HealthyGamerGG - Why World Mental Health Is Declining

Episode Date: September 30, 2021

Dr K Talks about Why World Mental Health is Declining, Suicide, and other issues Support this podcast at — https://redcircle.com/healthygamergg/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi, welcome to your neighborhood pharmacy. Hi, I've got a prescription for diabetes test strips. How much is the copay? Well, it depends on your type of commercial insurance and factoring in your yearly spend, subtracting the deductibles, also depending on your monthly allowance based on... Why can't there be a better option?

Or you could try Contournext test strips. A 35 counts only 1999 over-the-counter and proven to be highly accurate. Go to contournex.com slash radio to see if over-the-counter strips are a more affordable option for you. Hmm, I think I'll try Contour Next. Because some of them will just, I mean, you guys will hopefully realize this too, that you just don't have to live like this. It's like, you know, like you can fix this. Like you can feel better on a day to day basis. Like the sun can be a little bit brighter. You can be a little bit happier. You can just enjoy things more. So about one year ago, we had a pretty significant suicide in the gaming community. And I think we've had over the last year, we've had a lot of suicides in our community. I think we've had a lot of suicides in our community. I think. think some of them are not quite as advertised as others. And so I thought what we would do today is try to just do like a quick sort of like educational segment to help us understand suicide.

So today what I'd like to talk to you guys about is just sort of like a quick, almost like lecture about, you know, who commits suicide, why people commit suicide, how, like what's the process or what we what do we understand about the how of suicide and what you can do either for yourself or for someone else. So we're just going to answer these four basic questions. And the reason that I think that this kind of lecture is important is if you look at medicine, it's advancing and we're winning as a profession. So if you look at, for example, like HIV, so HIV used to be a terminal illness and now people

with HIV have a regular life expectancy. We've all but eliminated some kinds of cancer, at least in terms of people who get the appropriate treatment. So, for example, there are certain kinds of, like, B-cell lymphomas, if I'm remembering correctly, that we now have targeted antibodies that we have really good outcomes for. We also have, for example, like HPV vaccines, which have done a huge job at sort of reducing or almost eliminating cervical cancer, at least in countries that have access to the vaccine. So we're like, we're doing good. Like, I don't know if you guys get this, but like modern medicine is pretty dope. Like, do you guys understand that if my heart is busted, I can like literally

get a heart from someone else and we can transplant into my body and then I can continue to live a relatively normal life. If my kidneys are busted, I can literally like transplant someone else's kidney into my kidney, I mean into my body and then like I can live off of that kidney. So like medical science has advanced in an amazing rate and it is like really awesome. So we're seeing generally speaking improved outcomes in most disciplines or just about every day. discipline of medicine. The one place where we don't seem to be doing a good job, and in fact, arguably things are getting worse, is in the mental health realm. So we are sort of losing the war against mental illness. And so if we look at suicide, for example, like suicides have not

appreciably gone down. In fact, if I remember correctly, they've sort of gone up over time. It's also kind of staggering because, you know, if you look at statistics on suicide, like 80% of suicides are men, if I'm remembering correctly, I think that's kind of a ballpark figure. Depending on what source you kind of go to, it'll, you know, the numbers may look a little bit different depending on whether you're looking at the world or a particular country, developed countries versus developing countries have slightly different statistics around that. And so we're losing this war. And so like, I don't really know that just given the nature of the human mind, I don't

know that we're going to have like a pharmaceutical revelation. Like we're not going to have some kind of pharmaceutical discovery. I mean, if we do that would be great. That you're going to take a pill and it will cure you of your suicidality. Like we certainly have medications that improve outcomes for people with depression who, you know, may be somewhat protective against suicidality. So we'll talk a little bit about that. But as we'll see today, the reasons that people kill themselves may not all be solved by medication. So the reason that I'd like to talk to you guys about suicide today is because I think that like the first step in fighting this war is actually like education, right? So like kind of like Sun Tzu says, you know, you have to know your enemy in order to win. And so my hope today is to

educate our community and whoever is listening, whoever watches this down the road to help you understand a little bit about like, okay, who kills themselves? Why do they kill themselves? How do they kill themselves and what can we do about it. Whether you are dealing with suicidal thoughts or you're not dealing with suicide or a friend is dealing with suicidal thoughts. Furthermore, we're going to tackle a couple of different myths around suicidality. And some of these, I think, are quite dangerous. So it's really more of like a public health educational approach. And I will urge you for the first, but not the last time, that if you were dealing with suicidal thoughts, you should really go see a licensed professional and get help. And we'll deal with some of the reasons why people don't and why it's a

bad idea to listen to the part of your mind that says, basically, I haven't killed myself yet, so I can manage it, which we'll look at some interesting data around that. So the first question is who kills themselves? So what we what we can sort of discover, like I sort of mentioned, if you actually look at suicidal attempts, what you discover is that more women arguably attempt suicide than men. But it turns out that when we kind of, when we're sort of looking at attempts, what we sort of discover is that not all suicide looking behavior is actually like intended to be suicidal. So sometimes, for example, like I've had patients that will take a bunch of pills and then will proceed to call me or they will call a friend and they'll say, hey, I just took a bunch of pills.

So it's sort of a suicide attempt, but there's sort of like this kind of idea that like sometimes it's people are looking, you know, to say goodbye, but sometimes they're actually like it's a little bit more provocative. And it's sort of almost like a cry for help. You're sort of demonstrating the people that you really need help and you're willing to go to drastic measures. But at the same time, you're not like, you're not using your full faculty of thinking to actually commit suicide. And so what we sort of discover is that when you really talk about, you're not like, you're not using your full faculty of thinking to actually commit suicide. And so what we sort of discover is that when you really tunnel down into the research, there are a lot of parasuicidal behaviors. So things like cutting or self-injurious behavior or like threats for suicide attempts, that it seems like statistically we're not entirely sure about, you know, what's happening where, but women seem to make more suicide attempts and men seem to actually kill themselves more often. And so about four out of five suicides are men. So sometimes as we look at the research, what we sort of like look at. So one hypothesis is that the manner of suicide sort of determines is responsible for that statistic. So for example, women are more likely to try to commit suicide by taking pills and men are

more likely to commit suicide by using a firearm. And if we just sort of think about that from a medical standpoint, if someone tries to commit them, commit suicide via pills, the window to save that person is far larger than someone who, you know, uses a gun because like, you know, it's just g-g depending. So some people have argued that because of the variance in attempts, that's what sort of alters the statistic. In my experience, I think it's a little bit more complicated than that. And I think that as we get to the reasons of why people commit suicide, I suspect that, at least in my clinical experience, and I also suspect that epidemiologically, that men, there are more men who are more serious about taking their life than women on average. It doesn't

mean that women aren't serious about taking their life. I'm just saying that there seems to be something different there, which I think is sort of borne out in the statistics. Could it have to do with just the manner and psychologically, both genders are exactly the same? It's completely possible. In fact, there's good evidence for that theory. My experience is a clinician and we'll get to the kind of the how, or sorry, the why, and we'll sort of see that suicidality also. is not necessarily due to psychopathology, which I know sounds weird. But not all suicidality is due to mental illness. So let's talk a little bit more about who commits suicide. So, you know, men tend to be more of four out of five are men. I think we're seeing a rise in suicidality,

like in younger populations as well, just as other kind of interesting examples. One is that there's a black box warning on antidepressant medications called selective serotonin reuptake inhibitors that for the few weeks after you start taking an SSRI, adolescents especially are more likely to commit suicide. So there's something really interesting there that like if you kind of think about, you know, the mind of someone who may be suicidal, you may have thoughts, but if you're severely depressed, your low energy level and your like lack of motivation combined with the suicidal thoughts is almost like a protective mechanism that you may want to kill yourself, but you have such low energy or your motivation is.

so low that you never actually like get up off your ass and make an attempt. So there's a really interesting phenomenon that's been observed when you actually treat someone with depression, or treat adolescents with depression, with medication, is that there's actually a temporary spike in suicidal behavior, which suggests that, and the best kind of theory that I've heard is that the spike actually happens because you're sort of dealing with that motivation first. So people actually get a little bit more energy, but the suicidal thoughts take longer to treat. And so if you really have to be careful if you're a prescriber and you're prescribing antidepressants to someone in adolescents to really watch them carefully for like two weeks. And then it seems like the effect

kind of goes away in terms of like then it really starts treating the suicidal thoughts and depression as well. But it's a really interesting thing for you guys to be aware of that if you're starting antidepressant medication, so here's kind of like the first kind of like PSA, is be a little bit careful because there may be something weird going on and the suicidal thoughts. I don't know if they become stronger or you may actually feel like a little bit more motivated to act on them, which is kind of weird. Right. So it seems like younger people tend to be committing suicide more often. So it seems to be getting slightly worse. And it seems to be men more than women. So when we look at something like the gamer community, we don't really have a good idea about, you know, who,

like what the suicide rate is specifically in our community. At least I haven't seen any convincing research in that. We don't really know, but hopefully over time we'll learn more about that and we'll figure out how to intervene a little bit better. So now what I'd like to do is actually screen share for a minute. And we have an awesome, one of our coaches is actually a suicide researcher. And so he's done awesome work as a coach and kind of does research on the side.

So he put together an awesome presentation to educate, are coaches. And what I'd love to do is, you know, it goes by James. So James has done an awesome job of putting together this presentation. And so what I'd love to do is share like one or two slides from the presentation with y'all. Okay. So let's kind of start with this. So suicide is the 10th leading cause of death in the United States with about 50,000 people dying by suicide. I think this number has actually gone up a little bit since the presentation was made. this is the key thing. So our pop, you know, when we talk about like who the audiences of people who watch stream and who healthy gamer reaches, we tend to reach people who are like, you know,

hopefully like 13 to 40 for the most part, but a lot of parents watch our stream now too. So when we think about, you know, what is the most likely thing that will kill you? I think it is probably accidents is number one for the leading cause of death. And number two is suicide. and so if we kind of look at like this is an important graphic so trends in the leading cause of death over time in the USA so this is USA specific what we kind of see is like I was saying earlier like we're we're winning the war against like stroke heart disease cancer but suicide I don't know if this is actually this is an interesting I'd have to double check this this particular statistic whether this is a 33% increase because the causes of death of other things are getting better, so the percentage increase is higher, but generally speaking, I think suicide has been increasing over time, which I feel pretty confident to say. The next thing that we're going to

kind of talk about, so that's sort of like who commits suicide. So, you know, we need to be really careful about that in this community. The next thing that I want to talk about is why people commit suicide. So this is going to sound kind of weird, but there are many reasons why people commit suicide that may not necessarily have to do with psychopathology, okay? So, there's a great paper by a guy named Maltzberger. So Maltzberger is like a great suicide researcher. And so if you actually sit down and you talk to people who are, have tried to commit suicide or thinking about suicide, and I've sort of definitely noticed this as a clinician, what I was really shocked to discover is that the reasons are not necessarily mental illness. So we sort of think about mental illness as the number one cause of suicide. And I think that that's probably,

reasonable. And yet, I know it sounds kind of weird, but like, psychopathology isn't necessarily the only cause of suicide. And what I mean by that is that if you actually talk to people, what you'll find is there are all kinds of reasons. And some of them have to do with, like, you know, self-worth, which is that like an organic brain disease? I'm not really sure. Sometimes suicide has to do with like not having a way out for lack of a better term. And so suicide sort of serves as an escape. And so I think we have to be really careful about sort of assuming any suicidal behavior has a root cause of mental illness. Because if we misdiagnose that, if we assume that everything is mental illness, what I think we end up doing is like we're going to leave out

and we're going to lose sight of a lot of important reasons why people kill themselves. So as a clinician, what I'd like to do is kind of start with this idea. Okay. So the first thing to understand is that suicidality is not an illness. It's actually a symptom. Okay? And so what do I mean by that? So if we think about like fever, for example, like fever is not an illness. It's actually a symptom that can have all kinds of different root causes. So if I have a fever, maybe I have a lymphoma. Maybe I have a cold. Maybe I have COVID. Maybe I have lupus. There are many different diseases that lead to fever. And so in that way, if I have suicidal thoughts, there are actually many different reasons why I may feel suicidal. So, for example, one reason is psychopathology. So what we mean by

this is we know that there are some kinds of mental illnesses, right? So we know that there are things like depression, or actually this is incorrect. Major depressive disorder is better, right? So there's like major depressive disorder, bipolar disorder. We also know that you have like things like addictions. Sometimes you'll have things like schizophrenia, right? And these are like arguably biological organic malfunctions in your brain that lead to a malfunction in your brain that sort of allows you to create suicidal thoughts and potentially act on suicidal thoughts. but if you kind of another really interesting thing

and I don't know that this mechanism is the same so this is what Malzberger calls loss of the ideal self-state or broken life dream so some people will have like let's say like

aspirations right so they say like I want to be this or I want to be this and something will happen in their life where they feel like their life has become broken and irreparable. And if you really talk to them, so a lot of people will assume that this thing, from a mechanism standpoint, is the same as major depressive disorder. But as a clinician, what I oftentimes find is people who have major depressive disorder

will become depressed even when nothing is wrong. So especially when I've worked with people who are like suicidal, sometimes I don't actually, like, do they qualify as depressed? Absolutely. But sometimes they don't really respond to medications. And what it really is is like their perception of life has become so shattered that they don't believe it is worth living. Now, this further gets complicated that sometimes this can actually trigger a major depressive episode. But it's not that the major depressive episode is like shattering your, I mean, it can actually go both ways.

But I know it sounds kind of weird, but in my experience, sometimes as someone like, so, for example, you know, I was working. working with a particular person who was accused of sexual harassment and was essentially like fired from their law firm or put on suspension. And they were, it was sort of a situation where it was kind of like guilty until proven innocent. They were sort of ostracized. It turned out that, you know, they didn't actually do anything inappropriate. But their life was sort of shattered. Like they had lost their job. Like they had lost the respect of their colleagues. and so like this person's life had fallen apart. I don't know that this was actually the result of an organic brain disease.

I don't know that the cause was like a neurochemical imbalance, but it really feels to me more like a broken life dream. There are other kinds of weird psychoanalytic sort of stuff, but other causes of suicidality are going to be sudden defense breakdown. So what do we mean by this? so sometimes we have something called chronic suicidality. And what that means is like I have, you know, I think about killing myself. And even though I think about killing myself, there are a lot of things like a lot of people.

So suicidal thoughts are remarkably common. I think something between like 10 and 30 percent of the population has suicidal thoughts or has had suicidal thoughts at some point. And so if we kind of think about it, suicidality is actually like a balance between pro-suicidal factors and anti-suicidal factors, and we'll get to that in a second in terms of how we deal with suicidality. But sometimes what can happen is that, like, you know, you've got this balance between, like, reasons that you don't want to live and reasons that you do want to live. And sometimes that defense mechanism, one of the things that you kind of use to hold the suicidality at bay, kind of falls apart. So, like, a good example of this that'll sort of use is like alcohol usage.

So, you know, in your normal mind, you can kind of keep the suicidality at bay. But in some situations, if you, like, alter, you know, your state of consciousness through alcohol or some other disinhibiting substance, the suicidality can kind of break through. And then you can sort of result, you know, can end an attempt. So I know it sounds kind of weird. It's not necessarily like, you know, you can say that addiction is like an organic disease. But alcohol in a temporary sense, this isn't an addiction.

this is just like, I can be not addicted to alcohol, use some mind-altering substance, and then it causes something in my psychology that keeps the suicide at bay from like, it kind of breaks down my defense mechanism and I end up acting. So, and I know it sounds kind of weird, but like just you don't have to have major depressive disorder to have suicidal thoughts. So the next thing to kind of think about in terms of why people commit suicide is anger turned against the self. So if we think about why people commit suicide,

side, some people find their life to be like intolerable, right? Like, this life is not worth living anymore. And sometimes if you go back to Freud's earliest theories on depression, I believe it was Freud, although I may be misquoting here, who basically said that he sort of discovered that depression is anger turned against the self. So like instead of being angry at the outside world, like if you look at the mind of a depressed person, they're actually like angry towards themselves. So if I get fired from my job, instead of blaming my boss for being incompetent or feeling threatened by my competence, which may actually be the reason that I got fired, what I'll end up doing is blaming myself, oh, I'm so bad, I'm so dumb, I can't do anything properly, like, I deserve to be fired. And so sometimes in the case of suicidality, what we actually see is anger turned against the self with like revengeful intent. So what this means is like sometimes we have these ideas about ourselves that are like,

like, I am such a bad person that like you almost want to like punish yourself for being so bad. And this, it's kind of really toxic. But if I really, it's kind of sad. But when I work with some people, what I really find is that when people have like this self-loathing and self-hatred, they don't believe they deserve to get better. They actually believe that they like deserve punishment. And so sometimes suicidality is not about like, oh, woe is me. I no longer have a life to live.

Sometimes it's not like a sudden breakdown of a defense mechanism of like a dynamic equilibrium. And sometimes what it is is like I deserve to kill myself because a POS like me doesn't deserve to be alive. And so what we can kind of see is as you talk or as I've talked to people, you know, I'll have someone like in the MDD camp who, for example, is like has a happy marriage. and has a stable job and has like kids who love them. And despite all of these positive factors, they'll still be suicidal.

And so when I kind of see that, like that's what I really think about, like this seems to me like a malfunction. This is not supposed to be the way that this person, this person isn't supposed to feel that way. Right? So if we think about a brain malfunction, it's like your brain is not thinking the way that it's supposed to be.

But as you actually spend time with people who are suicidal, what you actually find is that some people, like, it sort of makes sense that they're suicidal because their life really has fallen apart. They really don't believe that there's anything worth living for. And we may call that depression, they may get diagnosed with depression, but I don't know that this is like an organic brain disease. It's sort of a chicken or egg situation or like the brain in our psychology is complicated. And sometimes it's not that like life isn't worth living. So this is sort of like life isn't worth living. Okay?

And then over here what we have is I don't deserve to live. You guys see how like these thoughts are different? And over here is like, and over here what we have is I'm suicidal despite life being great. Right. And so these are very different buckets in terms of what goes on in the mind of the person. And then, like, you know, as we kind of go to other options, so like here's another kind of like psychological manifestation. But I'd kind of say that another one is intolerance of humiliation, shame, or envy. And so like this is kind of, I know it sounds kind of weird, but like this is sort of like a different bucket.

If you think about the emotion that's at play for these different buckets, like sometimes it's like hopelessness. So if we look at the first column, okay, so if we look at this column, okay, this is transmitting. So if you look at this column, this is hopelessness. This is going to be anger and this is going to be shame. Okay. So these are going to be like a little bit different. So the point here is that when we're thinking about, you know, why people want to kill themselves, you know, and what is the nature of their suicidality?

What we sort of arrive at is that there are actually like a number of different reasons, which are not all the same. So this isn't just like one thing. It's not just mental illness that is causing suicidality. And I think that it's the assumption that like, you know, SSRIs will cure suicidality, that despite the fact that our SSRI prescriptions have gone through the roof over the last couple of decades, suicidality is still increasing, which sort of naturally implies that, you know, we're missing something here.

Like, as a profession and as a society, we're missing something really important about suicidality. So if people are kind of curious, this is the paper that I'm pulling from, which is sort of an examination of a particular narcissistic person and different causes. And it's by Elsa Ronningstam, Igor Weinberg, and John Maltzberger.

I think all these, maybe all three of these people are at Harvard. That's number two. Okay? So we started off by talking about, you know, who is vulnerable to suicide. The second thing is like why people kill themselves. And what we sort of discover in terms of why people kill themselves is that there's actually like a lot of different reasons. So sometimes it's hopelessness. Sometimes it's anger. Sometimes it's shame and humiliation and some degree of envy. And I think each of these causes, as we sort of think about the differential diagnosis of suicidality, what we sort of result in is that different. causes are going to have different solutions. So once again, if you're feeling like killing yourself or you have suicidal thoughts, this is like reason number two to go see a mental health professional, right? Like, understand that these things when you work with someone can be addressed. So for the person who's hopeless, you know, we can sort of help them build a life dream again. So a big part of what we try to do here at Healthy Gamer is like help people construct a life that is worth living. Our original goal was like helping people with video game addiction. And what we sort of

found is the antidote to video game addiction is having a life that is worth living in the real world. And so as you build that life, which can absolutely be done, right? It takes time and it takes effort and you may feel hopeless. But like with a little bit of help and with a little bit of intention, you will be amazed at what you're capable of. The biggest thing about people who are hopeless is that they don't exert effort, right? And so, So you can even beat yourself up over that. So there can be some amount of hopelessness. They can be some amount of anger and self-hatred.

I don't deserve to live. I don't deserve to be happy. And so that sort of has a different solution as well in terms of like learning how to gain compassion. Right. So sometimes we'll teach like particular meditation techniques that can help people like learn how to love yourself and learn how to forgive yourself. There's a lot of stuff about this in one of the Dr. K guides around, you know, an Ahathe Chakra meditations and things like that. So like there are different antidotes to that. There's also things like shame and envy, which who-hoo, those tend to be some of the hardest things to deal with.

Like they require a lot of self-reflection because it's sort of like, you know, there's some amount of, you know, hopelessness is something that we want to fix. Anger is something that we want to replace with compassion. Like we sort of want to do that. But when I deal with people who are like really envious and suicidal because someone else's life is like better than theirs, that's really, really hard to deal with. It requires a lot of self-reflection because it's like people hold on to their envy so much more. So now what we're going to do is sort of talk a little bit about how people go about killing themselves and understanding sort of like a clinical approach to like suicide risk assessment and a couple of common myths that I want you guys to be careful about.

So the first thing to understand is that psychiatrists are notoriously bad at predicting whether someone is going to kill themselves or not. In fact, overwhelming amounts of research have shown, I know this is kind of shocking, that psychiatrists cannot see the future. And so we don't really know whether someone is going to kill themselves or not. And so the question sort of becomes, well, like, why is that? And this is where, like, research gets to be really, really interesting. We have this kind of idea that, When someone wants to kill themselves, what they do is put their affairs in order. Okay?

Their signs? Absolutely. We're going to get to those. So, like, they put their affairs in order because this is what the media sort of says, right? Like, you settle all your things. You, like, you know, you make sure no one's in the house. You write all your, like, suicide notes and things like that. But it turns out that, so there's sort of this idea that, like, people kill themselves, like, their suicidality kind of starts out here.

And then gradually over time, it increases, increases, increases, increases, increases, increases, and when it gets to up here, this is when you kill yourself. So a lot of people feel reassured, right? They kind of say like, okay, yeah, I'm suicidal, but like, I'm over here. And since I'm over here, it's okay, I don't need to get help yet because I'm not up here. And I'll know I need help when I start to feel worse and things like that. So there's sort of this myth that like suicidality builds up over time and people like make a calculated decision to kill themselves. Whereas if you look at the data, what you actually find is if we look at at the decision to make the most recent suicide attempt, the most common is that, like, you know,

I don't know exactly what the Y axis is here. It may be a number of people. So if you look at like, let's say this is like 30 people who tried to kill themselves. What you find is that 12 out of the 30 people decided to make the attempt within one minute of the attempt. You know, the the vast majority of people decided within half an hour or within two hours to make the attempt. So what we actually discover is that most of the like attempts of suicide are actually drastically impulsive decisions. And what we actually see is out of this sample, no one was planning suicide for more than three days. right so like what this means is that if you guys have been struggling with suicide for a long period of time and you think to yourself like oh like since i'm not planning it i don't need to be worried

i know it sounds kind of weird but you should absolutely be worried because what the data actually tells us if you take people who tried to commit suicide who survived and you ask them this is how this study was done when did you make the decision to kill yourself the vast majority was like within 60 seconds. And so this is kind of another thing to kind of look at. So if you look at suicidal ideation over time, okay?

And this is people like checking their suicidality like four to eight hours apart. What you basically see is that like the suicidal score like is all over the place. Right? So like this person will be very suicidal this moment and will be like not very suicidal four hours later. So basically like,

The key takeaway here is that the first important myth to address is that like, if you're telling yourself that because you're not planning to kill yourself, you are safe, that's something you need to be really careful about. So what you want to really do is go see a clinician either way. Like if you've been dealing with suicidal thoughts for a long time, I know it sounds kind of scary, but like you just never know. Like when we come to that sudden defense breakdown, you never know when the stars will line and like something will crack through and you will actually make an attempt.

So what I strongly encourage everyone to do is just because you've been feeling that way for a long time and nothing has happened yet is not a sufficient reason to not get help. So even if you feel like it hasn't, if you have it under control, if you feel like, you know, it hasn't happened yet. So there's a famous saying from the stock market, you know, like people in finance will say that the stock market past performance is not an indicator of future gains, right? And I think that's absolutely true of suicidality as well. When we're thinking about performing like a risk assessment, you know, that's not really like that reassuring because we just know as clinicians that it's

sort of like on a given day, like something may happen in your mind. We don't really know. And you can kind of result in an attempt. So what do we look at as clinicians? So we tend to look at means of access. And this is why means of access is like the number one protective thing. So if we think about, if we now understand that suicidality is impulsive and most people decide to kill themselves within 60 seconds of making the attempt, having a gun at home is part of the reason why suicide is like so much more likely if there's easy access to an attempt. If you have a gun at home, if you can like make a decision and 60 seconds later, you can actually make the attempt. You can actually make the attempt if you have the means to do that, that's incredibly dangerous. So when I think about

like suicidal like probabilities, what I really try to protect against, because remember, like, what we've got is like your mind working against you and your mind working for you. So as a clinician, what I really try to do is buy time for my patients to like get their head above water and reach out for help. And so if someone has to, you know, order something from the internet, in that 24-hour period, their suicidality will fluctuate and they'll reach out to me. And they'll say, like, hey, I had like a really scary, like near miss. And then we'll kind of talk about it. We'll help them through it. And then they end up, generally speaking, doing well. Okay. You know, when it comes to a risk assessment, we think about things like, and this is for you guys to understand, too.

if you're thinking about a particular, there's a big difference between it would be okay. So let's talk about like the scale of risk, okay? So if I went to bed and I never woke up, I would be fine with that. That's something that we call passive suicidality. It's not that you actually want to die. It's just sort of like, you know, if you unplug things like you would be okay with it. Then there's sort of like, I wish I went to bed and never woke up. So at that point, it's sort of like a desire, but it's not really like an intent.

right? You're not trying to not wake up. It's just like we move from a passive suicidality to like sort of a wish. And then the next phase is like, I actually don't want to wake up. Like I'm going to try to not wake up. Right. So then we sort of cross over into intent, which is like scarier. And then like the scariest thing is like plans and then means. So then like if you kind of think, okay, I am going to not wake up in this particular way. Right. So like once you start to think about a plan, that increase. your risk of a bad outcome. And then once that plan becomes available, that's when things get really scary. And it's usually towards those later stages that we sort of really think about things like hospitalization. You know, just another important reminder here that, like, you should not be using this risk assessment to determine whether you should go see a clinician or not.

If you were anywhere on this axis in any way, you should get a professional evaluation. Because we know how to ask questions that will sort of help us figure out where you are. Because I know hopefully you guys, if you guys have been watching the stream for a while, a big part of this problem is that people don't know what's in their mind. Right? The whole point of this stream, if you think about like how do people benefit from coming on stream, watching stream, it's that we help you understand the things that you are not aware of in your mind. And this is why I cannot urge you more strongly that if you are anywhere on the spectrum or even not on the spectrum, it's completely reasonable. And I urge each and every, it doesn't, and now that I think

about it, like, just go get evaluated. Like, even if you don't think you need to, right, because you may be missing something. And the other reason to go get evaluated or reach out for treatment, I know this sounds like absolutely crazy. Like it sounds absolutely crazy. It's that you don't have to live in this mindset. So for people who are chronically suicidal and think about never waking up again, you don't have to live that way. Right?

So like there are trained professionals whose job it is to help you through that stuff. And this is the really crazy thing, right? It's like our mind does this really stupid thing where it's like, if I can't figure it out, no one can figure it out. It's like, I've been dealing with this for a long time. I've read so many books. I've watched so many YouTube videos. I haven't figured it out.

So, like, I don't think anyone can help me. I'm unhelpable. Like, they can help other people, but I have tried really hard to figure this out, and I haven't been able to. So I don't really think there's any point in seeing a professional. Be careful, because if you have that thought, if you think there is no point,

that is actually, you should do the exact opposite. if you think there is no point to see a professional, you should actually go see a professional. If you're on that axis, you should absolutely go see a professional. And we'll get to this in a second in terms of what you can do. So now moving on to point number four is like, what do you do in this situation, right? So the answer is going to be like sort of a broken record here is like you go get help. So like in the same way that if like if you've got a flat tire, like maybe you know how to change it to yourself. but if you let's say your engine is busted, right?

Like, you go see a mechanic. Like, there are, as human beings, we have a society, we have a community, and we have a diversification of our labor pool. Like, if you want to eat a burrito, you go to a place where people know how to make burritos or you make it yourself, right? If you want to, you know, get, if you've got COVID, like you go see a medical doctor because they're going to help you with COVID, you go to the appropriate person for the appropriate thing. and if you're dealing with feelings of hopelessness or suicidal thoughts, the appropriate place to go because

there's a profession of people whose job it is and who's been spending years of their life to train and get good at helping you. So you should go see them, right? And be careful about all of the reasons that your mind may populate. And if your mind populates these reasons, then you should really like notice that and recognize that this could be a process, a part of like the negative process. So if your mind is telling you there's no point If your mind is telling you that you don't deserve help And that you deserve to feel this way Because you're such a POS And you like, you know

Like other people deserve help But you don't deserve help Like that's like just recognize that And then don't give into that So I know this sounds kind of weird But I encourage all of you all to really think about What is it that dictates your life Do you want to live a life that's based on like

What your emotions tell you And I know it sounds kind of weird But based on what your thought tell you? Because the mind is just a thinking machine. It just generates thoughts and generates all kinds of random crap. Like your mind will say like I want a burrito or it'll say like I want to play Dota or like I don't want to do this. And do you want to listen to your mind? So be careful right? Because sometimes you want to listen to your mind and sometimes you don't. But you don't want your mind and your emotions to be in control of you. You want to be in control of them. So the last thing that I'm going to kind of talk about is like

you know, the sentiment that you can handle it is not a sufficient reason to, this is not the last thing, this is the second last thing. The sentiment that you can handle it is not a sufficient reason to not see a mental health professional because it's just dangerous. Like statistically, it's very dangerous. So the last thing that I'm going to talk a little bit about is like how to help someone else who is dealing with suicidality. So this is really tricky because a lot of times people in our community are like good people and you try to help other people out, which is awesome, right? Like, we love that. It's part of the reason that we're here. Like, our Discord has a lot of people that try to help each other out. Our subreddit has, like, people posting about their problems and, like, other people post on the

subreddit to try to support them. It's, like, fantastic. Like, it's really great. It's beautiful. We have coaches who will also, like, you know, are also kind of trained in our methodologies or sort of specifically there to help you out. And that seems to be going really well. I had the privilege of dropping into a coaching group this morning. And it was fun to really see, like, you know, how people are progressing. So the last thing is, like, you may have a friend who is struggling with suicidal thoughts. So the first thing to understand is that, like, a lot of people feel like I don't know how to help them or they won't let me help them, which is sort of fair because it's, I know it sounds kind of weird, but, like, it's your job to be their friend, not their doctor. So a lot of times I notice that people get really kind of like frustrated or they feel like really like stressed out because they're trying to fix this person's suicidality. They're trying to like because it's like so scary and you want to fix it. But you're just not trained or capable. And so I know it sounds kind of weird, but like you shouldn't stress about that. Right. So like fixing someone's suicidality is not your job as a friend. You're not trained in it. So you, I mean, I guess you can kind of give it a shot, but like I wouldn't really recommend that.

really your job as a friend is to be their friend and support them through it. So this is where it's like encouraging them to actually get help. Because this is huge where a lot of times people won't want to get help for any number of reasons because they feel ashamed. So like, you know, you can kind of support them through that. Sometimes it's like practical. Like, you know, their mental is not functioning properly so that like they just don't have the wherewithal to like sit down and like call around and try to find an appointment. So you may be able to help with that. Like, it's kind of crazy, but you could ask them,

hey, would you like my help in making an appointment? Like, because 60 minutes from now, like, you could have two appointments. We can make, you know, one phone call every six minutes, and we can make 10 phone calls. And out of those 10 phone calls, there's a decent chance that 20% of the people, like, will have availability. So it's going to be an uphill battle because in the mind of the depressed person, in the mind of the hopeless person,

they may must drop the courage to make one, phone call, but when like, you know, they don't get an appointment, they kind of give up. So as a friend, you can help them get into treatment. You can encourage them to get into treatment. You can support them to get into treatment. The second thing is don't underestimate the power of being a friend. So while you may not be able to actually treat their suicidality and nor should you try, don't underestimate the value of you caring about them. Right? Because in their mind, remember that there's an equation between pro-suicidal factors and anti-suicidal factors. But like, one of the things that you're doing there just by being their friend, and even like,

I know it sounds kind of weird, but like, I'll even say this as a psychiatrist. Like, it's one of the most powerful things that I've like learned how to say. Like when I'm dealing with patients with trauma, you know, they'll tell me about all this terrible stuff that happened to them. And it's like, we're 10 years later. And I can't do anything about that. And just, sharing how much I wish I could like, you know, because really the cure for this person is for me to invent a time machine, go back in time and protect that from, protect them from like that ever happening. That's the cure. And I wish I could do that, but I can't. And I'm actually completely powerless in this situation to like take that trauma away from them. And being able to share that

with them because like instead of like, you know, you trying to help them, you're actually joining them in the hopelessness. And then what happens once you join them in the hopelessness is like both you all are down there together and you all are hopeless together. So at least you can't change time, you can't change the past. They can't change the past either. But at least both you all are down there and like they're not shouldering that powerlessness on their own.

You're helping them carry that powerlessness too. And so then once you kind of get down there and there with them and you say like, hey, I can't take this away from you. I wish I could. But I'd like to try to help you in some way. What can we do? What can we do? And that's really the most important question you can ask as a friend. Right? And then like meet them where they're at and try to like help them. Like if it's sort of like, can I make phone calls for you? Can I help you get into treatment? Like what can I do? You know, what is it that you would like to do that you're not able to do? And sometimes it's like other kinds of things. right? It's like, hey, let's play, like, let's make phone calls for 30 minutes, and then, like, we'll play, like, one game of league.

And then, like, after that, like, we'll take a break and we'll make phone calls for another 30 minutes. And then, like, we're going to keep doing that until you have two appointments. And then we'll, you know, there's a lot that you can do as a friend. So remember that your Dharma as their friend is to be their friend. It's not to cure them. And so be careful about what your time. capable of and what you're signing up for. So let's actually start with kind of a quick summary. So today we're talking a little bit about suicidality and how to understand it. So we started off by talking about, you know, who suicide affects, who has suicidal thoughts, kind of how that works.

We sort of talked a little bit about how women may be more likely to attempt suicide, although men are more likely to complete suicide successfully. About 80% of suicides are men. We also talked a little bit about why that statistic may be different. So some of it may have to do with the means of suicidality, like women are more likely to try to overdose, which means that the window for medical intervention and the window to save that person's life is a lot greater than using something like a gun,

which men are more likely to use guns. Women are more likely to try overdose by pills. So we talked a little bit about statistics. I suspect that there's more to it than that. I think that there's something going on in terms of like why men are so much more likely to kill themselves. The second thing that we kind of talked a little bit about is like, you know, why do people kill themselves?

And as we sort of get into the mechanisms to recognize that suicidality is a symptom, it's not a diagnosis, and that suicidality is born out of all kinds of psychopathology as well as potentially like psychological complexes that are not necessarily a discrete medical illness, brain malfunction, or neurochemistry imbalance. So we talked a little bit about diseases, like major depressive disorder, bipolar disorder, addiction, sometimes things like trauma, but also that when you actually sit down and talk to people with suicidality, what you discover is that sometimes they want to kill themselves because they don't feel like life is worth living, that their dreams have been shattered and they don't really feel like they can ever put

things together again. Sometimes people kill themselves because they have an immense amount of self-hatred. And it's not that life can't be put back together. It's that they don't deserve to live a life that is like put together. Sometimes it's born of things like envy and humiliation and shame. And sometimes what can actually happen is we always sort of have this war going on in our mind between reasons to live and reasons to not live. And sometimes we can have acute events that will sort of shatter some of our defense mechanisms that help keep us alive. And sometimes I'll see this especially in the case of disinhibition through substances. So like, you know, if you think about alcohol, alcohol will make you more likely to do things that you wouldn't do if you were like level-headed.

And suicidality includes that. So like the number of suicide attempts that I've seen under the influence of alcohol is like staggering. It's like through the roof. And then we sort of talked a little bit about, you know, how to think about suicidality. So we talked a little bit about risk assessment. And the main takeaway here is that regardless of how suicidal you've been, if you've had those kinds of thoughts or you're currently having those kinds of thoughts, you should absolutely go get help. It's a no-brainer. And a big reason for that is one of the most common myths

behind suicide, which is that people like really plan it out, right? It's like weeks and weeks of careful planning and I'm going to do this and settle my affairs in order. Whereas if you look at the research, at least in one study, no one planned more than three days and like the vast majority, like 50% or more, 70, 80% of people made the decision within two hours.

and about 30% of the people made the decision within 60 seconds. So the reason you should go get help is because you never know when your mind is going to change. And the last thing that we talked a little bit about is, okay, so what do we do about it, right? If you're struggling with these thoughts, like the short answer is get help. Recognize that there are all kinds of thoughts in your head that will prevent you from getting help. And if you're having those thoughts, that's not a reason to not get help. In fact, it's the very opposite. So sometimes your mind may be telling you things like no one,

will be able to help because I haven't been able to fix it myself. Your mind may be telling you, I don't deserve help. And if you have any of those thoughts, you should actually get help because you're having those thoughts. And the last thing is, you know, how do you support someone else? The short answer is get them into treatment. And in terms of how you do that, it's supporting them sometimes through like a very practical, hey, do you want me to like Google stuff for you? Can we make phone calls together? And sometimes it's just being their friend because it's your job to be their friend. It's not your job to be their doctor. And a lot of times people get really bent out of shape and stressed out because they try to be their doctor when you just can't. You're not trained to do that, nor should you.

I don't play doctor. I don't accept patients that are friends of mine. So like, you know, people who have working relationships with, people who are my friends, people who are my family, like I won't be their doctor. I will send them to someone else. So that's our quick talk about suicide. I hope it's been helpful. You know, the goal of having this talk is because, as we looked at earlier, we are sort of losing the war against mental illness. We are losing the war against suicide. And despite many advances in medicine, despite, you know, a lot of new pharmaceutical medications and things like that, some of which I've really seen, like, clinically do a fantastic job. I really have seen some patients with depression who've tried, like, five or six medications

and a new drug comes on the market. It really does turn things around for them. So it's great that like we have all these advances. And at the same time, you know, the suicide has like increased as a cause of death by like 33% over the last like 20 years, I believe. Whereas like, you know, deaths due to cancer and heart disease and stuff like that have gone down by 20 to 40%. And so the first, you know, we're going to start by educating us, educating y'all. Right. So we as a community need to understand more about suicide. We need to understand like what it looks like, what it feels like. what to do with it. And I encourage all y'all to get some help because the, you know, the biggest, the most common thing that I hear from my patients who are reluctant to engage in mental health is like, I wish I had done this sooner. Because some of them will just, I mean, you guys will hopefully realize this too, that you just don't have to live like this. It's like, you know, like you can fix this. Like you can feel better on a day to day basis. Like the sun can be a little bit brighter. You can be a little bit happier. You can just enjoy things more. You can actually live life with like more

motivation and like food can taste better. And all you have to do is just get a little bit of help. So someone's asking a question, what if you don't have money? So it depends a little bit on where you live. But, you know, most places actually have most places meaning like even countries. So the U.S. basically has free mental health clinics or community mental health clinics in most cities, actually. So I don't think people realize this, but you can just do like community mental health center. And you call the community mental health center and you say, hey, I have no money. I'm depressed. Can you guys help me?

You'll be surprised because there are all kinds of programs out there, right? So we also have programs like Rise Above the Disorder or Rad, which is like, you know, a gaming nonprofit that supports. like gamers and actually pays for their treatment through like scholarships and grants. So there are nonprofit organizations out there that'll help. There are community mental health centers that are helped. Just call them up and ask. So I wouldn't let that be a barrier. Okay.

So what's a good way I can open up to a clinic or therapist about this kind of topic without making it seem like I am in immediate danger, but it is still a very serious ongoing issue? So it is their job So my job as a clinician Is to keep people out of the hospital Right like the hospital is like a last resort It's not a first resort

And so I would say Just share that with them Just say like hey I'm not in any immediate danger But this is a very serious issue And I'm afraid That you're going to think I'm in immediate danger Just tell them

They'll be like Okay cool thank you for sharing that That's like one of the most reassuring things that I can hear as a psychiatrist. Oh, great. This patient is taking this seriously. Good. That means I can rely on them.

I can trust them. They respect the enemy that they're facing. Someone's asking, why do you not want to be a doctor for people that you know? So being a doctor is about being objective. Right? So what I want to do is like not let my emotions

get in the way of like my clinical training. And when personal relationships arise, emotions and other kinds of boundary issues arise that make it hard for me to actually function as a competent doctor. So there have been numerous studies done that show that physicians who treat family members are more likely to misdiagnoses than like a rando from the street. Ah, so what if your friend doesn't want you to get them help? How do you convince them otherwise? That's a great question. You don't convince them otherwise. So this is sort of where, like, what I would encourage you to do is, like, instead of trying to convince them to get help, ask them why they don't want help. So anytime you have a disagreement with someone, I think we try too hard in this society to, like, convince instead of understand. And I want you guys to just pay attention to any argument.

Like, I really wish I could. So I, anyway, I wish I could share something with you, but I can't. But so like I want you guys to just pay attention to any argument and like think about the arguments in your life where you try to convince someone and they try to convince you. What happens? Like it doesn't work. Whereas it's kind of interesting because if you try to understand them, they will automatically empathically like there's some circuit and their brain will flip where they will try to understand you. You know? And so it's kind of interesting because I wouldn't. try to convince them, but I would still like state your perspective. And you can say like, hey, I see you suffering. It hurts me to see you suffering. I care about you. I think this would help. But if you don't want to, like, you know, I can't make you. Can you help me understand why you

don't want help? Because there may be something there that needs to be addressed, right? So someone else is asking, what if I'm afraid of my parents not knowing, or my parents knowing? So like, there may be something like that where they're like, you know, they have some fear. Like they're afraid that they're going to be hospitalized or they're afraid they're going to, you know, get kicked off of like whatever team they're on or they're afraid that, you know, their parents will find out. And so then you can kind of like help them work through that, right? Like you can be like, okay, so like what, you know, what are you afraid of your parents knowing? What are you afraid of in terms of reaction? Or you think that they're not going to be supportive? You think they're going to call you weak? You think they're going to punish you for it.

And then like, you know, then the conversation sort of becomes like we can, maybe talk about, you know, parents who are against mental health treatment at some point, the conversation then becomes, like, you know, what's more important to you? I know it sounds kind of weird, but like, you know, when I work with kids whose parents aren't supportive of mental health treatment, it's actually like really amazing to see what happens because the kid actually, like, we work to the point where like they can be strong about it. And it's sort of like, my parents may react poorly and I can't control that, but that's on them. And I'm not going to let the opinions of my parents dictate the life that I lead. And that's hard. Like it's, it requires a lot of,

like, internal fortitude and support from the outside to get to that point where you can let your parents know. And sometimes we'll even coach people into how, how to have a conversation with your parents. So when you tell your parents, hey, by the way, like, I want to see a therapist, they'll be like, you don't need that. And then, like, once again, don't try to convince them, right? So You ask the question. You ask them like, what do you think I'm feeling and what do you think I need? And they'll be like, you know, and just listen.

And be like, okay, I see. So you think I'm feeling unmotivated because I got a B. How would, how would, like, how would that, like, how would you, so you think that I don't need therapy because you think this is just, just a temporary part of adolescence. If I were to tell you that what I'm feeling is very different from what you're describing, if I'm feeling something that's very different from what you think I'm feeling, would that change your mind about whether seeing a therapist is appropriate or not?

It's kind of like a weird question, right? Because they're like, it's kind of a weird question. It's like a hard question to answer because if they say, and then you may even get to, therapy doesn't do anything. And then you can ask them, like, what's your, like, help me understand why you think therapy doesn't do anything. What do you base that on? Where does that come from? And just have a conversation with your parents. And then like even I've had like, you know, people working with super religious parents who will be like, you know, you just need to go to church

more. Like, like, you know, mental weakness can be solved through, through God. So you can say, like, okay, so what's your understanding about like why people, like, you know, why the profession of psychiatry exists? And then the answer can be something like, well, it's because people have gotten away from God. And then you can be like, okay, so do you think that like seeing a therapist necessarily means that I've moved away from God? Or can I do both? Like, what do you think about me trying it? And like, just being open-minded and seeing what the deal is. And oddly enough, when you approach, I've approached very religious parents in that way and found them to be, you know, like quite receptive. It's bizarre.

You know? And even as a psychiatrist, like sometimes like they'll come into my office, right? And they'll be like prepared to do battle. And so you just listen to them. You can be like, yeah, like I completely agree. Would it surprise you guys that I spent seven years training to become a monk before I became a psychiatrist? I actually agree with you that a lot of the reason that's that mental health is getting worse in this country is because we've lost some element of spirituality. And I think that

God puts that, like, gives us like a lot of options, right? Like, and so we should use everything at our disposal. It's crazy. Like, they'll be like, and I'm like, do you guys think I'm evil? You just ask them. And they're like, no, you seem like a nice guy. And I'm like, okay. So like, how do you guys feel

about your son coming and seeing me once a week for an hour? And we're just like going to talk about stuff. stuff. They're like, okay. And I'm like, you guys can come once a month too. And let's just check in. Like when you guys drop him off, if you guys have any concerns, you can let me know. And they're like, okay. Like, it's really strange. But I think just, you know, if you have someone who's resistant to being convinced, don't try to convince them. Try to understand them. Right. And try to find some common ground. like because it's there. Like, just because they don't want to see a therapist for some reason does not mean that, you know,

they may want to avoid therapy for a reason, but they may want therapy for another reason. So it's about sitting with them in that space. And this is why it's kind of interesting that, you know, one of the outcomes we're now measuring from our coaching program is like how good our coaches are at getting people into therapy. Because a lot of people, a lot of times for whatever reason, you all feel more comfortable working with a coach than a therapist. Therapist will work with you for a while. Like, Asriel's a good example if you guys caught that interview.

Like, was in coaching for a little while, like went to therapy for a while and then came back to coaching. And he seems to be doing way better. The two are complementary. Yeah. So what if you're dealing with someone who's psychotic? So the other thing that I should, for the sake of complete, is that I really should have included is if you think that someone is at like imminent risk to themselves, it's absolutely

appropriate to call whatever emergency services is. 911, 112. If you think someone is actually going to hurt themselves, you all should absolutely just call 911 or whatever the emergency service is. And, like, you know, because like if someone asks a question, like, what if someone is psychotic? Like, if someone is high on drugs or psychotic or something like that, like you should just call an ambulance and get that person to an emergency room because

that's what the doctors in the emergency room are there for, which is most of my bread and butter when I work overnight shifts in the ED. And it's really fantastic. Like, I'm so glad that, you know, someone picked up the phone and, like, made a phone call. Because they're going to come, I mean, there's a decent chance

they're going to wind up in the emergency room either way. And it's just going to be like, you know, if their friend called, then we've got a good shot at saving this person's life. And if no one calls, then we have less of a shot at saving this person's life. And I can also say that, you know, I would say 90% of people that get hospitalized are grateful that they were hospitalized when they leave in my experience. I wish it was 99, but honestly, it's 90.

10% of people really dislike it. Yeah, so someone's saying, I feel like I'm where wreckful was that they died. I don't know where to go. Seriously, dude, I'd pick up a dude or woman or, you know, whatever you identifies. I'd pick up the phone and I'd call 911. If you guys are where he was, you'd pick up the phone call. Seriously, that's like, that's the only answer if you're aware he was.