kickstart them getting the help they need yeah absolutely and really we cannot
00:42:29.720
emphasize that enough if you are concerned please ask somebody directly whether they're suicidal
00:42:35.360
but i appreciate that that's a difficult thing to do and again i described sort of some tips in the book
00:42:41.720
but in essence so if the person answers yes that i am suicidal i mean in many respects that's your
00:42:47.860
biggest fear if you ask that question and somebody says well yes i am suicidal so your biggest fear is
00:42:53.480
well what do i do next so what you do next is you just validate validate how they're feeling and say
00:42:59.440
that must be really difficult for you that's all we mean by validation that must be really difficult for
00:43:04.760
you it's not about trying to solve their problems it's trying to acknowledge being be alongside them
00:43:10.380
in their distress and then encourage them to think about how they might be able to get support
00:43:16.080
if they think they cannot keep themselves safe and that sort of sense of common humanity that sense of
00:43:22.520
connection and sort of treating the individual as worthwhile as somebody who's valued in this world
00:43:29.940
because many people who are suicidal don't think that they have a role in society anymore and feel
00:43:35.980
that they are a burden so anything which promotes connectedness and then encourages them to maybe
00:43:42.040
reach out speak to their physician their general practitioner somebody else in their life who can help
00:43:47.360
keep themselves safe i would really encourage people to do that so please please reach out let's talk
00:43:53.620
about a little bit you talk about this in the book about those who are bereaved by suicide so family
00:43:58.100
members who had a loved one that that took their own life how does their grief differ from someone who
00:44:03.400
might have just experienced you know someone who died by other causes and any advice for them on how
00:44:09.360
they can navigate that and i guess the other question there too would be what can people do to help
00:44:14.960
those who are bereaved by suicide yeah i mean again really important questions so the grief associated with a
00:44:23.480
suicide is complicated because of course any sudden death is devastating but on top of the sudden death
00:44:30.760
there's often shame and guilt and what could i have done differently and again i speak as somebody who's
00:44:38.180
twice bereaved by suicide and in particular with a close friend of mine who took her own life i still ask
00:44:45.280
myself today what i could have done differently and i felt in part responsible for not being able to
00:44:51.540
save her life and many people bereaved by suicide feel the same so part of it is trying to be more
00:44:58.600
self-compassionate no one of us should ever be held or can ever be held responsible for the actions of
00:45:05.140
another person recognizing that the prediction of suicide is so so difficult and as i said earlier
00:45:11.180
it's no better than chance our ability to predict suicide and so recognizing that every day is different
00:45:18.500
every day is different and it's and that's the pain anger the steps of bereavement that people go through
00:45:25.820
them differently and probably the only certainty about bereavement by suicide is its uncertainty is its
00:45:32.760
unpredictability it's some days you might feel okay and other days not and it can come on in such a
00:45:39.560
unpredictably obviously and i suppose it's also recognizing that although as days become weeks and weeks become months
00:45:47.780
it's all about moving forward it's not forgetting it's just you're moving step forward step forward
00:45:53.540
step forward you're changed as an individual of course you are and it's just trying trying to sort of
00:45:58.900
recognize that and things do become a bit easier in terms of advice for those who are around those who have
00:46:06.080
been bereaved again it's just recognizing that the person is going through unbearable pain don't be
00:46:13.220
frightened because one of the big fears again is i'll say the wrong thing and again the advice that i would
00:46:20.040
certainly give and i know from speaking to countless others who have been bereaved is as long as somebody
00:46:24.340
treats you with humanity and compassion you're unlikely to say the wrong thing and don't judge it's non-judgmental
00:46:32.880
don't try and tell the person how they're feeling just be alongside the person and let them know that you'll be
00:46:38.720
with them you're there if if they need them at any stage and please don't cross the road because that
00:46:46.020
still happens that idea of people are bereaved by suicide and people cross the road instead of
00:46:51.760
speaking to them and that's often out of fear of saying the wrong thing so please please support each
00:46:57.320
other well rory this has been a great conversation where can people go to learn more about your work in
00:47:02.260
the book so to find out more about our work we have a website the website is www.suicideresearch.info
00:47:11.480
so that's suicideresearch.info and the book is available i think everywhere so wherever you tend
00:47:18.140
to get your books in amazon or wherever or other obviously booksellers the book's widely available
00:47:23.540
well rory o'connor thanks for your time it's been a pleasure thanks so much brett i really enjoyed our
00:47:28.180
conversation my guest name is rory o'connor he's the author of the book when it is darkest why people
00:47:33.560
die by suicide and what we can do to prevent it it's available on amazon.com and bookstores
00:47:37.900
everywhere check out our show notes at aom.is suicide where you find links to resources where
00:47:42.540
you can delve deeper into this topic well that wraps up another edition of the aom podcast make sure
00:47:54.280
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00:47:58.400
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