Mayim Bialik's Breakdown - Dr. Christine Moutier: We All Have A Role to Play

Episode Date: September 30, 2021

Dr. Christine Moutier (Chief Medical Officer, American Foundation for Suicide Prevention) debunks myths about suicide and discusses the big risk factors associated with the act. She details her path to becoming a suicide prevention advocate and shares how her own mental health journey during medical school led her to become a safe space for others. Dr. Moutier lists the occupations with the highest risk of suicide, the suicide patterns across every demographic, and the physical, emotional, and psychological factors that increase one’s risk. Mayim opens up about her family’s experience with suicide and highlights the importance of not waiting to seek help. She and Dr. Moutier consider the elevated suicide rates among LGBTQIA+ communities, the role social media plays in cyberbullying and suicide, and the importance of combating the epidemic of loneliness with interpersonal connections. They highlight the significance of having an open dialogue within family circles and the benefits of interactive screening programs before another engaging round of You Might Need Help If... NowMattersNow.org Suicide Prevention Hotline: https://suicidepreventionlifeline.org/ Family Acceptance Project: https://familyproject.sfsu.edu/ AFSP Interactive Screening Program: https://afsp.org/interactive-screening-program BialikBreakdown.com YouTube.com/mayimbialik Learn more about your ad choices. Visit megaphone.fm/adchoices

You have to learn to look for these patterns and connect all the dots up. If there's a history of a past suicide attempt, a history of depression, a family history of suicide, childhood adversity slash trauma, and now the person is experiencing a significant stressor or loss. And then acute risk happens at a moment in time. It's a very brief period of time. Hi, I'm I'm Biallic, and welcome to my breakdown. This is the place where we break down the things. that make us break down so that you don't have to.

It's my and be all this breakdown. She's going to break it down for you. Because you know she knows a thing or two. And now she's going to break down. Hang on to your hats, folks. Today we're going to break down suicide. It's going to be an intense episode. I'm not going to pretend like it's not.

We have a very, very special guest. The chief medical officer of the American Foundation for Suicide Prevention, Dr. Christine Moutier, is going to be joining us. She's a very, very impressive person. But first, let's check in with my co-pilot. Mighty as the maples of his homeland, sweet as the syrup that you tap from those trees, eh? It's Jonathan Cohen. That was really an intro to lighten up the episode. That was very special. I thought that was nice. One of your best. Thanks. How you doing? I'm doing pretty well.

Are you going to Zamboni? You're going to do a Zamboni roll for us around the hockey field? The hockey field that is your life. I'm going to clean up those edges. I do want to talk a little bit. You know, Dr. Moutier really is going to give a really interesting perspective also, just in terms of how to even frame conversations about suicide. But I do want to talk a little bit about some of the misperceptions about suicide before we get started.

Some of the things that we often avoid saying out loud, but really need that. to. When Jonathan and I started this podcast, we specifically wanted to be a place where we could say things that people weren't saying, you know, talk about things that people weren't talking about. To talk about things in a way that we haven't really previously talked about them, this is an episode I really didn't want to do because my family has been touched by suicide twice. And I don't share the details because while I'm a public person, everyone in my family is not. What I will say is that, you know, the issue of suicide is one that, you know, the issue of suicide is one that, you know, in particular regarding mental health challenges, carries a tremendous amount of shame and secrecy. And those secrets can be passed on through generations. And it's very painful. And it also does impact the people who those secrets are kept from, you know. And if you've lost someone you love to suicide or even have known someone who's attempted suicide, it is very different from other illness and from other pain,

while the grief, you know, from losing someone to suicide, does decrease in intensity in general, that specific pain of really, you know, the unfathomability of it. That really does not change. Like, I can call that up. I can call it up really any time that I want to, and that's, you know, something that I've experienced is very specific to grief from losing someone to suicide. It stays frozen in time, you know, like that person does. Being a scientist doesn't help with that kind of grief.

You know, it doesn't make it any more understandable or tangible that we try and explain it or understand it. It's not understandable. It is, it's really, it is an unbelievable thing. I do think it's important to make a distinction between suicidal thoughts, suicidal ideation and actual suicidal plans. And I know everybody's like, my, I'm so big on. terminology, but there are specific questions that a doctor will ask you if you're feeling like you might be suicidal, or there are specific questions that a loved one might encounter. And I think it's good for us just to have this vocabulary. So suicidal thoughts, simply put,

there are thoughts about suicide, but that in and of itself can be very scary. Those are the thoughts that are kind of like the, what if, you know, what if I were not to be here? What would happen if, you know, I died or I killed my... I mean, sometimes you think those things. And I had a lot of these thoughts specific. I was a very morbid teenager. I'm kind of a morbid adult. I lived with depression.

I was prone to deep depression. And I read a lot of heavy, dark, sad literature and philosophy. That's also why talking to a therapist is an important thing to do to help you kind of gauge what might be causing those suicidal thoughts. Because it is not abnormal or outside of the realm of possibility to be a young person. interested in thinking about your mortality. That in and of itself is not a problem. But if it is coming from a place of deep depression, if it's coming from a place of a recent loss or tragedy

or from trauma or from unprocessed trauma, then that is something that does need intervention. This is a very important distinction because questioning our existence has a huge amount of validity and potential upside to appreciate the moments we have on this earth now. Correct. There's the quote on your wall.

You have a little plaque that says... The problem is you think you have time. And imagining ourselves without that time can make us much more appreciative of the moment and wonder what our role is to have in this life. But tell us where it gets dangerous. Well, okay, so the kind of next level is suicidal ideation. Now, suicidal ideation is kind of a bit more of a fleshed out

set of thoughts and feelings. And this is all degrees. You know, there's not like a, there's not a questionnaire that I have that you can, you know, you take to a doctor and say, see, my Ambialial ideation. But there is a level of contemplating suicide that is not attached to a formal plan

or having taken any action. Or really starting to go down the path of thinking how you would harm yourself to kill yourself. So suicidal ideation is the volume's been turned up on those thoughts, and they're very, you know, they're specifically directed. They're not philosophical. This is a point, suicidal ideation is a point when I think most medical authorities would say, you need to seek help immediately. We don't wait and see what happens once you're in suicidal ideation. And plenty of people do.

And I know that there are going to be people who are like, I waited, I was fine. this is a thing you just you don't you don't mess around with this so this is what hotlines are for this is what therapists are for this is what trusted you know we say trusted adults trusted physicians are for and this is true even if you are an adult sometimes we don't feel close to our internal medicine doctor or maybe you know i i always say i grew up at kaiser where you didn't always get the same person you know maybe you feel closest to your dermatologist because you have good conversations with them. Maybe you like your OBGYN. You can talk to anyone about these kinds of feelings and you should. This is not something you wait on. And also the notion that you might be

bothering someone or what if you don't really go through with it, you put that aside and we deal with it after you make that call. It is not of primary importance. The what if it's not that bad. The third level of being suicidal involves the most complicated and elaborate set of thoughts and plans, including but not limited to writing a suicide note, saying goodbyes, having a plan, and doing things to prepare for that plan. So this is the point at which you go to an emergency room. That's that point. I've been in cars with people in this situation. This is when you go to an emergency room. This is when you call 911 from those states.

I want to touch on before we welcome Christine, what I think, these are literally what I think are the top four misconceptions about suicide. The first misconception is that you can protect yourself from it or anyone can, in theory, be protected from it. The answer is no. every person can be touched by suicide. Suicide does not discriminate,

nor does mental illness. There's no socioeconomic bracket. There's no part of the country. There's no part of the world that could not potentially be touched by suicide. Are there places where it's less likely for all sorts of interesting, important reasons? Absolutely.

Where this is true is that we can all protect from it equally by increasing education, learning what warning signs are, learning more about depression and suicidal depression, increasing awareness, and increasing access to mental health care. So the notion that you can be protected from it because of some superpower or, you know, luck is not true. But yes, the protection comes from a program and an understanding that we implement as a society. really that needs to be a priority, you know, of this government, any government. Number two, misconception that it's a cry for help and people don't really want to die. Like, oh, it's just a cry for

help. Now, it is true, and Christine will talk about this, that some people who experience suicidal ideation or suicidal thoughts do want and need support and help. However, we have to take everyone at face value as if they may actually be suicidal. Like, that's a full stop. We don't get to decide, I think it's just a cry for help. Well, they've never gone through with it before. You treat every single incident as a potential for that person to actually commit suicide. The third misconception, only crazy people do it. I tend to never use the word crazy, unless I'm singing songs that have that word. I don't like that word, so I'm intentionally saying like, only crazy people do it, because that's what people say. All kinds of people commit suicide or may attempt suicide. Crazy is not a

diagnosis. You know, people who don't want to go on living are experiencing a deep and critically fatal mental state and level of hopelessness that is not crazy. And people who otherwise behave and function in society and in the world are also people who can be suicidal. The fourth misconception is you can talk someone out of it, meaning you have the power to talk someone out of it. This is a really hard one. Professionals who are trained to deal with people

who are suicidal are the best people who are best equipped for the most part to deal with individuals who are suicidal. This is a job for professionals. And there are many wonderful free hotlines with trained individuals who take calls around the clock and we'll list some of those resources on the website. Telling someone how much you love them, telling them how terrific they are, telling them that they have no reason to be suicidal, it rarely helps. that does not have the power to transform the course of someone's life who is suicidal.

I'm not saying don't do those things, but also take it incredibly seriously if a person is expressing suicidal ideation and suicidal tendencies. Miami-Myallax breakdown is supported by superpower. We all know the feeling of leaving a doctor's office and kind of feeling like we didn't get anything out of the experience that was useful.

Maybe they're like, you're fine. Drink more water. There's no real data. There's no game plan. This has happened to me many, many times, especially on the perimenopause journey. That's why we're fascinated by what superpower is doing. They send a licensed professional to your home or you can visit a nearby lab. One simple blood draw with over 100 biomarkers.

That's way more than you usually get. It unlocks a true understanding of your body. Their app has detailed information on heart, liver, thyroid hormones, metabolism, vitamin, and mineral levels, even environmental toxins. From disease prevention to treating that annoying brain fog or simply optimizing your gym game, superpower is the most comprehensive and advanced system out there. I've been super tired of constantly guessing

or just trying to read articles online about what to do for health. Superpower gives you an actionable health plan based on personal results. It's a real game changer. Plus, they have an on-demand clinician team to answer questions. Supplement or prescription suggestions

can be directly bought through superpower so you don't have to go anywhere else. They also have nutritional guidance, for lifestyle and behavioral adjustments. You even get your true biological age that you can track over time. Superpower used to cost $499. Right now, it's $199 for the full experience,

which is much more affordable than anything else out there. Make this the year you stop guessing about your health with superpower. Superpower. Not only did Superpower reduce their price to just $199, but for a limited time,

our listeners get an additional $20 off with the code break. Head to superpower.com. Use the code break at checkout for $20 off your membership and after you sign up, they'll ask how you heard about them. Make sure to mention my and biolics breakdown to help support the show. I want to read the bio of Dr. Christine Mutier, who's going to be joining us.

She's the chief medical officer of the American Foundation for Suicide Prevention. She's super impressive. She has testified before the United States Congress, and she's provided multiple congressional briefings on suicide prevention. She's presented to the White House. She has spoken at the National Academy of Sciences, which is a very big deal. She co-anchored CNN's Emmy Award-winning Finding Hope Suicide Prevention Town Hall. She's one of those experts who's in the New York Times and the Washington Post and Time Magazine, name a network.

She's been on it. She co-founded the San Diego chapter of AFSP. She also co-led a successful suicide prevention program for medical faculty residents and students, meaning a program to prevent suicide in the physicians in training, which featured AFSP's groundbreaking interactive screening program. And as she'll talk about, this was before she worked for AFSP. She implemented their innovative screening program and then went on to be their chief medical officer. She's amazing.

She earned her medical degree and trained in psychiatry at the University of California, San Diego. She's been a practicing psychiatrist, a professor of psychiatry, a dean that all Always sounds so fancy when someone's like, I was a dean in the medical school. She was a dean. Also the medical director of the inpatient psych unit at the VA Medical Center in La Jolla. My middle name is Hoya, because I was supposed to be born in La Jolla, true story. Treating diverse patient populations from Asian refugees to veterans to corporate and academic leaders. She's authored articles and book chapters for very important things like JAMA, that's what we call it,

the Journal of American Medical Association, American Journal of Psychiatry, Journal of Clinical Psychiatry, Psychiatric Times, which really sounds like the title of my memoir. Let's welcome Dr. Moutier. She said I can call her Christine. Welcome, Dr. Moutier. Break it down. Thank you so much for joining us. We really appreciate you taking the time to talk to us in our little mental health

podcast community. You know, we're talking about a very heavy topic. But I think, you know, one of the things that I'm trying to do with my honesty as much as I can and, you know, partly some of my skill set as a science communicator and in particular a neuroscientist, trying to bring some humanity to aspects of mental health that are often really missing. And part of that revolves around, like, I need to know how does one become this specialist that you are? Like, is this something that when you're, you know, a teenager, you're like, really want to work?

in helping people understand suicide. Like, that's what I want to do. Or was it something that, you know, however comfortable you are, is it something that touched your family? Was it that you became a physician? Like, how do you get to be you? Thanks for asking, Ma'am. It's my stories.

I don't know if it's interesting or not. But when I was 13 years old, I discovered psych, I didn't know the difference between psychiatry and psychology, but honestly, through the Bob Newhart Show. What? And I was great at science and math. I was this young kid and a half Asian family where all you, you know, you earn your worth by studying and achieving and all that. And so, but I, but I always gravitated towards people, people's stories and people's suffering and hope and healing and recovery and all that, even as a kid. And so that was the start of my journey to sort of just fix my goal on going to medical school. That was the first. step, but it was because I thought that was the only path to a job like that, where you got to talk to people and use knowledge of the brain and the body to actually work through human experiences that touch our lives so profoundly. Honestly, you know, as a side note, mental health

is something we all have, whether we have mental health conditions or not. So to me, it's this very universal experience of just like a human experience. And then when I got to medical school, I had majored in music, was not entirely prepared for that hardcore curriculum in the first couple years. And also, I was utterly unprepared for feeling inadequate, of having to fear failure, all of that sort of classic stereotypical stuff that med students deal with. And I think we do all deal with that at different points in our lives in so many different ways. but for me, it was at a point in my life where I hadn't developed those coping skills around anxiety and fears and things. And that led me on a path of my own sort of mental health journey that led to me wanting to and actually trying to drop out of med school. Fortunately, had a dean who saw us enough of what was happening to say, why don't you just take time off and kind of do what you need to do.

I don't think she entirely understood what I was telling her. Anyway, that's all to say that by the time I came back, finished med school, went into psychiatry, was chief resident. By then, I had had my own reentry into this culture that I had viewed as incredibly toxic around mental health experiences, but then was excelling enough to become a safe person and a safe resource for others. So I learned very quickly that these are super common. experiences among medical trainees. And then fast forward later, a few years into my faculty role at

UCSD School of Medicine, I was a dean for student affairs of medical education, and there were faculty suicides occurring in our UCSD community, 13 in total over a period of 15 years. And that, so it just synced up with being in it because I was passionate and believed that if we as future physicians, you know, our medical students and trainees, could just become more in tune with their own self-care and their own mental health, we would do better for patients. We would, you know, of course, mitigate our own risk of suicide, which was so terribly profoundly impacting us at that time. And I got put in charge of developing an approach to addressing it and figuring it out. I wanted to ask, and this is not at all to belittle, what you,

do, but I have to ask, is it true that dentists have the highest suicide rate? This is like something I was always told that among doctors that they have the highest suicide rate. Is that a true thing? There is some data from like the 70s and 80s and understand that suicide rates and surveillance in the United States is getting better, getting closer to being accurate and closer to real time, although we're still about 12 to 18 months, always looking back in hindsight. So it's a weird. So occupational data is actually harder to come by than you might think. And so it's no longer really thought that they have the highest rates. But, you know, among physicians, veterinary medicine

people, the data shows that we do have higher suicide rates than the general population. But when you look across the whole population of all types of occupations, it's actually the agricultural industry and the construction industry and law enforcement that have the very highest rates followed by kind of physicians, dentists, veterinary medicine people. It's a very helpful, I can't say it's a good statistic, but it's a very helpful statistic because part of the stigma, you know, and we talk about this really with depression and kind of other diseases of despair, you know, is this notion that there's like a profile, you know, for who this happens to, right? And the reverence, you know, my parents are first generation Americans. So I was

raised with like this reverence for the medical industry, you know, like, I'm not even a real doctor because I'm, quote, only a PhD because it's like, it's the people who go to med school who are like, you know, they're superheroes. And like when we, you know, my cousin Moshe is an anesthesiologist, like he may as well be like the first man on the moon, you know, in our family. It's like he's a doctor. You know, it's like a very big deal. But that notion that we no longer need to pretend that even that construction workers, right, or people in agriculture, people who work with their hands and their bodies and are, in often cases, the portrait of strength and virility and resilience or physicians, you know,

who go to med school, it's this, that those are people who also experience vulnerability. They may have a genetic predisposition and it could be the environment. a combination, you know, all those things. But that's sort of like an unveiling of so much of this stigma. And it is helpful, even for people like me who live with mental illness and who, you know, I've chosen to be very open about that, that makes me feel, I don't say better, but it makes me feel less alone, you know? It's not just sad, sad people who just like got a crummy genetic luck of the draw, you know? No, it's, in fact, you know, the way I look at the occupational piece, to suicide risk is that you have the whole swath of human beings with everything that you've

just talked about, our genetic makeup, our early childhood experiences, our environmental, our current psychosocial stressors, what we're doing, what we're putting in our bodies, you know, whether we're using healthy coping strategies, mindfulness, et cetera. And then you layer on top of that a culture. So the cultural piece to any population, whether it's, categorized out by occupational group or region of the country or gender. I mean, all the different ways that we identify. But that cultural layer can present protective factors and also can present extremely significant barriers to really allowing yourself to be human and needing support, needing treatment.

You know, I look at the sort of revolution that's going on, for example, among some of the male athletes who've come out. We literally were just talking about this. Yeah. Yeah. It's such an awesome thing because the truth is that no matter your gender, no matter whether you're an athlete, you train your body, you're tough and you're at, you know, you're a farmer, fisher, you are also human. You experiences affect us. We all have emotions. You know, we live in a culture that is really built around early independence, you know, like whose child can recite the alphabet first, as if that's a measure of really anything, except whose child recites the alphabet first, but also this notion of like, we don't have time. We don't have time to slow down. We don't have time to process. You know, I was

saying when my father died, I mean, more than one person said, oh, are you going to go on antidepressants? Like, no, I think I'm going to try just grieving first, you know, like I'm going to see what my body and what my kind of soul does and needs. But, you know, you bring up something in terms of culture and also in terms of kind of currency. I know what the kind of big five are for depression, right? You know, it's trauma, moving, divorce, death, you know, natural disasters. Are those the same for suicide? Like, do we look to economic?

Like, what are the things, if there are such things, you know, is there a big five, you know, that we look to when we look at suicide rates like that? Yes and no. The risk factors are clear in a way there. The issue with suicide, maybe even a tad more than depression, believe it or not, is that it's going to be a complicated interaction of multiple of them, interplaying, escalating one another, and then acute risk happens at a moment in time. It's a very brief period of time, even if somebody has been suffering over a long period of time.

And so, you know, among the mental health conditions that are known to, elevate suicide risk. Mood disorders are at the top of the list, in part because they are so much more common. And that one I get nervous to talk about because we want people to feel open to say, I'm bipolar, right? Or I suffer from depression or I'm schizoaffective. And we don't want people to associate that with, oh, you're a suicide risk, right? But it's important from a medical perspective for us to understand both those associations

and also potential correlations. Right, right. And the truth also being, by the way, that the vast majority of people with those mental health conditions don't attempt, let alone die by suicide. So it's sort of like an almost necessary but insufficient risk factor is the mental health, mental illness piece. And then you have a whole lot of other things like early childhood trauma. So that's very similar for depression, right? In particular, a history of sexual abuse, traumatic brain injury. Say more because of lifestyle changes, because there's.

because traumatic brain injury can happen to many parts of the brain. It's not like, I just want to make sure for those at home, we're not saying there's a part of the brain that you can have damaged and then you commit suicide. No, no, right. Not that at all. It's again, look at it as like a history of depression or even physical illness too. Honestly, if you look at heart disease, rheumatoid arthritis, diabetes, epilepsy, all of those also have higher rates of suicide. but not on their own. So you have to learn, it's like you have to learn to look for these patterns and connect all the dots up. If there's a history of a past suicide attempt, a history of depression, a family history of suicide, childhood adversity slash trauma, and now the person is experiencing a significant stressor or loss,

which by the way, isn't always the case. There isn't always a precipitator for a suicidal crisis. Many times there are people who it is so much part of their hardwiring in a way that they are working against that. And actually the treatments that have been developed, I mean, the scientific area, you would love it, Ma'am, if you saw all of the studies that are just, the science is burgeoning with not only understanding these risk factors and how they interrelate, but also the development of interventions, both in the clinical setting, but also. in the community setting, in the families, homes, school-based, workplaces, programs, and interventions. So it's a time where I suspect that maybe, let's say, 10 years from now, we will have a lot more tools. And so all of the stigma reduction that's happening is a beautiful thing, but is limited by the fact that it's hard to produce change when you don't have easy sort of quick, you know,

plug and play solutions and interventions, but they're coming. Can you also speak a little bit to you know, those with sexual identity, confusion, or gender identity, were seeing a lot of statistics, which previously had not really been gathered from some of these communities because of lack of interest and, you know, certain policies by historical government tendencies, you know, to ignore these communities. But this is a growing concern also, especially, and this is not like the internet makes people kill themselves. But we do have a culture that has also been incredibly infused in the last 20 years or so in ways that we've never seen before with really a network, you know, of communication that's often very

difficult to supervise. So for those of us, especially who are parents, it's very, very hard to kind of also keep a, you know, a finger on what's going on. So if you have a child who's a teenager or questioning sexual identity, like this is an arena that also feels like we're getting all these statistics. And can you speak a little bit to what what you think might be happening? I know you don't, you know, I want you to wave a wand and like make it all go away. But can you speak a little bit to to some of those statistics, both in terms of social media? And in particular, kind of bullying and often of populations like those with sexual identity or gender identity confusion. Absolutely. And let's let's start with the LGBTQ population because this is very important.

And everyone has a role to play and actually can can prevent suicide. at large, but certainly we all know people who are either, you know, LGBTQ or our youth and are figuring that out. And so the bottom line, the quick to cut to the chase, is that suicide risk is elevated, is extremely elevated, and particularly among transgender people, but also for LGBT populations. And also transgender communities of color, I mean, it's even another level, right? Right. Wherever there's intersectionality, I mean, that can produce additional risk, especially if there's racism, marginalization for multiple reasons in the person's life. The race issue, though, is interesting because in general, white people have two to three times the risk of suicide compared with people

of color. But some micro trends are very concerning actually around black youth in particular and Latino youth as well. But back to the LGBTQ. group of people. We've known that their risk for attempting is much higher than the straight counterpart in the general population. What we haven't been clear on is actual suicide rates. And that is because at the time of death, believe it or not, in most states, that is a demographic piece of data that is not collected. It's starting to be. But this has been an effort that, as an important project and advocacy area at AFSP, but one of many, many, many, we've been fighting for

because that is wrong to not have data at all around that. And it's discrimination, it's stigma. That's the only reason it hasn't found its way into the death investigation system in our nation. But imagine training law enforcement and medical examiners and others around how to collect that data after the person has passed. That's a difficult scenario.

because you know, you're dealing with layers of cultural stigma there. So anyway, but the bottom line is risk is higher. But it's not higher because of their innate LGBT identity. It's what that produces for them in this world we live in. And so there is some incredible research that a woman named Dr. Caitlin Ryan, who runs the Family Acceptance Project, has produced that shows that particular behaviors in the home for LGBT youth can protect them in terms of those negative outcomes that are so common among that population or can elevate the risk. And they are the physical things that are said and done in the

home. It's a special area of suicide prevention because even if you're a parent who has a religious or value system that is at odds with LGBTQ status, you can still choose to behave in certain ways in your home because of your love for your child and once you understand the data, they are not totally inconsistent. You can still love somebody and accept them and support them. And so, anyway, that is worth looking into for any of your community. I would send them to the Family Acceptance Project. And those behaviors are spelled out in terms of the protective ones, as well as the detrimental ones. Thank you for that resource. We'll put it on the website for sure. And in terms of the internet, like I hate to sound like a hysterical parent, but there's been a lot of, you know, movies or shows on Netflix that are, you know, kind of aimed at teens. I have a 15-year-old and a 12-year-old, both boys. And I've been nervous, you know, sometimes to have them watch these things because I don't fully understand, you know, the language around understanding the role specifically of the internet, you know, in how it impacts teenagers in terms of bullying and

suicide. So what's your kind of, I don't mean to make you answer all the tough questions, but what's your sort of stance or perspective on that? Because I cannot, I don't know every single thing my kid is doing. And kids get bullied all the time. Kids get teased all the time. And sometimes it's bullying. And, you know, to me, those are, you know, slightly different distinctions. But I guess I don't want to be that parent who's like, well, no one uses TikTok and then nothing's wrong. But I do worry, you know, about the impact also of the kind of talk that happens and the kind of, like, being excluded from a party was excruciating for me, you know, when I was a kid. If that was broadcast on a phone in my hand, I literally said, I don't know if I would have

made it through school without saying to my parents, if you'd like me to make it through, I cannot interact with those people. Like, I need to be home. Like, that phone, You know, like that seems like, and I don't mean to like blame the internet, but it's all this kind of like culture of the world gets so small and so big at the same time. Yeah. I mean, there's there's so much there. And there is a whole research arena around the interaction and associated relationship between screen time and social media utilization. And of course, that is an extremely diverse issue right there. People use it in different ways. Their experience of it is. is different and also, by the way, influenced to some degree by their baseline traits. So if you already have some struggles with insecurity, anxiety, being exquisitely sensitive to rejection or missing out, that not only sets you up to experience those many slights as, you know, kind of more than perhaps for a kid without those vulnerabilities, but it also might influence

what they're putting out there in response. And so it is like real life for those of us with depression or anxiety, that it affects interpersonal relationships. So I think that's there. But like you said, it is so hypertrophied because you can't get away from it once the kid is feeling bullied, left out, or targeted. They just want to stare at the sadness playing out that they weren't invited to, you know? And it's so, it's so painful. I, I, I, I think, think for you and for your viewers and your community, if you have children, but honestly, this applies to other people in our lives too. I get more depressed when I go on Instagram than he does. You're not allowed to go on Instagram. I do not. I shouldn't go there. I think there should be

thoughtful boundaries around social media, just like there are in about every other aspect of our life. And it's not about setting rules and being a disciplinarian. It's actually, in a way, quite the opposite. It's about opening up as much as you can. I know this is not a perfect science, but like open dialogue in the home where you have to say the things that are obvious to you and your partner for the kids' sake because they will assume that they're in trouble. If you don't say that, you know, no matter what happens to you, no matter what challenges you face, we are in this together. We have your back. There is nothing that you'll face that we can't get through together. and not just a one-time conversation, but like, again, like that culture.

I'm laughing because, like, my dad in particular, my dad was very, very old school. And there was this kind of notion of, like, if anything ever happens to you, make sure you let me know. You know, like, if you ever happened to drink, which I didn't drink until I was 21, if you ever happened to drink, make sure, but, like, I was terrified of telling my parents anything. Because, like, you know, like, dropping something and having a break was like, oh, my gosh. You know, like everything was so heightened that the thought of like actually introducing really heavy emotional stuff, they seemed to have too much to handle on their own, which is, that's just what it was. But it is very, very difficult.

And especially surrounding suicide, it's very difficult to know when a child is ready to know that that has happened in your family. It's very, very scary, you know, and they hear so many things. there's so much you can't control, but I love that idea of just like trying to constantly keep a notion of there's nothing we don't get to talk about, you know? And I say that to my kids. Like, it seems like a long time ago that I was your age, but it really wasn't. Like, I remember, you know, and I hope that's more true for this next generation of kids than it was for me and my parents because they seemed like they were from another planet. Like really, you know, they really did. Well, I'm sure we do too to our kids. We wish and we try.

And we are, but to our kids. Right. But that's not the, to me, that's a given. That's great. That's fine. It's that they have internalized the things that they think, we think of them. And so that layer in the environment where you're both being, you know, having the way we do things and our values and those guardrails are healthy and good. But also allowing them to, you know, to be human.

to have a growth mindset. We're going to fail. It's not a question of hiding any failures or that, you know, avoiding them. We will. And it's a question of how we learn from them. And then maybe even also, like being willing to talk about how you coped with various challenges and struggles in your own life. Oh, they still see me trying to cope. They still see it. This is, we're a work in progress over here. Absolutely. I wanted to ask because I believe this was in your time at San Diego, this interactive screening program. You designed it, correct? Well, actually, I implemented it as part of that effort for the physicians suicide prevention. AFSP had developed it, and now I'm at AFSP. So this kind of came full circle. So tell us what that interactive screening program is and, and I guess,

what it was used for and are there other applications of it? It went from being kind of a small project to allow people in colleges and universities, primarily was how it was intended. to be used to anonymously, you know, answer questions and interact with a program counselor without having to say who you are. And without being chased down, if you decide I'm out, I'm done talking to this counselor, even if you've said that you're struggling mightily, you're having suicidal thoughts. This is not a clinical treatment program. So it is very unique. Because that is what a lot of people worry about is that if I start to engage with somebody, what is that going to mean for my fill in the blank, my career, my reputation, my, you know,

my medical license, whatever. And when you're suffering, you think that the microscope is on you in a way that when you're in your normal frame of mind, you tend to realize, oh, we're all kind of busy going about our business. Like, it'd be nice of people. We're paying that close of attention to me all the time, but it's just not the way it is. But when you're in distress, you really think there's scrutiny on you and that you're going to bring upon, you know, really serious negative ramifications for yourself. If you show any sign of weakness, let alone start talking about it with a counselor or getting treatment. And I mean, that's changing, obviously, even like the fact that you got asked about going on an antidepressant

after your father died. I mean, in a way, that's a weird thing to ask. But in another way, you know, it's like, okay, there are times when we can use medical treatment or talk therapy for our benefit. So anyway, the ISP now is in hundreds of colleges, universities, medical schools, hospitals, law enforcement units, the military. It's out there for veterans. It's now available to an entire state of the general public. Which state? It's in South Carolina. Wow. Just being implemented actually kind of as we speak.

An interesting first state. Like if you had said to me, Ma'am, guess which state? Yeah. And it really just depends on the leadership in any given place, being ready to try something different to not only do the usual stuff with education and stigma reduction and wellness programming, but this pays attention to who might be struggling right now in real time and not able to. to speak to anyone about it because of all of those restraints that are true and that also that we place on ourselves, sort of our internal barriers. So it's really, it is a groundbreaking program. I'm really excited that you know about it. It also is very cool that I happen to find it as the one kind of core piece in addition to all those other things that I mentioned. We did all those things at UCSD. And I truly believe what happened was the 13 physicians who died in the 15 year period before the start of the program. After we launched this program, it's now been 12 years. It's still

going strong in my absence at UCSD. And there's been one death by suicide. That's obviously incredibly meaningful if it is saving lives. But the culture has changed as well. And that was a key piece to it. So it is something that any company could implement any government agency. So we definitely can include a link to learning more about that program as well. Okay. I have a few. facts that I think are facts, which I could be wrong about. It's not a quiz. I'm sure you know the answers to these. But I have a few, I guess, either kind of myths or kind of areas that I was hoping you could just flesh out and kind of explain in lay people's terms. Some people say that

men choose more violent and lethal methods in suicide attempts. Women tend to overdose. Is that true? And if that's not true, are there differences between suicide patterns in men versus women? That is true. And it is also thought to be the case that one of the reasons for the differential with men dying by suicide at almost four times the rate compared with women across every country where it's measured, more or less. So it's not just unique to American culture and a gun culture either. That's interesting. But there are other forms of, you know, more lethal means in other countries. Pesticides is actually the most common means for suicide worldwide. And that's because that is the most common method in Asia, where the numbers are even greater. Obviously, just the populations is greater. And so it is thought that aggression is a fact. kind of biologically, I mean, you know, for individuals, not just between genders. And it's also true, though, that again, back to that cultural layer where beliefs and attitude and sense of identity matter. I mean, think about the way we as women tend to be in the world. We tend to talk, share, lean on each other. that has been probably a natural biological, but also socialized in the way to be rewarded.

And so, again, I think it's a point of prevention strategy around the fact that if the view of male identity becomes more multidimensional, where emotions and disclosure and vulnerability is sort of in a way celebrated, you know, in a relationship, it is. We get upset if our man is too closed off and then it's just sort of, you know, blowing up or using alcohol or other means to cope with stress. So anyway, I don't think it's a false thing to actually say that that actually could change. But, but yes, you're right about that in terms of the method and the rates of suicide. Yeah, but also I love that notion that, you know, a lot of the, the changes that we do see and how we view gender in general, you know, are often criticized or politicized by people saying like, oh,

that's the left. And the fact is it's, it's an apolitical issue that the more we allow both men and women to be communicative, to be expressive, to be vulnerable, and know that that does not take away from your ability to also be perceived as attractive and virile and assertive and masculine, you know, that the more that shifts, the really the better we all do. Relationships get better, individuals feel better. Okay, issue number two that I had a question about. So self-harm is something that we see in many situations that are not necessarily related to suicide. Unfortunately, you know, it can be a marker of, I mean, it can be a marker of obsessive compulsive disorder. You know, you can have self-mutilation that is, you know, in many cases, neurologically driven. It is often a response to sexual abuse.

or trauma. And yes, it can be a precursor to more significant challenges, depression. Is there a link that kind of we should know about? Yeah, I don't know. And I thought that you might. Well, you're talking to a suicide person. So I'm going to look at it through the lens of what we know about self-harm and its relationship to suicide risk. The truth is that the rates of self-harm among adolescent girls, but also boys, has been escalating. And the way that we clinicians define and look at non-suicidal self-injury is exactly that. That in that moment, there is no intent to die. They're not doing that behavior for the purpose of ending their life. They're doing it for quite a different reason. And the, and the

Those reasons are varied, but oftentimes it is about coping and diverting pain to a different experience. Or making it tangible, a lot of young people will describe needing it to have a physical representation for a psychic, you know, or emotional pain. Yeah. And then I think what can happen is that endorphin cycle does play in. And so there is a dopamine response and, you know, a tendency for not among everybody. but among some for it to become more of a recurrent pattern. And I think it's terrifying to parents because I think it's often hard to tease apart what's happening in the moment. And is this a medical emergency? But, you know, if you called 911 every time that's happening in the home, that would

not make any sense at all. But it obviously does indicate distress and something that should be addressed professionally 100%. So there's this odd thing that even though the intent, is clearly not suicidal. Over time, in the long run, it becomes yet another risk factor among those many, many risk factors for suicide that does put that young person potentially at risk later. And I think that's complicated around the self-injury method itself, but also around where that journey takes them in terms of their coping and their life and wellness overall.

Got it. And the last of these kind of quiz questions for Christine, Jonathan talks a lot about something, which I sometimes roll my eyes at because it feels very, it feels impossible to wrap my head around a lot of the time. But he's absolutely right to be concerned about these things, this kind of, you know, epidemic of displacement and increased alienation, increased alienation, increased isolation, as technology increases, as we get more and more efficient and more and more connected, we actually are getting more and more disconnected and actually less efficient at the things that actually make us human. Jonathan, is there anything to add to that? But I'd love Christine to kind of speak to that because it's something that feels so impossible to even, like, I don't even know how to undo that. And so I don't even want to think about it. But it is important. And I do think it is becoming and probably has been, but likely will continue to be either a risk factor or, you know, kind of an intersection with suicide. You know, I have a disabled brother who doesn't have a role in society that if he was in a small village, he would be put to work and he would have a role to play.

And he would have his responsibilities to contribute to a larger hole. So I see that in a microcosm. But then I see it in a larger macrocosm as the world moves. into this very different way of operating from how work is being done. So, you know, with life expectancy falling in the U.S. for the last three years after decades of it expanding. And my understanding is that is a lot to do with diseases of despair, both from suicide and people drinking themselves to death, to the opioid crisis from not having a role to play in the world around them, I just think It's a huge problem.

You see why I don't want to talk about it. It's depressing. Yeah. Well, and, you know, the former surgeon general, Vivek Murphy, has made a platform of the epidemic of loneliness, you know, sort of related, not entirely the same as what we're talking about. But it's a huge concern. But, you know, I guess it's the way I'm wired.

Some of us have our in positions where we can actually make decisions. at a top-down policy level, looking out for that balance of efficiency versus these less tangible human needs. I mean, but even those of us who aren't in those kind of policy or leadership positions can play a role just by making the choice to make interpersonal connection a daily, regular part of your life's practice. I know it sounds so simple, and yet I think that's what we got away from. I love your example about, you know, if your brother were living in a small village, that small village that we would look back on and say, oh, you know, our society has advanced

in these technological ways and sophisticated ways. We have forgotten some of the most basic human needs that we have, that we need each other. And so, I mean, I'm not really touching the economic part of that, because that is so much more about policy. But we all can actually cultivate a life for ourselves and those around us where that is part and parcel, where we understand that's part of our thriving. And that if we don't pay attention to it, we will actually fall into that trap of becoming, you know, just hyper-screen attached or even letting unhealthy kind of, of relationship patterns seep into our relationships because that's also part of human nature. If we're not really proactive about that, conflict will come up and can kind of rule the day. So I do see it as something that we can all actually sort of actively kind of keep in mind,

if not work against. Thank you. So what we do at the end of our episodes is a section that I call, you might need help if. And I usually list, you know, the things, depending. on, you know, if we're talking about depression or anxiety or OCD, things that people, you know, kind of, I want them to hear, you know, kind of as we go. So I was actually wondering if you will help us and kind of help us do our you might need help if section. It can be, you know,

three to five things that you think that if you could say in, you know, a concise, a concise manner. And also something Jonathan brought up, maybe we could do a someone else might need help if. One of the most painful aspects, you know, of being touched by suicide is the wondering, you know, was there something I should have done, could have done? So we'd love for you to address those two things and I'll kind of direct you through it. But before we do that, let's ask a fun question. Are you all suicide all the time? Like, what's your life like? Do you do things for fun? What's it like to kind of have this be what you do for a living? and also have to compartmentalize that and, you know, be part of the regular world. Like, what do you do for fun? I'm very curious. Well, I've got two young adult kids and a husband and a great group of friends. And so it's not compartmentalized for me, believe it or not. The experience, you know, that I mentioned of like how I came to do what I do full time,

probably for the rest of my life, is through and through a passion. And it is about saving lives, but it's also much more than that. It's about being free to be authentically you. And whatever it is you're experiencing, that you get to lose whatever other people's expectations or whatever you thought so that you can simply make choices that allow you to be yourself, your fullest self. And that has incredible ramifications in so many different ways. And I think I've been lucky to have a husband who's a partner in this, not, you know, he majored in psych, but he went into business. But like, these, these are actually conversations we have about, you know, how our kids are doing, how we're doing. You know, we've had, we've gotten couples therapy before when we've hit bumps in the

road. I mean, and I don't know, I think my friends would tell you that I love, just being and being with people. I think I did go into all of this because people ultimately to me are the most, on my, you know, Twitter account, I say lover of people, lover of humans. Like, we all matter. And I think it's partly that I discovered that for myself. I already felt that way about other people. But once you actually liberate yourself in that way, it's good. I was going to ask a little bit more to expand on the future of intervention. I spend a lot of time. I spend a lot of I'm thinking about the applications of new technology. I know quite a bit about the UCLA Grand Depression Challenge, which I'm sure you're familiar with,

everything from chatbots being deployed with warning systems to voice analysis for stress and pattern recognition, which is part of a company that I've co-founded. So I'm just curious to know more about what you're seeing at the forefront of the intervention side and what the future holds for new possibilities for how we might help people. Yeah. Oh, thanks for what you do and for touching on this because this is to me, this is what has to be scaled to really, you know, along with the other things we talked about, culture change, get rid of stigma, all that stuff. But we also need systems in place, activities that help our brains with new patterns because we're all prone to our brains lying to us and those cognitive distortions that certainly come with depression and anxiety, but they also just come with being human. and being insecure at times. And our brains really play tricks on us. So, I mean, I think where the science is, is we're still in a phase where kind of both

things are happening. We're in the development phase of actually what are the interventions and what is the essence of those interventions that reduces suicide risk. So we know that cognitive behavioral therapy, dialectical behavior therapy, and several others clearly reduce not only attempts, but suicide risk. And some of those principles, the key essence, features of those are being worked into some of those things that you mentioned. Even in some cases, video games, my hope is that they're not just like that wonky video game over there that, you know, is for, you know, this population, but that it could get worked. If like if one of the big box companies got interested in that and some of them are.

We actually had a conversation to remain anonymous right now about one of the major game creators. and we started talking about how do you gamify self-improvement? Yeah, exactly. I mean, I think it could be threaded in in a way that is part of this bigger, you know, experience. And you see it happening, but it's still a little bit on the fringe to date. So, you know, I think it's both in a way like the basic science of what works and then turning those into a place. slide interventions in traditional ways like with a therapist, either in person or televirtual, but also through the use of technology and ways that we're interfacing with anyway in our

everyday lives. So people who aren't necessarily seeking treatment are actually having that exposure. We can sneak you some therapy when you're not looking, Jonathan. All her text messages to me are really just whizzes to diagnose me. Okay, so you might need help if. So give us, like I said, give us the three to five things. If someone is thinking, I can handle these feelings. Everybody wonders about what it would be like if they died. Everyone wonders about what their funeral would be like. What's that point when you might need help? And by help, I don't mean, because you've never done a you might need help if section, so you don't know. I don't mean you might need to be, put into the hospital. I mean, make that phone call, ask someone who knows, go to our website, go to your website. What is it? You might need help if, what would you say those things are? I would say you might need help if you notice that some part of your daily routine or your thought life or your behavior at work or in a relationship are different for you. I know that's super broad.

and vague, but I'm a believer in the fact that even though we think, and we do have free will and we're autonomous creatures and all of that, we can. But like our chemistry in our bloodstream and so many physiological processes, we operate within a very narrow range that is normal for human beings. And when it comes to behavior, even more so that's normal for us. And so if it's your loved one, I would get concerned even if they're a teenager, by the way, and we say, well, they're teenagers, so everything's off kilter. But even in that teen angst mode where there are more emotional, you know, emotions are heightened and reactivity and responses are heightened, even with that, you know what the pattern has been. And so that could mean things like

not feeling like getting out of bed, not wanting to, you know, go do that favorite thing you do, whatever, you know, see your favorite person, softball league, exercise, the things you normally gravitate towards. And when you find yourself sinking back into either withdrawing, sleeping, retreating, using alcohol, drugs, more, more, more, to me, that is actually a sure sign that something is distressing you. And without really thinking about it too much, you've fallen into a pattern that is coping, but might lead down a path that takes your health to an even more negative place. So I love that question, because I agree with you, it's not about maybe even anything terribly drastic. It could just be that you sort of take

a step back and take inventory or you talk to your trusted person. They don't have to even be a professional, but it might help you sort out. Where is this coming from? With all those other things, you know, losing interest in things that brought you pleasure, change in appetite, change in sleep. What are the kind of specific guidelines, you know, does AFSP have those? Or what in your experience, what are the things that we would look for for you might need help if regarding that? Yeah, these are in our category of warning signs.

And so the clear and away ones sometimes are kind of actually tricky in real life because we attribute them to stuff going on at the moment. Oh, they're facing this hard thing in their class. So that's why they're stressed out. That has become such a common sort of reason for us to excuse ourselves from actually reaching out and just having an open dialogue, a caring conversation. So I want to lower the bar. You are not going to freak someone out if you just express loving concern and support

and open up the potential for them to talk about stuff that might be going on with them at any time. It might not be now. might be later. And with kids, they're often not going to take your invitation to talk right now. It's going to be like when you least expect it. And so the signals to us and to me are oftentimes not laid out super clearly. But if the person is speaking and behaving in a way that makes you wonder, they seem like they might feel trapped, like they might feel overwhelmed, hopeless, or like they feel like they're a burden on others. Those are all signs that there's probably something underlying that that's worth inviting that, that sort of more, we call it, you know, have a real combo.

We have a whole social media campaign actually around hashtag real convo that has a little guide that's animated. It's very cool. Check it out. Yeah, it started around May mental health month, like a year or two ago. And then it just kept going because it had legs. Like, you know, there's always a moment for hashtag real convo. Christine, give us some websites to tell the audience to check out. Okay, absolutely. NAMI is awesome. And we at the American Foundation for Suicide Prevention have worked really hard on our website too. So check us out, AFSP.org. You can find all the stuff we've talked about there. We've also talked about the Family Acceptance Project. And that is a really

cool resource, especially if you have LGBT youth in particular in your life. I'll send you to a website that is great for people who have suicidal thoughts and want to start learning some techniques to manage them and to deal with their distress. It's now matters now.org. So that's one of those intervention specialists where they're trying to actually put it on their website and actually there's some research that goes on with their their website too. So those are the ones that come to mind. I really want to thank you for your time. And, you know, I have to say, like, you're the person that I want to believe, you know, is going to have a part in changing this world because you chose to become a doctor and to give your life for the lives of others. It is unbelievable. Like, when I think of

the person who I would want caring for anyone in my life. Like, you're that person. And it's really, really unbelievable that you give so much of your life. And I'm sure, you know, I'm sure that your husband and your children have had to make, you know, a certain amount of sacrifice to share you with all of the people whose lives you touch. So I'm just so grateful to you for speaking to us. Thank you so much. I am a huge fan. and this is something that that needs to continue on in our culture. All of us have a role to play. I think this session and your interest in using your platform in the way that you are is a huge thing.

And that's what we all can do. That was a lot. She's a very, very, very, very interesting woman. Besides all the information she gave us and all of the beautiful work she does for AFSP, I just can't believe that there are people, you know, who dedicate. their lives like like that's her life i appreciated her dispelling a lot of myths and and clarifying a lot of things well we don't have to do a you need help if because she did it was very helpful yeah she did it and and um we will revisit this topic i think in in other episodes for sure but this

was a really she was a really beautiful guest and i'm very honored that she um that she came on to speak with us so i think that's about it my name thank you for facilitating that. It was a beautiful conversation. Thank you, Jonathan. And anyone who wants to get more information, please go to the website, Bialikbreakdown.com. BIA.L.K. Breakdown.com.

Help us make more of these by reviewing us, giving us a five-star review. Tell a friend. Tell a friend about us. Talk about the podcast with a friend. It's a way to reach out. From my breakdown to the one I hope you never have. We'll see you next time. It's my Bealik's Breakdown. She's going to break it down for you. Not a neuroscience PhD or two. One fiction, and now she's gonna break down.