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

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Suicide's one of the leading causes of death around the world, taking the lives of about a million people each year around the world, taking more lives than all wars, all homicide combines.

We're each more likely to die by our own hand than we are by someone else's.

The family of the teenager who died by suicide alleges OpenAI's chat GPT is to blame.

Blackmailed with AI-generated nude photos that he died by suicide.

Dr.

Matthew Knock, a world-renowned expert on self-harm, pioneering new ways to understand and treat these behaviors.

What's the biggest myth about suicide that you think it's important to dismantle?

If someone really wants to die, then we shouldn't try and help them.

It's destiny.

Not at all true.

90% of people who try and kill themselves say, I didn't want to die per se.

I wanted to escape from seemingly intolerable pain.

How many people actually move from suicidal thoughts to making a plan?

In the U.S., about 15% of people think about suicide.

One-third of people who ever think about suicide will ever make a suicide attempt.

Those who attempt and survive, about one in five, will make another attempt.

For those people who have attempted suicide but then survived, do they regret it?

Three-quarters said the first thing they thought was they regretted it immediately.

Two-thirds of people who die by suicide told someone beforehand, why aren't we catching those warning signs early?

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Hey, everyone, welcome back to On Purpose, the number one health podcast in the world.

Thanks to each and every one of you that come back every week to listen, learn, and grow.

Now, you know that our mission is to make the world happier, healthier, and more healed.

And today's guest is someone who has dedicated his life to do just that through his work.

I had the fortune of speaking to our guest a few months back when I was interviewing him for a book that I was writing.

And this is the next book that I'm working on.

And while I was doing that, I was so fascinated by his story, his research, the insights he was sharing that I said I had to have him on the podcast.

Today's guest is Dr.

Matthew Knock, a professor of psychology at Harvard University and director of the Laboratory for Clinical and Developmental Research.

Dr.

Knock's work focuses on understanding why people engage in self-harm with a particular emphasis on suicide.

Through large-scale surveys, lab experiments and clinical studies, his research aims to uncover how suicidal behaviors develop, how to predict them, and most importantly, how to prevent them.

Please welcome to on purpose Dr.

Matthew Knock.

Matthew, it's great to have you here.

Thank you so much for having me.

Really, really appreciate you having me on the show.

Yeah, this is such an important issue.

It's an issue that I think is underspoken about.

It still feels taboo.

It feels like it stays far away from the mainstream unless and until something happens in the space that then puts a spotlight on it and then it seems to disappear again.

I wanted to ask you, what brought you to do this work?

How did you become passionate and committed to doing this work in the first place?

This is a big problem.

It's been around for a long time.

We don't talk about it a lot.

So just want to state from the outset that I really, really appreciate you shining a light on the problem of suicide.

I wasn't looking for it.

I was actually, I was an undergraduate,

20 years old, and I was studying actually in London doing a semester abroad.

And I was placed in an externship, a sort of clinical practicum placement in a psychiatric hospital.

And I was assigned to a unit with self-injurious, suicidal, violent patients.

And I was just really struck and captivated and overwhelmed by the problem of suicide and self-injury.

And there were patients there who were cutting themselves, burning themselves, trying to kill themselves.

And I was really alarmed.

I was confused, perplexed, inspired by the work of the staff.

And at the time, I wanted to be a clinician.

I wanted nothing.

I do a lot of research now.

Didn't like the idea of research.

And I thought, if I can understand suicide and know how to better treat it, This is really, you know, for me jumping in the deep end of the pool.

Everything else should be easier after this.

And I, I, you know, fast forward 30 years later, I haven't gotten out of the field.

What kept you in it?

Well, there was so much work to be done.

I mean, we, it's such a challenging problem.

Um, and it's, it grabbed me philosophically.

I was a philosophy, biology, interested young person and found psychology.

And suicide touches so many different disciplines, epidemiologically, public health-wise.

It's a huge taker of life.

Philosophically, it's something that virtually every major philosopher is focused on.

Camus called it the one truly serious philosophical problem.

And scientifically, there's just so much work to be done and so much impact to try and have and so many people to try and help and so much suffering underlying all of this, I got pulled into it and have not stopped.

And I feel like I can't stop and we can't stop because there's so much more work we have to do.

What's the biggest myth about suicide that you think it's important to dismantle before we dive in?

One of the biggest ones is

there's so many.

One of the biggest ones is that if someone really wants to die, then we shouldn't try and help them.

That, you know, if someone wants to die, it's destiny and they're going to kill themselves.

Not at all true.

Most people who try and kill themselves are ambivalent.

They don't want to die.

And I've talked at this point, thousands of people who've been struggling with suicidal thoughts.

90% of people who try and kill themselves say, I didn't want to die per se.

I wanted to escape from seemingly intolerable pain.

And for most people, they're able to work through that and survive.

And

most people who try and kill themselves don't end up dying by suicide.

So there's a lot that we could do to better help people who are having suicidal thoughts and who are at risk for suicide.

How many of the people that attempt to commit suicide actually

not only go through with it, but ultimately

complete the belief?

I'll walk through the pathway.

So about in the U.S., about 15% of people think about suicide.

They say they've had serious thoughts of suicide at some point in their life.

About 5% 5% of people try to kill themselves.

They make a suicide attempt.

So only about one-third of people who ever think about suicide will ever make a suicide attempt.

Of those who attempt and survive,

20% or so, one in five, will make another attempt.

And a small percentage will end up dying by suicide, something like 5% or so, 5% to 10%.

So there's a lot more suffering with suicidal thoughts and a lot more non-lethal suicide attempts than there are suicide deaths.

At the same time, suicide is one of the leading causes of death in the U.S.

and around the world.

One of the most staggering facts,

I'll mention two.

One is suicide takes more life than all wars, all homicide, all interpersonal violence combined.

So if you think about it, we're each more likely to die by our own hand than we are by someone else's, which every time I think about that, every time I say it is

startling.

We worry a lot about, you know, in the news, there are wars happening.

We lock our doors, we lock our windows,

we're concerned about people coming for us and attacking us.

We're more likely to die by our own hand than we are by someone else's.

And that continues to really perplex me.

And how many people who attempt suicide will do it again?

About 20% of people who

make a suicide attempt and survive will go on to make another attempt.

And it's often within the next year.

So when someone first has thoughts of suicide in their life, that next year is the highest risk time for making a suicide attempt.

When someone makes a suicide attempt, if they're going to make another attempt, it's going to come right after that.

And the highest risk time for suicide death ever is in the weeks after a person leaves a psychiatric hospitalization for the treatment of suicidal thoughts or behaviors, which is a little counterintuitive.

So you would think that if a person just got treatment, they should be okay.

They're out of the woods.

Not so.

A lot of times people go into the hospital and get maybe an antidepressant.

Those take two to four weeks to have any effect, and people are discharged from hospital stay in a week or so.

And we're good at finding people at risk.

We're not good at

getting them fully treated in the short period of time the hospitalizations typically happen in.

So I would say keep a close eye on people.

If someone you know or if you yourself have been hospitalized for suicide risk, just because a person's release doesn't mean that things are totally fine now.

Keep an eye on them, stay in touch, engage in treatment, make sure they're engaged in treatment.

Yeah.

Can you walk me through the different stages of suicidal thoughts and behaviors and action so that we can actually understand it from a more detailed perspective?

Because I think for anyone who's not aware, like myself, it seems like there's suicidal thoughts and then there's the act.

But what does it really look like?

So we, as we as researchers, as clinicians, think about a few steps in the pathway to suicide.

And the big sort of signpost or stop along the way is first people think about suicide.

So having suicidal thoughts or what we call suicide ideation, having ideas about suicide.

And that's a big outcome we focus on.

We try and understand what gets some people to think about suicide while others don't.

Next is suicide planning.

So actually formulating a plan to kill yourself.

More intentional.

Some people have suicidal thoughts and it's really aversive to them and they don't have plans.

They just have the thoughts.

They might have them involuntarily and be really spooked by them.

But some go on, about a third go on to make a suicide plan.

They think of a place, a time, a method to kill themselves.

And then the next is...

engaging in behavior, engaging in a suicide attempt, taking steps to intentionally end your own life.

And as I mentioned, a lot of people will do that and not die by suicide.

And then the next is, of course, dying by suicide.

For someone who dies by suicide, the making a plan piece makes it believe that there is preparation and premeditation.

It's not something that happens at random.

There often is.

There's a lot of variability here.

So some people will die by suicide in a really planful way.

They'll make a plan.

They'll leave a note.

Often the notes are very practical.

I made the last mortgage payment.

And so, you know, here's where the keys are.

Very practical and to the point.

Not always, but a lot of the time.

A huge percentage of the time, they're more impulsive.

A person might have thought about suicide, and it's only in a few hours before the event that they make a decision they're going to end their life.

It's rare that it comes out of nowhere, that a person's walking along living their life and all of a sudden they have a thought of suicide and die by suicide.

It usually is a much slower buildup, that there's distress, there's depression, there's anxiety,

there's thoughts of suicide.

Sometimes the thoughts of suicide can last years before a person takes action.

Most of the time, though, if someone's going to make a suicide attempt, it's within the first year after onset of suicidal thoughts.

So that when the thoughts come on is the highest risk time.

But it's not always planned out.

What are some of the most, looking at each of those areas, what are some of the most common reasons people find themselves having suicidal thoughts?

Far and away, the biggest reason is escape.

If I had to sort of give one message and try and demystify suicide, for those who are struggling with, who haven't had suicidal thoughts and are struggling with understanding why would someone ever think about suicide, again, nine out of 10 times, it's,

I don't want to be dead per se.

I want to escape from this seemingly intolerable pain.

People describe it often like trying to get out of a burning room.

I don't want to die.

I just, I can't.

I don't think I can take this pain anymore.

And so that gets people thinking a lot about suicide a lot of the time.

And what is that pain?

A lot of time, it's depression.

So depression is one of the strongest predictors of having suicidal thoughts.

And depression takes many forms and manifests differently.

Some people describe it as having like a weighted vest on.

Some people describe it as just really psychological pain, as despair.

But it is one of the biggest drivers of having thoughts about suicide.

Interestingly, the things that predict who acts on their suicidal thoughts are different.

Depression doesn't really predict acting on your suicidal thoughts.

What does is anxiety, aggressiveness, poor behavioral control, drug use, alcohol, over-alcohol use.

These things predict acting on suicidal thoughts.

And it's the combination of these things that we think really puts people at risk.

The symptoms of someone thinking about suicide are different to the ones that actually act on it.

Yeah.

And I'll go a step further.

This is one of the more interesting findings I've come across.

Your parents' history of depression, if you have a parent with depression, that increases your risk of thinking about suicide.

And it actually increases the length of your suicidal thoughts, the persistence in years of your suicidal thinking, but doesn't predict you acting on your suicidal thoughts.

What does is your parents' history of antisocial behavior, panic disorder, so hyper-arousal,

tendency to act impulsively, this predicts you acting on your suicidal thoughts.

So we think these different pieces of the pathway to suicide might be passed down differently, genetically, familiarly.

Aaron Powell, when you talk about those

almost extreme feelings of escaping, that idea of running out of a burning room, is there a correlation between that feeling and

money more or relationships or like life situation?

Or is it across the board and we don't have clarity on that yet?

Yeah, we don't have a lot of clarity.

I think pain manifests differently for different people.

And one thing about suicide is there are socio-demographic factors that predict who becomes suicidal.

For instance, for gender, women are more likely to have suicidal thoughts and engage in non-lethal suicidal behavior.

Men are more likely to die by suicide by a ratio of about four to one.

And that's true in virtually every country around the world.

There's a lot of other things that go into suicidal thoughts and behaviors that put a person at risk, that lead to that sort of fire, that feed that fire.

And it's different for different people.

So relationship problems predict.

Legal problems predict.

But suicide knows no bounds where it comes to income.

There aren't, by and large, big financial differences.

People at all income levels are almost equally at risk.

So socioeconomic factors, education levels, income levels, suicide doesn't really discriminate.

It's a problem for all, almost all members of society.

What does that tell us?

There's a lot of roads leading to Rome.

I mean, there's a lot of ways to put a person at risk for suicide.

And again, I've been trying to figure out what is the thing, what is the motivator.

It's this burning room.

It's this fire.

So that's where I usually start scientifically and where I start clinically.

I'm a licensed psychologist.

So

have worked with patients over the years, trying to figure out the motivation and what is it for this person that's leading them to want to escape?

What are they trying to escape from?

What is the pain for this person?

I think attempts to try and find the silver bullet of, oh, it's relationship or, oh, it's finance, or oh, it's a mental illness are a little bit misguided.

They're one piece of the puzzle.

I think we've got to start, or I think it's helpful to start with, what is a person's experience?

What are they trying, what's making them suicidal?

What's making them not want to live anymore?

What is it for them?

Let's try and understand that and see if we can figure out some way to solve that problem,

help them tolerate what they're experiencing without dying, and then work backwards from there.

Yeah, that makes a lot of sense.

Like the idea of seeing everyone's experience as unique to them and recognizing what their burning room is

and not projecting a external value or belief onto that and why it exists.

Yeah.

You spoke a bit about this a couple of moments ago.

What are the key differences between how men and women think and approach suicide?

As I said, there's big gender differences.

So women are much more at risk for thinking about suicide and for engaging in suicidal behavior.

Men are much more at risk for dying by suicide.

And we think that difference is due to women

having much higher rates of anxiety and depression, which are more closely linked with suicidal thoughts.

Men having higher rates of alcohol and drug use disorders and aggressive behavior and impulsive behavior being more linked with impulsive, aggressive action.

And we think those are two of the big drivers of why we see those gender differences and why they persist almost everywhere around the world.

There are some commonalities though across genders in terms of age.

Suicide is pretty rare in young people, meaning children.

In every country we've looked at around the world, and we've looked at dozens of them, suicide rates and rates of suicidal thinking skyrocket in adolescence, every country.

They even out in young adulthood and then they go up again later in life.

And that increase later in life is especially prominent among men.

We think this is because women, these are generalities,

tend to be more socially connected, have more friends, have more close relationships.

Men tend to have fewer of them.

And later in life, when people hit retirement age, men tend to be less connected.

And we think this lack of social connectedness, lack of reaching out for help, is what leads people to have this increase in suicide later in life.

Wow.

And so looking at the different ages, the first was adolescence.

Yeah.

And the key reasons for that was...

We're still trying to figure it out scientifically what is it about adolescence that increases risk.

One of the leading explanations is this imbalance that we see in adolescence, in brain development, where this is a little bit of an oversimplification.

Parts of the brain involved with emotionality, impulsive action, the limbic system are ramping up in adolescence.

But the breaks, the prefrontal cortex, isn't fully online until early adulthood.

And so we see huge increases in risk-taking behavior, aggressive behavior, alcohol use, drug use in adolescence.

We also see huge increases in depressive illness, anxiety disorders.

We also see increases in bipolar disorder, which is a huge contributor to risk, psychotic illness.

So in adolescence, aspects of adolescent brain development are coming online,

likely leading to increases in psychopathology, leading to increases in suicide.

risk.

Is there any difference between countries and ages?

And

No, there's differences in rates.

So rates of suicidal thoughts and behaviors and suicide death vary around the globe, and we're still trying to understand why.

They're not explained by geography.

They're not explained by high, middle, low-income countries.

So we're trying to understand how,

undoubtedly, religion and culture play a role.

There's also differences in reporting.

So a lot of the numbers we have, we think, aren't completely accurate.

Suicide is still illegal in many countries around the world, and that's going to influence how it gets reported.

Do you think we should be talking about suicide at school?

Because I was thinking about an analogy that you gave around being in a burning room.

Yeah.

And I was thinking that we were all trained what to do

in the event of a fire.

We were all trained what to do if you live in a country that experiences earthquakes.

And again, those two things are pretty

Not many people are going to experience those, but we train people because

we believe it's a possibility.

When you were saying 15% of people are going to have suicidal thoughts, do you think it's important that we almost equip everyone with a safety plan or with the idea of what to do when that happens?

Yeah.

I do.

You know, you look at what's happening with school shootings in the U.S.

and it's, you know,

training of what to do if there's a shooter.

It's more likely there's going to be someone who's suicidal, who's going to die by suicide, who's going to try and kill themselves.

So there's going to be a suicide cluster, a number of kids who try and kill themselves.

Again, we know that asking about suicide, talking about suicide does not make people suicidal.

There are programs that go into schools and do a little mini-educational module about suicide in health class or outside of health class.

Here's what suicidal thoughts are.

Here's what the suicidal behaviors are.

Here's what you can do to keep yourself safe.

Here's effective interventions.

Here's what you do if someone you know is struggling with suicidal thoughts.

It's something that...

is being done on a small scale now.

I think it'd be wonderful to see it done on a much larger scale.

It could help help save lives.

Yeah, it just sounds like

because it's something that 15% of people are going to think about at some point.

And if you thought about any of the other things we get trained to do, it just feels like it would be useful.

Absolutely.

It would be really useful.

Absolutely.

I think, again, it's taboo.

It's stigma.

It's fear that's keeping it away from more common use.

And we've shown over and over again, there's no reason to be scared.

It's not going to do harm.

And again, continued experimentation will be our friend here.

And we can see, are there some versions of this that do harm?

If so, then we won't do them.

Are there ones that work and help keep kids safe and prevent loss of life due to suicide?

Wonderful.

Let's expand those and make them available so that people don't needlessly lose their kids to suicide or their friends or their loved ones.

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Drew and Sue in Eminem's Minis.

And baking the surprise birthday cake for Lou.

And Sue forgetting that her oven doesn't really work.

And Drew remembering that they don't have flour.

And Lou getting home early from work, which he never does.

And Drew and Sue using the rest of the tubes of Eminem's Minis as party poppers instead.

I think this is one of those moments where people say it's the thought that counts.

Eminem's, it's more fun together.

When you were talking about adolescence, I mean, I just came across this story in the New York Times a couple of months back.

I'm sure you saw it, but it was the family of a teenager who died by suicide alleges OpenAI's chat GPT is to blame.

And for those who don't know, I'm reading from the New York Times article.

It says, the parents of Adam Raine, who who died by suicide in april claim in a new lawsuit against open ai that the teenager used chat gpt as his suicide coach

and it goes on to say that you know after the suicide they were searching through his phone desperately looking for clues about what could have led to the tragedy they say we thought we were looking for snapchat discussions or internet search history or some weird cult but they were led to find his conversations with chat gpt yeah I mean, I can't,

it's so tragic.

And, you know, when you see Adam, it's this picture of him.

It's, it's so hard to wrap your head around it.

And

when I was reading that, I was just thinking, I can't imagine being a parent

right now where you're already scared about bullying and how that affects.

children.

You're scared about online bullying

to the level of whatever this gentleman was sadly going through then leading to actually using AI as his suicide coach.

Walk me through how you think about that when you read something like this.

It's tragic.

As I mentioned, I think as a parent of three,

I

find it difficult to imagine anything more tragic, horrible than gut wrenching than losing a child to suicide.

So that's the first thing that comes to my mind always still

having worked in this area for over 25 years.

It's still a gut punch and a feeling like we need to do more.

It's an interesting time

to be a little cliche, but in terms of the possibilities of machine learning, of generative AI, of all of the data points that we're getting, I think there's huge promise in

these advances, but there's also a lot of dangers.

And for me, it's very early days and it's tragic when we see instances like this where, and if you read through the article, which I saw as well, you can see pretty clearly how the AI went, how things went awry and how things were missed and how it's amazing how human-like these technologies currently are, but they're not human and they're missing things.

And in some cases, there's a number of, I think, two or three stories this week on this topic in the New York Times and other leading outlets.

The AI right now often gets it wrong, misses opportunities to jump in.

Humans missed them too, but misses pretty clear ones.

And in some cases, encourages people and says, yeah, based on what you're experiencing, it sounds like this is a logical solution to your problem.

And so it's screwing up majorly.

And I think huge changes are needed in how it's being used.

Generative AI, again, I know it sounds cliche, but it's true, is a tool.

And like a sharp knife, it can be used to help and it can be used to harm.

And we haven't yet figured out how to use generative AI to help in this instance.

And in some cases, it's harming.

No doubt, in a lot of cases, generative AI, large language models are helping people.

One problem with suicide, or

one problem with suicide overall, is a huge taker of lives, and many people don't have access to care.

And so there's great potential here to use generative AI to help people.

But it's not developed for this purpose.

And it's going awry.

And it's contributing to the problem in many cases.

I've seen so many people, heard of so many people, have so many friends who use chat GPT as therapy and finding it very useful, finding it very powerful, finding it very practical.

And then you see this side and it almost seems like there's a great need for guardrails connecting to a human as soon as possible.

I mean, finding care before it goes awry because...

Yeah, there's, and from my perspective, there's a need for research.

So as in any area, everyone here, I'm sure, is well-intended.

I'm sure OpenAI is well-intended.

And a lot of the the digital mental health startups that are popping up all over the place are well-intended, but intentions in themselves don't always lead to positive outcomes.

And there's instances, I'll mention one platform that I won't mention the name of, had this wonderful app where it could find people online who were suicidal and it would inform their friends, reach out to this person they're struggling.

Very well-intended, very logical.

It was pulled down in just a few days because it totally backfired.

And it was finding kids online who were being bullied and informing people in the network, including the bully, who was then bullying them more.

I see you're suicidal.

You should go and kill yourself.

And so the platform, to their credit, pulled it down pretty quickly.

Just one instance of the intentions are good.

The idea is a good one.

But without testing, without experimentation, lots of bad stuff is going to be put out there and lots of ineffective things, lots of harmful things.

So this is where I think science has to come in to evaluate things and see what's working, what's not working.

Let's pull down the things that are not working, improve the things that are and get them to people so they can be helped.

Yeah, I mean, bullying isn't a new issue, but I was reading some statistics that were saying that

cyberbullying makes someone over three times more likely to contemplate suicide.

And then general in-person bullying makes it two to nine times more likely to consider suicide.

It seems like humans, especially at the adolescent age, when I feel like bullying is the most prevalent,

it seems like we still haven't figured out a way to help young people curb their desire to bully others.

No, it's a, I'm sure, a perennial issue, a timeless issue where

we see it in non-human animals where adolescent elephants will bully other elephants and they'll bully other animals if there's not parents around constantly.

Zoos have to sort of address this when it occurs.

So it's a problem in a lot of animals, a lot of organisms.

It's not new.

And it's not caused by the internet and AI, but it manifests in new ways.

And it manifests in ways.

Bullying manifests in ways that parents don't really know about.

What kids are doing online is unknown to parents.

And the bullying now is taking new forms.

And it's unknown to clinicians, it's unknown to parents.

And so it's more

insidious.

And it's more around the clock.

It used to be when I was young, perhaps when you were young, you go to school and you get bullied or maybe you bully or and then you go home and it's over.

And now it's round the clock.

And that lack of ability to escape, we think, can be really problematic for a lot of kids.

And so here too, it's a tool and we've got to figure out how to best use it and how to use it for good and for improving well-being and for improving mental health.

We did a qualitative study with suicidal adolescents in a local hospital.

And we asked them about their social media use, their online use.

And what they described was, yeah, it's, there's bullying, there's social comparison.

I see what other people have and I don't and I feel really bad about myself.

I'm learning new ways to cut myself in ways that it can't be discovered.

So there's a lot of bad happening.

There's just as much good.

And they're saying, I'm learning skills.

I'm learning how to be mindful.

I'm learning about ways I can help calm myself down when I'm upset.

So there's, as with any tool, there's good and bad happening.

We just need to do a better job clinically, parentally, societally, scientifically, at catching up and learning how to use this in ways that are helpful and can improve mental health and decrease with guardrails or otherwise the harms that it's clearly doing.

This was the other one I saw on AI that was heartbreaking:

Teen was blackmailed with AI generated nude photos of himself, then he died by suicide.

And so

Eli died by suicide on February 28th, 2025 after receiving alarming texts.

The sender threatened to send AI-generated nude photos of the 16-year-old to friends and family if he didn't hand over $3,000 in alleged sextortion scam.

Sextortion often targets teens and children and is becoming increasingly dangerous, according to the FBI, the article read.

And so, yeah, it's such a,

I mean,

again, I think as a parent,

it's such a stressful time.

What have you seen have been,

what are things parents can do

to help to be involved in the conversation, to be useful?

What have you seen through research?

that parents can shift and change about their behavior attitude.

Reach out and have the conversation.

So talk about suicide.

Talk with your child about suicide, about what they're experiencing, about their mental health.

Suicide is still incredibly taboo.

And one of the biggest myths that I hear is if I talk about suicide, if I ask my child or ask my spouse or ask my friend about suicide, it's going to give them the idea and make them suicidal.

And so I'm not going to say anything.

And that's been shown experimentally, time and again, to not be true.

Oh, it doesn't.

It does not happen.

And people have done experiments where they ask some kids if they're suicidal and don't ask others and follow them up.

Kids who get asked about suicide, middle school students, high school students, adults are not more distressed.

They're not more suicidal.

If talking about suicide, asking about suicide made someone suicidal, you know, I've been talking about it every day for the past 25 years.

Our team has, clinicians have.

I've talked with my kids about suicide.

It does not.

The research shows does not make people suicidal.

So I would encourage parents to have these conversations.

I'd encourage any younger folks listening, have these conversations.

If you think someone might be at risk, ask them.

Even if they're not at risk, ask them, have the conversation.

And it signals, it communicates to your child, to your friend, that it's okay to talk about this and that I'm a person that you can come to and talk about what's happening with you, whether it's suicide or mental health more broadly.

What age did you have that conversation?

You have two three kids.

Three, okay, three.

Yeah, you have.

Are they all teenagers?

Our youngest is 12.

Our oldest is 19.

Probably around 10 or so.

Wow.

That's wow.

It used to be the common thinking that kids can't even contemplate the idea of death until age 10, 12.

We're now seeing

suicide among younger people, among children, increasing dramatically.

And the U.S.

National Institute of Health has put a call for research on this problem of child suicide to try and figure out what's happening and why is it that younger people are now thinking about suicide and dying by suicide more than they have been historically.

And so it's probably around age 10 or so.

I let my kids know what I do and and have conversations with them and ask them questions about have they ever

had feelings of depression or anxiety or thoughts about suicide, perhaps earlier than other parents.

This is what I study.

And so this is what's on my mind a lot.

But I also have had instances personally, professionally, I've seen instances of people missing, missing the opportunity to talk with someone about suicide, losing someone to suicide.

And as we all do, if you've lost one to suicide,

torture ourselves thinking back, could I have said anything?

Should I have asked?

Should I have done something differently?

And knowing that it's not harmful to ask someone about suicide, it's not going to increase their risk.

Just as it wouldn't if you asked someone, are you thinking about killing someone?

If they're not, they're very unlikely to now go out and want to kill someone because you raise the idea.

It's the same kind of situation.

Well, how did that conversation go?

Because I can imagine that maybe when kids are 10, they

maybe have been listening.

Of course, you're a researcher and an expert in the field.

What about when kids are kind of like, I don't want to talk about that, mom and dad, like, I'm not interested in having this conversation with you, which seems like a natural teenage response.

I'm thinking if my parents had asked me that at 14, 15, I would just have been like, what's wrong with you?

Yeah.

And so.

My kids never want to talk to me.

So

it's hard to tease that one out.

Yeah.

I think that's okay.

I think it, again, it still signals that you're open to having that conversation with them.

So even if it seems to not go well and your child says or your friend says, I don't want to talk about it, you've at least let them know that it is okay for them to come to you and that you're someone who's open to talking about this.

I've also seen instances of kids saying, I'm thinking about suicide, and the parents say, we're not going to talk about this, or

you're just doing that for attention.

That's a missed opportunity to talk.

And if the child's doing it for attention, if I need to tell you that I'm going to hurt myself or kill myself to communicate my pain, maybe that's pain worth attending to and talking with the person about.

So even if someone's joking about it or laughing about it or puts it in that kind of frame, it's not something that should be disregarded because it's so extreme.

I'd follow up.

I'd ask about it about two-thirds, 66% of the time, when people die by suicide, they told someone ahead of time.

They mentioned,

I'm thinking about death.

They might have joked about it.

They've talked about it in some way.

So people are putting those signals out there.

I think it's worth following up and asking someone,

are things so bad that you're actually thinking about suicide?

Have you thought about taking your life?

Even if they're joking, You don't need to every time.

If it's a clear joke, it's a clear, you know, it's a joke.

But if you have the thought, have the feeling to ask about it, I would ask about it.

It's hard, admittedly, it's still hard to do.

I've been doing this for decades and it's still, I still have a little hesitation before I ask friends, family members, but I ask because I know the consequences of not asking and I know the statistics and I know that we've done studies asking people who have tried to kill themselves, is there anything that could have prevented you from trying to kill yourself?

And the top two things people say are if there was some way to make the pain go away and if I was able to talk with someone else about what I was experiencing.

So I know firsthand and I know scientifically, that lack of connection, that lack of communication can be deadly.

And so push through the anxiety, push through the uncomfortability of asking someone and ask them.

Invariably, in almost every experience I've had, I can't think of one where this hasn't been the case, it's gone well.

And the person has either said, yes, I am thinking about it and I'm glad you asked, or no, I'm not.

And now they know that if they do have those thoughts or if those thoughts intensify, I'm someone they can talk.

talk with.

And I think the bigger the network of people that one has,

the more likely they are to not die by suicide.

And so let's say, parents or your friend, you've had the conversation with them.

You're worried about them.

What do you do next?

Where should people go, parents or friends of kids, teens who are listening right now?

And they go, I think someone's struggling.

I don't fully know.

What do I do?

Yeah.

I like to think about, acronyms can be helpful, giving a person air.

AIR.

So ask the question.

If you think someone might be at risk, ask them.

Initiate a conversation, initiate support.

There's There's a tendency for people to pull away and the person who asked and not to follow up.

And R for refer.

Don't try and do it all on your own.

Refer them.

So AIR, ask the question.

And I usually try and ease into it.

And I ask, and we teach our doctoral students who are learning to be clinical psychologists, ask in a calm, dispassionate demeanor, are things so bad that you've thought about suicide?

And I'll lead into it with asking about depression.

Have you had thoughts of death?

Have you had thoughts of suicide?

So you can ease into it.

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

In the U.S., it's 988.

You can find these easily on a search online.

A lot of them operate 24-7.

You don't need to bring a person to the hospital.

You can.

If the person's thinking about killing themselves today, I would take them to the hospital and have them get an evaluation.

But you can call 988.

You can text the text line.

Refer the person for help.

A lot of, probably the most common thing I've seen is a person will say, yeah, I've thought about suicide, but please don't tell anyone.

Promise me you won't tell anyone.

I wouldn't promise.

I would say, I care about you and I want you to stay alive and I value your life even more than I value our friendship.

And if you're not going to be my friend anymore because I shared this with someone, then so be it.

Again, I can't emphasize enough how important it is to try and take that step and how gut-wrenching it is to lose a person to suicide and to struggle with the question of could I have done more?

Could I have, should I have taken one more, one more step?

Yeah.

Matt,

why are suicide rates especially high among white men?

It's a great question.

There's a lot about suicide.

that are sort of perennial statistics that we just don't understand.

And this is one of them.

So I mentioned the men part of that.

We think that the rates are higher among men than women because men tend to use, tend to be more aggressive, more impulsive, to use more lethal means.

In the U.S., much more likely to use firearms than women are.

Women tend to use

means that tend to be less lethal, cutting, overdose, and so on.

Why white men, we're not sure.

That's been a statistic that's been prevalent in the U.S.

for a really long time, and we don't fully understand it.

Another

really striking statistic is the rate of suicidal behavior among black teens in the U.S.

is skyrocketing in the past few years among

black male youth in particular.

And that's another one we don't fully understand.

And there's ideas about why this might be, but there's a lot of science happening right now to try and better understand this.

It's such important research and so needed.

Is this area of research underfunded?

It's wildly underfunded.

Suicide is one of the leading causes of death in the U.S.

around the world.

It's the second leading cause of death among people ages 10 to 34

behind only accidents.

So among young people, it takes more lives than anything other than accidents.

And overall, the fourth leading cause or contributor to years of life lost because it takes so many young people of all causes of death.

Yet it is almost at the end of the list in terms of funding.

There's about a...

We need to triple the funding for suicide research to even come close to the causes of death that that surround it.

So there's just an incredible dearth of scientific research being done on suicide relative to the scope of the problem.

And it's not for lack of want.

I think it has to do with stigma.

That, again, people don't like talking about suicide.

It's a taboo topic.

There's a fear that if I talk about it, if I shine a light on it, it's going to make things worse.

And I think this trickles down to funding as well.

And so we're not funding it at the rate that we should be.

And another myth about suicide is it's an epidemic.

The rates have skyrocketed.

They haven't.

The suicide rate in the U.S.

now is virtually identical to what it was 100 years ago.

Contrast that with many of the other leading causes of death that have dropped precipitously over the past 100 years.

Heart disease, accidents, tuberculosis, pneumonia, HIV, AIDS, most recently COVID.

We dedicate science to these things.

We do medical research.

We disseminate the results.

We're really good.

Humans are really good at applying scientific study to big problems and decreasing the mortality rate.

We haven't done that to suicide.

The suicide rate is pretty flat over 100 years.

And so I loved, that's why I'm really excited that you're focusing on this problem and bringing attention to it, shining a light on it.

We need more research on this topic because there's these huge questions about why young black males, why older white men, how can generative AI be used, on and on and on.

There's so much opportunity that's not realized because we don't have enough research on the topic.

Yeah.

If you were advising AI companies right now, how would you encourage them to think about it?

A commitment to the scientific process.

Again, it's one thing to have a good idea, a really clever idea, a good idea, and well-intentions.

You have to do the research.

You have to do the experiments.

I would encourage AI companies to collaborate with scientists, academic researchers who are independent or working closely with and do studies on the best ideas, see what works, see what doesn't, disseminate the things that work, and drop out the things that don't.

One thing that gives me great hope about this the problem of suicide and the potentials that are there, this is, although it's a leading cause of death, it's a low base rate problem.

And we haven't been able to predict it and target it for treatment because we've had a lack of data.

It's kind of like I often think about tornado prediction or hurricane prediction where tornadoes, hurricanes have been around as long as the Earth has been here.

And for a long time, we have these sort of mystical, religious explanations for why they exist.

And as we've got more and more data and better science and better statistical models, we can predict them and we know when they're going to occur.

And we get warnings weeks ahead for hurricanes, hours ahead for tornadoes, and we save lives.

We now have a lot of data on people.

We all have cell phones and wearable devices and we're online and there's all these digital breadcrumbs all around us.

We can predict and we can tailor using generative AI to people better than we ever could in human history.

And so there's so, we're right there, I think, with, we've got all the tools to be able to have a big impact, but we're not doing doing it.

So

if I could send a message to the big AI companies, it'd be collaborate with researchers on this,

lean into the problem and experiment and find ways

to use the incredible tools that we now have

to help young people to improve mental health, to decrease suffering, to save lives.

I also saw that new mothers can actually struggle with suicidal thoughts.

Yeah.

Yeah.

That fascinated me.

Yeah.

It's a really interesting pattern in the data where new mothers have huge increases in suicidal thoughts, which, you know, having young kids can be stressful.

It makes sense that you have perhaps increased depression, postpartum depression, anxiety, and thoughts of suicide.

Young mothers have a huge decrease in risk of suicide death.

So I think there's a reason to not take your life if you've got young kids.

And so although there's an increase in suicidal thoughts, there's a decrease in suicide death.

Having young kids is protective.

Yeah, I feel like, and that, I can't imagine how much stress that puts on someone.

Like the reason you're having suicidal thoughts is because there's some sort of extreme stress in your life.

Yeah.

I'm assuming there's then an associated stress of having suicidal thoughts, almost like the double guilt and shame of,

I can't believe I'm having suicidal thoughts.

I just gave birth, or I can't believe I'm having suicidal thoughts.

I have to take care of my family.

And that almost feels like a vicious cycle.

Yeah.

And yes.

And people often feel really isolated and they pull back from others because they're afraid to tell other people how they're feeling.

And if I've got a young child at home and I'm thinking about suicide and I communicate that to someone else, are people going to fear for the safety of my child?

There's a lot of guilt.

There's a lot of shame that people report when they have thoughts of suicide.

Many people

also often report relief when they have thoughts of suicide, almost like imagining a vacation from their problems, imagining an escape.

from their situation.

And so it brings temporary relief to someone.

So it's reinforced, having the thoughts can be reinforcing and we think lead them to persist.

But overall, suicidal thoughts are dangerous, even if they're seen that way or they're dangerous insofar as they can lead to suicide death.

But again, 15% of people have thoughts of suicide.

Two-thirds of people who have thoughts of suicide will never act on them.

So they're dangerous in themselves, but they're

incredibly distressing.

Is the goal to never have a suicidal thought again for someone who's having suicidal thoughts?

I think that would be the ideal goal is to not have suicidal thoughts to begin with.

Interestingly, most treatments that, most psychological treatments that show an effect for preventing suicidal behavior, they don't work by decreasing suicidal thoughts.

They work by decreasing people's likelihood of acting on their suicidal thoughts.

So we're not really good yet, scientifically, clinically, at getting people to not think about suicide.

What we can do through psychotherapy is get them to not act on those thoughts.

Targeting depression, targeting anxiety doesn't seem to work as well as we thought it would for getting rid of suicidal thoughts.

What does that program look like

to stop that transition?

Yeah, so some of the best evidence we have is for interventions like cognitive therapy, cognitive behavior therapy, or a newer version called dialectical behavior therapy, which is basically cognitive therapy but with an Eastern Buddhist influence.

Cognitive therapy is a lot about change.

Dialectical behavior therapy or DBT is acceptance and change.

So accepting the thoughts, the feelings that you have, noticing them and not acting on them.

And so those interventions are a lot about helping people to understand understand when their risk is increasing and what skills they can develop and use to get through those periods and try and ultimately decrease the likelihood of having thoughts of suicide, but our interventions aren't quite there yet.

So they're teaching skills of distress tolerance.

When you have thoughts of suicide, when you feel that fire, when you feel that intense pain,

what can you do to try and tolerate it?

What can you do to try and distract from it?

Either by using some skill, cognitive reframing,

taking a shower, going for a walk, reading, doing some mindfulness practices, or reaching out to someone else, getting good at reaching out to your friends, your family when you're at risk, or taking a step further and reaching out for professional help when you're at risk.

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Matt, for those people who have attempted suicide but then survived, do they regret it?

Most do.

So there are some data on this and about three quarters of people who there's one study on the on the Golden Gate Bridge, which is if you jump from a really tall bridge, it tends to be lethal.

So people who jump off and survive are rare.

And there was a

interview done with people who jumped off and survived, and three quarters said the first thing they thought when they jumped was they regretted it immediately.

And when we followed up and asked people who have made suicide attempts and survived how they felt afterwards, the majority report feeling shame and guilt and disappointment that they had made suicidal, they had engaged in suicidal behavior.

And so that's a message that I would hope that could be heard by people who are thinking about suicide.

Those who have

taken the step to try and kill themselves most immediately regret it.

And most in the longer term continue to regret it and feel bad and wish they didn't try and kill themselves.

And the majority verbalize that they wish they had someone they could have talked to or wish they talked to someone about what they were experiencing ahead of time.

And some people say after the fact, when they're in the hospital, they didn't realize how much people cared.

They didn't realize how much treatment is available and how much better things could be.

So, I would hope that if people are listening to this who are struggling with thoughts of suicide, that they would keep that in mind, that there is help out there.

People who have taken these steps wish they hadn't.

So, please do reach out for help now.

Are you seeing people who die by suicide have a mental health disorder?

Is that a connection that you see?

It's a huge connection.

So, 90 to 95 percent of people who die by suicide had a diagnosable mental disorder before they died.

So, depression, anxiety disorders, bipolar disorder, 20% of people with bipolar disorder will die by suicide.

One in five.

Psychotic illnesses, virtually every mental disorder in the DSM, all the ones that we study on a regular basis, increase risk of suicide.

When they start to pile up, risk really increases.

When a person, you know, having two disorders we call comorbidity,

three or more disorders, multimorbidity, multimorbidity is associated with a huge increase in risk of suicidal behavior.

It's clear what people are experiencing when it comes to suicidal thoughts.

You talked about the connections that you make to actually people who die by suicide, but it's hard to predict it.

Really hard to predict.

Another thing that gives me optimism is we're getting better at prediction with the increasing amount of data that we have.

I'll give a few examples.

50%,

5-0 of people who die by suicide saw a clinician within the month before their death.

People are coming in.

Half of people who die are coming in to a clinic, to a hospital, primary care doctor, their psychologist, psychiatrist, social worker.

They're not always saying, actually, they're rarely saying, doctor, I'm going to kill myself.

They're coming in saying, I'm depressed.

I can't sleep.

Sleep problems are strongly linked with suicidal behavior.

Something's just not right.

So half the people are coming in.

We're really bad clinically at knowing which people coming in are at high risk.

But here's where I have hope.

With a switch to electronic health records, it used to be you go see your doctor and they write down some things on a piece of paper and they put it in a folder and put it in a filing cabinet.

Now it's all digital.

We can use machine learning algorithms to find in the huge amounts of data we have on every patient who's at risk for suicide.

And we can identify, if we think about predicting suicide as like looking for a needle in a haystack, we can put patients into risk bins and the top 5% of patients account for 50% of all the suicides that are going to happen.

So we can find these concentrations of risk where we have patients who are at really high risk for suicide, and so we can target them with interventions.

We're also doing a lot of work now over the past almost 10 years, giving patients apps on their smartphones and asking them questions each day about how they're feeling, how they're doing, collecting passive data with their consent from their GPS, from their accelerometer, getting sleep information.

And we're getting pretty good at predicting among patients at risk who's going to make a suicide attempt in the next few days.

So we're getting better at identifying which patients are at risk and now, most recently, in the past few months, when they're at risk.

And we now have apps that we can, with people's consent, give them on their phones that

help decrease risk of suicide in time and place.

So we don't have to have someone coming into the hospital when they're at risk.

We still want people to do that.

Coming in to see their clinician once a week, whatever the case is.

We still want them to do that.

Those in-between times, when risk increases, what does a person do?

We're getting better at identifying when those are going to happen and how we can help keep people safe.

Yeah, because all of that is what you hoped those clinicians did,

after which 50% of those people died by suicide.

Right.

Whereas, but it's hard to know.

It's hard.

So, so I mentioned earlier, two-thirds of people who die by suicide told someone ahead of time they were thinking about suicide.

What I didn't mention is 78% of those people explicitly denied suicidal intentions in their last communication before dying.

So, and this is a really common pattern that people will say, I'm thinking about killing myself.

And then they'll recant and say, I'm no longer thinking about killing myself.

And in a lot of the cases, they're not.

It's really hard to know when is a person who has suicidal thoughts going to act on those thoughts.

And when we do studies where we interview people and ask, when did you know you're going to make a suicide attempt?

It's usually the hours before.

So people have thoughts of suicide, maybe for a year or so.

And it's the same day that they make a decision they're going to kill themselves.

So if you see your clinician once a week, once every two weeks, even twice a week, those in-between times we haven't had access to.

But now, again, with smartphones, with social media platforms, social media apps, we now have people in the in-between times.

And there's a lot of people saying these are, it's bad.

We're on our phones too much.

We're on social media too much.

And there's a case to be made there.

But these, they're tools and they can be used for good.

And they can help us find people when they're in distress.

And we're getting better at doing that and reaching out to people.

What have you found are the...

top reasons why people don't tell people they are having suicidal thoughts.

I thought I could handle it on my own.

I didn't want anyone to bring me to the hospital or call the police to make a big deal out of it.

Depending on population, college students are afraid they're going to get kicked out of school.

We do a fair amount of work with the military and

a lot of service members fear that, and police fear they're going to have their firearm taken away from them.

They're going to lose their job.

They're going to get demoted.

I don't want my health.

insurance company to figure out are my rate's going to go up.

So there's a whole plethora of reasons that people don't tell others.

It's logical.

It makes sense that if you fear bad things are going to happen, if I tell someone this, I'm going to try and handle it on my own and muscle through it.

I understand why people would do that,

but they're missing an opportunity to get help.

And it's hard because it's how do you convince that individual to seek help and be okay with meeting others.

And admittedly, our care could be better.

We have a long way to go.

I mentioned we have interventions that can decrease people's risk of suicidal behavior.

A lot of them have wait lists.

A lot of our focus right now is if someone's at risk for suicide, we bring them to the hospital.

We're just learning now that hospital treatment for people at risk for suicide does seem to help some people.

It's less helpful for other people and it seems to potentially harm some people.

They get worse after they get hospitalized.

This is a study published just in the past year.

So we're in the process of trying to get better and figure out how can we better help people?

How can we tailor interventions to people to figure out who's likely to benefit from which intervention?

So again, we're making progress, but there's still a long way to go.

Are there certain careers that are predisposed to suicidal thoughts or suicide?

It's hard to tease apart from race and ethnicity.

So, physicians are at high risk, police officers are at high risk.

There was a big concern a few years back,

there was a spike in suicides in New York City police officers.

We did a study on this.

New York City police officers are mostly white men,

and there was a blip up in one year, but it came right back down.

Actually, female police officers had a higher risk, even when accounting for age and race and ethnicity.

Occupations where a person has access to means.

This is another explanation for why physicians, why police officers, why soldiers,

army soldiers, service members do have significantly higher risk of suicide.

Access to means, we think plays a role.

Access to means.

Access to lethal means, firearms,

medications.

Yeah.

And that, of course, sadly is widely accessible as well.

Right.

And yeah, I mean, there's also big geographic differences in the U.S.

So suicide rates are highest out west.

If you look sort of north and south of Las Vegas, people call this the suicide belt.

There's access to firearms.

There's not ready access to good hospital care, good treatments.

You might have to drive three, four hours to go see a clinician.

And there's low population density.

So you don't have contact with a lot of people day to day.

So if you're having thoughts of suicide and and you don't have people right around you, you don't have access to care, and you have access to firearms, we think this is a pretty lethal cocktail.

Rates are lowest historically in New York, New Jersey.

I'm from New Jersey.

I think this might be high quality of life.

People might disagree.

But there's high population density.

There's a lot of people around.

It's pretty easy to find a hospital, to find a clinician where you can get treatment.

So we think these factors do play a role.

So not just occupation, but where you live and what access you have.

Again, which is another reason why I think online care, generative AI, has a great role to play here.

If you can access the internet, you can now access care.

And so, this changes the playing field quite a bit or has the potential to.

Matthew, I know when we spoke on Zoom a few months back,

you shared a personal story with me that really resonated with me because of the incredible work you do, but then the personal experience you have.

Would you be comfortable sharing that?

with us?

Sure.

Because I'd love my listeners to just recognize just how complex and layered this subject is, not just for you, but in the experience of it for anyone who goes through it as well.

When I first became interested in suicide in a hospital in Tooting Beck, in London, Springfield Hospital, I didn't know anybody who was suicidal.

It was a clinical human interest.

Over the years, I've had friends and family members who have who have struggled with thoughts of suicide and have died by suicide.

And actually, one of my best friends, Dan,

Dan Eisenbud, I met in London when I was working in this hospital and became very close friends.

We became roommates.

We were roommates through my graduate studies.

And just a few years back, we lost him to suicide.

And

it wrecked me and I continue to

struggle with the loss.

He was one of my dear friends.

And I went back and looked at my notes and looked at my emails.

He was living in Israel, working as a journalist, was planning on coming back to the U.S.

And I was reading over his emails.

Hey, I'm coming back.

Maybe I'll move to Boston, looking for apartments.

Can you help me out?

And I was looking for any clues.

What might I have missed?

Nothing.

I didn't see anything in the emails.

But it was, I think, just an example of how difficult it can be, not just to lose someone, but then to struggle with wanting to have done more

for him, for his family,

for his friends.

It's a tough problem.

It's a perplexing problem.

It's a gut-wrenching problem.

And I think just for me, it's motivation to do better and to not rest and to keep trying to get better at doing this.

Thank you for sharing that.

How do people even begin to recover from that feeling that they let someone down or that they missed a sign or that they could have done more?

Because I imagine that's a very heavy weight to carry.

Yeah.

And it can be really difficult when,

like in your case, there were no signs that you could spot.

Yeah.

And you're someone who's trained to do that.

Yeah.

When we're not trained.

I think giving yourself that grace that

I would say, you know, those of us who I've been trained to do this, I've spent the past few decades of my life trying to do this.

I can't do it.

I can't predict accurately who's at risk and who's not.

If I can't do it, chances are those among us who haven't spent their life trying to do this probably

can't do it either.

So don't expect that you should have been able to do it.

People grieve differently.

There's a lot of misconceptions about the stage.

There are stages of grief and we all must go through them in this linear way.

That's not true.

We all grieve differently.

And I think it's important for people to do what's right for them.

Here, too, I would say reach out to others.

There are groups of survivors.

There's an organization, the American Foundation for Suicide Prevention, AFSP.org, has survivor groups, support groups in every state in the U.S.

These exist in other countries around the world where you can go as you want and meet with other people who have lost loved ones to suicide.

Or do this online or do this among your friends and family, but

use the supports supports you have around you to try and work through whatever way makes sense for you.

But here too, again, I would encourage people to reach out and to communicate with others about what they're experiencing.

It can be powerful to know other people who have been through what you've been through and to share with them.

When someone dies by suicide, what does it do to their family?

What have you seen happen to people, friends, and family from a research perspective?

Yeah, losing someone to suicide increases the risk.

So having a family member die by suicide increases a relative's risk of suicide death.

It's not destiny, but there is statistically an increased chance of suicide.

And it just leads to often, not always, a lot of psychological distress is an understatement, turmoil.

There's a loss, as there is if you lost someone to a car accident.

So there's a tremendous loss of life.

And that is gut-wrenching to anyone who's ever lost a family member.

It's disorienting.

It changes.

It can change.

People are different.

It can change your whole world, your world orientation,

your own mental health.

When someone dies by their own hand, it's often so much worse because

there's often guilt.

There's questions about should I have done more?

Could I have done more?

Did I play some role in this?

Was I not nice enough last time I saw the person?

Did I not reach out enough?

There's a lot of second guessing, a lot of beating oneself up.

So it can be really, really difficult.

But again, people respond differently.

Some people respond by never talking about it.

Some respond by getting closer to those around them.

Some respond by becoming an advocate and trying to decrease the likelihood that this happens to other people in the future, which always, always blows me away.

And I find really inspiring.

Is there any truth in the feeling that people who die by suicide believe that everyone will be better off without me?

Or is that a myth?

Yeah.

Not a myth.

Feeling like there's a brilliant psychologist named Thomas Joyner who's got a wonderful book called Why People Die by Suicide.

And he lost his father to suicide and is a leading scientist in this problem.

And in his

theory on suicide, he says feeling like a burden to others is a key piece.

And feeling like you don't belong is the other key piece.

And that those two things together, I'm a burden to others.

They'd be better off if I wasn't here.

And I don't really belong.

with anyone or to anyone.

Those things get a person thinking about suicide.

And then the other piece of the puzzle from his perspective is what he calls an acquired capability to die by suicide.

It's not an easy thing psychologically to take your life.

And it takes, he says in his book, he used to call it courage, but courage isn't quite right.

And now he calls it an acquired capability that we have to sort of build up an ability to, like we have to build up an ability to hurt someone else to hurt ourselves.

And this is why he thinks maybe physicians and police officers,

prostitutes are at higher risk.

that it's if you've been injured, if you've injured, you've now acquired the ability to hurt yourself and that this increases a person's risk.

Feeling a burden, feeling like you don't belong certainly resonates.

And there are good data on this, that this does increase a person's risk.

Again, thinking about the pathway, this increases your risk of thinking about suicide, but not acting.

You need this other component to get you to act.

It's interesting that you said that suicide rates haven't really

gone up because I guess we'd assume that because of social media, because of online bullying because of the news cycle yeah there's almost so much more overexposure to yeah depressive negative difficult thoughts yeah why is that how how how do you even explain that yeah the suicide rate does ebb and flow if you look back and we've mapped it out over the past hundred years you see a little up and down and it's crept up in the past 20 years but it crept down the 20 years before that and people will say well it's because of social media and breakdown of the family.

There's always post hoc explanations we can give.

But again, it's the same now as it was 100 years ago.

And I don't think the explanation is as simple as we now have social media, social media bad, it's making kids suicidal.

I think it's a tool and things that happen on social media can put people at risk.

There are things that happen on social media that could also decrease risk.

And so again, I think it's incumbent upon us to try and figure out how do we use these tools that are here to stay for good and not allow them to be used for evil.

Matthew, thank you so much.

It's been so useful and insightful talking to you today.

And thank you for your work.

And I look forward to hoping that our listeners support your work, whether it's sharing it with a friend, passing this episode on to a family member, or directly supporting the work that you're doing there in the lab.

So thank you so much.

I'm really grateful for your time and energy.

Thank you so, so much for focusing on this problem, for shining a light on it.

And I'm hoping that this podcast and the work you're doing can help save lives.

So thank you.

I've learned so much today, Matt.

And it's one of those subjects that I feel like needs needs to be talked about needs to be trained in

needs to be spoken about just with I mean with the couple of news stories I shared today I had one more as well that I saw which

was

I think this was like yeah dad struggling with money pressures leaves behind a wife baby son after taking own life you know battling with financial stress yeah everything turned upside down the family said and and then eventually led to that like when you see the multitude of reasons even in the couple of stories that I've found and shared,

it's an area that I just feel like

we can't leave in the dark anymore.

Because

like you said, the fact that you can't predict it perfectly means we should be more vigilant and more aware.

Yes.

Because someone literally could appear to not be struggling at all and then,

you know, potentially take their life.

Absolutely.

Closing our eyes to it is not making it go away.

That's not going to solve the problem.

We're getting better at predicting it.

We can't predict it perfectly, but that doesn't mean we should stop.

Again, you think about the weather app that's on your phone, it can tell us with a startling degree of accuracy when it's going to start raining, when it's going to stop, what the temperature is going to be in any time and place.

That's a model.

It's a simple analogy, but there's a lot more we could do.

There's a lot greater accuracy we could have in predicting who's at risk and when.

And there's a lot more we could do to try and keep people safe.

We just need to try and stop the stigma around it, talk about the problem more and allocate resources to try and get it done.

Has there been a

not wanting to sound reductive in any way, but has there been, seeing as you've spent

decades studying this now, what keeps you going?

What motivates you?

What allows you to feel potentially positive about the future of this?

I'm increasingly hopeful about our

to better understand, predict, and prevent suicide because of the people who are doing this work.

The people who have lost loved ones to suicide, who support research on suicide,

the clinicians, the researchers, the progress that has been made in the past 10, 15 years, I mentioned we're now better able to identify who's at risk and when they're at risk.

Our interventions are getting better and more numerous.

There's newer interventions coming out all the time.

So we're seeing a lot of traction, a lot of positive progress.

So that keeps me optimistic.

And I also continue to see people die by suicide and continue to see how big of a problem it is.

And I see the opportunity for us to do a lot better.

And so those things together, how bad we're doing and the instances where we're losing life, but also the positive steps we're making give me hope that with more of a push, with more resource, with more effort, there's reason to be optimistic.

There's reason to be hopeful.

And this is a problem where we hopefully in the coming years can start to see

the needle bend and the suicide rate drop, especially given how connected we all are now.

We have the ability to find people at risk.

If we can just figure out how to use these tools in a more positive way, I think we'll

really make an impact.

Yeah, Matthew, thank you so much.

Is there anything I haven't asked you that you think would be important to ask you about this or anything you haven't shared that you think would be useful for us to know?

I think, no, I think we covered a lot of the most important things.

I think the most important thing is what you're doing, which is shining a light on the problem, talking about it,

encouraging others to talk about it, knowing that there are resources out there and knowing what to say to someone or having a sense of what to say to someone who you think is at risk because you can take steps to try and help them.

Yeah.

Any other resources or any other directions or practices that you'd recommend that we could share with people today?

So if people want to get involved and support this cause in some way, there's a number of ways to do so.

I would definitely recommend reaching out to the American Foundation for Suicide Prevention, AFSP.org, which supports research on suicide and also supports educational programs.

They have great resources if you've lost someone to suicide, if you're looking for a support group.

So, I would definitely look at them as a resource.

And if you want to give to support research on suicide, we'd be grateful if you did.

You can do so by reaching out to Harvard University.

You can reach out to our lab directly and donate through our lab's website.

If you Google my name or look at knocklab.fas.harvard.edu, you can support our work directly.

You can also support the Center for Suicide Research and Prevention at Harvard University and Mass General Hospital, which is a center devoted to conducting research on suicide to try and prevent the loss of life due to suicide.

So any of those would be amazingly helpful to support this work.

Amazing.

Yeah, very useful.

Yeah, I'm sure there's so many people who've been affected directly or indirectly by someone in their life.

And I'm sure there will be people who want to support.

So thank you for sharing those.

And yeah, I'm really grateful for the work you're doing and the light you're shining on it and just your ongoing commitment and dedication.

If you love this episode, you will enjoy my interview with Dr.

Daniel Amon on how to change your life by changing your brain.

If we want a healthy mind, it actually starts with a healthy brain.

You know, I've had the blessing or the curse to scan over a thousand convicted felons and over a hundred murderers, and their brains are very damaged.

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