Instant Genius - The psychology of suicide - Jesse Bering

Episode Date: October 3, 2018

Psychologist and science writer Jesse Bering explains the factors that lead someone to take their own life, and how we might be able to help those who are at risk. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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alongside French acoustic specialist focal, combine handcrafted tradition with cutting-edge innovation and high-end materials, delivering digital precision with analogue warmth. So you can experience exceptional sound at home. Music just as the artist intended. Visit name audio.com to learn more. I think that it is a human phenomenon. And until we accept that and acknowledge how common suicidal thinking is,

it will just seem like it's something that happens to other people and not those close to us or even ourselves. You're listening to the Science Focus podcast from the BBC Focus magazine team. With the UK's best-selling Science and Technology Monthly, available in print and in several digital formats throughout the world. Find out more at ScienceFocus.com or look out for us in your app store. Hello and welcome to the Science Focus podcast. I'm Daniel Bennett, the editor of BBC Focus magazine.

This week we discuss a topic that's talked about all too little. Suicide is one of our major public health problems. According to 2014 reports from the World Health Organisation, someone ends their life every 40 seconds and suicide kills more people around the world than all the wars and natural disasters combined. In the UK, it's the leading cause of death in men under the age of 45. Jesse Bering is a psychologist and science writer

who knows firsthand what it's like to feel suicidal. In his new book, A Very Human Ending, he uses his personal experiences to explore the inner workings of the suicidal mind, looking at the factors that lead someone to take their own life and how we might be able to help those who are at risk. Before we start, please note that this podcast deals with topics that some people might find distressing. Here's our staff writer, James Lloyd, speaking to Jesse.

Okay, so Jesse, your book is called A Very Human Ending. I was wondering, is suicide a uniquely human behaviour, or has it been observed in other animals? Well, it's a contentious subject. there are some animal behaviors that would insist that they are convincing cases of animals killing themselves or taking their own lives. I've argued in the book that, in fact, we are the only species that intentionally ends our lives. And if you look very closely at these sort of idiosyncratic anecdotal reports of animals, they are interpretable by other means.

One good example is for some reason, in the early 20th century in the American press, there were a lot of reports of animals killing themselves, dogs, you know, jumping off cliffs. There was a story about a dog that was at a menagerie or a zoo in Central Park and jumped into, to the hippopotamus tank and drowned, or actually I think was killed by the hippopotamus,

but the journalist insisted that when it was finally sort of fished out of the water, it was clear that it had committed suicide because it was friendless and was clearly emaciated and just sort of decided that life wasn't worth living. But from my perspective, I mean, it's the more parsimonious explanation is that it was simply very hot and thirsty,

and found itself in a real predicament. And if you look at our closest living relative chimpanzees, where you would expect to find something like suicide if it does appear in other species, despite the equivalent of hundreds of years of ethological fieldwork with chimpanzees by primatologists, there's not a single incident of a chimp climbing to the highest branch you can find and jumping, which it would be something that you would see only in human.

I think that we are the ape that jumps. That was actually the original title of my book. Why did you decide to write a book about suicide? What set you off on that journey? I guess a confluence of factors. I mean, for one, I just find it a dark territory, certainly. it's a grim subject matter, but it's also, it's very fascinating to me as a psychologist with sort of a philosophical bent, I guess, to my writing. I also have, you know, have sort of had fleeting bouts of suicidal feelings throughout my life.

They come and they go. Fortunately, I'm not experiencing them. I haven't experienced them in quite a while. But I remember when I experienced them last, I kind of had this. idea in mind to put those feelings in a bottle or somehow capture them because one day I would like to write a book about suicide. So I tried to sort of imprint that emotional intensity, that incredible depth of sorrow and remember what that was like because I wanted to be able to describe it scientifically in a book one day. And part of my coming out of that, that dark,

period was my intellectualizing the problem. That was my defense mechanism, being able to sort of keep these dark feelings at arm's length emotionally by analyzing them critically. So over the years, I started reading the literature on suicidology and found that quite therapeutic. And I guess I I wanted to basically communicate that to others that have gone through similar periods in their life. So I guess every suicide is different in a way. But I was wondering, are there commonalities between them? Are there lots of things that we see cropping up time and time again? I think that there are some common denominators.

You know, it is incredibly difficult to get a handle on the vast array of reasons that somebody would end their life. life, what expert referred to it as dizzying in its variety in terms of the reasons that somebody would end their life. And I think that's true. However, you do find some patterns. Some, for instance, when people have a very rapid loss of status that is oftentimes associated with suicidal thinking. So just to give you an example, somebody that has been single their entire life, they're not at a special, especially high risk of suicide. It's the person that has been in a long-term relationship that suddenly finds themselves alone, that sort of rapid shift to a new social status or somebody that has had money and then they lose all of their money rather than somebody that's been at the poverty line,

their whole life long. So if you're at the, if you're at, you know, basically sort of the bottom of the mountain, you're not really adjusting to that, that intolerable level. But if you, if you fall off of the mountain from the very height, then that's where you see real despair. So you find suicide suicides flaring up, for instance, in the first month of incarceration, when you're thinking about suicide among prison inmates or among those that are institutionalized in mental hospitals, it's usually that sort of month, that first month period where the person is most at risk as they're navigating their new social identity. And is there a kind of genetic component to suicide? Are some people more likely or more at risk of suicide than others kind of genetically?

Surprisingly, yes. There's a reasonably significant concordance rate among identical twins when it comes to suicidality, either attempts or actual suicide. It's not completely equivalent in the sense that just because of it's just because of, your identical twin kills themselves doesn't mean that you are destined to do so as well. But most experts would say that there's a vulnerability to suicidology that seems to be heritable and is distinct from other types of mental illness. So even if you control for bipolar disorder, schizophrenia, many of the psychiatric conditions that oftentimes are comorbid with suicide, even if you rule those out, there's still a heritability component when it comes to suicide. So there does seem to be some genetic basis, although it's not entirely clear what that is.

It could be related to individual differences in impulsivity or aggression or, or perfectionism. These are all personality attributes that contribute to suicidality as well. And those who take their own life, what proportion do you suffer with a mental illness? Is it the vast majority or is that not the case? I think it's fair to say that the vast majority of people who die by suicide would have some diagnosable mental illness. However, I'm a little reluctant to, embrace that 90% statistic that is very commonly flouted as being the case for suicides, that 90% of people who die by suicide would have a diagnosable mental illness. Because if you isolate those

cases and you present them to psychiatrists that do not know that that individual died by suicide and they just simply evaluate their psychiatric case history. It's a far, far smaller percentage than 90% in terms of what these experts would diagnose as this individual having a mental illness. So I think that 90% statistic is a product of psychological autopsies, which is that when people die by suicide, they retroactively sort of look at their symptomology and their case history and they diagnose them after the fact knowing that they've killed themselves. But if you control for that, experts are, and psychiatrists are far less likely to identify a mental illness.

You also talk about the fact that media coverage of suicide, for example, when a celebrity takes their own life can actually lead to more suicides. Can you tell me a little bit about this effect, about what causes it, and then about how we should report suicide in the media? Yeah, it's kind of a paradox that I ran into and writing the book, because on the one hand, I wanted to communicate the science of suicidology and share findings in this field with readers. But on the other hand, I was always very wary and cognizant of the fact that simply by talking about it, could potentially put vulnerable individuals at risk by mere exposure. So, you know, it's this sort of delicate balance, I think, between talking about it and talking

about it responsibly in a way that doesn't make those that are significantly at risk more likely to harm themselves. And I think ultimately at the end, I sort of justified it in the sense of, well, I think it's much more important that we understand the mechanisms and the processes by which we think about suicide and have some meta-awareness or meta-knowledge of the processes of suicide contagion and these psychological epidemics and know how our brains work when we are exposed to news of a high-profile suicide by a celebrity. So, you know, Anthony Bourdain or Kate Spade had recently been in the news. And what we do know, what we do know is that suicide contagion is real. We do find an increase,

an uptick in suicides in the weeks surrounding a celebrity's death. And, you know, responsible journalists at this stage do follow rules that I think, you know, they follow ethical rules about how to report suicide so that they, you know, they don't use sensationalized language. They don't show images or depict methods graphically. And they talk about suicide as a health person. problem. So there are there are ways to sort of address it, but the effect is still genuine. In terms of why it happens, I have my own suspicions. I think that many people implicitly expect people that are sort of in this vulnerable state and highly susceptible to suicide contagion because they're

suicidal already might see the sort of the accolades and the attention and the press and the praise that these deceased individuals are getting from the public. And there's a part of them, even though they might not articulate this explicitly. There's a part of them that expects that somehow they will experience that after their death as well. I mean, I'm a extinctivist. or extinct a person who believes that once you're dead, you're dead, and that's it psychologically. But I still think that it's very difficult to embrace that sort of that knowledge very clearly. I think that a lot of people just simply assume that somehow they will be around to observe what people are saying about them or their funerals and the memorials that they're getting. And it's just simply a cut into bias that human beings operate with.

So I think that's part of the reason that suicide contagion is so virulent that people want others to understand their suffering and think that by killing themselves, they will finally be understood just like these other people. I was wondering what changes do you think we can make at a more societal level to help prevent suicides? Well, personally, I think that we will be able to save a lot of lives by educating individuals about what it feels like to be suicidal subjectively so that people can recognize when they are in that state themselves, rather than rely on others being able to detect what are oftentimes very subtle symptoms. of this altered state of consciousness. I think a lot of people who lapse into suicidal thinking are not even aware of themselves that they're at risk of suicide.

You know, they don't identify as a suicidal person. And I think this harkens back to your earlier comment about mental illness, which is that we, you know, it's very easy to simply say that, well, suicides are, you know, we need to really shed light on mental illness and so on. But I think when we use that sort of low language about mental illness and suicide, it almost feels as though somebody with depression or

anxiety, for instance, although technically they are mentally ill, they might not identify as a mentally ill person. So when they hear there's a link between mental illness and suicide, they don't necessarily grasp that connection and see themselves as being a vulnerable individual. So one of the things that I found in writing about this is that the stages of suicidal thinking that one can find themselves in, people see themselves in these stages and never really realized that they were at risk. So, you know, we hear all the time about, you know, stories of people that I never, you know, I ever thought that they would actually take their own life or I didn't realize it was quite that bad. And I think, you know, in some cases, that the person themselves might not have realized it was quite that bad until that last impulsive moment when they were in that impoverished state of decision making. So I think educating, this is what I'm trying to do in the book. I'm trying to, I guess, educate readers about what it feels like, that sort of phenomenology or the subjective sense of being a suicidal person

and stepping back from it and allowing it to pass. That acute suicidal thinking rarely lasts longer than 24 hours. And if we can just wait long enough for it to pass, we can probably get over that horrendous hurdle. So in your book, you talk about there being a kind of series of steps almost that people might go through on the way to ending up, you know, taking their own life. Could you give an example of those steps? And then explain how we go about recognizing that. Is it a case of kind of stepping back and having a more objective look at our own mind almost? Right. So when I write about the stages of suicidal thinking, it is in reference to the social psychologist Roy Baumeister's model of suicide, what he calls suicide as a skisible.

from self. And I guess the best way, first of all, to distinguish his model from other theories of suicide is that he views the primary motivation of people who kill themselves as avoiding or shutting down consciousness. That consciousness itself is crippling and debilitating and incapacitating. And what somebody who takes their own life is doing, in effect, is. is trying to enter oblivion. And that is contrasted with a lot of more traditional psychoanalytic models of suicide,

which would envision it as more of a sort of execution of the self that you're punishing the self in some way. For Baumeister, it's all about escape from the self. And suicide is an extreme manifestation of that. But watching movies is an escape from the self or going for a long run or abusing. drugs, it's all about somehow diluting the piquancy of self-awareness, diluting self-awareness. So first of all, that's what underlies his stages of suicidal thinking. But the first step is that somebody has experienced a dramatic setback or they failed to live up to their expectations in some way. And this is related to what we talked about earlier in terms of loss of social status that somehow we have experienced a social problem.

And typically these are social issues. You know, depression, anxiety, and suicidology is oftentimes a reflective of something that's going wrong in our social lives. But that's the first step. It somehow is that we have failed to live up to. our own expectations. And, you know, whether that's expectations that have been thrust upon us or just our own perfectionism is irrespective of that. It's somehow that, you know, we are disappointing ourselves. And we also, so, so, so I talk in the book about, I live in New Zealand now in rugby. Rugby is a big sport. And there have been some very high profile cases of people in

New Zealand and Australia, former all-stars athletes in rugby that have found themselves injured or they retire and all of a sudden the spotlight is not on them. And they're sort of leading this pedestrian lifestyle now. And it's even though they're by all objective measures, they're doing well and they're successful. Somehow it's that loss of status that they're just a regular person now that is intolerable. Yeah, so it goes back to the thing you're saying about the sudden change. It's redative then, really. Yes, absolutely.

The second stage is blaming yourself, basically, attributing the problem that you're experiencing to your own shortcomings or ineptitude or failure, self-blame, shame. These are all very powerful and ubiquitous predictors of suicidal thinking. So, you know, we all have bad things happen to us. But, you know, if that's all that it would take is bad things happening, then everybody would be suicidal. But what makes, you know, what makes somebody particularly at risk, and this is certainly something that I suffer from is being shame prone, you know, seeing yourself as having some sort of inherent flaw that is responsible for the setback that you experienced in that first stage. So that's the second stage.

Stage three is an exceptionally high self-awareness. So we find ourselves in this sort of myopically egocentric state where we are painfully. self-aware. And, you know, this is why, for instance, people would do things like drink to somehow tone down the presence of other minds or anything that would allow them to get out of their own head. I remember being, you know, a suicidal teenager. I talk about this quite extensively in the book. and, you know, I was coming out of the closet, or I was almost being forced out of the closet,

and I wasn't really prepared to do that, so I found myself sort of panicking state. And I remember trying, I remember being so self-aware that it hurt. And the only way to get out of my own head was to read obsessively. And I was, you know, all these sort of trashy, you know, novels and just anything basically that would serve to replace my own. rancid thoughts with somebody else's ruminations, that was comforting to me. And it makes sense now, in retrospect, looking back, that what I was trying to do was to escape from myself. So high self-awareness is something that you'll find quite often with suicidal people. The four stage in Baummeister's model is what he calls negative.

negative affect and this kind of is self-explanatory that, you know, when you're suicidal, you have intensely negative, painful, emotional experiences. One of the more heartbreaking case studies that I discuss in the book is a is a girl, a 17-year-old girl named Victoria McLeod, who jumped off a 10-story building in 2014. And when she did so, her parents didn't know she was suicidal at the time. In fact, there was just a note in her pocket that said something like, if I'm found, I don't want to be a vegetable, please donate my organs and end my suffering or something like that. She didn't survive the jump.

But it was only seven months later that the parents, found a diary on her laptop after they got it back from the police after the inquest was completed, that the diary was basically four months, the four months leading up to her death where pretty much every day she kept this really intense journal about her suicidal thinking and the fact that she was planning this. but you know this this feeling of intense pain suffering negative affect was present you can sort of see her slipping into these stages and that's the way that I discussed it at the book but she talked you know and one it's just sort of like this you know please make this pain stop and she's you know

crouching in the shower and you really really get this sort of visceral sense of what she was going through in that moment so negative affect is a is a big part of it. Now, the fifth stage is what Baumeister refers to as cognitive deconstruction, which is basically just what it sounds like. It's very strange if you think about it. Your experiences are deconstructed, broken down into very concrete experiential parts. So you'll find things like in suicide notes, you'll find typically they're not like lofty,

existential, philosophical in nature. They're more concrete in the sense of feed the cat, pay the bills. There's even some evidence of genuine suicide notes containing more references to concrete objects

in the environment like refrigerators and beer cans than that abstract mental states. like love and honor and things like that. So somehow this being sucked into the suicidal frame of mind leads to more concrete thinking. And Baumeister says that this is basically the self's attempt to sort of dial down that negative affect that the individual experiencing to sort of concentrate on the things in your immediate

environment, concrete problems, not dealing with the past or the future, but just what you're facing in the here and now. But this also means that people that are in the suicidal state are typically not very good at empathy. So because that's sort of an abstraction, we have difficult time when you're in that state thinking about how what our actions will do will affect others. We are compromised in our ability to take somebody else's perspective when we are suicidal. So I think that that helps a lot of bereaved people to know that what their loved one did wasn't out of selfish reasons or to hurt them. It was simply that they were unable to be empathetic because they were in this altered state of consciousness.

And then the final stage and what separates somebody who is just a, somebody that's experiencing suicidal ideation from an actual suicide attempt or somebody who goes through with it is disinhibition, which is overcoming whatever psychological obstacles that prevent most of us from actually ending our lives. So Victoria McLeod, who I talked about just a little while ago, who jumped off that 10-story building, discusses rehearsing in her journal. She talks about rehearsing her suicide by standing on top of the building on the roof,

looking down and imagining herself falling. There are other examples of people sort of strangling themselves to get a sense of what it would feel like to hang. and all of that is to somehow overcome our natural instinct to avoid pain and death ultimately that that would be the primary obstacle. So unfortunately, you know, some people do lapse into this final state of this inhibition where they go through with the act that, you know, the agony, of living is much more painful than at least in their mind what it will feel like to die. And so you think that by educating ourselves around these stages that we can recognize when

we're in one of those stages, either ourselves or a loved one and then hopefully stop people from getting to that last stage. Absolutely. I mean, I think that our best bet is to be able to recognize when we are in these stages ourselves and to understand that we are in, typically in an altered state of consciousness and to pull out of that or to be able to look at it again from this sort of meta perspective and realize that tomorrow will be different. Would you like to see any changes in the way we talk about suicide?

I think that it's, I think that talking about suicide as though it's a, psychopathology or a mental, you know, it's a product of mental illness, although I understand the intention is good. I think that it's actually potentially destructive to those who don't identify as being mentally ill, but nonetheless are at risk of suicide themselves. So again, that sort of foreign exotic notion of, you know, psychiatrically disturbed people killing themselves and everybody else is safe, I think that's inherently problematic. So I would like to see the discussion move more toward the fact that we are all, potentially, if given it sounds strange to say the right circumstances, but certain circumstances at risk of suicide.

I think that it is a human phenomenon. and until we accept that and acknowledge how common suicidal thinking is, it will just seem like it's something that happens to other people and not those close to us or even ourselves. Okay, so Jesse, my last question for you is, what do you hope people will take from your book? I think I just want people to have a richer appreciation or a deeper understanding for the intense death,

and range of emotional experiences that others are undergoing. You know, when we cross somebody in the middle of the street, for instance, we seldom think about the fact that inside that person's brain is this incredibly endless expanse, a cosmos of existence, a universe of thought, that is identical to what we ourselves are experiencing. And I just want people to develop a greater empathy, I guess, for the fact that we're all just kind of hanging on by a thread sometimes. And words and social interactions can make an enormous difference. And sometimes the difference between life and death.

That was Jesse Bering, talking about the psychology of suicide. His book, A Very Human Ending, is out now. If you've been affected by some of the themes discussed in this podcast, you can find support and information at samaritans.org. Samaritans is a safe place for anyone to talk about difficult feelings, 24 hours a day. Those in the UK and Ireland can phone free on 116-1-2-3. The October issue of BBC Focus magazine is out now and inside we discover how we could leave Earth for good

and build a new civilisation in space. We also speak to a panel of leading female scientists about why there are so few women in science. We discover why Curry is so good for you and explore whether machine learning could help shed new light on the problem of male suicide. Find out more at sciencefocus.com. Thank you for listening to the Science Focus podcast from the BBC Focus magazine team.

We're the UK's best-selling science and technology monthly, available in print and in several digital formats throughout the world. Find out more at sciencefocus.com or look out for us in your app store. This podcast is sponsored by Name, Audio and Focal. The texture and emotional depth of music can be lost through digital sources or poor signal. Name audio believes you can have digital precision with analogue. Walkth. Alongside French acoustic specialist focal, Name creates high-end audio systems, combining innovation with craftsmanship, so you can listen to music, just as the artist intended. Discover more at namea audio.com. Ambition comes in all shapes and sizes. At First Citizens Bank, we roll with

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