HARVARD PSYCHOLOGIST: #1 Life-Saving Question to Ask Someone Struggling with Mental Health!

1. 0:00 – 3:13

   Intro

   1. MNDr. Matthew Nock0:04

      Suicide's one of the leading causes of death around the world, taking the lives of about a million people each year around the world, taking more lives than all wars, all homicide combined. [gentle music] We're each more likely to die by our own hand than we are by someone else's.

   2. SPSpeaker0:18

      The family of a teenager who died by suicide alleges OpenAI's ChatGPT is to blame. Blackmailed with AI-generated nude photos, then he died by suicide.

   3. SPSpeaker0:27

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

   4. SPSpeaker0:34

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

   5. MNDr. Matthew Nock0:39

      If someone really wants to die, then we shouldn't try and help them. It's destiny. Not at all true. Ninety percent of people who try and kill themselves say, "I didn't want to die, per se. I wanted to escape from seemingly intolerable pain."

   6. SPSpeaker0:51

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

   7. MNDr. Matthew Nock0:56

      In the U.S., about fifteen percent of people think about suicide. One-third of people who ever think about suicide will ever make a suicide attempt. Those who attempt and survive, about one in five will make another attempt.

   8. SPSpeaker1:07

      For those people who have attempted suicide-

   9. MNDr. Matthew Nock1:10

      Mm-hmm

   10. SPSpeaker1:10

       ... but then survived-

   11. MNDr. Matthew Nock1:11

       Mm-hmm

   12. SPSpeaker1:11

       ... do they regret it?

   13. MNDr. Matthew Nock1:13

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

   14. SPSpeaker1:17

       Two-thirds of people who die by suicide told someone beforehand. Why aren't we catching those warning signs early? [dramatic thud] The number one health and wellness podcast. Jay Shetty. Jay Shetty. The one, the only Jay Shetty. [clapping] [laughs] Hey, everyone. Welcome back to On Purpose, the number one health podcast in the world. Thanks to each and every one of you that come back every week to listen, learn, and grow. Now, you know that our mission is to make the world happier, healthier, and more healed, and today's guest is someone who's dedicated his life to do just that through his work. I had the fortune of speaking to our guest a few months back when I was interviewing him for a book that I was writing, and this is the next book that I'm working on. And while I was doing that, I was so fascinated by his story, his research, the insights he was sharing, that I said I had to have him on the podcast. Today's guest is Dr. Matthew Nock, a professor of psychology at Harvard University and director of the Laboratory for Clinical and Developmental Research. Dr. Nock's work focuses on understanding why people engage in self-harm, with a particular emphasis on suicide. Through large-scale surveys, lab experiments, and clinical studies, his research aims to uncover how suicidal behaviors develop, how to predict them, and most importantly, how to prevent them. Please welcome to On Purpose Dr. Matthew Nock. Matthew, it's great to have you here.

   15. MNDr. Matthew Nock2:52

       Thank you so much for having me. Really, really appreciate you having me on the show.

   16. SPSpeaker2:54

       Yeah. This is such an important issue. It's an issue that I think is underspoken about. It still feels taboo. It feels like it stays far away from the mainstream unless and until something happens in the space-

   17. MNDr. Matthew Nock3:09

       Right

   18. SPSpeaker3:09

       ... that then puts a spotlight on it, and then it seems to disappear again.

2. 3:13 – 4:24

   Why Mental Health Conversations Are Limited

   1. SPSpeaker3:13

      I wanted to ask you, what brought you to do this work? How did you become passionate and committed to doing this work in the first place?

   2. MNDr. Matthew Nock3:21

      This is a big problem. It's been around for a long time. We don't talk about it a lot. So just wanted to state from the outset that I really, really appreciate you shining a light, um, on the problem of suicide. I wasn't looking for it. I was... Actually, I was an undergraduate, um, [lips smack] twenty years old, and I was studying actually in London, uh, doing a semester abroad, and I was placed in an externship, a sort of clinical practicum placement in a psychiatric hospital, and I was assigned to a unit with self-injurious, suicidal, violent patients. And I was just really struck and captivated and overwhelmed by the problem of suicide and self-injury. And there were patients there who were cutting themselves, burning themselves, trying to kill themselves. Um, and I was really alarmed. I was confused, perplexed, inspired by the work of the staff, and at the time, wanted to be a clinician. I wanted nothing... I do a lot of research now. Didn't, didn't like the idea of research. But I thought, "If I can understand suicide and, and know how to better treat it, this is really, you know, for me, jumping in the deep end of the pool. Everything else should be easier after this." And I, I, you know, fast-forward thirty years later, I haven't gotten out of the field.

   3. SPSpeaker4:23

      What kept you in it?

3. 4:24 – 5:09

   Suicide Awareness Saves Lives!

   1. MNDr. Matthew Nock4:24

      There was so much work to be done. I mean, we, uh, it's such a challenging problem, um, and it's... it grabbed me philosophically. I was a philosophy, biology-interested young person and found psychology, and suicide touches so many different disciplines. Uh, epidemiologically, public health-wise, it's a huge taker of life. Philosophically, it's something that virtually every major philosopher has focused on. Camus called it the one truly serious philosophical problem. And scientifically, there's just so much work to be done and so much impact to try and have and so many people to try and help and so much suffering underlying all of this. I got pulled into it and, and have not stopped, and I feel I can't stop, and we can't stop 'cause there's so much, so much more work we have to do.

   2. SPSpeaker5:08

      What's the biggest

4. 5:09 – 6:02

   Debunking the Biggest Myths About Suicide

   1. SPSpeaker5:09

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

   2. MNDr. Matthew Nock5:13

      One of the biggest ones is... There's, there's [chuckles] so many. One of the biggest ones is that, um, if someone really wants to die, then we shouldn't try and help them, that, you know, if someone wants to die, it's destiny, and, and they're going to kill themselves. Not at all true. Uh, most people who try and kill themselves are ambivalent. Uh, they don't want to die. Uh, and I've talked to, at this point, thousands of people who've been struggling with suicidal thoughts. Ninety percent of people who try and kill themselves say, "I didn't want to die, per se. I wanted to escape from seemingly intolerable pain." Uh, and for most people, they're able to work through that and, and survive and, and most people who try and kill themselves, um, don't end up dying by suicide. So there's a lot that we could do to, to, to, to better help people, um, who are having suicidal thoughts and, and who are at risk for suicide.

   3. SPSpeaker6:00

      How many of the people that

5. 6:02 – 8:40

   What the Data Really Reveals About Suicide Rates

   1. SPSpeaker6:02

      attempt to commit suicide actuallyNot only go through with it, but ultimately complete the-

   2. MNDr. Matthew Nock6:10

      Yeah

   3. SPSpeaker6:10

      ... complete the belief.

   4. MNDr. Matthew Nock6:11

      I'll walk through the pathway to, to-- So about, in the U.S., about 15% of people think about suicide. They say they have, they've had serious thoughts of suicide at some point in their life. About 5% of people, uh, try to kill themselves. They make a suicide attempt. Uh, so only about one-third of people who ever think about suicide will ever make a suicide attempt. Of those who attempt and survive, uh, 20% or so, one in five, will make another attempt, and a small percentage will, will end up dying by suicide, something like five, 5% or so, 5 to 10%. Uh, so for a l- there's a lot more suffering with suicidal thoughts and a lot more non-lethal suicide attempts than there are suicide deaths. At the same time, suicide is one of the leading causes of death in the US and around the world. One of the most staggering facts, I'll men- I'll mention two. One is suicide takes more life than all wars, all homicide, all interpersonal violence combined. So if you think about it, we're each more likely to die by our own hand than we are by someone else's, which every time I think about that, every time I say it, is, is startling. Uh, we worry a lot about, you know, in the news, there are wars happening. There are-- We lock our doors. We lock our windows. Um, we're concerned about people coming for us and attacking us. We're more likely to die by our own hand than we are by someone else's, and, and that, um, continues to really, um, perplex me.

   5. SPSpeaker7:28

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

   6. MNDr. Matthew Nock7:32

      About 20% of people who make a suicide attempt and survive will go on to make another attempt, and it's often within the next year. Um, so when someone first has thoughts of suicide in their life, that next year is a, is the highest risk time for making a suicide attempt. When someone makes a suicide attempt, if they're gonna make another attempt, it's gonna come right after that. And the highest risk time for suicide death ever is in the weeks after a person leaves a psychiatric hospitalization for the treatment of suicidal-

   7. SPSpeaker8:01

      Wow

   8. MNDr. Matthew Nock8:01

      ... thoughts or behaviors, which is a little counterintuitive. So you would think that if a person just got treatment, they should be okay. They're out of the woods. Not so. Um, a lot of times people go into the hospital and get maybe an antidepressant. Those take two to four weeks to have any effect, and people are discharged from hospitals in a week or so. And we're good at finding people at risk. We're not good at, at, at getting them, um, fully treated in the short period of time the hospitalizations typically happen in. So I would say keep a close eye on people. If you, if someone you know, uh, or if you yourself have been hospitalized, um, for suicide risk, just because a person's released doesn't mean that things are totally fine now. Keep an eye on them. Stay in touch. Uh, engage in treatment. Make sure they're engaged in treatment.

6. 8:40 – 12:06

   Understanding the Stages of Suicidal Thoughts

   1. SPSpeaker8:40

      Yeah. Can you walk me through the different stages of suicidal thoughts and behaviors in action-

   2. MNDr. Matthew Nock8:47

      Yeah

   3. SPSpeaker8:47

      ... so that we can actually understand it from a more detailed perspective?

   4. MNDr. Matthew Nock8:51

      Yeah.

   5. SPSpeaker8:51

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

   6. MNDr. Matthew Nock9:00

      Right

   7. SPSpeaker9:00

      ... what does it really look like?

   8. MNDr. Matthew Nock9:01

      Right. Uh, so we, as, as we as researchers, as clinicians, think about a few steps in the pathway to suicide, and the big sort of signpost or, or, or stop along the way is, uh, first people think about suicide. So having suicidal thoughts or what we call suicide ideation, having ideas about suicide, uh, and that's a big outcome we focus on. We try and understand what gets some people to think about suicide while others don't. Next is suicide planning, so actually formulating a plan to kill yourself. More intentional. Some people have suicidal thoughts, and it's really aversive to them, and they don't have plans. They just have the thoughts. They might have them involuntarily and be really spooked by them. But some go on, about a third go on to make a suicide plan. They think of a place, a time, a method to kill themselves. And then the next is engaging in behavior, engaging in a suicide attempt, uh, taking steps to intentionally end your own life. And as I mentioned, a lot of people will, will do that and not die by suicide. And then the next is, of course, dying by suicide.

   9. SPSpeaker9:57

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

   10. MNDr. Matthew Nock10:04

       Yeah

   11. SPSpeaker10:04

       ... premeditation.

   12. MNDr. Matthew Nock10:05

       Yeah.

   13. SPSpeaker10:06

       It's not something that happens at random.

   14. MNDr. Matthew Nock10:08

       There often is. There's, there's a lot of variability here. So some people will die by suicide in a really planful way. They'll make a plan. Um, they'll leave a note. Often the notes are very practical. "I made the last mortgage payment, and so, you know, here's where the keys are." Very practical and to the point. Um, not always, but, but, but a lot of the time. And a, a huge percentage of the time, they're more impulsive. A person might have thought about suicide, and it's only in a few hours before the event that they make a decision they're gonna end their life. Uh, it's rare that it comes out of nowhere, that a person's walking along, living their life, and all of a sudden they have a thought of suicide and die by suicide. It usually is a much, um, slower buildup, that there's distress, there's depression, there's anxiety, um, there's thoughts of suicide. Sometimes the thoughts of suicide can last years, uh, before a person takes ac- takes action. Most of the time, though, if someone's gonna make a suicide attempt, it's within the first year after onset of suicidal thoughts. So that, when the thoughts come on is the, is the highest risk time. But it's not always planned out.

   15. SPSpeaker11:07

       What are some of the most-- Looking at each of those areas-

   16. MNDr. Matthew Nock11:10

       Yeah

   17. SPSpeaker11:10

       ... what are some of the most common reasons people find themselves having suicidal thoughts?

   18. MNDr. Matthew Nock11:16

       Far and away, the biggest reason is escape. Uh, if I, if I had to sort of give one message and try and demystify suicide, um, for those who are struggling with-- who haven't had suicidal thoughts and are struggling with understanding why would someone ever think about suicide, again, nine out of 10 times, it's, "I don't wanna be dead per se. I wanna escape from this seemingly intolerable pain." People describe it often like trying to get out of a burning room. "I don't wanna die. I just, I can't-- I don't think I can take this pain anymore." And so that gets people thinking a lot about suicide a lot of the time. And what is that pain? A lot of time it's depression. So depression is one of the strongest predictors of having suicidal thoughts. And depression takes many forms a-and manifests differently. Some people describe it as having, like, a weighted vest on. Some people describe it as, as just really, uh, psychological pain, as despair. But it is one of the biggest drivers of, of having thoughts about suicide.

7. 12:06 – 16:55

   Who Is Most at Risk for Suicide?

   1. MNDr. Matthew Nock12:06

      Interestingly-The things that predict who acts on their suicidal thoughts are different. Depression doesn't really predict acting on your suicidal thoughts. What does is anxiety, aggressiveness, poor behavioral control, drug use, alcohol-- over alcohol use. These things predict acting on suicidal thoughts, and it's the combination of these things that we think really puts people at risk.

   2. SPSpeaker12:25

      The symptoms of someone thinking about suicide-

   3. MNDr. Matthew Nock12:28

      Are different

   4. SPSpeaker12:28

      ... are different-

   5. MNDr. Matthew Nock12:29

      Yeah

   6. SPSpeaker12:29

      ... to the ones that actually act on it.

   7. MNDr. Matthew Nock12:31

      Yeah. And I'll go a step further. This is one of the more interesting findings I've come across. Your parents' history of depression, if you're, if you have a parent with depression, that increases your risk of thinking about suicide, and it actually increases the, the length of your suicidal thoughts, the persistence in years of your suicidal thinking, but doesn't predict you acting on your suicidal thoughts. What does is your parents' history of antisocial behavior, panic disorder, so hyperarousal, um, tendency to act impulsively. This predicts you acting on your suicidal thoughts. So we think these different pieces of the pathway to suicide might be passed down differently, uh, genetically, familially.

   8. SPSpeaker13:09

      Is there any truth in the feeling that people who die by suicide believe that everyone will be better off without me, or is that a myth? When someone dies by suicide, what does it do to their family? What have you seen happen to people, friends, and family from a research perspective? How do people even begin to recover from that feeling that they let someone down, or that they missed a sign, or that they could have done more? I believe that travel is one of the greatest gifts that we've ever been given, and Chase Sapphire Reserve has been my gateway to the world's most captivating destinations. When I use my Chase Sapphire Reserve card, I get eight times points on all the purchases I make through Chase Travel, and even access to one-of-a-kind experiences like music festivals and sports events. And that's not even mentioning how the card gets me into the Sapphire Lounge by the club at select airports nationwide. Travel is more rewarding with Chase Sapphire Reserve. Trust me. Discover more at chase.com/sapphirereserve. When you talk about those almost extreme feelings of escaping-

   9. MNDr. Matthew Nock14:24

      Yeah

   10. SPSpeaker14:24

       ... that idea of running out of a burning room, is there a correlation between that feeling and money more, or relationships, or, like, life situation, or is it across the board and we don't have clarity on that yet?

   11. MNDr. Matthew Nock14:40

       Yeah, we don't have a lot of clarity. I think pain manifests differently for different people. And one thing about suicide is there are, there are socio-demographic factors that predict who becomes suicidal. For instance, for gender, women are more likely to have suicidal thoughts and engage in non-lethal suicidal behavior. Men are more li-likely to die by suicide by a ratio of about four to one, and that's true in virtually every country around the world. There, there's a lot of other things that go into suicidal thoughts and behaviors that put a person at risk, that lead to that sort of, that fi- that feed that fire, and it's different for different people. So relationship problems predict. Uh, legal problems predict. But suicide knows no bounds where it comes to f- income. Uh, there aren't by and large big financial differences. People at all income levels are almost equally at risk. Um, so socioeconomic, um, factors, education levels, income levels, suicide doesn't really discriminate. Uh, it's a problem for all, almost all members of society.

   12. SPSpeaker15:39

       What does that tell us?

   13. MNDr. Matthew Nock15:41

       There's a lot of roads leading to Rome. I mean, there's a lot of ways to put a person at risk for suicide. And again, I've been, been trying to figure out what is the, what is the thing? What is the motivator? It's this burning room. It's this fire. So that's where I usually start scientifically and where I start clinically. I'm a, I'm a licensed psychologist, so, so, um, have worked with patients over the years. Try and figure out the motivation and what is it for this person that's leading them to want to escape? What are they trying to escape from? What is the pain for this person? I think attempts to, to try and find a silver bullet of, oh, it's relationship, or oh, it's finance, or oh, it's a, a mental illness are a little bit misguided. They're, they're, they're one piece of the puzzle. I think we've got to start, or I think it's helpful to start with what is a person's experience? What is... What are they trying t- What's making them suicidal? What's, what's making them not want to live anymore? What is it for them? Let's try and understand that and see if we can figure out some way to, um, solve that problem, help them tolerate their experience without dying, um, and then work backwards from there.

   14. SPSpeaker16:39

       Yeah. That, that makes a lot of sense, like the idea of seeing everyone's experience as unique-

   15. MNDr. Matthew Nock16:44

       Yeah

   16. SPSpeaker16:44

       ... to them and recognizing what their burning room is-

   17. MNDr. Matthew Nock16:47

       Right

   18. SPSpeaker16:48

       ... and not projecting-

   19. MNDr. Matthew Nock16:49

       Right

   20. SPSpeaker16:49

       ... a external value or belief onto that and why it exists.

   21. MNDr. Matthew Nock16:53

       Yeah.

   22. SPSpeaker16:54

       You spoke a bit about this a

8. 16:55 – 18:30

   How Men and Women Differ in Suicide Risk

   1. SPSpeaker16:55

      couple of moments ago. What are the key differences between how men and women think and approach suicide?

   2. MNDr. Matthew Nock17:02

      As I said, there's big gender differences, so women are much more at risk for thinking about suicide, um, and for engaging in suicidal behavior. Men are much more at risk for dying by suicide, and we think that's, that difference is due to women being much, having much higher rates of anxiety and depression, which are, are more closely linked with suicidal thoughts. Men having higher rates of alcohol and, and drug use disorders and aggressive behavior and impulsive behavior being more linked with impulsive, aggressive action. Um, and we think those are two of the big drivers of why we see those gender differences and why they, uh, persist almost everywhere, everywhere around the world.

   3. SPSpeaker17:38

      Mm.

   4. MNDr. Matthew Nock17:38

      There are some commonalities, though, across genders, um, in terms of age. Suicide's pretty rare in young people, meaning children. Um, in every country we've looked at around the world, and we've looked at dozens of them, uh, suicide rates and rates of suicidal thinking skyrocket in adolescence, every country. Um, they even out in young adulthood, and then they go up again later in life. Um, and that increase later in life, uh, is especially prominent among men.We think this is because women, these are generalities, uh, tend to be more socially connected, have more friends, have more close relationships. Men tend to have fewer of them. And later in life when people hit retirement age, men tend to be less connected. And we think this, this lack of social connectedness, uh, lack of reaching out for help is what leads people to have this, um, increase in suicide, uh, later in life.

   5. SPSpeaker18:28

      Wow. And so looking at the different

9. 18:30 – 20:02

   Why Adolescence Brings Higher Risk

   1. SPSpeaker18:30

      ages, the first was adolescence.

   2. MNDr. Matthew Nock18:31

      Yeah.

   3. SPSpeaker18:32

      And the key reasons for that was?

   4. MNDr. Matthew Nock18:34

      We're still trying to figure it out science- scientifically, what is it about adolescence that increases risk? One of the leading explanations is this imbalance that we see in adolescence, uh, in brain development, where this is a little bit of an oversimplification, parts of the brain involved with emotionality, impulsive action, the limbic system are ramping up in adolescence, but the brakes, the prefrontal cortex, isn't fully online until early adulthood. And so we see huge increases in, uh, risk-taking behavior, aggressive behavior, alcohol use, drug use in adolescence. We also see huge increases in, uh, depressive illness, anxiety disorders. We also see increases in bipolar disorder, which is a huge contributor to risk, psychotic illness. So in adolescence, aspects of adolescent brain development are coming online, likely leading to increases in psychopathology, leading to increases in suicide risk.

   5. SPSpeaker19:26

      Mm. Is there any difference between countries and ages and-

   6. MNDr. Matthew Nock19:31

      No, there's differences in rates.

   7. SPSpeaker19:33

      Mm.

   8. MNDr. Matthew Nock19:33

      So rates of suicidal thoughts and behaviors and suicide death vary around the globe, and we're still trying to understand why. They're not explained by geography. They're not explained by high, middle, low income countries. So we're trying to understand how undoubtedly religion and culture play, play a role. There's also, also differences in, um, reporting.

   9. SPSpeaker19:53

      Mm.

   10. MNDr. Matthew Nock19:53

       So a lot of the numbers we have we think aren't completely accurate. Uh, suicide is still illegal in many countries around the world, and that's gonna influence how it gets reported.

   11. SPSpeaker20:01

       Do you think

10. 20:02 – 22:19

    Should We Teach Suicide Awareness in Schools?

    1. SPSpeaker20:02

       we should be talking about suicide at school? Because I was thinking about an analogy that you gave around being in a burning room.

    2. MNDr. Matthew Nock20:10

       Yeah.

    3. SPSpeaker20:10

       And I was thinking that we were all trained what to do in the event of a fire.

    4. MNDr. Matthew Nock20:15

       Mm-hmm.

    5. SPSpeaker20:16

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

    6. MNDr. Matthew Nock20:21

       Mm-hmm.

    7. SPSpeaker20:22

       And again, those two things are pretty-- not, not many people are gonna experience those, but we train people because-

    8. MNDr. Matthew Nock20:30

       Mm-hmm

    9. SPSpeaker20:31

       ... we believe it's a possibility.

    10. MNDr. Matthew Nock20:34

        Yeah.

    11. SPSpeaker20:34

        When you're saying fifteen percent of people are gonna have suicidal thoughts-

    12. MNDr. Matthew Nock20:37

        Yeah

    13. SPSpeaker20:37

        ... do you think it's important that we almost equip everyone with a safety plan or with the idea of what to do when that happens?

    14. MNDr. Matthew Nock20:45

        Yeah, I do. Uh, you know, you look at what's happening with school shootings in the U.S. and it's, you know, train- training of what to do if there's a shooter. It's more likely there's going to be someone who's suicidal, um, who's gonna die by suicide, who's gonna try and kill themselves. So there's gonna be a suicide cluster, a number of kids who try and kill themselves. Again, we know that asking about suicide, talking about suicide does not make people suicidal. There are programs, uh, that go into schools and do a little mini educational module about suicide in health class or outside of health class. Here's what suicidal thoughts are. Here's what suicidal behaviors are. Here's what you can do to keep yourself safe. Here's effective interventions. Here's what you do if someone you know is struggling with suicidal thoughts. It's something that is being done on a small scale now. Um, I think it'd be wonderful to see it done on a much larger scale. Could, could help save lives.

    15. SPSpeaker21:32

        Yeah. It just sounds like because it's something that fifteen percent of people are gonna think about at some point, and if you thought about any of the other things we get trained to do, it just feels like it would be useful. [chuckles]

    16. MNDr. Matthew Nock21:46

        Absolutely.

    17. SPSpeaker21:47

        It, it would be really useful.

    18. MNDr. Matthew Nock21:47

        Absolutely. I think again, it's, it's taboo, it's stigma-

    19. SPSpeaker21:50

        Yeah

    20. MNDr. Matthew Nock21:50

        ... it's fear that's keeping it a-a-away from more, more common use. And we've shown over and over again, there's no reason to be scared. It's n- it's not gonna do harm. And again, continued experimentation will, will be our friend here. And we can see is it-- are there some versions of this that do harm? If so, then we'll, we won't do them. Um, are there ones that work and help keep kids safe and prevent loss of life due to suicide? Wonderful. Let's expand those and make them available so that people don't needlessly lose their kids to suicide or their friends or their loved ones.

    21. SPSpeaker22:18

        When you talk about adolescence,

11. 22:19 – 26:06

    The Promise and Perils of AI in Mental Health

    1. SPSpeaker22:19

       I mean, I just came across this story in The New York Times a couple of months back. I'm sure, I'm sure you saw it, but it was the family of a teenager who died by suicide alleges OpenAI's ChatGPT is to blame.

    2. MNDr. Matthew Nock22:32

       Yeah.

    3. SPSpeaker22:32

       And for those who don't know, I'm reading from The New York Times article. It says, "The parents of Adam Raine, who died by suicide in April, claim in a new lawsuit against OpenAI that the teenager used ChatGPT as his suicide coach." And it goes on to say that, you know, after the suicide, they were searching through his phone, desperately looking for clues about what could have led to the tragedy. They say, "We thought we were looking for Snapchat discussions or internet search history or some weird cult," but they were led to find his conversations with ChatGPT.

    4. MNDr. Matthew Nock23:08

       Yeah.

    5. SPSpeaker23:09

       I mean, I can't-

    6. MNDr. Matthew Nock23:10

       Tragic

    7. SPSpeaker23:11

       ... I can't-- It's so tragic. And, you know, when you see Adam, it's-- th-this picture of him, it's, it's so hard to wrap your head around it. And when I was reading that, I was just thinking, I can't imagine being a parent-

    8. MNDr. Matthew Nock23:26

       Yeah

    9. SPSpeaker23:26

       ... right now where you're already scared about bullying and how that affects children. You're scared about online bullying-

    10. MNDr. Matthew Nock23:36

        Yeah

    11. SPSpeaker23:36

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

    12. MNDr. Matthew Nock23:46

        Yeah.

    13. SPSpeaker23:46

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

    14. MNDr. Matthew Nock23:52

        It's tragic, as I mentioned. I think as, as a parent of three, um, I find it difficult to imagine anything more tragic, horrible than gut-wrenching than losing a child to suicide. So that's the first thing that comes to my mind, always still, um, having worked in this area for over twenty-five years, it's still a gut punch, um, and a feeling like we need to do more. It's an interesting time, um, to, to, toBe a little cliché, but in terms of, uh, the possibilities of machine learning, of generative AI, of all the, the data points that we're getting, I think there's huge promise in these advances, but there's also a lot of dangers. And for me, it's very early days, and it's, it's tragic when, when, when we see instances like this where-- And if you read through the article, which I s- I saw as well, you can see pretty clearly how the AI went... how things went awry and how things were missed and how it's amazing how, um, human-like these technologies currently are. Um, but they're not human, and they're missing things, and in some cases, there's a number of st- I think two or three stories this week on this topic in, in the New York Times and other leading, um, outlets. The AI right now often gets it wrong, uh, misses opportunities to, to jump in. Humans miss them too, uh, but misses pretty clear ones, and in some cases encourages people and says, "Yeah, s- based on what you're experiencing, it sounds like this is a logical solution to your problem." Um, and so it's screwing up, um, majorly, and I think huge changes are needed in how, how it's being used. Generative AI, again, s- I know this sounds cliché, but it's true, is a tool, uh, and like a sharp knife, it can be used to help, and it can be used to harm. Uh, and we haven't yet figured out how to use generative AI to help in this instance. Um, and in some cases, it's harming. Uh, no doubt in a lot of cases, generative AI, large language models are helping people.

    15. SPSpeaker25:44

        Mm-hmm.

    16. MNDr. Matthew Nock25:45

        One problem with suicide, or one problem with [chuckles] one problem with suicide overall, it's a huge taker of lives, and many people don't have access to care. And so there's great potential here, um, to use generative AI to help people. But it's not developed for this purpose, and it's going awry, and it's contributing to the problem in many cases.

12. 26:06 – 27:36

    Why Good Intentions Aren’t Enough

    1. SPSpeaker26:06

       I've seen so many people, heard of so many people, have so many friends who use ChatGPT as therapy-

    2. MNDr. Matthew Nock26:12

       Yeah

    3. SPSpeaker26:12

       ... and finding it very useful, finding it very powerful-

    4. MNDr. Matthew Nock26:15

       It's amazing. Yeah

    5. SPSpeaker26:15

       ... finding it very practical. And then you see this side, and it almost seems like there's a great need for guardrails connecting to a human as soon as possible. I mean-

    6. MNDr. Matthew Nock26:26

       Yeah

    7. SPSpeaker26:26

       ... finding care before it goes awry because-

    8. MNDr. Matthew Nock26:29

       Yeah. There's a-- And from my perspective, there's a need for research. So as in any area, everyone here I'm sure is well-intended. I'm sure OpenAI is well in-intended, and a lot of the digital mental health startups that are popping up all over the place are well-intended. But intentions in themselves don't always lead to positive outcomes. And there's instances, I'll, I'll mention one. A platform that I won't mention the name of had this wonderful app where it could find people online who were suicidal, and it would inform their friends, "Reach out to this person. They're struggling." Very well-intended, very logical. It was pulled down in just a few days 'cause it totally backfired, and it was finding kids online who were being bullied and informing people in the network, including the bully, who was then bullying them more. "I see you're suicidal. You should go and kill yourself." And so the platform, to their credit, pulled it down pretty quickly. Um, just one instance of the intentions are good, the, the idea is a good one, but without testing, without experimentation, lots of bad stuff is gonna be put out there and lots of ineffective things, lots of harmful things. So this is where I think science has to come in to evaluate things and see what's working, what's not working. Let's pull down the things that are not working, improve the things that are, and get them to people so they can be helped.

    9. SPSpeaker27:35

       Yeah. I mean, bullying isn't

13. 27:36 – 30:03

    Bullying Is Still a Serious Risk

    1. SPSpeaker27:36

       a new issue, but-

    2. MNDr. Matthew Nock27:37

       Yeah

    3. SPSpeaker27:37

       ... I was reading some statistics that were saying that cyberbullying makes someone over three times more likely to c-contemplate suicide.

    4. MNDr. Matthew Nock27:45

       Yeah.

    5. SPSpeaker27:46

       And then general in-person bullying makes it two to nine times more likely to consis- consider suicide. It seems like humans, especially at the adolescent age when I feel like bullying is, you know, the most prevalent-

    6. MNDr. Matthew Nock28:00

       Sure

    7. SPSpeaker28:00

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

    8. MNDr. Matthew Nock28:07

       No. It's a, it's a, I, I'm sure a perennial issue, a timeless issue where we see it in ani- in non-human animals where adolescent elephants will bully other elephants and they'll bully other animals, uh, if there's not parents around, um, constantly. Um, zoos have to sort of address this, uh, when it, when it occurs. So it's a problem in, in a lot of animals, a lot of organisms. It's not new. It's-- And it's not caused by the internet and, and, and, and AI, but it manifests in new ways. And it manifests in ways, bullying manifests in ways that parents don't really know about. Um, what kids are doing online is unknown to parents, and the bullying now is taking new forms, and it's unknown to clinicians, it's unknown to parents, and so it's more, um, insidious, and it's more around the clock. It used to be when I was young, perhaps when you were young, you go to school, and you get bullied-

    9. SPSpeaker28:56

       Yeah

    10. MNDr. Matthew Nock28:56

        ... or maybe you bully or... And then you go home, and it's over. And now it's round the clock. Uh, and that lack of ability to escape, we think can be really problematic for a l- for a lot of kids. And so here too, it's a tool, and we've got to figure out how to best use it and how to use it for good and for improving wellbeing and for improving mental health. We did a, a, a qualitative study with, uh, suicidal adolescents in a local hospital, and we asked them about their, their social media use, their online, um, use. And what they described was, yeah, it's-- there's bullying, there's social comparison. "I see what other people have, and I don't, and I feel really bad about myself. I'm learning new ways to cut myself in ways that it can't be discovered, so there's a lot of bad happening." There's just as much good, and they're saying, "I'm learning skills. I'm learning how to be mindful. I'm learning about ways I can help calm myself down when I'm upset." So there's, as with any tool, there's good and bad happening. We just need to do a better job clinically, parentally, societally, scientifically at catching up and learning how to use this in ways that are helpful and can improve mental health, uh, and decrease with guardrails or, or otherwise, uh, the harms that it's clearly doing.

14. 30:03 – 33:57

    Why Parents Should Talk About Suicide with Their Children

    1. SPSpeaker30:03

       This, this was the other one I saw on, on AI that was heartbreaking was teen was blackmailed with AI-generated nude photos of himself, then he died by suicide.

    2. MNDr. Matthew Nock30:13

       Yeah.

    3. SPSpeaker30:14

       And so-Uh, Eli died by suicide on February 28th, 2025, after receiving alarming texts. The sender threatened to send AI-generated nude photos of the sixteen-year-old to friends and family if he didn't hand over three thousand dollars in alleged sextortion scam. Sextortion often targets teens and children-

    4. MNDr. Matthew Nock30:35

       Yeah

    5. SPSpeaker30:35

       ... and is becoming increasingly dangerous, according to the FBI, the article read.

    6. MNDr. Matthew Nock30:39

       Yeah.

    7. SPSpeaker30:39

       And so, yeah, it's, it's such a-- I mean, again, I, I think as a parent, it's such a stressful time. What have you seen have been-- What are things parents can do to help to be involved in the conversation, to be useful? What have you seen through research that parents can shift and change about their behavior, attitude-

    8. MNDr. Matthew Nock31:04

       Yeah. It's a great question

    9. SPSpeaker31:05

       ... interaction?

    10. MNDr. Matthew Nock31:06

        Reach out and have the conversation. So talk about suicide. Talk with your child about suicide, about what they're experiencing, about their mental health. Um, suicide is still incredibly taboo, and one of the biggest myths that I, that I hear is, "If I talk about suicide, if I ask my child or ask my spouse or ask my friend about suicide, it's gonna give them the idea and make them suicidal, and so I'm not gonna say anything." Uh, and that's been shown experimentally time and again to not be true.

    11. SPSpeaker31:33

        Oh, it doesn't?

    12. MNDr. Matthew Nock31:34

        Does not happen. And people have done experiments where they ask some kids if they're suicidal and don't ask others and follow them up. Kids who get asked about suicide, middle school students, high school students, adults, are not more distressed. They're not more suicidal. If talking about suicide, asking about suicide made someone suicidal, you know, I've been talking about it [chuckles] every day for the past twenty-five years. Our team has, clinicians have. I've talked with my kids about suicide. It's-- it does not, the research shows, does not make people suicidal. So I would encourage parents to have these conversations. I'd encourage any younger folks listening, have these conversations. If you think someone might be at risk, ask them. Even if they're not at risk, ask them. Have the conversation, and it signals, it communicates to your child, to your friend, that it's okay to talk about this, and that I'm a person that you can come to and talk about, uh, what's happening with you, whether it's suicide or mental health more broadly.

    13. SPSpeaker32:22

        What, what age did you have that conversation? You have two-

    14. MNDr. Matthew Nock32:25

        Three kids. Um-

    15. SPSpeaker32:26

        Yeah. Three. Okay, three. Yeah. You have-- Are they all teenagers?

    16. MNDr. Matthew Nock32:29

        Our youngest is twelve.

    17. SPSpeaker32:30

        Yeah.

    18. MNDr. Matthew Nock32:30

        Our oldest is nineteen. Um, probably around ten or so.

    19. SPSpeaker32:35

        Wow, that's-

    20. MNDr. Matthew Nock32:36

        Um-

    21. SPSpeaker32:36

        I-- Wow.

    22. MNDr. Matthew Nock32:36

        It used to be the common thinking that kids can't even contemplate the idea of death until age ten, twelve. We're now seeing, um, suicide among younger people, among children, increasing dramatically. Uh, and the-

    23. SPSpeaker32:51

        Really?

    24. MNDr. Matthew Nock32:51

        ... US National Institute of Health has put a call for research on this problem of child suicide to try and figure out what's happening and, and why is it that younger people are now thinking about suicide and dying by suicide more than they have been historically. And so it's probably around age ten or so, I, I let my kids know what I do and, and have conversations with them and ask them questions about have they ever, um, had feelings of depression or anxiety or thoughts about suicide. Perhaps earlier than other parents, this is, this is what I study, and so this is what's on my mind a lot. Um, but I also have had instances personally, professionally, I've seen instances of people missing, missing the opportunity to talk to someone about suicide, losing someone to suicide, and as we all do, if you've lost one to suicide, torture ourselves thinking back, "Could I have said anything? Could I-- Should I have asked? Should I have done something differently?" And knowing that it's not harmful to ask someone about suicide, it's not gonna increase their risk. Just as it wouldn't if you ask someone, "Are you thinking about killing someone?" If they're not, they're very unlikely to now go out and wanna kill someone because you raised, raised the idea. Uh, it's the same kind of, um, situation.

    25. SPSpeaker33:56

        How did that

15. 33:57 – 36:40

    What If Kids Don’t Want to Talk About It?

    1. SPSpeaker33:57

       conversation go? Because I can imagine that maybe when kids are ten, they maybe have been listening. Of course, you're a-

    2. MNDr. Matthew Nock34:03

       Yeah

    3. SPSpeaker34:04

       ... researcher and an expert in the field. What about when kids are kinda like, "I don't wanna talk about that, Mom and Dad." Like, "I am not interested in having this conversation with you," which-

    4. MNDr. Matthew Nock34:12

       Yeah

    5. SPSpeaker34:12

       ... seems like a natural teenage response. I'm thinking if-

    6. MNDr. Matthew Nock34:14

       Yeah

    7. SPSpeaker34:14

       ... if my parents had asked me that at fourteen, fifteen, I would've just been like, "What's wrong with you?"

    8. MNDr. Matthew Nock34:18

       Yeah.

    9. SPSpeaker34:18

       And so-

    10. MNDr. Matthew Nock34:19

        My kids never wanna talk to me, so I, I [laughs] -

    11. SPSpeaker34:22

        [laughs]

    12. MNDr. Matthew Nock34:22

        ... it's hard to tease that one out.

    13. SPSpeaker34:23

        Yeah. Yeah, yeah.

    14. MNDr. Matthew Nock34:23

        Uh, I think that's okay. I think it-- again, it still signals that you're open to having that conversation with them. So even if it seems to not go well and your child says or your friend says, "I don't wanna talk about it," you've at least let them know that it is okay for them to come to you and that you're someone who's open to talking about this. I've also seen instances of kids saying, "I'm thinking about suicide," and the parents say, "We're not gonna talk about this," or, "You're just doing that for attention."

    15. SPSpeaker34:48

        Mm.

    16. MNDr. Matthew Nock34:48

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

    17. SPSpeaker35:01

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

    18. MNDr. Matthew Nock35:08

        I'd follow up. I'd, I'd ask about it. About two-thirds, sixty-six percent of the time, when people die by suicide, they told someone ahead of time. They mentioned, uh, "I'm thinking about death." They might have joked about it. Uh, they've talked about it in some way. So people are putting those signals out there. I think it's worth following up and asking someone, "Are you-- Are things so bad that you're actually thinking about suicide? Have you thought about taking your life?" Even if they're joking, you don't need to every time. If it's a clear joke, it's a clear-- you know, it's a joke. But if you have the thought, have the feeling to ask about it, I would, I would ask about it.

    19. SPSpeaker35:40

        Yeah.

    20. MNDr. Matthew Nock35:40

        Um, it's hard, admittedly. It's still hard to do. I've been doing this for decades, and it's still-- I still have a little hesitation before I ask friends, family members. But I ask because I know the consequences of not asking, and I know the statistics, and I know that we've done studies asking people who've tried to kill themselves, "Is there anything that could have prevented you from trying to kill yourself?" And the top two things people say areIf there was some way to make the pain go away, and if I was able to talk with someone else about what I was experiencing. Um, so I know firsthand, and I know scientifically, that lack of connection, that lack of communication can be deadly. And so push through the anxiety, push through the uncomfortability of asking someone, and ask them. Invariably, in, in almost every experience I've had, I can't think of one where this hasn't been the case, it's gone well, and the person has either said, "Yes, I am thinking about it, and I'm glad you asked," or, "No, I'm not." And now they know that if, if they do have those thoughts, or if those thoughts intensify, I'm someone they can talk, talk with. And I think the bigger the network of people, uh, that one has, the, the, the more likely they are to, to, to not die by suicide.

    21. SPSpeaker36:39

        Mm. And f-

16. 36:40 – 38:52

    What Steps Should You Take Next?

    1. SPSpeaker36:40

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

    2. MNDr. Matthew Nock36:43

       Yeah.

    3. SPSpeaker36:43

       You're worried about them.

    4. MNDr. Matthew Nock36:44

       Yeah.

    5. SPSpeaker36:45

       What do you do next?

    6. MNDr. Matthew Nock36:46

       Yeah.

    7. SPSpeaker36:46

       Like, where should people go, parents or friends of kids, teens who are listening right now-

    8. MNDr. Matthew Nock36:51

       Yeah

    9. SPSpeaker36:51

       ... and they go, "I, I think someone's struggling. I don't fully know. What do I do?"

    10. MNDr. Matthew Nock36:55

        Yeah. I like to think about, acronyms can be helpful, giving a person AIR, A-I-R. So ask the question. If you think someone might be at risk, ask them. Initiate a conversation. Initiate support. There's a tendency for people to pull away and, and, uh, the person who asks and not to follow up. And R for refer. Don't try and do it all on your own. Refer them. So A-I-R. Ask the question. And I usually try and ease into it. Uh, and I ask, and we, we teach our, our, our, our doctoral students who are learning to be clinical psychologists, ask in a calm, dispassionate demeanor, "Are things so bad that you've thought about suicide?" And I'll lead into it with th- asking about depression. Have you had thoughts of death? Have you had thoughts of suicide? So you can, can ease into it. And i- if so, initiate a conversation. Initiate support. As with death, as with funerals, people get uncomfortable, and they don't want-- they don't know what to say, and so they pull back. Lean in. Initiate a conversation. Initiate support. Be there for the person. But also always refer. Don't, don't try and do it all on your own. Bring a person to professional care. There are hotlines, there are crisis lines in, in most countries around the world. In the US, it's 988. Um, you can find these easily on, on a search online. M- a lot of them operate twenty-four/seven. Uh, you don't need to bring a person to the hospital. You can. If, if the person's thinking about killing themselves today, I would take them to the hospital and, and have them, um, get an evaluation. But you can call 988. You can call a, a, a-- you can text the text line. Refer the person for help. A lot of-- probably the most common thing I've seen is a person will say, "Yeah, I've thought about suicide, but please don't tell anyone. Promise me you won't tell anyone." I wouldn't promise. I would say, "I care about you, and I want you to stay alive, and I value your life even more than I value our friendship. And if you're not gonna be my friend anymore because I shared this with someone, then so be it." Again, I can't emphasize enough how important it is to try and take that step and how gut-wrenching it is to lose a person to suicide and to struggle with the question of could I have done more? Could I have-- Should I have taken one more, one more step?

    11. SPSpeaker38:51

        Yeah.

17. 38:52 – 42:06

    Why Men Are More Likely to Die by Suicide

    1. SPSpeaker38:53

       Matt, why are suicide rates especially high among white men?

    2. MNDr. Matthew Nock38:58

       It's a great question. Um, that's-- there's a lot about suicide, um, that are sort of perennial statistics, um, that we just don't understand and, and, and this is one of them. So I mentioned the, the, the men part of that. We think that the rates are higher among men than women because men-

    3. SPSpeaker39:13

       Men

    4. MNDr. Matthew Nock39:13

       ... tend to use, tend to be more aggressive, more impulsive, to use more lethal means. In the US, much more likely to use firearms than women are. Women tend to use, um, means that tend to be less lethal, cutting, uh, overdose, and so on. Why white men? We're not, we're not sure. That's been a statistic that's been prevalent in the US for, for a really long time, and we, we don't fully understand it. Another really striking statistic is the rate of suicidal behavior among, um, Black teens in the US is skyrocketing in the past few years among, uh, Black male youth in particular, and that's another one we don't fully understand. And there's ideas about why this might be, but, but, but the, there's a lot of science happening right now to try and better understand this.

    5. SPSpeaker39:55

       It's such important research and so needed. Is, is this area of research underfunded?

    6. MNDr. Matthew Nock40:00

       It's w- wildly underfunded. Uh, suicide is one of the leading causes of death in the US, around the world. It's the second leading cause of death among people ages ten to thirty-four, behind only accidents. So among young people, it takes more lives than anything other than accidents. And overall, the fourth leading cause or contributor to years of life lost because it takes so many young people, of all causes of death. Um, yet it is almost at the end of the list in terms of funding. There's about a-- We need to triple the funding for suicide research to even be-- come close to the l- causes of death that surround it. Um, so there's just an incredible dearth of, of, of scientific, uh, research being done on suicide relative to the scope of the problem, and it's not for lack of want. Um, I think it has to do with stigma, that, again, people don't like talking about suicide. It's a taboo topic. There's a fear that if I talk about it, if I shine a light on it, it's gonna make things worse, and I think this trickles down to funding as well, and so we're not funding it at the rate that we should be. And another myth about suicide is it's an epidemic. Um, the rates have skyrocketed. They haven't. The, the suicide rate in the US now is virtually identical to what it was 100 years ago. Contrast that with many of the other leading causes of death that have dropped precipitously over the past hundred years, heart disease, accidents, tuberculosis, pneumonia, HIV/AIDS, most recently COVID. We dedicate science to these things. We do medical research. We disseminate the results. We're really good. Humans are really good at applying scientific studies to big problems and decreasing the mortality rate. We haven't done that to suicide. The suicide rate is pretty flat over 100 years. Uh, and so I'd love t-- This is why I'm really excited that you're focusing on this problem and bringing attention to it, um, shining a light on it. We need more research on this topic because there's these huge questions about why young Black males, why older white men, how can generative AI be used, on and on and on. There's so much opportunity that's not realized because we h- don't have enough research on the topic.

    7. SPSpeaker42:05

       Yeah.

18. 42:06 – 44:02

    Why Science Must Guide Suicide Prevention

    1. SPSpeaker42:06

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

    2. MNDr. Matthew Nock42:12

       A commitment to the scientific process. Uh, again, it's one thing to have a good idea, a really clever idea, a good idea, and well intentions. You have to do the research. You have to do the experiments. Um, I would encourage, um, AI companies to collaborate with scientists, academic researchers, um, who are independent or working closely with and do studies on the best ideas, see what works, see what doesn't, disseminate the things that work, and drop out the things that don't.

    3. SPSpeaker42:38

       Mm.

    4. MNDr. Matthew Nock42:38

       One thing that gives me great hope about this, the problem of suicide and, um, the potentials that, that are there, this is-- although it's a leading cause of death, it's a low base rate problem, and we haven't been able to predict it and target it for treatment because we've had a lack of data. It's kind of like, uh, I often think about tornado prediction or hurricane prediction, where tornadoes, hurricanes have been around as long as the Earth has been here. And for a long time, we had these sort of mystical religious explanations for why they exist. And as we got more and more data and better science and better statistical models, we can predict them, and we know when they're gonna occur. And we get warnings weeks ahead for hurricanes, hours ahead for tornadoes, and we save lives. We now have a lot of data on people. We all have cell phones and wearable devices, and we're online, and there's all these digital breadcrumbs all around us. We can predict, and we can tailor using generative AI to people m-m better than we ever could in human history. And so there's so-- We, we're right there, I think, with... We've got all the tools to be able to have a big impact, but we're not doing it. Um, so my-- If I could send a message to the, the big AI companies, it'd be collaborate with researchers on this. Lean into the problem, uh, and experiment and find ways to, to, to, to use the incredible tools that we now have, um, to help young people to improve mental health, to decrease suffering, to save lives.

    5. SPSpeaker44:00

       Mm. I also saw

19. 44:02 – 46:01

    New Mothers Experience With Suicidal Thoughts

    1. SPSpeaker44:02

       that new mothers can actually struggle with suicidal thoughts.

    2. MNDr. Matthew Nock44:05

       Yeah. Yeah.

    3. SPSpeaker44:06

       That fascinated me.

    4. MNDr. Matthew Nock44:07

       Yeah. It's a really interesting pattern in the data where new mothers have huge increases in suicidal thoughts, which, you know, having young kids can be stressful. Um, it makes sense that you have perhaps increased depression, postpartum depression, anxiety, and, and thoughts of suicide. Young mothers have a huge decrease in risk of suicide death. So I think there's a reason to not take your life if you've got young kids. And so although there's an increase in suicidal thoughts, there's a decrease in suicide death. Uh, having young kids is protective.

    5. SPSpeaker44:36

       Mm. Yeah, I feel like-- and that I can't imagine how much stress that puts on someone. Like, the reason you're having suicidal thoughts is because there's some sort of extreme stress in your life.

    6. MNDr. Matthew Nock44:45

       Yeah.

    7. SPSpeaker44:46

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

    8. MNDr. Matthew Nock44:54

       Yeah

    9. SPSpeaker44:54

       ... I can't believe I'm having suicidal thoughts. I just gave birth, or I can't believe I'm having suicidal thoughts. I have to take care of my family. And that almost feels like a vicious cycle.

    10. MNDr. Matthew Nock45:02

        Yeah, and yes, and people often feel really isolated, and they pull back from others because they're afraid to tell other people how they're feeling. And if I've got a young child at home and I'm thinking about suicide and I communicate that to someone else, are people gonna fear for the safety of my child? There's a lot of guilt, there's a lot of shame, um, that people report when they have thoughts of suicide. Many people often-- also often report relief when they have thoughts of suicide, almost like imagining a vacation from their problems, uh, imagining an escape from their situation. And so it brings temporary re-relief to someone. So it's rein-- having the thoughts can be reinforcing and we think lead them to persist.

    11. SPSpeaker45:38

        But overall, you-- suicidal thoughts are dangerous. They're-- Even if they're seen that way or?

    12. MNDr. Matthew Nock45:43

        They're dangerous insofar as they can lead to suicide death. Um, but again, fifteen percent of people have thoughts of suicide. Two-thirds of people who have thoughts of suicide will never act on them. Um, so, uh, they're dangerous in themselves-

    13. SPSpeaker45:57

        But is the goal-

    14. MNDr. Matthew Nock45:57

        ... but they're, but they're distress-- incredibly distressing. Um-

    15. SPSpeaker46:00

        Is the goal

20. 46:01 – 47:53

    Most Effective Therapies For Suicide Prevention

    1. SPSpeaker46:01

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

    2. MNDr. Matthew Nock46:05

       I think that would be the ideal goal is to not have suicidal thoughts to begin with. Interestingly, most treatments that-- most psychological treatments that show an effect for preventing suicidal behavior, they don't work by decreasing suicidal thoughts. They work by decreasing people's likelihood of acting on their suicidal thoughts. So we're not really good yet, scientifically, clinically, at getting people to not think about suicide. What we can do through psychotherapy is get them to not act on those thoughts. Targeting depression, targeting anxiety doesn't seem to work as well as we thought it would for getting rid of suicidal thoughts.

    3. SPSpeaker46:36

       What does that program look like-

    4. MNDr. Matthew Nock46:39

       Yeah

    5. SPSpeaker46:39

       ... to stop that transition?

    6. MNDr. Matthew Nock46:42

       Yeah. So some of the best evidence we have is for interventions like cognitive therapy, cognitive behavior therapy, or a newer version called dialectical behavior therapy, which is basically cognitive therapy but with an Eastern Buddhist influence. Cognitive therapy is a lot about change. Dialectical behavior therapy, or DBT, is acceptance and change. So accepting the thoughts, the feelings that you have, noticing them, and not acting on them. And so those interventions are a lot about helping people to understand when their risk is increasing and what skills they can develop and use to get through those periods, uh, and try and ultimately decrease the likelihood of having thoughts of suicide. But, but our interventions aren't quite there yet. So they're teaching skills of, um, distress tolerance. When you have thoughts of suicide, when you ha-- when you feel that fire, when you feel that intense pain, how-- what can you do to try and tolerate it? What can you do to try and distract from it, either by using some skill, cognitive reframing, um, taking a shower, going for a walk, reading, doing some mindfulness practices, or reaching out to someone else. Uh, getting good at, at, at reaching out to your friends, your family, uh, when you're at risk or taking a step further and, and reaching out for professional help when you're at risk.

21. 47:53 – 49:23

    Do Suicide Survivors Regret Their Attempts?

    1. SPSpeaker47:53

       Matt, for those people who have attempted suicide-

    2. MNDr. Matthew Nock47:56

       Mm-hmm

    3. SPSpeaker47:56

       ... but then survived-

    4. MNDr. Matthew Nock47:58

       Mm-hmm

    5. SPSpeaker47:58

       ... do they regret it?

    6. MNDr. Matthew Nock48:00

       Most do. Um, so there, there are some data on this, and about three-quarters of people who-- There's one study on the, on the Golden Gate Bridge, which is a-- If you jump from a really tall bridge, it's, it's-- tends to be lethal. So people who jump off and survive are rare. And there was a, aInterview done with people who jumped off and survived, and three-quarters said the first thing they thought when they jumped was they regretted it immediately. Uh, and when we followed up and asked people who have made suicide attempts and survived how they felt afterwards, the majority report feeling, um, shame and guilt and disappointment that they had made suicidal, uh, they had engaged in suicidal behavior. And so that's a message that I would hope that could be heard by people who are thinking about suicide. Those who have enga-- taken the, the step to try and kill themselves most immediately regret it, uh, and most in the longer term continue to regret it and feel bad and wish they didn't try and kill themselves. And the majority verbalize that they wish they had someone they could have talked to or wish they talked with someone about what they were experiencing ahead of time. And some people say after the fact when they're in the hospital, they didn't realize how much people cared. They didn't realize how much treatment is available and how much better things could be. So I would hope that if people are listening to this who are struggling with thoughts of suicide, that they would keep that in mind, that there is help out there. People who have taken these steps, um, wish they hadn't. Um, so please do reach out for help now.

22. 49:23 – 50:07

    How Mental Disorders Increase Risk

    1. SPSpeaker49:23

       Are you seeing people who die by suicide have a mental health disorder? Is that a, is that a connection that you see?

    2. MNDr. Matthew Nock49:31

       It's a huge connection. So ninety to ninety-five percent of people who die by suicide had a diagnosable mental dis- mental disorder before they died. So depression, anxiety disorders, bipolar disorder. Twenty percent of people with bipolar disorder will die by suicide, one in five. Psychotic illnesses. Virtually every mental disorder in the, in the DSM, all the ones that we study on a regular basis, increase risk of suicide. When they start to pile up, risk really increases. When, when a person, you know, having two disorders we call comorbidity, more-- three or more disorders, multimorbidity. Multimorbidity is associated with a huge increase in risk of suicidal behavior.

23. 50:07 – 52:39

    Can We Predict When Someone Will Act on a Suicidal Thought?

    1. SPSpeaker50:07

       It's clear what people are experiencing when it comes to suicidal thoughts. You talked about the connections that you make to actually people who die by suicide, but it's hard to predict it.

    2. MNDr. Matthew Nock50:21

       Really hard to predict. Another thing that gives me optimism is we're getting better at prediction.

    3. SPSpeaker50:26

       How?

    4. MNDr. Matthew Nock50:26

       With the increasing amount of data that we have. I'll give a few examples. Uh, fifty percent, five zero, of people who die by suicide saw a clinician within the month before their death. People are coming in-- Half of people who die are coming in to a clinic, to a hospital, primary care doctor, their psychologist, psychiatrist, social worker. They're not always saying, actually, they're rarely saying, "Doctor, I'm gonna kill myself." They're coming in saying, "I'm depressed. I can't sleep." Sleep problems are strongly linked with suicidal behavior. Something's just not right. Uh, so half the people are coming in, we're really bad clinically at knowing which people coming in are high risk. But here's where I have hope. With the switch to electronic health records, it used to be you go see your, your doctor, and they write down some things on a piece of paper, and they put it in a folder and put it in a filing cabinet. Now it's all digital. We can use machine learning algorithms to find in the huge amounts of data we have on every patient who's at risk for suicide, and we can identify if we're-- Think about predicting suicide as like looking for a needle in a haystack. We can put patients into risk bins, and the top five percent of patients account for fifty percent of all the suicides that are gonna happen. So we can find these concent- concentrations of risk where we have patients who are at really high risk for suicide, and so we can target them with interventions. We're also doing a lot of work now over the past almost ten years, giving patients apps on their smartphones and asking them questions each day about how they're feeling, how they're doing, collecting passive data with their consent from their GPS, from their accelerometer, getting sleep information, and we're getting pretty good at predicting among patients at risk who's gonna make a suicide attempt in the next few days. So we're getting better at identifying which patients are at risk, and now most recently, in the past few months, when they're at risk, and we now have apps that we can, with people's consent, give them on their phones that help decrease risk of suicide in time and place. So we don't have to have someone coming into the hospital when they're at risk. We still want people to do that, coming in to see their clinician once a week, whatever the case is. We still want them to do that. Those in-between times when risk increases, what does a person do? We're getting better at identifying when those are gonna happen and how we can help keep people safe.

    5. SPSpeaker52:38

       Yeah, because all

24. 52:39 – 54:00

    Predicting Who’s at Risk And When

    1. SPSpeaker52:39

       of that is what you hoped those clinicians did, after which fifty percent of those people-

    2. MNDr. Matthew Nock52:45

       Right

    3. SPSpeaker52:45

       ... died by suicide.

    4. MNDr. Matthew Nock52:46

       Right.

    5. SPSpeaker52:47

       Whereas-

    6. MNDr. Matthew Nock52:47

       But it's hard to know.

    7. SPSpeaker52:48

       Yeah.

    8. MNDr. Matthew Nock52:48

       It's hard. So, so I mentioned earlier two-thirds of people who die by suicide told someone ahead of time they were thinking about suicide. What I didn't mention is seventy-eight percent of those people explicitly denied suicidal intentions in their last communication before dying.

    9. SPSpeaker53:02

       Mm.

    10. MNDr. Matthew Nock53:03

        So-- and this is a really common pattern, that people will say, "I'm thinking about killing myself," and then they'll recant and say, "I'm, I'm no longer thinking about killing myself." And, and, and a lot of the cases, they're not. It's really hard to know when is a person who has suicidal thoughts going to act on those thoughts. And when we do studies where we interview people and ask, "When did you know you were gonna make a suicide attempt?" It's usually the hours before.

    11. SPSpeaker53:26

        Mm.

    12. MNDr. Matthew Nock53:26

        So people have thoughts of suicide maybe for a year or so, and it's the same day that they make a decision they're gonna kill themselves. So if you see your clinician once a week, once every two weeks, even twice a week, those in-between times we haven't had access to. But now, again, with smartphones, with social media platforms, social media apps, we now have people in, in the in-between times. And there's a lot of people saying these are-- it's bad. It-- We're, we're on our phones too much. We're on social media too much. And there's a case to be made there, but these, they're tools, and they can be used for good, and they can help us find people when they're in distress, and we're getting better at doing that and reaching out to people.

25. 54:00 – 55:41

    The Shame Around Suicidal Thoughts

    1. SPSpeaker54:00

       What have you found are the top reasons why people don't tell people they are having suicidal thoughts?

    2. MNDr. Matthew Nock54:06

       I thought I could handle it on my own. I didn't want anyone to bring me to the hospital or call the police to make a big deal out of it. Depending on population, college students are afraid they're gonna get kicked out of school. Uh, we do a fair amount of work with, with, um, the military, and, and, uh, a lot of service members fear thatAnd police fear they're gonna have their firearm taken away from them, they're gonna lose their job, they're gonna get demoted. "I don't want my health, um, insurance company to figure out are my rates gonna go up." Um, so there's a whole plethora of, of, of reasons that people don't tell others. Um, it's logical. It makes sense that you, you know, if you fear bad things are gonna happen if I tell someone this, I'm gonna try and handle it on my own and muscle through it. Uh, I understand that-- why people would do that, um, but they're missing the opportunity to get, to get help.

    3. SPSpeaker54:50

       And it's hard because it's how do you convince that individual to seek help and-

    4. MNDr. Matthew Nock54:56

       Yeah

    5. SPSpeaker54:56

       ... be okay with meeting others?

    6. MNDr. Matthew Nock54:57

       Yeah. And admittedly, our care could be better. We, we have a long way to go. I mentioned we have interventions that can decrease people's risk of suicidal behavior. A lot of them have wait lists. A lot of our focus right now is if someone's at risk for suicide, we bring them to the hospital. We're just learning now that hospital treatment for, for people at risk for suicide does seem to help some people. It's less helpful for other people, and it seems to potentially harm some people. They get worse after they get hospitalized. Uh, this is a study published just in the past year. So we're in the process of trying to get better and figure out how can we better help people? How can we tailor interventions to people to figure out who's likely to benefit from which intervention? So again, we're, we're, we're making progress, uh, but there's still a long way to

26. 55:41 – 57:50

    Careers Linked to Higher Suicide Risk

    1. MNDr. Matthew Nock55:41

       go.

    2. SPSpeaker55:41

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

    3. MNDr. Matthew Nock55:46

       It's hard to tease apart from race and ethnicity. So physicians are at high risk. Police officers are at high risk. Uh, there was a big concern a few years back, the, the s- there was a spike in suicides in New York City police officers. We did a study on this. New York City police officers are mostly white men. Uh, and s- and there was a blip up in one year, but it came right back down. Actually, female police officers had a, had a, a higher risk even when accounting for age and, uh, race and ethnicity. Occupations where a person has access to means, this is another explanation for why physicians, why police officers, why soldiers, um, army soldiers, service members do have significantly higher risk of, of, of, of suicide. Um, access to means we think, we think plays a role.

    4. SPSpeaker56:28

       Access to means.

    5. MNDr. Matthew Nock56:29

       Access to lethal means, uh, firearms, um, medications.

    6. SPSpeaker56:35

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

    7. MNDr. Matthew Nock56:40

       Right.

    8. SPSpeaker56:40

       And, and yeah, that, I mean-

    9. MNDr. Matthew Nock56:42

       There's also big geographic differences in the US. So suicide rates are, are highest out west. If you look sort of north and south of Las Vegas, people call this the suicide belt. There's access to firearms. There's not ready access to good hospital care, good, good treatments. You might have to drive three, four hours, um, to go see, to go see a clinician, and there's low population density, so you don't have contact with a lot of people day to day. So if you're having thoughts of suicide and you don't have people right around you, you don't have access to care, and you have access to firearms, we think this is a pretty lethal, um, cocktail. Rates are lowest historically in New York, New Jersey. From New Jersey, I think this might be high quality of life. People might disagree. Uh, but there's, there's high population density, and there's a lot of people around. It's pretty, uh, easy to find a hospital, to find a clinician where you can get, um, treatment. So we think these factors do, do, do play a role. Um, so not just occupation, but where you live and what, what access you have. Again, which is another reason why I think online care, um, generative AI has a great role to play here. If, if you can access the internet, you can now access care, and so this changes the playing field quite a bit, or has the potential to.

27. 57:50 – 59:41

    Losing a Close Friend to Suicide

    1. SPSpeaker57:50

       Matthew, I know when we spoke on Zoom a few months back, you shared a personal story with me that really resonated with me because of the incredible work you do, but then the personal experience you have. Would you be comfortable sharing that with us?

    2. MNDr. Matthew Nock58:03

       Sure.

    3. SPSpeaker58:04

       Because I'd love my listeners to just recognize just how complex and layered this subject is, not just for you, but-

    4. MNDr. Matthew Nock58:11

       Yeah

    5. SPSpeaker58:12

       ... in the experience of it for anyone who goes through it as well.

    6. MNDr. Matthew Nock58:15

       When I first became interested in suicide, uh, in a hospital in, in, in Tooting Bec in, in, in London, Springfield Hospital, I didn't know anybody who was suicidal. It was a clinical human interest. Over the years, I've had friends and family members who have, who have struggled with thoughts of suicide and, and have died by suicide. And actually, one of my best friends, Dan, I, I... Dan Eisenbud, I met in London, uh, when I was working in this hospital and became very close friends. We became roommates. We were roommates through my, um, graduate studies. Um, and just a few years back, we lost him to suicide. Um, and it, it wrecked me, and I continue to, to, to struggle with, with the loss. Um, he was one of my dear friends, and I went back and looked at my notes and looked at my emails. He was living in, in Israel, uh, working as a journalist, was planning on coming back to the U.S., and w- I was reading over his emails. "Hey, I'm coming back. Maybe I'll move to Boston, looking for apartments. Can you help me out?" And I was looking for any clues. What might I have missed? Nothing. I didn't, I didn't see anything in, in, in the emails. But it was, I think, just an example of how difficult it can be not just to lose someone, but then to s- to struggle with, you know, wanting to have done more, um, for him, for his family, for, for, for his friends. It's a tough problem. It's a perplexing problem. It's a gut-wrenching problem. Um, and I think just for me, it's motivation to do better, um, and to not rest, and to keep trying to get better at, at, at doing this.

    7. SPSpeaker59:40

       Thank you for sharing

28. 59:41 – 1:01:29

    How Do You Begin to Heal After a Loss?

    1. SPSpeaker59:41

       that. How do people even begin to recover from that feeling that they let someone down or that they missed a sign or that they could have done more? Because I, I imagine that's a very heavy weight to carry.

    2. MNDr. Matthew Nock59:56

       Yeah.

    3. SPSpeaker59:56

       And it can be really difficult when, like in your case, there were no signs that you could spot.

    4. MNDr. Matthew Nock1:00:03

       Yeah.

    5. SPSpeaker1:00:03

       And, and you're someone who's trained to do that-

    6. MNDr. Matthew Nock1:00:05

       Yeah

    7. SPSpeaker1:00:06

       ... when we're not trained.

    8. MNDr. Matthew Nock1:00:07

       I think giving yourself that grace that, um, I, I would say, you know, those of us who I've been trained to do this, I've spent the past few decades of my life trying to do this, I can't do it. I can't predict accurately who's at risk and who's not. Um, if I can't do it, chances are those among us who haven't spent their life trying to do this probably can't do it e- can't do it either. So don't expect that you should have been able to do it. People grieve differently. There's a lot of misconceptions about the stage. There are stages of grief, and we all must go through them in this, um, linear way. That's not true. We all grieve differently, and I think it's important for people to doWhat's right for them. Here too, I would say reach out to others. There are groups of survivors. There's an organization, the American Foundation for Suicide Prevention, afsp.org, has survivor groups, support groups in every state in the U.S. Uh, these exist in other countries around the world where you can go as you want and meet with other people who have lost pe- lost loved ones to suicide, or do this online, or do this among your friends and family. But, um, use the supports you have around you, um, to try and work through in what- whatever way, um, makes sense for you. But here too, again, I would encourage people to reach out and to communicate with others about what they're experiencing. It can be powerful to, to, to know other people who have been through what you've been through, um, and to share, um, with them.

    9. SPSpeaker1:01:25

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

29. 1:01:29 – 1:02:55

    The Impact of Losing Someone to Suicide

    1. SPSpeaker1:01:29

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

    2. MNDr. Matthew Nock1:01:34

       Yeah. Losing someone to suicide increases the risk. So ha- having a family member die by suicide increases, um, a relative's risk of, of, of suicide death. It's not destiny, but there is statistically an increased chance, uh, of suicide, and it just leads to often, not always, a lot of psychological distress is, is an understatement. Turmoil. Um, there's a loss as there is if you lost someone to a car accident. So there's a tremendous loss of life, uh, and that is gut-wrenching to anyone who's ever lost a family member. It's disorienting. It changes-- It can change, people are different, can change your whole world, your, your world orientation, um, your own mental health. When someone dies by their own hand, it's often so much worse, uh, because there's the, the, the-- there's often guilt. There's questions about should I have done more? Could I have done more? Did I play some role in this? Was I, was I not nice enough last time I saw the person? Did I not reach out enough? Um, there's a lot of second-guessing, a lot of, um, beating oneself up, so it can be really, really difficult. But again, people, people respond differently. Some people respond by never talking about it. Some respond by getting closer to those around them. Some respond by, uh, becoming an advocate and trying to decrease the likelihood that this happens to other people in the future, which always, always blows me away, uh, and I find really inspiring.

    3. SPSpeaker1:02:53

       Is there any truth in

30. 1:02:55 – 1:04:30

    You Are Never a Burden

    1. SPSpeaker1:02:55

       the feeling that people who die by suicide believe that everyone will be better off without me? Or is that a myth?

    2. MNDr. Matthew Nock1:03:02

       Yeah. Not a myth. There... The feeling like there's a, there's a, a, a brilliant psychologist named Thomas Joiner who's got a wonderful book called Why People Die By Suicide, and he lost his father to suicide and is a, a leading scientist in this problem. And in his theory on suicide, he says feeling like a burden to others, uh, is a key piece, and feeling like you don't belong is the other key piece, and that those two things together, "I'm a burden to others, they'd be better off if I wasn't here, and I don't really belong with anyone or to anyone," uh, those things get a person thinking about suicide. And then the other piece of the puzzle from, from his perspective is what he calls an acquired capability to die by suicide. It's not an easy thing psychologically to take your life, and it takes-- He, he says in his book, he used to call it courage, but courage isn't quite right. It's-- and now he calls it an acquired capability that we have to sort of build up an ability to... Like, like it-- We have to build up an ability to hurt someone else, to hurt ourselves. And this is why he thinks maybe physicians and police officers, um, prostitutes are at higher risk, that it's if you've been injured, if you've injured, you've now acquired the ability to hurt yourself.

    3. SPSpeaker1:04:13

       That's fascinating.

    4. MNDr. Matthew Nock1:04:13

       And that this increases a person's risk. Feeling a burden, feeling like you don't belong certainly resonates, and there are good data on this, that this does increase a person's risk. Again, thinking about the pathway, this increases your risk of thinking about suicide, but not acting. You need this other component, um, to get you to act.

    5. SPSpeaker1:04:28

       It's interesting that you said that suicide

31. 1:04:30 – 1:06:05

    How to Use Social Media Safely and Responsibly

    1. SPSpeaker1:04:30

       rates haven't really gone up, because I guess we'd assume that because of social media-

    2. MNDr. Matthew Nock1:04:36

       Yeah

    3. SPSpeaker1:04:36

       ... because of online bullying, because of the news cycle-

    4. MNDr. Matthew Nock1:04:39

       Yeah

    5. SPSpeaker1:04:39

       ... there's almost so much more overexposure to-

    6. MNDr. Matthew Nock1:04:42

       Yeah

    7. SPSpeaker1:04:43

       ... depressive, negative, difficult thoughts.

    8. MNDr. Matthew Nock1:04:45

       Yeah.

    9. SPSpeaker1:04:45

       Why is that? How, how, how do you even explain that?

    10. MNDr. Matthew Nock1:04:48

        Yeah. The suicide rate does ebb and flow. If you look back, and we've mapped it out over the past hundred years, you see a little up and down, and it's crept up in the past twenty years, but it crept down the twenty years before that. And people will say, "Well, it's because of social media, uh, breakdown of the fam..." There's always post-hoc explanations we can give. Um, but again, it's the same now as it was a hundred years ago. And I don't think the explanation is as simple as we now have social media, social media bad, uh, it's making kids suicidal. I think it's a tool, and things that happen on social media can put people at risk. There are things that happen on social media that could also decrease risk. And so again, I think, uh, it's, it's incumbent upon us to try and figure out how do we use these tools that are here to stay, um, for good and not, and not allow them to be used for evil.

    11. SPSpeaker1:05:33

        Matthew, thank you so much. It's been so useful and insightful talking to you today, and thank you for your work, and I look forward to hoping that our listeners support your work, uh, whether it's sharing it with a friend, passing this episode on to a family member, or directly supporting the work that you're doing there in the lab. So thank you so much.

    12. MNDr. Matthew Nock1:05:51

        Great. Thank you.

    13. SPSpeaker1:05:52

        I'm really grateful for your time and energy.

    14. MNDr. Matthew Nock1:05:53

        Thank you so, so much for focusing on this problem, for shining a light on it, and, and I'm hoping that this podcast and the work you're doing can help save lives. So thank you.

    15. SPSpeaker1:06:02

        I've learned so much today, Matt, and it's, it's one of those subjects

32. 1:06:05 – 1:07:48

    Suicide Is Rarely Sudden, It Builds Over Time

    1. SPSpeaker1:06:05

       that I feel like needs to be talked about, needs to be trained in, needs to be spoken about just with, I mean, with the couple of news stories I shared today.

    2. MNDr. Matthew Nock1:06:15

       Yeah.

    3. SPSpeaker1:06:15

       I had one more as well that I saw, which was [sighs] which one? I think this was like, yeah, "Dad struggling with money pressures leaves behind wife, baby, son after taking own life," you know, battling with financial stress.

    4. MNDr. Matthew Nock1:06:29

       Yeah.

    5. SPSpeaker1:06:29

       "Everything turned upside down," the family said, and, and then eventually led to that. Like, when you see the multitude of reasons, even in the couple of stories that I've found and shared-

    6. MNDr. Matthew Nock1:06:39

       Yeah

    7. SPSpeaker1:06:40

       ... it's, it's an area thatI just feel like we can't, we can't leave in the dark anymore because-

    8. MNDr. Matthew Nock1:06:47

       Yeah

    9. SPSpeaker1:06:47

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

    10. MNDr. Matthew Nock1:06:53

        Yes.

    11. SPSpeaker1:06:53

        Because someone literally could appear to not be struggling at all and then, you know, potentially take their life.

    12. MNDr. Matthew Nock1:07:03

        Absolutely. C-closing our eyes to it is not making it go away. That's not gonna solve the problem. Uh, we're getting better at predicting it. We can't predict it perfectly, but that doesn't mean we should stop.

    13. SPSpeaker1:07:13

        Mm.

    14. MNDr. Matthew Nock1:07:14

        Uh, again, like you think about the weather app that's on your phone.

    15. SPSpeaker1:07:18

        Yeah.

    16. MNDr. Matthew Nock1:07:18

        It can tell us with a startling degree of accuracy-

    17. SPSpeaker1:07:21

        Yeah

    18. MNDr. Matthew Nock1:07:22

        ... when it's gonna start raining, when it's gonna stop, what the temperature's gonna be in any time and place. That's a model. Uh, it's a simple analogy, but, but there's a lot more we could do. There's a lot greater accuracy we could have in predicting who's at risk and when, and there's a lot more we could do to try and keep people safe. We just need to try and stop the stigma around it, talk about the problem more, and allocate resources to try and get it done.

    19. SPSpeaker1:07:46

        Has there been a--

33. 1:07:48 – 1:11:43

    The Future of Suicide Prevention

    1. SPSpeaker1:07:48

       not wanting to sound reductive in any way, but has there been, seeing as you've spent, you know, decades studying this now, what keeps you going? What motivates you? What, what allows you to feel potentially positive about the future of this?

    2. MNDr. Matthew Nock1:08:03

       I'm increasingly hopeful about our ability to better understand, predict, and prevent suicide because of the people who are doing this work. The people who have lost loved ones to suicide, who support research on suicide, the clinicians, the researchers. Uh, the progress that has been made in the past ten, fifteen years, I mentioned we're, we're now better able to identify who's at risk and when they're at risk. Our interventions are getting better and more numerous. There's newer interventions coming out all the time, so we're seeing a lot of traction, uh, a lot of positive progress. So that keeps me optimistic, and I also continue to see people die by suicide and continue to see, um, how big of a problem it is, and I see the opportunity for us to do a lot better. And so those things together, how, how bad we're doing and, and the instances where we're losing life, but also the positive steps we're making give me hope that, uh, with more of a push, with more resource, with more effort, w- there's reason to be optimistic. There's reason to be hopeful. Uh, and this is a problem where we hopefully in the coming years can start to see the, the, the needle bend and the suicide rate drop, especially given how, how connected we all are now. Uh, we have the ability to find people at risk. If we can just figure out how to use these tools, uh, in a more positive way, I think, I think we'll, we'll, um, really make an impact.

    3. SPSpeaker1:09:26

       Yeah. Matthew, thank you so much. Is there anything I haven't asked you that you think was-- would be important to ask you about this, or anything you haven't shared that you think would be useful for us to know?

    4. MNDr. Matthew Nock1:09:35

       I think-- No, I think we covered a lot of the most important things. I think the most important thing is what you're doing, which is shining a light on the problem, talking about it, um, encouraging others to talk about it, uh, knowing that there are resources out there, uh, and knowing what to say to someone or having a sense of what to say to someone who you think is at risk so you can take steps to try and help them.

    5. SPSpeaker1:09:56

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

    6. MNDr. Matthew Nock1:10:02

       So if people want to get involved and support, um, this cause in some way, there's a number of ways to do so. I would definitely recommend reaching out to the American Foundation for Suicide Prevention, afsp.org, which supports research on suicide and also supports educational programs. They have great resources if you've lost someone to suicide, if you're looking for a support group, so I would definitely look at them as a resource. And if you want to give to, um, support research on suicide, uh, we'd be grateful if you did. You can do so by reaching out to Harvard University. You can reach out to our lab directly and donate through our lab's website. If you google, um, my name or look at nocklab.fas.harvard.edu, you can support our works-- work directly. Uh, you can also support the Center for Suicide Research and Prevention at Harvard University and Mass General Hospital, uh, which is a center devoted to conducting research on suicide to try and prevent, uh, the loss of life due to suicide. So any of those would be, uh, amazingly helpful to support this work.

    7. SPSpeaker1:11:02

       Amazing. Yeah. Very useful. Yeah. I'm sure there's so many people who've been affected directly or indirectly by someone in their life, and I'm sure, I'm sure there will be people who want to support. So thank you for sharing those. And, and yeah, I, I'm really grateful for the work you're doing and, and the light you're shining on it and just your ongoing commitment and dedication. If you loved this episode, you'll enjoy my interview with Dr. Daniel Amen on how to change your life by changing your brain.

    8. SPSpeaker1:11:27

       If we want a healthy mind, it actually starts with a healthy brain. You know, I've had the blessing or the curse to scan over a thousand convicted felons and over a hundred murderers, and their brains are very damaged.

Episode duration: 1:11:43